Wisconsin SB 306 will greatly impede the continuity of care and put up obstacles between a woman and her primary care physician. It is an unacceptable intrusion into the doctor-patient relationship because, among other things, it requires abortion providers to give patients inaccurate post-procedure instructions.
Dear Chairwoman Vukmir and Senate Health Committee Members:
I provide abortion care to patients in hospital settings as well as in outpatient clinics. A significant number of these patients undergo medically indicated abortions for lethal fetal anomalies or to preserve their life or health. Often, patients have significant medical problems (as cancer, diabetes, heart failure) which require expertise and care in addition to a safe abortion procedure. Many of the patients I treat are referred to me by their primary care physician in Wisconsin, often from a significant distance. I have described examples of the care I provide in the attached article I wrote for the Capitol Times a few months ago.
I oppose SB 306 since it interferes with the ability of myself and other physicians to practice sound evidence-based medicine. This bill interferes with my ability to provide care to patients in need of my expertise and it limits patient choice and autonomy.
1) SB 306 creates an unacceptable barrier in the doctor patient relationship, harming the continuity of care providers strive for in Wisconsin.
Like This Story?
Your $10 tax-deductible contribution helps support our research, reporting, and analysis.
Under current law, Wisconsin Statute Sec. 253.10, any qualified physician in the state of Wisconsin can provide informed consent counseling, make the voluntariness determination and obtain the state required 24-hour consent form from a patient. Oftentimes these primary care physicians refer the patient to an abortion provider, who provides counseling and again obtains consent for the procedure. This bill would require that the abortion provider obtains the initial consent. This new and additional requirement delays care and interferes in the patients existing relationship with her primary care physician. In addition, the referring physicians know their patients and are often the best informed regarding the patients’ medical condition. Certainly any licensed physician is qualified to obtain the initial consent. The physician performing the abortion will verify that consent and provide counseling prior to a procedure. This bill will greatly impede the continuity of care and put up obstacles between a woman and her primary care physician.
2) SB 306 is an unacceptable intrusion into the doctor-patient relationship because it requires abortion providers to give patients inaccurate post-procedure instructions.
This bill requires that patients be told that they must return to the same clinic where they received their abortion for a follow up visit with the abortion clinic within a specific time frame written into the law. I absolutely agree and best practice requires that women undergoing an abortion have a follow up exam to ensure a successful termination with no complications. Frequently this follow up care is better and more conveniently provided in a continuity of care setting by a primary care provider or referring physician in their own community. There is a medical necessity for follow up care, but no medical rationale that this follow up care must be provided by the abortion provider. This requirement can create a distance and access barrier for patients with no medical rationale or benefit. In addition, it is not the role of the legislature to practice medicine. This level of control over the doctor-patient setting is unacceptable and amounts to the legislature practicing medicine—without a license or any medical expertise.
3) SB 306 interferes with a doctor’s ability to use his or her professional judgment to determine the appropriate medical care in each individual patient’s unique circumstance.
The safe use of abortion medication, including proper dosage and administration, is extensively studied in the medical literature and established in evidence-based practice guidelines that are available for medical professionals. The timing, administration and dosing of legal medications is a practice which should not be legislated but left to the physician and patient to decide based on individual circumstances, as is the standard for all medical care. SB 306 undermines this standard of care and restricts the ability of physicians to prescribe and direct medication use in a location of choice. Currently FDA rules and guidelines are followed for medication abortions and in hospital settings medications are often used off-label based on evidence based literature. This bill interferes with physicians’ ability to establish an individual care plan.
There is no need for this bill. The bill will not enhance public safety. This bill will not improve the counseling or informed consent. The medical community is not asking for this bill—in fact, many of my colleagues are mobilizing against its unacceptable intrusion into medical practice. What this bill does is create barriers for patients to obtain abortion care in a timely fashion within a continuity of care context. This bill interferes negatively with continuity of care which is important for patients after an abortion procedure, especially when medically indicated.
The members of Congress who flocked to the Democratic National Convention in Philadelphia this week included a vocal advocate for the intersection of racial and reproductive justice: Rep. Bonnie Watson Coleman (D-NJ).
Watson Coleman’s longstanding work in these areas “represented the intersection of who I am,” she said during a discussion in Philadelphia sponsored by the Center for Reproductive Rights and Cosmopolitan. Reproductive health-care restrictions, she stressed, have a disproportionate effect on the poor, the urban, the rural, and people of color.
“These decisions impact these communities even more so [than others],” she told Rewire in an interview. “We don’t have the alternatives that middle-class, suburban, white women have. And we’d rather they have them.”
