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Part 004
Testimony of Physicians for Reproductive Health

Transcribed by: Tammy Ackerson

Senator Wendy Davis: We also had written testimony provided to the Health and Human Services Committee by Robin Wallace, MD/MAS, who is a Leadership Training Academy Fellow with Physicians for Reproductive Health. She testified before the Texas Senate Committee on Health and Human Services, on Senate Bill 537, during the regular session on March 19, 2013, and she provided this written testimony, which I think is compelling:

"Physicians for Reproductive Health is a doctor-led national advocacy organization that uses evidence-based medicine to promote sound reproductive health policy. We work to make quality reproductive health services an integral part of women's health care.

"Physicians for Reproductive Health opposes Senate Bill 537, which would impose burdensome, expensive, and unnecessary requirements on facilities providing surgical abortion in Texas, causing many to shut down. Though this bill purports to improve patient safety, it would in fact harm women by reducing access to safe, timely abortion services.

"I am a board-certified family medicine doctor licensed to practice medicine in Texas. I received my medical degree from the University of North Carolina in Chapel Hill. I completed my postgraduate training at the Santa Rosa Family Medicine Residency, an affiliate of the University of California, San Francisco. I also completed a fellowship in primary care research and family planning at UCSF, as one of a select number of family physicians who have participated in this specialty training. I currently live and practice in the Dallas/Fort Worth area. I am pleased to submit this testimony in opposition to SB537 on behalf of Physicians for Reproductive Health.

"SB537 is harmful to women. As a physician who takes care of women every single day, I cannot stress enough how dangerous these laws are to the health and well-being of my patients. Women need timely access to safe abortion care. SB537 imposes medically unnecessary standards on abortion facilities. SB537 would require abortion facilities to become ambulatory surgical centers (ACSs), [sic] which are the setting for complicated and invasive surgical procedures. Abortion, especially early abortion in the first twelve weeks, is a safe medical procedure with inherently low risk in outpatient settings without hospital-like facilities. Serious complications arising from surgical abortions at any gestational age are uncommon.

"By comparison, pregnancy and childbirth are significantly more dangerous to women than abortion. For example, CDC data indicates that the pregnant--pregnancy-related mortality ratio in the United States is 15.2 deaths per 100,000 live births compared to .64 deaths per 100,000 legal abortions."

Senator Wendy Davis: And she provides a footnote for that from the CDC in a report that was compiled in 2011.

"The requirements imposed by this bill are simply medically unnecessary, unsupported by scientific evidence, and contrary to the standards of care."

Senator Wendy Davis: She goes on to say:

"I think of my patient, Samantha, a mother of a two-year-old son who was born two months early. Upon determining that she was pregnant again, Samantha was overwhelmed by the thought of another pregnancy with a potential risk of complications, and she decided to terminate that pregnancy. Luckily, Samantha lived within fifteen miles of our outpatient clinic, which was easily accessible on a major city bus route. Samantha was able to have her abortion safely and timely in the first trimester.

"Another patient named Monica, a 23-year-old woman, presented to me at almost twelve weeks. She had a three-and-a-half-month-old baby girl at home who was delivered by Caesarean section. This patient did not realize she was pregnant earlier, because she had not had a menstrual period since her delivery. We were able to provide her abortion procedure to her safely and quickly, so that she could return home to care for her baby. A young mother does not have time to travel many miles or hours away. She needs to be able to get back to her infant and take care of herself and her family.

"My patients come from all walks of life, from every situation imaginable. One thing they have in common, is that they seek abortion because they've weighed all the options and know in their hearts that this private decision is best for themselves and their families. They do not deserve the burden of a law that has no medical benefit or basis.

"If SB 537 becomes law, I fear for my patients like Samantha and Monica, who already face challenges receiving abortion care in Texas. The cost-prohibitive regulations associated with SB 537 would force safe, accessible abortion facilities to close, while doing nothing to improve patient safety. SB 537 would deny women safe, needed medical care. SB 537 would create unreasonable obstacles for health care providers like myself, who are committed to protecting the health of women by making these needed services available. Many health centers would close due to the inability to comply with the standards of an ASC. In turn, this would force women in Texas to travel out of state, if they have the resources, or would deny them safe care altogether.

"I cared for a patient, Julia, a Registered Nurse with a young child at home. Julia was pregnant, and this was a very wanted pregnancy. She and her husband discovered through a routine 14-week ultrasound that she had a very high-risk pregnancy with a significant chance of stillbirth. They made the difficult decision to end the pregnancy. We were the closest provider to Julia, but still a four-hour bus ride away. Due to current Texas state law, she had to make this trip twice: once for her required ultrasound, and again after the mandatory 24-hour waiting period to have her procedure performed.

"Another patient of mine drove five hours by herself, because there was no provider closer to her. Her pregnancy was diagnosed at 22 weeks with a lethal fetal anomaly. Continuing the pregnancy would mean waiting for the fetus to die in utero, during labor, or immediately after delivery. My patient and her husband made the heartbreaking decision to end the pregnancy. She had to stay alone at her hotel until her husband could follow two days later for the final day of her procedure. I provided care for her, and she did medically well, but she experienced financial hardship associated with traveling such a long distance to receive care.

"As a physician, I know that access to safe and legal abortion care is critical to the health of women. When abortion becomes less accessible, it becomes less safe. Medically unnecessary restrictions on abortion cause women to delay their care as they locate a provider, travel greater distances, or even seek services of an unlicensed provider, all resulting in taking unnecessary risks with their health. While Texas women have the right to safe legal abortion, in reality, there are already very few facilities in Texas to provide this essential care. In 2008, 92% of Texas counties had no abortion provider."

Senator Wendy Davis: And she cites for that, a report prepared by the Alan Guttmacher Institute, "State Facts About Abortion", available online and last accessed according to her footnote, March 15, 2013.

"Decreasing the number of providers in Texas will have negative effects on women, even beyond the immediate outcomes of their pregnancies. Recent research has shown that when a woman seeking an abortion is denied access to care, she is more likely in the future to become unemployed, live below the poverty line, and experience intimate partner violence."

Senator Wendy Davis: And she cites for that statement, [Diana] Greene Foster, "Reports on the Socioeconomic Consequences of Abortion Compared to Unwanted Birth", and she also cites K.S. Chibber, "Receiving vs. Being Denied an Abortion and Subsequent Experiences of Intimate Partner Violence", in support of her statement.

"If additional facilities are forced to close under the burden of SB 537, this would have a devastating impact on the health and well-being of Texas women and their families.

"Conclusion: SB537 does nothing to improve patient safety. Rather, it would close the doors on many clinics that provide comprehensive, safe, legal, and compassionate care to women in Texas. On behalf of Physicians for Reproductive Health, I strongly urge the Senate Health and Human Services Committee to oppose SB537 and protect Texas women's health."


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