Abortion Doctor


Congressional-sealCongress began the 2015 session proposing more anti-abortion legislation, keeping in step with legislators at the state level doing the same. Abortion rights have been chipped away so continuously, many of us have come to expect more, no matter how ludicrous.

The proposed laws calling for intrusive, expensive, and uncomfortable (even painful)  transvaginal ultrasounds and mandated scripted information containing unscientific , inaccurate or incorrect information to abortion patients serve no purpose but to promote anti-abortion propaganda and delay access to abortion services.  Some proposals are truly bizarre. An addendum to legislation in North Carolina that passed in 2013 is currently being pushed by some politicians to “…[establish] governing and quality assurance boards and [designate] a chief executive to handle day-to-day operations…”  Exactly what will an additional layer of bureaucracy in a medical practice accomplish for women’s health?

restrictions-2011-2013_smWhen asked to describe the benefits of these laws, the answers are generally the same and women generally have reactions of disbelief to their claims:

Women need to be “properly” informed. Once they are provided the right information, they will be less likely to have an abortion. Uh, yeah, even we women know that we really just do not know what we are doing when it comes to pregnancy, abortion, or other decisions involving our reproductive lives. Yep. We women need the wisdom and personal, often religious, convictions of politicians before we can feel confidence in our decision. We should not trust ourselves or our medical care providers.

It protects women’s health. Abortion is such a dangerous procedure with two victims – the pregnant mom is scarred for life and her child is killed. Can you please just give specifics about how it actually protects women? Are you saying that childbirth is safer or, really, be honest, are you just trying to put another barrier in place to stop women from choosing to have an abortion? Or, are you thinking illegal abortion would be better somehow?

We care about women and children. Oh, I know, I know…you will eventually convince me to give birth whether I am a healthy young woman, a 46-year-old woman with four children and no desire for more, a woman with chronic health conditions, a 13-year-old unprepared for pregnancy and parenting, an 11-year-old pregnant as a result of repeated sexual molestation from a male relative, or any other woman in any other circumstance. You care so much that you will promise to support me spiritually, emotionally, and financially until my offspring become adults. Oh, wait…I forgot, most of you actually stop supporting women once we give birth, once the fetus becomes a child.

preg patientsIf we assume for a moment that those who support abortion restrictions are sincere in their claims that they believe women should be properly informed, that the laws protect women’s health, and that they care about women and children, then they should also support other reproductive healthcare-related proposals that have the same goal in mind. If the premise of restrictive abortion laws is really about informing and protecting women, then laws must be developed to ensure that all women who get pregnant and plan to give birth are aware of the risks involved. All medical practices that have pregnant women as patients must arrange for structural modifications to their facilities to ensure women and the government that they can properly respond to medical emergencies that might arise. The medical providers of pregnant women must also be required to make specific, politically dictated statements about the range of risks involved in pregnancy and childbirth although, unlike the “abortion information,” statements can be based on empirical data and medical facts.

acogResearch by Elizabeth G. Raymond, MD, MPH and David A. Grimes, MD and published in the American College of Obstetrician and Gynecology’s Obstetrics & Gynecology (February 2012), concluded, “Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion.”  (Full PDF article available at no charge through embedded link.) While I am not interested in shattering the joy of women learning of a wanted positive pregnancy test, fair is fair. There are risks associated with pregnancy and childbearing for which women should receive appropriate medical information. Given the political and religious propaganda out there, the chances are that a lot of women think that pregnancy and childbirth are safe. If women cannot be respected as able to independently make decisions about abortion, how can we possibly believe them able to make decisions concerning pregnancy and childbirth?

In addition to pregnancy and childbearing putting women at a higher risk of death than abortion, there are numerous risk factors that require medical attention and monitoring, including prior to conception. Rh incompatibility, kidney disease, diabetes, polycystic ovary syndrome, and autoimmune diseases are among the many conditions that can dramatically complicate the health of pregnant women and their babies. Age and lifestyle are other factors that obstetricians must consider during preconception consultations and prenatal treatment practices. The latest blow to pregnant women and fetal wellbeing is research concerning the influence of the time interval between the delivery of the first baby and conception of the second.  “[A]n interval of less than 12 months causes an increased risk for severe preterm birth in women who already suffered preterm birth in their first pregnancy” was the primary finding of the research, which will be presented this week at the Society of Maternal-Fetal Medicine’s annual meeting.

