Tag Archives: abortion

Picking a medical school that trains abortion providers

23 Jan

I visited colleges with my best friend when I was 16, hoping to jolt myself awake from my junior year case of senioritis. I predictably discovered that I didn’t know what I was looking for. We decided upon two (decidedly superficial) tests: First, did the admissions office give free frisbees? Were they the ones with monogrammed liberal arts school seals on them? Were they weighty, with a good lip, or were they cheap three-quarter sized neon knock-offs? And secondly, did the cafeteria offer chocolate milk, and if so, was it whole milk? Skim? Good chocolate syrup or a generic chalky powder?

I eventually chose one of those schools; realizing the vast number of factors actually more important than their chocolate milk or their free frisbees. And I developed into a person who cares about more and different things…but now I’m applying to medical school, with still two tests of my future happiness there. They are both of the social-justice variety, based in my professional interests, and tests of what kind of school I am interviewing at:

Test #1: Are there curriculum hours committed to abortion-training, and will the school help me find rotations that allow me to learn this skill set?

Test #2: Are there curriculum hours, a student group, and administration-commitment to training tomorrow’s doctors to care for folks in the LGBT community?

My most recent interview and visit left me not only certain I wouldn’t attend, but utterly discouraged. When asked about LGBT-inclusive healthcare training at his school, my student interviewer looked baffled. He mentioned the first name of “a girl who is involved in the student group, probably”. He also casually mentioned how uncomfortable he would be to ask “if my patient slept with boys or girls”. In response to the inquiry about abortion care, he felt empowered to share that he is a libertarian, so approves of a woman’s right to choose, but he wouldn’t feel comfortable performing an abortion or even referring someone to a different provider. He was also quite sure that “the school probably wouldn’t take action” against me if I pushed to do a rotation specifically focused on abortion care.

I’ve been able to stay excited in the often draining days leading up medical school by planning what kind of doctor I will be. Every doctor has a specialty (right now, I think gynecology and obstetrics for me), but every doctor also has a defined philosophy. Who will I be as a provider? How will I demand excellence from myself? These questions bring me back to the framework of reproductive justice: I will be a better doctor if I can understand every patient, their unique situation, and the forces in their lives that lead them to one decision and not another. Reproductive justice means an intersectional understanding of the struggles and triumphs my patients will experience in their journeys toward reproductive self-determination, and understanding my place as a medical professional.

Access to competent, quality, and respectful health care for lesbian, gay, bisexual, transgender individuals is reproductive justice. Access to competent, quality, and respectful abortion providers is reproductive justice. And despite being utterly thrilled and excited to interview at several medical schools, my experiences asking about these important issues have been disheartening at best, terrifying at worst. As respected as the medical profession is, and as difficult as it is to be admitted to school, doctors can only be as good as their training. My ideal medical school would train and nurture students to become tomorrow’s trusted, inclusive, and knowledgeable health-care providers, willing and able to help anyone who comes to them regardless of their choices, their gender identity, or their sexual orientation. It wouldn’t be bad if they had good frisbees and chocolate milk, too.

Over-the-counter abortion? Why not?

21 Sep

Access to abortion services is becoming more and more difficult around the country, and remains problematic worldwide. One potential way to improve access for the majority of women who need abortion services in the first 9 weeks of pregnancy would be to make the medications that induce abortion available over-the-counter at pharmacies nationwide.

Medical abortion (see below for a detailed definition, but for our purposes, an abortion that is completed at home, with just pills rather than a procedure in a clinic) is an extremely safe and effective way to end unintended pregnancies. The most effective regimen, a combination of misoprostol and mifepristone, works up to 98% of the time. In other words, 98% of women who take these two drugs correctly to induce an abortion at up to 9 weeks after their last menstrual period will expel their pregnancy completely, with no medical intervention whatsoever. So why not take the providers out of the equation?  It would certainly make abortion far more accessible and affordable for many women.

Additionally, such an approach might present a missed opportunity for providing contraceptive care. If women aren’t seeing a medical provider for their abortion, they may lose out on the opportunity to start a contraceptive method immediately after their abortion. In fact, offering contraceptive counseling and providing a method if desired is a key component of quality abortion care. It’s true that in a perfect world, women would be able to start their chosen contraceptive method immediately after their abortion in all cases (and in fact it would be much easier for many women to do so if more contraceptive methods were available over-the-counter as well!). However, it is never appropriate to make availability of one health service contingent on provision or acceptance of another. (Unfortunately, this is common practice; many medical providers still require patients to come in for their preventive care visits before they will renew prescriptions for contraceptives. Just because it’s common doesn’t make it right).

