Will At-Home Therapeutic Miscarriage Make Abortion Clinics Obsolete?

Medication abortionAt the turn of the millennium, the FDA approved a pill that could replace most abortions with early at-home therapeutic miscarriage.  When will that potential be realized? 

Fifteen years ago, in September of the year 2000, the FDA approved a French pill known at the time as RU-486 that offered women a safe, inexpensive alternative to clinic-based abortion. Better known by the name mifepristone or mife (rhymes with spiffy), the pill triggers the body’s natural process for rejecting an ill-conceived pregnancy.

When a woman’s reproductive system is working normally, most fertilized eggs either fail to implant or spontaneously abort—a process designed to cull pregnancies that are unlikely to produce healthy babies. This natural process of spontaneous abortion (the medical term for miscarriage) is imperfect, but it stacks the odds in favor of thriving children and families. Therapeutic miscarriage, which has the same goal, makes the process voluntary, allowing rational decision-making to enter the equation.

After mife blocks the hormone progesterone, the lining of a woman’s uterus releases any attached embryonic sac and begins a shedding cycle. Coupled with a second medication, misoprostol, mife provides the most effective means of ending a pregnancy prior to seven weeks and it works well throughout the first trimester. For most women, the experience is like a very bad menstrual period—the kind with cramps, clots, heavy bleeding, nausea and so forth—definitely unpleasant but within the range of normal.  (True fact: Many times when a woman experiences unusually heavy period cramps and bleeding she is going through an early, spontaneous abortion.)

Dire Predictions and High Hopes

At the time mife came on the market, conservative Christians warned that it would increase the number of abortions.  It hasn’t. Health advocates predicted that it would replace clinic-based abortion with early, at-home therapeutic miscarriage. That hasn’t happened either. Today, mife is used for a third of U.S. abortions up to nine weeks, with most women still relying on clinic-based procedures. But medical experts believe that the potential of mife is largely unrealized—that many of today’s abortion procedures could be replaced by earlier, less intrusive, and less expensive at-home therapeutic miscarriage.

Safety not the Barrier 

To date, more than two million American women have used mife to end an unwanted pregnancy. The drug was approved in France in 1988 and is now used globally for early pregnancy termination; a quarter century of data show that it is highly safe and effective. In about two percent of cases the medication fails to cause a complete abortion and the woman requires an aspiration procedure—as can happen with spontaneous miscarriage as well.  About 4 in 1000 women will experience a serious infection or blood loss that requires hospital treatment, a rate that is much lower than comparable risk associated with full-term pregnancy.

Improvement in Clinic-based Abortion  

One reason that many women prefer to simply schedule an abortion is that abortion procedures themselves have improved significantly in the last generation. A retired Seattle doctor tells the story of a young woman decades ago who asked partway through her abortion, “Where are the whirring blades?” The doctor marveled at the patient’s courage and determination—she had scheduled and gone through with the procedure despite thinking that “whirring blades” were somehow involved—but assured her that the then-standard D&C required no such thing.

Today the D&C itself isn’t required for a first trimester abortion, which typically extracts an egg sac smaller and softer than a cherry.  An early abortion procedure can be completed with a small disposable hand-held aspirator, not quite as simple or cheap as a turkey baster, but operating on the same principle. In contrast to an induced miscarriage, which takes place over the course of several days, the aspiration procedure can be as short as ten minutes. That makes it an important option for women who, once their minds are made up, simply prefer to get the procedure done.

Obstruction and Unnecessary Restrictions 

Some women may always prefer a quick clinic-based procedure over an at-home process that takes several days, however private and convenient the latter may be.  But the main reason many choose clinic-based abortion procedures today is that conservative politicians have erected a barricade of “health regulations” that have nothing to do with health and everything to do with obstructing access to misoprostol.  These regulations take what should be a simple prescription—take 1 pill this afternoon and 4 tomorrow and call if you have any concerns—and turn it into a regimen that is complicated, expensive, and difficult to access. That is their purpose. They also cause women to delay abortions past the window in which at-home therapeutic miscarriage would be safe and effective, forcing them to seek later, clinic-based procedures.

