Carole Joffe

What Abortion Counselors Want From Their Clients

Drawing on data gathered in a participant observation study of an abortion service, this paper discusses some of the responses of abortion counselors to their work. Specifically, it describes the role clients play in shaping the meaning of this work. The major findings are that the counselors prefer client “soberness,” are intolerant of client cynicism, and are angered by repeat aborters. The paper concludes by relating these findings to a consideration of responses to “dirty work” among social service workers.

Advanced Practice Clinicians as Abortion Providers: Current Developments in the United States

Abstract A hopeful note in the contemporary abortion environment in the United States is the expanding role of advanced practice clinicians — nurse practitioners, physician assistants and nurse-midwives — in first trimester abortion provision. A large percentage of primary health care in the US is currently provided by these non-physicians but their involvement in abortion care is promising, especially in light of the shortage of physician providers. Two national symposia in 1990 and 1996 approved the expansion of early abortion care to non-physicians. As of January 2004, trained advanced practice clinicians were providing medical, and in some cases, early surgical abortion in 14 states. This has required not only medical training but also political organising to achieve the necessary legal and regulatory changes, state by state, by groups such as Clinicians for Choice and the Abortion Access Project, described here in examples in two states and the reflections of three advanced practice clinicians. Recent surveys in three states show a substantial interest among advanced practice clinicians in abortion training, leading to cautious optimism about the possibility of increased abortion access for women. Most encouraging, advanced practice clinicians, like their physician counterparts, show a level of passionate commitment to the work that is rare elsewhere in health care in the US today. Résumé L’expansion du rÁle des cliniciens spécialisés — infirmières spécialisées, assistants médicaux et infirmières accoucheuses — dans les avortements du premier trimestre est source d’espoir dans l’environnement contemporain de l’interruption de grossesse aux Átats-Unis. Ces personnels paramédicaux assurent un fort pourcentage des soins de santé primaires aux USA, mais leur participation aux interruptions de grossesse est prometteuse, compte tenu surtout de la pénurie de médecins dans ce secteur. Deux symposiums nationaux en 1990 et 1996 ont approuvé la pratique d’avortements précoces par les personnels paramédicaux. En janvier 2004, les cliniciens spécialisés assuraient des avortements médicamenteux et, parfois, chirurgicaux précoces dans 14 Átats. Cela a exigé une formation médicale, mais aussi une organisation politique pour introduire les changements juridiques et réglementaires nécessaires, Átat par Átat, de la part de groupes tels que Clinicians for Choice et Abortion Access Project; ce processus est décrit dans deux Átats etàtravers les réflexions de trois cliniciens spécialisés. De récentes enquÁtes dans trois Átats montrent que les cliniciens spécialisés s’intéressentàla formationàl’avortement, autorisant un optimisme prudent sur la possibilité d’élargir l’accèsàl’avortement. Plus encourageant encore, les cliniciens spécialisés, comme leurs homologues médecins, s’investissent passionnément dans ce travail, chose rare dans le domaine de la santé aux USA aujourd’hui. Resumen Una nota esperanzadora en el ambiente contemporáneo de aborto en Estados Unidos es el aumento del personal clánico de práctica avanzada — enfermeras practicantes, auxiliares médicos y enfermeras-obstetrices en la prestación de servicios de aborto en el primer trimestre. Actualmente, este personal no médico presta un alto porcentaje de la atención de primer nivel en EE.UU., pero su participación en el aborto es prometedora, particularmente en vista de la escasez de prestadores médicos. En dos simposios nacionales en 1990 y 1996 se aprobó la ampliación de las funciones del personal no médico. A partir de enero de 2004, el personal clánico de práctica avanzada capacitado practicó abortos con medicamentos y, en algunos casos, abortos quirúrgicos en etapa temprana, en 14 estados. Para ello fue necesaria no sólo una capacitación médica, sino también una organización polática para lograr los cambios jurádicos y reguladores requeridos, estado por estado, promovidas por grupos como Clinicians for Choice y Abortion Access Project, descritos aquá en ejemplos en dos estados, y las reflexiones de tres colaboradores de práctica avanzada. Las últimas encuestas de tres estados muestran un marcado interés entre el personal clánico de práctica avanzada en la capacitación en aborto, lo cual fomenta un optimismo cauteloso sobre la posibilidad de un mayor acceso al aborto. Aun más alentador, dicho personal clánico, al igual que su contraparte médica, muestra un nivel de compromiso vehemente al trabajo, raro en otros ámbitos actuales de atención en salud en EE.UU.

Commentary: Abortion Provider Stigma and Mainstream Medicine

This commentary describes the various manifestations of the stigmatization and marginalized status of abortion providers in relation to mainstream medicine. The article also addresses some of the current efforts to respond to this stigmatization.

