Mississippi’s governor has just signed a TRAP law that may well shut down the state’s only abortion clinic. Like many TRAP laws, on its face the regulation looks reasonable and aimed at patient safety. Abortion providers in the state will have to be board-certified in obstetrics & gynecology, and will have to have admitting privileges at a nearby hospital. However, dig a little deeper and it becomes clear that this is yet another of many laws that have nothing to do with safety and everything to do with restricting women’s access to a legal medical procedure.
First of all, although the majority of physicians who provide abortions are obstetrician/gynecologists, any doctor with the appropriate training can provide abortions. Although national numbers are hard to come by, in 2010 in Minnesota, family physicians performed over 1/3 of abortions (compiled by @wentrogue). Surgical abortion is considered an advanced skill for family medicine residents by the American Academy of Family Physicians (Dr. George Tiller was a family physician). Medical abortion (using medications to induce abortion) requires less training than surgical abortion and fits well within the scope of practice of general family medicine. Multiple studies have shown that abortion care performed by family physician is as safe and effective as abortion care by obstetrician/gynecologists. (Some pediatricians, emergency medicine doctors, internists, and surgeons have completed extra training to be able to provide medical and surgical abortions, although the numbers are low). There is no medical reason to restrict the practice of abortion to doctors certified in obstetrics & gynecology; this move is clearly political and aimed at preventing women from getting the medical care they need.
Secondly, although on its face the requirement that a physician performing abortions have “admitting privileges” at a nearby hospital appears to be important for patient care, such a requirement is unnecessary and again only serves to decrease access to abortion care. Admitting privileges, or the right for a doctor to take care of his or her own patients in the hospital, are granted by hospitals based on multiple criteria. Doctors who do not have their own local practice or cannot be available to take “call” (to be on-site or nearby to admit patients who have no physician) may be denied such privileges. Also, because such privileges are granted at the discretion of the hospital, they may be denied for purely political reasons (for example, the fact that the doctor applying provides abortions).
Abortion is a very safe procedure; complications are rare. Complications serious enough to require hospitalization are even more rare, occurring after less than 0.1% of first trimester cases. In those rare cases that require hospitalization, a transfer agreement with a nearby hospital is more than sufficient to ensure that patients requiring a higher level of care have appropriate continuity of care. Doctors around the country perform other comparable surgical procedures (such as incision & drainage of wounds and suturing of injuries) without the additional burden of a requirement of admitting privileges to a nearby hospital. Only abortion providers are being singled out, and safety is clearly not the motivating factor.
This becomes even more clear on close reading of the law. Abortion is defined as:
“The use or prescription of any instrument, medicine, drug or any other substances or device to terminate the pregnancy of a woman known to be pregnant with an intention other than to increase the probability of a live birth, to preserve the life or health of the child after live birth or to remove a dead fetus.” (Emphasis mine)
The procedure used to “remove a dead fetus” is the same as the procedure used to perform an elective abortion. Exact same procedure, exact same risks, fewer unnecessary regulations.
Does anyone still want to argue this is about safety?