Valley News – New Hampshire abortion limits and funding have side effects for the healthcare system
LEBANON – As this summer’s national debate focused on the controversial restrictions on abortion in Texas, Republicans in New Hampshire have also worked to tighten access to abortion in Granite State.
Upper Valley healthcare providers said the findings would likely create barriers to healthcare for low-income women and interfere with complex medical decision-making that would be best left to doctors and doctors. patients.
“(It) is changing access to quality health care for the entire state of New Hampshire,” said Dr. Ilana Cass, chair of the Department of Obstetrics and Gynecology at Dartmouth-Hitchcock Medical Center.
Last Wednesday, the state’s five-member Executive Council, which has final say on most state contracts, rejected a six-month extension of agreements with seven family planning clinics statewide, including the Planned Parenthood clinic in Claremont. The money would have funded services, including birth control and sexually transmitted infection and cancer screening for thousands of low-income residents, according to information provided by state health officials to executive advisers before the vote. By law, state funds cannot go to abortion services.
The four Republican advisers who rejected the contracts have expressed fears that the funds will mix with other income from clinics used to support abortion, despite a recent state audit that found the clinics are separating. family planning and abortion funds.
The Planned Parenthood clinic in Claremont affected by the decision does not perform abortion.
Outside of DHMC, Upper Valley women seeking abortions can visit the White River Junction Planned Parenthood Clinic. This clinic offers medication or in-clinic abortions for up to 11 weeks and six days of gestation.
Randolph’s Gifford Medical Center, the only hospital other than DHMC in the upper valley still delivering babies, does not perform abortion.
Dr Pat Glowa, a semi-retired family doctor from Dartmouth-Hitchcock, said the rejection of contracts combined with a ban on abortions after 24 weeks’ gestation that goes into effect on January 1 will have a “significant impact on health. public. “
The contracts aim to make reproductive health care accessible and affordable, even for low-income people, Glowa said. They also aim to ensure that clinics have the capacity to meet the needs of patients. For example, Planned Parenthood’s reward amount for the six-month period would have been $ 238,464, or approximately $ 47,693 for each of the organization’s Granite State health centers, according to a press release.
“What do you do if you can’t get an appointment because the center is overcrowded?” Glowa said.
The ban on abortions after 24 weeks was particularly troubling for Cass of the DHMC, who said such procedures are “extremely rare” and are sought after by patients under difficult circumstances.
Such procedures are only needed when the health of the mother is threatened, the fetus will not survive on its own, or when a woman is a victim of rape or incest, she said. The new law includes an exception to the 24-week ban if the life or health of the mother is threatened, but not for a fetal abnormality, rape or incest.
Cass estimates that in the past 15 years, only 10 patients have sought to terminate a pregnancy after 24 weeks gestation at Dartmouth-Hitchcock Medical Center.
Cass and Glowa both said the law sets a troubling precedent for healthcare in the state that could discourage providers from coming to New Hampshire for training or practice.
“The search for a late abortion for a fatal fetal defect usually stems from compassion for the prevention of inevitable suffering and ultimately the death of an affected fetus,” Glowa said. “These are not fortuitous decisions. They are not made lightly.
After Jan. 1, those patients, except those whose life or health is threatened by continued pregnancy, will have to seek an abortion outside of New Hampshire, Cass said. Her department will likely refer women to university medical centers in neighboring Vermont and Massachusetts.
The law also requires health care providers to perform ultrasounds to determine the gestational age of a fetus before any abortion, which Cass says is not always necessary.
For example, an ultrasound may not be necessary to determine the age of a fetus when a woman seeking an abortion is very sure of her last normal menstrual cycle, has very regular cycles, and is in early pregnancy, has she declared.
“A politician has no place to question this literature, this experience and these best practices,” Cass said.
If doctors do not comply with the new law, they face a prison sentence of up to seven years and a fine of up to $ 100,000. The law also allows the husband of a patient who has an abortion after 24 weeks and the parents of a patient under 18 who has an abortion after 24 weeks to take legal action for “appropriate redress”. , including pecuniary damages for psychological and physical injuries resulting from the Abortion.
“When you have crime penalties… it has a huge chilling effect on people’s ability to put their skills and knowledge into practice,” Glowa said.
Cass said she was concerned this would criminalize elements of best practice as determined by medical organizations and believes lawmakers have overstepped their bounds in dictating how doctors deliver care.
“It’s absolutely not in their training,” Cass said. “It’s a philosophical gateway to something that’s a science fiction novel.”
New Hampshire has already seen a consolidation in obstetric and gynecological care in recent years, with maternity wards in most small hospitals having closed due to costs exceeding revenues and difficulties in finding providers.
Cass said she was concerned the new law and penalties for violation would discourage obstetricians from coming or staying in New Hampshire.
The Executive Board on Wednesday approved contract extensions for four other family planning service providers – none of which are in the Upper Valley – who do not provide abortion care.
Gov. Chris Sununu, a Republican, who signed the 24-week abortion ban this summer, expressed disappointment during the Executive Council vote last week on clinic contracts.
Meanwhile, Sununu, who maintains the 24-week ban, expressed willingness to revisit the issue of the ultrasound requirement in an interview with NHPR last week.
“If they’re too onerous or don’t make sense, then absolutely, I’m always willing to go back and consider changing that, and I think we will in the next couple of months. Sununu told NHPR.
A Sununu spokesperson told the New Hampshire Bulletin this month that as a supporter of abortion rights, he would not sign a bill like the one in Texas.
About 2,200 abortions were performed in New Hampshire in 2017, the most recent year for which data was available from the Guttmacher Institute, a New York-based nonprofit abortion policy group. There was a 12% drop in the abortion rate in New Hampshire from 2014 to 2017, from 10.4 to 9.2 abortions per 1,000 women of reproductive age, according to the institute.
Vermont, where 1,300 abortions were performed in 2017, saw its abortion rate drop 5% between 2014 and 2017.
Supporters of abortion rights in Vermont are moving forward with Proposition 5, also known as the Reproductive Freedom Amendment, which would enshrine abortion rights in the Vermont constitution.
After the initial adoption by the Senate and the House in 2019, Proposition 5 was again adopted by a freshly elected Senate earlier this year. If passed by the House in the next session which is due to begin in January, it will go to a ballot in November 2022 for voters to approve, VTDigger reported this month.
In New Hampshire, abortion is already somewhat restricted. The state requires patients under the age of 18 to obtain parental permission for an abortion, Glowa said. Additionally, New Hampshire Medicaid does not cover abortions.
Those “most strapped for cash have to pay out of pocket for an abortion in New Hampshire,” she said.
Cass warned that it might be difficult to quantify the broader effects the new restrictions could have on patients and their health, as it will be difficult to account for those who choose not to seek treatment.
“It will be one more obstacle,” she said. “One more stone on their way to exercise their right. “
You can reach Nora Doyle-Burr at [email protected] or 603-727-3213.