Coleman said she’s largely found support and encouragement among her fellow lawmakers during her first term as a woman of color and outspoken advocate for reproductive rights.
“What I’ve gotten from my Republican colleagues who are so adamantly against a woman’s right to choose—I don’t think it has anything to do with my being a woman or an African American, it has to do with the issue,” she said.
House Republicans have increasingly pushed anti-choice policies in advance of the ongoing August recess and November’s presidential election. The House this month passed the Conscience Protection Act, which would give health-care providers a private right of action to seek civil damages in court, should they face supposed coercion to provide abortion care or discrimination stemming from their refusal to assist in such care.
Speaker Paul Ryan (R-WI) lauded passage of the bill and the House’s thus-far unsuccessful effort to prove that Planned Parenthood profited from fetal tissue donations—allegations based on widely discredited videos published by the Center for Medical Progress, an anti-choice front group that has worked closely with GOP legislators to attack funding for Planned Parenthood.
The Hyde Amendment’s restriction of federal funding for abortion care represents a particularly significant barrier for people with low incomes and people of color.
The Democratic Party platform, for the first time, calls for repealing the Hyde Amendment, though the process for undoing a yearly federal appropriations rider remains unclear.
For Watson Coleman, the path forward on getting rid of the Hyde Amendment is clear on at least one point: The next president can’t go it alone.
“The president will have to have a willing Congress,” she said. She called on the electorate to “recognize that this is not a personality contest” and “remove some of those people who have just been obstructionists without having the proper evidence.”
In the meantime, what does a “willing Congress” look like for legislation with anti-choice roadblocks? A majority voting bloc helps, Watson Coleman said. But that’s not everything.
“There are lots of bills that Republicans will vote for if their leadership would simply bring them up,” she said.
A Texas GOP lawmaker has teamed up with an anti-choice organization to raise awareness about the supposed prevalence of forced or coerced abortion, which critics say is “wildly divorced from reality.”
Rep. Molly White (R-Belton) during a press conference at the state capitol on July 13 announced an effort to raise awareness among public officials and law enforcement that forced abortion is illegal in Texas.
White said in a statement that she is proud to work alongside The Justice Foundation (TJF), an anti-choice group, in its efforts to tell law enforcement officers about their role in intervening when a pregnant person is being forced to terminate a pregnancy.
“Because the law against forced abortions in Texas is not well known, The Justice Foundation is offering free training to police departments and child protective service offices throughout the State on the subject of forced abortion,” White said.
Like This Story?
Your $10 tax-deductible contribution helps support our research, reporting, and analysis.
White was joined at the press conference by Allan Parker, the president of The Justice Foundation, a “Christian faith-based organization” that represents clients in lawsuits related to conservative political causes.
Parker told Rewire that by partnering with White and anti-choice crisis pregnancy centers (CPCs), TJF hopes to reach a wider audience.
“We will partner with anyone interested in stopping forced abortions,” Parker said. “That’s why we’re expanding it to police, social workers, and in the fall we’re going to do school counselors.”
White only has a few months remaining in office, after being defeated in a closely contested Republican primary election in March. She leaves office after serving one term in the state GOP-dominated legislature, but her short time there was marked by controversy.
During the Texas Muslim Capitol Day, she directed her staff to “ask representatives from the Muslim community to renounce Islamic terrorist groups and publicly announce allegiance to America and our laws.”
Heather Busby, executive director of NARAL Pro-Choice Texas, said in an email to Rewire that White’s education initiative overstates the prevalence of coerced abortion. “Molly White’s so-called ‘forced abortion’ campaign is yet another example that shows she is wildly divorced from reality,” Busby said.
There is limited data on the how often people are forced or coerced to end a pregnancy, but Parker alleges that the majority of those who have abortions may be forced or coerced.
‘Extremely common but hidden’
“I would say that they are extremely common but hidden,” Parker said. “I would would say coerced or forced abortion range from 25 percent to 60 percent. But, it’s a little hard be to accurate at this point with our data.”
Parker said that if “a very conservative 10 percent” of the about 60,000 abortions that occur per year in Texas were due to coercion, that would mean there are about 6,000 women per year in the state that are forced to have an abortion. Parker believes that percentage is much higher.
“I believe the number is closer to 50 percent, in my opinion,” Parker said.
Busby said that White used “flawed research” to lobby for legislation aimed at preventing coerced abortions in Texas.
“Since she filed her bogus coerced abortion bill—which did not pass—last year, she has repeatedly cited flawed research and now is partnering with the Justice Foundation, an organization known to disseminate misinformation and shameful materials to crisis pregnancy centers,” Busby said.
