In a recent New York Times op-ed, Saad Omer, an associate professor of global health, epidemiology, and pediatrics at Emory University, suggested several reasonable measures to “nudge” vaccines skeptics into vaccinating their children. “We should borrow a concept from behavioral economics,” he argued, and institute administrative measures that make it more difficult to opt out of vaccination through “personal belief” exemptions:
[States] can require parents to write a letter elaborating on the reason their child should be exempt. They can require that the letter be notarized. They can insist that parents read and sign a form that discusses the risks of nonvaccination. Better yet, they should mandate in-person counseling so that the decision not to vaccinate is truly informed.
These are all good recommendations and I agree with them. They are minimally intrusive on an individual parent’s liberty, and the minimal intrusion is justified by the threat nonvaccination poses to public health.
But there’s an irony here. State officials have been hesitant to limit the liberties of the “anti-vaxxers,” lest they anger certain constituents, but the suggested roadblocks (e.g., letter writing and in-person counseling) are miniscule compared to the obstacles already erected in many states to make it more difficult for women to access abortion. It’s a glaring inconsistency that underscores how intrusive abortion restrictions have become and how little women’s reproductive freedom is valued relative to other liberties.
Many states have allowed parents the freedom to opt out of vaccines if they merely cite — never mind explain or defend with good reasons — a personal, “religious,” or “philosophical” objection to vaccines. As has become abundantly clear, these exempted individuals put the rest of society (as well as their own innocent, nonconsenting children) at risk for diseases like measles that were once declared eradicated in the United States. New Jersey Governor Chris Christie fanned the flames of this controversy by unhelpfully framing vaccination as a personal liberty issue rather than a common sense public health requirement. And, rather oddly, the freshman Senator from North Carolina, Thom Tillis, similarly tried to pander to his liberty-loving constituents by claiming restaurant employees need not be required to wash their hands after using the bathroom.
Juxtapose these developments with anti-abortion activists’ steady and stealthy encroachment on the freedom of women to access legal abortion services. Over the last 20 years, we have seen state after state erect obstacles to women’s access to abortion, obstacles that have been inspired by the same logic behind Dr. Omer’s recommendations: “nudge” individual behavior in the desired direction by instituting administrative measures that make obtaining an abortion more difficult, more expensive, more time consuming, more unlikely.
For example, according to the Alan Guttmacher Institute, several states have made ultrasound a part – sometimes a mandatory part – of receiving an abortion:
Since routine ultrasound is not considered medically necessary as a component of first-trimester abortion, the requirements [for ultrasound] appear to be a veiled attempt to personify the fetus and dissuade a woman from obtaining an abortion. Moreover, an ultrasound can add significantly to the cost of the procedure.
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Three states mandate that an abortion provider perform an ultrasound on each woman seeking an abortion and requires the provider to show and describe the image; 10 states mandate that an abortion provider perform an ultrasound on each woman seeking an abortion, and require the provider to offer the woman the opportunity to view the image; 9 states require that a woman be provided with the opportunity to view an ultrasound image if her provider performs the procedure as part of the preparation for an abortion; 5 states require that a woman be provided with the opportunity to view an ultrasound image.
Many states also require counseling and waiting periods before a woman may obtain an abortion. Certainly one motivation for counseling is to ensure basic informed consent is taking place. Most states (35) require that women receive counseling before an abortion is performed. However, the waiting period can create a real roadblock:
Twenty-six states require women to wait a specified amount of time—most often 24 hours— between the counseling and the abortion procedure; 11 states require that counseling be provided in person and that the counseling take place before the waiting period begins, thereby necessitating two separate trips to the facility.
Another well-known strategy of anti-abortion activists who want to deter abortion is to introduce TRAP bills (Targeted Regulation of Abortion Providers), which are policies that ask abortion providers to “go beyond what is necessary to ensure patients’ safety.” In some states, the regulations imposed on abortion service providers have been so onerous that many or most of the state’s abortion clinics have closed.
So, it is in this environment, where women’s reproductive freedom has been so egregiously trampled, that we wring our hands over requiring parents to vaccinate their children against measles, whooping cough, polio, and the like. We are granting nearly absolute freedom to ill-informed parents to put their own living children and other people’s children at risk for potentially fatal diseases through opting out of vaccination. At the same time, we are increasingly denying women the freedom to terminate early-stage pregnancies — a decision that legally and morally belongs in the hands of the women themselves.
As Judith Jarvis Thompson pointed out in her famous pre-Roe vs. Wade defense of abortion, “Indeed, with one rather striking class of exceptions, no one in any country in the world is legally required to do anywhere near as much as this for anyone else. The class of exceptions is obvious.”[1] For women carrying unwanted pregnancies, duty to others must come first. For everyone else, apparently, liberty reigns supreme.
[1] Judith Jarvis Thompson, Philosophy & Public Affairs, Vol. 1, no. 1 (Fall 1971).