The rules now regulating misoprostol have turned what should be an evaluation, followed by at-home pill-swallowing and self-monitoring, into a process that is every bit as cumbersome as outpatient surgery. Depending on state rules:

  • A woman may be required to make multiple clinic visits days apart.
  • She may be required to actually swallow the pills in the presence of a physician.
  • A doctor may be forced to prescribe more medication than is necessary, based on an outdated procedure with more side effects.
  • Advanced practice clinicians like physician’s assistants and nurse practitioners may be barred from assessing pregnancy status or administering mife and misoprostol, even though World Health Organization guidelines and research indicate that they are perfectly qualified to do so.
  • The office in which the medications are given may be required to have an operating suite and halls in which two gurneys can pass, even though no surgery is being performed there.
  • The doctor may be required to watch the patient swallow the pills in the operating theater.
  • Telemedicine prescribing of mife may be specifically prohibited by law, even though this has been shown to be a safe and effective option for women in rural and underserved communities and to drop the number of second trimester abortions.

In sum, women don’t opt for early at-home therapeutic miscarriage because it is not available to them as an option.

Looking to the Future

Would more women choose at-home miscarriage over clinic-based abortion procedures if obstructions were removed? Certainly religious conservatives think so, or they would not have introduced hundreds of obstructive laws in recent years with the goal of forcing women to undergo more appointments and procedures in order to end a pregnancy. Self-proclaimed abortion foes who publicly talk about viability and fetal pain show little interest in helping women transition from later to earlier terminations, those that take place at the embryonic “lentil” or “bean” stage, long before pain or viability becomes a question.

Nor do they show any interest in preventing the unwanted pregnancies that lead to abortion. Today’s top tier contraceptives drop the abortion rate by over ninety percent. In a St. Louis study of nearly 10,000 women, the percentage drop in abortions almost perfectly matched the percentage of women who switched to long-acting “set and forget” contraceptives. I have written elsewhere about what a serious anti-abortion movement would look like—and how it would leverage advances in pregnancy prevention. But given a choice between clinic-based abortion and pregnancy prevention, self-proclaimed abortion foes choose more abortion every time. The recent attempt to defund everything that Planned Parenthood does except abortion care speaks for itself.

One great irony of the culture wars is that the most staunch defenders and providers of abortion care are also those doing the most to make abortion need dwindle into history, while the most staunch critics disdain and discredit family planning technologies and undermine access—driving demand for clinic-based abortion in an all-or-nothing bid to control female sexuality. But despite the obstructions, word has gotten out that women have options; and despite obstacles, women seek them out—determined to live the lives of their choosing and to stack the odds in favor of their children, their families, and our world. Despite—not because of— conservative obstructionism, both unintended births and abortions are declining as reproductive empowerment grows.

Dr. Daniel Grossman of Advancing New Standards in Reproductive Health, a research program at the University of California, San Francisco, is a tireless advocate for options including over-the-counter birth control pills, emergency contraception, “set and forget” IUDs and implants, and—when all else fails—abortion care.  He shares one opinion in common with his conservative opponents:  If obstacles are removed, more women will choose the privacy and convenience of at-home therapeutic miscarriage over clinic-based abortion. “What is the ideal ‘perfect’ proportion of medication abortion?” Grossman asks. He goes on to say, “We don’t know.  I think if women are given a true choice, at least half of eligible abortions would be medication abortion.”

One pill the first day, four to follow, have someone pamper you, pay attention to how you feel, call me. 

Will that put abortion clinics out of business? Not in the near term.

But in the long run, the men and women now providing abortion care may find themselves increasingly able to devote their energy to pregnancy planning and prenatal services. Clinic-based abortion procedures likely will dwindle as more women have access to at-home therapeutic miscarriage. Add that to the fact that abortions of all kinds will plummet as young women switch over to IUDs and implants—and by 2030, the familiar 1-in-3 statistic and the stand-alone abortion clinic may be a distant memory.

Originally published at ValerieTarico.com

If the Anti-Abortion Frenzy Were Actually about Abortion . . . What a Serious Anti-Abortion Movement Would Actually Look Like

Forty years after Roe v. Wade, the Pro-life movement is a radical failure by the very metrics that abortion foes cite to inspire their base. What would a real anti-abortion movement look like?

U.S. women have obtained nearly 53 million legal abortions since 1973. That is because self-described abortion foes ignore or oppose the most powerful strategies for making abortion obsolete. The anti-abortion movement is dominated by religious fundamentalists whose determination to control sex—who has it, with whom, for what purpose—takes priority over their desire to reduce abortions. This focus has seriously interfered with eliminating the supply and demand for abortion services.

If the top priority of the Pro-life movement actually were to end abortion, both tactics and results would be radically different. Imagine a fictional person whose chief life goal is to reduce abortion by, say, 90 percent over the next twenty years. This person might devoutly believe that every fertilized egg has a soul and that fetal demise is a tragedy; or he/she might simply think that abortion is an expensive, invasive, emotionally-complex medical procedure that should be made obsolete. Either way, this person believes that moving society beyond abortion is the most valuable cause to which he or she can devote a lifetime.

