News Abortion

Delaware Councilwoman Wants Personhood For Sperm

Robin Marty

The "every sperm is sacred" bills are beginning to spread.  

It may have started in Oklahoma, but “every sperm is sacred” bills are beginning to grow in popularity as more lawmakers look to them as a means of pointing out the ridiculous flaws of giving “personhood” rights to fertilized eggs.

The latest to introduce a “sperm” bill?  Councilwoman Loretta Walsh of Delaware.

Via Delaware Online:

The resolution, designed to address “equality” issues, said that lawmakers have not introduced similar legislation regarding men in the United States. If some lawmakers believe the female egg is “bestowed with all the rights of personhood,” government should think the same of sperm, the resolution notes.

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“[E]ach ‘egg person’ and each ‘sperm person’ should be deemed equal in the eyes of the government and be subject to the same laws and regulations as any other dependent minor and be protected against abuse, neglect or abandonment by the parent or guardian,” according to the resolution.

“What’s good for the gander is good for the goose,” Walsh said.

It’s in many ways the same argument that Oklahoma State Senator Constance Johnson used when asked to justify her bill.

[T]his amendment seeks to draw humorous attention to the hypocrisy and inconsistency of this proposal – from the Republican perspective of down-sized government and less government intrusion into people’s private affairs. Despite the great challenges our state faces, it is far more important that we address issues such as affordable healthcare to help improve our state’s ranking of 48th in health status; to create good, secure jobs that grow our economy; and ensure that all citizens have access to quality, affordable education.

Will “sacred sperm” bills help turn the tide against the onslaught of “fertilized egg as people” amendments?  One can only hope.

Commentary Law and Policy

An Incomplete Victory for Evidence-Based Abortion Care

Liz Borkowski & Amy Allina

On June 28, just a day after the Supreme Court ruling, Texas published a revised draft of the pamphlet that must, by state law, be given to all people seeking abortion services. But the brochure still includes misleading information, reminding us that anti-choice politicians are still interfering in patient-provider interactions.

Reproductive health advocates cheered in March when the U.S. Food and Drug Administration (FDA) approved a revised label for abortion drug Mifeprex (mifepristone). We cheered again when the U.S. Supreme Court struck down central provisions of Texas law HB 2, which would have closed most of the state’s abortion clinics. Both of these were victories not just for access to abortion care, but also for health-care policies based on current evidence. However, on June 28, just a day after the Supreme Court ruling, Texas published a revised draft of the pamphlet that state law requires physicians to provide to all women seeking abortion services, reminding us that anti-choice politicians are still finding ways to interfere in patient-provider interactions.

Laws and regulatory actions of this kind, which require the use of biased and incomplete information, prevent health-care professionals from providing women with care that meets basic medical and ethical standards.

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State requirements that are at odds with up-to-date scientific or medical research are nothing new. Several states have passed laws requiring abortion providers to follow the FDA-approved label for Mifeprex. Those laws are currently in force in North Dakota, Ohio, and Texas, and have been halted by courts in Arizona, Arkansas, and Oklahoma. Before March, this meant that providers in those states had to follow the original Mifeprex label, which was based on clinical trials conducted in the 1980s and 1990s, and which didn’t encompass variations in practice used for years to make medication abortions safer and more accessible. These included lowering the dose of mifepristone from 600 mg to 200 mg; offering medication abortions for pregnancies of up to 70 days, rather than only through 49 days; and allowing the woman to take the second drug in the procedure (misoprostol) at home rather than requiring her to return to a provider’s office to swallow a pill. (For more on current science about medication abortion, see our white paper.) The new label reflects those changes and makes it easier for providers everywhere to offer evidence-based care.

Normally, providers’ use of approved drugs evolves as the evidence does. This is important because experience and research can show that it’s safe and effective to use drugs in different doses or for different conditions than what the label specifies. Providers can adopt these variations without waiting for a new label to be approved by the FDA by prescribing a drug off-label. For instance, the asthma medication albuterol (found in inhalers) is often prescribed off-label for chronic obstructive pulmonary disease due to substantial evidence supporting this off-label use. Drug manufacturers may apply to FDA for an updated label (particularly when insurers won’t cover drugs for off-label conditions), but they don’t have to do so.