Finally, some may worry that women who are past the recommended 9 weeks since their last period will use the method even though the instructions say not to. First of all, as I mentioned above, many people do not follow the directions for the use of over-the-counter products. It doesn’t mean those products should not be available. Second, although misuse of over-the-counter products such as acetaminophen (Tylenol) are frequent causes of death and disability in the United States, there are no restrictions on their sale. Third, these medications are still safe to use after 9 weeks of pregnancy; however, their efficacy decreases. In other words, women who use the medications in these doses after 9 weeks of pregnancy are less likely to have a complete abortion, although much of the time the regimen will still work correctly. The worst case scenarios, therefore, are an incomplete abortion or an ongoing pregnancy if women do not use the product as recommended. Such situations would require medical attention, but if a good referral service is available women would be able to access appropriate follow-up care.

What would my dream over-the-counter abortion kit include?

1) Clear, easy-to-understand instructions and a 24-hour phone number to call with questions.  Information is key.  The instructions should help women determine if a medical abortion is the right choice for them, based on their gestational age and medical history, as well as provide information on where she can go if a medical abortion at home isn’t the best option for her.  Additionally, women need to have someone they can call at any time if they have questions before, during, or after the process.  The instructions should also point
women to websites and hotlines they can call for information and referrals for contraception after their abortion.

2) Mifepristone and misoprostol.  The mifepristone-misoprostol regimen is the most effective for inducing abortion.  If the method is going to be used by women on their own, it needs to be a method that is extremely reliable.

3)  Several doses of ibuprofen.  The most difficult part of a medical abortion for some women is the cramping; pain control is a key component of abortion care.

4) A low-sensitivity urine pregnancy test.  Women could take this test themselves at home 2 weeks after their abortion.  Although medical abortion is extremely effective, and most women are able to determine from their symptoms alone that their abortion is complete, this test will catch the very rare cases of continuing pregnancy.

Although this may seem to be a radical proposition, the fact is that we have the evidence to support that it would be safe and effective. I would like to see research that it is, additionally, acceptable to women, but it’s hard to believe women wouldn’t be happy about having more choices and more control.  What do you think?

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Medical abortion: Medical methods of abortion, or medical abortion, is defined by the World Health Organization as follows: The “use of pharmacological drugs to terminate pregnancy. Sometimes the terms “non-surgical abortion” or “medication abortion” are also used.” Medical abortion in the United States is most commonly performed using a combination of mifepristone and misoprostol (this is the recommended protocol as it is the most effective), although sometimes methotrexate is used in combination with misoprostol. In countries where mifepristone and/or methotrexate are not available, misoprostol alone can be used, although it is less effective, that is, less likely to end in a complete abortion.

Low sensitivity urine pregnancy tests: Similar to regular urine pregnancy tests, except they only are positive at higher pregnancy hormone levels. Although it can take several weeks for pregnancy hormone (ß-HCG) levels to become completely undetectable after an abortion, these tests will only turn positive if hormone levels are still high.

South Dakota: Where We Don’t Practice Science

27 Jul

In 2005, South Dakota passed a law which at the time was the pinnacle of crazy anti-abortion laws.  It contained a wide range of provisions which ended up going back and forth in the courts for the past several years.  Ultimately, the biological disclosure and “all known medical risks” disclosure stayed on the books, but the decision on a suicide advisory remained divided in the courts.  It became its own spin-off case, and only this week did a decision come down.

Though you may have already read how the 8th circuit ruled , 7-4, with the majority in favor of keeping the suicide advisory, i.e. doctors must tell women seeking abortions that they have an increased risk of suicide if they seek an abortion, on the grounds that is not misleading and irrelevant.

Some things you should know about the case before we dive into this:

  1. The parties are two crisis pregnancy centers versus Planned Parenthood.
  2.  The “friends of the court” of the crisis pregnancy centers include: Christian Medical & Dental Associations; American Association of Pro-life Obstetricians & Gynecologists; Catholic Medical Association; Physicians for Life; National Association of Pro-Life Nurses; Family Research Council; Care Net; Heartbeat International, Incorporated; National Institute of Family and Life Advocates, Incorporated; Eagle Forum Education and Legal Defense Fund; and the American College of Pediatricians.  Yes, you read that last one right.  Who knew?
  3.  The author most cited in the majority opinion for the “evidence” of an increased risk of suicide and suicidal ideation among women who had an abortion might have her major paper on the topic retracted because it is not scientifically sound.  Said author, Coleman, is referenced 14 times by name in the majority opinion.