Race, reproductive politics and reproductive health care in the contemporary United States

To paraphrase Leo Tolstoy, who famously wrote that all unhappy families are unhappy in their own way, we can say that all nations confront the thorny issue of demographics, but each in its own, typically controversial, way. Various European countries, for example, have anxieties about a “demographic winter,” which is a below replacement birth rate of the native population, which has led to corresponding fears about rising birth rates among Muslim immigrants. China, driven by worries about overpopulation, has instituted coercive reproductive policies that many observers find unacceptably harsh. The United States, a country marked by extreme stratification on both racial and economic grounds, is a particularly interesting case to consider from a demographic lens because there has been a history both of targeting the birth rates of people of color and at the same time deep political divisions about the provision of reproductive health services — particularly abortion but increasingly, as the current election season reveals, contraception as well. We, a sociologist and physician, respectively, write here of our dismay about the contemporary state of reproductive politics in the United States and particularly the cynical manipulation of racial themes by the opponents of abortion and birth control. However, we are acutely aware of the mixed legacy of the United States with respect to demographic issues. To name but a few examples, in 1905, President Theodore Roosevelt warned of “race suicide” because of his concern about falling birth rates among white Anglo-Saxon women and the higher rates among immigrants [1]. In the 1927 Supreme Court case, Buck v Bell, the Court upheld a statute instituting compulsory sterilization of the unfit, including the mentally retarded, “for the protection and health of the state” [2]. In the 1960s, impoverished AfricanAmerican and Latina women, along with some poor whites, were subjected to coerced sterilizations, often without these women fully understanding to what they had ostensibly agreed [3]. When the first federally funded family planning centers were established in the early 1970s, as a result of the passage of Title X, they were disproportionately located in African-American communities, although the language of the legislation did not mention race but rather the income status of the intended recipients [4].

Working with Dr. Tiller: Staff Recollections Of Women's Health Care Services of Wichita

WHCS’s closure raised important public health concerns; chief among these was what would become of women carrying wanted pregnancies that go horribly wrong late in pregnancy. For abortion providers wishing to offer similar specialized abortion care, and for scholars of the nation’s longstanding abortion confl ict, the closure raises other important questions: What services were developed for this unique segment of abortion patients? How did staff cope with working in a facility that was continually under attack by antiabortion activists? This report draws on interviews the author conducted with seven former WHCS staff members to address these questions. Open-ended group interviews took place in Wichita in December 2009. The author made follow-up queries by e-mail and phone. The institutional review board of the University of California, San Francisco, approved the project. The focus here is on the carefully choreographed experience of women who qualifi ed for abortions after 24 weeks’ gestation because of fetal indication—that is, their fetuses had anomalies such as anencephaly (the absence of a large part of the brain and skull) or trisomy 13 (a genetic disorder characterized by multiple abnormalities, which typically leads to death within the fi rst month of life). According to staff, Dr. Tiller devoted much thought to the particular care needed by fetal indication patients, and he refi ned his approach over many years. These patients made up about 15–20% of the WHCS caseload. (Of the remaining patients, about half sought fi rst-trimester abortions, and half either sought second-trimester abortions or came for later abortions because of “maternal indications”—serious physical or mental health conditions, such as cancer or pregnancy resulting from incest.)

Abortion: Statutes, Policies, and Public Attitudes the World Over

Introduction Historical Background Abortion Statutes in Selection Countries Worldwide Public Opinion about Abortion Abortion Statutes and Population Policies Concluding Comment Additional Recommended Reading Index

What will become of reproductive issues in Trump’s America?

Abstract The election of Donald Trump to the presidency came as a severe and unexpected shock to the already beleaguered pro-choice movement in the US. This article will review what the president-elect said during the campaign about abortion and what his administration is likely to do after his inauguration.

The Poetry of Politics

Katha Pollitt, longtime columnist for The Nation and one of the country’s leading political commentators, was recently interviewed by sociologist Carole Joffe. The interview offers Pollitt’s views on such subjects as the state of the feminist movement, academic feminism, the 2012 elections, and sociology.

Abortion and Antifeminism

RESPONSES to the issue of the current role of abortion in U.S. politics typically are made on two levels: that of electoral politics-the effect of the abortion issue on national and local elecbons-and, more broadly, at the level of political culture-the reshaping by the abortion issue of political discourse in this country in areas including but going beyond electoral campaigns. The latter is the focus of this essay. My argument, briefly, is that the antiabortion movement has a significance well beyond the campaign to abolish legal abortion itself. I suggest that we view the antiabortion movement as a powerful catalyst-a &dquo;battering ram,&dquo; as Rosaline Petchesky has usefully put it-for a number of right-wing causes, including explicit antifeminist mobilization.1 A quite vivid recent example of this was the convention of the National Women’s Political Caucus in Atlanta, where pickets carried signs reading &dquo;Feminists hate God and babies.&dquo; As I have written elsewhere, a major shortcoming of Kristin Luker’s book is her failure to consider the larger political context that informs the abortion activists that she studied. 2 The specific organizational links between antiabortion movements and larger New Right groups have been well spelled out by a number of writers

The Struggle to Save Abortion Care

Resisting both physical attacks and widespread policy proscriptions, mission-driven abortion care providers continue working to help their patients.