Waiting for abortion

This weekend, my letter to the editor on Utah's 72-hour waiting period was published in The Salt Lake City Tribune.

Starting this week, Utah now imposes the nation’s longest waiting period on women seeking abortion care.

This misguided legislation requiring a woman to wait 72 hours before she can obtain an abortion is burdensome and medically unnecessary. Utah already requires women to be offered certain information at least 24 hours before they can obtain abortion care.

As a result of this law, a woman may have to delay care, particularly if she has to take time off from work, arrange for child care, travel a long way and perhaps stay overnight in a distant city, as Utah has a limited number of abortion providers.

Further, it disrespects women and their decision making. Women carefully consider the options before they make an appointment and visit a clinic; they do not need to be subjected to a state-mandated waiting period.

The decision to seek abortion care is one that is best made by a woman in consultation with her health care provider. Politicians should not intrude on these private medical decisions.

California Measure Would Have Expanded Abortion Access

Today, my blog on the withdrawal of a California state bill that would have allowed advanced practice clinicians to provide first trimester aspiration abortion care, was posted on RH Reality Check: 

In late February, California Sen. Christine Kehoe (D-San Diego) introduced a bill in the state Senate that would allow nurse practitioners (NPs), physician assistants (PAs), and nurse midwives (CNMs) to provide first trimester aspiration abortion care. Although the bill had support from leading medical groups in the state, and was even co-sponsored by the heads of both legislative houses, Sen. Kehoe withdrew the bill Friday because it lacked enough votes to pass a key legislative committee.

NPs, CNMs, and PAs—collectively referred to as advanced practice clinicians (APCs)— play an increasingly important role in the delivery of a range of health care services in the United States, and are competent  providers of prenatal and postpartum care; family planning services; and gynecological care. In some parts of California—especially rural areas—women may see an APC for the rest of their health care, but are forced to travel outside their communities in order to obtain the abortion care they need. This legislation would have allowed women to obtain safe, early abortion care in their communities, from their current health care providers.

Abortion is well within the scope of practice of APCs and it’s unfortunate that some California Senators missed this point.

We’ve known for years that appropriately trained NPs, CNMs, and PAs have the skills and expertise to provide safe first trimester abortion care and increase women’s access to care. Abortion is one of the safest medical procedures provided in the United States, whether it is provided by a NP, CNM, PA, or physician.

There is a growing body of evidence, including studies published in 1986, 2004, and 2006, which have found comparable rates of safety and efficacy between first trimester abortion procedures provided by CNMs, NPs, and PAs and those provided by physicians. An on-going study from the University of California, San Francisco (UCSF) also confirmed that NPs, CNMs, and PAs can be successfully trained to competence in aspiration abortion care, and can provide first trimester abortion care that is clinically as safe as care provided by physicians. The study’s authors testified in support of the bill.

The UCSF study is based on outcomes from a multi-year pilot program that has trained more than 40 NPs, CNMs, and PAs at numerous health centers across the state to provide first trimester abortion care. In an effort to garner support, Sen. Kehoe even narrowed the bill to only allow NPs, CNMs, and PAs who had been trained by this specific program to provide first trimester abortion care. Yet the bill still stalled in committee.

In addition to leading pro-choice and women’s groups in the state, many health care organizations supported this bill, including the California Medical Association, California Academy of Physician Assistants, California Association of Nurse Practitioners, California Nurse Midwives Association, American Nurses Association of California, California Family Health Council, and Health and Women's Health Specialists California.

California has historically supported increasing women’s access to abortion care and it’s extremely disappointing that this bill isn’t moving forward.

Wednesday's Words From Women

As anti-choice legislators and groups around the nation continue their efforts to place unnecessary barriers on women’s access to abortion care, it is more important than ever that we bring forward stories from women who have chosen abortion. NAF is interested in hearing about your experience and why you are pro-choice. We encourage you to share your story and personal experiences on our ShareYour Story page.

Here are just a few of the stories that were shared with us recently:

When I was in college, I faithfully used birth control. Nonetheless, I found myself pregnant. The decision to have an abortion was one I entered into with much thought. At the time I was on scholarship. My rent, books, supplies, and very modest living expenses would have made it impossible for me to care for a child. Considering the cost of raising a child to adulthood, I would have had to drop out of school, making it impossible to increase my earnings and properly provide for a family. Now at 56, I strongly believe that contraception (in most cases) prevents abortions. Women do not consider abortion as a form of contraception but rather a difficult decision to make based on individual circumstances. Every woman deserves access.

