Victory!!!

We have received word that HB 695 will not make it out of committee, due to “the overwhelming concern from the people”!! Thank you to everyone who called or emailed the legislators, urged your friends to do so, spread the word in any way, or just sent happy thoughts! [Ok, but I'm enough of a cynic and a skeptic to say, "how do you know a politician is lying? - his lips are moving," and to still be holding my breath just in case Sen. Bryan, the Chairman of the committee... has it wrong. We may still go down to Jackson on Tuesday, just to be sure.]

This close call has made those of us who are concerned with home birth realize that we need to be PROactive, and not just REactive, so we’re trying to organize and take steps to get legislation that will make CPMs recognized… and also to be able to be reimbursed under insurance and Medicaid. Any thoughts, tips, suggestions or ideas would be more than welcome!! I can speak only with certainty for myself, but I’m fairly sure that most of us in Mississippi are in the same boat, and that is to say, that we have no experience in this matter, so would appreciate the wisdom of those who have “been there, done that.”

I’ve seen that Oregon has what I would call “model” legislation [not that I've looked in-depth at this or any other state, so if you know of any good states, or know of anything bad about Oregon's laws, please fill me in] — basically, midwives can certify, register, get licensed if they choose, but do not have to. If they are licensed, they can carry and dispense certain medicines legally (like IVs and anti-hemorrhagic medicines), which is good.

Frankly, I don’t know much about the midwives that serve Mississippi, except that in my area, they’re awfully scarce. Since MS doesn’t recognize the CPM credential, there isn’t much reason for a MS-based midwife to spend the time and money getting that credential, other than to say, “I did it.” Looking on Google, I’ve seen some CPMs in Mississippi, but for the most part they seem to be living in other states, and serving areas not too far from their respective state lines. My midwives, who were based in Memphis, traveled as far as 75 miles or so from Memphis, which would get a pretty good chunk of North Mississippi. It seems there is a similar situation with midwives in Arkansas and Louisiana. [CPMs are illegal in Alabama.] However, if Mississippi laws were such that there was a reason to become certified (like, to get insurance reimbursement and/or to legally dispense medication), I daresay that more qualified midwives would choose to get certified. Since I know that some midwives don’t like government interference in their business at all, I wouldn’t want the legislation to make non-certified midwives illegal. I’m enough of a libertarian to think that the government shouldn’t be able to mandate who is allowed to attend our births.

The Memphis newspaper The Commercial Appeal ran a story on the legislation today in which they gave the origin of the bill. Apparently, a baby died in a hot tub last year, which is the reason for Mississippi’s horrible infant mortality rates. Seriously — that’s what the Representative who introduced the bill in the House said:

The Mississippi Board of Nursing suggested the legislation because of the state’s high infant mortality rate. Holland says he believes that rate would go down if more babies were born in hospital facilities.

“We had a baby die on the coast last year being delivered in a hot tub,” Holland said.

Uh-HUH. Riiiiight! Ok, if you’ve been reading this blog regularly for any length of time, you know how I always have to dig a little deeper and get the numbers, relying on the CDC linked birth-death certificate query. No, it’s not perfect, but it’ll have to do. Let’s see how many deaths were due to “other midwife” for the latest years they have available, 2003-2005:

I’ll be honest that I don’t know for sure why there were no results for “other midwife.” This may mean 1) there were no births attended by non-nurse midwives; 2) there were births attended by “other midwives” but no deaths in this time period; 3) birth certificates that should have been marked “other midwife” were instead marked as “other” or “unknown,” (or even possibly but not likely as CNM, MD or DO).

So, next step: check out how many births/deaths happened at term, and where (because some of these babies were born as early as 17 weeks gestation, so it doesn’t matter who the attendant is nor where the birth took place; and no midwife I know of would knowingly attend the birth of a baby before 36 weeks gestation — if the woman seems to be in labor, the midwife would tell her to go to the hospital and/or accompany her there herself, so if she was the birth attendant, it would probably be because she happened to be in the back of the car or ambulance with her on the way to the hospital).