But what stood out to me was the bizarre argument throughout the majority opinion about relative risk, increased risk, and causation.  Anyone who has taken epidemiology 101 can parrot that correlation is not causation.  Essentially, science is all about theories and making your way as close to the “truth” as possible.  But will we ever know an absolute truth?  No, we wouldn’t.  This is 7th grade science people.  Stay with me.

The majority opinion states how the suicide disclosure cannot be misleading or irrelevant only if there is “medical and scientific uncertainty,” then goes on to say “in order to render the suicide advisory unconstitutionally misleading or irrelevant, Planned Parenthood would have to show that abortion has been ruled out, to a degree of scientifically accepted certainty, as a statistically significance causal factor in post-abortion suicides.”

So for example let’s say I have a theory that doughnuts cure cancer and I go out there and find some evidence of this and get published, but someone retorts saying this is blatantly false.  We now have medical and scientific uncertainty.  Fine.  But then according to the 8thcircuit the only reason I can’t force pediatricians to tell children to eat doughnuts is if I can show that doughnuts don’t cure cancer.   Doughnuts for everyone?

Now let’s return to 7th grade.   You can’t prove something is not a causal factor.  You can no less prove it is a causal factor.  You can be very sure one thing leads to another, e.g. smoking and cancer.  But proving that the doughnuts do not cure cancer is impossible, so it would be impossible to fulfill this alleged requirement.  Then what does the evidence tell us?

What we do know is that most scientists agree that risk of suicide does not increase with abortion.  There is some shaky evidence of a possible association between abortion and suicide due outside underlying factors, i.e. if you have poor mental health you are more likely to seek an abortion and more likely to be suicidal.   But it is a spurious relationship, it is the outside factor that connects them, the connection between the two is completely unfounded.

What is most upsetting is that the four dissenting justices even say how the majority recognizes that there is no proof in the literature that abortion causes suicide and that telling women that abortion causes an increased risk of suicide is untruthful.  They know this, they recognize it, and yet here we are.  Women across South Dakota will now be forced to listen to these lies before obtaining an abortion.   How is that not misleading and irrelevant?

Who is the 2012 Most Misogynistic Candidate? Rick Perry

9 Sep

Every election, whether it is for a local school board spot, a state governor or the White House, there are some candidates who can only be described as “out there.”  The guy running on a platform of legalizing marijuana – for medicinal and recreational use, Ralph Nader and his Green Party, and dozens of others.  What makes these candidates so “out there” is that, no matter how much money they raise or how many elections they run in, their views are wildly disparate from those that the rest of us hold.  Which means that no matter how bizarre their speeches or strange their platforms, most Americans can rest easy knowing that their chances of being elected are slim to none.

But what do you call a candidate who believes that Ohio’s so-called “Heartbeat Bill,” which will outlaw abortions if a fetal heartbeat can be detected, as early as six weeks of gestation, is something that should be rolled out to the rest of the country?

What do you call a candidate for President who signs a law in his home state which, were it not for the intervention of a federal judge, would force women seeking abortions to have (and pay for) sonograms and listen to the fetal heartbeat at least 24 hours prior to having their abortions?

Or  a man who wants to lead our country while forcing women who were the victims of sexual assault or incest to attest to that in writing before obtaining abortions?

This week, I have to call him Rick Perry, a man who the latest polls by ABC News and the Washington Post is in the lead to become the Republican contender in next year’s Presidential election.  Which either means that there is a lack of would be Republican candidates who care about woman or that there are more than just a few Republican voters who agree with Mr. Perry, who has been criticized for preferring to hew to an antiquated “Just Say No” style abstinence education plan in Texas, where he is Governor, rather than combat that state’s teen pregnancy rates, which have skyrocketed to become one of the highest in the country with more than 60 out of every 1,000 teenage Texan girls becoming pregnant.

What do you call Rick Perry, when he says that his abstinence only program “works” after being faced with those statistics?  Or the flock of pundits, politicians and voters who seem set on promoting his bizarre set of misogynistic values?

