Commentary Law and Policy

Major Medical Societies Call For End to Legislative Intrusion Into Women’s Medical Care and Decisions

Andrea D. Friedman

The medical community has been clear: intrusive laws restricting abortion care undermine the relationship between health care providers and their patients and are based on political ideology, not on providing the best possible care.

The October 18 edition of the prestigious New England Journal of Medicine (NEJM) features a compelling “sounding board” titled, Legislative Interference with the Patient-Physician Relationship. “Increasingly in recent years,” the authors argue, “legislators in the United States have been overstepping the proper limits of their role in the health care of Americans to dictate the nature and content of patients’ interactions with their physicians.” The piece addresses laws regarding a number of areas of health care, but a primary focus of the interference the authors challenge is women’s health, and particularly access to abortion care.

This argument comes not from an advocacy group with a political agenda, but from leaders of the medical community—the heads of the American College of PhysiciansAmerican Academy of Family PhysiciansAmerican Academy of PediatricsAmerican College of Obstetricians and Gynecologists and American College of Surgeons. It follows on the heels of a resolution by the American Academy of Family Physicians and a Statement of Principles on the Role of Governments in Regulating the Patient-Physician Relationship by the American College of Physicians. The piece was endorsed just this week by the Council of Medical Special Societies, which represents 39 organizations and over 700,000 physicians.

And around the country, state medical associations have been taking up the cause, openly opposing harmful laws. From the Idaho Medical Association:

“It is the policy of the IMA [Idaho Medical Association] to oppose inappropriate interference by the government and third parties that causes a physician to compromise his or her medical judgment as to what information or treatment is in the best interest of the patient.” (Idaho Medical Association House of Delegates July 27 – 29, 2012, Resolution 04 (12) Protecting the Patient-Physician Relationship)

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And the Texas Medical Association:

“The sanctity of the patient-physician relationship is the foundation of health care in America, and it must be preserved to assure candid communication and allow patients to evaluate their care options. The Legislature’s role should not be to dictate how physicians and patients communicate with one another or what procedures and diagnostic tests must be performed on a given patient.” (Letter from the Texas Medical Association opposing SB16 requiring an ultrasound before a woman can obtain an abortion, full letter available here.)

These statements are a sharp rebuke to legislators around the country busy passing laws that interfere with women’s health care. These are laws that mandate ultrasounds whether or not they are medically necessary; laws that require women to receive baseless, medically inaccurate information such as being told abortion causes breast cancer or suicidal tendencies; laws that make women wait as much as three days before getting an abortion; and laws that limit access to medication abortion, forcing some women to have an unnecessary surgical procedure, and the list goes on. As stated in the NEJM, “by reducing health care decisions to a series of mandates, lawmakers devalue the patient–physician relationship. Legislators, regrettably, often propose new laws or regulations for political or other reasons unrelated to the scientific evidence and counter to the health care needs of patients.” 

Anti-choice lawmakers often try to argue that these laws promote women’s health and protect women from bad decisions. But the reality is just the opposite; they harm women by taking the important decisions about their individual care away from them and their doctors and instead put them in the hands of politicians.

The medical community has been clear, intrusive laws restricting abortion care undermine the relationship between health care providers and their patients and are based on political ideology, not on providing the best possible care. This latest series of rebukes should put to rest the specious, transparent and patently false argument that these laws help women. They have no purpose other than to put up barriers to accessing abortion care and shaming and stigmatizing the women who are able to overcome those barriers.

They do not promote women’s health – they harm it. Don’t believe me? Just ask your doctor.  

News Science

‘Bad Medicine’: Anti-Choice Laws Ignore Medical Evidence

Nicole Knight

Nineteen states require providers to give verbal or written statements that are medically inaccurate or biased. Patients must be told fetuses can feel pain, despite the lack of scientific evidence.

Seventy percent of the 353 state-level abortion restrictions introduced so far this year are based on political pretext, false information, or stereotypes, according to an analysis released Thursday.

The advocacy group National Partnership for Women & Families released the analysis as part of its “Turning Lies into Laws” campaign focused on lies about abortion in 2016. The analysis follows on the heels of its report, Bad Medicine: How a Political Agenda is Undermining Women’s Health Care, which lays out the ideological motivations and inaccuracies that the report’s authors say underpin the majority of legislative impediments to abortion care.

Two hundred fifty-one cases of newly introduced abortion care restrictions run contrary to evidence-based medicine, according to the National Partnership’s analysis of data from the Guttmacher Institute.

“Lies about abortion and the women who have them are being turned into laws across the country, and it needs to stop,” Debra L. Ness, president of the National Partnership, said in a statement accompanying the memo. “All women deserve medically accurate information and access to a full range of reproductive health care, including abortion care.”

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The Bad Medicine report, which includes abortion restrictions in place as of 2015, notes how such regulations force health-care providers to deliver outmoded care, ignore patient preferences, and drive up costs for providers and patients without improving patient health.

The report’s authors detail a growing number of medically unnecessary impediments to abortion care, including:

  • Mandated counseling: 19 states require providers to give or offer verbal or written statements that are medically inaccurate, biased, or false. In 12 of those states, patients must be told fetuses can feel pain, despite the lack of scientific evidence. In nine states, the written statements stress the negative emotional effect of abortion, including depression and suicidal thoughts, even though the American Psychological Association has said the “overwhelming majority” of pregnant people feel relief after the procedure, rather than regret.
  • Mandatory ultrasounds: 13 states have passed laws to require ultrasounds before abortion care, and of those, five include a requirement that the providers display and describe the image even if the patient doesn’t wish to see it.
  • State-sanctioned delays: 31 states have passed laws to delay abortion care, typically 24 hours, with Missouri, North Carolina, Oklahoma, South Dakota, and Utah forcing a patient to wait 72 hours in the off chance that pregnant people might change their mind—a common anti-choice argument.
  • Onerous facility requirements: Nearly half of all states require abortion clinics to be outfitted like ambulatory surgical centers, despite research that indicates abortion procedures often are safer than wisdom teeth removal, which is performed in a dentist’s office.
  • Medication abortion restrictions: 19 states have passed measures to bar providers from administering medication abortion via telemedicine, with six states having “passed laws preventing providers from administering medication abortion in accordance with the standard of care that reflects the most up-to-date evidence.”

