Dr. Suzanne Poppema's blog

The Real Victims of Stupak-Pitts

2009-11-20T07:00:00-05:00

When I heard about the Stupak/Pitts amendment, I was in a room with 15 other doctors who shared my anger and disappointment. We had gathered for a board meeting for Physicians for Reproductive Choice and Health, and we were horrified by the cruelty the amendment has in store for our patients.

In examining rooms, we see women in terrible pain, but their suffering doesn’t count in Stupak/Pitts world. By banishing abortion from the reform bill, the amendment punishes women who need to end unwanted or unhealthy pregnancies.

We share the stories below and on our website to show what can happen to women physically, financially, and emotionally when they don’t have insurance coverage for abortion. As physicians, we try our best to help these women. As advocates, we will fight to protect their access to abortion.

From Nancy Stanwood, MD, MPH:

My patient Carol was excited to give birth to her first child. Her husband was a Marine serving in Afghanistan. Sadly, in her second trimester, Carol learned that her baby had a lethal anomaly. She and her husband made the difficult decision to have an abortion.

That’s when they learned that the military health insurance they relied on wouldn’t cover the abortion unless Carol’s life was in danger.

Her husband was outraged. He had just flown back from Afghanistan to be with her, and he angrily asked me, “I’m over there defending my country, and they won’t even take care of my family?”

From Natalie Roche, MD:

Renee was 18 years old and in prenatal care for a pregnancy she wanted. Her physician found that she had an elevated white blood count. Renee was diagnosed with acute leukemia.

Her oncologist could not begin treatment. The chemotherapy Renee needed came with a risk of miscarriage that could cause fatal hemorrhaging or infection. She decided to have an abortion to save her life.

But Renee did not have insurance. It took time for her to find a doctor who could perform her abortion. The time she spent searching for a provider she could afford endangered her health. She developed anemia and dangerously low white blood cell and platelet counts. She also entered the second trimester of her pregnancy, making her abortion riskier.

I performed her abortion successfully, and Renee went on to have her treatment for leukemia. I do not know if it was too late.

From Willie Parker, MD, MPH:

A woman who was 16 weeks pregnant and had an alcohol problem came to me for an abortion. She knew that she was not ready to be a mother. But she had a condition with her placenta that made abortion risky, and I had to tell her that the procedure would require a hospital stay, making it much more expensive.

She didn’t have insurance or enough money to cover the termination. She had no choice but to continue the pregnancy. I got her into prenatal care. That was the best I could do.

From Pratima Gupta, MD, MPH:

I wasn’t able to help Anna. She became pregnant unexpectedly and decided to have an abortion. But when I started the paperwork for Anna’s procedure, her insurance coverage was denied. Anna works for the postal service, and as a government employee, she is not allowed to have health insurance coverage for abortion.

I had to tell Anna that I couldn’t provide her abortion, and I gave her the phone numbers of some clinics that could help. In the end, Anna had to borrow money from several friends to pay for her abortion. I will never forget how frightened and frantic she was to learn that her good government health insurance didn’t cover the care she needed.

From Renee E. Mestad, MD:

My patient Sherry is 24, pregnant, and the mother of a 7-month-old son. Although her pregnancy was not planned, Sherry and her husband were initially excited to have a little brother or sister for their boy. Then Sherry’s early ultrasound showed she had twins. She and her husband spent several weeks eagerly anticipating the growth of their family.

But the next ultrasound showed that the twins are conjoined, or Siamese. The babies are joined at the head, sharing a brain, and chest, sharing a heart. They have two spines, four arms, and four legs. It would be impossible to separate them. If they survive after birth, it would only be for a few minutes. One heart can’t keep two bodies alive. The risk of stillbirth is also very high.

