TITLE
by
Student’s Name
A project prospectus submitted to the Johns Hopkins University in conformity with the
requirements for the degree of Master of Arts in Government
Baltimore, Maryland
Month, Year
© Your Name Year
All rights reserved
TABLE OF CONTENTS
PROJECT PROSPECTUS ...........................................................................................................................1
TITLE.............................................................................................................................................................1
QUESTION(S) ADDRESSED ......................................................................................................................1
ISSUES AND BACKGROUND ...................................................................................................................2
IMPORTANCE OF RESEARCH................................................................................................................2
LITERATURE SURVEY .............................................................................................................................3
COMPETING HYPOTHESES ....................................................................................................................7
METHODOLOGY ........................................................................................................................................7
CONCLUSION (CONFIRMING DATA) ................................................................................................. 13
BIBLIOGRAPHY ....................................................................................................................................... 15
LITERATURE .............................................................................................................................................. 15
INTERNET SITES ......................................................................................................................................... 16
ii
LIST OF TABLES
Table 1. Actors, Beliefs, and Voting Records .................................................................... 8
Table 2. Country Comparison ........................................................................................... 12
LIST OF FIGURES
Error! No table of figures entries found.
iii
Project Prospectus
Title
The Next Battleground of Abortion: The political feasibility of the distribution of
Mifepristone
Question(s) Addressed
RU-486 will play a major role in women’s reproductive health in the near future and its
availability will either help or hinder the choices or freedoms women will have in
deciding what outcome their unintended pregnancy will have. If there is going to be any
balance between a woman’s freedom to choose and a baby’s right to life the question of
how to fairly distribute the drug must be looked into from a politically feasible
standpoint. That balance can help direct the Legislature in enacting a law that will save
the lives, both literally and figuratively, of mothers and unborn fetuses over the course of
time.
If observed closely, the positions of the actors (i.e., legislators, department chiefs,
lobbyists, and members of the opposing groups) can be predicted in the policy making of
how RU-486 will be distributed. With careful analysis of these actors they can be
affected to give maximum access to the drug while also giving the unborn as much of a
possibility to live. Also, a major concern of the Pro-Life advocates is that Mifepristone
will increase the rate of abortions in the United States; if this is not true then it can help
alleviate some of the tension that the distribution of the drug will surely create.
1
The study will concentrate on the actors, their motivations and beliefs, and the possible
final outcome of the policy or law that they will decide on. It will also attempt to identify
the first few sites that will be critical in the actors’ legislative decision-making process.
Issues and Background
Since the 1973 Supreme Court ruling on Row versus Wade, there have been two sides
that have hotly contested either allowing more abortions to occur (Pro-Life advocates) or
reducing the availability to terminate fetuses (Pro-Choice advocates),1 and finding a
middle ground has become a political necessity. The ongoing debate has been given over
to the state governments to determine how to best fund and protect abortion sites and
clinics, if at all. Therefore, it will be hard to predict the outcome of the Federal Food and
Drug Administration’s recent approval of the drug Mifepristone (RU-486) on the overall
population of women without first seeing how these two groups differ philosophically.
Importance of Research
The importance of just trying to broach the subject of abortion with political players such
as individual members of Congress, the Secretary of the Department of Health and
Human Services, Pro-Life advocates and Pro-Choice advocates, and others players
without an enormous backlash of opposition cannot be overstated [simply saying it
cannot be overstated does absolutely nothing to convince a reader that the research is
important]. This research attempts to the middle ground of a very polarized debate.
There, in addition, is a question of more subtle importance: will RU-486 increase the
1
Fulfilling the Promise: Public Policy and US Family Planning Clinics. The Alan Guttmacher
Institute Washington, DC, 2000: 7.
2
number of abortions in the United States? The major concerns in this thesis are on this
issue and this question.
Literature Survey
I have just started the quest for information on the effects of Mifepristone on American
Society. As I have not yet mastered the entirety of the subject matter I can only present
information that I have already stumbled upon. This undoubtedly will become more
extensive as my thesis takes more of a form.
Henshaw SK and Van Vort J, Abortion services in the United States, 1991 and 1992,
Family Planning Perspectives, 1994, 26(3): 100–106 & 112. This gives a good beginning
background as to what clinic services are available in the United States as well the
numbers of abortions and clinic sites in the United States.
