Over the past decade or so, the public language in anti-abortion lobbying has shifted from “Save the children!” to “For the health of the mother!” Having apparently determined that over-the-top tactics of lying down in front of cars and chaining themselves to clinic doors were turning off the public at large, prominent groups like the National Right to Life now often push for laws they say benefit “everyone involved”—including the pregnant person.
While anti-choice groups still use inflammatory language like “infanticide” and “abortion mill” in their newsletters and blog posts, the emphasis has shifted to passing targeted regulation of abortion provider (TRAP) laws—all under the guise of protecting, as the National Right to Life puts it on its website, “mothers and their unborn children.”
As a reproductive justice advocate who has had a first-trimester abortion, anti-choicers’ language around these laws became even more clearly hypocritical to me following a different, in-office reproductive health procedure I recently underwent to save my life. Given the degree of anti-choice rhetoric about how much stress women undergo to get abortions, I hadn’t even considered the thought of being uncomfortable and emotionally exhausted by any other reproductive health service. After all, the public doesn’t hear much about the thousands of women like me who are at high risk for cervical cancer, and we certainly aren’t a priority of any anti-abortion group I’ve encountered. If anti-choicers truly cared about women to the degree they claim, surely they would treat abortion procedures just like any other reproductive health need—and leave decisions about safety and comfort up to women and their doctors.
An Arbitrary Standard
Sex. Abortion. Parenthood. Power.
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One TRAP law that has been particularly damaging in recent years requires abortion providers to adhere to ambulatory surgical center (ASC) standards. Conveniently omitting that first-trimester abortion only sends a tiny fraction of patients to the hospital in need of follow-up care, anti-choice groups and legislators have continuously maintained that the width of a facility’s hallways, number of parking spaces, and size of the janitorial closets guaranteed through certification as an ASC will be what safeguards the patient’s health during their five-minute procedure.
Dr. Leah Torres, a Salt Lake City, Utah-based OB-GYN specializing in reproductive health, says these laws do exactly the opposite.
“TRAP laws are passed under a false premise of patient safety,” Torres told Rewire. “Patient safety is the top priority of any physician, yet the laws that are passed prohibit me from taking care of people in the safest way I know how. This does, in fact, hurt my patients. Harm is done when physicians’ hands are tied.”
The most famous ASC law was penned in Texas, where its parent omnibus anti-abortion law, HB 2, is winding its way through the appeals courts, due to be heard by the full Fifth Circuit on January 8. Texas is certainly not the only state with this requirement. Anti-abortion groups across the country have pushed laws, such as the model legislation from Americans United for Life, that have proven to close the doors of clinics. Accreditations and building specifications are a matter of public record, so it’s easy to determine whether or not local clinics meet the expensive building requirements to become ASC-certified. If they—like many of the Texas facilities—do not meet those requirements, anti-choicers conceivably know that having the construction done to meet the standards is often a multi-million dollar ordeal that results in closure rather than renovation.
Occasionally a right-to-lifer will slip and publicly admit that abortion is safer than pregnancy, or that all the talk about “women’s health” is just a façade to divert attention from their intention to close clinics. With those missteps on the record, let’s just be honest about the whole thing: Anti-choice groups and the legislators they back aren’t interested in the health of the patient. Their interest stops at the health of the embryo or fetus. If they cared about the whole health of the patient, that interest would have revealed itself at some point during their more than 40 years in existence as a movement.
Dr. Torres says she has yet to see someone calling themselves “pro-life” advocating for preventive and life-saving care.
“It is discriminating to profess concern for patient safety for one procedure, for one population—women of reproductive age—and not for all people across all specialties,” says Torres. “It is hypocritical and it feels false, as well as insulting.”
Indeed it does.
Abortion is, after all, the only reproductive health-care procedure that seems to matter to these groups. Having spent time volunteering and organizing as a clinic defense escort in Chicago, New York, New Jersey, and Los Angeles, I can attest to the very singular focus of the picketers and the groups they represent: With the exception of the occasional anti-contraception sign, all the misinformation-filled pamphlets, screaming, and photoshopped, gory placards are abortion-motivated. This seems curious, as any “life”-focused activist should be interested in the lifesaving services offered at most clinics and doctor’s offices. You never see them screaming on their capitol building’s steps demanding the expansion of preventive care like Pap tests, STI testing, prenatal support, and the like. They aren’t passing out condoms at AIDS walks, or even offering child-care assistance for the children a patient already has. If a National Right to Life, Pro-Life League, or Operation Rescue member is holding a sign somewhere, their only concern is forcing a pregnant person to carry to term.
