As usual this year, legislative bills are being introduced around the nation that place limitations on contraception and abortion services. As an obstetrician-gynecologist, it is my professional duty to point out that such restrictions can and do endanger women’s health and safety. This is also my personal conviction and belief, and it is from this personal perspective that I write to educate the reader about consequences.
In 1972, a year before Roe v. Wade legalized abortion, 100 U.S. obstetricians and gynecologists could see it coming. They published a Statement on Abortion in the respected American Journal of Obstetrics and Gynecology, saying this “increasingly liberal course of events” presented “an imminent problem of rather staggering proportions.” They were prescient about the number of abortion requests they would get after legalization – a million a year – and they correctly predicted today’s abortion rate of one in four pregnancies.
But they were wrong about the resulting problem. They thought it was going to be an issue of increasing hospital capacity while keeping patients safe.
“Can we handle such a load?” they wrote then. “Yes, with careful planning, conscientious effort, and modern techniques.” Existing hospital facilities would be able to cope, they said, because “the requisite space will soon be freed by the lessened number of septic abortions and puerperal (after-delivery) cases.”
In those days, 20 American women died for every 100,000 live births, many from unsafe abortions. Today’s maternal mortality rate is half what it was then, in large part because legal abortion is safe and back-alley attempts are much rarer. Those physicians were optimistic that society would hail legalized abortion as a public health win for everyone. What they didn’t foresee was today’s ideological backlash.
I grew up in New Mexico, the oldest of six children wanted and loved by parents who used birth control and favored abortion rights. They viewed the need for abortion as a sad consequence of the failure to provide young women with appropriate sex education and contraceptive options. My mother, Shirley Leslie, was twice elected the Republican National Committeewoman from New Mexico at a time when the Republican Party was more interested in limited government than limiting women’s access to safe health care.
As a second-year resident at Georgetown Medical School in Washington, I saw the consequences of unsafe abortion first-hand when my senior resident showed me a dark old ward in the basement of DC General Hospital. Prior to liberalization of abortion rights, all the beds were full of suffering women. They had infections and injuries and hemorrhages, the complications of unsafe abortion attempts.
Earlier this year, I joined 99 other professors of obstetrics and gynecology in signing a Statement on Abortion that echoes the one in 1972: The safety of the woman must be the primary consideration.
“We have had 40 years of medical progress but have witnessed political regression that the 100 professors did not anticipate,” says our statement, soon to be published in the very same American Journal of Obstetrics and Gynecology. “In 2011 alone, 24 states passed 92 legislative restrictions on abortion. Waiting periods after consent are now law in 26 states.” In 27 states, laws force physicians to provide deceptive counseling, making a mockery of the doctor-patient relationship. Moreover, “many hospitals enforce fetal and maternal health restrictions that are not based on the law,” such as staffing and procedural requirements contrived to limit patient access.
“In our view, hospitals have disregarded the responsibility that our academic predecessors expected them to assume,” we wrote. So, echoing that previous generation, we reaffirmed that our responsibility as physicians is to teach all methods of contraception and abortion; to provide evidence-based information to all patients and legislators; to insist that the hospitals where we work admit abortion patients; and to ensure that all methods of contraception are widely available in order to reduce the need for abortion.
Reason and facts must not be cavalierly cast aside in this debate. The statement of 1972 insisted that the priority must be women’s health and safety. That is still true, and I am honored to be among those who have signed the current statement. The intrusion of government and ideology is undermining the doctor-patient relationship and threatening, not improving, women’s health.
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