Ultrasound: For Some CPC Clients, It's not Enough [SK]

Lots of optomistic talk today at NRO and other sites about ultrasound changing the debate over abortion. I agree: it's a great tool, but are we too optomistic? I'm reposting the following for consideration.

Friday night I spoke to a gathering of pro-life crisis pregnancy center directors (and staff) in Naples, Florida. One of my points was this: Although ultrasound is a wonderful tool for reaching abortion-minded women, sometimes it's not enough. Stronger, more provocative images may be needed (with the client's consent, of course) if we are to save lives. I no sooner made that point when this appeared in yesterday's New York Times:

Kori, 26, who was having her third abortion, asked to watch the procedure on the ultrasound monitor. "I wanted to see what it was like," she said. "It was O.K. to watch. Once you had your mind made up to do it, you just suck it up and go with it."

And this:

Venetia Grunder, 21, viewed an ultrasound image of the fetus in her womb. She was 12 weeks pregnant, though she had taken birth control pills as directed. "I feel pretty messed up," she said after seeing the image. "It's different, just knowing. My husband told me not to look. This changes my feelings, but I'm sticking by it. Damn it, $650, I'm sticking by it."

Problem is, her feelings didn't change quite enough.

Admittedly, the use of abortion pictures by pro-life pregnancy centers is a controversial subject. So, let me be clear about two points: First, I'm not claiming that graphic images work in every case. Sometimes a client is so hardened that we simply cannot reach her. Second, I don't think for a moment that every woman visiting a CPC needs to view these pictures. However, it doesn't follow from this that CPCs should never offer them. Sometimes abortion pictures do what ultrasound cannot: reawaken a client's moral intuitions.

As former CareNet center director Suzanne Genit points out, there are five types of abortion-minded clients:

Type #1: Responds to loving support, chooses life.
Type #2: Responds to information on fetal development—chooses life
Type #3: Responds to descriptions of abortion techniques—chooses life
Type #4: Remains unmoved by love, facts/information, and verbal descriptions of abortion techniques, but responds to graphic abortion videos—chooses life.
Type #5: Hardens her heart to all information—chooses abortion.

Genit’s point is that clients 1 to 3 do not need graphic depictions of abortion. For those women, it's true: Ultrasound and/or clinical descriptions are suitable alternatives. Client #4 is different. In her case, ultrasound misses the mark because it does not speak to the truth about abortion. It speaks to the humanity of the unborn, not the inhumanity of abortion, which is the act she contemplates. True, clinical descriptions of abortion address this concern, but it’s a stretch to assume that in a visual society like ours, they communicate the brutal reality of abortion as effectively as pictures. Gregg Cunningham is correct: If client #4 is not more horrified of abortion than she is terrified of her own crisis pregnancy, her baby will die. Given what’s at stake, it’s not enough for her to simply imagine this horror. We must at least offer her the chance to see it.

Nationally, pro-lifers have struggled for years to reach African-American women, a group that represents 12% of the population but has 35% of all abortions. You would think that if anyone would take offense at graphic pictures, it would be these women.

That’s not the case. According to a study conducted by the Center for Business and Economic Research at the University of Dayton (OH) and commissioned by Dayton Right to Life, graphic abortion pictures resonate powerfully with black women. Those with abortion experience are especially determined in their opinion, stating they would have never aborted had they seen the images first. Dayton Right to Life summarizes the research as follows:

One of the most interesting revelations of the research clearly demonstrates that graphic images of aborted unborn babies are highly effective within the African American community. This comes as a surprise to veteran pro-lifers who have seen the movement shy away from using this tool. There has been a concern that they are inflammatory and that they burden the consciences of women who have had abortions. Researchers found none of these negative reactions among African Americans….

[Researchers] were so struck by this finding that they repeatedly tested this, using various methods of testing. The results were always the same. The final focus group resulted in 100% of the participants feeling that graphic pictures were the most effective element in the literature.
***
The second piece [of literature] is geared toward pregnant women facing an unexpected pregnancy, with additional information that gives it a broader appeal. This brochure includes graphic pictures of aborted babies which have proven so effective when working within the African-American community. Researchers frequently noted a dramatic shift in attitudes after such photographs were viewed.