Now 19 weeks into her pregnancy, Sherry tells me she is depressed. She wakes up every morning wondering if today will be the day her babies will die inside her. How would she deliver them? She knows that she would probably need a cesarean section because their combined size might make them too large for the birth canal. Sherry then imagines carrying the twins for another four and a half months. She sees herself delivering stillborns or watching her babies die minutes after their birth.

Sherry must decide whether to continue her pregnancy. An abortion might give her and her husband some emotional relief. And if the twins are small enough, she might not need surgery to remove them.

But because Sherry’s insurance will not pay for her abortion, she has to worry about money on top of her other fears. She is on Medicaid, which will cover the twins’ delivery, alive or dead, but not an abortion—fetal abnormality isn’t enough to get around the Hyde amendment. Although the abortion would be less expensive in a clinic, Sherry would have to go to a hospital since she could need surgery. She would be responsible for the entire bill of at least $10,000 to cover the operating room, anesthesia, medication, and other fees. This expense would destroy her family’s financial well-being.

Sherry can carry her babies to term who cannot and will not live, or she can have an abortion and possibly bankrupt her family.

Sherry’s pregnancy is medically rare, but her dilemma about money is all too familiar. When a woman doesn’t have insurance coverage for abortion, she and her family suffer.

Save the Endangered Abortion Provider!

2009-03-10T09:00:00-04:00

In the 1990s, I ran an abortion clinic near Seattle, Washington. A most rewarding career - in all my years as a physician, I've never had so many patients thank me for helping them. But at the same time, I worried that I belonged to an endangered species.

Like the spotted owl, our habitats were being invaded and destroyed - not by loggers but by anti-choice protestors. These were the years of virulent anti-abortion activity, when my colleagues faced arson and acid attacks all too often. One doctor told me about a day when he performed an abortion as members of Operation Rescue battered down the clinic doors with a telephone pole. When he finished the procedure, his terrified patient got up, hugged him so tight he could barely move, and said, "You can't leave us now."

Those of us providing abortions in the 1990s were determined to stay with our patients. But like an endangered species, we were restricted to such a small habitat that we could not expand our numbers. Medical schools and residencies often failed to teach physicians-in-training about abortion or made it near impossible for residents to train at an outside clinic. Meanwhile, the provider population was getting older. Many doctors continued working past retirement age so their patients wouldn't have to travel hundreds of miles to get an abortion.

The threats abortion providers faced in the 1990s did have one benefit: they rallied the provider community to preserve this endangered - but highly valued - species of physicians. We formed new organizations, like Physicians for Reproductive Choice and Health and Medical Students for Choice, that were dedicated to training the next generation of providers and reducing the stigma around abortion. In 1996, March 10 was declared a National Day of Appreciation for Abortion Providers. We're still waiting for Hallmark to make us a special line of greeting cards, but the very existence of a day honoring abortion providers is a step in the right direction.

The threats to abortion providers have changed since the 1990s. Violent attacks, thankfully, have diminished. Our pro-choice president is quietly reversing some of the most egregious policies of the Bush administration, including a midnight regulation allowing a broad range of medical workers to refuse to provide reproductive healthcare.

But abortion providers aren't off the endangered species list yet. Even as federal policies improve, many states are doing their best to limit abortion. The latest anti-choice gambit requires doctors to provide an ultrasound - and often play a fetal heartbeat - for any woman who wants an abortion. As if she hasn't already thought hard enough about her decision! I treated thousands of women at my clinic, and not a single one took her choice lightly.

While we try to fend off state legislatures, we also watch out for the Supreme Court, which is just one vote away from overturning Roe v. Wade. The most conservative justices are likely to remain on the Court for decades. And too few medical schools and residency programs offer training in abortion, especially for specialties like family medicine. Even doctors who identify as pro-choice aren't always willing to offer abortion services.

