A Cartoonist’s Take on Reproductive Rights

One of my favorite comic strips — Doonesbury — disappeared from many newspapers this week. This is because the story being presented in the venerable 41-year-old strip deals with a rather controversial and polarizing topic: abortion.

As presented by cartoonist Garry Trudeau, this week’s series focuses on the experiences of a woman in Texas who is seeking selective termination of her pregnancy.   She is called a ‘slut’ by a Texas Senator channeling the voice of Rush Limbaugh. She is forced to listen to a counseling script that is written by state legislators rather than doctors. Finally, she is required to undergo an invasive transvaginal ultrasound while listening to the physician describe what he sees on the monitor.

This is not hyperbole. In 2011, the Texas legislature passed a law requiring that all women seeking an abortion undergo an ultrasound 24 hours prior to the planned termination procedure. Women thus must make to two trips to the clinic: one for counseling and ultrasound, and one for the abortion itself. The ultrasound must also use the method that provides the clearest image of the fetus which, since the vast majority of abortions occur within the first trimester, requires the use of a vaginal probe.

Seven other states also have ultrasound mandates, though not all are as restrictive as the Texas law. Sixteen other states require abortion providers to offer the ultrasound procedure, even if it is not medically necessary. Just last week, for example, Virginia enacted a law similar to that of Texas; it not only requires that the woman undergo an ultrasound, but also requires that the monitor face the patient while her doctor describes the image. Legislators in Richmond, however, backed off a controversial provision that would require the use of invasive vaginal probes.

Proponents of such laws argue that they are necessary to ensure that women are making a voluntary and informed choice about whether or not to terminate their pregnancy. This includes the required ultrasound and narrated description, but also counseling that provides dire warnings about the purported risks associated with abortion — such as breast cancer and mental illness.

Labelled with names as the “Women’s Right to Know Act” or the “Right to Know and See Act”, such laws are opposed by state medical societies and other groups … and rightfully so. Not only do they represent an unwarranted government intrusion into the physician-patient relationship, but they also require women to undergo a costly and often unnecessary medical procedure.

To provide all of the information that a handful of politicians deem necessary so that women make a voluntary and informed decision to end their pregnancy, these same women are forced to pay for a procedure that is performed on them against their will. They are also provided with information about the risks of the termination procedure that many scientists and physicians consider erroneous. For example, many women seeking abortions are told that they will face an increased risk of breast cancer later in life as a result, despite the fact that an expert panel convened by the National Cancer Institute found no such link. So much for voluntary and informed consent.

The real reason for these laws is not to protect the women or to ensure that they are making an informed decision to end their pregnancy. Rather, it is an attempt to overturn the US Supreme Court’s landmark Roe v. Wade decision that gave women nationwide the right to seek an abortion. It is ‘death by a thousand cuts.’ But it is also likely to have profound consequences for women, for financially strapped states like Texas, and even for the politicians who support such laws.

For example, the new Texas law is estimated to increase the cost of an abortion by $50 to $75. That is not a lot money. However, it comes at the same time as increasing restrictions on the use of public funds to subsidize abortions or other reproductive health services for low-income women. The increased price, coupled with the costs associated with an extra trip to the clinic, means that many poor women may be financially unable to access this procedure, or other family planning services.

Down the line, these laws will also increase the burden on other cash-strapped state services. Without access to low-cost family planning and reproductive services (which includes abortion), many women and their children will remain trapped in a cycle of poverty.

These laws may also doom the careers of the elected officials who passed them (at least those who seek national office). Politicians nationwide are engaged in a battle over reproductive rights. Recent polls suggest, however, that a majority of women are opposed to the ultrasound mandates that I just described. They also oppose attempts to defund organizations like Planned Parenthood, and they support current laws requiring employee insurance plans to cover birth control. While the upcoming 2012 election will likely be dominated by concerns about unemployment and the economy, given that women represent a larger proportion of the general electorate than men, the current reproductive health debate may be enough to sway some close elections.

It’s funny how comic strip like Doonesbury — and the controversy it engendered with its abortion-themed story line this week — can again raise such an important issue to national prominence.

Doonesbury Cartoon for March 15, 2012.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on March 15, 2012. It is also available on the WAMC website.]

About Sean Philpott

A public health researcher and ethicist by training, Sean holds advanced degrees in microbiology, medical anthropology, and bioethics. He is currently Director of the Center for Bioethics and Clinical Leadership at Union Graduate College and Director of the Bioethics Program of Union Graduate College-Mt. Sinai School of Medicine. Until his term expired in August 2012, he served as Chair of the US Environmental Protection Agency’s Human Studies Review Board, an advisory panel that reviews the scientific and ethical aspects of research involving human participants submitted to the EPA for regulatory purposes.
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