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A project prospectus submitted to the Johns Hopkins University in conformity with the requirements for the degree of Master of Arts in Government
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Table of Contents
Project Prospectus 1
Title 1
Question(s) Addressed 1
Issues and Background 2
Importance of Research 2
Literature Survey 3
Competing Hypotheses 7
Methodology 7
Conclusion (Confirming Data) 13
Bibliography 15
Literature 15
Internet sites 16
List of Tables
Table 1. Actors, Beliefs, and Voting Records 8
Table 2. Country Comparison 12
List of Figures
Error! No table of figures entries found.
ii
Project Prospectus
Title
The Next Battleground of Abortion: The political feasibility of the distribution of Mifepristone
Question(s) Addressed
RU-486 will play a major role in women’s reproductive health in the near future and its availability will either help or hinder the choices or freedoms women will have in deciding what outcome their unintended pregnancy will have. If there is going to be any balance between a woman’s freedom to choose and a baby’s right to life the question of how to fairly distribute the drug must be looked into from a politically feasible standpoint. That balance can help direct the Legislature in enacting a law that will save the lives, both literally and figuratively, of mothers and unborn fetuses over the course of time.
If observed closely, the positions of the actors (i.e., legislators, department chiefs, lobbyists, and members of the opposing groups) can be predicted in the policy making of how RU-486 will be distributed. With careful analysis of these actors they can be affected to give maximum access to the drug while also giving the unborn as much of a possibility to live. Also, a major concern of the Pro-Life advocates is that Mifepristone will increase the rate of abortions in the United States; if this is not true then it can help alleviate some of the tension that the distribution of the drug will surely create.
The study will concentrate on the actors, their motivations and beliefs, and the possible final outcome of the policy or law that they will decide on. It will also attempt to identify the first few sites that will be critical in the actors’ legislative decision-making process.
Issues and Background
Since the 1973 Supreme Court ruling on Row versus Wade, there have been two sides that have hotly contested either allowing more abortions to occur (Pro-Life advocates) or reducing the availability to terminate fetuses (Pro-Choice advocates),[1] and finding a middle ground has become a political necessity. The ongoing debate has been given over to the state governments to determine how to best fund and protect abortion sites and clinics, if at all. Therefore, it will be hard to predict the outcome of the Federal Food and Drug Administration’s recent approval of the drug Mifepristone (RU-486) on the overall population of women without first seeing how these two groups differ philosophically.
Importance of Research
The importance of just trying to broach the subject of abortion with political players such as individual members of Congress, the Secretary of the Department of Health and Human Services, Pro-Life advocates and Pro-Choice advocates, and others players without an enormous backlash of opposition cannot be overstated [simply saying it cannot be overstated does absolutely nothing to convince a reader that the research is important]. This research attempts to the middle ground of a very polarized debate. There, in addition, is a question of more subtle importance: will RU-486 increase the number of abortions in the United States? The major concerns in this thesis are on this issue and this question.
Literature Survey
I have just started the quest for information on the effects of Mifepristone on American Society. As I have not yet mastered the entirety of the subject matter I can only present information that I have already stumbled upon. This undoubtedly will become more extensive as my thesis takes more of a form.
Henshaw SK and Van Vort J, Abortion services in the United States, 1991 and 1992, Family Planning Perspectives, 1994, 26(3): 100–106 & 112. This gives a good beginning background as to what clinic services are available in the United States as well the numbers of abortions and clinic sites in the United States.
Childbirth by Choice Trust, 1996 Childbirth by Choice Trust 344 Bloor St. W. #502 Toronto, Canada M5S 3A7 416-961. An excellent source that will give me information on studies on RU-486 that exists outside the US statistics (e.g., Britain, France, Western Europe).
“The safety and effectiveness of the abortifacient RU486 in foreign markets: opportunities and obstacles to U.S. commercialization: hearing before the Subcommittee on Regulation, Business Opportunities, and Energy of the Committee on Small Business, House of Representatives, One Hundred Second Congress, first session, Washington, DC, December 5, 1991.” United States. Congress. House. Committee on Small Business. Subcommittee on Regulation, Business Opportunities, and Energy. Legislative information on Mifepristone that gives an idea of the political “climate” prior to the Clinton Administration. It seems to be more important now that Bush (Pro-Life administration) has been elected to the Presidency[2].
Speaking of Abortion: Television and Authority in the Lives of Women. Andrea Lee Cole, Elizabeth R., Chicago, Illinois: University of Chicago Press, 1999. During a four year period, the authors went into the homes of women of all classes and interviewed them about their attitudes toward abortion. The discussions revolved around the portrayal of abortion on television, which primarily views abortion as a dilemma for the poor and the working class.
The authors found that women who were ProLife were unified in their beliefs no matter what class they belonged to, and that they shared a skepticism about using the media as a source of information. The authors further found that ProChoice women’s beliefs were divided along class lines, with working-class women defending a woman’s right to choose because, as a group, these women feel under constant threat from legal authorities. In contrast, middleclass women’s arguments were based on the rights of the individual and, further, frame abortion as a necessity for those who are unable to afford having children. This leads the authors to argue that many middleclass ProChoice women “share the same point of view as displayed on television.”
