When It’s Not Actually about Women’s Health

Supposedly, conservatives believe in limited government. Supposedly, conservatives want to keep government bureaucrats out of the doctor-patient relationship. Supposedly, conservatives think that red tape limits business and gets in the way of free enterprise. Supposedly, conservatives oppose “nanny state” laws that infringe on individual choice. But when it comes to abortion, all of this goes out of the window. When it comes to abortion, conservatives forget all of the things they supposedly believe in and don’t believe in in their rush to use any tactic they can lay their hands on to ban abortion. I’ve been ignoring the news lately because of how depressing it’s been, but today I finally took a look and I thought I’d share some of what I found.

Ohio just passed an anti-abortion bill. What does it include, you ask?

Clinics must have an agreement with a local hospital to transfer patients there in the case of an emergency, but public hospitals are barred from entering into those agreements. Opponents of the restriction say they will be used as an excuse to close clinics that have no way of complying.

Another way the new law is unusual: the director of the state department of health, a political appointee, has the unilateral power to revoke variances given to clinics without a transfer agreement. The director also determines whether transfer agreements are satisfactory.

Emergency rooms have to accept patients no matter where they come from, meaning that there’s no reason to require local abortion clinics to have official transfer agreements. That said, having such an agreement does seem a bit like common sense. The problem is that the issue has become so politicized that getting such an agreement itself has become politicized. What’s to stop a Catholic hospital from refusing such an agreement for religious reasons? And there are plenty of areas where a Catholic hospital is the only one available. What is to stop the pro-life owner of a private hospital from denying such an agreement? But let’s assume for a moment that this measure really is about protecting women’s health (as anti-abortion activists allege): In that case, why bar public hospitals from entering into transfer agreements with local abortion clinics? That makes utterly no sense and makes a mockery of any attempt to claim that these regulations are about protecting women’s health. They’re not. They’re about doing everything possible to make sure that women don’t have access to abortion services.

The Ohio bill will also require abortion providers to attempt to find a heartbeat and to inform the woman if there is one, and slashes Planned Parenthood’s funding.

Then there is North Carolina’s “Faith, Family, and Freedom Protection Act,” which was passed by their house yesterday and their senate today. In addition to banning Sharia Law, this bill would require clinics to meet the same standards as ambulatory surgery centers, require that each clinic have a transfer agreement with a local hospital, and stipulate that a doctor must be in the room for the entire abortion procedure, whether surgical or medical (i.e., the abortion pill). In a move that flies in the face of the Republican party’s rhetoric regarding government regulations on health insurance, the bill also bans a wide swath of health insurance companies from providing coverage for abortion.

So let’s unpack this. First, only one of the state’s clinics meets the standards for ambulatory surgery centers. (An ambulatory surgery center is the same thing as an outpatient surgery center.) For more background, here are some interesting articles. Some abortion clinics are registered as ambulatory surgery centers already; some states view licensed clinics (which generally includes abortion clinics) as the equivalent of ambulatory surgery centers; and some states don’t actually regulate ambulatory surgery centers. First trimester abortions are extremely safe and routine procedures, and many critics of increased regulation argue that abortion is not a surgery, but rather a simple and routine procedure. The sorts of requirements many states place on ambulatory surgery centers don’t actually make sense for the more limited function of abortion clinics. Indeed, dental clinics often perform more invasive and risky procedures than do abortion clinics.

In addition to all this, the clinic where I volunteer only does abortions one day a week. The rest of the week it’s simply a family planning and women’s health clinic. I know what an ambulatory surgery center is first hand—my son had a minor surgery there last year. The entire function of such a clinic is different—it is designed for dozens of surgeries every day with numerous doctors staffing it at all times in company with anesthesiologists and other specialists. This isn’t how an abortion clinic works and there’s no need for it to be how an abortion clinic works. Requiring the entire facility to operate as an ambulatory surgery center just for that one day a week is both highly impractical and extremely unnecessary. Basic regulations to ensure that the clinic is clean and equipped to safely do what it does? Yes. But those regulations need to take into account just what these clinics are and what their actual needs and functions are. In practice, these laws are aimed at shutting down all but the largest and most busy abortion clinics, resulting in a situation where women have to travel hundreds of miles to access simple and routine procedures.

These bills are being pushed by Republicans who would just as soon ban abortion entirely if they could, meaning that their claims to be concerned about women’s health—especially when leading pro-life voices have argued in the face of hard evidence that abortion is never medically necessary—is obviously a ruse. Sometimes these individuals drop the charade enough to admit this with weirdly contradictory rhetoric:

But Dave Welch of the Texas Pastor Council told the panel that abortion rights supporters are trying to protect an industry “whose sole purpose is to take human life.”

“Why should we even question whether they [abortion clinics] should be held to the same standards as other medical facilities?” he asked, saying that it “is inhumane that any society would not protect the life of innocent children who have nobody else to watch over them.”

If there was actual concern about the safety of the clinics, rather than passing a bill that will close down all but one of the state’s abortion clinics—and thus tangibly endangering women’s health in addition to limiting their access to abortion—lawmakers should develop a workable plan for gradually improving the facilities offered by abortion clinics.

