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In Trying to Find Common Ground, Do We Hurt Abortion Rights?
 

In Trying to Find Common Ground, Do We Hurt Abortion Rights?

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Tracy A Weitz, PhD, MPA ...

Tracy A Weitz, PhD, MPA
Director
Advancing New Standard in Reproductive Health (ANSIRH)
Bixby Center for Global Reproductive Health
University of California, San Francisco
January 25, 2010

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    In Trying to Find Common Ground, Do We Hurt Abortion Rights? In Trying to Find Common Ground, Do We Hurt Abortion Rights? Presentation Transcript

    • In trying to find UCLA In trying to find common ground, do we hurtJanuary 25, 2010 do we hurt abortion rights? Tracy A Weitz, PhD, MPA Director Advancing New Standard in Reproductive Health (ANSIRH) Bixby Center for Global Reproductive Health University of California, San Franciscoy
    • UCLA Common Ground and Abortion Rights Today’s Talk Weitz 1/25/10 Define “common ground” approach to abortion Review its development Discuss the implications of thep search for common ground on abortion rights Offer an alternative approach October 2009 |
    • UCLA Common Ground and Abortion Rights Weitz 1/25/10 C G dCommon Ground Reducing the Need for Abortion / Prevention FirstReducing the Need for Abortion / Prevention First Most major pro-choice social movement organizations Obama and the Democratic Leadership
    • UCLA Common Ground and Abortion Rights Case Study: NARAL Weitz 1/25/10 NARAL, first formed in 1967 as the National Association for the Repeal of Abortion Laws With legalization changed its name to the National Abortion Rights Action League in 1973 In 1993 NARAL changed its name to the National Abortion and Reproductive Rights Action League and launched the "Real Choices" campaign “to highlight thelaunched the Real Choices campaign to highlight the goals of its expanded mission: to preserve access to abortion while working to enact policies to make abortion less necessary” In 2003 changed its name to “NARAL Pro-Choice America” NARAL became a word rather than an acronym, i th d b ti f it ti lremoving the word abortion from its name entirely In 2005 NARAL’s work prioritized a “prevention first campaign” to reduce the need for abortion
    • UCLA Common Ground and Abortion Rights Obama and Abortion Weitz 1/25/10 Internationally Removal of Global Gag Rule Appointment of Hilary Clinton as Sect of StateAppointment of Hilary Clinton as Sect. of State Domestically The search for common ground Acknowledging the importance of legality No further expansion of abortion rights Reducing the need for abortion Bringing Pro-Choice and Anti-Abortion activists together to identify places where they agree Agree to disagree October 2009 |
    • UCLA Common Ground and Abortion Rights Obama’s Statement Commemorating Roe Weitz 1/25/10 "Today we recognize the 37th anniversary of the Supreme Court decision in Roe v. Wade, which affirms every fwoman’s fundamental constitutional right to choose whether to have an abortion, as well as each American’s right to privacy from government intrusion. I have, and continue to, support these constitutional rights.” “I also remain committed to working with people of good will to prevent unintended pregnancies, support pregnant women and families, and strengthen the adoption system.” “T d d d t t i t th t ll“Today and every day, we must strive to ensure that all women have limitless opportunities to fulfill their dreams.” Obama, 2010Obama, 2010
    • UCLA Common Ground and Abortion Rights Components of the new “Common Ground” agenda Weitz 1/25/10 g R d i t d d iReduce unintended pregnancies 50 % of all pregnancies in the U.S. are unintended ½ of all unintended pregnancies end in abortion Increase support for adoption Data on adoptions is poor but somewhere between 1-5% of all unintended pregnancies Increase support for families Low-income women and women of color have higher rates of abortion Goal: Reduce the need for abortion
    • UCLA Common Ground and Abortion Rights The Underlying Assumptions Weitz 1/25/10 Decreasing the number of unintended pregnancies will result in a significant decline in the number of abortions Reducing the number of abortions will somehowg reduce the social conflict over abortion Acknowledging that abortions should be used lessAcknowledging that abortions should be used less frequently will demonstrate that we take abortion seriously and thus enhance people’s support fory p p pp abortion rights
    • UCLA Common Ground and Abortion Rights Weitz 1/25/10 Women’s individual desires to avoid an unintended pregnancy is lit ti l diff t fqualitatively different from a social goal of reducing the need for abortionfor abortion. Helping a woman achieve her reproductive desires is a laudablereproductive desires is a laudable goal, not because it reduces the need for abortion, but because it is what she wants for her life.
