What New Laws in North Dakota Tell Us About the Anti-Abortion Movement in 2013

Follow abortion law long enough, and you will begin to appreciate its Talmudic qualities.  Figuring out what the literal meaning is only the beginning.  For a deeper understanding, you must decode the text.  Consider these recent examples:

Earlier this month, Arkansas passed a law banning abortions after 12 weeks gestation.  Then, on March 15th, the North Dakota legislature passed a law banning non-emergency abortions after 6 weeks gestation.  So you ask yourself: are the North Dakotans really that competitive?  Quite possibly.  But that’s not what’s at issue here.  Actually, both bans are tied to the idea of fetal heartbeat, which can be detected by vaginal ultrasound at 6 weeks and abdominal ultrasound at 12 weeks.  Arkansas changed the terms of its law from 6 weeks to 12 weeks to avoid the whole ‘politicians want to stick a wand up your vagina’ brouhaha, while the North Dakota legislators hedged by sidestepping specifics on gestational age and declaring it a felony to do an abortion procedure after the heartbeat could be found, which means that any procedure after 6 weeks – or possibly even 5 – puts the doctor at significant legal risk.

Textual analysis requires a little context: these two laws are not without detractors within the anti-abortion community. Blatantly unconstitutional, they will not go into effect unless the Supreme Court chooses to overturn Roe v Wade altogether – or to redefine its standard of viability.  Since this law puts the state on the line for substantial legal costs if the challenge fails, it is entirely possible that North Dakota’s Governor Dalrymple will veto the law as fiscally irresponsible.

Deeper truth: in recent years the organized anti-abortion movement has eschewed direct challenges to Roe in favor of enacting an all-you-can-eat buffet of restrictions and regulatory hurdles that make the process of getting an abortion more difficult, humiliating, expensive and time-consuming – all of which serves to reduce access without making abortion illegal, and presumably to avoid triggering a popular outcry, a likely outcome if Roe v Wade was in obvious jeopardy.  What’s more, this smorgasbord approach (waiting periods, mandatory counseling, special requirements for abortion facilities, parental notification, etc) affects mainly the poor, the young and other vulnerable populations – leaving the empowered classes free to find abortion distasteful without giving up any of their reproductive rights.  The stealth approach, orchestrated by a sophisticated and media-savvy crew, has been largely successful at limiting abortion regionally, while chipping away nationally at popular support for abortion rights.

The new laws then, as a departure, represent a throw of the dice on the part of the anti-abortion movement’s country cousin, looking to win big on a game-changing Supreme Court decision – a long shot, though hardly impossible.  And not unlike the Tea Party with its candidates that win in the primary and lose in the general election, the constituency that launched these laws is a tail-wagging-the-dog phenomenon that illustrates hardening fissures within the conservative movement – a quasi-rebellious move on the part of ideologically motivated individuals who are not prepared to compromise or prioritize strategy over gospel.

While the prohibitions on first trimester abortion is sucking up most of the media oxygen, a second legislative initiative out of North Dakota presents an alternate window into anti-abortion sentiment in 2013 – and one of particular importance to genetic counselors.  The second bill prohibits any abortion for purposes of “sex selection” or “genetic abnormalities.”  Of course, intent is a tricky thing to prove and for the moment abortion is available for no reason, making these provisions hard to enforce, but it could vastly complicate a counselor’s ability to discuss options in the event of a fetal anomaly.  Would it be illegal to even suggest that abortion was an option, in the context of a prenatal diagnosis?  Could you raise the subject?  What if the patient brought it up?  How would you handle the informed consent for prenatal testing, if you could not mention termination?  Why even test?

Why indeed.  Was that not exactly ex-presidential candidate Rick Santorum’s point one year ago, when he criticized the system for forcing employers to provide insurance coverage that included prenatal testing?  Sure, he got some details wrong – but to point out what he does not understand is to miss what he does understand.  There was nothing random about his comments — or this law — and the heart of the problem is not an absence of science literacy.  This is a revolt aimed at what we do, based on a reasonably accurate understanding of what we do.  It reflects the hard truth that, for people who genuinely believe that a fetus is morally indistinguishable from a child, prenatal diagnosis amounts to a war on handicapped persons.  It suggests that we think that some people are more valuable than other people, and that some lives are more worth living than other lives, and that therefore parents deserve a choice about whether or not to have a child whose health or abilities or prospects are compromised.

