Abortion Stuff - February 3, 2020

Two things about abortion caught my eye today. The first one is that a Republican lawmaker in Michigan has proposed a bill that would require abortion providers in that state to provide women seeking abortions with information about "abortion reversal" in medication abortions. The second is a proposed bill in Florida that has been delayed in the Senate that would require that minors get parental consent for abortions.

Let's look at these. And, remember, I'm generally pro-life, although I have great sympathy for the pro-choice arguments.

The bill in Michigan is based on almost no science. A medical abortion occurs like this: a woman take mifepristone, an anti-progesterone medication, which blocks the normal pregnancy hormone, progesterone, which effectively ends the growth of the pregnancy; then she takes misopristol, which causes the uterus to cramp and bleed, thus expelling the non-viable pregnancy. This is effective 95-98% of the time. Complications are rare.

The idea behind "abortion reversal" is that after a woman takes mifepristone, she can change her mind and then take a dose of progesterone and reverse the effect of the mifepristone, since it is an anti-progesterone. There was one very small study that seemed to indicate that this procedure would work. Progesterone is, after all, a very safe medication to use during pregnancy. A study done last fall, however, in California was ended early because several women had to be hospitalized emergently for vaginal bleeding.

Medical abortions are very safe with a low complication rate. A woman who chooses to have a medical abortion needs to be sure that this is the route that she wants to go. Abortion reversal is not a viable option. There is no scientific evidence that "abortion reversal" works and good evidence that it causes harm. Politicians need to get out of practicing medicine. Physicians are the ones who should decide which procedures are appropriate for their patients and they make those decisions based on the data available not on hopes and dreams.

The second topic is a bill in Florida that would require minors to have parental consent before getting an abortion. Sigh. This is an incredibly complex issue. Here we need to balance the rights of the parents with the rights of the adolescents. Parents are given the responsibility of raising children to adulthood; they don't "own" their children. Yet, when a child does a very "adult" thing, like engage in sexual intercourse and become pregnant, they aren't necessarily ready to make an "adult" decision. Ideally, they would work with their parents to come to a good, mature decision.

Here's where we run into trouble. Not every family is a functional family. Not every adolescent who needs to make a decision about whether to abort a pregnancy, keep this child and raise it, or make an adoption plan has the family resources to help them make that choice. Abortion and childbirth are neither without physical risk to the adolescent. A kid can't get a Tylenol at school without their parent or guardian's consent, so it sits wrong with me that they can have a surgical procedure, however safe, without that same consent. Yet, carrying a baby to term and giving birth have at least the same amount of risk to life and limb.

The Florida bill does include a provision for applying to a judge when an adolescent does not feel safe talking to a parent or guardian to get consent for an abortion. While that is good, it may not be enough. If the adolescent is considering an early abortion, they need to apply to a judge ASAP, which may be difficult to do. This requirement may put excess hardship on them. Yet, it makes sure that a disinterested adult is involved in the process.

I'm torn about the Florida bill. As a parent, I would want to have input into my child's medical care. As a physician who has seen some serious dysfunction in the world, I can understand why this bill is problematic. I don't know the answer to this bill.

One thing I do know is that studies and experience have shown us that comprehensive sex education and the availability of reliable, long-acting, reversible contraception will decrease the need for abortion. We need to vote for candidates who will support these measures. Voting to outlaw abortion does nothing to reduce abortion rates. Voting to increase access to contraception decreases abortion rates, sometimes dramatically.

Unfortunately, the politicians most likely to support abortion rights are the least likely to support contraception access. Yet, if they really want to change the abortion situation in this country, they would make contraception more widely available. When you vote this year for president and other positions, remember what works.

Catherine