OB-GYNs say abortion ban will keep much-needed maternal fetal specialists away

By: - February 21, 2022 5:40 am
A side view of a pregnant woman holding her belly

There are just seven maternal fetal specialists practicing in New Hampshire. (Oscar Wong | Getty Images)

Reproductive choice advocates are sounding the alarm, predicting the state’s 24-week abortion ban is a first step toward something more restrictive, even as restrictive as Texas’ six-week ban. Those in reproductive medicine see a much more immediate threat: a challenge recruiting maternal fetal medicine specialists to a state that can imprison them for up to seven years and fine them as much as $100,000 if they perform an abortion after 24 weeks, even in cases of rape, incest, or when the baby will not survive outside the womb.

There are just seven maternal fetal specialists practicing in New Hampshire now, two of them part time, and four are expected to retire in the next two years, according to Dr. Barry Smith, who recruited most of them during his many years as chair of Dartmouth-Hitchcock’s OB-GYN unit.

Late-in-pregnancy abortions are a small part of their work, and they are done only in dire circumstances, not for a change of heart. Also at stake, Smith said, is the specialists’ expertise, which OB-GYNs here and across New England rely on for complicated pregnancies and deliveries.

“I cannot believe anyone in their right mind would come under the gun that they put in this new law because the toughest part of their life is to make these timely decisions,” Smith said. “And I’m afraid that it’s going to destroy the system’s ability to provide the best health care.”

Dr. Oge Young, a retired OB-GYN who practiced in New Hampshire for many years, counted on that expertise. “I look at that time when I chose to come to Concord,” he said. “It was nice to know I could call a fetal medicine specialist and have good backup and refer couples to.”

Young, who has urged lawmakers to repeal the ban, said he doesn’t think they understand its true impact.

“They need to clearly know what this law is not going to do,” he said. “It’s not going to prevent abortions of normal pregnancy after 24 weeks. We never had a law and never had to have a law to prevent that because nobody is doing that.”

It looks unlikely the law’s criminal penalties are going anywhere this legislative session. 

Bills seeking to repeal the law have been rewritten to instead scale back and clarify when an ultrasound must be done. And, an attempt to leave the law in place but remove the criminal penalties failed in the Senate this month in a party-line vote. 

New Hampshire is not alone in putting criminal or civil penalties in its abortion law. No state or national public health or abortion access group could provide a list of states that do, but some examples include California, Texas, and Alabama. 

That list, however, does not include New York and Massachusetts, which Gov. Chris Sununu and other supporters of the ban have pointed to as examples of “liberal” states that have adopted abortion bans similar to New Hampshire’s. Both, however, have dropped their criminal penalties, as did New Mexico.

During testimony this session, OB-GYNs and other maternal medicine practitioners have echoed Smith’s concerns about recruitment challenges criminal penalties will create. 

The Geisel School of Medicine at Dartmouth graduates about 90 students a year, 10 percent to 15 percent of whom go into obstetrics and gynecology, Dr. Ilana Cass, chair of the OB-GYN medical department at Dartmouth-Hitchcock Medical Center, told a Senate committee recently. That’s a first step toward subspecialties like maternal fetal medicine and neonatology. 

About half of those OB-GYN graduates seek residency at Dartmouth. That connection increases the chance they’ll remain in New Hampshire – a bit. Between the higher salaries paid in Boston and the rural nature of the state, Smith and Cass said recruiting often takes more, such as a spouse transferring here for a job or a personal connection to the area. 

The abortion law’s criminal penalties combined with its lack of most exemptions, especially for fatal fetal anomalies, will be a “fairly significant”deterrent to that recruiting effort, Cass said. That’s especially true, Smith said, because nearby alternatives like Maine, Vermont, and Massachusetts don’t have criminal penalties. 

The law “imperils lives and access to excellent health care that New Hampshire women and families deserve,” Cass said. “This will steadily erode high-quality health care in New Hampshire by deterring the brightest from coming to New Hampshire.”

Cass cited the existing shortage of OB-GYNs in the state and the closure of nearly 10 labor and delivery units in hospitals across the state in as many years. 

“If you then put some of those providers in jail or start to limit the way that they practice medicine, I fear we … will actually be able to have fewer and fewer OB-GYN doctors practicing in the state, thereby further limiting the access and compounding the problem,” she said.  

That’s even more a concern, Smith said, given the Executive Council’s repeated votes last year to defund the state’s three largest providers of reproductive health care for low-income, uninsured, and underinsured Granite Staters. Providers say later pregnancy complications occur more often for women who do not have access to reproductive health care early on.

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Annmarie Timmins
Annmarie Timmins

Senior reporter Annmarie Timmins is a New Hampshire native who covered state government, courts, and social justice issues for the Concord Monitor for 25 years. During her time with the Monitor, she won a Nieman Fellowship to study journalism and mental health courts at Harvard for a year. She has taught journalism at the University of New Hampshire and writing at the Nackey S. Loeb School of Communications.