Isn’t that interesting? From 2003-2005 there were 3 deaths among babies born at term in an out-of-hospital situation… but there were either 87 or 243 such births, and I don’t know why there is a three-fold difference between the “total” (243) births attended by “other” and the subtotal (87). If somebody knows, I’d appreciate a little illumination.  There is a slight discrepancy (51 births) between the bold total of the in-hospital births and the sum of the subtotals, and this may be attributable to weighting, but I’d say that a three-fold difference is more than the slight difference I would expect from weighting. The only thing I can reason I can think of would be that “other midwife” attended 156 out-of-hospital births with no deaths for these three years. [The reason I suggest that is that I remember doing a query quite some time ago, and realizing that if there were zero deaths in a category, the births just weren't included in the subtotals, but were in the totals. The query was trying to see how many births shared common factors with my first son's birth -- a home-birth with a CNM in Illinois in 2004 -- and when I changed it to "boy only," the line disappeared because no boys died in such circumstances that year.]

Now for the causes of death for these three babies:

In case you can’t read that, there was one death at 40 weeks, with the baby dying within an hour of birth, due to P21.9 (Birth asphyxia, unspecified); one death of a baby born at 40 weeks gestation, the death occurring after the first month of life, due to R95 (SIDS); and one death in a baby born at 42+ weeks gestation, after the first hour but within the first 24 hours of birth, due to R99 (Other ill-defined and unspecified causes of mortality). While each of these deaths is sad and tragic to the families who lost these babies, it is not realistic to believe that every baby will survive. Yes, it’s possible that these babies may have lived had they been born in the hospital, but that is no where near certain. There were 7 other babies born in the hospital with an MD attending, during this term period (5 at 39 weeks and 2 at 40 weeks) who died of the same code P21.9; and there were 193 babies born in the hospital (with a variety of attendants) from 37-42+ weeks who ultimately died of SIDS in the first year of life; and 9 hospital-born babies who died of ill-defined/unspecified cause of mortality (all with an MD in attendance at their birth).

So, back to the article — apparently some nurses got this legislation sponsored under the pretense that Mississippi’s high infant mortality rate (it’s #1, which is the worst, except for Washington, D.C.) is due to all these babies dying in out-of-hospital births. Who are all these babies dying after having been born outside the hospital?

That’s right — 12 total deaths after an out-of-hospital birth from 2003-2005: 3 “unknown” gestational age, 3 term births, 2 very preterm births (probably had a 65-75% chance of living, with the best possible care, at that gestational age… but they had a doctor for the birth attendant, which makes me wonder if it was really out-of-hospital), 1 extremely preterm birth (a 50/50 chance of living at that age, regardless of what is done), and 3 babies born at 20 weeks — no reasonable chance of living, regardless of what was done. The causes of mortality are prematurity for the two 20-week babies and one of the “unknown”; hydrocephalus for the 24-week baby; breech extraction and “ill-defined/unspecified” for the 27 & 28 week babies attended by doctors; the three causes of death for the term infants previously discussed above; and for the remaining two unknown gestational age, one died by assault (perhaps a teen mom strangled or smothered her newborn baby?), and the other died from some unspecified cause of the perinatal period.

There were a total of 127,602 births during that period in the whole state, with a state-wide infant mortality rate of 10.74 [11.46 for just 2005]. The hospital-birth infant mortality rate was 10.67 [11.40 for just 2005] — still worse than the #2-ranked state for infant mortality in 2005. And that’s assuming that all of these babies who died would have lived if they had been born in hospitals (which is false), and assuming that these births were all attended by midwives, rather than being either planned unassisted or unplanned unassisted births (in a taxi? on the side of the road with EMTs? who knows — you can’t tell from this data). So, leaving out the premature births, there are a total of 4 possible deaths that maybe, just maybe, were possibly somehow due to an intentional planned home-birth with a non-nurse midwife. Nope — four deaths does not change the numbers or ranking for Mississippi when it comes to infant mortality.