It might come as a surprise to the audience of today’s anti-abortion theater—but our protagonist’s goal is attainable. Armed with just the information and technologies available today, someone genuinely committed to reducing abortion by 90 percent in 20 years could map out a plan to get there—and even make people’s lives better in the process.

Skeptical? Let me map it out. When someone gets serious about building an effective beyond-abortion campaign the strategic plan will look something like this:

Serious beyond-abortion advocates will ensure that all Americans have the knowledge and means to prevent the kind of pregnancies that lead to abortion.  

    1. Since many parents had poor role models for birds and bees conversations, serious anti-abortion activists will promote programs that help parents to overcome discomfort and create healthy, age-appropriate conversations about genitalia, sexual health, sexual pleasure, intimacy and reproduction.

      Conversations between children and trusted adults delay the onset of sexual activity while increasing the percent of sexually-active teens who protect themselves against unwanted pregnancy (and so the need for abortion). Therefore, serious anti-abortion activists will help parents build trust and credibility on sexual matters. Despite the discomfort of aging traditionalists, who might prefer to avoid frank conversations about sex, serious anti-abortion activists will keep their eye on their prize, which is fewer abortions.
    2. Since preventing abortion is a higher priority for them than promoting chastity, serious anti-abortion activists will promote open, honest conversations about sex within religious communities.

      Approximately 85% of Christian youth have sex before marriage and the rate of abortion is as high among Christian believers as non-Christians, so beyond-abortion advocates will work diligently to ensure that Christian young people are equipped to manage their fertility and thus initiate pregnancy only when they are prepared to carry forward a new life.Because beyond-abortion activists are single-mindedly intent on reducing abortion, they will take to heart the social science research showing that shaming—for example through abstinence-only sermons, books and classes—drives down intimate conversations and preparations for safer sex while doing little to delay or reduce more impulsive sexual activity. They will recognize that guilt and shame about normal sexual urges can lead to denial, wishful-thinking, church-avoidance and impulsive high-risk behaviors. They are also committed to helping young people understand and manage sexual desire and pleasure rather than simply trying to suppress those urges, which has been shown not to work. They will challenge old attitudes that treat youth contraception as “premeditated sin” or pregnancy as a punishment and will instead help young Christians to explore the spirit and purpose of ancient chastity laws. They will develop faith-compatible programs like Our Whole Lives, which was created by the Unitarian Church to integrate thoughtful, responsible family planning with other spiritual and moral wisdom.
    3. Serious beyond-abortion advocates will treat the school system as part of the sexual education “village.”

      To quote a research summary from Advocates for Youth: “Evaluations of comprehensive sex education programs show that these programs can help youth delay onset of sexual activity, reduce the frequency of sexual activity, reduce number of sexual partners, and increase condom and contraceptive use . . . teens who received comprehensive sex education were 50 percent less likely to experience pregnancy than those who received abstinence-only education.”Recognizing that some families struggle with addiction, mental illness and other challenges that keep kids from getting excellent health information and care and recognizing that some children suffer unwanted sexual contact at home, serious anti-abortion activists will support school efforts to fill knowledge gaps. They will invest in accountable, effective sexual health curricula demonstrated to delay sexual initiation and reduce risky sexual behavior (as measured by self-report, STIs, pregnancy and abortion). They will also lobby for age-appropriate education that starts long before youth become sexually active. When public dollars are limited, they will fund these materials and programs through charitable giving. Beyond-abortion advocates will insist that family planning be integrated into educational and career planning, not because this helps students attain their goals but because preventing surprise pregnancy prevents abortion.
    4. Serious beyond-abortion activists will recognize that attempts to restore traditional gender roles and the traditional family formation sequence (education-marriage-sex-childbearing) have largely failed. They will also recognize that abortion prevention must adapt to a shifting pattern of pair bonding and family formation. Expanding beyond abstinence-till-marriage, they will deploy whatever tools are necessary to reduce the pregnancies that lead to abortion.

      For over 20 years, advocates for child well-being promoted a return to traditional marriage as a means to ensure that parents get ready before getting pregnant. Lead advocate, Isobel Sawhill (National Campaign to Prevent Teen and Unplanned Pregnancy, Generation Unbound) concedes that the changes in family structure are likely irreversible and that new methods are needed to support well-timed pregnancy and family flourishing. To reduce abortions, serious anti-abortion activists will adopt a pragmatic approach to intentional childbearing and family well-being, including community services for young families and access to better birth control.
    5. Serious anti-abortion activists will drive a technology revolution in contraception—from every-day and every-time birth control methods to long-acting contraceptives like IUDs and implants that radically reduce unintended pregnancy and abortion.

