“There are few times where we dictate what medical care should be.” -Representative Kolste
“We have the state dictating the physician’s words.” -Representative Pasch
Assembly Bill 227 (and its counterpart in the Senate) is just one more bill in a line of women’s health legislation that has been pushed through the state legislature this week while the state budget is taking up most peoples’ attention. These bills (including AB216, which was discussed last week) will have real and detrimental effects on the availability and access to women’s health needs in Wisconsin, and is sure to change the overall state of health over time. Furthermore, women’s health in Wisconsin took another hit on Tuesday, when the Joint Finance Committee rejected a motion to expand BadgerCare (Medicaid) with federal dollars, and instead is choosing to spend over $100 million more in state taxpayer dollars to cover fewer people.
Key Points of AB 227:
- Mandates undergoing an ultrasound (which are offered for free at many clinics) before an abortion, for the purpose of protecting the health and safety of the woman.
- The woman choices which type of ultrasound she will undergo, either transvaginal or abdominal.
- Mandates a physician to tell the woman opting for the abortion a detailed description of the fetus, show her the ultrasound, and have her listen to the fetal heartbeat.
- A woman has a “choice”: she can decide not to have the ultrasound (and therefore not have the abortion) or bring earplugs or loud music so she does not have to listen to the doctor.
- Waivers are available for women in cases of rape or incest, but a police report must have been filed.
- The physician performing the abortion must have admitting privileges at a hospital within a 30 mile radius.
This bill offers a myriad of potential problems that will overall make it more difficult (and in some cases, more traumatic) for a woman to undergo an abortion.
First, in a theoretical situation where an abortion provider does not offer ultrasounds (note: Planned Parenthood offers the service at all three locations that provide abortions in the state) a woman must go elsewhere and come back, adding to the time before the procedure is completed and furthering her expense.
Second, the bill does offer exemptions for women in cases of rape or incest if a police report has been filed. However, when the majority of these cases go unreported, women who have already undergone traumatic experiences and wish to end the pregnancy will be forced to endure another procedure and listen to the fetal heartbeat and descriptive details. Doctors will not have the ability to decide on a case-by-case basis what is appropriate for their patients.
Third, this law will take away a woman’s right to make her own medical decisions. Because ultrasounds during any pregnancy are a routine standard of care, they should not be denied to a woman. However they should not be mandated.
Fourth, during most of the first trimester, the routine standard of care is to use a transvaginal ultrasound. This is especially true before 6-8 weeks, because the fetus is too small to be effectively viewed through an abdominal ultrasound. While the bill mandates that a woman choose which type of ultrasound, most doctors typically perform this more invasive procedure on newer pregnancies and might therefore advise a woman to do so. Therefore, there will be cases of women who have been assaulted and have not filed a police report, and that may have to undergo an extremely invasive procedure.
Fifth, the 30 mile admitting privilege rule is an uncommon requirement for outpatient procedures. While the justification is that a doctor should be able to bring a patient to a hospital ER in the case of an emergency, hospitals will still admit patients of doctors who do not have an agreement to perform in the facility. However, when 40% of hospitals in Wisconsin are Catholic-affiliated, it is quite likely that this agreement to give admitting privileges may be difficult for doctors who provide abortions to obtain.
Lastly, pregnant women who are carrying fetuses to term are not forced to have mandatory ultrasounds at 20 weeks. Even though it is a routine standard of care, the American College of Obstetricians and Gynecologists only recommends the procedure if there is a specific medical reason. Only 75% of expecting mothers have an ultrasound during pregnancy, so it is unreasonable for 100% of women wishing to end a pregnancy to have one. Furthermore, the purpose of an ultrasound during a pregnancy which will be brought to term is to inform the physician about the state of the pregnancy. Therefore, mandating a woman (whether she is ending a pregnancy or carrying one to term) does not fulfill the original purpose of the procedure.
This bill is not only opposed by the Wisconsin Alliance for Women’s Health, but also Planned Parenthood Advocates of Wisconsin and the Wisconsin Medical Society, among other provider groups. The current Wisconsin law already in place mandates that a doctor offer an ultrasound or inform her on the availability of services elsewhere. Therefore AB227 is unnecessary.
According to the bill’s advocates, a woman has a “choice” in regards to this mandatory ultrasound: she can refuse to have an abortion to get out of having one. Making abortions more difficult to obtain negatively affects the health and safety of women in our state, and therefore this bill does exactly the opposite of its claimed intended purpose.