    • UCLA Common Ground and Abortion Rights Weitz 1/25/10 A brief review of the how we got to th “ d” hthe “common ground” approach
    • UCLA Common Ground and Abortion Rights 1973: Abortion as a social positive Weitz 1/25/10 Roe decision articulated as a way for women to shape the course and destiny of their lives Seen as central to women’s equality in society Synonymous with notions of modern feminism Unqualified support for both the right to and use of abortion abortion on demand abortion without apology
    • UCLA Common Ground and Abortion Rights 1980’s: Changing the Social Meaning of Abortion Weitz 1/25/10 g 1970’s time of growing strength of the anti-abortion movementmovement Rise of single issue politics Election of Ronald Reagan Administrative restrictions on abortion Changes in the composition of the Supreme Court The “Culture War” Goal: To change the hearts and minds of the AmericanTo change the hearts and minds of the American public To make abortion a non-normative practice unworthy of societal approval Tactics: Humanizing the fetus Vilifying women Solidifying the relationship between religiousSolidifying the relationship between religious identification and abortion opposition
    • UCLA Common Ground and Abortion Rights Understanding Abortion as Violent Social Conflict Weitz 1/25/10 Rise of direct actionRise of direct action Rescues Siege on Atlanta Summer of MercySummer of Mercy Clinic defense as a response Extensive media coverage The violent wing Direct targeting of abortion doctors and clinics Murders and attempted murders Abortion is an angry hostile debate between two sides willing to win at all costs.
    • UCLA Common Ground and Abortion Rights Longing for a way out of the war Weitz 1/25/10 The introduction of the mantra “abortion should be safe, legal and rare” Bill Clinton in 1992 presidential campaign First day in office, reversed anti-abortion policies of Reagan and Bush I with the affirmation that his vision was “an America where abortion is safe, legal and rare”rare Since introduction in 1990 almost every pro-choice politician has used the phrase From the left and from the center/rightFrom the left and from the center/right Accepted as the middle ground USA Today editorial, 2003 Abortion is a “right most Americans want preserved: reproductive choice that makes abortions safe, legal d ”and rare.”
    • UCLA Common Ground and Abortion Rights “Reducing the Need for Abortion” is Next Iteration Weitz 1/25/10 SLR is still used Used in conjunction with “Reducing the Need,” which is the implementation efforts of the sentiment Core of the current common ground approach
    • UCLA Common Ground and Abortion Rights Weitz 1/25/10 What’s so wrong about wanting to d th d f b ti ?reduce the need for abortion? Discounts the role of abortion as a positive force inDiscounts the role of abortion as a positive force in women’s lives Increases the stigma surrounding abortion Provides the fertile ground for the “abortion hurts women”Provides the fertile ground for the abortion hurts women message of the anti-abortion movement Reduces access to care I di itiIncreases disparities Does nothing to reduce the structural factors that produce larger social inequalities in which reproduction is imbedded
    • UCLA Common Ground and Abortion Rights Produces a normative judgment about abortion Weitz 1/25/10 Suggest that abortion is happening more than it should Separates the “good” and the “bad” abortions Those that could have been avoided
    • UCLA Common Ground and Abortion Rights Understanding the Contradiction Weitz 1/25/10 Pastor Rick Warren challenge to Obama’s position on abortion: “Now, I don't understand the, the idea of it should be rare and, and less. Well, either you believe it's life or you don't. It--why would you believe it should be rare? Because if ifIt--why would you believe it should be rare? Because if, if it's not--if a baby, a fetus is not a life, then why restrict it?” Meet the Press Nov. 29, 2009,
    • UCLA Common Ground and Abortion Rights Creates an understanding that women’s individual decision making Weitz 1/25/10 g is the cause of social conflict Which women’s decisions are implicated? African American women have 5x the abortion rate of WhitWhite women Latina women have women have 2x the abortion rate of White women W ith i l th 100% f th FPL hWomen with income less than 100% of the FPL have an abortion rate 3.2x as high as those at 200% of the FPL Rates for low-income and minority women are notRates for low income and minority women are not declining as fast as for higher-income and white women
    • UCLA Common Ground and Abortion Rights Weitz 1/25/10 Increases stigma and creates theIncreases stigma and creates the fertile ground for acceptance of the new “Abortion Hurts Women” framenew Abortion Hurts Women frame of the Anti-Abortion Movement