This gap in empathy and what constitutes “saving a life” exhibited by millions of anti-choicers was particularly evident to me when I went in to my gynecologist this August for a loop electrosurgical excision procedure (LEEP), which removed abnormal tissue on my cervix both for further testing and to hopefully excise any pre-cancerous cells, thus preventing cervical cancer. I am on what I call the “HPV merry-go-round,” having contracted a strain of the human papillomavirus (HPV) in my 20s that my immune system has not yet successfully fought off ten years later. HPV is so common that, according to the Centers for Disease Control and Prevention, “nearly all sexually active men and women get it at some point in their lives,” so I’ve never felt particularly “damaged” by the diagnosis, just frustrated and extremely inconvenienced.
Most strains don’t cause health problems (especially in men, who often never discover they were or are a carrier). The handful of problematic strains, however, lead to annual HPV-associated cancer diagnoses in approximately 20,000 women and 12,000 men, with cervical cancer in women being the most common (12,109 cases and 4,902 deaths in 2011). As a consequence, preventive treatments such as colposcopies and LEEPs can be literally lifesaving.
Over the past decade, I’ve gone through occasional stretches with normal Pap test results and just the one doctor’s visit for that year. More often than not, though, I’m back for additional Paps, the now routine-for-me colposcopy to determine just how abnormal or pre-cancerous the cells of my cervix are, and, most recently, a LEEP.
So after three colposcopies and a LEEP—all performed in my doctors’ offices—I’ve had more than my share of “work” done in terms of reproductive health procedures. Personally, I am comfortable saying that my first-trimester abortion was a less stressful appointment and came with less discomfort than the four procedures performed to prevent any developing cervical cancer. My LEEP in August was particularly traumatic because my doctor and her staff had what I will politely describe as a lack of bedside manner. Picturing the cold procedure room where I was left for nearly 90 minutes in only a gown, with no information or counseling from my doctor, makes my pulse race even months later. (According to Torres, the pre-procedure counseling for LEEPs should take place in an office setting with the patient fully clothed.)
When I got home, after having used Twitter heavily during my lengthy wait for the doctor, I checked my feeds. Many people had responded with words of concern and love. Two of my best friends—knowing I have an anxiety disorder and that the lidocaine used to numb my cervix might still be causing heart palpitations in addition to the ones my body was producing on its own—had continued to check in on me while I was on the subway without cell phone service. Everyone, it seemed, was concerned with my health.
Everyone except the anti-choicers who routinely harass me online for my abortion advocacy, that is. Their silence on my experience—and on the everyday experiences of patients who visit their doctors’ offices for procedures carrying risks similar to abortion—is deafening. They seem to trust medical professionals to perform all manner of non-abortion-related care without bystander intervention; do they not understand that the abortion specialty operates just like the rest of medicine?
As with other medical fields, best practices for obstetrics and gynecology procedures are governed by associations of medical professionals like the American Congress of Obstetricians and Gynecologists and the National Abortion Federation. Torres says that she spent time developing skills for both LEEPs and first-trimester abortions early on in her career; she considers the “level of surgical skill,” as she put it, required for each to be comparable.
And the risks for both procedures are comparably negligible, too. The LEEP takes longer because of the time spent waiting for the lidocaine to fully numb the cervix (think the time you spend in the dentist’s chair waiting for the Novocain to kick in before a filling). According to Planned Parenthood, it’s rare to have issues requiring follow-up care after either procedure; the organization’s website counsels patients to watch for similar symptoms, including abnormally heavy bleeding or signs of infection such as fever or vomiting.