Local news coverage on the Mississippi Midwives bill

WMC-TV5 (the local NBC affiliate in Memphis) covered the story on HB 695 which is in committee in the State Senate. Read past posts for more info, but the nutshell version is that it would restrict “the practice of midwifery” to CNMs only, which would effectively make homebirth illegal, since there are few or more likely no CNMs in the state who attend home births. In fact, there are almost no CNMs at all. Here is the link to the video, and here is the write-up about it. Looks good!

P.s., Melissa Stallings, one of the CPMs featured in the story, was the midwife assistant and apprentice when I had my younger son.

My letter to my fellow Mississippians and my state Senators

My note on facebook which I slightly altered into a letter to the Mississippi Senators:

I was shocked to find out today that HB 695 which would amend current Mississippi state law to restrict the practice of midwifery to only Certified Nurse Midwives (CNMs) has passed the House and is in the Senate. This is a historic and unwelcome revision of long-standing Mississippi law which has always allowed for the free practice of midwifery.

There are only about 25 CNMs in the state (as of 2008) [Update - someone told me that there are only 2 CNMs that she knows about, both hospital-based and in the far South], and most serve the lower third of the state. This leaves the rest of us without the benefit of a legal home-birth attendant. Tennessee, Louisiana and Arkansas allow for CPMs (Certified Professional Midwives), and some may even allow for non-certified or “lay” midwives to legally practice (as current Mississippi law does). When I was pregnant with my son, now three years old, I was unable to find a local Mississippi midwife close enough to attend my birth, so chose a CPM from Tennessee. If this bill becomes a law, I fear that that option will no longer be available. What then? My choices will be limited to an unassisted birth or giving birth in a hospital.

A midwife is a safeguard of normal birth — monitoring the mother throughout pregnancy, just like a doctor (only better), and monitoring the mother and baby throughout labor. In most hospitals, this one-on-one labor care is nonexistent, replaced by machines monitoring the mother and baby, with nurses checking in only rarely. Sure, it’s more cost-effective since there can be a higher patient-to-nurse ratio, but it’s not better! With the close “with woman” care that homebirth midwives can give mothers, they can pick up on indications that labor may not be progressing normally, and take steps to put it back on track at home, or make an appropriate and timely transfer to the hospital.

Without homebirth midwives, women such as myself will be forced to give birth at home without a midwife in attendance, or to give birth in substandard conditions in a hospital. There are no baby-friendly hospitals in Mississippi. Our fair state consistently ranks at the bottom of most health criteria, including breastfeeding (see also this link). Home-birth is very “baby friendly” — what we need is more encouragement for women to have home birth, not less! This is just one of many benefits to babies of home birth. Among the many benefits to mothers are a much lower rate of interventions, including C-sections, epidurals, inductions, augmentations, episiotomies and vacuum- or forceps-assisted births.

Home birth is not for everyone. Many women would not choose it if they could; and some who want to give birth at home have risk factors that cause them not to be good candidates for a home birth, so give birth at a hospital. Yet most women are low-risk, and about 90% of women who plan on giving birth at home do so (and only a very small minority of the 10% who transfer to hospitals do so in an emergency; most are calm, routine transfers for pain medication or labor augmentation).

CNMs are wonderful — I had one during my first pregnancy (I lived in Illinois then). CPMs are likewise wonderful — I had one during my second pregnancy. As far as practice style went, there was no difference. The main difference between CNMs and CPMs is that CNMs are Registered Nurses who go on to complete midwifery training — training which is very similar if not identical to the midwifery training that CPMs complete.

With midwives already in short supply, changing the law to an even more restrictive one will be counterproductive. If you care about home birth, midwifery, the right of mothers to choose where and with whom to give birth, or just plain don’t like government interference, please contact State Senators and urge them to vote against this legislation! And for good measure, contact Representatives and express your disappointment that this bill passed.

Thank you.

And some links on this issue — the “Big Push for Midwives” facebook profile page and a page to sign up for updates; and a facebook group to keep everyone abreast of the situation in Mississippi.

