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Opinion: From the Clinic to the Capitol

On February 12, I made my way to Jefferson City to testify for my first state house committee hearing. I am not a politician or a lobbyist or even a lawyer. I am an obstetrician/gynecologist in St. Louis City, and a Missouri resident. My drive to the state capitol was not short and the last minute announcement of the bills to be heard in the committee on an early Tuesday morning required rescheduling several patients that had appointments long before the bills were even referred to the committee. But that day, the House Children and Families Committee was hearing three bills that would further restrict access to abortion. While I have watched Missouri chip away at the Constitutional right to abortion over the past decade, one piece of legislation finally moved my work from the clinic to the Capitol.

I testified against House Bill 126, sponsored by Representative Nick Schroer (R-O’Fallon). I stated the bill is an extreme and dangerous measure that if signed into law would be a near-total ban on abortion in Missouri. This bill would ban abortion before most people even realize they are pregnant. I told the state legislators that I see patients in downtown St. Louis for all types of gynecologic care. I see patients on a daily basis that did not know they were pregnant before walking into my office. The vast majority of these new pregnancy diagnoses are beyond six weeks gestation by the time they come in to my office. If HB 126 were made law, it would mean that every single one of those patients would simultaneously confirm that they were pregnant and learn that it was too late for them to get an abortion in their own state.

For example, the week before my testimony a patient presented to me to be evaluated after being assaulted by a family member. It had taken her weeks to gather the strength and courage to tell anyone – let alone a complete stranger – about this event. She learned in my office that she was also pregnant. I can’t imagine looking her in the eye and telling her that because she lives in Missouri, she has no option of a safe and legal way to end this pregnancy in her own state that this decision has already been made for her by her legislature. If HB 126 were enacted, it would no longer matter what this patient wanted, her life circumstances, or what could be best for her medically.

I also explained to our elected officials, that I have a very unique perspective, as I also am the Executive Director of Hope Clinic for Women located in Illinois. At this office, where I provide abortion care, many of our patients are Missouri residents. There are so many obstacles that make it difficult for patients to reach my office in Illinois from surrounding states to access abortion care. Patients face lengthy trips—sometimes several hundred miles; challenges getting childcare during their appointment; missed work and lost wages; and difficulty gathering funds to pay for their care as well as gas and lodging. This disproportionately affects patients in rural areas, patients of color and patients with lower incomes. There are resonating impacts on patients’ families and their whole communities. I also see patients who are facing a devastating fetal anomaly in a highly desired pregnancy, or patients who have become pregnant as a result of rape or incest, for whom no exception is made in this extreme bill. There is no question that an essential ban on abortion in Missouri, like HB 126, would place an undue burden on the 1 in 4 women in this state that will seek abortion care.

I based my entire testimony in medical facts to try to combat the layers of fiction and sad, painful but also inapplicable stories that were being told in other testimony heard that morning. As a doctor, my first priority is providing high-quality and evidence based care to my patients while doing no harm. I have 8 years of graduate and post-graduate training in gynecology as well as 15 years of clinical experience. Any statement made about improving patient care by creating arbitrary restrictions around abortion is completely false. Abortion is one of the safest medical procedures performed. Hundreds of medical studies completed with adherence to strict standards of data collection and analysis have shown without a doubt that laws (which for the most part are less restrictive than this bill) have no medical benefit for the patients and have resulted in a clear undue burden on patients. In fact, in 2016 the Supreme Court of the United States (yes, the court that makes decisions that Missouri is supposed to follow) reviewed a case of restrictive abortion laws in Texas (again less restrictive than HB 126) – a clear decision was made by the court and in her concurring opinion, Justice Ginsburg stated that “It is beyond rational belief that [the restrictive law] could genuinely protect the health of women” and the restriction “would simply make it more difficult for them to obtain abortions” she went on to include that similar laws which “do little or nothing for health, but rather strew impediments to abortion… cannot survive judicial inspection.”

My time was up quickly and my testimony was cut short by the Committee Chairwoman before I was able to ask each legislator to consider the following: Each one of you is different from the next; your health status is different, your finances are different, your relationships with the people in your lives and families are different. If you needed access to medical care, you would talk to your health care provider, and maybe your loved ones or faith leader. It would be up to you to decide who you wanted to share in the decision about how to precede with your medical care, not politicians. Every day, I have these conversations with pregnant people as they decide what’s best for them as individuals.

Coming from medical practice which is a world of research, evidence and work to improve outcomes and patient care – my trip to the Missouri State Capitol was like stepping into a different universe. In the sponsorship and supporting testimony of HB 126, there were only gut instincts, personal opinions and incorrect information. There were no facts, there was no logic, and there was a clear disregard for the rights and autonomy of a patient. To make matters worse, HB 126 easily passed out of the committee and was debated on the House floor just two week later. Eight more restrictive and equally arbitrary amendments were added to the bill. The original six-week ban now includes other extreme measures that hurt my patients , including changing the name of the bill from “… fetal heartbeat…” to “Missouri Stands for the Unborn Act,” taking out exemptions for rape and incest, a 20-week ban, two-parent notification, a ban on race, sex, or Down syndrome diagnosis, a law immediately making abortion illegal in this state should Roe v. Wade get overturned, additional malpractice insurance for abortion providers that other doctors aren’t mandated to get in Missouri, and adding a class B felony to anyone who performs abortions against these regulations. HB 126 now sits in the hands of the Senate, who also has its own version, Senate Bill 139, sponsored by Senator Andrew Koenig (R-St. Louis County).

The citizens of this Missouri, the patients that I serve, are about to be completely restricted by a near total ban on abortion in this state.