Improvements in prenatal diagnosis – the innovations we celebrate because they allow us to do what we do more safely and effectively – are threatening developments for a significant minority.  The better we get at our jobs, the more blowback we can expect to experience.  The North Dakota statute may not survive a challenge – it may not even get signed into law – but the rallying cry of anti-abortion forces against the use of genetic testing for eugenic purposes is a sound we will hear again, and louder.

7 Comments

Filed under Laura Hercher

7 responses to “What New Laws in North Dakota Tell Us About the Anti-Abortion Movement in 2013

  1. Sally E Cohen MD

    excellent points and timely!

  2. Katie Stoll

    The abortion legislation you highlight does have prenatal diagnosis at it’s core, but it is worth noting that the criticism of our profession is not just coming from those who identify as pro-life. There are also vocal supporters of abortion rights who are concerned about how prenatal testing is being delivered and it’s impact on individuals with disabilities. I think we need to take a hard look at what we do and how we do it. I do not view my role as a facilitator of selective abortion, but I am concerned that this view of our profession is often well founded through individual experiences. Sometimes it seems that there is an overemphasis in prenatal diagnosis on patients making choices about whether or not to continue a pregnancy while underemphasized is the discussion about what these tests are for and why testing is being considered. What are people hoping/fearing for as expectant parents? Preconceived notions about Down syndrome, neural tube defects and other commonly tested for conditions are often way off base. Although genetic counselors often are the ones who talk openly with patients about decisions around pregnancy continuation/termination, I believe we first have the duty to do our best to ensure that patients know what they are choosing for or against. A checklist of medical and developmental concerns and a picture of a karyotype are not enough to convey what Down syndrome is. I think as a community we should give more thought to the questions of how, when and what information needs be conveyed. Can we talk about how to do a better job of not unintentionally demoralizing the lives of people with disabilities while at the same time allowing patients to make more informed decisions about testing and what to do with the information they may gain from it? I recognize this is no easy task but I think we are up for it.

  3. SD

    Katie,
    I think you have made an excellent point by stating how the profession may be seen by others and how genetic counselors today and in the future will have to work to clarify the purpose of genetic counseling and to provide patients with the education they need to make their OWN decisions and should not be pressured by the views of the genetic counselor in ANY way.

  4. Anon

    Laura, thanks for your overview of these current abortion laws, the root of these laws and their potential impact. As a pediatric genetic counselor who works primarily with metabolic patients, I have been the first health care provider that my families come to after learning about their pregnancies after we have cared for their first child with a metabolic disease. I have been fortunate, in some sense, that I have had a rapport with these families built after working with them for a time to care for their affected child. Often I know what their wishes are regarding a future affected pregnancy because we have discussed it many times. And many of them have chosen to have prenatal testing and to terminate a future affected pregnancy. They have seen exactly what the disease entails, and they don’t want to watch another child suffer. Interestingly, many have had children with diseases identified by newborn screening, and often their OB’s, and prenatal gcs I’ve passed them on to will have a bias toward telling them that the disease isn’t so bad because it is detected by newborn screening, and is therefore treatable. So, in this case, the opposite is true, which is that prenatal gcs have a rosy, happy picture of these treatable diseases that are less than rosy. Overall, however, I’m saddened that in these cases, when parents know the full extent of the disease affecting their unborn child, they have to jump through ridiculous hoops to make their choice a reality. We seem a profession that has so much knowledge, and can give so much support, but we are politically silent on this issue. Why is that? I encourage gcs to get involved, as we have the knowledge to make a difference.

  5. I agree with Katie’s points, as I am fervently in favor of reproductive rights and also concerned with how prenatal testing is performed. I’ve done interviews with many women who’ve terminated their pregnancies because the fetus was identified as having Down syndrome, and some of them have gotten biased–or even blatantly false–information from their healthcare providers. Even those who had outstanding genetic counselors walked away feeling that they’d been given a list of potential medical problems (including Alzheimer’s) rather than help seeing through our layers of societal stereotypes around people with Down syndrome and other disabilities.

  6. Katie Stoll

    Here is a blog post related to this topic written by one of the commenters, Alison Piepmeier. It is worth a read and the many reader comments paint the picture of the how emotionally charged and polarizing these issues are.
    http://parenting.blogs.nytimes.com/2013/04/01/outlawing-abortion-wont-help-children-with-down-syndrome/

  7. Pingback: Ohio seeks to criminalize abortion based on a prenatal diagnosis of Down Syndrome. Can they do that? The answer may be more complicated than you think. | The DNA Exchange

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