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Sat Jul 5, 2014, 04:19 PM

A Reproductive Rights Moonshot

With the help of 5COTU5 and state medical regulations, it seems that Forced Birther forces have found a potentially winning strategy in their war on reproductive rights: (1)From the provision side, load abortion clinics down with so many regulations that it becomes a practical impossibility to continue operating. And (2) from the demand side, create so many economic disincentives - including allowing employers to violate federal law and refuse coverage for contraception on religious grounds - that it becomes a practical impossibility for the demographic most vulnerable to unplanned pregnancy to afford abortion.

These strategies are typically underhanded and unconstitutional, but having subverted the Supreme Court there is little chance that any but the most clumsily-worded of these assaults will fall through legal challenge or reinterpretation in the foreseeable future. There is also little chance of state legislatures dominated by religious conservatives suddenly becoming socially liberal, so simply reversing what's been done would be a long, vertical climb with little chance of success and no intermediate achievements likely. So, short of reproductive rights activists becoming radicalized - which seems unlikely given the extreme imbalance in commitment between the two sides - it seems the only path forward is to think outside the box. If we do this, I think there is a possibility of winning once and for all, in ways so complete that nothing short of a Constitutional Amendment banning abortion could reverse it.

Rather than endlessly complaining and waging judicial trench warfare over the obstacles conservatives have created, we need to simply circumvent them - make them irrelevant. So think about this:

1. They have made abortion geographically unavailable by sharply reducing the number of clinics. How do we address this: Eliminate the need for clinics altogether.

As I say this, you are probably thinking about doctors making house calls, or mobile clinics, but any of these would still be subject to state medical regulations, and thus could be banned or so heavily regulated that it becomes financially impractical. Again, short of radicalization - i.e., large numbers of doctors ignoring the regulations and being willing to martyr their licenses and their livelihoods to perform abortions - we have to think further outside the box than this. We need to think even more ambitiously. The clinics are only the immediate manifestation of the problem, so more fundamentally...

2. We need to eliminate the need for doctors in obtaining abortions. A doctor is an extremely vulnerable bottleneck in the process of abortion provision: An affluent, highly-trained professional who has invested years if not decades into their practice, and almost none of them would be willing to jeopardize that by directly challenging state laws and regulations. Doctors, unfortunately, are currently necessary in abortion because the process is delicate and can lead to complications that need a medical professional to be involved. Which leads us to my next point...

3. Abortion needs to advance technologically. The safety, simplicity, and reliability of abortion must advance to the point that a doctor is no longer a necessity in the process. These advances can be done incrementally, with stepwise increases in availability and safety, because it would still be a remarkable level of progress if you merely needed a nurse to be involved rather than a doctor: Nurses are a lot more numerous than doctors, make far less money, far more of them are women, and you can bet more of them would be willing to violate regulations if Forced Birth states still insisted that a doctor be present if they knew they weren't jeopardizing the safety of the patient by performing one themselves. But that is just a stepping stone. The Moonshot referred to in the title is...

4. Abortion needs to be safe and simple enough to be self-administered. I realize this is a highly ambitious medical technology goal, but if it's achieved we would be 95% of the way to total and permanent victory for reproductive rights in this country. Nurses, being medical professionals, would still be subject to scrutiny, retaliation, terrorism, and perverse regulation (i.e., regulations intended to prevent rather than enable what is being regulated), so the need for any professional at all needs to be eliminated from the abortion procedure. Given just how ambitious a goal this is - it would frankly be easier to perform your own dentistry - we can identify some intermediate goals toward self-administration:

4a. Performed by a friend or family member with no medical training in the presence of a non-interfering medical professional. To be performed by a non-professional would require the procedure be approved by the FDA first, but since the FDA is federal, a fair shot at approval once the technology is safe enough is reasonably likely. That doesn't mean no political interference would happen at all, but the process is likely to ultimately resolve in favor of whatever a fair medical assessment would be.

On the state level, there are some legal niceties involved in this: I.e., a doctor cannot be legally compelled to either intervene or leave the premises simply because there are people performing an unlicensed abortion in the patient's own home, so states couldn't just insist that doctors intervene to stop it or else leave. That would never pass constitutional muster. So long as they play no role whatsoever in the procedure, but are on hand to provide emergency care if called upon, the federal courts (including, most likely, even 5COTU5) will probably find they cannot be held liable or criminally culpable by states.

States could still potentially wreak professional havoc by trying to revoke licenses, so still a problem - but less of one than needing to do the procedure themselves, and also less for nurses than for doctors. So those are some sub-increments: a(i) in the presence of a doctor, a(ii) in the presence of a nurse.

4b. Performed by a friend or family member with no medical training, with guidance from a non-present professional via video conferencing. This muddies the waters a bit, since a doctor or a nurse can be anywhere in the world while offering guidance through a high-resolution video conferencing system. You could actually combine this function with 4a, having a distant doctor or nurse verbally guiding and visually monitoring the process who is outside the jurisdiction of the Forced Birth institutions creating the obstacles, and then a physically present doctor or nurse who remains uninvolved and silent unless an emergency occurs. You could do any combination thereof (call that option 4ab) that you find convenient: Net doctor, present doctor; net doctor, present nurse; net nurse, present doctor; or net nurse, present nurse.

4c. Performed by a friend or family member with no medical training, alone. Even with your FDA-approved process that can be performed by non-professionals, there could still be some liability issues: Forced Birth states could opportunistically try to charge the non-professional performer with a crime if something went wrong, but that would be difficult to sustain without a 100% Forced Birth jury, especially with proper documentation detailing the patient's consent and trust in the performer.