Obesity is one of the most common risk factors for women in developed countries. According to research published in Science Daily (July 2010), “The heavier the woman, the higher the risk of induced preterm birth before 37 weeks, with very obese women at 70% greater risk than normal weight women.  Overweight or obese women also had a higher risk of early preterm birth (before 32 or 33 weeks). Again, the heavier the woman, the higher the risk of early preterm birth, with very obese women at 82% greater risk than normal weight women.”

CDC pregnancy-related-death-2010_600pxAll proposed Pregnancy and Childbearing Risk Awareness legislation should reach far to include all possible complications – just as restrictive abortion legislation underscores improbable complications such as a perforated uterus or death. For example, maternal mortality is on the rise in the United States, with roughly 18 out of 100,000 women dying from pregnancy-related complications in 2013; between 1998 and 2005, the figure was much lower, with roughly eight deaths per 100,000 pregnant women. In 2011, the Center for Disease Control reported 17.8 deaths per
100,000 pregnant women, noting also significant racial disparities with a rate of 12.5 per 100,000 white women and 42.8 per 100.000 black women. The death rate from abortion is one for every one million abortions performed at eight weeks or less, one for every 29,000 abortions performed at 16 to 20 weeks gestation, and one for every 11,000 abortions performed at 21 weeks or later. Obviously, far more women die due to pregnancy-related complications than abortion complications, even at the later stages of gestation. It is only appropriate to ensure that women have the correct information so that they can decide if they really want to be pregnant and if motherhood is actually worth such possible health concerns.

Those of us who believe that reproductive justice is critical to achieving social and economic equality for women know that women can and do think for themselves in every sphere of life and most especially their reproductive lives. We also make many household and relationship decisions, not to mention educational and career decisions. We do not need politicians, pastors, or “sidewalk counselors” to help us make informed, personal decisions nor do we need them to create laws to try to impose their views on us. If they feel they must be a part of our reproductive lives, they should go about it fairly and provide complete and accurate information on abortion and pregnancy.

Well, suppose it’s time for me to give the obligatory “Year in Review” report on abortion rights.    

I’ve always been a bit of an optimist when it comes to the future of Roe and access to abortion, but I’m not so sure anymore.  Sure, when it comes to the basic right to abortion, we’re still in decent shape in the Supreme Court.  They don’t have the votes to overturn Roe.  But all we need is an anti-abortion President to be elected in 2016 and, without the threat of a filibuster (thanks to the Democrats in the Senate), it may be a little more difficult to stop an extremist from being appointed to the Court.   And, depending on which legal authority you subscribe to, all the antis need is maybe one vote to reverse Roe.  Indeed, I really wish some of the older more liberal justices would resign now so Obama can at least make those seats secure.

But when it comes to access issues, there is no doubt the anti-abortion movement is on a legislative roll.  In 2013 alone, 22 states adopted 70 different restrictions, including late-abortion bans, doctor and clinic regulations and limits on the use of the abortion pill. Twenty-four states have barred abortion coverage by the new health exchanges and nine of them forbid private insurance plans, as well, from covering most abortions. A dozen states have barred most abortions at 20 weeks of pregnancy, based on a theory of fetal pain that has been rejected by major medical groups. Such laws violate the viability threshold and have been struck down in three states, but proponents hope the Supreme Court will come up with a new standard.

What’s most frightening, however, are the laws that on their face seek to “protect the health of women seeking abortions” by imposing severe regulations on the clinics.  Such regulations include absurd requirements like mandating that hallways be a certain width (to get the gurney out when a woman has an emergency).  Personally, I have never heard of a patient getting stuck in a hallway and it might not sound like a big deal to some to widen the hall, but when you think about how much it might actually cost to get the necessary permits, hire construction crews, etc., it’s an onerous and very expensive proposition.   Some of the new laws also require the clinic to provide more parking spaces, as if that’s an easy thing to do, especially in a more urban environment. 

