California officials have rolled out a new state law that permits non-doctors to perform first trimester abortions. While the blogosphere tussles over whether the loosened regulations endanger or liberate women seeking abortions, this one woman worries that, in their fervour to see reproductive justice done, pro-choice activists have written off some very real health risks simply because pro-lifers were among those voicing their concern.
Signed by Gov. Jerry Brown, the new law authorizes non-physicians such as nurses and midwives to perform aspiration abortions, a first-trimester procedure that involves inserting a small tube through the cervix to remove the fetus. Before the bill was passed, only doctors could perform such procedures because many in the medical field feared that possible complications — incomplete abortions, haemorrhages, infections, cervical injuries, uterine perforations — could endanger a woman unless there was someone trained to respond.
Advocates of the new law defend this looser regulation by asserting that it will expand access to cheaper reproductive services (aka abortions), particularly for the  1% of California women who live in rural counties without an abortion provider. They claim that the rate of complications during aspirations had only a marginal increase when performed by a non-physician and, more pointedly, that the “hysteria” over lowered standards of care was driven primarily by anti-abortion propaganda.
This seemed to be the central talking point throughout the legislative debate. A skeptic would question whether the expanded access merited the potential health risks, and the pro-choice lobby would dismiss these concerns as utterly disingenuous, not worthy of any further rebuttal.
Let me confess: I understand why pro-choice activists might want to question the motive behind laws that restrict access to abortion under the guise of advancing a woman’s health. There is certainly a cheering section of the pro-life movement that recognizes that these types of objections are a backdoor to cutting, if not ending, the number of abortions nationwide, just as they recognize that these same concerns can be used to thwart new legislation aimed at expanding abortion access.
However, the fact that medical risks are sometimes co-opted by a political opponent does not mean that those risks are nonexistent. Abortion, regardless of its morality or lack thereof, is at its heart a medical procedure and, as such, has all the inherent risks and complications associated with surgery. California’s new abortion law does not remove such risks. Skeptics have every reason to question a law that potentially ranks convenience above the safety of women.
Don’t believe me? Just take a look at the study California policymakers and pro-choice activists relied upon. The new law treads on the heels of a University of California, San Francisco, survey that implemented a type of pilot program, where non-doctors performed first-trimester abortions at some 22 sites. These results were then compared with procedures performed by experienced doctors.
The findings left many questions unanswered. The study found that non-physicians had a complication rate of 1.8 percent as compared to the 0.9 percent complication rate under physicians. But Tracy Weitz, the associate professor in charge of the study and a trained social scientist, interpreted these results as a statistical dead heat and deemed the procedures “enormously, incredibly safe.” Pro-choice policymakers were quick to follow her lead.
Forgive me, but I’m not convinced. Even ignoring the relative ability of non-doctors to appropriately respond to severe and unexpected mishaps, a doubling of the complication rate shows there is a real difference in results between physicians and clinicians. Admittedly, as written (.9% versus 1.8%), the distinction appears tiny, but when written as a ratio and then projected over the number of Californian women who obtain aspirations per year, the percentages assume an ominous tone.
As a ratio, the difference is 1 out of 100 women who visit a doctor versus 1 out of 50 women who sit before a clinician. When projected over the approximate 160,000 Californian women who seek an aspiration per year, the actual number rises from 1,600 cases to 3,200. That means over 1,600 additional women face a life changing tragedy, all because pro-choice activists elected to slacken the law in order cut down on someone’s driving time.
Now, I won’t question the motive behind the new law, nor will I do its supporters the disservice of assuming that their need for a moral victory in the face of other legislative defeats drove them to ignore the safety of their own self-claimed constituency. I believe they honestly thought that this new law would advance the medical health of women and that their eyes were just so focused on the destination that it made them blind to the hazards on the road.
At the same time I believe that pro-choice activists made one of the simplest mistakes in politics, and possibly the worst mistake they could make in the abortion debate. First, they judged and then dismissed real concerns over the safety of the new law, based not the merits of the claim, but on the identity of the speaker. They let themselves get distracted by their own press releases.
Second, they conflated the idea of healthcare with abortion. Again, this is not to suggest that abortion doesn’t play a role in feminine health (although we can debate that later), but that there is more to a woman’s health than access to abortion alone, even if that access plays an important role. Legislatures also need to be concerned with the quality that service takes. It’s here where the pro-choice movement failed.
Pro-choice policymakers, and the activists behind them, cannot let the narratives driving the abortion debate blind them to genuine worries over their proposed laws. Otherwise, we will soon find ourselves in more situations where politics and abortion trump a woman’s health. Teresa Ackley is a human rights lawyer based in Washington, DC. This article is reproduced with permission from The Belltowers blog.