Come on, Michigan. I mean, COME ON.

I’m aware I should be studying right now, but I also know that you need to hear about the seminar I went to at lunch yesterday. Anyone who knows me is aware that I am completely ignorant when it comes to politics, but that doesn’t mean I can’t sometimes pretend (or make things up). We need to talk about this Michigan bill with the lovely name HB 5711. We should know what’s going on with this. Let’s put aside some names and details and talk about the stuff that counts. Also, there shalt not be pictures of fetuses or tiny crushed skulls. Tasteless, people, really.

Wait, really? I should care?

Of course more girls (oh, excuse me, “women”) than boys were at this talk explaining the bill. Outside in the sun was the “we-don’t-have-a-uterus-and-so-we-are-not-going-to-optional-seminars” club. You know who you are. I saw you guys smiling in the courtyard. I guess I’ll forgive you since I rarely go to these talks either. In all seriousness, though, as future healthcare providers or future good-people-in-general, I think everyone should care about these things.

I don’t even think it matters whether you are pro-choice or pro-life — terms I hate, by the way, since I don’t think anyone is actually “anti-life” or “pro-abortion.” We need more dialogue about comprehensive sex education, about valuing and respecting the decisions made by women, and about avoiding unwarranted stigma and shame. (This is loosely related to what I wrote about a few weeks ago: insurance coverage and stigmatization of psychiatric illness.) The Michigan State Medical Society has come out against this bill because, quite simply, it is bad for the medical field. It’s not only about abortion; the bill sets some dangerous precedent for regulating the doctor-patient relationship. And, yeah, it’s bad for women’s health.

Reproductive justice is much more than the issue of abortion and pro-choice. It’s also about the right to have a baby, the right to raise a child, and the right to healthcare. Look at the big picture: get over the silence and stigma too often surrounding abortion. Look at numbers: 1.2 million abortions per year and 4 million births per year. Look at facts: women have about 35 childbearing years, during about five of which they want to be having children and the other 30 of which they are trying to avoid having children.

The 1973 Roe v. Wade decision is the obvious landmark case on the issue, but it has been upheld countless times since, perhaps most notably in the 1992 Casey decision. Laws prohibiting abortion are unconstitutional. Period. But what about laws that make the costs prohibitive? This might be a good time to add that while I’m pro-choice, I’m also pro-children. Families are the best thing in the world, especially when they are so awesome that they follow you all over the world.

I’m lucky, of course, that I know the greatest family ever. Not that I am biased or anything. But I digress…

So what does the bill actually say, anyhow?

It’s long. I haven’t read the whole thing. The gist is that it’s all under the guise of “making abortion safer” but that what ends up happening is that costs become prohibitive and autonomy is taken away from patients and physicians. It requires all facilities that perform abortions, even those that only provide medical pill-based abortions, to be free-standing surgical facilities. This means they need negative air flow systems installed and 14-foot-wide hallways to accommodate gurneys. Right? Right? Because of course we need huge gurneys for tiny pills. Construction and space cost money.

The bill also stipulates that remains of fetuses be kept separate from other medical waste, but no currently existing companies are willing to pick up this waste. Do we really want overflowing freezers at individual clinics? No. But we also don’t want small establishments to have their own incinerators. The bill even requires funeral directors to be involved with the disposal of fetal remains, since it requires burial or cremation and death reports. There are additional potential complications involved with consent for disposal of remains, such as if the two parents disagree about burial v. cremation. Disposal of remains and death certificates cost money.

One million dollars of malpractice insurance would be mandatory for “abortion providers” (as in trained medical doctors) if they performed more than six procedures per month (which we sort of hope they do since we want to work with someone experienced). $1 million is a lot, especially considering that abortion is one of the safest procedures. Legal abortions are certainly much safer than almost any surgery and WAY safer than childbirth. We don’t require any other professionals (architects, whatever) or even any other type of doctor to have insurance like this. There are not even insurance companies in Michigan that have insurance set up for this right now. Insurance costs money.

Here’s the thing: public policy can either straight-out discourage abortion or it can make it so that clinics won’t be able to operate. Certain Michiganders are currently going for the latter. In previous decades, there was the decrease demand or discourage strategy, whereby anti-abortionists used scare tactics, presented false information, and made stuff up about increased risks of cancer, etc. If HB 5711 becomes law, it will add excessive costs to abortions and is expected to shut down the majority, if not all, facilities that provide abortions in Michigan.