Mississippi Midwives Facebook Group

If you’re on facebook, you can join this group to keep up with the latest news on the legislation to outlaw non-nurse midwives.

If you know of any other groups or organizations, big or small, official or unofficial, please let me know so we can join forces. Thanks!

Making Mississippi Midwives Illegal

I was horrified to find out that a bill has passed the Mississippi House of Representatives, and was sent to the Senate, to make CNMs the only legal midwives in Mississippi. My state was one of the few that was “alegal” — there was no language specifically protecting or prohibiting non-nurse midwives.

While it’s too late to contact the Representatives (I emailed mine anyway), you can email the Senators and ask them to vote against it. Even if you’re not from Mississippi, I would still appreciate a show of support for CPMs from citizens of other states. There are almost no CNMs in Mississippi anyway — none that I know of in the top half, perhaps the top 2/3 of the state; when I had Seth, my midwife (a CPM) was from Tennessee — I don’t know how that might affect midwives crossing state lines. Currently, CPMs are illegal in Alabama, but some Tennessee CPMs have set up a “birth house” just over the border to accommodate women who don’t want to give birth in the hospital, but live close enough to the border to drive there in labor.

My mind is still reeling — I feel like I’m writing pretty scattered, here — hopefully you can find the coherent thought in it, though.

I have nothing against CNMs — I had a CNM attend the birth of my first baby. This isn’t some sort of turf war — just trying to keep alive the only form of midwifery available in my area.

Please share the word, too, if you will. Thanks!

Update: — I just noticed that some of the email addresses of the Senators are incorrect — two at least are misspelled (one “seante” and another “.us” instead of “.gov”), and one email address was listed as the same address for at least 3 different Senators. Sandra has commented below with a list of email addresses which appear to be correct, so you may want to use those instead. The first list is by district whereas Sandra’s list is alphabetical, so you should probably use one of the other and not both, in order to make sure you get them all.

2nd Update: — if you’re on facebook (and maybe even if you’re not), here is a post I wrote that I hope was a little more collected, outlining why I support home birth. It is what I used as the base for my email to the Senators (mostly changing the end from “please contact” to “please vote against this bill”). Feel free to pass it around and use what you want from it in your own emails if you wish. I don’t know if emails make more impact if they’re similar or if they’re all unique (probably the latter), but if you don’t have time to write a response of your own, I don’t mind if you use portions of what I’ve written and make it your own.

3rd Update: — if you’re on facebook, you can join this group to keep up with what’s going on. If you know of any other groups (large or small, official or unofficial) that are involved in defeating this bill, please let me know, so we can join forces.

“You’re not instilling a lot of confidence into me, Doc!”

Thus said Marty McFly in Back to the Future. The scene was Doc Brown simulating the lightning bolt that would send Marty in the DeLorean back to 1985… and the model car caught fire. But it works for this news as well: research doctor is accused of having falsified data in at least 21 studies (and perhaps more), as far back as 1996. It literally makes me sick to my stomach to know that stuff like this goes on. Plus, at least two of the papers had the name of another doctor on them as a co-author, though the other doctor says he had no part in writing them, and the addition of his name was a forgery. Niiiiiiice. One of the basic tenets or underpinnings of research is that the authors, researchers, scientists and doctors are all academically and intellectually honest. While they may have hidden biases (or open biases), and they are human so may make errors, the automatic assumption is that they attempt to be as honest as possible. If we can’t trust the research, then we’re back to “he said, she said” — the blind leading the blind.

