A patient with asthma comes to a health center seeking an inhaler. This is the nearest health center where he can get one, and it took him three hours to drive there. Although an inhaler is a standard treatment for asthma, it is nearly impossible to obtain.
The doctor reads a government script that talks about the dangers of inhalers (which are not based on medical facts). The patient is told that if he still wants the inhaler, he can come back in 72 hours—driving six hours round trip and taking time off from work again. Through all of this, if the doctor fails to dot any “i” or cross any “t”, that physician could end up in jail.
If this scenario seems too ludicrous to exist in medicine, think again. This is the reality for abortion care in the U.S. And it’s a major threat to public health across the country.
Today, 27 large cities are abortion deserts where people have to travel 100 miles or more for care; 19 million women live in reproductive health deserts; and six states have only one abortion provider left. Last week, Missouri came within hours of becoming the first state—since 1974—to “go dark” when the state declined to renew the license of its last remaining health center.
Roe v. Wade established abortion as a constitutional right, but without access, it becomes a right in name only. Opponents of abortion recognize this and have steadily put into place laws and regulations that chip away at access to abortion care—with nearly 480 restrictions on abortion care since 2011.
One type of targeted regulation of abortion providers law—known as TRAP laws, they are medically unnecessary regulations of abortion—forces doctors to convert their offices into surgical centers (even though according to the Centers for Disease Control and Prevention, abortion care is one of the safest medical procedures, with a 99% safety profile). Michigan and Mississippi specify corridor width and procedure room size; Virginia politicians even attempted to enact regulations on what fabric can be used in window coverings.
Another TRAP law attempts to restrict which health professionals can provide abortion care. Thirteen states have enacted laws trying to require physicians providing abortion care to have an affiliation with a local hospital, such as admitting privileges. Forty-two states have “physician-only” laws on at least some form of abortion, despite numerous studies that demonstrate the safety and efficacy of abortion care performed by advanced-practice clinicians. According to the National Academies of Sciences, Engineering, and Medicine, TRAP laws hurt women, cause delays in care, and ultimately hinder the quality of care delivered.
In early 2019, the Trump administration proposed a gag rule that would ban doctors in the Title X program from telling patients how they can safely and legally access abortion care. The American Medical Association, as well as 19 other leading healthcare organizations representing more than 4.3 million providers, have publicly opposed the rule.
Unfortunately, politicians are ramping up their threats to physicians. Under the law signed by the Alabama governor last month, provision of abortion is now considered a Class A felony, punishable with up to life in prison. Alabama’s law, and the other abortion bans, could lead to the state investigating the circumstances leading to a woman’s miscarriage. Last month, Missouri took it a step further to put medical trainees’ careers at risk, refusing to renew a health center license unless residents and fellows who rotated through agreed to interrogation that could lead them to lose their medical license and face criminal charges.
In any other area of medicine, such threats to doctors and restrictions on care would be unthinkable. Nearly 1 in 4 women in the U.S. will have an abortion before age 45. Banning abortion will not stop abortion, but it will stop safe, legal abortion.
Political interference with the practice of medicine has a cost—patients’ lives. It’s time to regard reproductive healthcare as the standard healthcare that it is, and for politicians to leave personal, medical decisions to patients and their healthcare providers.
In a future issue, Modern Healthcare will be providing an alternative viewpoint on this topic. Also, share comments in an email to [email protected].
