As of January 1, 2004, abortion care providers in Texas have been subjected to one of those ever more commonplace TRAP (Targeted Regulation of Abortion Providers) law packages being crafted by state legislatures under the cynical lie of "protecting women," that in reality accomplish only the creation of greater barriers to the provision, availability, and access to safe, legal, professional abortion care - which, of course, is exactly the result desired by the supporters of such laws - not any improvement in the safety of abortion care, which was already so safe it could scarcely be improved upon (and certainly not by making it even less accessible and less affordable).
One of many requirements of the TRAP laws in Texas is that women seeking abortion care must be given, orally by phone or in person, a litany of state-mandated "information" about abortion, much of which is flagrantly false and misleading, at least 24 hours before she can obtain an abortion. It was the naïve hope of the drafters and supporters of this law that women would be scared out of having abortions by hearing how "dangerous" abortion is.
. . . of having each woman come into the clinic, some from hours away, I responded by means of evening conference calls using the following script.
HELLO AND WELCOME.
This is Dr. (Beket).
Thank you for joining this conference call.
I’m going to wait a couple of minutes to see if any others join the call.
If you hear the same beeps I hear, they are kind of like in that old movie "It’s a Wonderful Life," in which every time a bell rang an angel got his or her wings. Every time you hear a beep another woman joins the call – in a way gets her wings. Really. It might seem far-fetched to some of you, but for many a woman the experience of having an abortion is much more than just a medical procedure. It’s often one way of claiming her wings – her wings of independence – taking charge of her own life – summoning up from inside herself the courage to claim her freedom from the old oppression of the past. It is about nearly every thing in our culture that has to do with anything. It is about life – death – sex - power – religion – God – right and wrong – family. An unplanned pregnancy challenges a woman to look at everything – her hopes and her dreams, her relationship choices, her ideas about family and career, her plans for the future. For many women abortion can be a transformational experience – one where she actively chooses what she wants for her life - one where she is in charge. One in which she is "born again."
Women were relegated for many centuries to powerless second class status in a male-dominated culture and required through guilt, shame, fear, and often stern reprisal to keep themselves sort of chained to an ironing board, washtub, and cook stove, barefoot and pregnant – seen and not heard. That’s the way it used to be – for centuries. Ugh! The "bad ol’ days!" Well, "You’ve come a long way, baby," as they say, but there’s still a long way to go and many barriers and hurdles to overcome to achieve full equality in such things as civil rights, opportunity, and pay. There are those who want to turn back the clock to those "bad ol’ days." They have hit us (and that "us" includes you) with the new law in Texas that among many other things requires a woman to wait at least 24 hours after contacting a clinic before she can have an abortion.
Since this is a conference call with a bunch of you and only one of me on the line, and since our time is limited, I won’t be able to take questions or comments from you. In fact, I’m going to mute your lines so that you can hear me, but we won’t be able to hear you (or your dog barking), and you won’t be able to hear each other. I’m not really being rude. The sole purpose of this call is to relate to you certain information required by state law, and it just gets too confusing and too hard to hear unless I mute your lines.
I won’t be able to take many questions during this call, but each and every one of you will have a private session at the clinic with one of our experienced counselors in which you can ask any questions you might have. Also, during this counseling session, those of you who might be uncertain about whether to have an abortion or not can discuss it with your counselor with the goal of helping you clarify what you want to do. It is very important to us that you come to your own decision for your own reasons, whatever they might be – not one that is forced upon you by anyone else.
It is those who want to outlaw abortions who want to decide for you and decide the same for you all – compulsory pregnancy and childbearing – even if your life is threatened by it.
As of January 1, 2004, I am required by Texas law to provide you with the information covered in this call either in person or by phone at least 24 hours before you can have an abortion. We are providing you with the opportunity to satisfy this requirement by phone so you can avoid an extra trip to the clinic.
