In New York State until 1970, abortion was considered homicide unless the procedure was to save the life of a pregnant woman. Then three years before the Supreme Court decision in Roe v Wade made abortion legal in the United States, New York State partially decriminalized abortion. But abortion was still classified as murder if it caused "the death of a person or an unborn child with which a female has been pregnant for more than 24 weeks." That law remains on the books until this day.
Now, however, with little fanfare, a bill has been introduced to once again revise New York’s laws, which some have called "antiquated and unconstitutional." This act would bring New York’s laws on abortion up to date and recognize a woman’s fundamental right to make medical decisions relating to reproduction. For the first time, "person, when referring to the victim of homicide [would mean] a human being who has been born and is alive."
Prior to the 1970 revision, women with unwanted pregnancies either had unwanted children or found some way to terminate their pregnancies. Often these illegal operations were expensive and performed blindfolded, in a back alley, or under unsanitary conditions by “quacks,” sometimes working without anesthetics or antibiotics, who could permanently harm or even kill their patients.
These came to be known as coat hanger abortions for the “medical" instrument used in performing them. The coat hanger or other device, used by a pregnant woman or someone assisting her, could perforate the woman’s uterus, sometimes causing severe bleeding. Ironically, such injuries were sometimes the only thing that allowed her to get medical attention.
Women who could afford to check into mental hospitals and have two psychiatrists certify that they might commit suicide if they had to continue a pregnancy could get a legal abortion by claiming the procedure was literally a case of life or death. Others who had money could go to foreign countries for the procedure. And some women did have access to licensed, cooperative physicians.
Even for those women able to get safe abortions, though, the criminal law controlled the process. Abortion was murder except where medical testimony established that the pregnant woman’s life was at risk. There was no right to choose, though the euphemism "right to choose," had not yet come into use, nor had the euphemism, "pro-life," meaning, respectively, for or against a woman’s choice to be or not be a mother at a given time.
In the late 1960s activists in the women’s liberation movement argued that women should have control of their bodies. In response, the state legislature amended the penal law. Under the changes, doctors performing abortions in the first 24 weeks of pregnancy would no longer risk being criminally prosecuted and losing their licenses, and women would no longer risk losing their lives.
Revolutionary though it was at the time, the 1970 law, which partially decriminalized abortion and took it out of the realm of homicide in most cases, did not go beyond that. Today, abortion in New York State remains defined as homicide when performed after 24 weeks unless the woman’s life is at risk. But now more than three and one-half decades later, when observers and activists say changes in the Supreme Court could again threaten women’s choice, New York is putting this health issue on the legislative agenda.
The Reproductive Health and Privacy Protection Act, proposed by Governor Eliot Spitzer, would establish and recognize reproductive rights and privacy. The bill would guarantee the right to abortion; it would also guarantee rights with respect to contraception including, for example, the purchase of birth control or "morning after" pills. It would amend the public health law, the education law, the penal law and criminal procedure law, and certain other statutes, all in relation to abortion. Specifically the bill contains a statement of a woman’s right to terminate a pregnancy before the fetus is medically determined to be viable or at any time necessary to preserve the woman’s life or health. According to lawyers who have assisted the Spitzer’s office in drafting the legislation, perhaps most significantly, it would recognize that the issue of abortion is medical, rather than legal or political.
Currently, New York does not have any provision for abortion after viability to protect a woman’s health. Also, the procedure remains criminal after 24 weeks even if the fetus is not viable -- "even if the fetus is dead," according to Dr. Maureen Paul, chief medical officer of Planned Parenthood of New York City. The law bans all abortion after 24 weeks except when necessary to preserve a woman’s life, although Paul says, "A threat to health is a threat to life."
Under the proposed changes, these statutes would be repealed and the bill would allow a woman to end a pregnancy until viability or at any time necessary to protect her life or health.
New York’s existing law was never challenged, but until this year federal court decisions had determined that laws restricting abortion after 24 weeks are unenforceable when the procedure is needed to protect a woman’s health. Then earlier this year in their second Gonzales v Carhart ruling on late-term abortions, the Supreme Court decided that the "state’s interest in promoting respect for human life in all stages of pregnancy could outweigh a woman’s interest in protecting her own health." That decision means that New York laws would no longer be adequate to insure that women who needed them would be able to obtain abortions in later stages of pregnancy.