--Submitted by Penelope* through our website

I am pro-choice because no one can or should tell you what’s right for you. I would never tell another woman to have an abortion or not. I would, however, tell her to do what’s right for her and not let anyone pressure her into continuing with a pregnancy that she is not ready for.

I am unemployed so any help at this time would be appreciated. I know there are people who are struggling worse than me but due to my student loans and other financial obligations, having a child right now would be another added stress that I cannot handle.

--Submitted by Cassidy* through a member clinic

I am just relieved to have choices and options open to me. My story is not very pretty. I never thought I would consider having an abortion but with my circumstances I felt it was the best choice. I was sexually abused for several months and when I found out I was pregnant, I was devastated. I did not choose to have sex with this man and did not want to be connected to him for life—it was a gut wrenching feeling. I am grateful to NAF for supporting me through my procedure.

--Submitted by Romy* through a member clinic

Letter to the Editor: All health clinics are not created equally

This morning, a letter to the editor was published in The Morning Call, which clarified the difference between a recently closed abortion care facility in Pennsylvania and NAF member clinic Allentown Women's Center:

 As an Allentown Women's Center patient advocate, I am concerned that The Morning Call's article about a recently closed abortion clinic may have confused some readers. Although one clinic, Dr. Brigham's Allentown Medical Services, has been shut down, another completely separate clinic — Allentown Women's Center — remains open.

Founded in 1978, the center is an independent health care facility offering routine gynecological, contraception, and lesbian, gay, bisexual and transgender services in addition to our quality, compassionate abortion care. Earlier this year, we relocated to an expanded facility in Bethlehem.

Allentown Medical Services had a history of complications, health code violations and licensing issues. I have heard too many heartbreaking stories about the substandard care given at some other clinics, and it's important that women know how to choose a safe reproductive health care provider. It's wise to pursue referrals from their doctors, from accrediting organizations like the National Abortion Federation (the Allentown Women's Center is a member) or from trusted friends — not just utilize the phone book or online advertisements.

Trustworthy clinics encourage women to ask questions and listen to their intuition. Seeking an abortion can be a confusing process, but a quality provider is crucial for women to make good and informed health care decisions.

~ Kate Wilgruber

Georgia Passes 20-Week Ban

With just minutes left in the 2012 legislative session, Georgia lawmakers passed a bill late Thursday night that will ban abortion care after 20 weeks in the state.

Although the House and Senate leadership disagreed about adding an exception for cases of rape, incest, or when an abortion is necessary due to fetal diagnoses, they agreed to move forward with the bill with the exception included.

Senate Democratic women walked out after HB 954 passed their chamber and joined with other HB 954 opponents. Sporting yellow police tape, they marched into the hallways and shouted "we will remember" loud enough to be heard through closed doors. "The GOP war on women is alive and well in Georgia," said Senator Nan Orrock, D-Atlanta.

If signed by the Governor, this law will go into effect in January 2013.

Georgia Senate Passes Abortion Ban

This week, the Georgia state Senate passed a revised version of a bill that would ban abortion care after 20 weeks. This bill would have devastating effects on the lives and health of women in Georgia.

Originally, this bill did not contain exceptions for cases of rape, incest, or when an abortion is necessary due to fetal diagnoses. Although the Senate added a narrow exception for cases when a fetus is diagnosed with a condition "incompatible with life," this bill is unconstitutional as it does not contain an adequate exception to protect women’s health and it bans legal abortion care protected under the Roe v. Wade decision.

Women need access to abortion care later in pregnancy for a variety of reasons, not just in cases of tragic fetal diagnoses. The state should not pass laws that disregard the importance of circumstances and complications women can face during pregnancy.

The Georgia Legislature adjourns for the year tomorrow, so the House and the Senate would need to agree on a version of the bill before moving forward. Currently, the members of both the House and the Senate have said they will only support their version of the bill.

Stay tuned…

Abortion measure misguided

Today, my op-ed on Georgia's 20 week abortion ban bill was published in the Atlanta Journal Constitution: 

A bill banning abortion care after 20 weeks was fast-tracked through the state House last month. This bill substitutes personal ideologies for scientific evidence and could have devastating effects on the health of women in Georgia.

The very premise of this bill — that a fetus can feel pain at 20 weeks — is contrary to credible scientific evidence and without support from leading international experts.

Although abortion opponents often use arguments about supposed fetal pain to advance an anti-choice political agenda, the body of scientific evidence clearly demonstrates that a fetus is incapable of feeling pain prior to the 24th week of gestation, and possibly throughout pregnancy.