This volume is meant to clarify “the rhetoric surrounding the abortion debate” and allows one, “to hear ordinary women discuss one of America’s most volatile issues.
Abortion: “Medical versus surgical abortion: a survey of knowledge and attitudes among abortion clinic patients.” Virgo, Katherine S. Carr, T.R. Hile, Allison Virgo, John M. Sullivan, George M. Kaikati, Jack G. Women’s Health Issues 9(3), May 1999: 143-154. The authors conducted a survey of 405 abortion clinic patients to ascertain their level of knowledge of the risks and benefits of RU 486 as a method of abortion, as well as their knowledge of and attitudes toward medical abortion versus surgical abortion. The respondents were patients at an abortion clinic in southern Illinois that serves women from a 10state area and is one of the largest in the country.
The questions in the survey covered: socio-demographic characteristics; reproductive history; history of contraceptive use; decisionmaking process regarding current abortion; and knowledge and attitudes regarding medical abortion versus surgical abortion. The questions about RU-486 included a section that described the process of medical abortion using RU-486, including the necessity for the total of three clinic visits.
Seventy-six percent of the respondents showed interest in learning about RU-486; 40.5% reported “they would use birth control more often if RU-486 were available.” A little more than 51% said they would be willing to return for the two follow-up clinic visits, “though a need for substantial educational efforts prior to making RU-486 widely available in the United States is still in evidence,” according to the authors.
“Pain Penance and RU 486: Pill isn’t likely to change the difficult emotional calculus of abortion” Washington Post by Hanna Rosin Oct 14, 2000. The author introduces the concept that not all the decision of having an abortion rests on the convenience of the drug. Share the case study of a woman who has made the decision to use the drug.
Fulfilling the Promise: Public Policy and US Family Planning Clinics. The Alan Guttmacher Institute Washington, DC, 2000: 7. Another good guide to the resources and clinics available in 1990’s for women. It is very comprehensive and covers everything from Title X (Public policy that allows for federal funds to be used for contraception and family planning) to the challenges and resources for continued research.
The Medical Letter: On Drugs and Therapeutics. New Rochelle, NY; October 2000, 42:101-102. The leaflet gave some medical terminology and information on the clinical use of mifepristone.
“Political Feasibility and Political Analysis”. Meltzer AJ. Public Admin Review; Nov/Dec 1972, 32:6:859-867. This is the major resource used for analysis. It was the basis of how this thesis took form.
I also used the following websites for my information: www.senate.gov: for Senate legislative information, party affiliation, and voting habits; www.house.gov: for House of Representatives legislative information, party affiliation, and voting habits; http://thomas.loc.gov/: for more information on the Congress’s legislative information, party affiliation, and voting habits; www.agi-use.org: The Alan Guttmacher Institute Site; www.plannedparenthood.org/index.html: Planned Parenthood Federation of America Site; www.fda.gov: The U.S. Food and Drug Administration; www.dhhs.gov: The U.S. Department of Health and Human Services and The Pro-Life Views Site: http://prolife.about.com/newsissues/prolife/mbody.htm.
Competing Hypotheses
There are three possible outcome hypotheses that can be derived from my original thesis and they are:
1) Extreme Right Hypothesis: If there is no distribution of Mifepristone, then there will be fewer abortions. This hypothesis is one of the major tenets of the Pro-Life advocates. They believe that the approval of the drug will directly increase the number of abortions in the United States.
2) Extreme Left Hypothesis: If there is complete and unsupervised distribution of Mifepristone to all physicians regardless of whether there is the support network in place already (i.e.: counseling centers in clinics, follow up visit to therapist, etc), then there will be a greater choice for women who seek an abortion. This is the main belief of the Pro-Choice advocates. They believe that the choice of women seeking an abortion should not be restricted in any way. Therefore, RU-486 should be accessible everywhere to everyone who is seeking an abortion.
3) Middle-of-the-Road Hypothesis: If distribution is regulated to supply only places that have the capability already in place to have surgical abortions, then the number of abortions will remain constant and the information gathered from other countries can be used as a directional tool for further information.
