During the election campaign of 1912, a mentally-unbalanced man fired a shot at Theodore Roosevelt, the candidate of the Bull Moose Party, at a rally in Milwaukee, Wisconsin. The bullet was slowed by TR's lengthy speech, which he had double folded in his pocket, and by his eyeglasses case, nevertheless the bullet entered his body and he was bleeding profusely. Roosevelt declined to seek immediate medical attention and mounted the podium, announcing that he had been shot but that "it takes more than that to kill a Bull Moose."

A minute later, Roosevelt delivered the following lines about his would-be assassin.

"Now, friends, of course, I do not know, as I say, anything about him; but it is a very natural thing that weak and vicious minds should be inflamed to acts of violence by the kind of awful mendacity and abuse that have been heaped upon me for the last three months by the papers in the interest of not only Mr. Debs but of Mr. Wilson and Mr. Taft.

"Friends, I will disown and repudiate any man of my party who attacks with such foul slander and abuse any opponent of any other party; and now I wish to say seriously to all the daily newspapers, to the Republicans, the Democrat, and Socialist parties, that they cannot, month in month out and year in and year out, make the kind of untruthful, of bitter assault that they have made and not expect that brutal, violent natures, or brutal and violent characters, especially when the brutality is accompanied by a not very strong mind; they cannot expect that such natures will be unaffected by it."

These words bring to mind the mendacity, abuse and foul slander that were heaped upon Dr. George Tiller by the Right Wing talk show machine, most prominently by Bill O'Reilly, but by others as well. O'Reilly called Dr. Tiller a "baby killer," who has "blood on his hands" and who is guilty of what O'Reilly called "Nazi stuff." Others in the Right Wing routinely call abortion a "Holocaust."

Bill O'Reilly and his cohorts of hate cannot expect that "not very strong minds...will be unaffected" by their inflammatory language.

Truly delusional or deranged persons need little of this sort of "foul slander" to pick up a gun in order to prevent what they are told is a Holocaust. Those with weaker minds and constitutions need more instigation, which is what the daily litany of hate, intolerance and mendacity that Right Wing talk shows provide. They also provide a justification for murder — that murdering a doctor is justifiable homicide, preventing a greater evil, saving innocent lives. In this case, homicide isn't just justifiable, it is as necessary and imperative as bombing Auschwitz.

Delusional people often commit assassinations—Hinckley shooting Reagan to impress Jody Foster, for example. But an ordinary human mind, even a not very strong one, needs to be inflamed to commit the deed. Murder is a powerful taboo, but it can be overridden by the sort of bile that TR decried in 1912.

The Right Wing talk show juggernaut is an operation that would make Joseph Goebbels or the KKK proud — first dehumanizing the enemy, as the Nazis did the Jews and as the KKK did the black man, then dramatizing their threat to the home and hearth, and finally inciting the weak, in carefully coded and deniable language, saying that whatever happens to the enemy he brought on himself.

Those defending or excusing the murder of Dr. Tiller adduce a perverse variation on the civil obedience argument of Gandhi and King and Thoreau—murder for a higher principle. They press that principle further to say that it was necessary to kill the doctor in order to save lives—the lives of unborn children he might have aborted. This is to adapt the Hiroshima/Nagasaki Greater Good justification (we dropped the bombs to end the war to save American and Japanese lives, as many as a million and more) to the abortion issue.

General George S. Patton used to give incredibly bloodthirsty speeches to his men in order to inflame them to kill in battle, believing that it was necessary get men's passions up in order to induce them to commit murder. So the atrocities they committed in war seemed to them condign revenge and (as with the murder of an abortion doctor) a morally justified preventative measure. In his famous "Blood and Guts" speech to his Third Army on the eve of D-Day, Patton said the following:

"We're not going to just shoot the sons-of-bitches, we're going to rip out their living Goddamned guts and use them to grease the treads of our tanks. We're going to murder those lousy Hun cocksuckers by the bushel-fucking-basket. War is a bloody, killing business. You've got to spill their blood, or they will spill yours. Rip them up the belly. Shoot them in the guts."

Scott Roeder, the accused murder of Dr. Tiller, upon hearing that Dr. Tiller's clinic would not reopen, said the closure would mean "no more slicing and dicing of the unborn child in the mother's womb and no more needles of poison into the baby's heart to stop the heart from beating..." I wonder which Right Wing Patton he heard that from.

As expected, on January 23, 2009, President Obama rescinded, by Executive order, the Mexico City Policy/Global Gag Rule and announced that he would ask Congress to fund the United Nations Population Fund (UNFPA), which has been denied US funding for the past eight years.

