With this coming Tuesday marking the 40th anniversary of Roe v. Wade, I’m inspired to post this month’s column early.

I encourage readers to check out the work of ANSIRH (Advancing New Standards in Reproductive Health), a UCSF research program ”dedicated to ensuring that reproductive health care and policy are grounded in evidence.” So, rather than cover the breadth of political and social dynamics related to abortion policies, I’m focusing on one specific new study which has important implications for protecting women’s health:

A newly published landmark study by ANSIRH demonstrates that trained nurse practitioners, certified nurse midwives, and physician assistants match physicians in the safety of aspiration abortions they provide. We hope that these results will give policymakers the evidence they need to move beyond physician-only restrictions in order to enable more women to have their reproductive health care needs met in their local communities by health care providers they know and trust.

The results of this study are significant because PAs, NPs and CNMs have been shown to be important and accessible health care providers for rural and low-income women. ANSIRH’s new findings support policies which would reduce health care disparities and increase continuity of care because a larger group of health care providers would be able to offer early abortion care. For more on this topic, read the latest post by Tracy Weitz, Director of ANSIRH. This research should inform health policy across the U.S.

For more on the realities of abortion in the U.S., watch Abortion in the United States, a short video from the Guttmacher Institute.

The National Advocates for Pregnant Women (NAPW)’s new study, “Arrests of and Forced Interventions on Pregnant Women in the United States, 1973– 2005: Implications for Women’s Legal Status and Public Health” appears today in the peer-reviewed Journal of Health Politics, Policy and Law. I’m sharing some highlights from their press statement, but check out the entire piece, including their discussion of political actions.

Here are some of the cases NAPW summarizes:

• A woman in Utah gave birth to twins. When one was stillborn, she was arrested and charged with criminal homicide based on the claim that her decision to delay cesarean surgery was the cause of the stillbirth.
• After a hearing that lasted less than a day, a court issued an order requiring a critically ill pregnant woman in Washington, DC, to undergo cesarean surgery over her objections. Neither she nor her baby survived.
• A judge in Ohio kept a woman imprisoned to prevent her from having an abortion.
• A woman in Oregon who did not comply with a doctor’s recommendation to have additional testing for gestational diabetes was subjected to involuntary civil commitment. During her detention, the additional testing was never performed.
• A Louisiana woman was charged with murder and spent approximately a year in jail before her counsel was able to show that what was deemed a murder of a fetus or newborn was actually a miscarriage that resulted from medication given to her by a health care provider.
• In Texas a pregnant woman who sometimes smoked marijuana to ease nausea and boost her appetite gave birth to healthy twins. She was arrested for delivery of a controlled substance to a minor.
• A doctor in Wisconsin had concerns about a woman’s plans to have her birth attended by a midwife. As a result, a civil court order of protective custody for the woman’s fetus was obtained. The order authorized the sheriff’s department to take the woman into custody, transport her to a hospital, and subject her to involuntary testing and medical treatment.

In all, the researchers identified 413 criminal and civil cases involving the arrests, detentions and equivalent deprivations of pregnant women’s physical liberty that occurred between 1973 and 2005. These 413 cases in 44 states, the District of Columbia and federal jurisdictions are likely a substantial undercount and does not include more than 250 known cases that have occurred since 2005. You can read here about a decision last week in Alabama that will intensify the state’s ability to police pregnant women.

In the cases reviewed for this paper, pregnant women were subject to arrests; incarceration; increases in prison or jail sentences; detentions in hospitals, mental institutions and drug treatment programs; and forced medical interventions, including surgery. The researchers wanted to know, what was the basis of these arrests and forced interventions?

“Our analysis of the legal claims used to justify these arrests found that they relied on post-Roe measures such as feticide laws and the same arguments made in support of so-called ‘personhood’ measures – namely that state actors should be empowered to treat fertilized eggs, embryos, and fetuses as completely legally separate from the pregnant woman,” said Lynn Paltrow, Executive Director of National Advocates for Pregnant Women (NAPW) and lead author of the study.

