I mean it.

What Rush and his women-hating, slut-calling, reproductive rights bashing cronies have done is the best thing that could have happened for women in this election year.

I know you think things are horrible, what with us now having to fight the battle for reproductive rights all over again, and on 50 different fronts.

But don’t you see? That battle has been going on for years – you just weren’t really aware.

Rush and his pals who oppose reproductive rights were all here last year, when you thought your reproductive rights were safe. They were here in 2010, when Arizona became the first state to limit insurance coverage of abortions. They were here when the Hyde Amendment was cemented into law and when George Bush, Jr reinstated (and Obama reversed) the Global Gag Rule limiting family planning funding across the globe. They were here when 20 our 50 states passed laws regulating ultrasound use prior to abortion, while others mandate counseling (often including erroneous health information) prior to abortion or limit insurance coverage of this legal medical procedure.

During all this time, if you did know they were there, you thought they were just against abortion – you did not realize that they were also against birth control. You thought their agenda was pro-life, not anti-woman. You thought you and they shared common ground, but now you know that ground is filled with landmines targeting women’s rights and your ability to plan your own family.

Thanks to Rush, we’ve finally started the conversation about reproductive rights in America that we should have been having for the past decade.

Like a family with a secret that is finally coming out, that conversation is exceedingly uncomfortable. Fine – let’s have at it. But don’t talk amongst yourselves – make sure your local, state and federal representatives know what you think.

Great news, folks – Virginia’s governor has backed down on the forced ultrasound issue.

Facing an issue that could redefine his political legacy, Virginia Gov. Robert F. McDonnell (R) retreated from a measure that would require women to have invasive ultrasounds, performed by inserting a probe into the vagina, before receiving abortions.

“No person should be directed to undergo an invasive procedure by the state, without their consent, as a precondition,” McDonnell said Wednesday.

Not to be dissuaded, the Virginia Senate (115 of the 140 are men, by the way) turned around and amended the bill to mandate transabdominal sonograms instead.

Wrong move, gentlemen. Here’s why -

1. While transvaginal sonograms are invasive, transabdominal sonograms can actually be even more difficult to endure. In order to do the transabdominal study, one has to drink 32 ounces of water and sit and wait, sometimes up to an hour, until your bladder is full almost to overflowing. Then another person presses on your very full bladder for about 5-10 minutes to take pictures of your uterus. And in case you didn’t know, the urge to urinate with a barely filled bladder is one of the first and more common symptoms of early pregnancy.

2. Transabdominal sonograms are not as good as transvaginal sonograms . Transvaginal is far superior for confirming gestational age and excluding ectopic pregnancy in early first trimester pregnancies.  The law makes no sense clinically.

3. State legislators are ordering a medical test without a medical indication. And that’s bad medicine.

4. The issue of informed consent applies for any procedure, whether it’s vaginal or not. You cannot force a person as a condition of informed consent, to undergo a procedure without her consent.

Finally, the biggest argument of all -

5. Mandatory ultrasounds have little to no impact on abortion choice. In fact, they can have other than their intended effect, by reassuring women having very early abortions just how small the pregnancy is. Before 6 weeks, an embryo is not even visible within the gestational sac.  And on transabdominal sonogram, later but still early embryos will be even less visible, as will the heartbeat.

In one of the few studies of the issue — there have been none in the United States — two abortion clinics in British Columbia found that 73 percent of patients wanted to see an image if offered the chance. Eighty-four percent of the 254 women who viewed sonograms said it did not make the experience more difficult, and none reversed her decision.

That generally has also been the case in Alabama, which enacted its law, the first of its kind in the United States, in 2002.

“About half of women opt to view them,” said Diane Derzis, who owns the Birmingham clinic. “And I’ve never had one patient get off the table because she saw what her fetus looks like.”

In some instances, the ultrasounds have affected women in ways not intended by anti-abortion strategists. Because human features may barely be detectable during much of the first trimester, when 9 of 10 abortions are performed, some women find viewing the images reassuring.

“It just looked like a little egg, and I couldn’t see arms or legs or a face,” said Tiesha, 27, who chose to view her 8-week-old embryo before aborting it at the Birmingham clinic. “It was really the picture of the ultrasound that made me feel it was O.K.”

