Tuesday, August 25, 2009

PP Clinic in Sioux Falls Stays Open!

After I graduated from college, I worked for Planned Parenthood of MN/SD. Actually, when I started there, it was PPMN - we added SD and right after I left, they added ND.

Those of us who live on either coast may not understand what it's like to get an abortion in most of the country.  It's not just making your decision, making your appointment and having the procedure.  It can be an ordeal.

First, you have to get to the clinic.  In many states, that involves a long drive.  Of several hours (or more).  Wyoming doesn't have a clinic at all.  Neither does western South Dakota or North Dakota. Some states require a 24 hour waiting period between receiving counseling and having the abortion.  Because, you know, women are stupid.  And aren't able to make up their minds on their own.  Or maybe didn't realize that having an abortion would end their pregnancy?  And if you're under 18?  Well, you have to notify one or both of your legal parents.  Even if you don't actually have a relationship with one of them.  Or, if say, one of them is in jail for abusing you and their parental rights weren't terminated (I'm not going for effect here, that actually happened to one of my clients).  Of course, you can go to court to get around the parental notification rule.  Which means getting to court.  Not a problem if you live in a metropolitan area.  But in rural areas?  Well, I know one 15 year old woman who "borrowed" her parent's car in order to drive to the county seat to see the judge.  45 minutes away.

I worked with the Regional Services department of PPMNSD when we took over the Sioux Falls clinic. There, women drove more than six hours and slept in the parking lot.  They couldn't afford to pay for a motel.  The doctors wore bullet proof vests to go to work.

A few years ago, an abortion "informed consent" law was passed in SD.

In order for anyone to have any type of medical procedure they must sign a a release, and go through a process called informed consent. A medical professional reviews the risks and benefits of the medical procedure with the patient, answers questions, and makes sure that the patient is firm and clear in their decision to have the procedure and that there are no contraindications to the patient receiving this procedure. It's basic medicine.

And as someone who performed the informed consent and decision counseling, let me assure you, the process used at Planned Parenthood and most other clinics that provide abortion services?  It's way more comprehensive than what I went thru as a patient for my tonsilectomy or my knee reconstruction.

Part of the anti choice stragey has been to pass laws that specifically dictate what must be covered when a woman is getting an abortion. You can have heart surgery or a tonsilectomy and your doctor determines what needs to be covered in informed consent, but an abortion, which is way safer than either of those two procedures? Your friendly neighborhood policitician would like to tell your doctor what to say.

These laws serve two purposes. First, they ensure that the anti-choice agenda is present in the treatment room. Second, they put an increased burden on the physician. What they don't do is improve the quality of care.  Informed consent is already a critical part of providing good care and of risk management.  It's the doctors who don't do good informed consent who get sued.  And lose.  Any doctor worth their salt is going to put an emphasis on this part of the procedure (or ensure that it is well taken care of by their staff).  These laws aren't about good medicine.  Or well informed patients.  They are about harassment.

What's the big deal? 

Generally, most of the informed consent process (with any medical procedure) is handled by nurses, counselors or other clinic staff. The physician checks in with the patient, answers additional questions and signs off on the forms (which have already been signed by the patient and every other part of the clinic staff that has seen the patient).

It's done this way for several reasons. The most obvious is money. Physician time is expensive - when you go to see your doctor, your doctor is expected to see 4-6 patients an hour depending on the type of medicine. A nurse practitioner can see fewer patients per hour, a counselor even fewer. Since doing good informed consent work takes time, it is usually performed by someone who's time is less expensive, hopefully ensuring the patient is able to get all of the attention that she needs and deserves. 

Secondly, physicians are trained to perform medical services. And they're really good at that.  They receive very little training in how to talk to people.  They often aren't that great at it. And even less good at speaking in a way that is intelligible to someone who is not well versed in medical terminology. Telling a woman that there is an X percentage chance of uterine perforation isn't very useful when she doesn't know what perforation means.

So what happens when these "informed consent" laws are in place is this. The informed consent takes place like it always has. Then, the physician has to read the patient a statement that was prepared for them by the legislature. Not prepared by a medical professional. And in most states these statements are not even medically correct.