Childbirth by Choice Trust, 1996 Childbirth by Choice Trust 344 Bloor St. W. #502
Toronto, Canada M5S 3A7 416-961. An excellent source that will give me information
on studies on RU-486 that exists outside the US statistics (e.g., Britain, France, Western
Europe).
“The safety and effectiveness of the abortifacient RU486 in foreign markets:
opportunities and obstacles to U.S. commercialization: hearing before the Subcommittee
on Regulation, Business Opportunities, and Energy of the Committee on Small Business,
House of Representatives, One Hundred Second Congress, first session, Washington,
DC, December 5, 1991.” United States. Congress. House. Committee on Small Business.
Subcommittee on Regulation, Business Opportunities, and Energy. Legislative
3
information on Mifepristone that gives an idea of the political “climate” prior to the
Clinton Administration. It seems to be more important now that Bush (Pro-Life
administration) has been elected to the Presidency2.
Speaking of Abortion: Television and Authority in the Lives of Women. Andrea Lee
Cole, Elizabeth R., Chicago, Illinois: University of Chicago Press, 1999. During a four
year period, the authors went into the homes of women of all classes and interviewed
them about their attitudes toward abortion. The discussions revolved around the portrayal
of abortion on television, which primarily views abortion as a dilemma for the poor and
the working class.
The authors found that women who were Pro-Life were unified in their beliefs no matter
what class they belonged to, and that they shared a skepticism about using the media as a
source of information. The authors further found that Pro­Choice women’s beliefs were
divided along class lines, with working-class women defending a woman’s right to
choose because, as a group, these women feel under constant threat from legal
authorities. In contrast, middle­class women’s arguments were based on the rights of the
individual and, further, frame abortion as a necessity for those who are unable to afford
having children. This leads the authors to argue that many middle-class Pro-Choice
women “share the same point of view as displayed on television.”
This volume is meant to clarify “the rhetoric surrounding the abortion debate” and allows
one, “to hear ordinary women discuss one of America’s most volatile issues.
2
Same as #2.
4
Abortion: “Medical versus surgical abortion: a survey of knowledge and attitudes among
abortion clinic patients.” Virgo, Katherine S. Carr, T.R. Hile, Allison Virgo, John M.
Sullivan, George M. Kaikati, Jack G. Women’s Health Issues 9(3), May 1999: 143-154.
The authors conducted a survey of 405 abortion clinic patients to ascertain their level of
knowledge of the risks and benefits of RU 486 as a method of abortion, as well as their
knowledge of and attitudes toward medical abortion versus surgical abortion. The
respondents were patients at an abortion clinic in southern Illinois that serves women
from a 10-state area and is one of the largest in the country.
The questions in the survey covered: socio-demographic characteristics; reproductive
history; history of contraceptive use; decision-making process regarding current abortion;
and knowledge and attitudes regarding medical abortion versus surgical abortion. The
questions about RU-486 included a section that described the process of medical abortion
using RU-486, including the necessity for the total of three clinic visits.
Seventy-six percent of the respondents showed interest in learning about RU-486; 40.5%
reported “they would use birth control more often if RU-486 were available.” A little
more than 51% said they would be willing to return for the two follow-up clinic visits,
“though a need for substantial educational efforts prior to making RU-486 widely
available in the United States is still in evidence,” according to the authors.
“Pain Penance and RU 486: Pill isn’t likely to change the difficult emotional calculus of
abortion” Washington Post by Hanna Rosin Oct 14, 2000. The author introduces the
concept that not all the decision of having an abortion rests on the convenience of the
drug. Share the case study of a woman who has made the decision to use the drug.
5
Fulfilling the Promise: Public Policy and US Family Planning Clinics. The Alan
Guttmacher Institute Washington, DC, 2000: 7. Another good guide to the resources and
clinics available in 1990’s for women. It is very comprehensive and covers everything
from Title X (Public policy that allows for federal funds to be used for contraception and
family planning) to the challenges and resources for continued research.
The Medical Letter: On Drugs and Therapeutics. New Rochelle, NY; October 2000,
42:101-102. The leaflet gave some medical terminology and information on the clinical
use of mifepristone.
“Political Feasibility and Political Analysis”. Meltzer AJ. Public Admin Review;
Nov/Dec 1972, 32:6:859-867. This is the major resource used for analysis. It was the
basis of how this thesis took form.