By addressing that issue directly, advocates say, New York would make a major commitment to protecting the rights intended by a majority of the sitting justices’ predecessors three and a half decades ago. If the current state bill is enacted into law, it will reflect the public policy of New York by declaring that every individual has a fundamental right of privacy with respect to personal reproductive decisions and the right to refuse or choose contraception. It would make clear that in New York State every female can determine the right to bear a child and terminate a pregnancy prior to viability, or whenever it is necessary to protect her life or health.
In the wake of recent court rulings, and anticipating decisions in the future, abortion rights advocates are increasingly turning their attention to the state level. In this state, the proposed legislation "will ensure that New York remains a beacon for choice in the face of broad federal attacks on reproductive health and women’s rights," said Donna Lieberman, executive director of the New York Civil Liberties Union, which participated in the drafting of the bill. "The Reproductive Health and Privacy Protection Act would be just that. It would make reproductive rights a matter of health, not law and politics," she said.
Unless the state legislature returns for a special session later this year, the bill is unlikely to win passage in 2007. But supporters say they will press for the legislation. NARAL Pro-Choice New York, for example, has said it will target key state senators who have opposed the bill “until the bill is passed.
For their part, antiabortion advocates are working to defeat the measure. In a “memorandum of opposition,” the New York State Catholic Conference listed objections to specific provisions of the bill, including its guarantee of privacy rights and its removal of New York abortion laws from the criminal code. Calling the bill “uncompromising in its terms and extremely sweeping in scope,” the statement said the measure “goes against the increasingly pro-life sentiment in this country,”
Let the wars begin.
Emily Jane Goodman is a New York State Supreme Court JusticeÂ
Young mothers whisk by pushing baby strollers heading toward the pediatric floor at the Gouverneur healthcare facility on the outskirts of Manhattan's Chinatown.
Even on a slower than usual Monday, mothers and children clutter the waiting area, where signs promote a brand new vaccine and urge parents to ponder "how (their) daughter could become one less affected."
At Gouverneur and other medical care facilities within the city's Health and Hospitals Corporation, check-ups for girls as young as 11 years old can now include a vaccine aimed at wiping out four types of a virus that causes 70 percent of all cervical cancers - the Human Papillomavirus or HPV.
The Food and Drug Administration has approved only one vaccine for the virus – Merck's Gardasil. Both the Health and Hospitals Corporation as well and the Department of Health and Mental Hygiene say they are pushing immunization for girls between the ages of 11 and 18 and are making it more accessible, both physically and financially, across the five boroughs. But others say the city is not doing enough.
A Campaign Against Cancer
Approximately 11,000 new cases of cervical cancer are reported every year of which 3,000 are fatal, according to the American Cancer Society. The vast majority are caused by HPV - the most common sexually transmitted disease in the country that is known to cause genital warts. Approved by the Food and Drug Administration last summer, Gardasil, administered over six months in three doses, protects against four types of HPV.
Gardasil is increasingly in demand in the city - thanks to a tailored media campaign by Merck, medical professionals said. But although the vaccine has been applauded by medical professional far and wide, access has been an issue due to its exorbitant cost – estimated at nearly $400 for the entire immunization.
The cost can deter women of lower incomes from perusing the vaccination. This poses a particular problem in New York City, where minority women are screened far less for cervical cancer than other women. By skipping an annual Pap test – an exam that screens for cervical cancer – women are less likely to catch the disease early on before it is to late. In 2004, according to a survey by the health department, 41 percent of Asian women said they had not had a Pap screening in the last three years.
The national Centers for Disease Control and Prevention has recommended the vaccine be given to girls age 11 and 12 and that older females, from ages 13 to 26, be given a "catch up" vaccination. The vaccine is licensed for women ages 9 through 26 and is aimed at younger populations to catch them before they become sexually active.