Such states could also try to criminalize the procedure altogether, but of course, that likely wouldn't pass muster since abortion is Constitutionally protected. But even if they did somehow manage to criminalize it, once again we're talking about something people can do in their own homes with a trusted friend or family member, so a ban at this point would be unenforceable under the vast majority of circumstances.

4c. Performed by the patient alone. Once you are confident enough of the technology and procedures, and the FDA has ratified your confidence by approving it for self-administration, you are close to full reproductive liberalization. Even if states tried to ban or tax or regulate the equipment out of existence, you could buy it over the internet and circumvent their obstacles. Attempts to punish women for self-aborting would be unenforceable and quickly struck down as unconstitutional. But this isn't the end of the process, because there are still things that need to happen to achieve complete victory:

5. The cost of liberalized abortion must be at or below current costs. It does little good to invent safe, self-administered abortion if the needed equipment costs $10,000. That in itself would represent an insurmountable obstacle for most people. In fact, even current costs are on the high end - between $300 and $1,500. Economically, the main problem is that abortion clinics can spread the Fixed Cost of their equipment out over many patients, while a single patient doing a self-abortion is probably not going to use the equipment again, so they have to swallow the entire Fixed Cost if they outright buy it. That's where business strategies come into effect - you could have rentals rather than purchases, or anonymous pooled ownership.

Those are just a couple of ideas, but there are actually tons of possibilities in this area. And once you eliminate the need for the Baghdad-level security that Forced Birther terrorists impose on abortion clinics, and also all the paperwork and bureaucracy further imposed by many state governments, a huge amount of the cost imposed on clinic patients disappears. But first and foremost it's a technology problem - making the equipment cheap enough, but also safe enough, for self-administration to be practical. That means it will have to differ substantially from the technology currently used at clinics, and incorporate all sorts of new methods and innovations to make it simpler, safer, more intuitive, etc. Unfortunately, medical technology moves pretty slowly precisely because the human body is so complex and small things can have outsized consequences on it. So the term "Moonshot" is fully appropriate here to describe the difficulty and probably cost of achieving these advances.

But even then, having cheap, safe, self-administered abortion, you're still dealing with bottlenecks in the supply chain that are vulnerable to interference if/when the federal government is again taken over by the radical right as under Bush: I.e., only one or a few companies licensed to sell these products. So if what we've achieved in the description so far is total victory, the next step would ensure the victory is permanent:

6. Release the patents for the equipment into the public domain, and publish how to build it on the internet on ultra-secure servers around the world. This could give rise to "open source abortion equipment" community. Even those who stick to purely theoretical designs because they don't want to hassle with FDA approval might contribute to reducing cost and complexity on paper until someone else does try to get approval and commercialize designs based on their work. The endpoint of such a process, however far away it is, would be that ending a pregnancy would be something a woman does herself, safely and affordably, with a wide variety of equally safe technical options to fit her budget and schedule, that no authority or terrorist group could interfere with in any practical way on any effective scale.

Q: Why not a pill?
A: Ideally abortion would come in the form of an all-encompassing pill whose formula and synthesis procedures are all public domain and published online, but the complexities of chemistry are such that I think this is actually more complicated and less likely to happen than developing a self-administerable extraction procedure. The statistically minimal dangers of terminating a pregnancy are well-understood, but the consequences of a chemical compound that did the work for you would be very complex and take a lot more time to map out - as the tortuous journey of even the "morning after" pill RU-486 can attest. Even finding such a compound or combination thereof would be ludicrously difficult. You would probably have to run high-throughput computer simulations for decades to even generate a list of viable candidates, let alone conduct physical trials.

Q: How might such a process as you describe begin?
A: My thinking is that a combination of wealthy reproductive rights activists and Kickstarter (or other crowdfunding sites) campaigns could pool resources and form a medical research organization toward this objective. They could rigorously break down the technological and economic advances needed to get there, and develop a plan for funding and perhaps commercializing each step along the way. Every single step that is achieved toward this goal would be progress in and of itself: Progress that doesn't need the permission of 5COTU5 or some corrupt legislature.

This is how we win. This is it. If we keep fighting the same old battles, having the same old arguments, they'll wear us down and erode reproductive rights in this country until they no longer exist. That's what's been happening, and that is what will continue to happen unless we change the nature of the struggle - unless we decide to finally and completely win this long and preposterous conflict for basic freedoms the other side should have simply conceded decades ago. But they have made it clear that they are fanatically determined, that no tactic is too low for them, and they will respect no law or moral principle that gets in their way, so it's long past time to drop The Big One: Make their opposition irrelevant - hand every single woman the practical means to determine her own reproduction with no possibility of interference or obstruction.

P.S., If anyone likes this idea enough to run with it, please do so: I myself am just a thinker, not a leader. And while this may be presumptuous to say, please feel free to republish this anywhere if you find it worthwhile.

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Reply A Reproductive Rights Moonshot (Original post)
True Blue Door Jul 2014 OP
Trillo Jul 2014 #1
True Blue Door Jul 2014 #2

Response to True Blue Door (Original post)

Sat Jul 5, 2014, 09:28 PM

1. There are existing "morning after pills" as well as abortifacients.

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Response to Trillo (Reply #1)

Sun Jul 6, 2014, 12:03 PM

2. Yes, but there would be no abortion clinics if those were anywhere near sufficient.

There should be a hugely publicized effort to dramatically reduce the cost, and improve the efficacy of self-administered abortion. Drive the other side berserk by pursuing methods they can do absolutely nothing about.

In particular, I would hope that people who already pursue projects like this quietly would get noisy and go through Kickstarter and seek Silicon Valley donors.

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