The President said in his written remarks, "For the past eight years, they have undermined efforts to promote safe and effective voluntary family planning in developing countries...For these reasons, it is right for us to rescind this policy and restore critical efforts to protect and empower women and promote global economic development."

The President added, "For too long, international family planning assistance has been used as a political wedge issue, the subject of a back and forth debate that has served only to divide us. I have no desire to continue this stale and fruitless debate."

Alas, politics being what it is, the stale and fruitless debate on this issue flared up almost immediately, and opponents brought motions before the Congress to overturn the President’s repeal of the Global Gag Rule. All these motions failed by wide margins, wide enough so that another proposed bill, which would codify the end of the Global Gag Rule and prevent its re-issuance by future Presidents, is almost certain to pass. That said, politically-motivated future administrators of United States Agency for International Development (USAID) could simply refuse to fund IPPF projects.

As for money for family planning, well, no surprise, given the U.S. financial crisis, there is none — not this fiscal year anyway. Even in the future, there will be little new money for Latin America and the Caribbean. The Western Hemisphere is not high on the list for U.S. foreign aid — the priorities being in Africa and Asia. There is a proposal before Congress from a coalition of international agencies, including IPPF, to increase U.S. funding for family planning to $1 billion a year from its current level, which is about half that amount.

In response to our proposal, on June 17, 2009, a House Appropriations Subcommittee approved $648 million for family planning programs in the 2010 fiscal year appropriations bill, including $588 million for USAID programs and a $60 million contribution to the UN Population Fund.

If enacted, this appropriation would represent a 19 percent increase over the 2009 fiscal year allotment of $545 million. It also marks a 40 percent increase in funding over the past two years.

Progress!

In August 2004 I journeyed to Kansas City to do a benefit with George Tiller to raise funds for his political action committee, ProKanDo.

His ever present opponents knew where we were and circled the house with a truck carrying large photographs of fetuses.

About fifty brave supporters gathered. I spoke about the importance of being politically strong and giving backbone to our elected representatives.

George then spoke. He roared, "Tiller, George, First Lieutenant, reporting for duty!" George told of his days as a Navy Surgeon and, when his parents were killed in a plane accident, that he was discharged from the navy to take over his father's solo medical practice. His patients soon let him know that his father had performed abortions and pleaded with him to continue. George realized how necessary safe and legal abortion was once he heard of a patient dying from an illegal abortion. So, George continued his father's practice.

His clinic brochure said on the cover: "Kindness, Courtesy, Justice, Love, Respect." George said, "Women and families are intellectually, emotionally, spiritually, and ethically competent to struggle with complex health issues — including abortion — and come to decisions that are appropriate for themselves."

George was a hero in our Cause, but especially to all the women he helped over the years. He will be missed.

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The small, Switzerland-sized, Himalayan nation of Bhutan has only recently emerged from the Middle Ages and from its Middle-Ages-level reproductive health problems.

Fifty years ago in Bhutan, there were no schools, no currency, no mail, no roads and no health care beyond what traditional healers provided. There were no clinics, hospitals, doctors or nurses. There were no modern contraceptives. There were no statistics on either health or demography. The size of the population was unknown, as was life expectancy, and infant and maternal mortality. There was a tradition of traditional medicine, although the traditional medicine practitioners I spoke to professed not to know which herbs were and are currently used for pregnancy prevention and pregnancy termination.

From a standing start in 1960, Bhutan has developed, so that now there is universal primary education (classes are taught in English, except those in Bhutanese history and language), as well as a free health care system of hospitals and rural health clinics that reaches almost the entire population. It would reach all of it, but the rudimentary road system does not come close to covering the nation, and the vast majority of the populace has to walk or rely on overcrowded and sporadic busses to reach nearby towns.

Statistical gathering remains less than scientific. For instance, the UN reports that Bhutan has a population of 2.3 million, whereas the Bhutanese report a population of approximately 700,000. See the UN State of the World Population Report for 2007. http://www.unfpa.org/swp/2007/english/notes/indicators.html

See also http://www.nationsencyclopedia.com/economies/Asia-and-the-Pacific/Bhutan.html

Therefore, any statistics that are reported should be taken with a grain of salt. According to the UN, life expectancy is about 63 for males and 66 for females; infant mortality is 48 per 1000 live births (it was 102 in 1984) and the maternal mortality ratio is 420 (it was 770 in 1984), both about 20% lower than neighboring India; contraceptive coverage is around 20%; the TFR is 3.9 (it was 4.7 in 2000); about a quarter of births are attended by a skilled birth attendant. Childhood vaccinations are almost universal, and as a result of reduced infant mortality and increased life expectancy, the population has been growing rapidly (at 2.2% annually the UN reports; it was at 3.1% in the mid-1990’s), yet labor is imported for road and construction work from Nepal and India.