    • UCLA Common Ground and Abortion Rights Central Arguments Weitz 1/25/10 Women are victims of society, men and the abortion industry Promotion of restricted laws that prescribe the type and timing of information women receive related to abortion Focus is on telling women about the psychological risks of abortion Push for formal recognition of Post-Abortion Syndrome (currently not recognized by the American Psychiatric Association)
    • UCLA Common Ground and Abortion Rights Weitz 1/25/10  Connectingg  Personal experience  Post-abortion recoveryy  Social activism  Religion
    • UCLA Common Ground and Abortion Rights Weitz 1/25/10
    • UCLA Common Ground and Abortion Rights Post-Abortion Recovery Weitz 1/25/10
    • UCLA Common Ground and Abortion Rights David Reardon Weitz 1/25/10 Architect of this approach Founder of Women Exploited by Abortion (WEBA) in 1982 toAbortion (WEBA) in 1982 to minister to the needs of aborted women and to help them heal their pain. A h f Ab d W Sil NAuthor of Aborted Women Silent No More (1987) Founder of the Elliott Institute in Springfield IL 1988Springfield, IL, 1988 Since 1987 –7 books and a dozen articles
    • UCLA Common Ground and Abortion Rights Goal is to replace Weitz 1/25/10 the fetus with the guilt-ridden, grief- stricken images ofstricken images of women victimized by abortionby abortion 1996 1987 1996 1997 2002 1997
    • UCLA Common Ground and Abortion Rights Using the Apparatus of the Gov’t Weitz 1/25/10  Anti-abortion Surgeon General tasked with investigating effects fof abortion on women  1989 Koop finds insufficient data to determine that abortion harms womento determine that abortion harms women  Koop’s Conclusion “The pro-life movement always focused- rightly, I though-p y g y g on the impact of abortion on the fetus. They lost their bearings when the approached the issue on the grounds f th h lth ff t th th ”of the health effect on the mother.”
    • UCLA Common Ground and Abortion Rights Supported by the Science Weitz 1/25/10 1990 American Psychological Association (APA) report published in Science: Exhaustive review of literature “Women tend to cope successfully and go on with their lives” Position of most professional medical associations American Psychological Association American Psychiatric Association American Public Health AssociationAmerican Public Health Association American Pediatric Association
    • UCLA Common Ground and Abortion Rights What do Women Experience? Weitz 1/25/10 Most feel relief Some experience short-term feelings of: Anger regret guilt/sadnessAnger, regret, guilt/sadness Natural emotions to big life decisions Rare cases of psychological problems Best predictor of mental health after an abortion is mental health before an abortion No such entity as “post-abortion syndrome” Conducting this research has many serious methodological challenges
    • UCLA Common Ground and Abortion Rights Significant methodological flaws to research finding harm Weitz 1/25/10 g Using data not designed to answer the question Incorrect comparison groups Ignoring prior mental health statusg g p Recall bias Abortion underreporting Conflation of association with causationConflation of association with causation
    • UCLA Common Ground and Abortion Rights Gaining Traction Weitz 1/25/10
    • UCLA Common Ground and Abortion Rights Policy Change Weitz 1/25/10 Texas Information Booklet: “A Woman’s Right to Know” “You should know that women experience different emotions after an abortion. Some women may feel guilty,emotions after an abortion. Some women may feel guilty, sad, or empty, while others may feel relief that the procedure is over. Some women have reported serious psychological effects after their abortion, including d i i f i t l d lf t tdepression, grief, anxiety, lowered self-esteem, regret, suicidal thoughts and behavior, sexual dysfunction, avoidance of emotional attachment, flashbacks, and substance abuse. These emotions may appearsubsta ce abuse ese e ot o s ay appea immediately after an abortion, or gradually over a longer period of time. These feelings may recur or be felt stronger at the time of another abortion, or a normal birth, or on the i f th b ti ”anniversary of the abortion”
    • UCLA Common Ground and Abortion Rights Validation from the Supreme Court Weitz 1/25/10 “Respect for human life finds an ultimate expression in the bond of love the mother has for her child....While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained…Severe depression and loss of esteem can follow.” Gonzales v Carhart, 2007
    • UCLA Common Ground and Abortion Rights But the Evidence is Still the Same Weitz 1/25/10 2008 APA report Critical review of recent literature (2006) “Women who have abortions have no greater risk ofWomen who have abortions have no greater risk of mental-health problems than if they deliver the pregnancy.”
