Modern-Day Ob-Gyns Affirm Physicians' Obligations Outlined in 1972 Statement on Abortion

April 25, 2013 — Summary of "A Statement on Abortion by 100 Professors of Obstetrics: 40 Years Later," Darney, American Journal of Obstetrics & Gynecology, March 21, 2013.

"Forty years ago, leaders in obstetrics and gynecology published a compelling statement that recognized the legalization of abortion in several states and anticipated the 1973 Supreme Court decision in Roe v Wade," write Philip Darney of San Francisco General Hospital and 99 other professors of obstetrics and gynecology who compare the original analysis with "what actually occurred and with legislation that has been adopted over the 40 years since their writing and the passage of Roe v Wade."

Comparison of Former, Current State of Abortion Care

Noting that the 100 professors in 1972 accurately predicted "today's abortion rate of 1 in 4 pregnancies," Darney and colleagues argue that hospitals "have disregarded the responsibility that our academic predecessors expected them to assume."

Darney and colleagues outline several examples of how hospitals have fallen short of the 100 professors' call to help meet women's need for abortions. They note that "90% of abortions, which include the 10% that are in the second trimester, are done away from hospitals," in part because many hospitals "enforce fetal and maternal health restrictions that are not based in the law but are contrived and enforced by the same kind of 'ethics committees' that were common before the professors' 1972 statement."

A related factor is that states -- "under the guise of patient safety" -- have enacted "cumbersome and expensive building regulations" for abortion clinics and "restrict[ed] abortions to hospitals that have their own restrictions or to specialized facilities."

Darney and colleagues also discuss the failure of hospitals and physicians to adopt the clinical methods recommended by the 100 professors -- namely, that physicians should learn uterine aspiration, which accounts for the vast majority of abortions, and local anesthesia and analgesia, including conscious sedation, as an alternative to general anesthesia. They note that many hospitals only provide abortions in operating rooms and cannot opt for conscious sedation because of their credentialing rules. These practices "not only dramatically [increase] patients' recovery time and expense" but also add "significant and unnecessary staffing and clinical costs that [discourage] hospitals from providing abortions at all," Darney and colleagues write.

Regarding "doctors with conscientious objections" to providing abortions, the 100 professors recommended that such doctors be excused from performing the procedure but refer patients to providers who could care for them. However, "many physicians are now prohibited by law from referring patients to vital services," Darney and colleagues write, noting, "In Texas, for example, referral for abortion can result in denial of contraceptive funding."

Noting that the 100 professors correctly predicted that legalized abortion nationwide would reduce septic abortions, the modern-day professors lament that "[t]he savings in lives and money from legalization were soon forgotten." They note that today many hospitals "claim they cannot afford to provide abortions" because of financial and regulatory challenges, including low reimbursement rates, competition from free-standing clinics, and refusals by providers, especially nurses. However, Darney and colleagues point out that today's hospitals provide many other procedures with low reimbursements, that "some hospitals are able to provide cost-effective abortions" and that it is "unlikely true" that "all or most nurses" refuse to participate in abortions.

Further, Darney and colleagues note that state legislatures "have interfered in the consent process by requiring that irrelevant, even untrue, information be given by the physician ... and enacting burdensome waiting periods that increase risks and costs."

In addition, although the original statement called contraception "'an integral part of any abortion program,'" the most effective contraceptive methods "are still not easily accessible immediately after abortion when women most want them," authors write. Lastly, Darney and colleagues discuss how restrictions on abortion coverage in public and private health insurance have prevented the realization of the 100 professors' call to make abortion "'equally available to the rich and the poor.'"

Conclusion

Darney and colleagues conclude by endorsing a new pledge to carry on the work outlined in the original statement. They pledge to "teach future practitioners about all methods of contraception and about uterine evacuation throughout pregnancy"; provide evidence-based information to all patients seeking abortion or contraceptive care; "refute legislative demands for unnecessary and invasive treatments that are designed to intimidate and humiliate women" seeking abortions; insist hospitals "admit patients who require hospital-based" abortions; and "ensure the availability of all methods of contraception," especially long-acting reversible methods, "to reduce the need for abortion."