What The Texas GOP Hopes No One Will Say Out Loud: Proposed Bills Weaken Inspections; Requirements Currently Kick In At 16-weeks

[UPDATED] Austin has become center stage for the religious conservative effort to reverse Roe v Wade. Many Texans, like Rep. Greg Bonnen (R), insist that they support these legislative proposals to insure access to safe medical procedures.

What they don’t acknowledge is the state of the current law.

Since January 1, 2004, Texas “law requires that all abortions at 16 weeks gestation or later be performed in an ambulatory surgical center.”

What was the impact of the law?

In the month the law went into effect, not one of Texas’s 54 non-hospital abortion providers met the requirements of a surgical center. The number of abortions performed in Texas at 16 weeks gestation or later dropped 88 %, from 3642 in 2003 to 446 in 2004.

The bills being considered in this second special session — bills which did not pass during the general session — would require all clinics performing abortions to be certified as ambulatory surgical centers.

Let’s see that again.

The current law requires that abortions after 16 weeks be performed in an ambulatory surgical center.

After the law changed in 2004, the number of abortions after 16 weeks that year dropped from 3,642 to 446.

This is the goal of the law. Not to ensure “safe medical procedures” but to stop access to abortion. To neuter Roe v Wade in the off-season (special session) because they couldn’t get the bill passed in the general.

What are the statistics that make the case for danger?

No women died while undergoing an abortion in 2011, however 116 women died of pregnancy complications that year.

And even though Governor Rick Perry asserted that abortions are the “second-most conducted surgical procedure” in America, they’re not according to PolitiFact research.

Because most abortions aren’t surgeries in the classic sense of surgery (no cutting) and many are induced by taking oral meds.

Dr. Barbara Levy, vice president of health policy for the American College of Obstetricians and Gynecologists and former medical director of the Women’s Health and Breast Center in Washington state, said by telephone that abortions are “minimally invasive” procedures, akin to colonoscopies, and do not involve surgical cutting unlike, say, hysterectomies. “We call these procedures, not surgeries,” Levy said. “I don’t even think it’s appropriate to talk about” abortion “as a surgical procedure.”

Moreover, the numbers should make you do a double-take. Because there aren’t that many abortions performed each year compared to other outpatient procedures/surgeries.

According to the federal Centers for Disease Control and Prevention, in 2009 there were 784,507 abortions in the United States. The Guttmacher Institute, a reproductive health research and policy analysis group, reports that there were 1.21 million in 2008; their numbers include California, Maryland and New Hampshire, which are not in the CDC data.

In a report issued in 2008 and revised in January 2009, the CDC reported that the nation’s most common outpatient surgeries in 2006 (the latest year with compiled estimates) included endoscopy of the largest intestine (5.7 million surgeries), meaning colonoscopy; endoscopy of the small intestine (3.5 million), meaning examinations through the mouth and throat; extraction of the lens (3.1 million); injection of prosthetic lens (2.6 million); and injection of an agent into the spinal canal (2 million). Its report said the leading diagnoses included cataracts (3 million) and benign and malignant growths (3.2 million). [emphasis added]

Second most common surgical procedure my sparklepony.

The risk of the medical procedure is extremely low and it’s not, as a general rule, a surgery.

So much for there being a public health issue that the bills would address.

Surely inspections will be more stringent under the current law?

Under the current law, abortion clinics are inspected annually.

Surgical centers, on the other hand, are inspected about every three years.

So much for making facilities “safer.”

 

No, this is a movement designed to restrict choice, to inject the state into the lives of women. Whether it’s vaginal ultrasounds or hurdles for clinics, these bills represent a patriarchal, Old Testament view of the world and a woman’s place in it, court rulings be damned.

No-spin reality doesn’t go down as easy as “we just want to make everything safer.”

Bollocks!

According to Bloomberg, so far this year, “17 states have enacted 45 new curbs on abortion.” Much of that effort comes from Americans United for Life (AUL), a Chicago advocacy group that prepares model legislation and has fought against legalized abortion since 1971.

One more stat and I’ll close. AUL wants to impose its minority position on the majority. For 40 years, most Americans have agreed that abortion is a decision best made by a woman in consultation with her doctor and partner. A distinct minority, less than 20%, has consistently told pollsters that they believe all abortion should be banned.

This 20% probably comes from the religious right and the heartland culture warriors, who account for about a quarter of the US population.

And they will continue to fight inch by inch until they’ve gotten their way. Along the way, expect contraception to fall victim as well.

The numbers and facts here will not ever convince that minority to rethink its position. But these facts might nudge their passive opposition into a vocal state. Because that’s what it’s going to take.

I’m convinced that the minority’s passion to ban all abortion far exceeds the majority’s passion for choice. So use facts like these to talk to your electeds — in Congress and the statehouse. Send a dispassionate letter or make a simply stated phone call. You don’t have to be an activist. But you do have to act.