I’m calling it scary – what about you?

The $11,000 Convenience

5 Sep

A couple weeks ago I had a girls weekend with 2 very good friends. Both of them would describe themselves as feminists. My one friend was recently married but doesn’t expect to have kids any time soon. We were discussing birth control and sex, as we are wont to do. My married friend and her husband are very careful and use hormonal and barrier methods; I just use hormonal. She pondered what would happen if she got pregnant now. I piped up and told her that if she wasn’t ready for kids, she could have an abortion. She was quite taken aback by my suggestion that she have an abortion “for convenience.” In her mind, she is married, she has a house, they have jobs, albeit her job is as a TA while in grad school – she and her husband could afford a child, and thus an abortion would be for mere “convenience.” As I am wont to do, I stated in no uncertain terms that if I got pregnant before I was ready, I would have an abortion.

Antis love to talk about how women have abortions for “convenience.” The definition of which is a moving target depending on which anti you speak with. I am currently reading Delusions of Gender by Cordelia Fine. While little of it surprises me, it is very eye opening. She references hundreds of studies that have been done to discredit any notion that gender is innate. Many of these studies illustrate how women are constantly subjected to moving targets. In a series of studies, researchers demonstrated how participants would mould a job that was traditionally male in such a manner so as to make it fit the strengths of a male applicant. For example, when the job was as a construction manager, 1 applicant had more education and less experience and the other had more experience and less education. When sex was not mentioned, 76% of male undergrads strongly preferred the more educated applicant. When sex was mentioned, 75% preferred the better educated male candidate over a female candidate with more industry experience. But when the female applicant had more education, only 43% preferred her over the male with more experience (Norton, Vandello & Darley, 2004). In a similar study involving a police chief position when the applicant was a male, participants placed greater value on whatever skill he possessed more of, be it education or experience, more than the skill he possessed less of, so as to mould the job to fit his skills (Uhlmann & Cohen, 2005). As the researchers wryly stated, it is not a matter of picking the right person for the job, it’s picking the right job for the man. No matter what, when a job is traditionally male, women face a moving target that cannot be met.

When discussed in relation to motherhood notions of gender are even more punishing for women. In a study using identical resumes for 2 women, participants consistently rated the mother as 10% less competent and 15% less committed than the non-mother. Only 47% of mothers compared with 84% of non-mothers were recommended for hire as head of the marketing department for a start-up communications company. Not only that, but the mother was docked in her salary by a whopping $11,000 (Correll, Benard & Paik, 2007). When antis discuss abortion as a matter of convenience, are they considering that a mother is less hireable and worthy of significantly less salary than non-mothers? How can $11,000 be considered a matter of convenience? In a follow up study, employers were sent resumes for 2 applicants, both of the same gender. Men, whether they had kids or not, received the same number of call-backs. But women who had kids were subjected to a significant “motherhood penalty” and received half as many call-backs as their identically qualified childless counterparts (Crosby, Williams & Biernat, 2004). And the kicker? Women are punished for displaying “masculine” traits such as aggression just as much as they are punished for displaying “feminine” traits such as compassion (eg. Bolino & Turnley, 2003, and others).

Nothing about those statistics is a matter of convenience. I do not believe that any abortion can be said to have be done for mere convenience sake when mothers face this sort of discrimination. This is not even about career advancement, but simply hiring. The fact remains, if you are a mother you are less likely to be brought in for an interview, less likely to be hired, and you are going to be paid less. How can the inability to get interviews, get hired, or get paid be considered matters of convenience? The fact is abortions for convenience sake are a myth.

Abortion and “The Fly”

2 Sep

Recently I watched “The Fly” (the 1986 version) for the first time. I have had this film on my shelf for almost two years now; my reason for avoiding it was that I am obsessed with Jeff Goldblum and I was afraid that seeing him all gross and decomposing would make me love him less. I know how ridiculous that sounds.

The thing about being completely in love with Jeff Goldblum is that, unlike many other stars to whom I am attracted, he tends to, in general, make pretty good movies. I think this must be difficult as an unconventionally attractive person, particularly one with a very distinctive cadence, so it is all the more admirable that the Goldblum ouevre has very few misses. So I was fairly confident that “The Fly” would be good.

