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AMA and ACOG File Amicus Brief Opposing Provisions in Abortion Bill

by: Genevieve Cato

Sun Dec 29, 2013 at 03:30 PM CST

"Access to safe and legal abortion is an important aspect of women's health care."

Last week, the American Medical Association (AMA) and the American Congress of Obstetricians and Gynecologists (ACOG) filed an amicus brief opposing provisions in the omnibus abortion bill, HB 2, including the admitting privileges provision. A panel from the Fifth Circuit Court of Appeals will hear oral arguments on January 6th. Both AMA and ACOG are widely respected in the medical field as experts in access to healthcare, and they are generall bipartisan (though AMA recently hosted Ted Cruz as a keynote speaker). Possible ideological differences aside, the message of the brief is clear: these provisions do nothing to advance access to healthcare, and instead pose a great threat to women's health in Texas if they are allowed to continue.

More on the organizations' opposition to HB 2 below the jump.

Both the American Medical Association (AMA) and the American Congress of Obstetricians and Gynecologists (ACOG) are invested in the provision of the best healthcare for women in Texas. The brief touches on many issues with the provisions in HB 2, including the negative impact on women's access to healthcare:

H.B. 2 does not serve the health of women in Texas, but instead jeopardizes women's health by restricting access to abortion providers and denying
women well-researched, safe, evidence-based, and proven protocols for the provision of medical abortion.

Much time is spent addressing the requirement for admitting privileges and the arguments of those supporting this provision as a safeguard for women's health. AMA and ACOG argue that it does just the opposite:

The privileges requirement imposed by H.B. 2 does nothing to enhance the safety of, or healthcare provided to, women in Texas.  There is no medically sound reason for Texas to impose a more stringent requirement on facilities in which abortions are performed than it does on facilities that perform other procedures that carry similar, or even greater, risks.  Therefore, there is no medically sound basis for H.B. 2's privileges requirement.

The brief spells out the various ways in which the arguments for the provisions in HB 2, specifically the admitting privileges and facility requirements, are not logically sound. Nor, the brief argues, does HB 2 truly improve the health conditions for women in Texas. The brief points out that birth is fourteen times riskier than abortion, and that the vast majority (90%) of abortions are outpatient procedures. Not only is hospitalization "rare" as the result of an abortion, but "there is a less than 0.3% risk of major complications following an abortion that might need hospital care." First trimester abortions are even safer, according to a recent study cited by the brief which found that the risk of complications during that period was only 0.05%.

What's more, after the clinic closures resulting from the budget cuts since 2011 and the implementation of HB 2, most women do not live within 30 miles of a clinic that provides abortion services. Should a woman need medical attention after her abortion, the brief points out, it is highly unlikely that she will be in the proximity of the physician who administered the abortion services. The continuity of care argument is moot due to the impact of other provisions in the very same bill.

AMA and ACOG also draw attention to the difficulty of obtaining admitting privileges, even for qualified physicians. Hospitals have various requirements for admitting privileges that do not necessarily reflect quality of care, but instead reflect the needs and/or value system of the hospital in question. Admitting privileges, the brief argues, are not an adequate indicator of quality - though this is a central piece of the argument for the provision.

The brief also lays out the disparities in access resulting from these provisions in HB 2, saying  "as a result of the closures of the only two clinics in the lower Rio Grande Valley, the closest abortion provider for the more than quarter of a million women of reproductive age living in that area is now 150 miles away and the closest ambulatory surgical center ("ASC") is 250 miles away." As is explained in the brief, the larger distance proves more expensive in terms time and travel costs, which means that women have to wait longer before they can afford to have an abortion. Then, another provision in the bill kicks in, requiring them to travel even farther in order to reach an ASC. Not only does this increase the burden on women hoping to access abortion services, but the longer a person waits to have an abortion, the more risky the procedure becomes.

These are only a few of the arguments put forth in the brief, and to those familiar with the debate over HB 2 the facts are nothing new. These are the same arguments opponents to the bill have reiterated since the beginning of this contentious debate during the first special session. The real question is whether they will carry more weight coming from bipartisan professional organizations committed to women's health, and whether that weight will be enough to tip the scales in favor of reproductive justice as the case against HB 2 works its way through the judicial system. Reproductive justice in Texas and across the county depends on it.

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Do not republish without express written permission.

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