      Long-acting contraceptives are the most dramatically-effective means to date of reducing demand for abortion. A St. Louis program that offered top-tier, long-acting contraceptives to 9,000 women and youth dropped unwanted pregnancy and abortion to less than half the local average. A Colorado program that provided long-acting contraceptives to sexually-active teens reduced teen pregnancy and abortion by 40 and 35 percent respectively. Serious anti-abortion activists will challenge the false perception that these methods work to end rather than prevent pregnancy and instead promote the science-based awareness that these methods are true contraceptives with bonus health benefits. They will work to reform liability practices that undermine development and distribution of better birth control.
    6. Serious anti-abortion activists will ensure that young and poor women in marginalized communities have access to excellent reproductive health services free of charge, since these are the youth and women with the highest rates of unplanned pregnancy.

      While unsought pregnancy and abortion are declining for middle and upper middle income families, they are on the increase among those least able to absorb the impact of another child. But making excellent contraception available to teens at no cost can drop the abortion rate by three quarters. As is, Title X family planning services prevent 2.2 million unplanned pregnancies yearly, without which the abortion rate would be two-thirds higher.Drawing on tested models like A Step Ahead in Memphis, serious anti-abortion activists will create programs that recognize the complexity and financial challenges of life in poor communities. These programs will provide rapid response, single-visit services and they will systematically eliminate financial barriers to better birth control. They will address anxiety (and contraceptive avoidance) that is due to forced sterilizations and other bad history and ensure that women are freely able to choose and switch contraceptive methods, as well as have them removed as desired.
    7. Serious anti-abortion activists will insist that medical practices be updated so that family planning becomes a routine part of adolescent medicine, family practice, prenatal care, and hospital labor and delivery services.

      Women and men are most likely to engage in effective pregnancy prevention when primary care providers and other doctors routinely assess family plans and fertility management as a part of all medical care. Serious anti-abortion activists will promote innovative and effective programs that treat pregnancy intentions like one more vital sign for both healthy and chronically-ill patients. They will ensure that continuing education programs teach doctors how (and why) to include family planning conversations in prenatal care and birthing services. They will monitor hospitals and other care systems to ensure that the best fertility management options are available on patient request.
    8. As both unintended pregnancy and abortion decline, serious anti-abortion activists will ensure that any woman who does end up with a surprise pregnancy will never be driven by financial or educational or career concerns to terminate that pregnancy.

      Forty percent of women seeking abortions cite financial concerns as a factor in their decision to end a pregnancy. Serious anti-abortion activists will tackle structural barriers to broad family prosperity including policies that create income inequality and cause families to fall out of the middle class. They champion family-friendly workplace norms and public policies including maternity leave, paid family leave, affordable childcare, and mom-friendly education alternatives for youth and women who decide to carry forward a surprise pregnancy.
    9. Serious abortion advocates will work to minimize maternal health problems and fetal anomalies by promoting pre-conception care and prenatal care and by ensuring that fertility management is integrated into care for chronic conditions such as diabetes and HIV.

      Only a small percent of abortion is triggered by threats to maternal health and life, or by fetal anomalies, but serious anti-abortion activists will work to prevent these difficult situations. They will raise awareness that preconception care can prevent some fetal anomalies and maternal health risks and they will make sure that medically-compromised women receive integrated care so that high-risk pregnancies occur only when a woman or couple actively wants a baby.
    10. With an eye to the future, serious anti-abortion activists will aggregate $200 million in philanthropic dollars, public research funds and investment capital to develop better birth control for men and take it to market.

      A man is involved in every pregnancy and men are involved in many abortion decisions, but today male contraceptives lag behind female contraceptives by almost a century. As of 2015, the best reversible method for women has an annual pregnancy rate of 1 in 2000, while the best for men (the condom) has a 1 in 6 annual pregnancy rate. Serious anti-abortion activists will recognize that giving men better means to manage their fertility will result in fewer surprise pregnancies and fewer abortions.

Forty years after Roe v. Wade, the Pro-life movement is a radical failure by the very metrics that abortion foes cite to inspire their base—or would be if the goal were actually to eliminate abortion. Unintended pregnancy and abortion are in decline, thanks to a number of cultural and economic factors and better birth control. But American care providers still serve over a million women seeking abortions annually and over 900,000 of these women terminate a pregnancy.