Jeanne Flavin, PhD, Fordham University professor of sociology, president of NAPW’s board of directors, and the study’s co-author, said “The public debate about personhood and other anti-abortion measures tends to focus narrowly on abortion. Our study makes clear that all pregnant women are threatened by such measures. These measures not only undermine maternal, fetal, and child health, they deny women’s status as full constitutional persons, as human beings.” Flavin is author of Our Bodies, Our Crimes: The Policing of Women’s Reproduction in America.

While the study shows that low-income women and African American women are more likely to be deprived of their physical liberty, it also confirms that these state interventions are happening in every region of the country and affect women of all races. The researchers argue that as “personhood” measures continue to be promoted in state legislatures and in Congress, and as we observe the 40^th anniversary of Roe v. Wade, this study broadens the conversation from one just about abortion to one about health policy and the legal status of pregnant women.

Read the report.

-Virginia Rutter

My colleague Stephanie Coontz at Council on Contemporary Families and I put together this item about a great new study: At a time of dramatic change in attitudes towards gays and lesbians in America, a new study released this month in Gender & Society highlights the diversity of gay and lesbian experiences in America. “Midwest or Lesbian? Gender, Rurality, and Sexuality,” by University of Nebraska sociologist Emily Kazyak, puts the lives of rural gays and lesbians under the microscope. Almost 10 percent of gays and more than 15 percent of lesbians in the United States live in rural areas. While 25 percent of same-sex couples are raising children, same-sex couples in rural areas are even more likely than their urban counterparts to have children.

As University of Massachusetts sociologist Joya Misra, editor of Gender & Society, puts it, “the rapidity of changes in attitudes toward gays and lesbians has been stunning. Kazyak’s article helps bring into focus how greater acceptance of gays and lesbians is not simply a phenomenon of big cities – but reflects changes and opportunities in rural communities as well.”

How much change? Researchers at Sociologists for Women in Society and the Council on Contemporary Families recently surveyed how much and how rapidly gays and lesbians have been integrated into mainstream life. Consider these changes in the past year alone:

• In November, for the first time, three U.S. states approved same-sex marriage by popular vote. Just three years ago, Maine voters defeated same-sex marriage by a margin of 53 to 47 percent. This year they reversed themselves, approving it by 53 to 47 percent. Maine joins a growing list of rural states including Iowa and Vermont that recognize same-sex marriage. Meanwhile, Minnesota defeated the same kind of anti same-sex marriage measure that had passed everywhere it was introduced in the previous 15 years.
• While California defeated same-sex marriage in 2008, a February 29, 2012, Field poll shows that if the measure were submitted again, it would win. Today a record 59 percent of registered voters in California approve same-sex marriage.
• In numerous public opinion surveys, including one from November 2012, the past decade’s rise in approval for same-sex marriage in all regions of the country is evident: even the Midwest and the South, where gay and lesbian rights are less popular, have seen a 14 percent increase in approval for same-sex marriage.
• In 2009 Hispanics opposed same-sex marriage by a large margin. In 2012 exit polls, 59 percent of Hispanics supported it. In just the four months between July and October 2012, the number of African Americans opposing same-sex marriage fell from 51 percent to just 39 percent.
• White evangelical Christians are seeing a dramatic generational shift, with 40 percent of those under 30 supporting same-sex marriage, compared to only 18 percent of those over 30.
• And on December 6, a new poll by USA Today found that almost three-quarters of Americans 18 to 29 years old now support same-sex marriage, while more than a third of Americans say their views about same-sex marriage have changed significantly over the last several years, with approval rising in every age group.

Are these changes significant for gays and lesbians living in rural areas? Dr. Kazyak’s Gender & Society study, published by Sage Publications, offers answers, based on her examination of the experiences of gays and lesbians who live in rural areas (with populations as small as 2500 people). The University of Nebraska-based researcher focused on rural areas in the Midwest. She finds that rural gays and lesbians enjoy more acceptance than stereotypes about rural life would suggest. In fact, Dr. Kazyak reports that lesbians in rural areas can pick and choose from a wider range of gender behaviors than their urban counterparts. Largely because of the tradition of shared labor in farm families, behaviors and activities that would be considered unfeminine or “butch” among urban women are more widespread and meet greater approval in rural areas.

