By Diana Duong and Dr. Sharon Vorona
What started as a radical tactic to stop abortion has now been tabled as legislation in several states.
When the idea of a “heartbeat” legislation was first introduced in 2011, it was considered too extreme to ever pass. Last month, Ohio signed a law banning abortions as early as six weeks, joining Kentucky and Mississippi. This week, Georgia Gov. Brian Kemp signed a similar law, making Georgia the fourth state to pass such a law this year alone. Iowa passed a similar version in May last year and North Dakota just signed a bill in April outlawing second-trimester abortions. Louisiana is currently debating the six-week bill while Alabama is pushing it even further, seeking to ban nearly all abortions.
Figure 1 spoke with Dr. Diane Horvath, an obstetrician-gynecologist who has spent her career advocating for the right to an abortion. She is the medical director of Whole Woman’s Health in Baltimore, MD, a group of women’s clinics providing comprehensive gynecology services. We spoke with her about this wave of change across the U.S, the myths surrounding it, and its implications.
Why a six-week ban on abortions is effectively a total ban on all abortions
GA @GovKemp’s approval of a 6-week abortion ban is part of a countrywide trend to criminalize abortion care. These bans put women’s health in danger and constitute political interference in the practice of medicine. #stopthebans 1⁄6— ACOG Action (@ACOGAction) May 7, 2019
“It’s important to remember what we call six weeks pregnant is really two weeks after a missed period,” said Dr. Horvath. “This is not a case where people have had six weeks to discover they are pregnant, reflect, and make an appointment. This is two weeks or less—you have to miss your period to know you’re pregnant.”
But even if someone finds out they’ve missed their period before the six-week mark, it’s difficult to get an appointment within the two-week window.
“Many groups have worked to restrict abortion with funding restrictions, waiting periods, and by preventing clinics from staying open in some places. It is impossible by design. When they pass a law that bans abortions at six weeks, they know that’s a near total abortion ban.”
It’s not “fetal heartbeat,” it’s fetal pole cardiac activity
FETAL POLE CARDIAC ACTIVITY — GET IT RIGHT https://t.co/2wmQu6nWHF— Jennifer Gunter (@DrJenGunter) May 7, 2019
Dr. Jen Gunter, a Canadian-American obstetrician-gynecologist, pain medicine physician, and Twitter’s “resident gynecologist,” shared a video of Georgia governor Brian Kemp signing a bill that would ban abortions after six weeks, or if there is a “detectable human heartbeat.” This is not a heartbeat but fetal pole cardiac activity, as Dr. Gunter has explained in the past.
Basing a bill on a “heartbeat” is an appeal to emotion, not science, says Dr. Horvath. At six weeks, a fully formed heart has not yet developed.
“We can grow cardiac cells in a culture and watch the pulsations of electricity at six weeks. They beat because it’s just electrical pulsation. We can see that pulsation in a dish. This idea that this is a marker in pregnancy is an appeal to emotion, it’s not a timepoint in fetal development which something magical happens. This is part of this six-week abortion ban, to make it illegal for everybody.”
Why “reimplanting” a fertilized ovum in ectopic pregnancy should be removed from Ohio’s bill
Unfortunately, an ectopic pregnancy cannot be “reimplanted” into the uterus. We just don’t have the technology. So I would suggest removing this from your bill, since it’s pure science fiction.— Dr. Daniel Grossman (@DrDGrossman) May 8, 2019
Dr. Daniel Grossman, a San Francisco-based Professor of Obstetrics, Gynecology, and Reproductive Sciences and public health researcher on abortion and contraception, tweeted at Republican House of Representative John Becker, the sponsor for Ohio’s bill HB182. The bill suggests that, in the case of an ectopic pregnancy, the patient undergo “a procedure to reimplant the fertilized ovum into the pregnant woman’s uterus”—a procedure that defies current medical capabilities. Although treatments for ectopic pregnancies that preserve a patient’s fertility exist, the bill prohibits insurance and coverage for them.
His response to the bill: “It is unconscionable to consider placing obstacles in the way of treatment for ectopic pregnancy” during a time when the U.S. is going through a maternal mortality crisis. He tells Becker to change the bill because ectopic pregnancies cannot be carried to term, much less be “reimplanted.”
Dr. Horvath puts it succinctly: “Leave these decisions to pregnant people working with their healthcare providers.”
Healthcare professionals who deny a basic health service should consider another profession
Caring for patients is a PRIVILEGE. It cannot be about our own egos or moral hangups or religious beliefs. We are here to care for the people who need our help, not turn people away because we don’t like their “lifestyle”.— Dr. Diane Horvath (@GynAndTonic) May 2, 2019
Dr. Horvath feels lucky to practice in the state of Maryland, which she says has “a good record of protecting evidence-based healthcare.”
“We are a haven state for the states around us that have limited access. I’m able to provide care to my patients, but it should be like that everywhere.”
She says any religious or moral refusal that affects the basic elements of healthcare—whether contraception, abortion, or couples wanting to conceive—harms patients and the health of people who need our care.
“Whether it’s abortion or care for LGTBQ people, or people of various races and ethnicities, it’s not about us and our feelings. It’s about the care of our patients and their needs. It’s important that as a healthcare provider, I center the needs of my own patients before any personal beliefs.”
“If you feel that your own personal beliefs prevent you from providing, you should stop providing that care to someone and find another line of career.”
A Stanford medical student said he was “astounded by the length [Planned Parenthood] will go to try and both normalize and mask abortion as healthcare.” #MedTwitter called him out.
As a medical student I am astounded by the length @PPact will go to try and both normalize and mask #abortion as #healthcare.— Dylan Griswold (@DylanPGriswold) January 8, 2019
Last I checked, pregnancy is not a disease.
And #abortion is anything but safe when at least one “patient” will be killed.
Abortion hurts women. https://t.co/l3LQI8dp7O
Dr. Horvath has seen the damaging effects of the stigma and shame surrounding abortion.
“I would ask Dylan to respectfully come spend some time with me and listen to the stories my patients are telling. It’s easy to demonize this and act like it’s not healthcare or it seems wrong and immoral when you haven’t sat with people and listened to who they are and who they’re caring for,” she says.
“I wonder, as a medical student who isn’t going into reproductive healthcare, what he is basing his views on. This attitude of shaming patients perpetuates stigma for patients who want normal, routine healthcare and fear rejection. It shouldn’t matter how Dylan or anyone else feels about it — it’s just healthcare.”
Dr. Horvath says she’s had countless patients come into her clinic who say, ‘I was so upset when I found out my friend got an abortion,’ or ‘I never thought I would get an abortion.’
“It changes you when you have to walk in those shoes,” she says. “We see people who took every precaution, but every contraceptive has a failure rate. There are people who did everything they could to not get pregnant and, yet here they are. I don’t think children should be a punishment for having your contraceptive fail.”
“These groups of people who call themselves ‘pro-life’ should want every child born into a family where they’re wanted.”
The case of the week
Seven-week-and-two-day intrauterine pregnancy with visible yolk sack, fetal pole and ring of the amniotic sack around the fetus. See the case here.
This case is featured in the most recent issue of The Differential, our regular email roundup of fascinating medical cases shared on the Figure 1 network. To get this newsletter and other specialty-specific editions, healthcare professionals can sign up for a free Figure 1 account here.