    • UCLA Common Ground and Abortion Rights But focusing on reducing the need Weitz 1/25/10 for abortion increases the legitimacy of these arguments at a i t l l lsocietal level
    • UCLA Common Ground and Abortion Rights Weitz 1/25/10 H #2 N N d f S iHarm #2: No Need for Services Real implications for access to careReal implications for access to care
    • UCLA Common Ground and Abortion Rights Abortion Services Today Weitz 1/25/10 Only 1,787 abortion providers (facilities) remained in 2005 Abortion clinics (>50% of patient visits are for abortion services) provide 71% of all abortions 87% of U.S. counties have no abortion provider 35% of women live in these counties 97% of counties in nonmetropolitan areas have no provider Significant maldistribution across and within states
    • UCLA Common Ground and Abortion Rights Declining Number of Abortion Providers Weitz 1/25/10 41% of counties are now without an abortion provider Guttmacher Institute
    • UCLA Common Ground and Abortion Rights Access in California Weitz 1/25/10 Bay Guardian, 10/10/06, Front Cover
    • UCLA Common Ground and Abortion Rights No Solution in Common Ground Approach Weitz 1/25/10 pp Focus is reducing need not meeting access goals Further negates mandates for routine training Currently less than 50% of Ob/Gyn residencyy y y programs offer routing training Only 11 of 480 Family Practice programs acknowledge abortion in the curriculum No NP/CNM/PA training programs incorporate Limits our ability to critique reductions in accessy q
    • UCLA Common Ground and Abortion Rights Further legitimizes efforts to restrict use of abortion Weitz 1/25/10 1989/1992 shift from abortion as a fundamental right to “ d b d ” th h lda new “undue burden” threshold States allowed to demonstrate a preference against abortion W iti i d t l i l t d tWaiting periods, parental involvement, mandatory information, scripted provider speech Allowances for misinformation Breast cancer (6 states)Breast cancer (6 states) Fetal pain (8 states) Mental health consequences (7 states)
    • UCLA Common Ground and Abortion Rights South Dakota Weitz 1/25/10 Physician must tell the woman that the abortion will “terminate the life of a whole, separate, unique, living human being; that the pregnant woman has an existing relationship with that unborn human being, and that the relationship enjoys protection under the United States Constitution and under the laws of South Dakota; and that by having an abortion, her existing relationship and her existing constitutional rights with regards to thatexisting constitutional rights with regards to that relationship will be terminated.”
    • UCLA Common Ground and Abortion Rights Proliferation of Policies to Reduce Use and Provision of Abortion CareWeitz 1/25/10 and Provision of Abortion Care Targeting the Woman Targeting the ProviderTargeting the Woman State-mandated information Targeting the Provider Public facilities and employees exclusionsinformation Waiting periods (usually 24-48 hours) Two visit minimums employees exclusions Broad refusal clauses TRAP laws Two visit minimums Parental involvement Funding Restrictions Hospital admitting privileges Abortion procedure bans Mandated ultrasound provision and viewing Reporting requirements
    • UCLA Common Ground and Abortion Rights Impact of Reduced Access Weitz 1/25/10 Increases gestational age at which abortions are performed Medical risk Costs Emotional consequences
    • UCLA Common Ground and Abortion Rights Timing of Abortion Differences by Race/Ethnicity* Weitz 1/25/10 y y 70% 50% 60% 70% 30% 40% 50% Black Hispanic 10% 20% 30% Hispanic White 0% 10% <8 weeks 9-12 weeks >12 weeks * Data does not include CA and 3 other states
    • UCLA Common Ground and Abortion Rights Timing Differences by Age* Weitz 1/25/10 70% 80% 50% 60% 70% <15 15-19 30% 40% 50% 15 19 20-14 25-29 >30 10% 20% 30% 30 0% 10% < 8 weeks 9-12 weeks 13-20 weeks >21 weeks * Data does not include CA and 3 other states
    • UCLA Common Ground and Abortion Rights Weitz 1/25/10 Two Other Components of the C G d A dCommon Ground Agenda No federal fundingNo federal funding Allowances for denials of care
    • UCLA Common Ground and Abortion Rights Health Care Compromise Weitz 1/25/10 “I want to clear up - under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place” (Obama, Joint Session of Congress on Health Reform, 2009).