However, a new Mifeprex label was important because some states were requiring abortion providers to adhere to the outdated label—in essence, telling providers that their practice could not evolve based on evidence, and denying women access to the care that’s been demonstrated to be safe and effective.

Much like laws requiring medication abortion providers to adhere to an outdated label, so-called informed consent laws requiring that a woman receive certain information before getting an abortion essentially substitutes the judgment of legislators for the judgment of health-care providers. In states like Texas, where a majority of the legislators are committed to a political agenda blocking access to abortion, this all too frequently means replacing scientific evidence with intentionally distorted information. When the Rutgers University Informed Consent Project asked anatomists specializing in embryological and fetal development to evaluate statements in the previously available version of Texas’s required pamphlet, they determined that 34 percent of the statements were either scientifically incorrect or misleading. (Preliminary findings on the revised draft suggest the accuracy hasn’t improved, project head Cynthia Daniels told the Texas Tribune.) True informed consent is a necessary and ethically valuable part of any medical process, but these types of laws subvert the true intent of consent when they require providers to give inaccurate or incomplete information under the guise of improving transparency.

Also problematic is what the revised Texas pamphlet still doesn’t say. The section on abortion risks reports the extremely low risk of death from abortion complications, but doesn’t mention the 2012 study that found the risk of death associated with childbirth to be 14 times higher than that from legal abortion. The pamphlet tells readers that “some women have reported” negative emotions, including depression, grief, and anxiety after abortions. However, it remains silent about rigorous, peer-reviewed research that compared outcomes for women who sought and received abortions to those who sought and were denied them. Those studies found no differences between the two groups in anxiety, depression, or post-traumatic stress disorder, and documented positive emotions, such as relief and reduced unhappiness, in those who obtained abortions. (See the Turnaway Study for details on this research).

Especially disturbing examples of legislators requiring providers to give women misleading information are laws passed in Arizona and Arkansas based on poorly supported claims that medication abortions can be “reversed” if a women decides to do so before taking the second drug. Such laws require physicians to provide a woman seeking a medication abortion with information about the possibility of “reversing” the procedure by taking another hormone to counter the mifepristone, despite the absence of reputable evidence that such “reversal” can occur. Requiring providers to give information like this, which is not borne out by human studies, conflicts with the responsibility of clinicians to do no harm.

These laws, along with many others that interfere with abortion care, are enacted amid claims that they are designed to benefit women. The evidence, however, contradicts those claims. As U.S. Supreme Court Justice Stephen Breyer wrote in his majority opinion striking down the provisions of the Texas law, the requirements imposed by the state “vastly increase the obstacles confronting women seeking abortions in Texas without providing any benefit to women’s health capable of withstanding any meaningful scrutiny.” Noted Supreme Court analyst and New York Times reporter Linda Greenhouse wrote that in this decision “evidence-based medicine meets evidence-based law.”

The next step is for evidence-based medicine to meet with evidence-based legislating. It’s time for legislators to stop requiring health-care practices based on outdated or incomplete evidence, and instead focus on promoting health and high-quality health care for all.

News Abortion

Study: Catholic Hospitals ‘Dump’ Abortion Patients, Often Refuse Referrals

Nicole Knight

"What doctors told us is sometimes for abortion ... there was a sense of, 'You're on your own,'" said Dr. Debra B. Stulberg, assistant professor of family medicine at the University of Chicago.

The patient learned she had brain cancer in her first trimester of pregnancy. She needed chemotherapy and abortion care.

“I’ve got a woman whose life is threatened by brain cancer,” her doctor, an OB-GYN at a Catholic hospital, told authorities there. “I need to do a termination.”

Catholic hospitals follow religious directives that generally bar certain types of health care, including abortions, except when the patient is in imminent danger.

The hospital refused the treatment, telling the OB-GYN to refer his patient elsewhere.

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“They said, ‘Go take her to another hospital. Take her to another place. Those places are available to you. We don’t have to do it here…’,” the OB-GYN explained.

