Statement of the National Partnership for Women & Families on HB708
Submitted to Chairman Cook and Members of the House Committee on State
Affairs, Texas House of Representatives
April 22, 2015
The National Partnership for Women & Families is honored to submit this testimony on
behalf of the women and families we represent. The National Partnership is a nonprofit,
nonpartisan organization located in Washington, D.C., dedicated to promoting public policies
that expand opportunity for women and improve the well-being of our nation’s families. We
advocate for fairness in the workplace, reproductive health and rights, access to quality
affordable health care, and policies that help women and men meet the dual demands of work
and family. Through education, outreach, and advocacy, the National Partnership is an
effective advocate for millions of women and families.
Thank you for the opportunity to submit testimony on HB708, a bill that would require that
the information provided in "A Woman's Right to Know" Information Booklet (hereinafter
the Booklet) conform to the medically accurate and factual standards adopted by the
National Institutes of Health and its partner organizations. This bill aims to protect
women’s health and safety by requiring that health information be based on science and
medical evidence.
The National Partnership promotes access to high quality health care for all people.
Quality care is defined as the right care at the right time in the right setting for the
individual patient. Quality care should be evidence-based, delivered in a patient-centered
manner and provided without judgment or bias. Quality care improves health outcomes and
is cost-efficient for patients and providers.1
Patients want and need access to medically accurate and relevant information so that they
can make the best decisions. The Booklet should reflect medical standards for quality
health care. Per the Department’s own mandate, the information in the Booklet must be
based on the “current and relevant science and evidence-based literature, medical
professional resources, and government health and medical resources.”2 HB708 reiterates
the importance of providing women with information that is accurate and unbiased.
We must ensure that all health care, including reproductive health care such as abortion, is
delivered in a way that meets the needs and is in the best interest of every woman.
1875 connecticut avenue, nw ~ suite 650 ~ washington, dc 20009 ~ phone: 202.986.2600 ~ fax: 202.986.2539
email: [email protected] ~ web: www.nationalpartnership.org
CONCERNS WITH
“A WOMEN’S RIGHT TO KNOW” INFORMATIONAL BOOKLET
Quality care should be based on the strongest clinical evidence. In contrast, the Booklet
currently lacks citations or statistics to support its assertions. It lalso acks transparency by
failing to mention which aspects of care are mandated by the state regardless of the health
care provider’s medical opinion or the needs or desires of the individual woman.
I.
Information should be provided with sufficient detail to allow an informed
decision and all information should be cited to reliable medical sources.
The Booklet does not enable a woman to find out more information through the medical
data provided and it is impossible to verify without requesting further information. Medical
claims should be cited throughout the Booklet. Further, concerns about risk should be
clarified with statistics demonstrating the rare rate of occurrence. For example:
•
•
•
There is no data provided as to how likely it is a woman will actually be affected
by any of the risks listed for the abortion or childbirth, nor any citation to
medical literature explaining the occurrences of any of the risks. Given that the
risks of each potential complication are low, including the list without the
likelihood of occurrence misleadingly inflates those risks. (pp. 11, 12, 13, 14, 15,
17, 18).
Claims about abortion side effects are broad, as well as unsupported by any
citation. For example, the Booklet makes strong assertions about the impact on a
woman’s mental state after an abortion without evidence. “[S]ome women feel
guilty, sad, or empty, while others may feel relief that the procedure is over.
Some women have reported serious psychological effects after their abortion
including depression, grief, anxiety, lowered self-esteem, regret, suicidal
thoughts and behavior, sexual dysfunction, avoidance of emotional attachment,
flashbacks and substance abuse. These emotions may appear immediately after
an abortion or gradually over a longer period of time” (p. 16)
In the “Future Childbearing and Infertility” section, the Booklet states, “Some
large studies . . .” and then makes broad claims about the findings of those
studies in regards to future fertility after abortion. There is no citation to these
studies, no mention of the authors, the place of publication, when they were
performed or their methodology (p. 17)
II. All medical information provided should be accurate and based on the best
available scientific evidence.
No specific medical information should be included if it is not verified by the best available
medical and scientific evidence.
For Example:
• The breast cancer section (p. 17) presents the possibility of a risk related to abortion;
while admitting it hasn’t been proved, it posits it as an open medical question,
ignoring the significant medical evidence finding that this is not the case, including
a determination of an expert meeting convened by the National Cancer Institute.3 2
•
The statement that “some experts have concluded that the unborn child is probably
4
able to feel pain” is not cited and none of the strong evidence to the contrary is
presented.