So, just be patient, and I’ll be as brief as I can. It is very important that you stay on the call until the end, because I will give you a code word at the end by which you can verify that you participated in this call at this day and hour. When you come to the clinic for your appointment, you will be required by state law to sign a state certification form to verify that you received this information at least 24 hours before your appointment.
I am Dr. (Beket). Two other doctors are associated with the clinic – Dr. (--) and Dr. (--). We are all MD’s with specialized training in obstetrics and gynecology, which means we are specialists in pregnancy and childbirth and other conditions related to the medical care of women. We all have had extensive experience in providing abortions. One of us three physicians will perform your abortion should you decide to have one, depending upon which day you schedule your appointment.
I want to explain something about this new law that the state legislature has hit us with and its larger meaning.
For reasons I could go on and on and on about - but I promise I won’t - I believe very strongly that women and teenage girls should have the right and the opportunity to obtain safe, legal, professional abortion care. This belief puts me in direct conflict with the political power of the extreme right-wing Republicans who pander to religious extremists and currently dominate the Texas state government – and our federal government as well. They believe you should be forced by law to comply with their narrow religious beliefs, or to those of the religious zealots whose votes they covet, regardless of what your own beliefs might be. They know, understand, and care nothing about you and your predicament, or about your human rights as women and American citizens. Thousands of women and teenage girls are right now, today, at this very moment, in the same predicament you are in - faced with an unwanted pregnancy. If these extreme right-wing politicians have their way, women will no longer have the freedom in this supposedly free country to follow their own conscience and obtain safe, legal, professional abortion care if they so choose. As of January 1, 2004, their new law is in effect. This law, which has many more tedious and pointless aspects to it than the 24-hour waiting period, has made it very difficult for us to continue to provide abortion services, but we intend to hang in there as long as we can, because we know how important this right is for women, teenage girls, and those who care about them.
There are probably some of you on this call who were actually against abortion until you got pregnant yourself, but now you suddenly realize how important this right really is. That’s just often the way it works – it’s often hard to relate to or understand until you experience it personally in yourself or in someone close to you. Abortion is a decision that's very easy to judge when you're not in the position of having to make it for yourself.
This law has nothing to do with making abortion safer. Nothing. It has everything to do with, stepwise, bit by bit, taking away your rights of reproductive freedom, imposing their religious beliefs on you, controlling your behavior, and forcing you to endure a pregnancy you don’t want, even if it will exert a terrible effect on your life and health.
Nor is it about information. Doctors routinely inform patients about medical procedures and their risks, as we have always done. This law is not about giving women a chance to "think it over." By the time a woman seeks to have an abortion, she has thought it over and over and over. She has no need whatsoever for a state law forcing her to "think it over" for 24 more hours. If the law were really about giving people more time to think over medical decisions it would apply to all medical decisions, certainly including those regarding medical procedures far more dangerous than abortion.
This law is designed, purely and simply - and only - to place a barrier between a woman and her human right to govern the domain of her own body, to make it impossible for many women to legally obtain an abortion, and to drive the cost of abortions beyond the ability of more women to afford them.
You might be feeling all alone in your predicament. You might fear that you must be about the only woman in the world planning to have an abortion. Well, fear not. You are far from alone. You will probably be surprised at how full the clinic waiting room is – and the parking lot. About 4,000 women every day have abortions in the United States. More than 40% of all adult women in the country have had an abortion. More than 40%. You just never hear about it because they keep it secret. About 5% of women having an abortion are under the age of 18. About 20% of women are over the age of 35. About 2/3 of our patients have at least one child already.
The World Health Organization (WHO), an agency of the UN, has estimated that in those parts of the world in which abortion is illegal, more than 70,000 women and teenage girls die every year from illegal attempts to abort unwanted pregnancies. That is more than one every 10 minutes dead because they are prohibited by law from calling a reputable legal clinic as you have done for a safe, legal abortion.