I also used the following websites for my information: www.senate.gov: for Senate
legislative information, party affiliation, and voting habits; www.house.gov: for House of
Representatives
legislative
information,
party
affiliation,
and
voting
habits;
http://thomas.loc.gov/: for more information on the Congress’s legislative information,
party affiliation, and voting habits; www.agi-use.org: The Alan Guttmacher Institute Site;
www.plannedparenthood.org/index.html: Planned Parenthood Federation of America
Site; www.fda.gov: The U.S. Food and Drug Administration; www.dhhs.gov: The U.S.
Department of Health and Human Services and The Pro-Life Views Site:
http://prolife.about.com/newsissues/prolife/mbody.htm.
6
Competing Hypotheses
There are three possible outcome hypotheses that can be derived from my original thesis
and they are:
1)
Extreme Right Hypothesis: If there is no distribution of Mifepristone, then there
will be fewer abortions. This hypothesis is one of the major tenets of the Pro-Life
advocates. They believe that the approval of the drug will directly increase the
number of abortions in the United States.
2)
Extreme Left Hypothesis: If there is complete and unsupervised distribution of
Mifepristone to all physicians regardless of whether there is the support network
in place already (i.e.: counseling centers in clinics, follow up visit to therapist,
etc), then there will be a greater choice for women who seek an abortion. This is
the main belief of the Pro-Choice advocates. They believe that the choice of
women seeking an abortion should not be restricted in any way. Therefore, RU486 should be accessible everywhere to everyone who is seeking an abortion.
3)
Middle-of-the-Road Hypothesis: If distribution is regulated to supply only places
that have the capability already in place to have surgical abortions, then the
number of abortions will remain constant and the information gathered from other
countries can be used as a directional tool for further information.
Methodology
This thesis will be gathering the following information as research material:
1)
Chart the actors and their political beliefs along with their prior voting histories in
regards to women’s health issues such as abortion rights, contraceptive rights,
welfare rights, and maternal morbidity views. This thesis will only use national
actors, because initially this is where the legislation is going to come from. This
will give a good overview of the political climate that US is currently in and
therefore observe whether one, two, or all three hypotheses are possible. (See
Table 1 below)
7
Table 1. Actors, Beliefs, and Voting Records
Actor(s)
Senate3
Members
(Will break
down into
individual
Senators)
Partisanship
Democrat,
Republican,
or Other
Women’s Health Issues: History of Beliefs
Yea or Nay for the following Women’s Health Issues
in the 2000 Legislature:
S. 3157: To require the Food and Drug Admin to
establish restrictions regarding the qualifications of
physicians to prescribe the abortion drug commonly
known as RU-486;
S. 1692: To amend title 18, United States Code, to
ban partial-birth abortions;
S. 661: To amend title 18, United States Code, to
prohibit taking minors across State lines in
circumvention of laws requiring the involvement of
parents in abortion decisions;
S. 1605: To establish a program of formula grants to
the States for programs to provide pregnant women
with alternatives to abortion, and for other purposes;
S. 326: To improve the access and choice of patients
to quality, affordable health care;
S. 1344: To amend the Public Health Service Act, the
Employee Retirement Income Security Act of 1974,
and the Internal Revenue Code of 1986 to protect
consumers in managed care plans and other health
coverage;
S. 976: To amend title V of the Public Health Service
Act to focus the authority of the Substance Abuse and
Mental Health Services Administration on
community-based services for children and
adolescents, to enhance flexibility and accountability,
to establish programs for youth treatment, and to
respond to crises, especially those related to children
and violence;
House of
Representativ
es4
(Will break
Democrat,
Republican,
or Other
Yea or Nay for the following Women’s Health Issues
in the 2000 Legislature:
H.R. 5385: To require the Food and Drug Admin to
establish restrictions regarding the qualifications of
3
www.senate.gov and http://thomas.loc.gov/ websites used for information.
