Commentary: Reproductive freedom is under attack in New Hampshire

January 13, 2022 5:48 am
A sign reading "Abortion is Freedom" at night outside the U.S. Supreme Court

Abortion rights activists from UltraViolet organize a light brigade outside the U.S. Supreme Court on Nov. 30, 2021, in Washington, D.C. (Chip Somodevilla | Getty Images)

As a New Hampshire resident and a specialist in reproductive health, it is shocking and unsettling to watch unprecedented attacks on access to family planning and abortion care play out in our state.

My unique and privileged position allows me to care for patients through life-changing medical events. Many experience happy, fulfilling, and joyful outcomes through pregnancy and childbirth. Others, less frequently discussed in public, experience life-shattering medical diagnoses, tragic and unimaginable social circumstances, and other factors leading to impossible choices for the health of themselves and their families.

On Jan. 1, a new state law took effect that limits options for the families I work with and criminalizes doctors like me, who work every day to provide the best care possible. An abortion ban was written into the state budget at the last minute, and it has an immediate chilling effect on the delivery of reproductive health care in our state.

The law bans all abortion after 24 weeks gestation, a procedure which is rare. Only 1.3 percent of abortions are performed at 21 weeks or later. However, there are several reasons why pregnant patients may seek abortion later in pregnancy, including poor access to care, socioeconomic circumstances, and most commonly fetal diagnoses later in pregnancy, which often cannot be detected at or before the routine screening ultrasound around 20 weeks.

While medicine has undergone many advances, even in 2022 we aren’t able to fix every problem. There are medical conditions that have no cure, and those that would doom an infant to pain and suffering without hope of meaningful existence by our most basic standards. In addition, some pregnancy-related conditions threaten a patient’s health so significantly that it may be safer to end the pregnancy than to risk the life of both. These situations are thankfully rare, but when they do happen, individual families should be able to decide the best course of action without government interference.

Politicians should not require a doctor to wait for a fetal or maternal medical condition to worsen and become life-threatening before being able to provide evidence-based care to their patients, including abortion. While this ban may not affect many patients or providers, undoubtedly its effect on those patients with exceedingly complex circumstances is likely to be devastating. Due to the way our health system functions, this law will also disproportionately affect patients who do not have the means to travel out of state or pay tens of thousands of dollars for a procedure.

Further, New Hampshire’s abortion ban mandates every person seeking abortion care – at every stage of pregnancy – have an ultrasound, regardless of whether or not it is medically necessary. In the age of COVID-19 and a statewide pull on resources, requiring this medically unnecessary procedure will make it even more challenging for other patients to schedule their medically indicated ultrasounds. At early stages of pregnancy, a transvaginal ultrasound is often required, which is an invasive experience. For survivors of sexual assault, this unnecessary procedure could be traumatizing. Before this law, providers could work with our patients to determine the best health care plan; this law erases our expertise and flexibility.

There is no medical necessity for New Hampshire’s abortion ban and ultrasound mandate, and it pains me to see medical decisions taken out of the hands of health care professionals and most importantly out of the hands of the patients whose lives they affect. Rather than dictating care for patients in impossible situations, we as a state should be focused on improving access to health care for all New Hampshire residents, funding basic medical care for low-income residents, including family planning counseling, cancer screening, and early pregnancy detection.

While the writers of this law clearly want to restrict access to abortion, its unintended repercussions advertise to the country that New Hampshire is not a friendly environment for reproductive health care providers. New Hampshire faces a dire shortage of primary care doctors. The American Congress of Obstetricians and Gynecologists (ACOG) projects a national shortfall of obstetricians and gynecologists (OB-GYNs) of up to 22,000 by 2050. What better way to discourage the next generation of providers from coming to New Hampshire than threatening to charge them with a felony for providing evidence-based care? This will negatively impact all Granite State women: your daughters, sisters, mothers, and friends who seek out care for everyday health issues, pregnancy, and gynecologic care.

As a physician and as a woman, I feel strongly that all patients should be able to make their own personal, private health care decisions without politicians standing in the way, no matter where we live. New Hampshire’s abortion ban and ultrasound mandate threatens the reproductive freedom of us all; every lawmaker should be working expediently to repeal this cruel statute.

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Maris Toland
Maris Toland

Maris Toland is a resident physician in obstetrics and gynecology. She lives in the Upper Valley.