For those who haven’t seen it, I highly recommend it – but I also recommend staying away from this post until you have seen it; I know it’s ridiculous to post spoiler warnings for a 25-year-old film, but I do plan to discuss a plot point that I did not know about before watching and I just want to make sure you’re prepared. Also I find it tiresome to do plot summaries so if you haven’t seen it and want to keep reading, better start googling.

“The Fly” has been understood in some circles as a cinematic metaphor for AIDS, although David Cronenburg was reportedly surprised by this interpretation as he had intended the film to be about disease, aging and death in general. In the cultural context of the 1980s, though, even an unintentional reference to AIDS makes a lot of sense and the interpretation has stuck – even I thought that was what it was about, going in. What I didn’t know was that this film deals unflinchingly with the abortion issue and more generally with bodily autonomy.

What I loved about the abortion theme was that there was no hemming and hawing over the politics of it; it was simply a choice that Veronica needed to make, and once she made it even the slimeball ex-boyfriend was fully ready to help her out. If this film was made today I am certain that either the pregnancy storyline would have been cut altogether, or there would have had to have been some obligatory consideration of the “pro-life” viewpoint before she could ultimately go ahead with it. How dreary it is that we have regressed so much.

There are moments in the film that were so real, I felt as if Cronenburg (and Geena Davis) must have spent some time hanging out in the counselling offices of abortion clinics. When Veronica sees Seth in the last stages of deterioration and decides she needs to go ahead with the abortion immediately, Stathis reminds her that it is the middle of the night. “I need it out of me! Now!” she screams. What clinic staffer hasn’t seen that level of desperation before? I know this is Goldblum’s star-making role but I think Davis was note-perfect. Her whole story is a woman who falls in love with someone who changes, and becomes something different than she thought – whether from disease, or obsession – and when she finds herself pregnant, she has to decide how much of that man she wants in her life through the potential child. Also it might end up being a giant maggot. We’ve all been there. And Seth’s fear that the child might be all that is left of the pre-disease him…I have a friend whose partner died, and at the funeral his mother said to her (my friend) that she had hoped she might be pregnant, that her son might have left her with a part of him to carry on. This is a real thing in the world.

I was thrilled to find this plot in “The Fly” – it’s not unlike going back to rewatch “Dirty Dancing” and finding the abortion part, that I didn’t understand as a child, is actually amazing and realistic and integral to the story and themes. It’s not so much about films showing abortion as it is about them portraying it realistically. Everything about “The Fly” is a total mind fuck (this is Cronenburg after all), so finding this ridiculously straightforward, unquestioned abortion plot is such an unexpected gem.

Of course, after Veronica decides to have the abortion, Seth kidnaps her from the operating table and brings her back to the lab, where he wants to fuse himself to her and the baby, creating “the perfect family”. Holy social commentary, batman! At this point I may have been reading too much into it but I really think there is a lot going on here regarding not just Veronica’s immediate physical safety and that aspect of bodily autonomy, but also the idea of the nuclear family and gross antichoice dudes who won’t “let” their girlfriends have abortions. And the idea of marriage as a solution for unintended pregnancies. It’s 1986. There is a lot going on, friends.

Obviously there are a lot of themes interwoven throughout “The Fly” and it is not just a straight up horror movie, but I think bodily autonomy is one of the main ones and it manages to deal with a lot of complex issues around that, possible because it buries them in horror. It’s like Frankenstein! Or more contemporarily, it reminded me a lot of “District 9” (upon which it was clearly a huge influence). But it really can be viewed as a complex narrative of the abortion decision: the feeling of violation, the uncertainty about who the baby might be if it is born, the complicated emotions of the men involved, the urgency – it was all there.

Nothing delights me more than when I consume some pop culture that is unexpectedly feminist. And best of all, the makeup effects were so good I could barely even tell it was Jeff Goldblum under there, so my undying love emerges undamaged. Good movie night.

Having One-Minus-One Choices

15 Aug

A guest post from Gretchen Sisson.

Last week’s New York Times Magazine featured an article “The Two-Minus-One Pregnancy” about the reduction of multiples pregnancies – that is, the selective abortion of one or more fetuses to reduce twins to singletons. Given the risks associated with higher order multiples births (triplets or more), it’s a fairly accepted procedure to reduce to twins. However, the focus of this article was reducing to one, even when the chance of having healthy twins is high.