Self-described abortion foes in Congress pass copy-cat TRAP laws (targeted restrictions of abortion providers) that drive up the price of abortion care. Other self-proclaimed abortion foes have launched a multi-year “yuck factor” media campaign aimed at triggering moral and physical disgust. Still others harry women and care providers, forcing them to walk gauntlets of posters and prayers at clinic entrances or stalking and doxing them online. Indeed, self-proclaimed foes have so stigmatized abortion care that most of us have no idea which third of our female friends have terminated ill-conceived pregnancies.

But, if a half century of evidence from around the globe is to be believed, no amount of shaming or harassing women, nurses and doctors—however well-organized and sustained—will produce anything close to a 90 percent reduction in abortion. Nor will another 800 restrictive laws like those passed in the last twenty years, even if they criminalize women and providers. Such approaches may force some women to carry forward unwanted pregnancies, but their effect is limited by the power of human desperation. Extreme restrictions and stigma in Eastern Europe filled orphanages with unwanted babies but also filled backrooms with bleeding women. In pre-Roe America, compassionate clergy became weary of burying dead parishioners and helped to create an underground railroad to safe. Around the globe, 22 million women each year undergo a back-alley abortion rather than carry yet another unwanted pregnancy to term and over 20,000 pay with their lives. More restrictions, more disgust, more stigma—these may feel righteous to some, but at best they produce an impasse that destroys dreams and hopes and even lives and that satisfies no one.

By contrast, we know what it would take to make most abortion simply go away. Ironically, the upstream solution lies in the common ground between those who oppose abortion care and those who support it—the value we all place on empowering young people to flourish, and parents to love and care for their children. The only question is whether an anti-abortion movement will emerge that takes this challenge seriously.

Originally published at ValerieTarico.com

42 Splices and Counting: Nine Facts You Should Know About the Planned Parenthood Smear Campaign

Imagine that someone hated you (or your company) and wanted to make you look bad. So, he pretended to be a friend or colleague, went to your events, repeatedly asked you to meetings or lunch, gained your trust, and then spent two years recording private conversations. Could he find stuff that would make you sound like a heartless monster? If you’re like me, the answer is a resounding yes. In fact, there’s no way it would take years.

Like me, you probably can think of five things you said in the last week that you would cringe to hear on the evening news. But would a selectively edited patchwork of your worst (or most easily misinterpreted) moments accurately reflect who you are? Almost certainly not.

The scraps of conversation with Planned Parenthood employees that were recorded and released by fundamentalist Christian David Daleiden and his front organization, the Center for Medical Progress (CMP), sounded shockingly nasty. But as details of the smear campaign emerge, we probably should be surprised that they didn’t sound worse.

Here are nine facts that put what you heard in context:

42 Splices – According to forensic analysis by Fusion GPS, the first five videos released by Daleiden and CMP, contained 42 splices where sentences were cut and patched to create the appearance of a seamless conversation. By design, these edits changed the meaning of individual sentences as well as the overall conversation. In one example, a Planned Parenthood staffer’s comment about lab protocols was edited to sound like she was talking about abortion procedures. Her words got echoed repeatedly by mainstream media who falsely assumed they knew what she was talking about.

Contradictory Evidence Omitted – In a Colorado interview, a Planned Parenthood employee said 13 times that all fetal tissue donations must be reviewed by attorneys and follow all laws. All 13 times were omitted.

Edits in “Unedited Videos” – The “unedited” videos released along with shorter excerpts were themselves edited, rendering them useless as evidence in legal cases or regulatory hearings.

Thousands of Hours of Recordings – To shock audiences and create the appearance of callous wrongdoing, abortion foes selectively released less than one percent of their recordings, compiling even smaller fragments to create viral videos. By Daleiden’s own report, CMP agents recorded “thousands of hours,” from which they selected the ten or twenty hours of (moderately edited) recordings to obtain a few minutes of (heavily spliced) inflammatory sentences.

Expensive Taxpayer-funded Investigations Find No Wrongdoing – A growing list of government committees in states including Massachusetts, Indiana, South Dakota, Georgia and Pennsylvania have now cleared Planned Parenthood of wrongdoing, and in California and Texas lawmakers have also called for investigation of fraud by the Center for Medical Progress.

Yuck Factor – Rather than seeking to expose wrongdoing, the campaign appears optimized to trigger a frenzy of disgust among religious conservatives, activating them for the upcoming campaign cycle. Research suggests that, in contrast to liberals (who base moral judgments primarily on questions of fairness and harm), many conservatives fail to differentiate between physical disgust and morality. Conservative campaigns leverage this fact. Homophobes wielded the “yuck factor” effectively for decades to block gay rights and are deploying the same strategy against reproductive rights. Repeated reference to fetal remains functions as a powerful arousal trigger for the Religious Right.

