To the Editor:
We’d like to set the record straight. In his guest column (Budget, education in spotlight at State House, Tuesday, Feb. 26, 2019), speaker of the house Nicholas Mattiello misrepresented the legislation being considered that would protect safe, legal abortion in Rhode Island.
Facts are important, and when it comes to women’s health, misinformation is rampant. Opponents of protecting a woman’s right to control her own body have portrayed the Reproductive Health Care Act and the Reproductive Privacy Act as expanding these protections considerably beyond those in Roe v. Wade and subsequent Supreme Court decisions.
This is simply untrue. In fact, the RHCA or the amended version of the RPA would cement the protections of Roe into our state law. Enshrining these protections in our state law is critically important as Roe’s federal constitutional protections face mounting partisan legal efforts to undermine or altogether eliminate them.
Speaker Mattiello parrots the extremist rhetoric being pushed by opponents of safe, legal abortion swarming in the media. For example, Speaker Mattiello writes that the RHCA, and by implication, the RPA, contain “a deceptive provision in Rep. Ajello’s bill that would allow late-term abortions up until the day before a birth.”
Physicians do not perform abortions on viable fetuses up until the moment of birth. It is callous to suggest that healthy women would request this or that physicians would comply. When a woman develops complications later in pregnancy with a viable fetus, our goal as obstetricians is to ensure the best possible outcomes for both her and her fetus, usually via cesarean section or induced delivery.
Talking about abortion later in pregnancy, usually meaning after 21 weeks, can be uncomfortable for many people. Many may not realize that they know a woman who has accessed this procedure: abortions after 21 weeks account for approximately 1.3 percent of all abortions in the United States. They may not have counseled a woman facing a severe fetal anomaly diagnosis or known the fear a family faces when medical complications threaten a pregnant woman’s health or life. But these are the lived experiences of women and families. Many serious and potentially fatal medical complications do not develop until later in pregnancy. Preeclampsia can cause strokes, liver and kidney failure. Extensive blood loss due to placental abruption or septic shock from infection related to premature rupture of membranes can lead to death. In some cases, abortion can be the medical intervention that saves the patient’s life. Politics should not dictate that a doctor stands idle in such medical crises when a safe, evidenced-based treatment exists.
Fetal development problems or genetic anomalies are often not detected until later in pregnancy as many of the diagnostic tests are not available until almost 20 weeks. Many of these anomalies are incompatible with life, meaning the fetus will not survive outside the uterus. When testing confirms a severe fetal anomaly, the medical decisions patients must subsequently make are complex and it is essential that they are able to consider the full range of appropriate treatments, whether that is an abortion or delivery. These diagnoses are devastating for patients and their families and they deserve compassion, not stigma.
As with all medical decisions, the decisions made during a woman’s pregnancy should be based on what is best for her specific circumstances. The proposed legislation is vital to ensuring that women who face medical complications later in pregnancy have safe, legal access to the full range of medical treatment options. It does not seek to expand abortion rights beyond what federal law currently protects.
Every Rhode Islander deserves to trust that their health and the health of their loved ones will drive each important medical decision – not partisan tactics. Fear mongering and myths around when and why abortions occur must be rebuked. There is no room for politics in the delivery of care. Every individual needs access to the full range of evidenced-based treatment options, and abortion care should be no different. Our state legislators must stand on the side of medical accuracy and compassion and pass legislation that keeps abortion safe and legal in Rhode Island.
Emily White,MD is the RI Section Chair of the American College of Obstetricians and Gynecologists, and practices in Providence, RI.
Beth Cronin, MD is the RI Section Vice Chair of the American College of Obstetricians and Gynecologists, and practices in Providence, RI.