    • UCLA Common Ground and Abortion Rights State Medicaid Coverage for Abortion Weitz 1/25/10 17 states use state funds for all or most medically necessary abortions17 states use state funds for all or most medically necessary abortions AK, AZ, CA, CT, HI, IL, MA, MD, MN, MT, NJ, NM, NY, OR, VT, WA, WV. • 4 of these states provide such funds voluntarily •13 of these states do so pursuant to a court order•13 of these states do so pursuant to a court order
    • UCLA Common Ground and Abortion Rights North Carolina’s Natural Experiments Weitz 1/25/10 Cook et al, 1999 Examined impact of episodic lack of state funds for indigent women’s abortions between 1980-1993 Happened at different times of the year F d d i b i d i iFound a decrease in abortion rates and an increase in birthrates when funds were not available Conclude that 37% of women who obtained an abortion on Medicaid would have continued theabortion on Medicaid would have continued the pregnancy if funds were not available 10% more abortions among black women and 1% more among white womeng Morgan and Parnell, 2002 added additional administrative variables Approx 3% of white women and 5% of black womenpp would have carried a pregnancy to term without funding
    • UCLA Common Ground and Abortion Rights Weitz 1/25/10 Who pays the price f fi di “for finding “common ground”?g
    • UCLA Common Ground and Abortion Rights Denials of Information, Referral and Services Weitz 1/25/10 Refusal clauses, often called “conscience clauses,” in which institutions and individuals are shielded from liability for failing to provide health services, counseling and/or referrals because the individual or institution has an objection to the service;j Institutional prohibitions in which institutions override physician-patient decision-making and prohibit the provision of certain services in their facilities, refuse to cover those services in their insurance products orcover those services in their insurance products, or otherwise restrict services that meet evidence-based standards of care; and Political restrictions including those laws and regulationsPolitical restrictions including those laws and regulations that are enacted based on political ideology or electoral politics and mandate how health care must be delivered, where and how it can be delivered, or what care is covered by health care payerscovered by health care payers.
    • UCLA Common Ground and Abortion Rights An Exercise of “Conscience” Weitz 1/25/10 Carla who lives in eastern Oklahoma thought she had the flu. Her family doctor referred her to an Ob/Gyn who discovered she was pregnant and that she had a largediscovered she was pregnant and that she had a large mass growing on her uterus. The Ob/Gyn refused to remove the mass because it would endanger the pregnancy. The anesthesiologist in the practice group refused to give her any drugs that would harm therefused to give her any drugs that would harm the pregnancy. At this point the mass was shutting off her colon and bladder. Eventually Carla found a doctor in another city who found that after substantial delay, he had to remo e her ter s a proced re that o ld ha e beento remove her uterus, a procedure that would have been unnecessary if the abortion had been performed earlier in her pregnancy. Carla was uninsured. Her hospital bill for the abortion and the hysterectomy was $40 000over $40,000.