As a medical procedure, selective reduction is different than abortion; it does not involve the evacuation of the uterus. However, the discussion around reduction has interesting overlaps with the discussion around abortion given that a) they both involve the death of a fetus and b) they both place a burden on the woman seeking the procedure to justify why she is doing it.

The article describes two doctors whose positions on reduction have shifted. The first, Dr. Evans first opposed twin reductions:

Two years later, as demand for twin reductions climbed, Evans published another journal article, arguing that reduction to singletons “crosses the line between doing a procedure for a medical indication versus one for a social indication.” He urged his colleagues to resist becoming “technicians to our patients’ desires.”

While the article goes on to say that Dr. Evans now endorses the practice of twin reductions, other providers remain adamantly opposed. One sonographer says:

“I told him [the doctor] I just wasn’t comfortable doing a termination of a healthy baby for social reasons, and that if we were going to do a lot of these elective reductions, I thought he should bring in someone else who was more comfortable. From the beginning, I had wrestled with the whole idea of doing reductions, because I was raised in the church. And after a lot of soul searching, I had decided there were truly good medical reasons to reducing higher-order multiples to twins. But I had a hard time reconciling doing reductions two to one. So I said to Dr. Wapner, ‘Is this really the business we want to be in?’ ”

I struggle with these doctors’ perspectives on reduction for several reasons. The first is that, while the article claims that at Dr. Wapner’s medical office “every one of them — the sonographer, the genetic counselors, the schedulers — supported abortion rights” their stance places the burden on the women to have “good” reasons, here defined as medical reasons, for wanting a reduction. “Social” reasons (finances, only wanting to have one child at this time, etc.) are, in their opinion, not good enough.

And, I’m sorry, but that’s not good enough for me. That’s not trusting women to make their own choices about the number and timing of their children. Many of the women in the article who choose to reduce twins are desperate to have only one baby: they consider aborting the entire pregnancy because they can’t obtain or can’t afford a safe reduction, and, as desired as these pregnancies are, they would rather have no children than two. Another woman carrying triplets says she “felt like the pregnancy was a monster” and eventually paid $6,500 for a reduction. She describes leaving the doctor’s office:

“I went out on that street with my mother and jumped up and down saying: ‘I’m pregnant! I’m pregnant!’ And then I went and bought baby clothes for the first time.”

Forcing a woman to carry twins when she is not emotionally, financially, or physically prepared to raise two children is no better than forcing a woman to carry a singleton pregnancy when she wants no children. It is a simple matter of choice.

The second reason I struggle with providers’ reluctance to do twin reductions is that they are often part of the reason women are pregnant with twins in the first place.

For part of my doctoral dissertation, I interviewed couples that were struggling with infertility. They visited doctors who could not explain why they were not getting pregnant, and could then not explain why their treatments were failing. Medicine offers few concrete answers to infertility, and in vitro fertilization will sometimes not work at all, or can work too well and end with a multiple pregnancy. (I spoke with one couple who had no healthy fertilizations one month, and 29 fertilizations the next – but no successful transfers from test tube to uterus. The doctor could not explain to them why this happened. Stories like this are common.) So much of fertility treatment remains, in the words of the women I interviewed, an “art rather than a science,” “a matter of luck”, or “just like rolling a dice.”

Furthermore, because of the high cost of fertility treatments, some couples will make decisions that seem counterintuitive: desperate for one baby, they’ll transfer two or three embryos in the hopes that at least one will implant, simply because they can’t afford another IVF cycle. Then they end up with triplets and find they aren’t prepared for multiples, and can’t find a doctor that will help them reduce to the one child for whom they are desperate.

Pregnancy reduction is only one of the more obvious areas where infertility treatment intersects with traditional, abortion-focused considerations of reproductive rights. The pursuit of pregnancy when faced with biological challenges (and the consequent financial and logistical barriers) should be as much as part of a broader “choice” framework as the avoidance of pregnancy. I’d like to challenge pro-choicers to include considerations infertility and access to safe, affordable, and respectful assisted reproductive technologies in their paradigm for reproductive justice.

Gretchen Sisson recently completed her doctorate in sociology, writing her dissertation on the “right” to parenthood: who has it, why some don’t, and how society enforces its ideal of an acceptable pursuit of parenthood. To examine these questions, she spoke with couples pursuing infertility treatments, teen parents and teen pregnancy prevention advocates, and birthparents who have placed infants for adoption.