4
www.house.gov and http://thomas.loc.gov/ websites used for information
8
down into
individual
House
Members)
physicians to prescribe the abortion drug commonly
known as RU-486
H.R. 3660: To amend title 18, United States Code, to
ban partial-birth abortions;
H.R. 3400: To provide that the inferior courts of the
United States do not have jurisdiction to hear
abortion-related cases;
H.R. 2901: To establish a program of formula grants
to the States for programs to provide pregnant
women with alternatives to abortion, and for other
purposes;
H.R. 1218: To amend title 18, United States Code, to
prohibit taking minors across State lines in
circumvention of laws requiring the involvement of
parents in abortion decisions;
H.R. 3000: To establish a United States Health
Service to provide high quality;
H.R. 4365: To amend the Public Health Service Act
with respect to children’s health;
H.R. 1200: To provide for health care for every
American and to control the cost and enhance the
quality of the health care system;
Department of
Health and
Human
Service5: Sec.
Donna E.
Shalala.
Democrat,
Republican,
or Other
(Will use
Head of
Department as
main actor)
Programs set up for Women’s Health Issues under
current leadership:
The department oversees more than 300 programs,
covering a wide spectrum of activities. Some
highlights include:

Medical and social science research
 Preventing outbreak of infectious
including immunization services

disease,
Assuring food and drug safety
 Medicare (health insurance for elderly and
disabled Americans) and Medicaid (health insurance
for low-income people)

5
Financial assistance for low-income families
www.dhhs.gov websites used
9

Child support enforcement

Improving maternal and infant health

Head Start (pre-school education and services)

Preventing child abuse and domestic violence

Substance abuse treatment and prevention
 Services for older Americans, including homedelivered meals
 Comprehensive health services delivery for
American Indians and Alaska Natives
Different
Medical
Societies
Democrat,
Republican,
or Other
Programs and legislature overviewed by the group(s):
(Will use
American
Medical
Association6
and The
American
Board of
Obstetricians
&
Gynecologists
)
(These
groups will
be looked at
as a one actor
unless
otherwise
noted)
H.R.358: House Democratic leadership patients’ bill
of rights legislation
H.R.216: Rep. Charlie Norwood’s (R-GA) “Access
to Quality Care Act of 1999”
H.R.448: House Republican leadership patients’
rights legislation
H.R.528: Clinical Laboratory Improvement Act
Amendments of 1999
H.R.719: Rep. Greg Ganske, MD’s (R-IA) “Managed
Care Reform Act of 1999.”
H.R.1304: Campbell Antitrust Bill 221
H.R.2723: Bipartisan Consensus Managed Care 156
H.R.2723: Norwood-Dingell: Bipartisan Consensus
Managed Care Improvement Act of 1999
H.R.2824: Coburn-Shadegg
S.6: Democratic Leadership patients’ bill of rights
legislation
S.300: Republican Leadership patient protection
legislation
S.326: Sen. Jim Jeffords’ (R-VT) patient protection
legislation
S.374: Sens. John Chafee (R-RI) and Bob Graham
(D-FL) bipartisan managed care reform legislation
6
www.ama.org website used
10
Roman
Catholic
Church7
Democrat,
Republican,
or Other
Programs and legislature lobbied for or against by the
group:
Other
Democrat,
Republican,
or Other
Programs and legislature lobbied for by the groups:
(These are
groups that
have some
political clout
but are not
affiliated with
any of the
above actors)
2)
Supports Anti-abortion legislation listed above;
(These
Supports Anti-contraception legislation listed above;
groups will
Supports Conservative Women’s Health legislature
be looked at
as a one actor Supports Republican Women’s Health legislature
unless
otherwise
noted)
Will identify as these actors become more
influential
Graph the different rates of abortions in countries that have already approved
Mifepristone. This information will give the ability to justify the different
hypotheses. Since there is standardized health care in most of the countries that
have already approved RU-486 distribution is not an issue and it can be inferred
that an increase of abortion is greatly dependent on the drug. So, if there has been
an increase in the rate of abortion when the drug was introduced to the public,
then the Extreme Right Hypothesis will be validated. If the abortion rate remains
constant, then both the Extreme Left and the Middle-of-the-Road hypotheses can
be concluded as being valid. (See Table 2 below)
7
The Catholic Review newsletter used
11
Table 2. Country Comparison
Country
Rate of abortion prior to the
approval of RU-486
Rate of abortion after the
approval of RU-486
France
Great Britain
Sweden
Canada
Germany
Other(s)
These two tables will establish the concentration of information of the two variables that
this thesis will look into, the political viability of distribution of Mifepristone and
whether or not the FDA approval of the drug will increase the rate of abortion overall in
the US, thus making the federal government’s attitude towards abortion the dependent
variable and the rate of abortion with the approval of RU-486 the independent variable.