In addition, every minute, night and day, no holidays or weekends off, around the world one woman dies of complications of pregnancy and childbirth, ten teenage girls undergo unsafe abortions, thirteen infants under twelve months old die, fifty seven people contract an STD, eleven people are infected with HIV, and the already-burgeoned-beyond-the-planet's-capacity-to sustain human population increases by one hundred fifty people, all sanctioned, encouraged, and even required by our Republican-dominated government through international interference with and withholding of funding from worldwide reproductive health programs.
The ultraconservative Republicans now in control of the Texas state government, as well as the United States government, would like to completely take away your right to have a safe, legal abortion – even in cases in which a your life might depend upon it - and shut down all of our clinics – returning us to those "bad ol’ days" of dangerous illegal abortion in which women and teenage girls in very large numbers were injured, and many died from abortions performed by criminals. I can remember those days. I was there, in Parkland and Baylor Hospitals in Dallas TX. I saw it and dealt with it hands on. It was not so long ago – and I shudder to think of the horror of going back to that.
Kept from completely outlawing abortion by the U. S. Supreme Court decision known as Roe vs. Wade, which BTW originated in Dallas (Henry Wade was the District Attorney of Dallas County), they have done all they can to make it harder for you to obtain an abortion, and this restrictive Texas law is just one of their grim creations.
I want you to know that the choice you have made today, or are considering making, is not likely to be available much longer. What if you were in the predicament you are in right now, and you could not legally obtain an abortion? What would you do? If George W. Bush and his fellow extreme right-wing Republicans in Texas and around the country win the next election, in November of this year, women might well not have this choice two years from now. In a second term, he will doubtless appoint one or more new justices to the Supreme Court, and they will be right-wing ideologues who will vote to overturn Roe vs. Wade. The day that happens, abortion will be illegal everywhere in Texas, even if needed to save a woman’s life. I am uncomfortable speaking to you about a political matter, but I believe that this political matter is a medical matter that can have a terrible impact on you and other women for years to come. On your friends, your daughter, many others you care about – perhaps on you yourself. Just think what it would mean to you right now if abortion was against the law and available only through underground criminal channels that were very difficult to access, very expensive, and extremely dangerous, in addition to being a criminal offense. If you didn't vote, or if you voted Republican, this is what you got for not going to the trouble to vote or to understand what you were voting for. Voting matters. For this and many other reasons having nothing to do with abortion rights I urge you to vote this year and to vote Democratic.
I am required to talk to you about risks:
[1] RISKS
The main purpose of this call is to inform you that having an abortion carries risks to your life and health. The right-wing lawmakers hope you will thus be scared out of having an abortion. Well, let's simply admit that of course abortion carries certain risks. It would never occur to us to claim otherwise, and we have always thoroughly informed women of the risks. There is not one form of medical or surgical treatment – or dental treatment - that does not carry risks, including carrying a pregnancy to term and giving birth, the risk of which is many times greater than having an abortion. The relatively much greater safety of abortion compared to continued pregnancy and childbirth should not necessarily be your reason for having an abortion, since both are essentially quite safe with modern medical care, but it should reassure you of the safety of abortion compared to the only alternative. (We all wish there were a third alternative. There’s not.)
We encounter many risks of all kinds every day. We just need to put all these risks in perspective to enable us to simply get through each day without collapsing into a quivering lump of inconsolable fear.
To put the risk of abortion in perspective let me say this: Be sure to buckle your seatbelt and drive carefully on the way to the clinic and back home. YOUR TRIP TO AND FROM THE CLINIC IN YOUR CAR WILL BE THE MOST DANGEROUS PART OF YOUR ABORTION. Driving in Dallas traffic is more dangerous than having an abortion – and I’m sure that’s something most of you do every day without giving it a second thought.
Abortion as provided in legal clinics is one of the safest procedures known to medicine and is the most common surgical procedure performed today. Complications from having an abortion are many times less frequent and less serious than those associated with giving birth. The combined minor and major risks of 1st trimester abortion are significantly less than 1%.
