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Over the weekend, I was exchanging emails with an old friend, and I invited him to visit San Antonio. He turned me down. He’s an OB/GYN, and he said Texas laws could make him subject to arrest.

It isn’t only abortion that is affected by Texas law, he said. Common medical procedures used in failed pregnancies also make physicians like him potential criminals in Texas. He told me, for example, that a D&C, an essential procedure for certain problems in pregnancy, is potentially criminal activity in Texas.

He’s a very experienced OB/GYN who has performed over 6,000 deliveries, so I took seriously what he was saying. He’s been practicing for multiple decades, he has taught at a top medical school, and he’s heavily involved at senior levels of both state and national OB/GYN medical associations. He's got credibility.

I wanted to know more, so I phoned him.

I asked him if he thought that the new laws were causing OB/GYNs to leave Texas. He said that he didn’t think that was the case yet. While he personally knows one doctor who is leaving, he said that he believes most are committed to staying and trying to protect and care for women in Texas.

He points out that Texas -- prior to these laws -- already had a high maternal mortality rate. Roughly 30 out of every 100,000 pregnancies in Texas result in the death of the mother. That's almost five times the rate in California, where 6 to 7 out of 100,000 women die, a rate that's similar to most Western European countries. With the new Texas restrictions on legal abortion, he expects that the maternal mortality rate in Texas will significantly increase due to complications of illegal abortions, as occurred prior to 1970.

“But we won’t know,” he said. “Texas is no longer publishing all of their maternal mortality data.”

He says that the low maternal mortality rate in California is due to an intensive effort in the state, first to determine the causes of maternal mortality and then to publish toolkits with algorithms for care to prevent those deaths.  OB/GYNs in California have, he says, managed to eliminate most ‘preventable’ deaths. California is sharing its approach with states that have a higher level of maternal mortality, he told me, via a program run by ACOG (The American College of Obstetricians and Gynecologists), the leading national OB/GYN society.

However, keeping existing doctors in Texas won’t be enough to protect women’s health here, and there are other trends that are potentially more damaging, he said.

Here are a few.

  • Applications to OB/GYN residency programs in Red states, where laws like those in Texas are taking effect, are declining. Medical schools in Blue states like California, on the other hand, are seeing applications climb dramatically. Over time, that could affect where these new doctors locate. (My friend, for example, still lives in the state where he went to medical school, not in the state where he grew up.)

  • OB/GYNs in those Red states can’t fulfill all of their educational needs locally, so they have to get part of their training in states that don’t have these legal restrictions on women’s health care.

  • Testing for OB/GYN board certification (typically a requirement for associating with a hospital) has, for years been held in Dallas. Roughly 1,500 physicians each year have traveled to Dallas to be board certified by the American Board of Obstetrics and Gynecology (ABOG). That certification testing is being moved out of Texas or done virtually.

  • He expects to see a recurrence of pre-Roe health problems, where women who received unsafe abortions ended up in the hospital with serious complications, including life-threatening infections. There were ’septic wards’ dedicated to that issue in the past, he says, and they could return.

  • IVF — fertility treatment — is also being adversely affected and made much more difficult. Dealing with current frozen embryos and determining how to manage future embryo production has become "a legal nightmare" in many states, he says.

ACOG’s position, he told me, is that abortion is a health issue for a woman and her doctor — it’s an issue of women’s health and women’s autonomy. It should not be legislated by someone who is not involved in a woman’s reproductive health care.  Not all OB/GYNs agree with that position, my friend says. About thirty percent, for religious or ethical reasons, won’t perform abortions. In that case, ACOG advises, the physician has a right to decline, but must refer the care of their patient to a physician who will provide care for her according to her religious and ethical beliefs, rather than the physician’s.

Jim Feuerstein is co-editor of LNF Weekly; he also designs and manages the website.

Texas has a high maternal mortality rate, and it's probably going to get worse.

Not a safe place to visit anymore

Thursday, October 20, 2022

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