To me, this undermines the whole field of science and research. It shouldn’t, but it does. Sort of like the woman that finds out her husband is cheating on her, and then thinks all men are scumbags like her husband. Not fair, but understandable. I think of Dr. Hannah who did the Term Breech Trial which more or less completely eliminated the possibility of vaginal breech birth. Other researchers have questioned the conclusion of the paper, and the validity of some of the negative outcomes that were included in the paper. The Canadian Society of Obstetricians and Gynecologists has in fact reversed its recommendations, citing the problems with the paper, and is now suggesting that doctors learn how to properly manage breech birth. It seems that a couple of other major studies Dr. Hannah did have likewise come under similar criticism — though I don’t know that they have been retracted. Though the results may be invalid, I would assume that at least she was academically honest — I believe she did actually perform the research, and the data was real — so is better than that guy. Some people will point to his getting caught as an example of “the system working,” while others (like me) will say that if the system was actually working, it shouldn’t have gone on as long as it did. I understand that it is impractical to “police” doctors to make sure fraud like this doesn’t occur, and I’m not advocating treating researchers like two-year-olds. At the least, I’m asking for a return to integrity. Like in so many other areas, if people would “just do the right thing” then there wouldn’t have to be laws and fines and oversight committees and what-not. I don’t think that’s asking too much.

Prevent C-sections — learn about cervical scar tissue

This was an interesting post, and I thought I’d pass it along. If you’ve ever had a procedure done on your cervix (including, surgery to remove pre-cancerous cells, and, rarely, a D&C), you may have scarring, which can cause slow or no dilation, despite adequate contractions. One to save in the files…

Just the facts, ma’am…

Using the World Health Organization’s 2005 maternal mortality statistics, and this summary of abortion laws, I put together the chart below, which I ordered from lowest to highest maternal mortality rate. The figure I used for maternal mortality was the official number or estimate, although many countries had a wide “range of uncertainty” (for instance, Laos had an official MMR of 660, but the range was from 190-1600). You can read more about what the different numbers and letters mean in the abortion laws portion of the chart by clicking on the above link, although they are pretty self-explanatory, with Y meaning abortion is legal, 1 meaning legal in the first-trimester only, R is legal but with significant restrictions, etc.

The abortion laws portion transferred easily to the spreadsheet, but the MMR portion did not, so I entered those numbers in by hand (so I possibly made some typographical errors — you’re welcome to double-check me). Since they were both in alphabetical order, I then had to go through and match up the lists, because some countries were listed on one but not the other. There were also several countries that were named differently in the two lists (the Republic of Congo vs. Congo, as an example), and many of these I deleted, not realizing that they were actually listed, only further down on the list. I did not take the time to go back and figure out which ones I could have matched up, so I know the list is slightly incomplete (probably fewer than half a dozen countries in this group, although probably another half-dozen or so were deleted that could not have been matched up — Vatican City, for one). I divided the list into six roughly equal portions, to make it easier to see the abortion laws of the countries.

Then, because I’m a glutton for punishment, I organized the countries by type of abortion law. Unfortunately, they often don’t fit into nice, neat little packages, so while I tried to group them, it was quite difficult. Where they were the same (for instance, no legal abortion; or only for the life of the mother; or legal for any reason), I kept them together; where they were similar (YYNNNNN and YY?NNNN), I put them under the same heading, but with a blank line between. Some countries allow abortion only to save the mother’s life and health while other countries allow abortion only to save the mother’s life and in cases of rape. Since these both had two “yeses” I put them under the same heading, but with two or more blank lines between, to show that they were separate. While I tried to be consistent, it’s possible that there are numerous inconsistencies in there, but I mostly erred on the side of assuming a restricted abortion status for question marks. There were some weird things in there — Mozambique, for instance, which supposedly allows for abortion “on demand,” but it is not legal in cases of rape, fetal defect, or for “social” reasons. I don’t know if that’s a typo — nor do I know the difference between “demand” and “social” reasons for abortion.

So, those are the facts. Why am I presenting these facts? To show that there’s more to maternal mortality than just restrictive or relaxed abortion laws, because I’ve heard numerous abortion advocates talk about liberalizing abortion laws as if it is some sort of magic panacea for maternal mortality. But if you look at the group of countries where abortion is legal on demand, you’ll see that the MMR ranges from 3-830/100,000; and countries where abortion is absolutely outlawed (or illegal except in restricted circumstances) the MMR ranges from 8-1100/100,000. Some people look at the problem of “unsafe abortion” and try to remove the “unsafe” part of it. But abortion is a symptom of a problem. The root causes of abortion run far deeper than just legality and illegality. Just making abortion “safe” does little to help the underlying causes of why women seek abortions. If a child is being raped by her uncle, giving her an abortion and then returning her to the same conditions will not really help her, because she’s just being returned to that abuse (and will likely get pregnant again, and “need” another abortion to solve her “problem”). Ditto women in abusive relationships (married or unmarried), or those that abuse drugs or alcohol.