In 2010, the Royal College of Obstetricians and Gynaecologists published a report commissioned by the British government, which found that “the fetus cannot experience pain in any sense” prior to 24 weeks gestation. ... In addition, increasing evidence suggests that the fetus never enters a state of wakefulness inside the womb.”

Responsible medicine requires that patients and health care providers make treatment decisions together, based on medically accurate, unbiased information. The state Senate should not allow the personal ideologies of some abortion opponents to trump credible scientific evidence.

This bill is also unconstitutional as it does not contain an adequate exception to protect women’s health and it bans legal abortion procedures protected under the Roe v. Wade decision. Arkansas Deputy Attorney General Elisabeth Walker testified against a similar bill in her state last year because she said it contradicted years of U.S. Supreme Court rulings finding that states cannot ban abortion care before viability. For this reason, the Arkansas bill was stopped in committee.

Women need access to abortion care later in pregnancy for a variety of reasons. The National Abortion Federation hears from thousands of women every month who have a medical complication or condition that could worsen if they continue the pregnancy; others find out in a very wanted pregnancy that their fetus has an anomaly that is incompatible with life.

Some medical issues are not detectable prior to 20 weeks, and this bill contains no exceptions for these heartbreaking cases.

Nor does it contain an exception for cases of rape, incest or when an abortion is necessary to preserve a woman’s health.

But even if it had those narrow exceptions, this bill would still have a devastating impact on women in Georgia. Some women do not recognize that they are pregnant until the pregnancy is well-advanced — sometimes due to irregular periods, health conditions or misdiagnosed pregnancies — and others may have to delay care while they raise necessary funds or travel great distances to obtain the abortion care they need.

For a woman with limited financial resources, gathering enough money can take time and delay her abortion care by weeks, and the price of abortion care can increase each week of the pregnancy.

We recently heard from a woman who obtained abortion care in Atlanta after she learned during a very wanted pregnancy that her fetus had a severe medical condition and brain deformity. As medical professionals, she and her husband knew first-hand the severity of the diagnosis, which could not have been detected earlier in her pregnancy.

The state should not pass laws that disregard the importance of scientific evidence or the real circumstances and complications women can face during pregnancy. The Senate should reject this harmful and misguided legislation.

Not a matter of health

This weekend, my letter to the editor on Pennsylvania's ultrasound bill was published on Lancaster Online: 

In their March 4 column, Republican lawmakers inaccurately state that "national standards of abortion providers and best medical practice require" the use of ultrasounds for women seeking first-trimester abortion care.

The National Abortion Federation is the professional association of abortion providers in North America, and we set the standards through our evidence-based clinical policy guidelines. We do not require an ultrasound for first-trimester abortion care because there is no evidence that doing so improves patient outcomes or safety. Abortion is already one of the safest medical procedures.

Although many of our members use ultrasound evaluation to confirm pregnancy in the first trimester, that does not mean that states should make it mandatory. That ... should be a medical decision left to the clinician and the patient. The state has no place interfering in these decisions.

In response to the public outcry, the House has temporarily set the bill aside, but we urge Pennsylvania lawmakers to permanently reject this misguided bill.

Happy International Women's Day

Today is International Women’s Day, a day dedicated to celebrating the achievements and contributions of women and girls around the world. And while there have been great strides to celebrate in the more than 100 years since International Women's Day was established, it's hard to ignore the current attacks on women and our autonomy.

As Toronto Star columnist and friend of NAF Heather Mallick wrote today:

"Women have few public defenders right now...As the years passed, we grew overconfident. We took our hard-won rights for granted, we assumed our enemies accepted our triumphs--abortion rights, equal pay, work equality, contraception--as a done deal...and look at us now."

Clearly the fight isn't over. In states where some of the worst abortion restrictions have been recently introduced, women and our allies have organized, protested the state houses, and drawn national attention to this war on women. Women in Canada have been champions for those facing barriers to abortion access and are fighting to ensure that the abortion debate isn't re-opened. Our provider members in Mexico City are expanding women’s access to abortion care as they prepare to celebrate five years of legalized abortion.

We know the work that NAF and our members do every day not only preserves women’s health and saves women's lives, but it empowers women to make the choices that are right for themselves and their families...and that's something to celebrate.

So happy International Women's Day! Today, as we are reminded of the accomplishments of women around the world, we should also be reenergized to fight the attacks on women and our access to abortion care.

Pennsylvania Tables Ultrasound Bill

Today, I issued the following statement: 

The Pennsylvania state legislature has temporarily set aside a bill that would subject women to a mandatory ultrasound at least 24 hours before obtaining abortion care. This bill would inappropriately allow politicians to dictate medical practice and should be dismissed permanently.