When compared to my LEEP this August, my abortion experience four years earlier at a Planned Parenthood in Chicago was warm, comforting, less painful, and over much more quickly. In fact, I can theoretically see a more understandable case for some of the ASC guidelines being pertinent to the LEEP than to the abortion, as the former felt more invasive—the doctor wears a mask to keep the smoke produced during cauterization out of their eyes, and I was in stirrups more than twice as long.
Still, no one is demanding legislation to regulate it. Nor, as Torres points out, are they rallying against colonoscopies, which are 40 times as risky as abortion, or dental procedures that require anesthesia.
“There are many riskier procedures done by other specialists in the office and no mention is made of their needing admitting privileges”—another common TRAP law—“or that their procedures require a surgical center,” said Torres. “No one demands [gastro-intestinal] specialists only perform [colonoscopies] in an ASC. Also, if you think about the sedation procedures dentists perform, those medications are also used in surgical procedures in ASCs yet dentists are not required to be in an ASC to use them.”
In fact, Torres has never seen a law proposed to regulate how she performs any other procedures, including LEEPs, in her office—or how dentists and proctologists and plastic surgeons perform procedures in theirs.
A LEEP, Torres said, “Saves the life of the patient. I don’t know why those who value life do not advocate for all surgical procedures be performed in ASCs if they are that convinced [ASCs] ‘safer’ and ‘saves lives’ over anything else.”
She’s not advocating in favor of more of these laws, of course, as they increase the financial and logistic burden on both patients and providers, along with occasionally decreasing safety. She is simply pointing out the reality of which procedures get held up for additional scrutiny.
“Medically, sometimes the office is safer for a procedure and sometimes the hospital is safer. That [decision] should be made by the medical professional—not the patient, not the lawyers, not the politicians,” said Torres.
“I’m prohibited from performing abortions in Utah hospitals, for example. You’d think that would be the ‘safest’ place, but state laws prohibit facilities receiving state funds from performing abortion—and all Utah hospitals receive state funds. Lots of contradiction,” she continued. “So, if I think I can’t safely perform the abortion in the office, even [one] with ASC standards, then I have to send the patient to another state. This happens all over the country.”
The Growing Restrictions
Torres couldn’t be more right. Legislators in nearly every part of the country are wasting time and money exhibiting a complete disregard for women’s basic humanity as autonomous persons. Hundreds of laws have been introduced restricting abortions across the country. In fact, since Roe, nearly every state in the union has enacted legislation inserting the state house into exam rooms.
Why do we not trust providers and patients when it comes to one of the safest procedures in medicine? Because, apparently, the patient seeking an abortion has a uterus and presumably was so bold as to have sex, and that means legislators—overwhelmingly rich, white men—have a centuries-old right to dictate what happens next. While no one, not even an anti-abortion “advocate” or legislator, would deny me access to the procedures that have hopefully prevented me from developing cervical cancer, they don’t recognize my right to control the contents of my uterus.
The abortion that I know saved my life? That, anti-choicers feel compelled to weigh in on.
If “pro-life” organizations and legislators truly cared about women’s health, they would be campaigning for wider access to HPV screenings and vaccines. Or, just perhaps, they would stop to consider leaving it up to the experts: the doctors and patients.
Certainly, the incoming wave of new Republican legislators following the 2014 midterms won’t lead to a lessening of the country-wide trend anytime soon. As Rewire has reported, Americans United for Life is well-funded thanks to wealthy donors like the Koch brothers; its model legislation is ready and waiting for right-wing legislators to introduce this January. Meanwhile, likely Majority Leader Mitch McConnell has promised to introduce a federal 20-week ban in the Senate to match the one the now farther-to-the-right House passed last year. The president is opposed to the ban and would probably veto such legislation, but the national prominence of a bill pushed and passed “for women’s health and safety” gives undue validity to the state-level measures that will follow on its heels.
Providers like Torres are not opposed to the public discourse and legislator interest in their profession; Torres simply takes issue with the motivation revealed by the way they circumvent evidence and care guidelines from physicians.
“I have no problem with elected representatives involving themselves in public health issues. I think political involvement in health care is necessary,” said Torres. “However, political dictation of how medical care is provided should not occur without the proper medical training and knowledge to support it … Just as I do not walk into a courtroom and start practicing law, they should not interfere with the safe, evidence-based health care [being provided] to their constituents.”