On November 4, Tennessee's Amendment 1 passed with 53% of the vote. The Amendment is designed to give the Tennessee legislature broader power to regulate and restrict abortion. The assumption that more regulation is a public health priority deserves scrutiny. Supporters of the Amendment now plan to roll out several regulations that have been used elsewhere to restrict access to abortion.
- Mandatory waiting period: Currently 26 states require a "cooling off" period between counseling and performance of an abortion; in ten, this is constructed to require two separate visits.
- State-scripted counseling: 17 states now require counseling that includes false information about breast cancer, the potential for fetal pain, and the emotional aftermath.
- Ambulatory surgery center requirements: Provision of abortion should be limited to facilities capable of performing complex operations like mastectomy.
Underlying assumption: Women are flighty and capricious about such decisions.
Net effect: This requirement delays abortions to later, more risky gestational ages and drives up the cost and inconvenience. For example, if I have a pregnant patient who is found late Monday afternoon to have fetal anencephaly (no brain), I cannot take care of her in my Tuesday morning abortion clinic, which meets weekly. Twenty-four hours will not have elapsed since her counseling late Monday. She will have to wait 8 days to comply with state law in North Carolina. Who benefits from this delay in ending a doomed pregnancy, and at what cost?
Underlying assumption: Physicians have done a poor job of informed consent with more than 50 million abortion patients since Roe v. Wade, and medically untrained politicians can do it better.
Net effect: Providing false information frightens women under duress and thus violates the ethical principles of beneficence and autonomy.
Funded by the Kaiser Family Foundation, the Picker Institute of Boston surveyed more than 2200 abortion patients concerning their quality of care; 98% reported that the procedure was well described to them, and 99% said the explanation was clear and comprehensible. Providers do a better job with abortion counseling than they do with other common operations, such as hysterectomy.
Underlying assumption: Clinics and physicians' offices are dangerous places for abortion care.
Net effect: These laws are designed to drive providers out of business or make the cost (usually paid out of pocket) beyond the reach of most women. Women of minority race and those disadvantaged by poverty, abuse, illness, and psychiatric problems disproportionately rely on abortion to control their fertility -- and thus their destiny.
The claim that abortion in these settings is hazardous is refuted by the Centers for Disease Control and Prevention (CDC). According to the CDC, the risk of death from abortion is about 1 death per 100,000 procedures. By comparison, the risk of death from an injection of penicillin is about 2 per 100,000 injections. A recent report using CDC data found that the risk of continuing pregnancy to delivery was 14 times higher than having an abortion. State legislatures have shown little interest in a true public health problem: more than 500 pregnancy-related deaths (and rising) and more than 2 million women suffering complications of pregnancy, childbirth, and the postpartum period each year.
Forcing an abortion clinic to mimic an operating room is based on yet another false assumption: hospitals are safer than clinics. In contrast, two studies published by the CDC documented that abortion is safer in a clinic than in a hospital.
In my neighboring state of North Carolina, more patients die in dentists' chairs than in abortion clinics. Preoccupied with gynecology, the N.C. General Assembly has to date shown no interest in further regulating dentistry. The regulations soon to be trotted out in Tennessee are based on assumptions that are demonstrably incorrect, demeaning to women and physicians, or both. Moreover, all major medical and public health organizations in the U.S. opposed these needless laws that hurt women. As noted by state representative Eddie Rodriguez of Texas, "politicians make...crummy doctors." Tennessee women deserve better.