There are a few flaws in the methodology that should be looked into prior to the thesis’s
final conclusion. First, is that the large-N table (TABLE 1) will not cover all the different
actors and therefore marginalize the results of the chart to some degree. This is because
there are always going to be groups that will be overlooked by any system of graphing
because it is impossible to cover everyone who could be involved in the policy process.
Secondly, because there are different medical health plan standard in the foreign
countries and the similarities will not be completely identical and therefore the result will
12
not be completely conclusive. There is also a different cultural view of abortion in
Europe and other areas that is not concurrent with that of the US’s.
Another flaw that is not controllable is the recent election. The national scene politically
will be changing shortly (If the Presidential election is still won by Gov. G.W.Bush). This
will make it hard to predict the way that the Senate, Congress, and president of the
country will vote in the future.
None of these flaws will destroy the relevance of the proposed study because it will allow
for the most complete picture of the political climate as well as showing the effects that
Mifepristone distribution will have on the rate of abortion in the US.
Conclusion
This thesis will argue that there is a need to understand and predict the environment of
the Legislative Branch of the US government before one tries to resolve the issue of
distribution of RU-486. [It does not argue the need. Its argument will eventually be about
predicted outcome.] If the Senate and the House are both very conservative then it would
be pointless to try to attempt universal distribution of the drug (Extreme Left Hypothesis)
because there would be too much opposition. Whereas it would not be wise to
recommend that there be no distribution of Mifepristone to the general public if the
House and Senate are fairly liberal (Extreme Right Hypothesis). It would be much more
politically feasible to attempt distribution of the drug only to places that the drug can be
used as a supplement to surgical abortion clinics.
13
Because there has not been an increase in the abortion rate (above a rate within 3-6%8) in
counties where there is no distribution problem, then it can be concluded that the Pro-Life
argument to reduce the distribution of RU-486 is invalid. It is also observable that
because the United States has a very conservative Legislative Branch, then it would be
politically foolish to attempt a policy that would be too liberal because it would never get
passed into law.
8
Childbirth by Choice Trust, 1996 Childbirth by Choice Trust 344 Bloor St. W. #502 Toronto,
Canada M5S 3A7 416-961
14
Bibliography
Literature
Henshaw SK and Van Vort J, Abortion services in the United States, 1991 and 1992,
Family Planning Perspectives, 1994, 26(3): 100–106 & 112.
Childbirth by Choice Trust, 1996 Childbirth by Choice Trust 344 Bloor St. W. #502
Toronto, Canada M5S 3A7 416-961.
Subcommittee on Regulation, Business Opportunities, and Energy of the Committee on
Small Business, House of Representatives, One Hundred Second Congress, first session,
Washington, DC, December 5, 1991.
United States. Congress. House. Committee on Small Business. Subcommittee on
Regulation, Business Opportunities, and Energy.
Speaking of Abortion: Television and Authority in the Lives of Women. Andrea Lee
Cole, Elizabeth R., Chicago, Illinois: University of Chicago Press, 1999.
“Abortion: Medical versus surgical abortion: a survey of knowledge and attitudes among
abortion clinic patients.” Virgo, Katherine S. Carr, T.R. Hile, Allison Virgo, John M.
Sullivan, George M. Kaikati, Jack G. Women’s Health Issues 9(3), May 1999: 143-154.
“Pain Penance and RU 486: Pill isn’t likely to change the difficult emotional calculus of
abortion” Washington Post by Hanna Rosin Oct 14, 2000.
Fulfilling the Promise: Public Policy and US Family Planning Clinics. The Alan
Guttmacher Institute Washington, DC, 2000: 7.
15
The Medical Letter: On Drugs and Therapeutics. New Rochelle, NY; October 2000,
42:101-102.
“Political Feasibility and Political Analysis”. Meltzer AJ. Public Admin Review;
Nov/Dec 1972, 32:6:859-867.
Internet sites
www.senate.gov
www.house.gov
http://thomas.loc.gov/
www.agi-use.org:
www.plannedparenthood.org/index.html
www.fda.gov
www.dhhs.gov
http://prolife.about.com/newsissues/prolife/mbody.htm.
16