There is not the sex ratio imbalance at birth that is seen in India and China. In schools there is a dominance of females in the later grades, after many boys are sent to monasteries or drop out to work the family farm (about 10% of the male population are monks and 90% of the population work in agriculture or forestry). In one school I visited, in the 12 year old class, there were 16 girls and 7 boys. The society operates as a matriarchy. The eldest daughter inherits the family farm, and her husband comes to live with her, and with her parents until they retire after age 50 or so to a community monastery to pray and meditate.

Modern contraceptives are widely available, with the government health clinics offering free oral contraceptives, IUD’s, Depo-Provera and condoms, as well as male and female sterilization. Oral contraceptives are also sold in pharmacies at $2 per cycle and condoms are sold for $1 and $2 depending on the brand. Condoms are also distributed for free at various non-health locations in cities and towns. Still, as noted above, there are many couples not using contraception, due to a combination of a desire for large families and lack of access.

A visit to a rural health clinic gave some perspective on all these statistics. The following statistics (for 2007) were posted on the wall of the doctor’s office. This particular clinic covered an area with 243 households and 1257 inhabitants (about 5 persons per household), with slightly more females than males (641 to 616). There were 286 females of reproductive age between the ages of 15 and 49. There were 16 infants less than 1 year old and 91 children less than 5.

There were no reported infant deaths, child deaths or maternal deaths in 2007. The doctor has a network of “informants” around the village and as soon as it is known that a woman is pregnant, this fact is reported to him, and he makes a visit to the home, where he talks about prenatal care and sees to it that the woman has at least 4 prenatal appointments. When delivery time approaches, he arranges for the woman, if she can, to go to the regional hospital a week before her delivery date, accompanied by a relative who has her same blood type in case a transfusion is needed (anemia being a major complication in pregnancy). Naturally this is not possible in every case, and in 2007, of 18 pregnancies about half were attended at home and half delivered at the hospital.

Of the 286 females of reproductive age, there were 6 IUD users, 89 Depo users and 9 pill users. There were no sterilizations performed. Condoms are kept in a box by the door that woman and men can access without entering the clinic. The balance of the women of reproductive age presumably were using condoms, were not sexually active or were, or were trying to get, pregnant.

There are HIV/AIDS awareness signs in the clinic and along the roads of the town. Sex Ed begins in secondary school, though there is health and hygiene instruction in primary school, where teachers are required to inspect the children weekly to be sure that their uniforms and fingernails are clean, and that they have a handkerchief pinned to their uniform if their nose is running.

There is testing in the clinics for sexually transmitted diseases, and the rates are unofficially reported to be high. Bhutan is not a puritanical society, although public displays of affection are frowned upon, and couples pair and un-pair with some regularity and often get married only when the female becomes pregnant.

The abortion rate is unknown. I was told that abortion was against Buddhist ethics and was illegal except to save the life of the mother. Naturally, there is a problem of unsafe abortion. In a 1999 survey, of 654 obstetric complications, 71, or 14%, were due to septic abortion. In the clinic I visited, the physician did not report any septic abortions. Bhutan is surrounded by nations that have decriminalized abortion: India and China, and Nepal, although Nepal does not technically border Bhutan. One can hope that given the difficulties of travel for most citizens, Bhutan does not think it can rely on abortion tourism (or self induced abortion) to be the only alternatives for its women for pregnancy termination.

Despite its reputation as a Shangri-La, Bhutan has a domestic violence problem. Recently, one of the Queens founded an organization called RENEW to provide shelter and counseling for abused woman. It is located in a modern facility in the capital. Additionally, RENEW is constructing a residential safe house facility for women and their children to provided temporary housing until the woman can get divorced and resettled in society. They do a wonderful job, but it was sobering that such an organization needs to exist in this otherwise peaceful nation. See http://www.renew.org.bt/

Since Bhutan has a military force of only 4,000 (the Indian Army picks up the slack), it can, and does, spend a large proportion of its budget, approximately 15%, on health care. With improving infant and maternal mortality, the results are plain and commendable. One can hope that progress continues.

On August 28, Mexico’s Supreme Court by an 8-3 vote upheld as constitutional the decriminalization of abortion.