III. Information should be provided in an unbiased manner that enables a woman to
make a decision without shame or stigma.
The medical community has well-developed standards for informed consent for an abortion.
According to the American Congress of Obstetricians and Gynecologists, “A pregnant
woman should be fully informed in a balanced manner about all options, including raising
the child herself, placing the child for adoption, and abortion. The information conveyed
should be appropriate to the duration of the pregnancy. The professional should avoid
introducing personal bias.”5 The Booklet does not attempt to provide information in a
“balanced manner” or avoid introducing bias. Medical information about abortion should be
provided in a neutral manner. If the state expresses a position regarding abortion, it
should be made clear that it is the opinion of the state.
For Example:
• Pregnancy and birth are described as “usually a safe, natural process although
complications can occur;” no such description is included for abortion despite the
recognition in the statistics that most abortions are comparably safer than
childbirth.
IV. When providing a description of what women will experience when they access
abortion care, the information should be clear as to which aspects of the
experience are based on a state mandate and what is at the discretion of the
doctor.
Language should be clear when a part of the process is required by the legislature’s
decisions, not relying on the doctor’s own medical training, opinion, and professional
discretion. For example:
• Page 1 does not make clear that the 24-hour waiting period is the legislature’s
decision, not the result of a doctor’s medical opinion and discretion. And on p. 10 it
states, “you will have at least a full day to read this information,” which does not
make clear that the delay is mandated by law even if the woman and the doctor do
not believe it is necessary.
• Under “Abortion Procedures and the Risks” it states that the doctor “may do an
ultrasound” without mentioning that Texas law mandates an ultrasound prior to an
abortion.
As national advocates on behalf of women and families, the National Partnership works to
see that all aspects of women’s medical care are high quality. As currently written, “A
Women’s Right to Know,” lacks in scientific rigor and evidence-based information. HB708
aims to ensure women are provided with care that meets the highest standards to
safeguard women’s health and safety. We urge you to provide women in Texas seeking
abortion care with only unbiased and factual information.
3
1 The standards for quality care are developed by collaborative groups representing the health care provider and consumer communities through entities such as the National Quality Forum (NQF) and the National Committee for Quality Assurance (NCQA). NQF describes the process for achieving quality care as a three step process, “The first step toward achieving quality is convening expert members across the healthcare industry, including patients to define quality with uniform standards and measures that apply to the many facets of care patients receive. Second, information gleaned from measuring performance is reported and analyzed to pinpoint where patient care falls short. Third, caregivers examine information about the care they are providing and use it to improve.” 2 25 Tex. Admin. Code § 1.73(c)(1) 3 In February 2003, the US National Cancer Institute (NCI) held a workshop of more than 100 of the world’s leading experts who study pregnancy and breast cancer risk. The experts reviewed human and animal studies that looked at the link between pregnancy and breast cancer risk, including studies of induced and spontaneous abortions. The findings included that “induced abortion is not linked to an increase in breast cancer risk. Available at www.breastcancer.org 4 See H. Tobin, “Confronting Misinformation on Abortion: Informed Consent, Deference and Fetal Pain,” Columbia Journal of Gender &Law 17, no. 1(2008): 111 – 152, at 113-­‐114 (reviewing existing evidence for various state laws that include claims that fetuses feel pain at 20 weeks gestation and declaring them “questionable on the issue of truthfulness, and… misleading.”). See also The American Congress of Obstetricians and Gynecologists. Statement on HR 3803.” 2012. available at <http://www.acog.org/~/media/Departments/Government%20Relations%20and%20Outreach/20120618DCAborStmnt.pdf?dmc=1&ts=20120915T2120559712>, Statement on Pain of the Fetus.” 1984. The American Congress of Obstetricians and Gynecologists. February 13, 1984.Fetal Awareness: Review of Research and Recommendations for Practice.” 2010. Royal College of Obstetricians and Gynaecologists. available at <http://www.rcog.org.uk/files/rcog-­‐corp/RCOGFetalAwarenessWPR0610.pdf> Lee, SJ et al. 2005. “Fetal pain: A systematic multidisciplinary review of the evidence.” Journal of the American Medical Association 294: 947-­‐954. Vanhatalo, Samspa and van Nieuwenhuizen, Onno. 2000. “Fetal pain?” Brain & Development: 145-­‐150. 5 American Congress of Obstetricians and Gynecologists Statement of Policy, As Issued by the ACOG Executive Board, Abortion Policy, The American Congress of Obstetricians and Gynecologists (2007, reaffirmed 2011) 4