Opinion | In Texas, When Is Abortion Legal to Save a Woman’s Life?

If you will, join us in a thought experiment. It is autumn 2022. Dr. H., an obstetrician-gynecologist, is practicing in a red state. By then, a lot has changed in the reproductive rights landscape: in the spring, her state rushed to pass a law similar to the infamous Texan law of 2021, which bans a vast majority of abortions and encourages individuals to sue anyone who helps to perform an abortion. The Supreme Court that year also overturned Roe v Wade in the Dobbs v Jackson Women’s Health Organization case, leaving the issue of abortion regulation to the individual states; A few years earlier, Dr. H. Issued a withdrawal ban that automatically banned the few abortions that were legal in the state when Roe fell. In their state, the law only allows an abortion if the pregnancy threatens the life of a pregnant person.

Dr. H., Ms. R., has a severe cardiovascular disease which puts her at an extremely high risk of maternal mortality or severe morbidity. There is no way to say for sure that she will die; some patients like her survive their pregnancies. But doctors who care for them and others with the condition are encouraged to talk about abortion. If the patient chooses this option, Dr. H. then terminate the pregnancy with Ms. R.?

History shows us how this lack of clarity puts women at risk. While abortion was illegal in America in the pre-Roe era, the states theoretically gave doctors the right to perform abortions if doctors agreed that a pregnant woman’s life was at risk or, in some cases, her health in later years was. But what counts as a threat to a person’s life or health is often subjective, and those who make such judgments have not been immune from political pressure.

Initially, hospital abortion decisions were made rather informally in a small group of doctors. But in the middle of the century, doctors worried that too many hospital abortions were approved. Given the stigma surrounding abortion, they feared that their reputation, the reputation of their hospitals, and even their licenses could be compromised.

In reality, not a single doctor had been charged with hospital abortion in the 1950s. The only charges that took place concerned abortions performed outside of hospitals, whether by doctors or otherwise. (The majority of abortions before Roe took place outside of hospitals.) Even so, many hospitals established therapeutic abortion committees to formalize the abortion approval process.

These committees proved problematic in many cases. There were often strong disagreements among committee members, with their own views on the morality of abortion inevitably influencing their decisions. Some hospitals set quotas and didn’t want their facilities to be known as places where it was too easy to do the procedure. The committees disproportionately favored abortions for the hospital doctors’ private, mostly white, patients over the black patients and poor white patients who came to the hospital as charity cases. The number of approved abortions fell from an estimated 30,000 in the early 1940s to around 8,000 in the mid-1960s, leading more women to seek often unsafe abortions outside of hospital. Growing frustration at the arbitrariness of the committees’ decisions apparently helped the American Medical Association expand justifications for hospital abortions in 1970

In view of the bitter abortion fight that has raged in this country in the almost 50 years since Roe, an even stronger polarization is to be expected among the doctors who are tasked with decision-making in the post-Roe era. Perhaps they will reinvent a version of the therapeutic abortion committees of yesteryear. Hospital administrations that rely on funding from conservative state lawmakers could pressure these committees to approve as few abortions as possible. In fact, we already have evidence that hospitals – which performed only about 4 percent of abortions in America in 2014 – often have stricter requirements than the law makes.

Around 700 women die each year from pregnancy complications (and a disproportionate number of these women are black). We can expect even more pregnancy-related deaths when legal abortion becomes nearly impossible in about half of the states. Even the most restrictive laws, like the recent Texas bill, usually make exceptions for life-threatening physical conditions and sometimes serious risk to a woman’s health if a pregnancy continues. But history shows us that these supposed exceptions often just don’t work.

The best public health response to the current assault on the right to abortion would be for Congress to pass the Women’s Health Protection Act, which would protect the right to abortion in every state. Spokeswoman Nancy Pelosi plans to submit the bill to the House of Representatives when Congress returns from hiatus, and the Senate must follow suit. We also urge physician decision-makers in each state to set aside their personal views and make a commitment to timely ensure that all pregnant patients receive the care that will best ensure their survival and health. Everyone deserves safe, compassionate abortion care without the kind of political interference that has harmed people’s health since the days before Roe.

Carole Joffe and Jody Steinauer are professors in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco. Carole Joffe is the co-author of Obstacle Course: The Everyday Struggle to Get an Abortion in America.

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source https://www.bisayanews.com/2021/09/12/opinion-in-texas-when-is-abortion-legal-to-save-a-womans-life/