Wednesday, January 31, 2007

Amen, Eileen

Bad choices all around

By Eileen McNamara, Globe Columnist | January 28, 2007
The one, certain place Amber Abreu did not belong while prosecutors decide whether the Lawrence teenager's self-induced abortion amounts to manslaughter is the state's maximum-security prison for women.

Framingham state prison is where this teenager was incarcerated after her arrest last week on the archaic-sounding charge of "procuring miscarriage." It is where she spent three nights until her family was able to borrow $15,000 for bail, an amount inconceivable to a young woman whose Dominican street remedy for ending an unwanted pregnancy collided with American ambivalence about abortion.

What Amber did -- swallow pills marketed to prevent ulcers but known to induce abortion -- is a crime in the United States but commonplace in the Dominican Republic where misoprostol is available over the counter and where abortion is both illegal and widely practiced.

An autopsy will determine the gestational age of the 1 1/4-pound baby girl Amber delivered earlier this month. The baby died four days later. Whether Amber knew how far her pregnancy had progressed or understood the legal peril in which her actions placed her are questions yet to be answered. While those facts are being established, what possible purpose was served locking up a postpartum 18-year-old? If she did not have money for a legal abortion, she did not have the funds to flee the country.

What is clear is that an inner-city teenager who is still studying English made a desperate choice when a safe and legal one proved inaccessible. Amber knew abortion was legal in the United States. Her family had raised the money for her to undergo the procedure a year ago. Whether from shame or fear, Amber said , she could not ask her mother to help her again. She turned to the cheap home remedy that landed her in Lawrence District Court last week in shackles.

The law is a tool, not a cudgel. It is to be used with discretion by those who wield it. This tragedy -- and it is a tragedy -- is less a measure of one teenager's bad choices than it is an indictment of a culture that tells all women abortion is their legal, constitutionally protected right, but tolerates a lack of access for the neediest women. A well-heeled suburban 18-year-old who chooses to terminate a pregnancy need only write a check.

Massachusetts is one of 14 states that does not deny Medicaid funds for abortion, but finding a provider is a major challenge for low-income women who do not live in Boston, Worcester, or Springfield. According to a report by the nonprofit Abortion Access Project, more than half of the state's abortion providers are in Greater Boston. Only 13 of the 62 hospitals with obstetrics units perform abortions. Of 12 freestanding abortion clinics in Massachusetts, four accept Medicaid.

Beyond the challenge of access is the question of education. How comprehensive could Amber's understanding be of contraception if she faced her second unwanted pregnancy in a year?

"This is really about our failure as a society to educate her and to hook her up with available services," said Susan Yanow, the founder and former executive director of the Cambridge-based Abortion Access Project. "Instead, as women have through the centuries, she took matters into her own hands when faced with an unwanted pregnancy."

Amber is hardly alone out there. Yanow still remembers the young woman who called the project's hotline in a panic one night. "She told us, 'I had my boyfriend push me down the stairs and punch me in the stomach really hard and I am still pregnant, what can I do?' That is a reflection on what young people don't know and the stigma around abortion. What about a young woman who exercises in the extreme hoping to induce a miscarriage? Should we indict her if she succeeds?"

Amber Abreu will be back in court Feb. 25 for a probable cause hearing. She will come from home, not prison, in the company of her mother, not a prison guard.

Eileen McNamara is a Globe columnist. She can be reached at mcnamara@globe.com.

No comments: