Reproductive Freedom

Freedom And Privacy Of Your Reproductive Healthcare Descisions!

DEMOCRATIC PARTY POSITION:

Women should have the freedom to make their own decisions regarding their healthcare and reproductive issues and reject proposals for a national ban on abortions and contraception medicines. We actively support a current petition to include in the November 2024 election a referendum for an amendment to the State of Florida constitution which will codify the right to reproductive choice into Florida law that explicitly blocks the implementation of laws that prohibit, delay, or restrict abortion access.

• REPUBLICANS IN FLORIDA:
  
  Florida, with its GOP governor and GOP majority legislature, passed a six-week abortion ban earlier in 2023. Currently, abortion is legal in Florida up to 15 weeks, pending Florida Supreme Court hearings. If the six-week ban goes into effect, it bans abortion before most people even realize they are pregnant. Republicans also favor a national ban on abortion rights with few or no exceptions. They reason that it is immoral to end the life of the unborn under all or most circumstances, including rape, incest, and endangerment to the life of the mother.

“The good thing about science is that it’s true whether or not you believe in it.” – Neil deGrasse Tyson, 2011 CNN interview.

There is no more important fundamental freedom than the right to reproduce. The corollary naturally follows: the right NOT to reproduce is an equivalent freedom. And yet this freedom is under attack by groups with limited (to no) understanding of the complexities of reproduction as well as the vagaries of pregnancy and its potential outcomes. Understanding biological processes is key to crafting reasonable legislation that respects access to reproductive options. Informed medical science (truths) should frame legislative decisions, rather than false beliefs, myths, or political dogma.

Addressing Fallacies, Myths, and Mania

Currently, six week abortion ban legislation exists in several states. These are often called “heartbeat” bills, yet the six week embryo has no formed heart. The typical ”lub/dub” sound of a heartbeat results when blood flows through valves that do not exist at four weeks post-fertilization (a 6 week gestational pregnancy). The former (2019-2020) president of the American College of Obstetricians and Gynecologists (ACOG), Dr Ted Anderson stated, “What is interpreted as a heartbeat in these bills is actually electrically induced flickering of a portion of the fetal tissue that will become the heart as the embryo develops.” The ACOG is against heartbeat bills and states that “arbitrary” bans are not reflective of fetal development or science (Glenza, 2019).

A six week gestational embryo is not recognizable as uniquely human, and most non-embryologists would be hard pressed to tell this embryo apart from one of a mouse or chicken. After the eighth week of pregnancy, the developing tissue is accurately described as a fetus—there is no scientific recognition that this tissue is a “baby” or “child”. A baby only exists following birth. Use of the term “baby” prior to 40 weeks gestational age, is incorrect and the intentional misuse serves solely to inflame anti-abortion supporters. Speaking the word “baby” when describing a ten week fetus creates a mental image that is as fictional as the Easter Bunny, Santa Claus, and the Tooth Fairy.

Anti-abortion supporters often frame themselves as “pro-life”, but both scientists and nonscientists would be challenged to come up with a consensus definition of “life” or agree to the defining moment when life begins. Disingenuous politicians suggesting that scientists agree on “life” definitions and fetal viability timing are spouting political propaganda not based in scientific fact.

The Babylonian Talmud Yevamot 69b states that: “the embryo is considered to be mere water until the fortieth day” (approximately eight weeks gestational age). “Afterwards, it is considered subhuman until it is born” (Schenker, 2008). The Women’s Rabbinic Network has issued a statement noting that several sacred Jewish texts say the fetus has a soul only after birth. According to this group, replacement of Roe v Wade with state-level abortion restrictions is an infringement on their religious beliefs because anti-abortion legislation values the fetus over the pregnant mother (Hernandez, 2022). These restrictions are a violation of Jewish law, the religious freedom enshrined in the Constitution’s Bill of Rights and the Religious Freedom Restoration Act (RFRA) of 1993.

Genesis 2:7 of the Hebrew and Christian bible says, “Then the LORD God formed the man of dust from the ground and breathed into his nostrils the breath of life, and the man became a living creature.” While open to interpretation, in its simplest form, this statement seems to be underscoring the life-giving of breath which happens at birth not at any fetal developmental stage. It is also interesting to note that the Oxford dictionary defines “life” as the period between birth and death, certainly excluding the embryonic and fetal period.

Arbitrarily assigning abortion bans to gestational time points has no basis in medical or ethical discussions. The 15 week abortion ban passed in several states including Florida is an arbitrary date of no scientific or medical significance. The lower limit of viability is typically assigned to 22 weeks of gestation, but that lower limit is dependent upon many factors including availability of advanced medical resources, particularly Level III NICUs (Periviable Birth, 2017, 2021). In a 2022 study conducted at 19 neonatal academic research centers, survival rates to clinical discharge of 22 week gestational neonates was only 10.9%. (Bell et al., 2022). There were no survival statistics provided for neonates of less than 22 weeks’ gestation because none existed, suggesting that 22 weeks remains the viability limit.

Unexpected Outcomes

Many fetal developmental complications can arise during pregnancy including brain malformations and anomalies of the kidneys, heart valves, and liver. Genetic abnormalities resulting in multiple copies of single chromosomes (trisomy 18, 13) or multiple sets of chromosomes (triploidy, tetraploidy)—manifest in severe physiological anomalies but may produce live offspring that die shortly after birth. A parent faced with the challenge of giving birth to offspring that suffer from any catastrophic disorder, deserves the right, or FREEDOM, to determine if pregnancy termination is the option for their family and personal situation. Prenatal diagnostic testing (Amniocentesis, Chorionic Villus Sampling) can inform decisions; however, results may not become available until after 12 or more weeks of pregnancy. Parents who find themselves in these situations should be encouraged to grieve their loss in their own time rather than be forced to carry a pregnancy that prolongs their emotional and physical suffering (Simmons Duffin, 2023).

Medical Emergencies

During gestation, emergencies often arise that can result in pregnancy loss. Miscarriage, ectopic pregnancy, and loss of amniotic fluid are just a few examples. Without medical intervention, severe bleeding, infection, and tissue destruction may occur leading to infertility, scarring of reproductive tissue, or even maternal death. Fetal consequences of amniotic fluid loss include death, lung, and kidney damage. Anti-abortion laws have directly prevented persons in some states from accessing medical care to address a reproductive emergency (Steed Sellers, 2023). Uncomplicated pregnancy itself can exacerbate pre-existing disease conditions and raise the level of morbidity and mortality associated with reproduction. Politicians who fail to understand the health risks of both normal and complicated pregnancies simply do not have the expertise or empathy to understand the consequences of forcing all individuals to carry a pregnancy to term. The American Medical Association, the American College of Obstetricians and Gynecologists, the Society for Maternal Fetal Medicine, the American College of Emergency Physicians, the American College of Surgeons, the American Academy of Family Physicians, and the American Academy of Pediatrics, are just a few of the medical societies that consider abortion to be safe, essential, and an evidence-based component of reproductive health care.

How Abortion Bans Harm Women

Safe, legal abortion care is a medically sanctioned part of comprehensive reproductive health care. Illegal abortion can result in death often due to sepsis (or bacterial infection) or hemorrhage. Making abortion illegal doesn’t reduce the number of abortions, it simply makes them more dangerous because determined individuals will access termination however they can get it. Studies (Addante, et al., 2021) have shown that states restricting abortion access have higher maternal mortality rates than states that protect access. In the supreme court case that overturned Roe v Wade (Dobbs), the attorney for Mississippi argued that birth options (postnatal care, adoption, baby drop offs) would mitigate any perceived harm to individuals forced to give birth. However, this argument totally ignores the fact that individuals who are forced to complete a pregnancy are 14 times more likely to die than those who access abortion (Raymond and Grimes, 2012). Furthermore, black women are two-six times more likely to die during pregnancy than any other demographic. These statistics do not consider the mental and emotional harm a forced pregnancy takes on an individual who would prefer abortion care (Wilkinson et al., 2022). Although anti-abortion groups often mention maternal regret and mental trauma as consequences of undergoing an abortion, several studies have rebuked that position and shown no higher incidence of post-traumatic stress in individuals who had abortions than those who were denied abortion access (Biggs et al., 2016).

