How Planned Parenthood Prevents Abortions and Why Robert Dear is Not Unlike a Jihadi

Reading about the recent violence at a Planned Parenthood in Colorado, and noting that one of the three people killed was a mother of two children (the other two were a female Iraq War vet and a male police officer), and remembering that this is one of many attacks, some physical/martial, many political, against this non-profit organization, I have been thinking about what Planned Parenthood really does and what it has done for me during my reproductive years.

Before Obamacare, healthcare was even less affordable and obtainable than it is now, when I find myself in my second month of no coverage despite being enrolled in Medicaid. From the time I turned 18 in 2000 until ACA was passed, birth control generally cost around $50 a month, and not all types were fully or even partially covered by all health insurance plans, to say nothing of buying the pills (and obtaining the prescription as well as the required pap test) without insurance, which could easily run towards $1000 a year. That all health insurance plans must cover birth control under the Affordable Care Act is a very good thing: it is not easy to budget for even an extra $15 a month let alone $50, and certainly no one with health insurance (which has such incentive to keep health costs down, and pregnancy is hugely expensive) should be choosing between birth control and any other necessity.

I have used a non-Planned Parenthood gynecologist only a few times in my life, and the expense has always driven me back to Planned Parenthood, where I knew I would never be denied care or a birth control prescription, and where I knew my privacy would be respected. Staying not pregnant is time-consuming and expensive. I am not sure how many men realize that to obtain a BCP script, a woman needs a yearly pelvic exam and pap smear, which take time, are rather invasive (I think a lot of women find it mainly humiliating, actually, and having it performed by a man can feel quite psychologically uncomfortable), and even with insurance can have a copay of a hundred dollars or more. If this exam turns up any question of HPV, and up to 75% of people of reproductive age have it at some point in their lives, follow-up exams, often involving biopsy, cryocautery and other procedures can be involved. All of these have co-pays (or out-of-pocket) and require time (usually off work), can cause pain and require some recovery, and this can happen far more than once. Not that I am opposed to these procedures; they can save lives that otherwise would be lost to cervical cancer (which is caused by some strains of HPV but does not result from most cases of HPV), and prior to the introduction of Gardisil in 2006 was the only way of preventing cervical cancer. But the fact remains that in most heterosexual, committed relationships the burden of preventing pregnancy is on women, and it is a disproportional burden indeed. That is before you consider women who are abandoned by their partners to deal with pregnancy and STD prevention or treatment alone. So when I think of men, whether they be politicians or men teetering on the edge of mental health (if there is a difference) who have the temerity to pass judgment on how women pursue reproductive health, and to call non-profit organizations, 80% of whose business is administering birth control, to testify before Congress to defend themselves against falsified and partisan accusations, it makes me sick with contempt for the bullying attitude that it is all too acceptable in our society to take against any group you aren't a part of and don't understand.

What do the other 20% of services administered by Planned Parenthood represent? 3% are abortions and the rest are mostly STD testing and treatment, cancer screenings like the pelvic exams I have had and the mammograms (or mammogram referrals) I will one day no doubt get there, since referrals, like appointments with gynecologists, psychiatrists, and increasingly any private practice doctors, take a ruinously long time to obtain, and of course it is often the costliest doctors, or those who accept the fewest, or no, forms of insurance, who have the earliest availability.

So I have used Planned Parenthood for what 97% of all its services represent, and that is why I have never had to be  a part of the 3% statistic that represents the abortions they perform. During times in my life (like now) when I have had no health coverage, and even times when getting an appointment with a gynecologist would take too long or my prescription simply cost too much, Planned Parenthood was there to subsidize my care and make it possible for me to not only prevent pregnancy before I was ready for it, but screen for cancer and other reproductive dangers while they were still treatable. The fact is that the vast majority of women go to Planned Parenthood to avoid having abortions, not to have them. Personally, I do not believe that women who themselves judge that they cannot care for a child should be forced to carry that child to term or go through the torment of giving their children up for adoption, and I believe safe abortions should be legal as a measure that protects women's health and which promotes the care of children who already exist: 61% of all women terminating a pregnancy already have at least one child. The fact is, nobody, not even me, despite my very-high-indeed horse, knows what is going on for any individual that belongs to a given group, but we are all too eager to recommend, support, and in some cases take drastic, dreadful, hypocritical action to force prohibitions on groups we don't belong too. We see this in Donald Trump's comments about immigration policy, which many Americans agree with (as do Europeans!), and we see it in the discourse on abortion. This has become not only so nasty, but so much the purview of abstract political debate, that it is now regular, no matter who you are, how uninformed you are, or how distant your life experience is from that of most people the conversation is about and affects, to not only take rigid political stances on this "issue," but to position it as the single issue that will decide your vote.

