I Am Being An Alarmist About Bill’s Potential To Create A Database Of Women Who Take The Morning-After Pill. Here’s Why.

As a result of HB 388, the so-called “Unsafe Abortion Protection Act,” three of the state’s five abortion clinics would be forced to close, according to Amy Irvin, the founding board member of the New Orleans Abortion Fund. The bill, which was introduced by State Representative Katrina Jackson, a Democrat and the head of the Legislative Black Caucus, closely mimics the recently-passed law in Texas, a law that gained national attention due to State Senator Wendy Davis’s filibuster.

Clinics in Baton Rouge and New Orleans would likely be forced to close; the only clinics that could remain open are located in Shreveport and Bossier City. That’s because the bill requires physicians who perform abortions have “hospital admitting privileges.” These requirements are specious, unnecessary, overly burdensome, and, perhaps most importantly, they are based on a fundamental lie about the safety of abortions performed in clinics, which are already subject to more scrutiny, regulation, and oversight than any of Louisiana’s numerous ambulatory surgical centers.

Under the pretense of ensuring “safety,” the bill would effectively eliminate access to abortion services for the vast and overwhelming majority of Louisiana women. If this bill were truly concerned about ensuring safety, it would, at the very least, mandate regional hospitals to provide admitting privileges to physicians who perform abortions.

As I wrote on Monday, if, as a matter of public policy, we believe that abortions should be both safe and rare, then we must also ensure that they are legal. There is no evidence that the current regime is resulting in increased complications, but by essentially eliminating access to abortions in Louisiana’s two largest cities, we can be certain that abortions will become significantly less safe, forced into the metaphorical back alley.

This is, no doubt, the most egregious portion of this proposed legislation: Instead of making abortions safer, it will assuredly make them less safe.

My post on Monday received a lot of attention, and admittedly, I was being purposefully alarmist; I wanted the bill to be scrutinized thoroughly. I also recognized, perhaps cynically, that people would be more outraged by the revelation that the state government collects personal information on women who receive abortions and that the bill’s authors have published reports conflating emergency contraceptives with the abortion pill than they would be about the immediate closure of clinics.

But I think I was right to be an alarmist, and here’s why.

*****

In my previous post, I wrote about the bill’s requirement that the state’s Department of Health and Hospitals maintain a database on women who obtain an abortion, either surgically or medicinally.

I also wrote about my concerns that the bill’s expansion of the definition of the “first trimester” could lay the groundwork for increased regulation of the morning-after pill, also known as Plan B, and other emergency contraceptives.

While Representative Jackson, the bill’s sponsor, adamantly refutes that the legislation would impact Plan B, the organization that she worked with in crafting the legislation published reports on their website arguing that Plan B is, in fact, an abortifacient.

Yesterday, Gene Mills, the director of the Louisiana Family Forum, claimed that his organization was “pleased to be working with Representative Katrina Jackson” on the bill. Mills has publicly opposed Plan B and other emergency contraceptives for decades. In 2010, he attempted to lobby the Food and Drug Administration to deny approval of the emergency contraceptive ella, arguing that it was an abortifacient.

Notably, when I asked her yesterday whether she had been working with the Louisiana Family Forum, Representative Jackson flatly denied it, tweeting, “I have not spoken to anyone from the Family Forum on this bill and I do not believe they would make this claim.” The Louisiana Family Forum did, however, make the claim.

In a 2012 newsletter, Gene Mills, denouncing the federal government’s mandate that employers cover contraceptive services as a part of the Affordable Care Act, wrote (bold mine), “It (HHS) compels action, mandates commerce and pushes individuals into health compacts that provide abortion-inducing drugs, sterilization, and life destroying ‘medicines.‘” Later in the letter, Mills specifically referenced both ella and Plan B.

Even if it is true, in fact, that no one from the Louisiana Family Forum had ever contacted Representative Jackson, they are very clearly happy to publicly share ownership of the legislation.

Representative Jackson also disputes that the bill would create a database of women who receive abortions. The database, she points out, already exists. That is true. In fact, it’s cited in my original post. But regardless, it’s news to most people, and it was important to mention.

Maybe it was unfair for me to suggest that Representative Katrina Jackson was personally proposing the creation of a state database of women who take the morning-after pill. Maybe I was being hyperbolic. But I’m happy that this bill is finally getting the attention it deserves.

I have since learned that Katrina Jackson did not actually write this legislation; it was written by a pro-life public interest law firm. And Representative Jackson does not believe that this bill would include Plan B. But when I first asked her on Monday, she wasn’t as sure. In fact, she told me that she’d have to get back to me; she didn’t know.

Today, Representative Jackson told The Times-Picayune that there was a lot of misinformation about the bill, specifically referencing Plan B and the database. As I mentioned to the reporter, I wish they had quoted, instead, the folks who actually wrote the bill and had asked them, on the record, whether they believe that Plan B is an abortifacient.

Because there is a legitimate reason to believe that the authors of this bill intend to lay the groundwork for the inclusion of Plan B and emergency contraception. As Greg Zeman of Politix points out, despite Representative Jackson’s statements that the bill doesn’t include emergency contraceptives, “the language of the bill as written seems to suggest otherwise.” Zeman quotes from the bill:

If a physician prescribes, dispenses, administers, or provides any drug or chemical to a pregnant woman for the purpose of inducing an abortion as defined in R.S. 40:1299.35.1, the physician shall report the abortion to the Department of Health and Hospitals.