It’s just plain medically inaccurate

Vagueness and stupidity are rampant in this bill, in my humble opinion. “Gestation” is defined using the last menstrual period instead of conception, so that the fetus is “older.” In parts of the bill, the term “baby” replaces “fetus.” There is all this talk about coercion to abort (perhaps well-founded, but I don’t know), so physicians must ask a series of questions about threats. In fact, though, there is just as much or more coercion not to abort. For instance, in Ann Arbor, I’ve heard about some clinic right next to a Starbucks that gives out advice about adoption possibilities and the like. I’m not saying this is bad; I’m simply pointing out that the pressure goes both ways. Also, let’s be honest with ourselves. I can’t imagine a woman ever – EVER – actually wanting to have an abortion. Life does not always go the way you planned it, and I can imagine a lot of situations that are justified as more than mere “thoughtless mistakes.” I don’t care what anyone says; I bet that terminating a pregnancy is not something that any woman does without serious thought and many tears.

Further, prescription guidelines in the bill are set to match the FDA regulations, which most physicians agree are about 20 years out of date. Doctors would not be allowed to use current, best-evidence medicine. Do we want the state legislature to take control of people who are licensed physicians? Do politicians know more than doctors about these drugs? Plus, it places an undue burden on a woman’s right. The bill would require doctors to be physically present when the medicine was taken, which is stupid since smart women can follow directions like big girls, all by themselves. Telemedicine possibilities for women in the Upper Peninsula would be impossible, meaning that they would have to come way down south and probably stay overnight in addition to all the other mandated waiting. (Ask me some time about telemedicine, and I’ll get all excited and tell you about my college thesis on the Inuit natives up in Arctic Canada and Alaska.)

Where is this bill now?

HB 5711 has already passed the Michigan House. There was that whole national eruption about legislators being banned from the House floor for saying “vagina.” The bill was pushed through very quickly in the House at the end of June, since it came up in the last two days with no prior warning. Apparently there is some rule about notifying people of the bill by 18 hours prior (at the latest) and the bill was put up literally at the 18-hour mark before getting onto the floor. Then it went to the senate judiciary committee in July; in August, it passed again.

I don’t know Governor Snyder personally. I don’t even really know that much about his public opinions and policy. I would hope that he’d encourage Senate Republicans not to introduce this bill, and I’d ask him not to sign it if the Senate did pass it. The Senate returned from summer session September 11th. They could consider and vote on the bill at any time. I don’t know all the details about how long a bill can stay there. PoliSci 101 probably would have taught me these things, but I never took that class. Proponents of the bill might want to wait until after the election. It turns out that a lot of the most controversial bills are passed during that “lame duck” period after elections but before the new people take office. So, for this year, that means after that special Tuesday coming up in November. It is also possible that by the time the bill reached the senate that it wouldn’t be as terrifyingly all-encompassing as it is now.

Also remember that passing a bill and enforcing it are two very different things. If you do a count in the Michigan Senate, you have the votes to pass it (or so say people who know more than I about these things). The problem would be in the governor’s office. For starters, the bill is simply medically incorrect and absurd, but the governor might also not want to be known as an anti-abortion guy. If it gets onto his desk, he’d have 20 days to decide. If he signed it, it would take immediate effect.

Then again, it could be struck down as unconstitutional if there is no exception added for the health of the mother when abortions are needed in later stages of pregnancy. It could be voided for vagueness. It could be voided for being unnecessarily coercive or for placing undue burden on a women’s right to an abortion. It could be the Michigan ACLU who would attack it. Okay, I’m getting way outside my area of expertise now. I should get back to studying hemoglobinopathies. But, seriously, let’s talk more about what gets by under the pretext of “protecting women” because frankly it makes me sick.

Women going into labor everywhere

Not the about-to-have-a-baby labor, the going-to-work labor. But who knows? Maybe by the end of the post I will be talking about women who work and have babies. This weekend, even away from school, contemplating the fantasticness of life as we looked out at the lake, I couldn’t help but recall a certain interview. Last fall, I had a professor not-so-subtly ask about my commitment to a program that would suck away a huge chunk of my childbearing years. He was out of line, but still. It gets you thinking.