Now let’s look at the North Carolina bill’s restrictions on RU486, which a spokeswoman reported comprises 50% of all abortions in the state. Also called the abortion pill, RU486 is administered in two doses, one taken in the presence of a doctor and one taken 24 to 48 hours later while at home. After the second set of pills, the abortion takes up to 24 hours to complete—it’s essentially an induced miscarriage. As written, it appears that North Carolina’s new bill will ban medical abortions—the safest type available—entirely (for a comparison of surgical and medical abortions, see this link). The drugs involved in RU486 can be purchased over the internet, and because of restrictions like these some women in the U.S. are already doing that or, if they live close to the border, crossing into Mexico to buy the drugs. Now, taking the abortion pill without ever seeing a doctor, either to make sure that there is no extra risk of side effects up front or the standard follow-up appointment, is obviously more dangerous than taking it in a clinic. So, once again, these requirements actually do the opposite of improving women’s healthcare.

The abortion provisions inserted in this North Carolina bill at the last minute—meaning yesterday—and without any notification to the public. There is some chance North Carolina’s governor will veto this measure, but if he does, the Republican party holds a majority that will allow it to override this veto.

Finally, there is Texas. The bill working its way through the legislative process there will close 37 of the state’s 42 clinics.

The bill would require abortions, including those induced by drugs, to be performed in so-called ambulatory surgical centers. The regulations for such facilities include specific sizes for rooms and doorways, and additional infrastructure like pipelines for general anesthesia and large sterilization equipment.

. . .

Of the 416 ambulatory surgical centers in Texas, five perform abortions.

Abortion rights advocates say Texas women will be forced to seek dangerous and illegal abortions because they will no longer have ready access to the procedure.

Ambulatory surgical centers cost more to build and operate than abortion clinics, which in turn raises the cost of abortions for patients.

Like North Carolina, if this bill is passed abortion providers will eventually adapt—they won’t have any option. Some clinics will manage to transform themselves into ambulatory surgery centers, and some ambulatory surgery centers that don’t currently offer abortion might possibly be able to be leaned on to begin offering abortion services. But in practical terms, what we will see is abortion clinics closing down and becoming a think of the past as abortions become much more expensive and drastically harder to get, especially in the short term. And not surprisingly, this will all hit poor women the hardest.

And the Texas bill has a lot more than just the ambulatory surgical center requirement. The bill would also require abortion doctors to have admitting privileges at a hospital within 30 miles of each clinic where they perform abortions. Because of this:

The Texas Medical Association and the American College of Obstetrics and Gynecology both oppose the bill.

Stacey Wilson, assistant general counsel for the Texas Hospital Association, noted that admitting privileges are not required for any other procedure performed outside a hospital. Because hospitals generally do not perform elective abortions, either for religious or political reasons, they’re unlikely to grant privileges to a doctor for elective abortions, she said.

Wisconsin is on the verge of passing this same admitting privileges requirement. The problem with this requirement is that abortion doctors are generally on the move rather than settled in one place—they perform abortions in one clinic one day of the week, then move on to another clinic the next day, etc., on a rotation. They sometimes serve more than one state, travelling hundreds of miles as part of their job. This isn’t the matter of a local doctor who practices locally having admitting privileges, which makes it complicated. But the real problem is what happens on top of that—the problem is that hospitals are likely to deny abortion doctors admitting privileges not for any practical reason but rather solely for political or religious reasons. This is what happened in Mississippi, when legislators passed a similar law and local hospitals proceeded to deny admitting privileges to the two abortion doctors who serve Mississippi’s last abortion clinic. Again, if the concern was for women’s health, legislators would be seeking to find a way to solve this problem, perhaps by ensuring that hospitals cannot deny admitting privileges for unprofessional reasons. But then, it’s not about women’s health—it’s about using transparent claims of concern for women’s health as a tool to ban abortion. Oh, and there’s also the fact that there are no hospitals within 30 miles of some Texas abortion clinics, meaning that there is literally no way for those clinics to fulfill that requirement whatsoever.

Another point: Both the Texas and the North Carolina bills require that even medical abortions—i.e., ones involving a pill to induce miscarriage—be performed in an ambulatory surgery center. Medical abortions don’t require anything that could be construed as surgery no matter how you view it. Several months ago, Indiana passed a law requiring that clinics offering any form of abortion have the facilities for surgical abortions; as a result, Planned Parenthood’s Lafayette clinic there will almost certainly be forced to stop offering abortion services at all (previously, they only offered medical abortions). These sorts of restrictions clearly have nothing to do with women’s health.

I feel like I’ve said a lot here without really saying anything at all. If anything, I hope I’ve made clear some of the ways Republicans are seeking to eliminate abortion (i.e., through legislating abortion clinics out of existence, not through things like, you know, offering better sex education, working to make the most effective methods of birth control more widely available, or making it more affordable to raise children) and why claims that these measures are all about women’s health ring hollow. I hope, also, that this meandering exploration has shown you just how deep and widespread this problem is. I can only say that the widespread outcry against these measures gives me hope. Perhaps conservatives have overreached, and perhaps, just perhaps, there may be building momentum for support for women’s reproductive rights.