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Discusses Women's Health

The Supreme Court has struck down a law closing abortion clinics in Texas. This has major implications for abortion rights throughout the country and was discussed last week in viewpoint sections of both the New England Journal of Medicine and JAMA. “Whole Woman’s Health v Hellerstedt” will significantly expand women’s access to abortions. “Whole Women’s Health” (a truly misleading name) was a law that was enacted by Texas abortion right opponents in 2013. It required that the doctors who perform abortions have admitting privileges at nearby hospitals and required that clinics that have abortion services meet the space and personnel standards of surgical centers. The clause about admitting privileges caused the shutdown of half the clinics in Texas and has been shown not to improve the safety record for abortions in Texas. In the past, complication rates were so low that doctors did not admit enough women each year to qualify for admitting privileges. Implementing the surgical center requirements would have left only seven or eight clinics in operation for the entire state. The Supreme Court ruling in “Whole Woman’s Health” also will impact abortion access nationally. Ten states now have admitting privileges mandates; six of these laws are already blocked and in four states, the laws will likely be struck down. And in 23 states with ambulatory surgical center requirements, two have laws that are blocked and four have particularly burdensome standards. They too will have to go.

“The Texas law would have forced a woman to travel longer distances, wait longer and incur a higher cost to exercise her constitutional rights” according to the opinion in JAMA. The editors also stated that the law would affect major cities: in Dallas, wait times for abortion consultations increased from five to 20 days following the original law’s passage.

The best comment was one that was made by Justice Ruth Bader Ginsberg in her concurring opinion. My judicial hero noted that tonsillectomy, colonoscopy in-office dental surgery, and childbirth are far more dangerous to patients yet are not subject to surgical center or admitting privileges requirements. And I would like to point out that childbirth is 14 times more likely than abortion to result in death, but Texas permits midwives to oversee home deliveries.

The majority of both my colleagues and women (at least those that I know) agree that reproductive health is integral to our overall health. Abortions are extremely safe with less than 0.3% of patients experiencing complications requiring hospitalization. We are constitutionally supposed to have the right of choice. Constitutional rights are intended to safeguard the human dignity of every individual. Abortion restrictions clearly have a discriminatory effect on poor women and those who live in rural areas. And frankly, these are the same women who often lack access to health education and contraception and consequently have high rates of unintended pregnancy. They also are less likely to obtain prenatal, obstetrical, and newborn childcare.

We now have one more legal mandate that protects the health rights and dignity of women in the US. May the future Supreme Court continue to support these rights!

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