Unsafe abortion is unsafe, whether legal or illegal; and there are far better things to do for women than to promote the legalization of abortion, especially where it is inherently unsafe: working on the infrastructure so that health services are more available and reliable, improving food and water supplies, increasing the number of midwives, educating the populace (in general, as well as in particular about safe vs. unsafe health practices, including sticking non-sterile objects into your uterus to try to terminate a pregnancy), etc. It falls under the category of “give a man a fish, and you feed him for a day; teach a man how to fish, and you feed him for a lifetime.” Far too much time and energy is focused on “giving people fish,” and not near enough is focused on improving quality of life, which will help in many more and more far-reaching ways. An example — giving someone a condom may help that person keep from conceiving a baby one time. But they need condoms every time, so it is a continual and ongoing need and expense. Teaching a couple how to avoid pregnancy using ways that do not require ongoing expense (fertility cycles, cervical mucus to tell if she’s ovulating, etc.) can help even when condoms are not available. Giving people food is good; giving people the ability to grow their own food is better. Changing “unsafe abortion” by taking away the “unsafe” part may save some women’s lives; but changing “unsafe abortion” by taking away the real or perceived need for the “abortion” part will save even more lives, of both mother and child. This involves more than just drugs and technology and “things.” Changing men’s hearts so that they do not demand sex from their wives, nor rape children or women, nor are in other ways oppressive or abusive, but are good and godly men and husbands is the real answer, but those kinds of changes are not exactly easy to implement. There are similar changes that may need to take place in women, but it will take more than just throwing money and abortions at the problem, to make the real problem go away.

Abortion and Maternal Mortality

In response to my previous post about feminism, someone wrote (in part) why she supports abortion:

And wanting to dismantle those structures is why I support reproductive rights. In a different world, abortion would be unnecessary. Women’s lives would never be endangered by a pregnancy, no woman would ever be forced to get pregnant by her abusive partner, no woman would ever be raped, 10-year-olds would not get pregnant, there would be comprehensive sex education and free and unlimited access to birth control and free high-quality daycare and a year of paid maternity leave. These are, to me, highly feminist goals.

But we don’t live in that world; in this world, unintended pregnancies occur and a myriad of forces conspire to cause them and punish women for them. A system in which abortion is criminalized does nothing to help women; it makes their lives worse. If the only goal is to have somewhat fewer abortions, then banning abortion is probably an effective thing to do. There will still be abortions, of course: women with money will always find access to them, and women with less money will sometimes find a way, safe or unsafe, to access abortions; and sometimes they won’t, and those are the abortions the ban will have prevented. But it will also be causing maternal deaths (unsafe abortion is one of the top five causes of maternal death around the world, and causes an especially large percentage of maternal deaths in Latin America), and their fetuses won’t be carried to term; and when women are caught and prosecuted (and those will almost certainly be the women with less money), their other children will suffer (as so many women seeking abortions already have children). There is an excellent article about the consequences of what a full abortion ban looks like, as El Salavdor actively enforces one. It doesn’t seem like a good solution to me. To me, the feminist act is to dismantle the structures that make pregnancies unwanted, and that hurt women in myriad other ways as well.

Because this is an important topic (and because I recently read about Chile’s maternal mortality rate and abortion laws), I wanted to repost my answer here, slightly expanded:

The El Salvador link didn’t come through; you can re-post it if you want. It’s been some time since I’ve thought of El Salvador, but I remember being in a discussion some time ago in which I found out that they have an abortion ban in place which would prohibit abortions even for ectopic pregnancies as long as the fetus/embryo is still alive. Once fetal/embryonic death is confirmed (or the tube bursts), an abortion or other surgery can be performed to save her life. I think this is a bit too stringent, with the probability of a diagnosed ectopic resulting in a life-threatening if not a life-taking situation for the mother. In abortion cases such as these, the intent is to save the life of the mother, *not* to take the life of the child. It is the unfortunate inevitable result that the baby dies; but the likelihood (probably 99% or greater) is that the baby could never survive, so it is saving one life instead of taking two.