It is estimated that 80 percent of women will be exposed to the virus by age 50, and 6.2 million new infections occur annually throughout the country.
Access in NYC
A report released in March by Gotbaum found that just over half of the child and teen clinics within the Health and Hospitals Corporation offered the vaccine. The corporation contends this figure is flawed and inaccurate (it blamed uneducated phone operators). In a statement, the corporation said it had always provided the vaccine at its facilities.
Gotbaum’s report also took issue with the health department, which it found did not offer the vaccine at any of its sexually transmitted disease walk-in clinics or its immunization clinics. Most of these facilities cater to uninsured, low-income or minority populations that otherwise would not be able to afford the vaccine.
Public Health Post-Study
The hospitals corporation now provides the vaccine at its 11 hospitals and its community based healthcare centers. For families that meet income qualifications, which apply to individuals with an income below 400 percent of the federal poverty level, the cost of the vaccine is integrated into the cost of a visit. This means uninsured patients who qualify for the corporation's financial assistance program would not have to pay an extra fee to receive the vaccine. A visit can typically cost between $15 and $60, depending on income and family size.
The health department is now offering the vaccine at its four, year-round immunization clinics. The health department's assistant commissioner who heads the bureau of immunization, Dr. Jane Zucker, said that since the department started offering the vaccine in May, it has administered 150 shots at its immunization clinics.
Since this spring, through the federal Vaccines for Children program, the department has also distributed 75,000 free doses for eligible children 18 years old and under to an array of health care providers throughout the city. The department, Zucker said, is also pushing to make the vaccine available for children through their primary care physicians.
"The most important thing is to make sure that kids have access through their doctor's office," said Zucker. "The most important thing is to make sure that all providers… that all venues have access to the vaccine."
The department is not offering the vaccine at its sexually transmitted disease walk-in clinics, because the clinics are not meant to provide routine medical care, officials said. Based on its experience with the Hepatitis B vaccine, health officials said it is unlikely a patient would return to the clinic for all three doses. Without all of the doses, the effectiveness of the vaccine is questionable.
Gotbaum’s report recommended the inclusion of the HPV vaccine in immunization services provided at the sexually transmitted disease walk-in clinics. Another recommendation – providing information about the vaccine on the city's non-emergency hotline 311 – has been implemented, health officials said.
Reaching Women Over 18
Some community-based clinics are struggling with whether, or even how, to provide the vaccine to women over 18 who are uninsured, sexually active and are not eligible for the free vaccines under the Vaccines for Children program. Although the vaccine is recommended for young women who are not yet sexually active, the Centers for Disease Control and Prevention did not disregard its positive effects on women up to 26 years old.
Elizabeth Howell of the nonprofit healthcare provider, Community Healthcare Network, said it currently provides the vaccine only to those less than 18 years old. Howell said there is no system to get their patients – who are low income and uninsured - to come back for multiple doses.
"We’re in a catch 22," she said. "We can't offer it freely. We don’t have the resources to offer it to anyone off the street."
Planned Parenthood does not provide the vaccine. Neither does the Medical and Health Research Association of New York City, which is dedicated to researching and providing health care to underserved populations.
A Popular Shot
Unlike community or nonprofit clinics, physicians and nurses in the Department of Pediatrics at Gouverneur see Gardasil increasingly becoming a routine step in preventative medicine. They have worked with private providers of Gardasil to vaccinate women above 18 years old, regardless of sexual history.
"Professional medicine is the key to this whole HPV (prevalence)," said assistant director of pediatrics Lily Yiu. Yiu's own 18-year-old daughter will soon be taking her third and final dose of the vaccine.
The director of the pediatric department, Dr. Felix Santiago, said the vaccine has been integrated into the medical center's immunization processes and has been classified as a "recommended" vaccination. (Medical professionals interviewed at Gouverneur would not explicitly back Gardasil as a mandate).
Health professionals who interact with young girls everyday are seeing the popularity of the vaccination first hand. Gloria Perez, a pediatric nurse practitioner at Gouverneur, said most of her patients come in knowing about Gardasil, and some college-aged girls make specific visits in just for it.
