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Saturday, May 24, 2014

For many, it's privacy and freedom of choice as well

The Issue is Safety
By Philip Darney 

Over half of all American women of reproductive age now live in states with laws severely restricting their reproductive health care -- creating a potential public health and safety crisis unseen since the 1970s. This was not the future envisioned by my colleagues as the drive to legalize abortion took place.

More than 40 years ago, obstetrician-gynecologists around the country began to worry about what would follow the legalization of abortion, which they could see coming. One hundred leading obstetricians signed a landmark Statement on Abortion in the respected American Journal of Obstetrics and Gynecology in 1972, warning of "an imminent problem of rather staggering proportions" and calling on their peers to take action right away.

Roe v. Wade legalized abortion the following year, and the aftermath surprised the physicians. They had thought the problem would be women's safety. They predicted, correctly, that the 1973 legalization would lead women to request about a million legal abortions per year, one in every four pregnancies. Would hospitals have the needed capacity and skills? 

They decided that yes, U.S. hospitals would be able to handle that demand "with careful planning, conscientious effort and modern techniques," because "the requisite space will soon be freed by the lessened number of septic abortions and puerperal [post-abortion] cases."

In other words, they thought safe and legal abortions would prevent many of the unsafe abortion attempts that were then filling hospital beds with injured and dying women. They were right about that. 

The number of abortion attempts did not change -- it was and is one in every four pregnancies -- but the U.S. maternal mortality rate has declined from 20 deaths for every 100,000 live births in 1972 to half that now, in part because abortion has become much safer: the number of deaths each year has declined from a half thousand to a half dozen.

Those physicians were wrong; however, in thinking that legal abortion would be universally welcomed as the public health benefit it is. Instead, ideological backlash now threatens to overwhelm medicines historic and critical concern for womens health.

That is why, 40 years later, I followed the example of my mentor and teacher at The Harvard Medical School, Dr. Kenneth J. Ryan, one of the original signers of the Statement on Abortion, to help organize a second statement by 100 of today's obstetricians, soon to be published in the same respected journal. Dr. Ryan died in 2002, but I know he would have signed the new statement again himself.

"We have had 40 years of medical progress but have witnessed political regression that the 100 professors did not anticipate," the new statement says. "Forty years later, the change is not liberal. Its effects will threaten, not improve, womens health and already obstruct physicians' evidence-based and patient-centered practices"

In the past three years, 205 abortion restrictions have been enacted. Waiting periods that can endanger women are now law in 26 states. In addition, "Laws in 27 states force physicians to provide deceptive counseling," our statement says.

I knew as a child in Long Beach, California, that I would become a doctor. My conservative Republican mother, who had had an abortion herself, always felt as strongly as I did that government had no business interfering in any such crucial personal decision. 

Volunteering as a doctor during the Biafran civil war of the late 1960s, I saw starving women desperate for basic reproductive health care, and later as a clinician in Alabama and Georgia, where abortion was banned, I had to refer poor women to New York for the abortions they needed.

Six months after Roe v. Wade, Dr. Ryan organized an abortion clinic at The Boston Lying-in Hospital to help train physicians like myself. He thought most hospitals would set up such training centers, but it didn't happen. Instead, "Many hospitals enforce fetal and maternal health restrictions that are not based in the law," as our statement says. 

As one result, 90 percent of abortions are now done in private facilities, not hospitals. "In our view, hospitals have disregarded the responsibility that our academic predecessors expected them to assume."

When I began seeking signatures for this new statement, I was flooded with responses. Doctors are angry, but many are afraid to speak out. Several in Texas, Louisiana and Mississippi expressed support but said they couldnt sign because their state legislatures were likely to cut their hospitals funding in retaliation.

Our responsibility as physicians is to teach all methods of contraception and abortion; to provide evidence-based information to all patients and legislators; to insist that the hospitals where we work admit abortion patients; and to ensure that all methods of contraception are widely available in order to reduce the need for abortion.

Dr. Ryan's statement of 1972 insisted that our priority must be women's safety. We are channeling him and his 99 colleagues in our statement of 2013 that reaffirms that priority.

Dr. Philip D. Darney is a professor of obstetrics, gynecology and reproductive sciences at the University of California in San Francisco.