Safe and Fair Access? Or Dangerous and Risky Exposure? California's Consideration of Expansion of Abortion Rights

The California Legislature is currently considering SB 1338, a bill aimed at increasing safe and fair access to abortions for those living in areas without easy access to an abortion clinic. The bill would change the California Health and Safety Code to allow midwives, nurse practitioners, and physician assistants to perform aspiration abortions. Currently, California law only allows licensed physicians or surgeons to perform these procedures. Christine Kehoe a Democrat Representative from San Diego has said that the purpose of the bill is to "solve a pressing health access problem by helping women in need to obtain safe, early abortion care services... The longer women are forced to wait, the more complicated the procedure can become." The bill would allow an estimated 24,000 nurse practitioners, midwives, and physician assistants currently in the state to legally provide nonsurgical first-trimester abortions in outpatient clinics and a doctor's office. The bill does require that they would have to complete a specialized training program in order to be allowed to perform the procedures. Read the ACLU reporting on this bill here at http://www.aclunc.org/news/press_releases/sb_1338--now_more_than_ever_california_moves_to_expand_reproductive_health_care.shtml.

Representative Kehoe points out the purpose of the bill is to help women obtain safe abortion services; decreasing the standards as to who can perform these abortions, however, does not ensure safety for California women. There are several potential complications during a first trimester abortion, including uterine perforation, hemorrhaging, failed or incomplete abortion, and cervical injury. California is one of the least restrictive states when it comes to abortion regulations. The text of Kehoe's legislative proposal to expand abortion providers can be found at http://www.aroundthecapitol.com/Bills/SB_1338/20112012/.

While this bill is being supported and applauded by Planned Parenthood and NARAL as expanding safe access for women (see some of their promotional material at https://secure3.convio.net/ppac/site/Advocacy?cmd=display&page=UserAction&id=183), the reality is it would put women’s lives in jeopardy. In particular, it would put poor and minority women in targeted danger because the bill is focused on those women who do not have easy access to a physician who can perform an abortion. This profiling is inappropriate for women's health care. What does it say about California's commitment to protecting the poor and minorities if the "solution" to their alleged lack of easy access to abortion services is to allow them to have services from less qualified non-doctors with little regard to their safety? If California really wants to protect its women it would offer help to women in a vulnerable position by offering more safe and healthy options like adoption and counseling instead of offering a quick and dangerous way to terminate a pregnancy. If expanding access to healthcare for women is the goal, the solution for lack of access should not be lowering standards for their care.

When abortion was first legalized and recognized as a fundamental right forty years ago with the Supreme Court's decision in Roe v. Wade and subsequent reaffirming that right in Planned Parenthood v. Casey one of the most influential arguments then was that legalized abortion was necessary to keep women safe from the horrific and dangerous back alley abortions that placed women's lives in jeopardy. This proposed bill seems to completely ignore that argument; instead of logically determining that to keep women safe it is necessary to have trained and qualified physicians performing these procedures, a supposed high standard, California's lawmakers are rather claiming that, in the name of increasing access to abortion, California should decrease these standards and essentially allow for non-doctors to perform the abortion. This kind of legislation is a very real attack on the safety and welfare of women.

At a time when many states are introducing legislation to protect women by regulating those who can perform an abortion and the necessary procedures and counseling requirements before obtaining an abortion, California is looking to move in the opposite direction. Instead of protecting women, California appears willing to place them in increasingly dangerous situations with huge potential risks to their health.

An approach that ensures a woman’s total safety would require physicians or surgeons to do the procedure as the best way to protect a woman's health. If an abortion procedure is necessary, it should be safer, in line with the goals of legalizing abortion originally. These types of legislative proposals lead the general public to inquire whether legal abortion is really safe at all.

Furthermore, while abortion is legal the California Legislature would be wise to consider the total consequences of an abortion to a woman, such as the psychological and emotional effects after an abortion which can be traumatic. A legislative proposal to make post-abortion counseling easy and accessible would be more in line with standards designed to protect women's health. A bill that required abortion facilities to provide counseling to women, along with options including adoption before an abortion is performed would keep a woman's health care as paramount. These approaches would serve to protect vulnerable women and promote family restoration.

Thanks to guest bloggers and California residents Alana Martinez, Regent J.D. Candidate 2012, and Rachel Toberty, Regent J.D. Candidate 2013, for this thoughtful and provocative blog post.

1 comment:

  1. Although I oppose making abortion even easier to accomplish, I must take issue with your characterization of midwives, nurse practitioners, and physicians assistants as "less qualified." My husband has been a registered nurse for 11 years and gained his bachelor's of nursing a year ago. He is pursuing a nurse practitioner degree. The prejudice against APRNs and PAs is largely a function of professional jealousy on the part of doctors, who seem to think that they know more about medicine than anyone else in health care.

    My husband did want to become a D.O. (doctor of osteopathy), but things did not go as planned. He discovered in 3 semesters of coursework though that medical students get a very broad, but shallow knowledge of everything. One of his classmates, a former psychologist, was quite disappointed and unhappy to realize that the semester of psychiatry/psychology taught in medical school does not even approach the depth that he gained as a therapist in his program. But doctors - even general practitioners - look with scorn on the professional opinions of someone who is a "non-doctor," because they are treated like little gods by the hospital system and the general public.

    A registered nurse requires only 2 years study, but it is just as painfully intense as anything my husband encountered in medical school. An R.N. must be familiar with anatomy, physiology, pathology, medications, treatments, therapies, and much more, and is more closely involved in care for patients than is a doctor, who sees the patients for less time, and less often (especially in a hospital). If a doctor prescribes a course of action harmful to the patient, and the RN doesn't note this and raise objections to it, the RN could lose his or her job, especially since doctors are considered less expendable than nurses. This means also that the RN doesn't need to be a specialist, but he does need to be as familiar with health care, treatments, and medication interactions as any physician.

    One additional difference between physicians and nurses, is that someone can become a physician after 8 years of schooling, only the last two of which are spent in direct personal involvement with patients. Volunteer work earlier than that is encouraged, of course, but the average age of medical students is lower than the average age of advanced nursing practice degrees (whether bachelors or nurse practitioner [a master's degree]). To advance to higher levels of nursing, an RN *must* have some years of work experience, and this applies for each additional degree. Thus, an advanced practice nurse has spent *more* hands-on time with patients, and gained more real-life experience and on-the-job training and education than a physician has. There is a mystique about physicians that is harmful to them, to other advanced healthcare practitioners, and to the public, especially when we do everyone the disfavor of assuming that a "non-doctor" is simply "not as good."

    R.L.E. - Tulsa, OK