"It's in their teen magazines. It's in the subways," Perez said of Merck's advertisements. "It's part of your wealth visits. It's part of your health maintenance visits, just like any of the other shots are."
Since it was introduced in the center in December, nearly 100 percent of patients have opted for the vaccine when offered, the director added.
The Public Perspective
Gardasil has taken the nation by storm and sparked heated debates in legislatures across the country. But with any political storm, usually comes a thunderous backlash.
In Texas, the legislature rescinded an executive order by Governor Rick Perry that mandated the vaccine for all young girls. Some parents and advocates have claimed a requirement would encourage young girls to have sex, while others objected for religious reasons.
Since then, 25 states, including New York, have considered mandating the vaccine. Assemblywoman Amy Paulin of Scarsdale introduced a bill this past legislative session that would have required the vaccine for school-aged girls, although it would have allowed parents to opt out for religious reasons. The measure was unsuccessful and never received a co-sponsor in the Senate, but Paulin intends on introducing it again in hopes of improving access to the vaccine for all socioeconomic classes.
"With a vaccine like this, one that requires three dosages, you often see families go for the first one, maybe even the second one and forget the third one," said Paulin. "(A mandate) also closes the socioeconomic gap. Poor children do not get vaccines unless they are mandated."
Although the City Council has held hearings on the subject, Councilmember Helen Sears, chair of the Women's Issues Committee, said the council is currently taking a wait and see position on the vaccine. Sears said she hopes to work with the health department and monitor the vaccine's success and popularity since its recent implementation in some of the walk-in clinics.
"The big thing is that they’re starting it," she said.
[Further reading: Human Papillomavirus (HPV) @verywellhealth.com]
From the moment the footagefrom the infested Taco Bell aired, the rat story had legs. Tourists came to gawk and have their pictures taken at the Greenwich Village restaurant where the large rodents had been seen scurrying across the floor and climbing the tables. Passersby scrawled rodent-themed graffiti on Health Department closure notice ("Gimme a Side of Mice and Beans!"; Try Our New Burrato!"). The rats were "the best local news story you could possibly have," gushed an editor for WNBC. David Letterman made jokes about them on late night television.
Officials at City Hall, however, did not seem so amused. Having rats take over a restaurant was a major embarrassment, especially given that the Taco Bell/KFC in question had passed a health inspection less than 24 hours earlier. The department closed over a dozen other restaurants for health violations since February 23, and city officials have talked up the toughness of its inspection process.
Once again, City Hall seems to be at war with the fast food industry.
Such conflicts have been commonplace during the Bloomberg administration, which takes pride in its aggressive actions on public health. After pushing through a controversial smoking ban, the health department turned to obesity, and the restaurants that it says enable it. It passed rules banning transfats and requiring some restaurants to list calories on their menus.
The issue extends beyond the health department: the head of the City Council's health committee floated a plan to restrict fast food restaurants from opening in low-income neighborhoods, and two Dunkin Donuts franchise owners are suing the city's building departmentfor illegally blocking fast food restaurants from opening in busy places. Still, the rules passed by the Board of Health have attracted the most attention. Restaurateurs and civil libertarians argue that officials shouldn't restrict people from eating unhealthy food, and say that that such attempts to improve public health interfere with the right of restaurants to do business.
Nobody, of course, argues that the city shouldn't clamp down on rat-infested restaurants (well, almost nobody). But some see the same overzealousness in the aftermath of the Taco Bell rat incident that they have in the health department's previous campaigns. Officials shouldn't be so quick to scapegoat restaurants, they say, when the problems of public cleanliness and health extend far beyond their industry.
Rats are nothing new to New York City, as anyone who ever waits for a subway or walks at night knows. Like many New Yorkers, they are the descendants of ancestors who came from Europe on a boat, scraping out an uncertain living in the big city. "I think of rats as our mirror species, reversed but similar, thriving or suffering in the very cities where we do the same," wrote Robert Sullivan in Rats: Observations on the History & Habitat of the City's Most Unwanted Inhabitants. "If the presence of a grizzly bear is the indicator of the wilderness of an area, the range of unsettled habitat, then a rat is an indicator of the presence of man."