The SD law was particularly awful. The law requires that the physician disclose to the patient the following:
That the abortion will terminate the life of a whole separate, unique, living human being;
That the pregnant woman has an existing relationship with that unborn human being and that the relationship enjoys protection under the United States Constitution and under the laws of South Dakota;
That by having an abortion, her existing relationship and her exisiting constitutional rights with regard to that relationship will be terminated;
A description of all known medical risks of the procedure and statistically significant risk factors to which the pregnant woman would be subjected, including:
Depression and related psychological distress;
Increased risk of suicide ideation and suicide;
A statement setting forth an accurate rate of deaths due to abortions, including all deaths in which the abortion procedure was a substantial contributing factor;
All other known medical risks to the physical health of the woman, including the risk of infection, hemorrage, perforation, danger to subsequent pregnancies, and infertility;
The probable gestational age of the unborn child at the time the abortion is to be performed, and a scientifically accurate statement describing the development of the unborn child at that age; and
The statistically significant medical risks associated with carrying her child to term compared to undergoing an induced abortion.

S.D. Codified Laws, § 34-23A-10.1 (2006)

What's the problem here? Well, first of all, there is no good medical definition of when life begins. A definition of life and when that begins is a spiritual, religious, ethical and philosophical decision that is utterly personal. Telling a woman that her pregnancy is a "whole separate, unique, living human being" is both insulting and medically inaccurate.  A fetus at 12 wks LMP is absolutely not capable of existing on it's own.  For some woman, such a statement may be ethically true. But that's for her to decide.

"That by having an abortion, her existing relationship and her existing constitutional rights with regard to that relationship will be terminated;" makes it sound like if something went wrong during the abortion and it was a result of medical malpractice, she would have no legal recourse. Also not true.

"Depression and related psychological distress; Increased risk of suicide ideation and suicide;" Also not true. Study after study has found that patients who were emotionally healthy before an abortion are emotionally healthy after. Patients that struggled with their mental health before an abortion may have increased symptoms after, just as they would be at increased risk for symptoms after any stressful event.  Furthermore, these individuals would be at significantly increased risk of post partum depression or psychosis. Even Regan's Surgeon General C. Everret Koop found that there was no increased risk to a woman's mental health after an abortion. And he was (is) prolife.  Every clinic in which I have worked has taken the mental health of our clients very seriously.  And clients with pre-existing mental health issues were provided with additional support and follow up.

"All other known medical risks" - well, this part isn't a big deal. It was already covered. In detail. And, may I remind you, an abortion is always safer than a full term pregnancy and delivery. And all women receiving abortions are pregnant. So a full term pregnancy and delivery? Yeah, that's the only other choice.

PP refused to follow this law for multiple reasons (although they have always engaged in a comprehensive informed consent process) and has been engaged in legal battles over it since 2005. Which of course is costing money on both sides that could be better spent on things like, oh, WIC programs, accurate and useful (eg. not abstinance based) sex education, reduced cost or free birth control including Plan B (the morning after pill), etc.

Recently, the Health Department threatened to shut down the Sioux Falls clinic. Last week, a court decision came down that allowed the facility to remain open. The physician still has to tell the patient that "the abortion will terminate the life of a whole separate, unique, living human being". But, they don't have to state the crap about suicide.

So, for now, the clinic stays open. And women from South Dakota still have access to abortion services. Although they have to jump through absurd hoops.

I have counseled thousands of women seeking abortions.  The truth is, for all of the women that needed counseling, a shoulder to cry on, or for someone to tell them that it was ok for them to not have an abortion and continue the pregnancy, the vast majority of the women I saw knew what they wanted. They'd thought it through. They were clear that having a child at this point was not a good option for them and/or their families. Women aren't stupid. Never once did a client say to me, "Really? You mean if I have this baby the father will have to pay child support? I had no idea!"

These laws aren't about supporting women. They are about restricting access.  And controling women.

So here's to a small victory in South Dakota. That leads to a much bigger victory. Another day of providing the women of South Dakota with the ability to control their own destiny.

Want to support the clinic in South Dakota?  Click here.
To support political action - PP of MN, ND and SD Action Fund
To donate funds in support of the SD Clinic email gifts@ppmns.org

Want to support an agency that fights for abortion rights? Click here.

Or support a woman in need of an abortion who can't afford one?  An average first trimester abortion costs $300-600 depending on where you are in the country and is often not covered by insurance (if you have insurance).

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