And then, he points out that the statute’s “definition of covered substances contains the following” (bold mine):

“Conception” and “fertilization” each mean the fusion of a human spermatozoon with a human ovum… “Pregnant” means that female reproductive condition of having a developing embryo or fetus in the uterus which commences at fertilization…”unborn child” or “fetus” means the unborn offspring of human beings from the moment of conception through pregnancy and until live birth.

This, as Zeman correctly observes, could include emergency contraceptives. “Under that definition,” he writes, “disrupting the natural progression of a fertilized ovum using the ‘morning-after pill’ would seem to amount to medication abortion.”

*****

Even better, why not ask Governor Bobby Jindal what he thinks? To be fair, it may be almost impossible to get a consistent, coherent answer from Governor Jindal on this. In 2003, during his first and unsuccessful campaign for Governor, Jindal only supported the use of emergency contraception in the case of rape and, apparently, only when the drugs were administered in a hospital. In 2009, Governor Jindal signed HB 517, a law that allows (bold mine) “any person . . . not to participate in the objectionable practices or dispense ‘abortifacient drugs,’ that would include the mifepristone abortion pill and the morning after pill, which can cause an abortion in limited circumstances.”

Then, in 2012, Governor Jindal completely changed his position, arguing that emergency contraception and the morning after pill should be “over-the-counter,” a position that, at the time, put him to the left of most Democrats and President Obama. He was even praised by the head of Planned Parenthood.

But most recently, Governor Jindal, in a speech at the Ronald Reagan Presidential Library, forcefully defended the company Hobby Lobby, who is suing the federal government over the Affordable Care Act’s mandate that large employers provide health insurance that covers contraception. Hobby Lobby’s lawyers have argued that Plan B and other forms of emergency contraceptives are abortifacients.

Again, who knows what Governor Jindal would say?

Either way, yes, I am being an alarmist, because it doesn’t take much research to uncover the broad agenda of those who wrote this legislation and those who claim to be “working” for its passage.

At least one pro-choice advocate told The Times-Picayune that she agreed with Rep. Jackson’s assessment that the legislation would not implicate or regulate emergency contraception, and that’s understandable and savvy. After all, it is settled science that the morning-after pill is, in fact, contraception and not an abortifacient. But settled science hardly matters to the zealots in the Louisiana Family Forum and those on the far-right.

We know that those who wrote this legislation and those who are pushing for this legislation believe that emergency contraception is, to quote Gene Mills, a “life-destroying medicine.” And we know that, in fact, the Louisiana Department of Health and Hospitals is responsible for maintaining a database of women who receive abortions and that the reporting requirements are extensive, including personal information on a woman’s age, education, marital status, reasons for seeking an abortion, and medical history, among other things. This isn’t merely about outcomes reporting, and contrary to Representative Jackson’s claims, it’s not comparable to the ways in which the state collects data on sexually-transmitted diseases; this is about shaming women.

And given this, it’s completely irresponsible and inaccurate for The Times-Picayune, the largest newspaper in Louisiana, to suggest that her bill has been plagued or beset by “rumors” and “misinformation.”

No, it’s been the subject of speculation and analysis, which is responsible.

That said, as I mentioned in the beginning of this post, there are more troubling, more immediate problems with this bill, and pro-choice advocates are absolutely right to focus on the more immediate implications.

Again, I am pleased that this legislation has received the attention it deserves, but I understand the concerns about focusing too much on the speculative.

Representative Katrina Jackson, apparently, wants to present herself as the victim of inaccurate reporting, and as I learned today, she’s using this as a way to completely deflect and ignore questions and concerns about the bill’s immediate impacts, which is shameful.

Today, I received a copy of correspondence between a Louisiana citizen and Representative Jackson. I have redacted the citizen’s name to protect her privacy. Here is their exchange, in its entirety:

On behalf of the New Orleans Abortion Fund, Inc. and the more than 12,000 Louisianans who obtain abortion care every year, I am writing to oppose House Bill 388, the so-called “Unsafe Abortion Protection Act.” 

This Act’s name could not be less appropriate. In fact, doctors who provide abortions are often unable to get hospital admitting privileges because the low rate of complications makes such arrangements unnecessary. According to the Louisiana Department of Health and Hospital’s own literature, “the risk of dying as a direct result of a legally-induced abortion is less than one in 100,000.” Contrast this with the risk of childbirth, which is ten times higher in the general population, and an appalling 22 times higher for African American women[1]! 

Furthermore, complications from an induced abortion are also extremely rare. Research has shown that only 2-3% of women who obtain medical abortions need any follow-up medical care at the clinic, their local doctor, or the hospital[2]. 

The doctors who provide abortions in Louisiana are skilled, patient-centered, and trusted community members. Only physicians who have completed or are enrolled in a residency in obstetrics/gynecology and family medicine can perform abortions in the state, which means providers are already some of the most skilled doctors in the medical profession. Additionally, these providers have “transfer agreements” with local hospitals where emergency room staff, hospital-based physicians, and on-call specialists provide the rare patient who suffers complications continuity of care.

If this bill passes, it will be at the expense of Louisiana women’s health. It will leave only two parishes with clinics and place onerous restrictions on respected doctors. I urge you and the Health and Welfare Committee to recognize that abortion services are too safe for this bill to be effective in its stated purpose, and rescind the bill.

Sincerely,

(Redacted)

[1] “Abortion and Pregnancy Risks.” Accessed February 25, 2014. 

http://www.dhh.louisiana.gov/index.cfm/page/915/n/275

[2] Curettage After Mifepristone-Induced Abortion: Frequency, Timing, and Indications. Obstetrics and