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<fontsize="1.5">The rats at Taco Bell disgusted some, and amused others |
Still, the coexistence is not mutually beneficial. Rats carry diseases, the most famous being the Black Plague. They bite babies. They chew through electrical cables, causing fires. And when they show up in restaurants, it's bound to cause a stir. The stock price of Yum!, the company that owns Taco Bell, has dropped off significantly since it infamous infestation. The record of the city's health inspectors has been suddenly and dramatically called into question. The New York Post pointed out the department's past of corruption, noting a scandal in 1989 resulted in 46 health inspectors– 65 percent of the total force – being found guilty of extortion. The Post doesn't accuse the department of corruption this time, however, but rather of neglect, saying that Commissioner Thomas Frieden has been too focused on changing New Yorkers' behavior, instead of the unglamorous aspects of his job like restaurant inspections.
Mayor Michael Bloomberg defended his record, presenting statistics that showed that 469 eateries had been closed at least temporarily since July 1, 2006, up from 255 for the corresponding period during the previous year. He also said that the department was carrying out exterminationson the block where the video had been shot, and reviewing the restaurants that had been given clean bills of health by the same inspector.
In the days that followed, other restaurants began to be closed down, including several Yum! franchises owned by the same proprietor, and other eateries nearby -- an Au Bon Pain, Risotteria, John's Pizzeria. City Hall has said that there was no crackdown, but local restaurateurs and representatives of the industry charged the department with being overly aggressive in an attempt to offset bad publicity by appearing vigilant. In the weeks since the Taco Bell incident, health inspectors have reportedly closed down restaurants at three times their normal rate.
"They came on a witch hunt," said Michael Frank, a long-time manager at John's Pizzeria on Bleecker Street, while sitting in the empty restaurant last Tuesday, several days after it was shut down. Health inspectors showed up on a busy night, he said, and closed the restaurant for a series of minor violations -- the lack of proper lids on bathroom trashcans, the presence of several holes in the foundation, and the discovery of some mouse droppings in the basement. The staff was forced to kick everyone out during the dinner rush.
In the past, said Frank, the department has given restaurants the opportunity to fix such problems instead of shutting them down immediately. Chuck Hunt, the head of the local chapter of the New York State Restaurant Association agreed, saying that most offenses are generally corrected during the inspection itself, if not soon thereafter.
John's addressed the problems, and was allowed to reopen last Wednesday, almost a week after it was shuttered.
City officials argue that the inspection process works well. The Taco Bell incident, they say, was an aberration. But the controversy has sparked discussion about several long-term solutions to make restaurants cleaner.
The New York Sun's prescription is the most radical. It thinks that City Hall should get rid of health inspectors altogether, cut taxes with the money its saves, and let customers "navigate the tradeoff between price and speed and cleanliness in a restaurant on their own, without the assistance of big government."
Hunt of the restaurant association says inspections are necessary, but would like to see them used as opportunities to educate restaurants on avoiding unhealthy conditions. He also argues that City Hall should rethink its banon garbage disposals at commercial establishments. Critics say it leads to piles of food waste sitting in restaurants until they can be taken away by garbage trucks, and Councilmember Joel Rivera has introduced a bill that would end the ban. He says that he hopes the recent controversy will bring urgency to the measure, which has been languishing.
"It will help to decrease the cost of carting garbage out of New York, which we all know is expensive," he said, describing the impact his bill would have if passed. "At the same time we get to mitigate the issue of rats."
The city's effort to control the rat population is not simply a problem in restaurants, of course. Almost 30 percent of rental housing units are infested, and the city's subway tunnels, old buildings, and abundance of waste makes an ideal habitat for rats. City officials describe a wide ranging campaign to combat the root causes of infestation. There is no perfect way to tell whether the campaign is working, because how do you measure the rat problem. By complaints about rats? They've almost doubled since Bloomberg took office. By the number of times rats bite people? That number is at its lowest level in decades.
Bloomberg claims the number of rats in the city " does seem to be on the decline," but others say the recent controversy proves that the war on rats will never be won.