As state-specific abortion restrictions are put in place, individuals may be forced to travel to seek the care they urgently need. Travel will place financial, medical, and emotional burdens on those who often can least afford to deal with these hardships, particularly individuals of color and those living in poverty.

Forcing an adolescent to carry a pregnancy may alter their life path and prevent them from accessing education and work opportunities. These lost opportunities can result in a lifetime of poverty for the family (Foster et al., 2018). Adolescent pregnancy and delivery are also associated with an increased rate of adverse outcomes and increased medical costs (Kawakita, et al., 2016). If a pregnancy is the result of incest or rape, the trauma associated with pregnancy and birth can lead to life-long mental and physical scars (van Ee and Blokland, 2019).

Emerging Threats

According to data from 2020, medication abortions accounted for over half of all abortions in the US. Now that several states have banned abortion, abortion pills have become more difficult to get. Some women have resorted to ordering pills from abroad, where shipping delays can lead to their use later in pregnancy (after 10 weeks). Consequences of delayed medication use include increased bleeding, pain, and heightened anxiety as the fetus passes from the body. Individuals experiencing these complications are often fearful of seeking emergency care due to legal consequences for themselves or their caregivers (https://www.hsph.harvard.edu/news/features/abortion-restrictions-health-implications/).

Medication abortion requires a two drug regimen: mifepristone and misoprostol. Recently a conservative Christian group in Texas filed a lawsuit to block access to mifepristone (approved in 2000 to terminate pregnancy). The combination of drugs has a 93-99 % termination efficacy and fetal tissue is more easily expelled when Mifepristone is taken first (Autry and Wadhwa, 2022). If the Texas group successfully blocks access to a tested, safe, and useful medication, individuals will need to use misoprostol alone to induce abortion. Unfortunately, Misoprostol alone may produce more painful contractions, accompanied by heavier, prolonged bleeding (Ibis Reproductive Health, 2021). Thus, it seems this group’s only goal is to make pregnant individuals endure a more painful, riskier termination that may require surgical intervention. Mifepristone is also effectively used to treat an endocrine disorder called Cushing’s Syndrome (Fleseriu et al., 2013). By revoking this drug’s approval, a valuable treatment will be lost to Cushing’s patients.

Restrictive abortion laws have other unintended consequences. If an individual loses a pregnancy while taking medications prescribed for chronic health concerns unrelated to pregnancy (ulcers, arthritis, acne, eczema, inflammation), physicians and pharmacists may be falsely accused of aiding an abortion. This is especially problematic in states with restrictive laws that encourage vigilantism. It is now becoming more difficult to get or fill prescriptions for retinoids, methotrexate, misoprostol, and certain NSAIDS because of vaguely written anti-abortion laws (Mahase, 2022).

Couples seeking to have children using assisted reproductive technologies (ART) face new barriers because of anti-abortion legislation. These parents desperately want children, yet underlying fertility issues and the technical aspects of ART can lead to consequences that may require termination of the pregnancy to avoid medical harm (Wu et al., 2022). Will these situations be remedied and addressed in a timely fashion in states with limited to no abortion access? It is essential that legislators recognize the complexities of ART and confer with appropriately credentialed medical specialists to avoid crafting legislation that limits access to medically sanctioned procedures including abortion care.

In conclusion, no one other than the pregnant person, in consultation with their physician and guided by their body, conscience, and their god, should have the option of choosing to continue or terminate a pregnancy. Medical autonomy is a fundamental human right, and unfettered access to accepted, medically sanctioned procedures, including abortion, should be universally respected and accepted.

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References

1. Addante AN, Eisenberg DL, Valentine MC, Leonard J, Maddox KEJ, Hoofnagle MH. 2021. The association between state-level abortion restrictions and maternal mortality in the United States, 1995–2017. Contraception 104: 496-501.

1. Autry BM, Wadhwa R. Mifepristone. Updated 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Available from: https://www.ncbi.nlm.nih.gov/books/NBK557612/ .

