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


Vote for Improvement

The vote is precious, the most important non-violent tool we have in a democratic society, and we must use it. 

The late Congressperson, John Lewis

            I received an unexpected call from a social worker friend whose client was pregnant and wished to have an abortion.

            The story was a sad one. The young woman had used drugs and realized that the fetus might have been harmed. She also knew that she probably would not be able to parent if she continued the pregnancy. Her 3 previous children had been taken away by social services.

            The hitch, my friend told me, was that the woman was already 23 weeks pregnant, much too late to have an abortion locally. Could I help? my friend asked.

            There are only a few places in the country where later abortions are performed safely. With the help of friends, I was able to arrange for the abortion to be paid for and done safely. The young woman did well.

            Proposition 115 on the November ballot would make it illegal to perform an abortion after 22 weeks. Currently there are only 6 other states that do not have gestational age limits. Fortunately requests for abortions after 22 weeks are very rare, and almost always due to unusual circumstances. I suspect that it took the young woman months to become sober enough to make the decision to abort.

            If this Proposition became law the only exception would be to save the life of a pregnant woman due to a physical health problem. The law would make no exception for a mental health problem, or for rape, incest or a nonfatal health problem. Please vote NO for Proposition 115.

            Reproductive health has taken a hit from the coronavirus, which makes it difficult for many people to get the care they need.  However, the problems caused by politicians have been worse and are longer-lasting than the pandemic. Soon we will have the opportunity to improve the situation when we vote in the national election on November 3rd.

            It appears to me that Mr. Trump has used religion and reproductive health issues to serve his own narcissistic needs. His past history shows little respect for women except as means to satisfy his own desires. Yet the religious conservatives have been taken in by Trump’s antiabortion stance. The religious right and Trump seem to have a pact that leaves out reproductive healthcare.

            In “Pro-life voices for Trump”, Trump brags that he has transformed the courts with antiabortion judges and extended the global gag rule to include the USA. This means that family planning clinics lose their funding if they perform or even counsel patients about abortion. The end result is there are more unintended pregnancies and more unsafe abortions. Trump hopes to fully defund Planned Parenthood and to pass a nationwide abortion ban. All of this is in opposition to the wishes of people in our country, where only about one out of 5 people wants abortion to be illegal in all circumstances.

            Another important issue will appear on the ballots in Colorado. Our electoral system to vote for the president is anachronistic. It was set up when horses were fastest means of transportation and before modern communication. Although it made sense to have the Electoral College in 1789, it is archaic and prevents truly democratic presidential elections. A vote for Proposition 113 will add Colorado to the 14 states already in the National Popular Vote Interstate Compact, and bring us closer to a true democracy.

            I also support Proposition 118, the Paid Family and Medical Leave Insurance Program. If passed, it will increase benefits for people who are sick or need to care for sick family members. It is especially important for young families after giving birth or adopting a child, because it extends state and federal benefits that already exist.

            Proposition EE doesn’t have much to do with reproduction. If passed, it will increase taxes on tobacco products. The money raised will support education and other good causes. Even more important is the public health benefit, because it will induce people to quit using tobacco. Come to think of it, there is a reproductive benefit: smoking during pregnancy increases the risk of small, premature babies and of birth defects.

To summarize, I recommend voting YES for Propositions EE, 113 and 118, but NO for Proposition 115. The people I will vote for include Diane Mitsch Bush, John Hickenlooper and–well, you can guess my favorite presidential and vice-presidential candidates.

`© Richard Grossman MD, 2020