Gallows Humor – Because black humor is a way people deal with stress, CMP was virtually guaranteed to catch shocking “callous, inappropriate” comments if they recorded long enough. Gruesome humor is particularly common among soldiers, doctors, EMT’s, medical researchers, farmworkers, nurses and others who work around bodily fluids and death. One friend commented that her nurse colleagues will joke rudely about their patients at one moment and then will be crying for the same patients an hour later.

Letting Down – From a psychological standpoint, things we say and do in private (or among trusted, like-minded friends) are particularly vulnerable to being distorted by people with ill intent. That is because we rely on the other person to interpret any given statement within their experience of us. For example, after my bike is stolen, I can safely rant among friends about capital punishment for bike thieves only because my friends and family already carry the rest of the context: they know I oppose capital punishment. A Planned Parenthood employee joking about wanting a Lamborghini relies on the same unspoken understanding.

Not About Abortion – The CMP smear campaign was designed not to reduce abortion but rather to control who has sex, by heightening the threat of pregnancy and STI’s among young women. Secondarily, it was timed to feed Tea Party Republicans fodder for election campaigns . Since public dollars pay for no abortions, defunding Planned Parenthood would eliminate only their preventive care services, including birth control, with the ironic effect of driving up need and demand for abortion. It is part of a broader anti-birth-control campaign aimed at protecting biblical (Iron Age) family structures and gender roles.

Don’t be deceived: The religious conservatives behind the Planned Parenthood smear campaign have shown repeatedly that they are willing to harm women and families and even drive up abortions in order to control the sexuality of females and youth. This isn’t about their hatred of Planned Parenthood, the healthcare nonprofit, it is about their hatred of planned parenthood, with two small “p’s.” It’s about their hatred of the changes in society that allow young people to create the lives and families of their choosing, free from the biological constraints that for most of human history have made pregnancy the price of sex.

Speaking of young people, online youth collective, Ultraviolet, has done a little selective splicing of their own. They just released a video in which Sean Hannity interviews Deleiden about Mike Huckabee’s sale of fetal squish. It is not to be missed.

Originally published at ValerieTarico.com

The Yuck Factor — What Planned Parenthood Smears, Homophobia, and Middle School Jokes Have in Common

Blood and GutsMedical procedures and research are yucky. Good healthcare means getting over it.

If religious conservatives have their way, reproductive healthcare will be dictated by the same psychology that drives middle school jokes about genitals, dead babies and poop—our instinctive squeamish reaction to things that are disgusting and shocking, especially if they relate to sex. Good thing public health advocates and medical providers have a higher set of priorities.

Each year in America, 650 women die from pregnancy, many leaving behind motherless children. Thousands more survive and thrive only because of “yucky” medical procedures like cesarean sections, hysterectomies, transfusions, and abortions. Given the latest deceptive smear campaign against Planned Parenthood, it appears that religious conservatives would rather some of those women died.

Blood, Guts, and the ‘Yuck Factor’

Most of us have little stomach for tasks, however important, that require cutting people open, removing body parts, or dealing with squishy tissue and bodily fluids. That’s why blood and guts are the stuff of horror movies. That is also why the Religious Right wants our national conversation about family planning to stay focused on “the yuck factor” of abortion surgeries rather than on the chosen lives and flourishing families empowered by well-timed, intentional childbearing.

Disgust evolved as a way to protect us against eating and touching things that might make us sick. Swamp water, decaying flesh, putrid food, feces . . . all of these carry pathogens that our ancestors needed to avoid long before people understood germs. Nature’s way of protecting our species was to make certain sights and smells disgusting. We have a similar instinctive revulsion for human forms that are damaged, disfigured, dying or dead. Our instinctive horror makes a mutilated body riveting.

An image or idea that triggers the yuck factor is “sticky” and viral, meaning it sticks in our brains and we are likely to describe or show it to others. The more disgusting something is, the more it rattles us out of the mindless routine of everyday living and creates a strong memory imprint. That is because paying attention to disgust had—and sometimes still has—survival value. As with every other sensation or emotion that grabs our attention, people have learned to take advantage of that.

Turning Instinct into Financial, Religious or Political Gain

Storytellers long ago figured out how to cash in on the yuck factor, turning disgust into gold at the bookseller or box office. From Homer’s Medusa, to Shakespeare’s witches and their brew, to Stoker’s Dracula, to modern zombie movies, the horror artist compels our attention by playing with gruesome details. Halloween merchants sell slime and goo for haunted houses or fake severed limbs and gashed faces because the instinctive disgust reaction is malleable and doesn’t differentiate between substances and situations that are truly dangerous and those that merely look so.