Major medical organizations oppose “this trend of political interference in medical decision-making,” according to the report. And courts have moved to block some of these anti-choice measures pushed by Republican-held legislatures across the country.

NPWF_Bad-Medicine_Overview-Map_2

The report issues a call for reform, asking lawmakers to reject legislation that interferes with the patient-provider relationship and to repeal laws that ignore medical evidence and science. In addition, the “Turning Lies into Laws” campaign encourages site visitors to take a pledge to fight back against politicians “using lies to push abortion out of reach.”

“The leading medical societies, including the American Medical Association and the American College of Obstetricians and Gynecologists, are on the record stating that obstacles to abortion care pose a threat to women’s health,” Sarah Lipton-Lubet, director of reproductive health programs at the National Partnership, said in a statement. “Abortion opponents need to learn that legislating something doesn’t make it true, and that when they lie we’re going to call them out.”

The American College of Physicians has said in its “Statement of Principles on the Role of Governments in Regulating the Patient-Physician Relationship” that “mandated care may also interfere with the patient-physician relationship and divert clinical time from more immediate clinical concerns.”

In February, a Rutgers University study suggested that people considering abortion care are provided with medically inaccurate information about a third of the time in the 23 states with so-called informed consent laws. Researchers found that more than 40 percent of information in booklets produced by Michigan, Kansas, and North Carolina was medically inaccurate.

Alabama, Alaska, and Georgia had the lowest percentages of inaccuracies, each with less than 18 percent.

Editor’s note: This piece has been updated to clarify the data in the National Partnership for Women & Families’ “Turning Lies into Laws” campaign and its Bad Medicine report.

News Abortion

End of Missouri 2013 Legislative Session Leaves Women Even Worse Off (CORRECTED)

Robin Marty

With less access to quality preventive care, and more money heading to deceptive crisis pregnancy centers, the 2013 legislative session was another tough one for women.

Correction, May 20, 2:50 p.m. EST: A version of this article incorrectly stated that HB 457, an expanded “conscience” protection bill, had passed the House. It had a hearing but was never voted on.

Missouri’s 2013 legislative session closed on May 17, as the house and senate wrapped up their final day of voting. For low-income and uninsured women in the state, the end couldn’t come soon enough. Lawmakers made it a priority to block expansion of Medicaid and access to birth control, while at the same time funneling tax credits to so-called crisis pregnancy centers (CPCs), which provide misleading or outright inaccurate information and are often run by volunteers passing themselves off as health-care providers. Add into the mix a new law that will make it more difficult for women to access medication abortion services, and Missouri politicians proved yet again their willingness to deny women access to health care.

“The Missouri Legislature is following a disturbing trend in state legislatures across the country,” said Peter Brownlie, president and CEO of Planned Parenthood of Kansas and Mid-Missouri, and Paula Gianino, president and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri, in a joint press release following the session’s close. “Just months after women’s health was a determining issue in a historic election, 42 states saw hundreds of provisions introduced to restrict access to health care and to put politicians between a woman and her doctor. Yet again, we are seeing the wrong priorities come out of the Missouri Legislature on matters of women’s health. Instead of increasing access to preventive health care, the legislature is working to restrict access to birth control and non-surgical abortion while giving millions of tax dollars to groups that are known to provide misleading information to women about their pregnancies.”

To curb the number of women able to access a less invasion early abortion procedure, the state passed a bill that forbids the practice of telemedicine as a means of delivering medication abortion, and prohibited the use of RU-486 unless the patient is in the physical presence of a doctor.

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Also passed this year is an extension of a program that allows donors to crisis pregnancy centers to write the donation off on their taxes. CPCs in the state claim that donations to their groups began to drop when the original program expired. Crisis pregnancy centers in many states have been under fire for passing themselves off as medical centers, for refusing to mention up-front that they do not offer abortion nor contraception nor provider referrals, and for spreading medically inaccurate falsehoods by claiming, for example, that abortion increases the risk of cancer, that contraception has high failure rates, and that condoms do not prevent sexually transmitted infections.

The legislature also refused to expand Medicaid, which will continue to affect low-income uninsured women who need access to basic preventive medical care. Currently, Missouri’s Medicaid program covers only citizens at 32 percent of the federal poverty level. The expansion, which would have been fully funded by the federal government, would have raised the cap to 132 percent of the federal poverty level (a single person making $15,000 a year would quialify). Expansion would have allowed an additional 267,000 individuals in the state to be covered by Medicaid, according to the Missouri Budget Project.

Still, there were a few reproductive rights wins. A bill that would have made it legal for medical providers not only to refuse to offer care or fill a prescription, but to refuse to offer a referral as well, failed. The state’s medication abortion bill might have required even more trips back to the clinic, but an amendment was passed eliminating such language. A bill to revamp an “informed consent” rules never gained any traction, and a spousal consent bill never got introduced.

Now, the legislature rests for another year. Meanwhile, activists on both sides will watch to see if Democratic Gov. Jay Nixon will veto the medication abortion bill, sign it, or simply allow the bill to become law by not acting.

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