1. Bell EF, Hintz SR, Hansen NI, et al. 2022. Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018. JAMA. 327(3):248–263.
2. Biggs MA, Rowland B, McCulloch CE, Foster DG. 2016. Does abortion increase women’s risk for post-traumatic stress? Findings from a prospective longitudinal cohort study. BMJ Open. Feb 1;6(2):e009698.

1. Fleseriu M, Molitch ME, Gross C, Schteingart DE, Vaughan TB, Biller BM. 2013. A new therapeutic approach in the medical treatment of Cushing’s syndrome: glucocorticoid receptor blockade with mifepristone. Endocr Pract. Mar-Apr;19(2):313-26.

1. Foster DG, Biggs MA, Ralph L, Gerdts C, Roberts S, Glymour MM. 2018. Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States. Am J Public Health. Mar;108(3):407-413.

1. Glenza, Jessica. 2019. https://www.theguardian.com/world/2019/jun/05/abortion-doctors-fetal-heartbeat-bills-language-misleading. The Guardian. June 2019. Accessed Feb. 2023.

1. Hernandez, Joe. 2022. https://www.npr.org/2022/06/26/1107722531/some-jewish-groups-blast-the-end-of-roe-as-a-violation-of-their-religious-belief. NPR online. June 2022. Accessed Feb 2023.

1. https://www.hsph.harvard.edu/news/features/abortion-restrictions-health-implications/ 2021.The negative health implications of restricting abortion access. Harvard T.H. Chan School of Public Health Interview with Dr. Ana Langer. 2021. Accessed Feb. 2023
2. Ibis Reproductive Health. 2021. Misoprostol-alone medication abortion is safe and effective. https://www.ibisreproductivehealth.org/sites/default/files/files/publications/Misoprostol-alone%20medication%20abortion%20is%20safe%20and%20effective.pdf Accessed Feb. 2023.

1. Kawakita T, Wilson K, Grantz KL, Landy HJ, Huang CC, Gomez-Lobo V. 2016. Adverse Maternal and Neonatal Outcomes in Adolescent Pregnancy. J Pediatr Adolesc Gynecol. Apr;29(2):130-6.

1. Mahase E. 2022. US anti-abortion laws may restrict access to vital drug for autoimmune diseases, patient groups warn BMJ. 378.

1. Periviable Birth. 2017 (Reaffirmed 2021). American College of Obstetricians and Gynecologists. Obstet Gynecol, 130 a187-1996.

1. Raymond EG, Grimes DA. 2012. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol; 119: 215-9.

1. Schenker, Joseph G. 2008. The beginning of human life. Status of embryo. Perspectives in Halakha (Jewish Religious Law). J Assist Reprod Genet 25:271–276.

1. Stead Sellers, Frances, 2023. https://www.washingtonpost.com/health/2023/02/18/florida-abortion-ban-unviable-pregnancy-potter-syndrome/. The Washington Post. 2/18/2023. Accessed Feb. 2023.

1. Simmons Duffin, Selena. 2023. To safeguard healthy twin, she had to ‘escape’ Texas for abortion procedure. February 28. NPR online. https://apple.news/ACVM2HqlzSMaEE7oPNqyldA

1. van Ee E, Blokland J. 2019. Bad Blood or My Blood: A Qualitative Study into the Dimensions of Interventions for Mothers with Children Born of Sexual Violence. Int J Environ Res Public Health. Nov 29;16(23):4810.

1. Wilkinson, Barbara, Chiamaka Onwuzurike, and Deborah Bartz. 2022. Restrictive State Abortion Bans — A Reproductive Injustice. N Engl J Med 386;13.

20. Wu, Pensee, Garima V. Sharma, Laxmi S. Mehta, Carolyn A.Chew‐Graham, Gina P. Lundberg, Kara A. Nerenberg, Michelle M. Graham, Lucy C. Chappell, Umesh T. Kadam, Kelvin P.Jordan, Mamas A. Mamas, 2022. In‐Hospital Complications in Pregnancies Conceived by Assisted Reproductive Technology. JAHA, 11:5, https://doi.org/10.1161/JAHA.121.022658 .