::Follow me on Twitter

Updated 11.55 am Pacific to clarify surgical status of abortion.
Updated 12:30 pm Pacific with tweets below

17 Comments

  1. Thank you Kathy. “you don’t have to be an activist, but you do have to act”. Indeed. What I find both interesting and troubling is the fact that such a small minority can be so legislatively effective.
    It certainly reflects your comment “the minority’s passion to ban exceeds the majority’s passion for choice”. Perhaps those who feel strongly enough should become a squeaky wheel themselves. It happened once with a single woman in Roe vs Wade.

  2. What a shocker that another major GOP elected official would use false claims of facts to shore up their case based on subjective moral beliefs in order so that they can make major life changing decisions for others. I am truly shocked and surprised.

  3. I’m going to nitpick a bit here. In the post Dr. Levy makes the point abortion is not surgery, it’s a procedure akin to a colonoscopy. In the CDC paragraph, they apparently classify colonoscopies as surgery and not a procedure, so there’s an inconsistency. In my area though all colonoscopies are performed in either an ambulatory surgery center or hospital outpatient surgery, so even if you do compare the abortion to colonoscopy I’m not sure it helps your argument.

    Really though the procedure most analogous to abortion would be a D&C, which in my area are generally performed in hospitals or ambulatory surgery. Of course D&C’s are just slightly different from endometrial biopsies, which are often performed in the office. The bottom line I think is do the procedure where it’s most advisable relative to the risk of the procedure, and not whether it’s classified as a surgery or not. Based on history, it sounds like it’s generally safe to perform abortions in a clinic.

    The comparison of inspection frequency of abortion clinics to ambulatory surgery centers is a red herring. Yes the government inspects the abortion clinics more often, but most ASC’s have private accreditation as well. The big difference thought is the ASC’s are required to have more equipment and capabilities than a clinic would. There’s not much doubt that if you have an emergency you’re better off in an ASC. That doesn’t mean the Texas legislature is right – I actually don’t agree with them but some of the arguments used in this essay are a little misleading.

  4. DaGoat – under the proposed Texas law, an abortion that is initiated orally (via meds) would have to be performed in a surgical center. Very early stage abortions are often initiated in this manner, per my reading on the subject.

    Also, a D&C can be an office procedure, according to Johns Hopkins. Just because in your area you say (no data provided, just anecdote) that D&C’s are performed in a hospital (talk about unnecessary medical expense if this is SOP!) or ambulatory surgery doesn’t mean that they have to be.
    HopkinsMedicine.org

    It was Perry who said that abortions were the #2 surgery. EVEN if you were to characterize this procedure as a surgery, it’s not even close. And if you honestly think we should characterize something as a surgery that takes place after you take oral meds … heaven help us all.

    Medication abortion accounted for 17% of all nonhospital abortions, and about one-quarter of abortions before nine weeks’ gestation, in 2008.
    http://www.guttmacher.org/pubs.....rtion.html

    Does the government tell a doctor when any other procedure has to be performed in a surgery center (most privately owned by doctors according to one article) or hospital? If so, what procedure? You can legally have a baby AT HOME – not in a medical facility – and we know that the complication/death rate from pregnancy is far greater than from abortion.

    More data:

    The risk of death associated with abortion increases with the length of pregnancy, from one death for every one million abortions at or before eight weeks to one per 29,000 at 16–20 weeks—and one per 11,000 at 21 or more weeks.
    http://www.guttmacher.org/pubs.....rtion.html

    Abortion – 9 deaths / 100,000 procedures at 21 or more weeks (above data)

    Pregnancy – 15.3 deaths / 100,000 live births (2008)
    http://www.cdc.gov/reproductiv...../PMSS.html

    More West Texas women giving birth at home:
    http://www.newswest9.com/story/14702288/m

    Why are the GOP legislators not regulating birth conditions? It’s clearly more of a health risk than abortion.

    Updated to fix a link.

  5. Hi, sheknows – thanks for the feedback.

    I rarely know where an essay is going or how it’s going to end when I start writing. Somewhere along the way my subconscious speaks to my conscious mind. :-)

    I’ve been trying to make sense of what’s happening in Texas and my reaction to it — and lost another night’s sleep along the way. (This is five nights I’ve spent “up” instead of sleeping since this saga began for me two weeks ago.)

    I think it was the busloads of people descending upon Austin that triggered that last graph. NOTE: I wrote this before the Rick Santorum announcement.
    http://livewire.talkingpointsm.....tion-fight

  6. It’s up to the judiciary to uphold the constitutional rights of a woman to an abortion. This will put the same target on their back that abortion doctors labor under, but at least it will get the constitutionality back into the conversation. It’s been missing too long.

    In his ruling, Conley wrote that the state is unlikely to meet its burden of proof that admission privileges requirement will improve care for patients who experience problems after an abortion. He said the evidence indicates “the current system already handles efficiently the very low percentage of women seeking abortions with serious complications.”

    Even if the state can meet that burden, the judge said, the plaintiffs are likely to succeed in proving the law erects impermissible obstacles to women seeking abortions.

    http://www.huffingtonpost.com/....._hp_ref=tw

  7. Also, a D&C can be an office procedure, according to Johns Hopkins. Just because in your area you say (no data provided, just anecdote) that D&C’s are performed in a hospital (talk about unnecessary medical expense if this is SOP!) or ambulatory surgery doesn’t mean that they have to be.