Want to help save the endangered abortion provider? Here are three things you can do today. If you know a doctor who provides abortions, thank them for what they do. Call or write to your elected officials and ask them to consult with an abortion provider before voting on any abortion-related legislation. Too often, bills are passed without input from the very people they affect most. Finally, if you've had an abortion, tell someone about it. One in three women will have an abortion by age 45, yet it remains a taboo topic. The more we can talk openly and honestly about women's abortion experiences, the more we can reduce the stigma around this procedure.

In Memory of Richard Hausknecht, MD

2008-11-01T09:00:00-04:00

On Sunday, the reproductive health community lost Dr. Richard Hausknecht, a pioneer in medication abortion, a founder of New York City's first abortion clinic, and a longtime advocate for women's reproductive health. He died of lung cancer.

With an M.D. from Tufts, Dr. Hausknecht became a resident at Yale before Roe v. Wade. Treating women who had been injured by illegal abortions compelled him to start advocating for reproductive rights and searching for ways to make abortion safer. He never stopped. "Abortion is stuck in a corner," he said later. "It should always be a part of general reproductive healthcare."

When New York State legalized abortion in 1970, he helped open the first abortion clinic in New York City, seeing patients who had traveled from around the country to have abortions. He also conducted pioneering research on the safety and efficacy of methotrexate-misoprostol for medication abortion, eventually serving as the medical director of Danco, the company that succeeded in bringing mifepristone to the U.S.

Over his five-decade career, he dedicated a great deal of time to training other doctors in techniques for both surgical and medication abortion. He maintained a private practice in New York City until joining Danco. He held academic positions at Yale, Columbia, Mount Sinai, and the Albany School of Medicine. He also served as a fellow in the American College of Obstetricians and Gynecologists and on the Medical Advisory Board of Planned Parenthood of New York City.

I knew Dr. Hauknecht as a founding board member of Physicians for Reproductive Choice and Health. In his eight years on the board, he helped build the organization, bringing his burning intelligence and passion to every project. Dr. Hausknecht did not suffer fools gladly, and his wit was sharp. I am sad to lose such a wonderful friend and colleague. He will be sorely missed.

Women's Health Exception in South Dakota Ban Not Enough to Protect Women

2008-10-21T08:00:00-04:00

Ever since Wednesday night's presidential debate, many Americans have been talking about what "women's health" really means. Nowhere is this issue more relevant than in South Dakota, where voters are poised to decide on a comprehensive ban on abortion. Initiated Measure 11 would ban most abortions, with narrow exceptions for rape, incest, and "serious risk of a substantial and irreversible impairment of the functioning of a major bodily organ or system of the pregnant woman." That's how South Dakota would define "women's health" if the initiative passes.

In August, I spoke out on behalf of the many doctors in South Dakota who, like myself, have devoted their lives to protecting women's health. They are concerned that the language used in this initiative would put women at risk. Doctors in South Dakota--and around this country--have all seen patients whose health was affected by pregnancy. As a family physician who ran an abortion clinic for many years, I've often seen women whose diabetes and heart disease were worsened by pregnancy. Many of them were mothers who chose to end their pregnancies so they could care for the families they already had. Every woman I treated made the decision to have an abortion thoughtfully and carefully, and thanked me for being there in a time of great need.

Proponents of Initiated Measure 11 argue that the health exception protects women's well-being. However, "substantial and irreversible harm" is hardly a black-and-white issue. Imagine a woman, recently diagnosed with cancer, who cannot begin chemotherapy while she is pregnant. Would she be forced to continue her pregnancy to term regardless of the risks? Who decides? If medical experts cannot agree on the precise risk to a woman's health, they may opt not to act at all rather than risk criminal penalties. As Dr. Marvin Beuhner, an obstetrician/gynecologist in Rapid City, told me: "We physicians [would be] left in the untenable position of trying to make a medical decision with our attorneys rather than our patients. The threat of a felony is truly frightening."