The law, passed in 2007 by the Mexico City Legislative Assembly, decriminalized abortion in the first 12 weeks of pregnancy. The law also defined a pregnancy as beginning upon implantation and required public health centers in Mexico City to provide abortion information and free services, with an opt-out for doctors with a conscientious objection. With this law, Mexico City joined Puerto Rico, Cuba and Guyana in the Hemisphere as having decriminalized abortion in the first trimester.

The law was immediately challenged by the pro-criminalization forces in Mexican society, as violating the right to life as set forth in the Mexican Constitution. The decision, finding that it did not, was a constitutionally limited one, unlike the broader Roe v. Wade decision from the U.S. Supreme Court in 1973. The Roe decision found that in the U.S. Constitution there was a right to privacy that required that abortion be decriminalized before fetal viability. The Mexican Court held that the Mexican Constitution permitted, but did not require, the state legislatures of the nation to decriminalize, or criminalize, abortion. One judge said, “It is not up to the Supreme Court to legalize or criminalize abortion.” With this decision as precedent, other states in Mexico can decriminalize abortion should they choose to do so.

The Mexico City abortion law addresses a catastrophic public health problem: unsafe abortion. There are estimates that there are between 500,000 and 1 million unsafe abortions a year in Mexico, with approximately 100,000 annual abortion-related hospital admissions. From 1990 to 2005, 21,646 women in Mexico died of maternal related causes, with abortion accounting for 537. These figures are probably understated given the illegality of the procedure. Since the decriminalization, there has been one death from abortion in Mexico City.

Additional maternal deaths in the past were in no doubt caused by lack of access to family planning services, which would have delayed pregnancies until the woman was older, spaced out a woman’s pregnancies and reduced the absolute number of pregnancies, thereby reducing the risk of death in childbirth. It was heartening to see that 58% of women seeking abortions in Mexico City ask for an IUD after their abortion to prevent their next pregnancy. Abortion decriminalization must be part of a broad public health plan to bring reproductive health care services to young, poor, indigenous, rural and uninsured women, who otherwise do not have access. About 40% of pregnancies worldwide are unintended. It is these pregnancies that result in unsafe abortion and maternal mortality and morbidity. This can be prevented only by simultaneously attacking gender inequality, gender violence, lack of information and access to contraceptive services, lack of an appropriate contraceptive method for every woman at every stage of her reproductive life, and, finally, the stigma that women face in many cultures in trying to control their bodies and their lives. A big agenda, but Mexico has shown that we can tackle it.

As far as global reproductive health, the foreign policies of John McCain and Barack Obama are as different as night and day. More particularly, the candidates have opposite positions on the Mexico City Policy, also known as the Global Gag Rule (the “Rule”), which prohibits U.S. foreign aid for family planning programs going to any U.S. non-governmental organization that either performs abortions, counsels on abortions or advocates for legal abortion. Senator McCain supports the Rule and Senator Obama opposes it. The difference is that clear. Senator McCain has voted consistently to support the Global Gag Rule in votes in the Senate to overturn the Rule, while Senator Obama has consistently voted to overturn it. In the September and December 2007 votes to overturn the Rule, neither Senator was present to vote. However, in a prior vote in April 2006 to overturn the Rule, Obama voted in favor of overturn and McCain voted against. In five previous votes since 1991, McCain voted to uphold the Global Gag Rule. Senator Obama was not a member of the U.S. Senate for those votes. Senator Obama told me personally in January 2008 that he would sign an executive order overturning the Global Gag Rule.

In the fight to reauthorize PEPFAR in 2008, the President’s Emergency Plan for AIDS Relief, both Senators were co-sponsors. In 2003 Senator McCain voted to require one-third of AIDS funds be spent on abstinence-only programs. Obama was not a member of the Senate for this vote.

With respect to funding UNFPA, McCain voted at least five times against funding UNFPA, while Obama has voted in favor. Obama says specifically that he will work to fund UNFPA as President. McCain has been silent on this issue.

The differences between the candidates on U.S. domestic reproductive health care issues are as stark, with McCain voting and calling himself “pro-life” and Obama voting and calling himself “pro-choice”. The Planned Parenthood Action Fund, the political arm of the Planned Parenthood Federation of America, rates McCain at 0% and Obama at 100% and has endorsed Obama for President. It is likely that, based upon past votes and statements made as candidates, as President that Senator McCain would continue the reproductive health policies of President Bush, while Senator Obama would pursue reproductive health policies more akin to those of President Clinton. The difference is clear.