Religions capitalize on disgust by blurring the difference between cleanliness and godliness—in other words by giving disgust moral and spiritual significance. In the Bible, for example, a woman is spiritually unclean while she is menstruating or after delivering a baby, and people with handicaps including crushed testicles are banned from the holiest part of the temple. In Islam, dogs are spiritually, not just physically dirty. In the Hindu tradition, holy men wear white, and spotless clothes represent spiritual purity. In Western Christianity, white wedding dresses have similar significance.

When disgust gets triggered, people may build a cognitive rationale to explain to themselves or others why the disgusting something is bad for other reasons, layering a veneer of rationalizations on top of what is really a gut feeling.

The boundary between disgust and morality is particularly blurry for self-identified conservatives. Psychologist Jonathan Haidt studies cognitive differences between liberals and conservatives. He found that liberals tend to base moral judgments on questions of harm and equity. Is it fair? Does it hurt anybody? Conservatives value fairness and non-harm too, but they also give moral weight to three other factors: loyalty, purity, and authority. What does my tribe want? Is it disgusting? What do authority figures say? In other words, conservatives are more likely to think something that triggers the yuck feeling is morally wrong, independent of other factors.

Practical and Moral Limitations of Yuck

Disgust works as a reasonably good shortcut to protect us from the dangers it evolved to avert, meaning pathogens and toxins. But even there, it has some real limitations. For example, in Ebola-stricken Africa, culturally-prescribed burial rituals trumped the instinctive aversion to touching dead bodies, which caused the virus to spread. On the other side of the equation, people with non-contagious physical deformities, like the Elephant Man, may face horrible cruelties and rejection.

When it comes to modern medical procedures and emerging technologies like GMO’s, or potable water from sewage, disgust correlates badly or not at all with real risks.

Likewise, moral disgust can arise from religious taboo violations, like eating cheese and meat from the same plate, that have little rational relation to humanity’s shared moral core or threats against wellbeing.

Homophobia and the Yuck Factor

For decades, people seeking queer equality found themselves up against the power of the yuck reaction. Any kind of sex that we ourselves don’t find titillating tends to arouse disgust; and so as long as the thought of queer people evoked images of anal sex between two men, the yuck factor created an almost insurmountable barrier to equality. But as a critical mass of queer people came out of the closet and advocates made the fight about families and love, other moral emotions like empathy and a sense of Golden-Rule fairness moved to front and center, and culture shifted.

Some years back I got schooled on disgusting sex by my middle school daughters. I had broached a conversation about their gay uncle and evangelical relatives who would soon be visiting us. I explained the yuck factor and said, “I might think about gay sex and say it’s not my thing, but they might think that its gross and so morally wrong.” One of the girls responded, “First off, Mom, the word isn’t ‘gay’ it’s ‘queer,’ and secondly, you know what kind of sex we think is really disgusting? Parent sex. That’s why we’re so glad you and Dad haven’t had any in 13 years.”

I chose not to enlighten them.

Today when most Americans think about queer people they think about loving couples, two moms or two dads raising kids, extended families, “sweet” members of the church choir, brave young soldiers, elderly partners making medical care decisions, and more—or they think about their own beloved relatives and friends who are queer. Although some members of the Religious Right may alternate between disgust and arousal (and disgust at their own arousal), conservative sects like the Southern Baptists are struggling and failing to keep disgust front and center even for their own members.

Reproductive Empowerment and the Yuck Factor

The culture shift toward equality for queer people, stands in contrast to the stalled progress around reproductive rights and chosen childbearing.

When it comes to reproductive empowerment for women, the Religious Right has been able to make disgust the dominant emotion by keeping the focus on sexual shaming and on abortion procedures, which are medical and messy. Those of us who see well-timed childbearing as fundamental to gender equality and flourishing families have gotten suckered into fighting on their terms.

Consequently, we are not creating the culture shift needed to make intentional childbearing the new normal, with all of the individual and family and community benefits that would bring. Half of U.S. pregnancies are unsought—either mistimed or unwanted—which makes American rates of teen pregnancy and abortion the highest in the developed world. Chosen pregnancy has been stalled around fifty percent for almost fifty years.