Nonetheless, some pro-life leaders insist that CPCs should never risk using these pictures. A CPC staffer once told me that he would not allow them because "our job is not to upset the client, but to meet her emotional and spiritual needs.”

I agree, but only in part. While the staffer is correct to say that CPCs must address the woman's emotional concerns, he is wrong to assume this means categorically rejecting graphic visual evidence. Are we to conclude that women can't be trusted to look at abortion objectively? As feminist author and abortion advocate Naomi Wolf points out, this view is condescending to women and treats them as less than full moral agents:

The pro-choice movement often treats with contempt the pro-lifers' practice of holding up to our faces their disturbing graphics....[But] how can we charge that it is vile and repulsive for pro-lifers to brandish vile and repulsive images if the images are real? To insist that truth is in poor taste is the very height of hypocrisy. Besides, if these images are often the facts of the matter, and if we then claim that it is offensive for pro-choice women to be confronted with them, then we are making the judgment that women are too inherently weak to face a truth about which they have to make a grave decision. This view is unworthy of feminism.

If clients are looking to us for help exploring all of their options, we should honor their wishes and respectfully offer visual evidence, including abortion pictures. That is the compassionate thing to do. After all, what is worse: a client seeing an abortion or actually having one because we prejudged her ability to handle all the relevant facts?

Tim Wiesner, Director of Choices Medical Clinic, underscores Wolf’s insistence upon truth. Choices Medical Clinic is adjacent to Dr. George Tiller’s notorious late-term abortion center in Wichita, Kansas. Nonetheless, Choices has a solid reputation for reaching abortion-minded clients. Part of its strategy includes graphic visual aids. Wiesner explains why gruesome pictures--when used appropriately and with the client’s consent--are not manipulative. Rather, they save lives and impact clients positively:

We tell each woman what [counseling techniques] we offer. These include items some CPCs may find objectionable, such as the “Harder Truth” video, abortion instruments, and a suction machine. We let the clients choose what items to view. You can't predict what will strike a chord with them. Sometimes the ultrasound does the trick, sometimes not. Sometimes it’s the abortion instruments. Sometimes it’s the “Harder Truth” or the suction machine. The point being that we need multiple points of influence to grapple for the life of that baby. Clients sign an informed consent prior to viewing the “Harder Truth.” They hold the remote and can stop it at any time. We’ve had only one person who agreed to watch it resent us for it. Meanwhile, there are countless stories of women choosing not to abort because they did watch it. Sometimes, it may not influence the client, but it may influence her friend who accompanied her to our clinic. That friend will then begin trying to influence the client not to abort.

Every client completes an exit interview prior to leaving the clinic. Over 99% say they would return, that they trust us, and that they would recommend us to their friends if they were in similar circumstances. If it’s their choice to have an abortion, let them choose what intervention may help them avoid one as well.

In short, graphic visual aids are appropriate (and powerful) tools of persuasion when the client consents to view them. It simply does not follow that because pictures are graphic, they are intellectually dishonest and manipulative. First, the clients are not coerced in any way but choose for themselves the kind of counseling they want. Second, far from being traumatized, the clients respond with trust in virtually every case (99%). Third, many women choose not to abort specifically because of this approach. Simply put, Wiesner’s “multiple points of influence” approach works, and I think that CPCs should give some careful thought to why it’s so effective.

I conclude with these suggested recommendations for CPCs using graphic visuals:

1. The CPC/medical clinic should have a written policy (protocol) on the use of graphic pictures and videos. The policy should instruct CPC staff volunteers to remain in the room with a client who is viewing a graphic video. This will allow the pregnant woman to ask questions and protect the center against false claims of what transpired.
2. A simple consent form should be used with any client who agrees to see a video. The form should state that the client is free to turn off the video at any time. It’s a good idea to actually place the remote control device in the hand of the client and instruct her where the on and off buttons are located.
3. CPC staff members should be trained to discern which (if any) videos will best meet the needs of the client. These videos should be respectfully offered and, if rejected, the client must still be treated with deference and compassion.
4. CPCs must choose adequately trained people to counsel women contemplating abortion. If a prospective counselor is too tenderhearted or emotionally sensitive to offer graphic videos in appropriate cases, she is not a good candidate for a counseling position. Thankfully, she can serve the CPC in other ways.