Chastise Texas about its unsafe abortion law

Women’s March, 3 October 2021, in Durango, Colorado

There is no such thing as banning abortion, there is only banning safe abortion.

            Texas has just passed the country’s most draconian and restrictive law on abortion, which the Supreme Court initially refused to consider. What bothers me is not just the lack access to safe abortion services but also some aspects of the law.

            S.B.8 (nicknamed the “Texas Heartbeat Act”) prohibits a doctor from performing an abortion if a fetal heartbeat is present. Before performing an abortion, doctors must know if the fetal heartbeat can be seen by ultrasound. An abortion can only be performed with a heartbeat if there is a “medical emergency”, although that term is not defined. I assume that would include true medical emergencies (such as an infected pregnancy), or if the woman has a serious medical condition that might kill her if the pregnancy were to continue, such as a tubal pregnancy.

            The law empowers normal citizens to be abortion “vigilantes”. It says: “Any person… may bring a civil action against any person who….” Reasons for legal action include a doctor who performs an abortion with a heartbeat, a person who helps someone else get an abortion, or even a person who has the intention to help someone have an abortion. The penalties are dire, and include a bounty of not less than $10,000 for each abortion. The law has no exceptions for rape or incest.

            What is really remarkable is that the law prevents the usual enforcement, but rather encourages spying and snitching. It states: “…shall be enforced exclusively through the private civil actions….” This law allows anyone, in or outside of Texas, to attempt to grab the bounty on a doctor who performs an abortion beyond 6 weeks.

            The people who wrote this law knew that it would be challenged and that the challenge would probably go to the Supreme Court of the USA, so put in a remarkable clause: that no regard would be given to “a defendant’s belief that the requirements of this subchapter are unconstitutional….”

            Furthermore, the legislature has stopped using the correct medical term for an early pregnancy, “fetus”, but rather substituted “unborn child”. Although this might be satisfying for people who are against abortion, I hate to see legislators change medical terminology for their nefarious purposes. Isn’t there a law against lawyers practicing medicine? To make things worse, courts are playing legal pingpong with women’s reproductive rights, the law having been stayed by one court, then reinstated by another.

            What can we expect to see as a result of S.B.8? More women will travel outside of Texas for abortion care. One clinic in Oklahoma City already reports that two thirds of their patients come from Texas. More concerning is that there will be more unsafe abortions as women become desperate—as was the case before Roe v. Wade in 1973. We can expect an increase in maternal mortality in Texas, as has happened in states when they have enacted laws that decrease access to safe abortion services. Texas already has a higher-than-average number of women dying from pregnancy-related problems. 

            A brave Texas OB-GYN, Dr. Alan Braid, openly broke the law and wrote about it in the Washington Post. His patient, a 42-year-old mother of 4 young children, couldn’t leave them to go to another state. Braid wrote that during his training, before 1973, he saw 3 teenagers die from illegal abortions; this is part of his motivation for performing safe abortions. 

            What can be done? Studies in other countries have shown that home abortions with medications can be safe. Women can put away their hangers and knitting needles and safely purchase the medications needed on Internet. AidAccess is one source of information about the medications that can cause an abortion safely. For Texas women who live close to the border, misoprostol is available in Mexico and is a safe way to cause an abortion by following instructions at the International Women’s Health Coalition website.

            What is clear, according to a recent Economist survey, is that the majority of Americans favor access to safe, legal abortion services. Texans, don’t be bullied by religious fanatics!

© Richard Grossman MD, 2021


Discuss Childbearing with your Fiancé

            A friend told me a story that revealed a blind spot in some relationships. He was speaking about his son and new daughter-in-law.

            My friend (who is also concerned about population) and the newlyweds had just seen the film An Inconvenient Truth. The groom, concerned about the future, asked his dad what was the most important thing that the newlyweds could do to slow climate change. My friend told me that his response was: “Have a small family”.
            The son responded that he never wanted to father a child. The new daughter-in-law replied “Of course we’ll have kids!
            My friend could understand his son’s reluctance to father children. This young man was born with a serious congenital problem that took multiple surgeries to correct. He was worried that any child he might father would have the same problem, even though the risk was only about 1 in 20.
            When practicing obstetrics and gynecology, I was amazed and concerned by the number of couples I encountered who disagreed about childbearing. Sometimes the woman wanted a child (or more kids) but the man didn’t, and sometimes it was vice versa. Often this was mentioned to me in passing as a minor concern. However, to parent or not was a major sticking point for some couples.
            There are a growing number of young people who plan to be childfree; most of them are women. Their reason for rejecting parenthood is fear of the future condition of the world that the movie describes.
            Fortunately, Gail and I both wanted two kids, and we even had the name for one chosen before we got together. I had always wanted to name a son, if I had one, David, and Gail the same.
            A few years ago, I mentioned Jane in one of my essays. She wrote me that she had resulted from an unplanned pregnancy. Her parents had different ideas about childbearing. When her mother found out that she was pregnant with the third child (Jane), she demanded that the father (a physician) abort the pregnancy. Jane’s mother and father went together to his office more than once, but he refused to perform the abortion. Jane wrote that being born from an unwanted pregnancy severely affected her life adversely. She never wanted, nor had, children. Jane reported that she was happily married, and that, fortunately, her husband was pleased to be childfree.
            Another couple was just the opposite. They were active in outdoor sports and had never planned on parenting. Accidents happen; they were delighted to relive their son’s birth and update me on his progress when we met at City Market. Fortunately, this sort of good outcome is much more common than lifelong regrets about parenting.
            How can this sort of discrepancy about parenting be approached? Many couples go through religiously-based premarital counseling, which makes sense to me, although Gail and I didn’t 50+ years ago. She went to a doctor and had her first Pap smear in order to get a prescription for birth control pills. We agreed to wait 5 years before deciding to have our first child, David.
            My understanding of most premarital counseling is that it is most common in religions that encourage large families, so I doubt that family size or contraception is likely to be discussed. My own faith, the Religious Society of Friends (Quakerism), does not have a prescribed curriculum for premarital counseling. Quakers recommend that the couple select a clearness committee of Friends to help them decide if marriage is right for them. The goal is for the two to determine for themselves if they are truly prepared to spend the rest of their lives together. Suggested topics for a clearness committee for marriage include “background”, “religious beliefs” and “growth and fulfillment.
            Under the heading “relationships with others” is a relevant question for a clearness committee to consider: “Have they considered whether they desire children, the problems as well as the joys children would bring, and the responsibilities for nurturing and guiding them?” There is no mention of birth control, but certainly no prohibition against using it.
            Fortunately, there is a happy ending to my friend’s story. Although the newlyweds started off their relationship with a serious discrepancy in their desire for childbearing, they eventually resolved their difference. My friend is the grandfather of a beautiful and playful young girl. The proud parents were reassured by the ultrasound pictures taken routinely during pregnancy that there was no sign of the same congenital defect that the father dealt with.
© Richard Grossman MD, 2020