    I’m very familiar with the practices in my area but cannot provide documentation. I’d be willing to bet there aren’t many Johns Hopkins docs doing D&C’s in their offices.

    You’re right, doing some of these procedures in ASC’s and hospitals is a huge waste of money. Why do you think that is? If you want to see some waste look into hospital “facility fees”. Medicare is actually looking at refusing to pay some of these fees and it’s high time.

  8. Just for clarification on abortion procedures…. 89% of Abortions are D&A which is not a D&C from my understanding…..

    In most cases, there is a choice between medical or surgical abortion procedures during the first trimester. Medical abortions are available up to nine weeks gestation. Abortion procedures performed during the first trimester are:

    Methotrexate & Misoprostol (MTX): A medical abortion procedure used up to the first seven weeks of pregnancy.
    Mifepristone and Misoprostol: A medical abortion procedure used up to the first seven to nine weeks of pregnancy. It is also referred to as RU-486, the abortion pill and Mifeprex.
    Suction Aspiration: A surgical abortion procedure used to terminate pregnancy between 6 to 12 weeks gestation. It is also referred to as suction curettage or vacuum aspiration.

    Abortion procedures used during the second trimester:

    Medication-based abortion procedures are not an option during the second trimester. Abortion procedures performed during the second trimester are:

    Dilation & Curettage (D & C): A surgical abortion procedure used to terminate a pregnancy between 13 to 15 weeks gestation. Also referred to as suction curettage or vacuum aspiration.
    Dilation & Evacuation (D & E): A surgical abortion procedure used to terminate a pregnancy between 15 to 21 weeks gestation.
    Induction Abortion: A rare surgical procedure where salt water, urea, or potassium chloride is injected into the amniotic sac; prostaglandins are inserted into the vagina and pitocin is injected intravenously.

    Abortion procedures used during the third trimester:

    Medication-based abortion procedures are not an option during the third trimester. Abortion procedures performed during the third trimester are:

    Induction Abortion: A rare surgical procedure where salt water, urea, or potassium chloride is injected into the amniotic sac; prostaglandins are inserted into the vagina and pitocin is injected intravenously.
    Dilation and Extraction: A surgical abortion procedure used to terminate a pregnancy after 21 weeks of gestation. This procedure is also known as D & X, Intact D & X, Intrauterine Cranial Decompression and Partial Birth Abortion

  9. Ah – Ordinary_Sparrow — thanks for that! I’d forgotten that most were D&As (dilation and aspiration). You’re right, most are not a D&C and even fewer are D&Es.

    Aspiration is an abortion procedure that can be performed on a woman up to 16 weeks after her last period. Aspiration, also known as vacuum aspiration, suction aspiration or D&A (dilation and aspiration), involves the insertion of a tube through the dilated cervix into the uterus. Gentle suction removes fetal tissue and empties the uterus.

    In some circumstances, a spoon-shaped instrument called a curette is used to scrape the uterine lining to remove any remaining tissue. This procedure is called a D&C (dilation and curettage.)

    http://womensissues.about.com/.....nTypes.htm

    Crash course in medical stuff that I’ve never needed to know about. I did have to have a colposcopy (with biopsies) once; it was in-office procedure. It required “cutting” (biopsy).

  10. So basically what Texas is saying is “yes, you have a right to an abortion, but we’re going to make it all but impossible for you to have access to the services necessary to exercise that right.”

    Faced with an inability to overturn Roe v Wade, they have instead gone after the providers. We can nitpick over medical terminology all day long, but the fact is the pro-life folks in Texas (and other states) have long since figured out that the way to stop abortion is to make it difficult if not impossible for a provider to operate.

    I wonder how Republicans would react if a state decided to treat the sale of firearms as Texas treats abortions?

    I mean, the 2nd Amendment quite clearly states that the right of the people to keep and bear arms shall not be infringed, but it does not grant the unrestricted right to sell them, does it?

    What would the reaction be if New York or California enacted such strict requirements on gun shops, gun shows, and independent gun dealers that they were for all intents and purposes regulated out of business?

    And what if they did it in such a blatant fashion that only a fool could miss the intent of what they were doing, while supporters nodded in smug self-satisfaction and patted themselves on the back for finally striking a blow against the 2nd Amendment?

  11. cjjack

    I wonder how Republicans would react if a state decided to treat the sale of firearms as Texas treats abortions?

    When it comes to these kind of Republicans, the only way they would not regulate reproductive rights for women would be if bullets could be shot from vaginas… :(

  12. “When it comes to these kind of Republicans, the only way they would not regulate reproductive rights for women would be if bullets could be shot from vaginas…”

    That would certainly cut down the number of sexual assaults in the military.:)

    Kathy, thank you for your great posts on the assault on reproductive rights. The laws being passed by republican legislatures regulating women’s bodies make me so mad I can hardly see straight. It’s great to see women and men fighting back and refusing to sit down and STFU. :)

  13. Hi, cjjack — thanks for posting that analogy. And ordinarysparrow – thanks for the chuckle!

    yoopermoose – you’re welcome — it’s made me mad as hell, too.

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