Methodology
This thesis will be gathering the following information as research material:
1) Chart the actors and their political beliefs along with their prior voting histories in regards to women’s health issues such as abortion rights, contraceptive rights, welfare rights, and maternal morbidity views. This thesis will only use national actors, because initially this is where the legislation is going to come from. This will give a good overview of the political climate that US is currently in and therefore observe whether one, two, or all three hypotheses are possible. (See Table 1 below)
Table 1. Actors, Beliefs, and Voting Records
Actor(s) / Partisanship / Women’s Health Issues: History of BeliefsSenate[3] Members
(Will break down into individual Senators) / Democrat, Republican, or Other / Yea or Nay for the following Women’s Health Issues in the 2000 Legislature:
S. 3157: To require the Food and Drug Admin to establish restrictions regarding the qualifications of physicians to prescribe the abortion drug commonly known as RU-486;
S. 1692: To amend title 18, United States Code, to ban partial-birth abortions;
S. 661: To amend title 18, United States Code, to prohibit taking minors across State lines in circumvention of laws requiring the involvement of parents in abortion decisions;
S. 1605: To establish a program of formula grants to the States for programs to provide pregnant women with alternatives to abortion, and for other purposes;
S. 326: To improve the access and choice of patients to quality, affordable health care;
S. 1344: To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to protect consumers in managed care plans and other health coverage;
S. 976: To amend title V of the Public Health Service Act to focus the authority of the Substance Abuse and Mental Health Services Administration on community-based services for children and adolescents, to enhance flexibility and accountability, to establish programs for youth treatment, and to respond to crises, especially those related to children and violence;
House of Representatives[4]
(Will break down into individual House Members) / Democrat, Republican, or Other / Yea or Nay for the following Women’s Health Issues in the 2000 Legislature:
H.R. 5385: To require the Food and Drug Admin to establish restrictions regarding the qualifications of physicians to prescribe the abortion drug commonly known as RU-486
H.R. 3660: To amend title 18, United States Code, to ban partial-birth abortions;
H.R. 3400: To provide that the inferior courts of the United States do not have jurisdiction to hear abortion-related cases;
H.R. 2901: To establish a program of formula grants to the States for programs to provide pregnant women with alternatives to abortion, and for other purposes;
H.R. 1218: To amend title 18, United States Code, to prohibit taking minors across State lines in circumvention of laws requiring the involvement of parents in abortion decisions;
H.R. 3000: To establish a United States Health Service to provide high quality;
H.R. 4365: To amend the Public Health Service Act with respect to children’s health;
H.R. 1200: To provide for health care for every American and to control the cost and enhance the quality of the health care system;
Department of Health and Human Service[5]: Sec. Donna E. Shalala.
(Will use Head of Department as main actor) / Democrat, Republican, or Other / Programs set up for Women’s Health Issues under current leadership:
The department oversees more than 300 programs, covering a wide spectrum of activities. Some highlights include:
· Medical and social science research
· Preventing outbreak of infectious disease, including immunization services
· Assuring food and drug safety
· Medicare (health insurance for elderly and disabled Americans) and Medicaid (health insurance for low-income people)
· Financial assistance for low-income families
· Child support enforcement
· Improving maternal and infant health
· Head Start (pre-school education and services)
· Preventing child abuse and domestic violence
· Substance abuse treatment and prevention
· Services for older Americans, including home-delivered meals
· Comprehensive health services delivery for American Indians and Alaska Natives
Different Medical Societies
(Will use American Medical Association[6] and The American Board of Obstetricians & Gynecologists) / Democrat, Republican, or Other
(These groups will be looked at as a one actor unless otherwise noted) / Programs and legislature overviewed by the group(s):
H.R.216: Rep. Charlie Norwood’s (R-GA) “Access to Quality Care Act of 1999”
H.R.358: House Democratic leadership patients’ bill of rights legislation
H.R.448: House Republican leadership patients’ rights legislation
H.R.528: Clinical Laboratory Improvement Act Amendments of 1999
H.R.719: Rep. Greg Ganske, MD’s (R-IA) “Managed Care Reform Act of 1999.”
H.R.1304: Campbell Antitrust Bill 221
H.R.2723: Bipartisan Consensus Managed Care 156
H.R.2723: Norwood-Dingell: Bipartisan Consensus Managed Care Improvement Act of 1999
H.R.2824: Coburn-Shadegg
S.6: Democratic Leadership patients’ bill of rights legislation
S.300: Republican Leadership patient protection legislation
S.326: Sen. Jim Jeffords’ (R-VT) patient protection legislation
S.374: Sens. John Chafee (R-RI) and Bob Graham (D-FL) bipartisan managed care reform legislation
Roman Catholic Church[7] / Democrat, Republican, or Other
(These groups will be looked at as a one actor unless otherwise noted) / Programs and legislature lobbied for or against by the group:
Supports Anti-abortion legislation listed above;
Supports Anti-contraception legislation listed above;
Supports Conservative Women’s Health legislature
Supports Republican Women’s Health legislature
Other
(These are groups that have some political clout but are not affiliated with any of the above actors) / Democrat, Republican, or Other / Programs and legislature lobbied for by the groups:
Will identify as these actors become more influential
2) Graph the different rates of abortions in countries that have already approved Mifepristone. This information will give the ability to justify the different hypotheses. Since there is standardized health care in most of the countries that have already approved RU-486 distribution is not an issue and it can be inferred that an increase of abortion is greatly dependent on the drug. So, if there has been an increase in the rate of abortion when the drug was introduced to the public, then the Extreme Right Hypothesis will be validated. If the abortion rate remains constant, then both the Extreme Left and the Middle-of-the-Road hypotheses can be concluded as being valid. (See Table 2 below)