Women are not men. Sit in on a scientific conference and you will see what I mean. The women giving talks often respond to audience questions with “maybe” and “perhaps” even when they have solid data to back up their claims. I hear far more men answering questions with bold, clear voices. I’d venture a guess that men are more likely to “elaborate” (or just make stuff up) to prove their point, but I have no data on that.

I am not particularly shy (I mean, I’m writing a blog, for cryin’ out loud), but I definitely fall prey to some of the more subtle expectations that society has of women. I went through the sparkly eyeshadow phase, the cheerleader phase, and the white-wine-only phase, but I’m not convinced I really enjoyed all of it. Let’s get it out in the open: I like doing calculus, I love being barefoot in deep mud, and I like drinking beer straight from the bottle. I’m still young and I’m still female, though, and there is a lot that comes with that – a lot that is not necessarily advantageous.

Certain “feminine” tendencies are a disadvantage in the workplace. Period. In medical practice and research, this manifests itself in a million (+/- 47) ways, but two of the most obvious are that women are (1) less likely to ask for a pay raise in the clinic and (2) less likely to appear confident during presentations related to research grant applications. So is it partly our fault? Do women just need to ask for more?

Medicine is decidedly not meritocratic. Let’s use an example I have no personal stake in whatsoever: the female physician-scientist. Yes, I will give you that female doctors tend to choose lower-paying specialties, have fewer publications, hold fewer administrative leadership positions, and work fewer hours. However, even if you adjust for all of these differences, the expected average salary for women is still more than $10,000 less than that of men. This is the difference due ONLY to gender, and so of course when you factor back in all of those other things the gap is quite large indeed. But let’s stick with the gender issue. Calculated out to approximate a thirty-year career, the income difference from sex alone is more than $350,000.

Studies have pointed out discrepancies between the salaries of male and female doctors for years, but people (read: men) have tried to put these off as due to personal choices. For instance, there are more male surgeons, more men who work long hours, blah blah blah. As it turns out, it goes a lot deeper than that. Men and women working in the same specialty with the same schedule and skill level are still not compensated equally. It’s sad, but unsurprising.

“We really didn’t expect to find such a substantial unexplained difference,” said Dr. Reshma Jagsi, lead author and an associate professor of radiation oncology at the University of Michigan. “In Michigan, that amount buys you a house, your kids’ education or a nice nest egg for retirement.”

It gets worse.

“The men and women we studied were the go-getters,” Dr. Jagsi said. “You have to worry that if you see such disparities among this group, you will see at least the same, if not more, differences among other groups of physicians.”

The point is not that we need jump up and address salary disparities (though perhaps we do) but rather that we should think more about the subconscious assumptions and stereotypes we all have. I include myself in this, of course, and we shouldn’t get carried away. I think it is important to note that certain stereotypes are there for a reason and that there are things that men genuinely do better; I have no problem with that. Obviously it’s all individual and I could easily name a woman who is a great navigator, a man who is a great cook, a woman who is insanely aggressive, a man who is very sensitive, a woman who likes hunting, and a man who likes knitting. There are many things I find myself doing where I can’t decide whether they’re personality things or female things or both or neither. (Am I really that terrified of forgetting to pay people back? Was that taught by my family? Did I just pick up that habit in Switzerland? And now I’m always afraid of leaving a bad impression? Or taking advantage of people?)

Maybe what I’m trying to get at is the fact that in our personal lives we figure these things out – or at least try. For instance, in most families, you see a fairly clear division of labor in a marriage when rearing children; it is not so important who cooks and who cleans and who drives the carpool, so long as it all gets done. Yet, somehow, we don’t seem to have found a parallel in the work force. Men just have some natural tendencies (note that I do not use the word “skills”) that are valued in our American workforce. I’m not saying that’s all bad. Maybe sometimes it “takes a man” to go ahead with something without everyone’s opinion. Maybe those types keep us running efficiently. I wonder, though. I have my doubts.

I could keep going – I really could – but I’m pretty sure there has already been plenty of talk this year about females as CEOs, reproductive rights, etc. etc. etc. Don’t worry. I’m fully prepared to mock myself and other fellow part-time feminists. Any and all comments and responses are welcome.