There is no medical reason to require any type of ultrasound procedure in a state statute. The National Abortion Federation sets the standards for quality abortion care in North America through our evidence-based Clinical Policy Guidelines. We do not require an ultrasound for first trimester abortion care because there is no evidence that doing so improves patient outcomes or the safety of abortion care. Abortion is already one of the safest medical procedures provided in the United States.

The decision about whether an ultrasound is done and by what method should be a medical decision left to the clinician and the patient. The state has no place interfering in these decisions. That’s why groups such as NAF, along with our members in Pennsylvania, and the Pennsylvania Medical Society oppose it.

Decisions about medical procedures and patient care should be left to clinicians and their patients—not to politicians. We urge Pennsylvania lawmakers to permanently reject this misguided bill.

Florida House Attacks Abortion Access

Last night, I issued the following statement on the passage of a Florida House bill that aims to reduce access to abortion care in the state: 

The Florida legislature is launching an all out attack on abortion providers and the reproductive health care of Florida women and their families. Today, the Florida House passed H.B. 277, which aims to make abortion care less accessible and disrespects a woman’s ability to make her own health care decisions.

H.B. 277 would require a woman seeking abortion care to make at least two trips to a health center and wait 24 hours after her first visit to obtain abortion care. This requirement will make it harder for some women to access the abortion care they need—especially those that have difficulty scheduling more time off work, arranging child care, or traveling to the clinic. Women carefully consider their options before they make an appointment and visit a clinic; they do not need to be subjected to a state-mandated waiting period before they can obtain care.

This bill also requires doctors to tell patients medically inaccurate information. Under H.B. 277, doctors would be required to tell patients that a fetus can feel pain at 20 weeks, even though leading international experts such as the Royal College of Obstetricians and Gynaecologists have found that this statement is not true and not supported by credible scientific evidence. Women deserve the facts about their health care, not misinformation aimed at dissuading them from choosing abortion care.

Additionally, the legislature is trying to limit the number of health centers that provide abortion care by mandating that they be wholly owned and operated by a physician. This provision is entirely unnecessary and not related to the safety of care provided at an abortion facility. Abortion is already one of the safest medical procedures provided in the U.S. This provision could require an unnecessary change in ownership for an existing facility that wants to move buildings or that is forced to relocate due to an act of violence like an arson. There have been 14 arsons of reproductive health care facilities in Florida—one just earlier this year. More doctors who provided abortion care have been murdered in Florida than anywhere else in the U.S., and Florida legislators should be mindful of how H.B. 277 could increase harassment and violence targeting abortion providers.

H.B. 277 also contains a provision requiring physicians to complete three hours of continuing medical education each year in ethics. Physicians already attend continuing medical education sessions to stay current with the latest research in the field. To single-out abortion providers for mandated education in ethics is insulting to doctors that already provide high-quality, ethical abortion care.

This is not the way the Florida legislature should be spending the final days of their session. We urge Floridians to contact their state Senators and tell them to oppose this politically-motivated bill.

Telemedicine is a safe and effective way of delivering medical abortion care

Today, WisOpinion.com published my letter to the editor about an abortion ban that would restrict women's access to medical abortion care in Wisconsin:

In her Feb 27 column and statements made on the Senate floor, Sen. Mary Lazich, R-New Berlin, misrepresents the National Abortion Federation's Clinical Policy Guidelines (CPGs) in her attempts to justify an unnecessary abortion regulation that would restrict women's access to medical abortion care through telemedicine.

Our CPGs set the standard for quality abortion care in North America. Contrary to Lazich's statements, our CPGs do not require that a physician conducts a physical exam or be present when a woman takes the first medication to begin a medical abortion.

During a medical abortion, a woman takes one medication at a facility, and then completes the process by taking a second medication in the privacy of her home. Medical abortion gives women a safe and effective way to terminate a pregnancy in the first trimester, and a growing number of facilities have sought to increase women's access to such care using telemedicine.

Telemedicine is safely expanding a wide range of health care, from cardiac care to asthma care. When telemedicine is used for medical abortion care, a supervising physician talks to the patient about the procedure via live two-way video conference while a nurse is in the room with the patient. Telemedicine has proven to be a safe and effective way of delivering medical abortion care.

The proposed bill in Wisconsin is politically-motivated and not about protecting women's health. That's why groups including the Wisconsin Medical Society oppose it. Decisions about medical procedures and patient care should be left to clinicians and their patients, not politicians like Lazich who have their own personal agenda of banning abortion.