Recently, women have been exhorting each other to come out of hiding and talk about their reproductive decisions including abortions. Like queer people, women and allies understand that a culture of secrecy reinforces shame and stigma. We understand that if mothers and grandmothers stay silent, religious conservatives will control the conversation and hence the options available to our daughters, nieces and granddaughters. Several storytelling projects have sprung up to help women or couplesdefy taboos and break the silence, and brave celebrities, including men, are leading the way as they did prior to Roe vs. Wade. High-integrity electeds like Lucy Flores in New Mexico and Wendy Davis in Texas have risked their political careers and told their abortion stories so that other women may one day do the same.

I honor their courage and think their candor is a step forward. And yet, the drama around abortion has so captured center stage that even brave personal stories may inadvertently reinforce the Religious Right’s framing. We talk about the circumstances of an unsought pregnancy and the medical procedure the rather than the life made possible by access to contraception and care. In doing so, we keep the focus right where the power of yuck is the greatest.

Surgery – What’s the moral story?

Through much of this year, I have been consulting with people who want to communicate more effectively about abortion care, and I sometimes use my experience with knee surgery to illustrate how we can move beyond the yuck factor:

Two years ago, I was using a brush mower to clear an overgrown trail. The mower got stuck on a root and, unthinking, I walked around in front of it and yanked without disengaging the three foot blade. As the wheels hit the root and the front of the mower tipped up, my leg slipped under it.

I will be forever grateful to the surgeons who reassembled my kneecap and sewed up the horror movie gashes.

So, what’s the story of my surgery? Well, certainly one could wax eloquent about the gruesome details of the accident or repair. But for me the real story is this: I can walk again, and even run. I can bicycle downtown. I can sit for long periods writing, and afterwards my knees don’t hurt any more than most do at my age. This winter I even got back on cross country skis with my two daughters and husband in Yellowstone and skied to a frozen waterfall.

Smart, kind doctors and allied health professionals gave me an unspeakable gift. Their day-to-day work may get their hands dirty. It may involve goo and guts and it may even produce human remains that get donated for further medical research. But that is the climax of the story only for juvenile thrill seekers. For me as the patient, my children, my husband, and even my community, the real story is the precious gift of a second chance. It is a story about grace and compassion, love and laughter, beauty, and dreams fulfilled.

The same can be said about my abortion and many others.

Far too often, the fight to protect abortion access focuses on the procedure itself or surrounding circumstances, rather than what comes after. As abortion counselor Charlotte Taft has put it, “I wish that we talked about ‘choices’ instead of ‘choice.’ Because when a woman has an abortion, she isn’t choosing the abortion itself, she is choosing an education, or military service, or her loyalty to the family she already has.” Or to the family she will have, when she’s ready.

Rising Above the Juvenile Fascination with Eew and Goo

In the coming months, with Hillary Clinton as the most viable female presidential candidate in American history, Democrats are queuing up a vigorous conversation about family friendly policies, policies that help children to flourish and that allow women to fully participate in our economy and our democracy. Their aspirations include paid maternity and family leave, more flexible work hours that accommodate parenting, affordable childcare, and better wages for working people at the bottom of the income spectrum (mostly women). But this policy agenda has a glaring omission: to fully participate in our economy and democracy, a woman must be able to manage her fertility.

I have said publicly that I am pro-abortion, not just pro-choice, but I also believe that when advocates think about reproductive empowerment, our minds too often jump to abortion. If we want a future in which children get created when couples feel ready, one in which empowered young women and men can invest in their dreams and stack the odds in favor of their kids, abortion care is just one small (and hopefully shrinking) part of the mix.

Abortion may be minor compared to many routine surgeries, but it is still an expensive, invasive medical procedure that can be emotionally and morally complex. Why mitigate harm if we can prevent it? For the price of one abortion, a woman can get a state-of-the-art IUD or implant that drops her annual pregnancy risk below 1 in 500 for up to 12 years. Access to top tier long acting contraceptives like these dramatically dropped the teen pregnancy and abortion rates in Colorado recently. But better birth control is also just one part of reproductive empowerment.

As I view it, people are trying to get from Point A to Point B in their lives; and abortion is like the guardrail that keeps them from going off the cliff when all else fails. Guardrails save lives. We definitely want them there when people need them. But we also want well-designed roads with lines down the middle, and cars with excellent brakes and steering, and well-trained drivers who have a clear idea of where they want to go and how to get there.

On the road of life, we all get by with a little help from our friends, and strangers, and sometimes even professionals. Most of us don’t need to be reminded how icky life can get when thing go wrong. What we do need is people who will be there regardless, who live by Planned Parenthood’s motto: Care. No matter what.

Originally posted at ValerieTarico.com