Dr. Kazyak describes how rural lesbians reported the gender flexibility available to them. One lesbian described the kind of upbringing that is common in rural areas: “I helped my dad a lot on the farm, raising…livestock…I really enjoyed driving the farm machinery! It just empowered me, driving a tractor or truck.” Another woman stated, “Tomboyishness was somewhat more acceptable than it might be somewhere else.” A third pointed out that “farm girls might dress up for the prom, but they also could slaughter a hog.” This flexibility allows lesbians who are drawn to masculine activities or who dress in masculine ways to find more acceptance than they might in an urban or suburban setting.

On the other hand, Dr. Kazyak discovered that gay men felt required to appear more macho than their urban counterparts. One man she interviewed commented on how few rural gay men display the mannerisms that are sometimes associated with gay life in metropolitan areas. He noted how surprised he initially was by “getting flirted with what I thought were straight men….[T]hey weren’t straight men, they were gay men, but they looked very straight, they acted very masculine…. It was, like, this wasn’t what I thought of as a gay man. So being in this town really changed how I thought of myself and the gay community.” Both rural gays and lesbians thought their lives and identities were much different than their urban counterparts.

Dr. Kazyak noted, “My research on rural gays and lesbians shows us that the lives, behaviors, and self-presentations of gays and lesbians are more varied and complex than portrayed on TV, even in shows such as ‘Modern Family,’ where one of the gay characters grew up on a farm. The rural Midwest is not a place we typically associate with gay and lesbian life, but my research shows us how gays and lesbians are increasingly out and accepted in small towns across the country.”

Dr. Kazyak adds, “Times have changed for gays and lesbians throughout the United States; but there are still many challenges, from the fact that employment discrimination on the basis of sexual orientation remains legal at the federal level and in many states, to the alarmingly high rate of homelessness among gay and lesbian youth.”

Article: Kazyak, Emily. 2012. “Midwest or Lesbian? Gender, Rurality, and Sexuality.”

Gender & Society 26 (6): 825-848. (.pdf available upon request.)

Link here to full press release and references to additional experts and resources on diversity among gays and lesbians.

-Virginia Rutter

Last week I showed my students the documentary The Business of Being Born, an eye-opening and important film about birth in the United States. While I applaud the film in multiple ways, I always wonder whether its critique of the medicalization of birth, and its elevation of natural birth without intervention, might not inadvertently make some women feel shame. What about those women who “fail” in their quest for a natural birth?

Writer Solange Lopes reflects on her own struggle with ideals of natural birth in the essay below. A mother, writer, and editor of the blog keurawa.com, Solange last wrote for Global Mama in July. Originally from Senegal, she now lives in Rhode Island.

- Heather Hewett

Natural or C-section: Birth or Stigma?

Hello, my name is Solange, and I did not give birth naturally, twice over….

Sounds like the typical introduction line at your local AA meeting, yes? Maybe there’s a reason. I delivered my daughter via emergency Cesarean section three years ago, and had a repeat, scheduled intervention for my son’s birth eight months ago.

Now, understand, I am an African woman, born and raised in Senegal, West Africa. My maternal grandmother walked herself to the hospital to deliver each one of her 12 children, all of them barely a year apart from each other. Where I come from, women are admonished not to scream in the labor room, because giving birth—naturally that is—is a woman’s ultimate pride.

As I suffered through 18 hours of excruciating labor, my mother, sitting by my side alongside my husband, kept reminding me to breathe… and to forego the epidural. I didn’t need it, she said, I could just push my way through it. Well, it turns out that my body wasn’t exactly in a cooperative mood, and neither was my mind.

I can still taste the disappointment in my mother’s eyes, as salty as the tears rolling down my face, as I signed the medical release authorizing the drugged relief into my body. A lifetime of suffering and self-denial flashed through her eyes, as she shook her head and sat back down with the heaviness of forced resignation. Despite the relief offered me a few hours later, pain still stung my entire being, this time more mental, more acute.