And, yes, I agree that we should be looking at ways to make pregnancy wanted. Often, when faced with an unwanted pregnancy/child, the solution offered is to get rid of the child. Most pro-life people would say that we need to get rid of the “unwanted” portion of the equation instead.

However, there is some equivocation about abortion. Often, “unsafe abortion” is juxtaposed against “legal abortion,” as if the two were opposite or mutually exclusive, when that is not the case. There are numerous unsafe legal abortions, as there are numerous safe illegal ones. [Safe for the mother, anyway.] Just recently, a woman in New York City died from an abortion when the abortionist lacerated her cervix during the procedure and she apparently bled to death. Legal, but unsafe. Ireland has the lowest maternal mortality rate in the world, and it also has strict laws against abortion. Illegal, but safe.

The reality is, that often in countries where abortion is illegal, health services in general and maternity services in particular are horrible, with high rates of death and disease from things that barely raise a blip on the radar of developed nations. I can’t speak for the current climate in these other countries, but I know that in America, about 90% of all illegal abortions were performed by a doctor or midwife, with most of the remainder being performed by someone else who had some medical training (veterinarian, nurse, etc.), and only a small minority being either self-induced abortions or by a complete amateur. [The term "back-alley abortion" does not refer to the place of the abortion, but rather that the pregnant woman would enter the doctor's office through the back door in the alley, often at night, so as not to be seen and raise suspicion.] These abortions were unsafe, not because they were illegal nor because they were done by unqualified personnel, but because they were unsafe by their very nature. Up until the development of antibiotics, if a woman got sepsis from childbirth or abortion, there was precious little that could be done for her. Maternal mortality dropped like a rock with the advent of sulfa drugs and penicillin, because it gave doctors for the first time the ability to fight infection. Maternal mortality dropped below 600/100,000 in 1934, and was in a free-fall for decades after, dropping to 75/100,000 in 1951 when abortion was still quite illegal, and continuing to fall to 18.8 in 1972, the year before Roe and Doe were decided. Legalizing abortion did not alter its safety; good health practices did. [In highlighting antibiotics, this does not exclude other advances, such as safer anesthesia, better technology in recognizing and treating maternal illness, a higher standard of living, etc.] MMR did fall below that, but is now on the upswing again — all with abortion still very legal. In countries where antibiotics and other health-saving measures are not easily available, we still see high rates of preventable deaths from all sorts of reasons, including abortion.

Here are abortion laws by country for 2007. As you can see, El Salvador does not allow for abortion for any reason. It has a maternal mortality rate of 170/100,000. However, what you may not have noticed from those same sources is that Chile also does not allow abortion for any reason, even to save the life of the mother, yet its maternal mortality rate is 16/100,000 — about the same as the United States’ rate.

While one might say (as is often said of Ireland), that women are merely going across the border to neighboring countries where abortion *is* legal, I would point out that their neighbors (Argentina, Bolivia and Peru) all have abortion restricted only for the life and health of the mother, and sometimes for rape. Plus, all three of these countries have *much* higher MMRs than does Chile: 77, 290, and 240/100,000 respectively. In fact, as you can see, El Salvador has a much lower maternal mortality rate than Bolivia and Peru, which both have abortion legal in the case of saving the mother’s life and health. Somehow, even with a full abortion ban, Chile enjoys an MMR comparable to that of the United States.

What is a feminist? Are you a feminist?