    • UCLA Common Ground and Abortion Rights A Snapshot of Institutional Prohibitions on Care Weitz 1/25/10 43 states allow health care institutions to refuse to provide services Only 1 state (California) limits that refusal to religious health care entitieshealth care entities Federal level—The Weldon Amendment to the FY 2005 Appropriations bill limits the ability of federal, state, and local laws to mandate abortion carestate, and local laws to mandate abortion care
    • UCLA Common Ground and Abortion Rights Catholic-Owned HealthCare Facilities Weitz 1/25/10 Broadest religiously-based health care restrictions Control > 16% of the U.S. hospital beds Serve 1 in 6 patients in the U.S. Governed by the Ethical and Religious Directives forGoverned by the Ethical and Religious Directives for Catholic Health Care Services (ERDs) Promulgated by the U.S. Conference of Catholic Bishops Prohibit abortion, sterilization, contraceptives and most forms of assisted reproductive technology Contain no exceptions Many patients who seek care or physicians who provide care do not adhere to the beliefs of the Catholic Hierarchy
    • UCLA Common Ground and Abortion Rights Example: PROM Weitz 1/25/10 Premature Rupture of Membranes (PROM) Amniotic membranes rupture pre-term Risk: infection sepsis maternal mortalityRisk: infection, sepsis, maternal mortality < 24 weeks: only 30% fetuses survive ACOG and AAP standard of care: balance risk to woman v potential for fetal survivalbalance risk to woman v potential for fetal survival Ob/Gy must counsel about risks and woman must decide whether to abort or attempt to continue pregnancy
    • UCLA Common Ground and Abortion Rights Weitz 1/25/10 “And at this point their personal decision-making runs afoul of their hospital’s policies Inducing laborafoul of their hospital s policies. Inducing labor before membranes have ruptured, or before there is a maternal indication such as infection, is technically an abortion This hospital like most hospitals in thean abortion. This hospital, like most hospitals in the metropolitan area in which they live, has a strict non-elective-abortion policy…” “You might wonder, reading this vignette, how I happen to know so many details about this case, or even whether this is a fictional teaching care that so bedevils medical student. The unfortunate truth is that this is real life: I am the husband in this story ” Ramesh Raghavan, MD, PhD JAMA, 4/4/07 that this is real life: I am the husband in this story.
    • UCLA Common Ground and Abortion Rights Prohibits Willing Doctors from Providing Care Weitz 1/25/10 “I’ll never forget this; it was awful—I had one of my hi i 19 k [P f] hpartners accept this patient at 19 weeks. [Part of] the pregnancy was in the vagina. It was over…. And so he takes this patient and transferred her to [our] tertiary medical center, which I was just livid about, and, you know, “we’re going to save the pregnancy.” So of course, I’m on call when she gets septic and she’s septic to the point that I’m pushing pressors on labor and delivery trying to keep her blood pressure up and I have her on a cooling blanket because she’s 106 degrees. And I needed to get everything out. And so I put the ultrasound machine on and there was still a heartbeat and [the ethics committee] wouldn’t let me because there was still a heartbeat. This woman is dying before our eyes…She was so sick she was in the ICU for about ten days and very nearly died… “ Freedman, Landy, & Steinauer,, 2008
    • UCLA Common Ground and Abortion Rights Low-Income and Minority Women More Vulnerable to Prohibitions Weitz 1/25/10 Less choice of care providers Default enrollment Less capacity to advocate for alternatives Catholic-owned facilities more likely to be in low-incomeCatholic owned facilities more likely to be in low income communities Historical providers of charity care
    • UCLA Common Ground and Abortion Rights Weitz 1/25/10 Does The Frequency of Abortion E M tt ?Even Matter?
    • UCLA Common Ground and Abortion Rights Examples to the Contrary Weitz 1/25/10 Dr. Tiller South DakotaSouth Dakota California parental consent Perhaps the best argument for abortion is its commonness 1.2 million abortions per year 1 in 3 women by age 45
    • UCLA Common Ground and Abortion Rights Weitz 1/25/10 So is there room for any “common d”?ground”? Common ground is different from common purposeCommon ground is different from common purpose Done without the expectation that it will depolarize the abortion debate in this country Important goals in their own right and not because theyImportant goals in their own right and not because they offer us a solution to the abortion wars i.e. reducing poverty, increasing self-efficacy, etc. H lth f d b t t ht i f l lHealth care reform debate taught us a painful lesson Support for prevention did not translate unto support for abortion Shifti th ti f b ti t UPShifting the stigma from abortion to UP
    • UCLA Common Ground and Abortion Rights Alternative Approach Weitz 1/25/10 Acceptance that abortion is a polarizing issue in the U.S. Acceptance that abortion has and will always be part of the human condition Internationally abortion is common even where it is highly restricted Difference is safety and social validation of the decision Engage in the hard conversations about abortion Moral status of life Rights and autonomy of women Right of the state to limit decisionsg Role of religion in public life
    • UCLA Common Ground and Abortion Rights What Do We Value? Weitz 1/25/10 Women deserve the legal right to abortion Women deserve to have an abortion(s) without judgment Women deserve high quality accessible and culturally appropriate abortion care U f t t l th h fUnfortunately the search for common ground moves us further away from achieving each of these objectivesachieving each of these objectives.