Even clean restaurants can be unhealthy, however. Until several weeks ago, most of the controversy over the health department has centered on its attempts to legislate healthy behavior.
Two rules the Board of Health passed in December to try to make restaurants healthier have set off the latest round in this debate, which first flared up when Bloomberg and Frieden decided to implement a full ban on smoking. In each case, the basic parameters of the debate are the same: On one side are those who laud Freiden as a visionary pushing innovative policies that will improve public health. On the other side are those who argue that he is interfering in areas where people should be allowed to make their own choices, no matter how unhealthy they may be, and hurting business owners in the process.
Under one of these rules, New York would become the first city to ban the use of trans fats, artificial fats that medical experts say increase the chances of heart disease and other serious health conditions.
Trans fats are used to make crunchier foods with longer shelf lives. They are widely seen as unhealthy, and Freiden says that they can be replaced without affecting the taste or cost of food.
Opponents of the bandon’t claim that trans fats are healthy; they argue that if people want to avoid them they can simply not eat foods that use them. A ban, they say, will harm businesses that will have to change suppliers and recipes. Switching to alternative fats could cost money and change the taste of their products.
But momentum has shifted against trans fats. Fast food chains like McDonalds and Starbucks are phasing them out, and cruise lines, hotel chains, and even shortening brand Crisco say they are also eliminating trans fats. Last week, the health commissionerof the EU said it should follow New York's lead on a trans fat ban.
The City Council initially sparred with Frieden, saying it wanted to introduce its own plan in the form of a law. But Councilmember Peter Vallone recently introduced a bill to simply pass a law codifying the board's plan, making it harder for the ban to be overturned when Bloomberg leaves office in 2009.
The Board of Health also passed a rule that would require restaurants to list calorie totals next to each menu item in the same size print. Only restaurants with standardized menus that already provide nutritional information will be affected when the requirements go into effect in July 1. Such establishments account for about 10 percent of the city's restaurants, and are mostly chain fast food places.
Restaurants that provide nutritional information already said they were being punished unfairly, and predicted the rule would be an incentive to stop providing any information. They also complained that even with a standardized menu there were too many variations on each dish to list a single calorie count honestly. The board of health argued that it allowed the restaurants to list a calorie range, but critics were not mollified.
In late February several chains including Wendy's and White Castle stopped providing calorie countsso that they would not have to comply with the new rule.
Spurred by the restaurant industry, Councilmember Rivera introduced a bill that would reverse the rule. Instead of requiring restaurants to list the calorie counts on menu boards, Rivera's bill would allow them to use brochures or on posters. Critics say this misses the point, since people will not see the counts when they purchase the food.
As with trans fats, some council members also said the board should submit its ideas as legislation
"This is a major policy change," said Councilmember David Yassky, head of the council's small business committee. "To do it administratively without the democratic process and a council vote is reason alone to oppose it."
Council bills generally do not pass without the blessing of the speaker, however, and Quinn has indicated she will not support the council's pushing back against the board on the calorie bill.
"I don't have any particular interest in changing what the Board of Health has done," she said.
Despite the controversy, there is no guarantee that the recent steps by the city will actually improve New Yorkers' health. Many remain skeptical that these seemingly intractable problems are going to disappear because of anything the Bloomberg administration does.
If listing the amount of calories in foods led people to make better choices, then Americans would have gotten healthier in the years since rules were put in place requiring packaged food to list nutritional information, said Hunt. Instead, Americans have gotten fatter. Michael Pollen, author of The Omnivore's Dilemma, sees the vilification of trans fats as only the most recent in the ever changing landscape of nutrients falling in and out of favor. Trans fats were actually introduced as a health alternative to saturated fats; today, the labels of foods containing saturated fats proudly proclaim the contents to be free of trans fats.
And as for rodents, well, few really see a future without them. Rats can be chased out of buildings or even blocks, but no one believes the city will ever be rid of them. The windows of the now-infamous Taco Bell are boarded up now; there's nothing more to see. But one vandal has offered some advice for latecomers hoping to catch a glimpse:
"Rats Now Appearing Next Door --->" Â