[2] SPECIFIC RISKS
You will have ample opportunity to discuss all the possible risks and benefits of abortion in your counseling session with an experienced counselor when you come for your appointment, as well as with the doctor, as we have always provided, but the State of Texas requires that I review certain specific risks with you now, 24 hours in advance of your appointment. All of these risks are possible, but extremely rare – and remember: the risks are much higher with continuing a pregnancy and giving birth than they are with abortion.
Abortion carries essentially the same risks as continuing a pregnancy and giving birth, the difference being that the risks are many times less likely and less severe with abortion. And there are additional risks of later pregnancy that are avoided by abortion, such as pregnancy-induced hypertension and a serious convulsive disorder known as eclampsia or toxemia of pregnancy, as well as the possibility of major abdominal surgery if a cesarean section is needed.
I could present information at great length on percentages of occurrence of various complications gathered from statistical studies, but I don’t think that would be meaningful or appropriate in this call. Just remember that they are all extremely rare -- and remember that all possible complications and any questions you might have about them will be considered in detail in your individual counseling session in the clinic. In general, there is a gradually increasing risk of complications as a pregnancy progresses in time, so that the risks, rare in any case, are generally somewhat greater as you enter into the second trimester, or above 12 weeks gestation.
Blood clots can accumulate in the uterus, requiring another suction procedure.
Infection can occur. We virtually never see infections because we of course use strict sterile technique and we prevent infection by prescribing prophylactic (or preventive) antibiotics to all women having an abortion. On those very rare occasions when they nevertheless do occur, infections are easily identified and treated if the woman carefully observes follow-up instructions.
Allergic reaction to one of the medications used in the procedure can occur.
A tear in the cervix can occur, which may be repaired with stitches or cautery, and is never serious.
Perforation of the wall of the uterus can occur. This means that a surgical instrument can accidentally be inserted through the wall of the uterus. This is extremely rare, and in over 95% of the rare cases in which it does occur it just heals itself. In extraordinarily rare cases, hospitalization and surgery might be required, including hysterectomy and repair of damaged internal organs.
What we call failed abortion can occur, which does not end the pregnancy and requires the abortion to be repeated.
Incomplete abortion, in which some tissue from the pregnancy remains in the uterus and requires a repeat suction procedure, can occur.
Hemorrhage, which just means excessive bleeding, can occur. This is rare. When it does occur it can almost always be treated easily in the clinic. On extremely rare occasions, hospitalization, blood transfusion, and surgery might be necessary.
Many women are concerned about the effect abortion might have on their future pregnancy and childbearing. They sometimes fear that having an abortion will render them less able to become pregnant and have children later. This fear, along with other unrealistic fears, is often aggravated by the scare campaigns waged by anti-abortion fanatics that are falsely claimed and rumored to be true. However, as is the case with all these malicious rumors, barring some extremely rare and unusually serious complication, this is just nothing to worry about. You can count on having all the children you want in the future.
By this misguided law I am required to tell you that there is a "possibility" of a link between having an abortion and an increased risk of breast cancer. They seem to have chosen the word "possibility" based upon the idea that "anything is possible." Maybe they still think it’s "possible" that the earth is flat, or "possible" that the moon is a big ball of green cheese floating around up in the sky. I wouldn’t put it past them. Is there an increased risk of breast cancer after having an abortion? NO! The anti-abortion zealots have for years been trying to hoodwink women with big scare campaigns to try to scare women out of having abortions. In one of these they claim that having an abortion will increase a woman’s risk of developing breast cancer, and they even circulate misinformation from flawed, fraudulent, discredited research to support that claim. This has been taken very seriously, studied by medical scientists throughout the world, and found to be without any basis whatsoever in fact. This false claim has been refuted and denounced by the American College of Obstetricians and Gynecologists (ACOG), the World Health Organization (WHO), the National Institutes of Health (NIH), the National Cancer Institute (NCI), the American Medical Association (AMA), and the American Cancer Society (ACS).