Just how murky the language in Initiated Measure 11 is became clear earlier this week, when a memo from Sanford Health (a hospital in South Dakota) was leaked to the media. In the memo, the hospital's lawyers state that the law is unclear, and could have "substantial legal implications." The end result is that, if passed, this law would tie doctors' hands and force them to watch as their patients' conditions worsen. As a physician, I can only imagine the needless suffering women in South Dakota would be forced to endure.

Beyond the risks to individual women, eliminating "women's health" in abortion regulations would undermine the doctor-patient relationship. Women rely on their physicians to give them complete and accurate information about their health, and to help them decide on the right medical treatment. Imagine your doctor saying, "Your heart disease is getting worse. I know a treatment that will cure you, but I can't provide it because our state believes you don't really need it." Women and men would be up in arms!

This isn't just an issue in South Dakota. We all need to be concerned about how women's health is defined in--or left out of--regulations that govern healthcare. Once a cornerstone of Roe v. Wade, protections for women's health were deliberately left out of the federal abortion ban-legislation upheld by the Supreme Court in 2007. We can no longer count on the courts to protect women's health.

When Roe was decided, women across America were dying from unsafe, illegal abortions. Women's health was essential to the ruling precisely because the risks of illegal abortion were so apparent. Thirty-five years later, we are fighting to protect the right of women to receive the medical care they need, and the right of doctors to provide it. I only hope we never go back to the days when the risk to women's health is visible in hospital wards everywhere.

Four Abortion Myths Dispelled

2008-01-11T09:04:00-05:00

For many years, I was an abortion provider. I owned and ran a clinic near Seattle, Washington, where I provided a range of reproductive healthcare-including abortions-to women, and I've remained active in organizations that support abortion providers across the United States. Over the years, I've heard many myths about abortion that are as pervasive as they are false. Four myths in particular never seem to go away, though any doctor who provides abortions can tell you they just aren't true.

Myth No. 1: Women need waiting periods so they can be sure they really want an abortion.

As if women haven't been agonizing about what they're going to do from the moment they missed their period! As if a woman who happens to be on her way to the grocery store drives past an abortion clinic and says to herself, "Hmm, I think I'll just pop over there and have one!" When a woman visits an abortion clinic, she has already thought long and hard about her decision. Mandatory delays just make it harder for a woman to get an abortion, especially if she needs to take two days off work for an initial appointment and then her procedure.

Myth No. 2: Women use abortion as a method of birth control.

I hear this one so frequently and yet in decades of providing abortion services to more than 30,000 women, I met only two women who used abortion as a birth control method. And they were absolutely right to do so. These two women experienced blood clots while on birth control pills, ectopic pregnancies with the IUD, and they were allergic to latex condoms and spermicide. Using the rhythm method with abortion as backup was the best method for them. I've never met a woman who cavalierly chose abortion as her method of birth control.

Myth No. 3: One abortion is okay, but three or four?

No woman thinks having an abortion is so much fun that she gets pregnant just to have one. The difference between the women who have unintended pregnancies and those who don't is pure luck-not age, education, social status, or intelligence. When women told me they were so ashamed of returning to my clinic for another abortion, I would ask them if they got pregnant on purpose just to have an abortion. It made them laugh, but really, that's the only reason for a woman to feel guilty. Abortion providers do our best to offer a very respectful and comfortable abortion, but they're not anyone's idea of fun.

Myth No. 4: Only irresponsible women need abortions.

We all behave irresponsibly at times. Have you ever driven without a seatbelt on, even for a short distance? Driven after drinking alcohol-even just a little? Smoked a cigarette? Not taken all of the antibiotics your doctor prescribed? These are all irresponsible behaviors, yet most of us have been guilty of at least one. Having unprotected sex is irresponsible, too, but a woman who decides that she is not prepared to be a good mother is behaving responsibly.

Until we have a foolproof, easy-to-use form of birth control-in my opinion, that would be a pill, paid for by insurance, taken only once a year, with absolutely no side effects or adverse reactions, and absolutely no failures -- then we cannot condemn women for having unintended pregnancies