The case is among many contained in a new paper, “Referrals for Services Prohibited in Catholic Health Care Facilities,” which will be published in the September issue of Perspectives on Sexual and Reproductive Health. The study explores whether Catholic hospitals make timely referrals, provide complete and accurate health-care information, and supply emergency treatment when needed.

And it comes as Catholic facilities exert more and more control over U.S. health care, now accounting for one in six hospital beds nationwide, according to recent figures from the advocacy group MergerWatch.

“Until now, there hasn’t been a study asking about referral patterns in Catholic hospitals,” lead author, Dr. Debra B. Stulberg, assistant professor of family medicine at the University of Chicago, said in a phone interview with Rewire. “We set out to ask OB-GYNs how the institution where they worked affected the care they provide.”

In 2011 and 2012, Stulberg and her co-authors conducted in-depth interviews with 27 OB-GYNs who were working or had worked in Catholic hospitals.

The OB-GYNs came from a diversity of faiths and hailed from all parts of the country; 17 were female, ten were male. And while the qualitative nature of the survey means the responses cannot be generalized across Catholic hospitals nationwide, the survey reveals a referral process plagued by reports of inconsistencies and treatment delays.

Survey respondents described cases where they felt that referring a patient to an outside provider put the patient’s health at risk.

One OB-GYN found it “nearly impossible” to treat heavy vaginal bleeding because of the hospital’s ban on hormonal contraceptives.

“Say you have…a 45-year-old who comes in [at three in the morning] with heavy bleeding and irregular periods. The most common approach to stopping her bleeding is to give her high-dose birth control pills for a short period of time. So, that became very difficult…’cause they didn’t have them in stock. I won’t say it’s impossible to get them, because like the head pharmacist knows where there’s three secret packs, and if you happen to manage to find the head pharmacist at [that hour], you can. But it’s nearly impossible to get birth control pills to treat heavy bleeding.”

OB-GYNs described broad inconsistencies in how hospitals handled referrals, with some hospital administrators and ethicists encouraging or tolerating referrals, and others actively discouraging referrals. Sometimes doctors kept referrals hidden. Respondents reported that patients needing abortion care were given less assistance with a referral than those requesting other prohibited services.

In one instance, a secretary tried to block an abortion care referral.

“What doctors told us is sometimes for abortion … there was a sense of, ‘You’re on your own,'” Stulberg told Rewire. She said the disparities in referrals can delay medical treatment and reinforce abortion stigma.

By referring patients for abortions rather than allowing the doctors to administer the prohibited care, some respondents felt the hospital “dumped” or “punted” the patients.

“It tells women that this care is not standard. It’s something we do on the side, under the table,” Stulberg said. “Imagining myself in those patient’s shoes, I might feel really abandoned by my doctor.”

Respondents reported that they received mixed messages from hospital authorities when the facility’s moral teachings were pitted against its financial interests.

For example, Catholic doctrine prohibits handling eggs and sperm for in-vitro fertilization procedures, but a respondent said a Catholic hospital system skirted the ban by opening an off-site fertility clinic.

As the OB-GYN explained, “Now, they’re getting a little crafty with how they get around it, and they go off-campus [to provide such services]. So we actually do now have…an infertility specialist, who is starting up an in vitro fertilization clinic off-campus…. We had somewhere to send them anyway before—it was just out of the system—but now the system wants the business.”

The authors call on policymakers to require Catholic hospitals that refuse to offer care to refer patients to providers and to inform patients beforehand about the limits on treatment at religiously run facilities.

“Having consistent procedures and help to access abortion will reduce the chance that the patient will be given the run around and have her care delayed,” study co-author Lori R. Freedman, assistant professor in the departments of Obstetrics, Gynecology, and Reproductive Sciences at University of California-San Francisco, told Rewire in a phone interview.

The recommendations are in keeping with ethical guidelines from the American Congress of Obstetricians and Gynecologists, which advises health-care providers with religious objections to abortion care to notify patients beforehand and to refer them to abortion care providers.

The study builds on research published in Contraception by a team that included Freedman and Stulberg. They found that Catholic hospitals’ ban on tubal ligations caused unnecessary second surgeries and erected barriers to care for patients with low incomes.

“You really want women to find safe and compassionate providers as soon as possible,” Freedman told Rewire. “Delays…are not good for women.”

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