This topic has been floating around in my head for quite some time — ever since I read a blog post which had a laundry list of “things feminists believe,” and if you said “yes” to any one of them, then you were (by their definition) a feminist. The two points I remember most clearly were as follows (paraphrasing): 1) if you think that your husband shouldn’t be allowed to beat you; and 2) if you think you should be allowed to own property in your own right (or maybe it was voting…). After the list, the blogger continued writing saying something along the lines of, “If you don’t want to call yourself a feminist, then ask your husband to start beating you, and give up your right to vote, and the right to own property.” Well, by that definition, then, I guess I’m a feminist. But I don’t call myself that, because my definition of “feminist” includes someone who is socially or politically liberal — the opposite, in many ways, of my conservative viewpoints — most particularly that they are “pro-choice,” or even “pro-abortion.” And yet, there are women who self-identify as feminists who are pro-life, including the group Feminists for Life. So are they “real” feminists? They would be by the very broadest definition, such as contained in that post. In fact, the early feminists (Susan B. Anthony, etc.) decried abortion as being “child-murder,” and “infanticide.” Elizabeth Cady Stanton wrote of abortion, “When we consider that women are treated as property, it is degrading to women that we should treat our children as property to be disposed of as we see fit.”

Yet I daresay that many liberal feminists (those who would fit my narrower definition of “feminist”) would disavow these other women as being truly feminists. In fact, the Feministing blog wrote a blog post bemoaning the election of Laura Chinchilla, the first female President of Costa Rica, saying it was not truly an accomplishment, because she “hates women.” How does she hate women? — she opposes same-sex marriage, abortion, and the morning-after pill. Somehow, I think that this “female self-loathing” as the Feministing ladies would probably call it, would be an automatic disqualification of the term “feminist.” In their view, at least.

I think part of the problem comes from the varying definitions and indeed the different permutations of feminism through the decades. Most of us would probably fit the definition of the early feminists — the suffragettes, for example, who fought for the right to vote — or to get laws changed so that women could independently hold property, rather than their possessions being legally their husbands’. These early feminists may have been ideologically similar to later versions in some or perhaps many respects; but since one of the (if not the) defining characteristics of feminism in the 60s and early 70s was a strong commitment to legalizing abortion, these two groups may not have thought the other was a “true” feminist. My idea of what a “feminist” is includes someone who looks down her nose at women who choose to stay home and take care of their children — that women who are mothers only, rather than being defined by a job, are somehow less than working women (mothers or not); yet I was pleasantly surprised to find many self-identifying liberal feminists who consider being a stay-at-home mom to be the highest calling. Perhaps the definition of “feminist” has changed from what it was in my formative years, to be broader in some aspects, and narrower in others. Because of the liberal connotations of the term, I cannot call myself a feminist, and do not think of myself as one. Yet others may consider me so.

Now, discussion time! I’m really curious to find out what my readers think of the question: What is a feminist? What do you consider to be some indispensable aspects of feminism? For instance, would you agree that any woman who wishes to own her own property, to vote, or not to be beaten by her husband, is a feminist, even if she opposes abortion? And also, do you consider yourself to be a feminist, and why (or why not)?

Please be kind and civil; no flaming. I daresay that everyone will have a slightly different view on the topic, and my intent is not to pit one against another, but to find out personal opinion (which cannot truly be wrong). I think of the discussion in Pride and Prejudice on the topic of “What is an accomplished woman?” and how that each person in the room had a slightly different angle on the topic.

[Fast-forward to about 1 minute, to where the topic of an accomplished woman really starts.]

Mr. Bingley thought that “all young ladies are accomplished,” while Mr. Darcy said that there were not half-a-dozen women whom he would consider to be truly accomplished. Yet they were best friends, and were not in a heated argument. We can disagree without being disagreeable. :-)

[Update: I asked my mom, "Are you a feminist?" and she said, "No!" I asked why not, and she said, "Because feminists demean men." Then she brought up the way Tim Allen's character Tim Taylor was portrayed on "Home Improvement," compared to how his wife Jill was portrayed -- he was basically an idiot while she had all the smarts; he made the mistakes while she cleaned them all up. She has a point. It seems that a lot of TV shows portray men and women this way -- men are dumb while women always come in and save them. Are men now living down to women's expectations, instead of living up to them?]

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