Abortion is not the only fight

Finally, a feminist health campaign telling it like it is: American women are being thrown under the bus for an insurance industry-friendly motion towards "health reform." Enough with the handwringing, Jane Fonda seems to say in this video for the "Not Under the Bus" campaign. It's time for women to stop that bus and start driving it. The healthcare bill currently headed for conference committee station in Congress is troubling to progressives on several accounts, but for women, it will have the ironic effect of making a medical procedure less accessible. The Senate's abortion "compromise," extorted by Ben Nelson of Nebraska (along with a pile of cash for his state), ostensibly means that women who want full coverage will have to write two checks: one to cover abortion, and one to cover everything else. Analysts worry this will amount to a Stupak-like ban on all insurance coverage for abortions – how many insurers, not to mention employers, are going to put up with separate checks? And that's only a question for "blue" states that won't ban abortion coverage entirely. If the expected happens, it will mean that women will have to pay more out of pocket and travel even longer distances to exercise what Roe versus Wade supposedly codified as a "right."

Last month, feminists were shocked at Stupak-Pitts, then outraged. Now, Jane Fonda is looking outright panicked on Youtube: "Help end discrimination against women," she pleads. It may well turn out that the decade's greatest threat to abortion access wasn't George Bush, but Obamacare. Odd as it is to say, I find Fonda's panic somewhat comforting. In both its boldness and its generality, it signals the women's movement to regroup at square one, to focus on women rather than on a procedure. After all, the right to abortion is based on broader Constitutional rights to autonomy and bodily integrity and the privacy to make decisions about what happens or doesn't happen to one's body. And if we apply these rights broadly, not only to a woman's "right to choose" to terminate a pregnancy but also her right to choose to carry that pregnancy to term, and her right to choose what happens or doesn't happen to her body at the time of childbirth, then we would see that all pregnant women are being denied these rights.

Case in point: Joy Szabo of Page, Arizona, pregnant for the fourth time. In order to exercise her rights, she sought long and hard for a provider and had to travel 300 miles away from her family for care. But Szabo wasn't seeking an abortion; she was seeking a vaginal birth. You see, Szabo gave birth previously by cesarean section. She is among the hundreds of thousands of U.S. women who seek vaginal birth after caesarian (Vbac) each year, though nearly half of hospitals won't allow it. Szabo was denied the right to deliver at her local hospital unless she delivered surgically. She was even threatened with a court order. You thought abortion was controversial? Ask a nurse about Vbac. Szabo also told it like it is: "Page Hospital: Enter my body without permission, sounds like rape to me," she wrote in lipstick on the back of her minivan. Szabo's ordeal ended happily on 5 December, when she gave birth vaginally in Phoenix. But the majority of American women in this situation are scheduling repeat surgery — either on their doctors' recommendation or insistence — though research has shown it is more likely to result in a baby's admission to neonatal intensive care for prematurity and breathing problems, to say nothing of the risks to mothers.

Meanwhile, the majority of labouring women are confined to hospital beds, strapped to mandatory but ineffective fetal monitors, induced or sped up with artificial hormones, and consequently experiencing unnecessary pelvic trauma and the highest cesarean section rate on record, at 32% (10-15% is considered the maximum we would expect for health reasons). If you question whether this has anything to do with women's bodily integrity, talk to a woman who's had an infected caesarian scar or an episiotomy that tore into her perineum. Perhaps the biggest loss for women's health reform is that with all the drama over abortion, maternity care has remained a huge blindspot — and a costly one, at that. The US spent $86bn on maternity care in 2006 and another $26bn caring for babies born preterm, now also at a record high of 12%. Prematurity is a leading cause of infant death, yet the majority of premies are induced or surgically delivered too early. This over-medicalisation means that childbirth costs Americans more than twice per capita what other countries with better outcomes spend.

Medicaid picks up nearly half the bill in the US. If they gave just a little attention to improving care, they could literally save billions. Improve quality and reduce costs" — this has been Obama's mantra for health reform. How is it that instead of addressing real threats to women's and babies' health, "reform" has led us toward rolling back abortion access? Advocacy groups have been defending "abortion rights" and, to a lesser extent, "birthing rights," but it's possible that such a single-issue focus has helped to marginalise. To what other bodily system or medical procedure do we attribute rights? We don't have endocrine rights or MRI rights; men don't have testicular rights or Viagra rights. Rights belong to human beings. Or do we? A society that would force a woman to carry an unwanted pregnancy would also force her to have major abdominal surgery. Women won't get real health reform until we reform this fundamental lack of respect for women. The bus stops here.