Hour after hour of pushing and breathing and laboring, and… nothing! Then the doctor’s stern face announcing that the baby’s heart rate was declining and that surgery was needed. The first thought that coursed my mind was: “What will my mother think about it?” I had mentally foregone my unborn child’s well-being, as always seeking my mother’s approval. I was not a grown woman giving birth; I was back to being a fatherless little girl looking for her mother’s approval.

And again, I saw it. The disapproval in her eyes, the images of centuries of strong women before me who gave birth alone, laying on dirt floors, with little or no assistance at all… And I, incapable, unworthy, weak thing!

The remaining hours were a blur. Within a matter of minutes, I was a mother: a child, my child, removed from the depths of my womb, or so it seemed. I was neither deserving nor did I feel entitled to receive the customary congratulations. The title of mother felt usurped, stolen by this little woman, this sell-out whom I could only perceive from my ego’s eyes. This other woman, not me, who had not proved worthy, or up to the task at hand.

In both Senegalese and Cape-Verdean cultures, both cultures I was raised in, how you gave birth is more important than the extraordinary act itself. When my more Westernized guests would inquire about the height and weight of my small angel, some other guests would ask, crudely and without compromise: “So did you have her natural?”

As I would fumble, searching for the right enough words to summarize one of the most defining moments of my entire existence, I would meet, yet again, disapproving glance after shocked look.

“Ay credu, you couldn’t push that baby out?”

Scheduling my son’s delivery via C-section was no easy feat either. Faced with the grim statistics of a repeat C-section delivery as opposed to a VBAC (vaginal delivery after C-section), I followed my doctor’s recommendation and opted for another intervention.

Another silent inner battle against deep-seated feelings of lacking self-worth and humiliation. Yet another excruciating series of questions from family members. Another opportunity at practicing my hard-earned skills at dodging inquisitive glances and words alike.

Yet in all this confusing brouhaha of egotistical mentalities, mine included, one cannot help but hear the deafening sound of sad world statistics around maternal mortality.

According to the World Health Organization’s May 2012 Fact Sheet, approximately 800 women die every day from preventable causes related to childbirth and pregnancy. Ninety-nine percent of these occur in developing countries like my native Senegal. The reported figures are staggeringly high: for each 100,000 births in developing countries, 240 result in maternal death. Compare this to a maternal mortality ratio of 16 per 100,000 in developed countries. As much as unnecessary surgeries should certainly be avoided, it is evident that adequate medical care before, during, and after childbirth is still lacking.

Having access to surgery saved my life and my babies’ lives, despite the cultural stigma I am trying hard to let go of. It will save the lives of many like me who are privileged enough to benefit from it.

But shouldn’t this privilege be available to all women?

Hello, my name is Solange, I am healthy, and so are my babies.

My colleague Bridgette Sheridan has been complaining about The Atlantic coverage of gender for the past few years. So she forwarded with delight a spot-on column “The Intellectual Situation” in n+1 , a literary magazine that publishes social criticism, political commentary, and essays. The editors at n+1 begin:

Listen up, Ladies

Every time a plane flies over New York, we think, “Oh my God — is it another Atlantic think piece?” We mean, “an Atlantic think piece about women.” The two have become synonymous, and they descend upon their target audience with the regularity and severe abdominal cramping of Seasonale. “Why Women Still Can’t Have It All,” “The End of Men,” “Marry Him!”

Read their piece all the way to its logical conclusion:

So far, this strategy seems to be working. The Atlantic had its first profitable year in decades in 2010, and in 2011 made more than half its ad revenue from digital sales, while print ad sales were the highest they’d been in years. In fact, since we married our deadbeat boyfriend, quit our job, and accidentally had quadruplets through in vitro fertilization (all boys, thank God!), we’ve realized we could use some of that cash, so we’re thinking of pitching an article: “Why You’re Failing the Daughters You’ve Never Had and Probably Never Will.”

Will definitely read more from n+1.

-Virginia Rutter