We know that this is all a bunch of crap, that the antis do not give a hoot about making the abortion experience “safer,” but the anti-abortion legislators, like those in my home state of Virginia, are buying it. They just get their marching orders from their local “Right to Life” chapter and vote in lock step.  Chalk up another victory for “women’s health!” 

But, truth be told, these regulations are starting to severely restrict access to abortion services.  For example, there is now only one clinic left in the state of Mississippi and in North Dakota and both of them are hanging by their fingernails in the face of a legislative onslaught led by the local anti-abortion forces. 

The bottom line is that more and more clinics are closing and women are now travelling further to get abortions.  Please note what I said – many of them are STILL getting abortions, even if it means having to miss several days of work to travel to another state.  On the other hand, many other women are simply deciding to give birth to an unwanted child instead of losing three days of pay. 

The only thing we can hope for is that ultimately there will be a backlash in this country on the political front and there is some evidence that that may be occurring.  For example, right here in Virginia we recently elected an outspoken pro-choice Governor who will hopefully reverse some severe clinic regulations that were passed two years ago that threaten the existence of several clinics in the state. And the National Abortion and Reproductive Rights Action League points to other recent successes on the political front.

Let’s hope it is not too late.

Abortion Care Network

Abortion Care Network

I recently received an email from a woman named Peg Johnston, an old friend up in Binghamton, New York who has been running an abortion facility for many years.  She has seen it all:  the murders, the bombings, the protests with hundreds of people at her front door.  And, like so many of her colleagues, she has persevered.

For many years, she was one of my closest confidants when I was the Executive Director of the National Coalition of Abortion Providers.  We went through a lot together and, yes, I was a pain in the ass to her at times (or maybe a lot of times).   After I left NCAP, she helped transform the organization into what is now called the Abortion Care Network.

In the early years, NCAP was a Capitol Hill lobbying effort that represented independent abortion providers.  To this day, I take pride knowing that we actually got three laws passed that provided protection to the doctors, staff and patients who use these facilities.  Later, NCAP started focusing on the business side of the industry, putting together group purchasing plans, business conferences, etc.  What really got my juices flowing, however, was NCAP’s effort to de-stigmatize abortion.  And I was pleased when I received Peg’s email to see that the Network continues to fight to make abortion more acceptable in this country.

Abortion Care Network

Abortion Care Network

It’s hard to believe that after 40 years of legal abortion, the procedure is still shrouded in mystery, spoken only in whispers.  Millions and millions and millions of women have availed themselves of this procedure but so many of them still sit by in silence.  And that has allowed the anti-abortion movement to fill in the blanks, to demonize abortion and to make women feel ashamed for having them.

But Peg and her group continue to press the envelope.  She and her colleagues have seen women come into their facilities, leave and move on with their lives.  They continue to insist that “good women have abortions” and that abortion is “okay.”  They also believe – and they taught me – that the pro-choice movement needs to speak more honestly about the abortion procedure.  They argue that women are not stupid, that they know exactly what goes on during an abortion and it is an insult to obfuscate.  “We Trust Women,” is their catch-phrase.

Whether or not the Abortion Care Network or, for that matter, NCAP has had an impact is hard to tell.  But I can tell you personally that it sure felt good not having to worry about trying to avoid the “A” word and just putting it out there.  Sure, our candor pissed off our pro-choice colleagues at times, but we slept well at night knowing we were telling the simple truth and that, by doing so, we were lifting the veil of secrecy about abortion.

And now Peg and the Abortion Care Network are on to their next project in their never-ending battle to make abortion more acceptable in this country.  Below is a link that announces a new video contest they are sponsoring, which speaks for itself.   I encourage everyone to submit their videos, to speak out if you’ve had an abortion and, yes, to send money to the Abortion Care Network:

  http://events.r20.constantcontact.com/register/event?oeidk=a07e880uqfe81765aa0&llr=rrbrm5cab

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