I think one of the great false premises of the abortion debate is that there is some group, let's call it pro-choice, which approves of abortion. I don't think there are many people who really approve of abortion as a form of birth control to be embraced, and I'm certainly not one. But to act like there are no circumstances that women can find themselves in when an abortion is the best outcome they can hope for is, unfortunately, wrong. We do not have a society in which poor families and single mothers are supported; it is not possible to raise healthy kids by yourself when you have to work for $7.50 an hour at more than one job so your employer isn't obligated to give you health benefits. Many people do not have computers, internet access, or even public libraries to figure out how to apply for insurance through the state-run health exchanges, where they might discover they qualify for Medicaid. Women who seek abortions are, at least most of the time, some of the most vulnerable members of our incredibly unequal society, and as so often happens to victims of an unequal system, it is the most powerful who control not only their access to abortion, but also to birth control, health care, and benefits for their children. Behind all of this we see, yet again, that the rich and powerful take an attitude of moral superiority towards the poor and vulnerable: the discourse frames abortion as a moral outrage whose perpetrators must be fought. These are the same terms that Islamic fundamentalists use to rouse vulnerable, poor, often mentally unstable young people to violence against unknown individuals that form part of a group they can easily vilify from the outside: Westerners, Christians, Parisians. Belonging to one or more of those groups, or moving in them freely, it's obvious to us that those individuals, now dead or wounded, were innocent, but it's so easy, and feels so good, to vilify, and there's a heavy dose of endorphins spilled in pulling triggers. If you want to eliminate abortion, immigration, or terrorism, you're just going to have to make the world a better place, and that will mean loosening a lot of tightly-closed fists.

Is It a State's Right Whether I Get Pregnant?

In truth, the title of this post should be, Is It a State's Right to Decide How and How Much it Costs for Me to Not Get Pregnant? A good subtitle might be: Make BCP OTC. Something I didn't know about Medicaid until I was on it for a second year is that because it is administered by states, a person's Medicaid benefits are only good in the state in which they applied for and were awarded them. That means that, because I recently moved from New York to Virginia, I am unable to use my health insurance to pay for my birth control pill prescription, which runs $35-50 retail, if I fill the prescription outside of New York State. And because we did not have the foresight to apply for insurance through the VA exchange earlier (we would have had to do it by Sept. 15th, 30 days before moving, in order for me to be covered in VA now) I will have no usable insurance (EMT driver, can you get on 81 N?) until December 1st.

To ice them cookies, pharmacies are not allowed to mail prescriptions being paid for with Medicaid out-of -state, presumably to prevent fraudulent purchases of the birth control pill by Virginians, Marylanders, Blue Hens, etc. from the good pharmacies of New York. The choice I have, then, is to pester people I'm not that close to in New York to pick up and mail me my prescription, pay retail in VA (have I mentioned we're on a budget?), or use condoms, which are not that cheap, and certainly not that fun, but they are over-the-counter. All those other miracle drugs for not getting pregnant, such as the patch, the injection, the implants, are all prescription-only. Short of that it's rhythm method and rubbers.

We've discussed the moral double-standards that exist in this country for poor people, and to be on Medicaid, you have to be poor. I have qualified for it for the last year and a half, during which I was adjuncting at Colgate and thus poor. As a nation, we do seem to be comfortable with the government adjudicating how women go about not getting pregnant: anyone (who has the money) can use condoms, and anyone who has access to a doctor to give a prescription can use the pill and other hormonal birth control options that are more desirable, practical, and far more effective than condoms for a number of reasons you have probably already worked out yourself. 

Since the Affordable Care Act passed, a person on Medicaid can get a doctor’s appointment, prescription for BCP and have it filled with no out of pocket expenses--but with considerable bureaucratic and practical hoops to jump through. And even those of us on Medicaid who are most adept at navigating those hoops can get caught in a predicament that amounts to embarrassing yourself just to rely upon the kindness of acquaintances, paying more money than you can afford, or going without. This can happen because we allow these programs, deemed constitutional and essential by three branches of the federal government, to be administered by states as a prerequisite to states accepting them, and the result is that a person availing themselves of a federal program is extremely limited in care not only by what providers will see them (another horror story for another post) or how long they have to wait for that care, but by where they find themselves when that care is required.

All of this leads to a default conservative outcome, and as ultra-conservative as can be: the only way to have sex for free is to have it unprotected. Every other way you need a dollar in your pocket and/or a primary care physician. The implication of such a state of affairs is that those with more access to money and resources deserve more choice in their reproductive health than those who have less. Dan, who already buys his health insurance through the NY State exchange, was able to get a free flu shot while we were at Walgreens figuring out another thing we're going to have to make lemonade out of for the next three months, but as a Medicaid patient I would have had to pay for that too. And as we know, as a man Dan cannot get the pill; it's all on me, as it is for many women when they so understandably fail, even once, to make sure they are medically infertile when they end up having sex under any circumstances and find themselves where so many politicians seem to believe, if you follow the logical outcomes of the policies they support, is where they belong: pregnant and taking responsibility.

Birth Control Pill Over-the-Counter and federally-administered Medicaid are women's rights and social justice issues. The cheaper, preferably free, and easier to obtain reproductive health needs are, the better for some of our most vulnerable populations.