There is even a recent study published by a world-renowned research institute in Sweden, the Karolinska Institute, in which there is reported an actual reduction in the risk of breast cancer from having an abortion!
Is there a risk of dying from an abortion? Yes. Statistically, one death occurs for every 160,000 women who have legal abortions. These rare deaths are usually the result of such things as adverse reactions to anesthesia, infection, or uncontrollable bleeding. You have heard of such rare deaths occurring even during dental work from anesthetic reactions – fortunately very rarely, as is the case with abortion. In comparison, again: a woman's risk of death during pregnancy and childbirth is more than ten times greater!
[3] GESTATIONAL AGE
I am required to tell you the gestational age of your pregnancy or how far along you are. It is possible for me at this time only to give you a way of estimating that which is reliable in the vast majority of cases, but not all. However, every one of you will have a sonogram when you come to the clinic to make an exact measurement of how far along you are. We do not leave so important a matter up to guesswork.
In the vast majority of cases, if your periods have been normal and regular, you can get a reliable estimate of how far along you are by simply counting back in weeks to the first day of your last normal menstrual period (LNMP)and then subtracting two weeks from that. This is because you likely got pregnant around the time you ovulated (which means the time one of your ovaries released an ovum, or egg), which is usually about two weeks after the first day of your last normal period. So, if you are pregnant and your LNMP was 10 weeks ago, subtracting 2 weeks from that, you are probably 8 weeks pregnant, if your LNMP was 14 weeks ago you are probably 12 weeks pregnant, if 6 weeks ago 4 weeks pregnant, etc. This does not provide a reliable way of estimating if your periods have not been regular, however, and we also occasionally see women who have had seemingly normal periods after they got pregnant. But – not to worry – you will each and every one have a sonogram to precisely determine how far along you are.
[4] METHOD OF ABORTION
Under the new law we are prohibited from providing abortions over 16 weeks gestation in clinics, although we have performed them safely in clinics for more than 30 years. At our clinic we provide abortions from about 4 weeks up to that unreasonable new limit of 16 weeks. In this time period, abortion is performed by dilating (or enlarging) the opening into the uterus, called the cervix, then inserting a small plastic tube into the uterus to suction out the pregnancy and related tissue. This generally takes about three to five minutes, somewhat longer if you are into the second trimester, and is done under local anesthesia to partially numb the cervix. If your pregnancy is at 14 – 16 weeks, forceps will also be used in the procedure. You will also have the option of IV sedation and nitrous oxide, or "laughing gas," to help you relax and lessen any pain you might feel. If you are less than seven weeks pregnant, you can consider the option of medical abortion, or the "abortion pill." We are not strong enthusiasts of medical abortion, but we do have it available. We are not strongly supportive of it because it is much more difficult and involved than just swallowing a pill – just not anywhere near as easy as it sounds - and we generally think it makes more sense to go through a brief surgical procedure of three to five minutes and leave the clinic knowing your abortion is complete than to go through maybe several weeks of uncertainty with medical abortion, often entailing several more visits to the clinic, more sonograms, and sometimes a surgical abortion anyway if it doesn’t work. However, in the vast majority of cases it works smoothly and without complication, so we do offer it to those who choose it, making sure that they know what they are getting into.
When you come to the clinic you will probably see some protestors standing around the parking lot entrance on public property motioning for you to stop so they can offer you some of their deceitful propaganda leaflets and try to deceive you into going into the Roman Catholic fake clinic next door so they can immerse you in lies about abortion designed to scare and shame you out of acquiring the abortion you have chosen. They might yell at you, but they will not assault you. Please just strictly ignore them. Don’t roll your window down or talk to them, since such gestures of recognition just encourage them to harass us and our patients.
Don’t feed the protestors.
Remember: Buckle those seatbelts!