White also sponsored HB 1648, which would have required a law enforcement officer to notify the Department of Family and Protective Services if they received information indicating that a person has coerced, forced, or attempted to coerce a pregnant minor to have or seek abortion care.
The bill was met by skepticism by both Republican lawmakers and anti-choice activists.
State affairs committee chairman Rep. Byron Cook (R-Corsicana) told White during a committee hearing the bill needed to be revised, reported the Texas Tribune.
“This committee has passed out a number of landmark pieces of legislation in this area, and the one thing I think we’ve learned is they have to be extremely well-crafted,” Cook said. “My suggestion is that you get some real legal folks to help engage on this, so if you can keep this moving forward you can potentially have the success others have had.”
‘Very small piece of the puzzle of a much larger problem’
White testified before the state affairs committee that there is a connection between women who are victims of domestic or sexual violence and women who are coerced to have an abortion. “Pregnant women are most frequently victims of domestic violence,” White said. “Their partners often threaten violence and abuse if the woman continues her pregnancy.”
There is research that suggests a connection between coerced abortion and domestic and sexual violence.
Dr. Elizabeth Miller, associate professor of pediatrics at the University of Pittsburgh, told the American Independent that coerced abortion cannot be removed from the discussion of reproductive coercion.
“Coerced abortion is a very small piece of the puzzle of a much larger problem, which is violence against women and the impact it has on her health,” Miller said. “To focus on the minutia of coerced abortion really takes away from the really broad problem of domestic violence.”
A 2010 study co-authored by Miller surveyed about 1,300 men and found that 33 percent reported having been involved in a pregnancy that ended in abortion; 8 percent reported having at one point sought to prevent a female partner from seeking abortion care; and 4 percent reported having “sought to compel” a female partner to seek an abortion.
Another study co-authored by Miller in 2010 found that among the 1,300 young women surveyed at reproductive health clinics in Northern California, about one in five said they had experienced pregnancy coercion; 15 percent of the survey respondents said they had experienced birth control sabotage.
‘Tactic to intimidate and coerce women into not choosing to have an abortion’
TJF’s so-called Center Against Forced Abortions claims to provide legal resources to pregnant people who are being forced or coerced into terminating a pregnancy. The website includes several documents available as “resources.”
One of the documents, a letter addressed to “father of your child in the womb,” states that that “you may not force, coerce, or unduly pressure the mother of your child in the womb to have an abortion,” and that you could face “criminal charge of fetal homicide.”
The letter states that any attempt to “force, unduly pressure, or coerce” a women to have an abortion could be subject to civil and criminal charges, including prosecution under the Federal Unborn Victims of Violence Act.
The document cites the 2007 case Lawrence v. State as an example of how one could be prosecuted under Texas law.
“What anti-choice activists are doing here is really egregious,” said Jessica Mason Pieklo, Rewire’s vice president of Law and the Courts. “They are using a case where a man intentionally shot his pregnant girlfriend and was charged with murder for both her death and the death of the fetus as an example of reproductive coercion. That’s not reproductive coercion. That is extreme domestic violence.”
“To use a horrific case of domestic violence that resulted in a woman’s murder as cover for yet another anti-abortion restriction is the very definition of callousness,” Mason Pieklo added.
Parker said a patient might go to a “pregnancy resource center,” fill out the document, and staff will “send that to all the abortionists in the area that they can find out about. Often that will stop an abortion. That’s about 98 percent successful, I would say.”
Reproductive rights advocates contend that the document is intended to mislead pregnant people into believing they have signed away their legal rights to abortion care.
Abortion providers around the country who are familiar with the document said it has been used for years to deceive and intimidate patients and providers by threatening them with legal action should they go through with obtaining or providing an abortion.
Vicki Saporta, president and CEO of the National Abortion Federation, previously told Rewire that abortion providers from across the country have reported receiving the forms.
“It’s just another tactic to intimidate and coerce women into not choosing to have an abortion—tricking women into thinking they have signed this and discouraging them from going through with their initial decision and inclination,” Saporta said.
Busby said that the types of tactics used by TFJ and other anti-choice organizations are a form of coercion.
“Everyone deserves to make decisions about abortion free of coercion, including not being coerced by crisis pregnancy centers,” Busby said. “Anyone’s decision to have an abortion should be free of shame and stigma, which crisis pregnancy centers and groups like the Justice Foundation perpetuate.”
“Law enforcement would be well advised to seek their own legal advice, rather than rely on this so-called ‘training,” Busby said.