A Handmaiden’s Country

Kentucky is the latest state to effectively ban legal abortions. Although the bill’s sponsors claim that a pregnancy may be terminated within 15 weeks of the fertilization of the egg that leads to the development of a fetus. The associated restrictions on who is eligible for the procedure and under what conditions a healthcare provider may perform the procedure make obtaining a legal abortion in Kentucky impossible. There is no exemption for the victims of rape or incest. If a teenager (or 12 year old) has been raped and impregnated by a family member, that child cannot get an abortion at any point in the pregnancy, regardless of how early after the assault the pregnancy is identified, unless the child’s parents or legal guardian is notified and gives written consent, even if that person may be the rapist.

The last two clinics in the state that offered legal pregnancy terminations announced last week that the law just passed by the state legislature, overriding the Governor’s veto, made them unable to offer women this service any longer. One of the state legislators supporting the bill ironically pointed out that poor and African-American women were disproportionately represented in the group receiving abortions and therefore were possibly being targeted by the purveyors of abortion. That these women might have the most limited access to healthcare in general and contraceptive measures in particular apparently did not occur to the legislators backing the anti-abortion bill. Seventy-seven percent of the Kentucky legislature is male and virtually all of this representative body is white. Only seven percent of the 138 members are non-white in a state with non-white (mostly African-American) citizens accounting for 15 percent of the population. Consequently, it is understandable that these Kentuckians might not be familiar with the healthcare challenges faced by African-American women.

Kentucky has historically been a somewhat peculiar state. During the Civil War, it remained as part of the Union with the northern states that fought to end slavery, but slavery was legal in Kentucky throughout the war. When Abraham Lincoln was pressured by his cabinet to outlaw slavery in Kentucky, he famously said, “I hope to have God on my side, but I must have Kentucky.”  The problem was that Lincoln, as a lawyer, believed he could legally dictate the disposition of all ‘property’ held by individuals in open rebellion against the federal government. Since the southern states insisted that their enslaved people were ‘property,’ Lincoln used their own classification of the enslaved as a legal rationale for ‘confiscating’ through liberation these people who were being used to support the southern rebellion. Since Kentucky was not rebelling against the federal government, Lincoln felt he could not legally emancipate the enslaved people of that state without passage of the Thirteenth Amendment to the Constitution.

And so, Kentucky joins the growing list of states whose legislatures have decided that the 1973 Supreme Court decision in Roe v. Wade was wrong. As their highly restrictive laws banning abortion come before the current Supreme Court, there is little doubt that they will be upheld. A majority of the current Supreme Court justices have publicly stated that they view the decision in Roe v. Wade as “established law,” but the unconcealed truth is that the justices appointed under the prior administration were selected in part for their opposition to abortion.

Healthcare for women and children in the United States is embarrassingly poor. One measure of healthcare delivery is infant mortality.  The United States has a higher infant mortality rate than Poland and barely surpasses Slovakia. Most industrialized European and Asian nations rank substantially higher in terms of infant survival than does the United States. Kentucky is amongst the poorest performers in the United States in terms of infant survival.  Prenatal care is a vital element in infant survival. The provision of that care to pregnant women and especially poor women has fallen primarily to institutions that have also provided birth control information and abortion services.  As states force these providers out of their jurisdictions by restricting the services they can deliver, indigent women are disproportionately affected.

States are waging a war on abortion that may eliminate access to legal abortions in most of the United States. History informs us that wide-spread, illegal abortion services will fill the void created by this crusade. The Roe v. Wade decision “established” the view that whether or not a woman should have access to pregnancy termination services was a healthcare decision involving a woman and her physician. The 1973 Supreme Court viewed the intrusion of legislatures into the appropriateness of pregnancy terminations as an invasion of both the affected woman’s privacy and the involved physician’s healthcare recommendation. With the spread of bans on legal abortions, the victims of rape, the indigent, women whose contraceptive measures have failed, and women whose sexual partners demand that they have more children than they can care for will contribute a growing number of children to the general population.  Whether you oppose abortion or support a woman’s right to choose will not affect your obligation to provide for these unplanned, unwanted children.  Most Americans agree that children should be clothed, fed, housed and educated, even if it requires their tax dollars to accomplish those goals.

As a healthcare provider, I would prefer our legislators worked on expanding and improving healthcare in America, rather than making decisions for women who have been exploited or victimized or ignored. What is best for a woman and her family cannot and should not be decided by the largely white, mostly elderly, financially comfortable men that comprise most state legislatures in our country.  Those who insist that this is a strictly moral issue and that abortion must be banned in all circumstances have never dealt with a pregnant 14 year old who was raped by her father. As thousands of Ukrainian women who have been raped and impregnated by Russian soldiers come to the United States, will we demand that they complete the pregnancies initiated by these monsters?   We need to work out individualized solutions for individual problems. That is what doctors, not legislators, are supposed to do.

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.

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