Enough. We are  spending our time and energy on fruitless attempts to limit access to a legal medical procedure.  If we were to spend a tenth of that energy working together to increase contraceptive use by both men and women, we actually might be able to reduce the need for abortions.

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Read the Va proposed legislation.

I don’t know how many more studies need to be done to prove once and for all what those of us providing reproductive care to women have always known – that abortion does not cause mental illness.  But just in case, here’s yet another one, this time  ”the most comprehensive and detailed review of the mental health outcomes of abortion to date worldwide” conducted by the UK National Collaborating Centre for Mental Health.

Data from 44 studies showed women with an unwanted pregnancy have a higher incidence of mental health problems in general. This is not affected by whether or not they have an abortion or give birth…Usually, a woman’s risk of suffering common disorders such as anxiety or depression would be around 11-12%. But the researchers said this rate was around three times higher in women with unwanted pregnancies.

How much better the British Health Services limited budget would have been spent in providing direct reproductive and mental health services to women.

Can we please just stop trying to prove the obvious to those who will never believe the data and spend our energies helping women and their partners prevent unplanned pregnancy?

In countries where abortion is illegal, a group called Women on Web is offering medical abortion over the Internet. (via National Women’s Health Report)

Clients complete an online questionnaire and are then contacted by a doctor who prescribes the medications that are then taken at home to induce abortion. The medications are mifepristone (RU-486) and buccal Misoprostol. (Buccal is holding the medication in your cheek till it dissolves.) The vaginal route for misoprostol is avoided so that no evidence of pills is left to implicate a user.

The group has published outcomes on 484 women from 33 different countries who received their services in 2006-7. Follow up was obtained via e-mail or phone for 367 women.

About 8% of the women never took the medication. For those who did, outcomes were reasonable for the method used – Between 6 and 12% reported having to have a D&C for bleeding or incomplete abortion, which presents as an early miscarriage and can be treated safely in a medical setting. Continuing pregnancy rates were less than 2%.

These results are similar to those reported in the initial clinical trials of mifepristone here in the US.

The Royal College of Obstetricians & Gynecologists has released a statement saying that it “neither approves or disapproves” of the work provided by Women on the Web. More from that statement -

In a landmark paper published this week in Lancet, researchers at the Alan Guttmacher Institute reported that abortion rates are down worldwide, due in large part to increasing use of effective contraception. The decline in developed countries was most marked in Eastern Europe, an area that until recently did not have widely available contraception.

I think the data are very real. I have seen many patients over the years who emigrated here from the former Soviet Union and who had upwards of 5 abortions, because, they told me, this had been their only available form of birth control. Here in the US, these women are using effective contraception, and not having abortions.

Another important finding from the study was that abortion rates were the same regardless of abortion laws. Again, I am not surprised. Abortion is not like drinking or gambling, a viceful pleasure that needs to be regulated by the state. It is a woman’s desperate response to an unplanned pregnancy, and desperate women do desperate things, regardless of the laws. But give these same women easy acccess to effective contraception, and the need for abortion disappears.

Unfortunately, the proportion of abortions that are unsafe increased from 44 to 48% in the same time period. According to an interview in the NY times with one of the study’s authors;

Generally, where abortion is legal it will be provided in a safe manner..And the opposite is also true: where it is illegal, it is likely to be unsafe, performed under unsafe conditions by poorly trained providers.

I am greatly encouraged by the media play on this study, and hope that it will help drive the battle over abortion into the common ground between the two sides – contraception.

In this regard, I read a very encouraging post in a The Mirror of Justice, a blog on Catholic legal theory that seems to be getting a lot of play on the internet (it’s number 4 when I googled “abortion rates” and “Lancet”…)

Here’s my question. If this study were true, and if it were the case that making abortion illegal would most likely only drive it underground, without having much effect on its actual incidence but making it far more dangerous for women to have an abortion, would that be a reason to rethink the Church’s teachings, not on the morality of abortion, but on the tight connection between abortion’s (im)morality and its legality? I’ve tried to get this conversation off the ground a few times at MOJ, but I feel like we often get side-tracked onto the question of abortion’s morality or into the empirical question whether studies like this one are actually correct.

If this is how the Catholics are starting to think, then there may be hope that one day abortion will become, as many of us hope, legal but rare.

Update – the conversation’s starting…