An Open Letter To The 83rd Texas Legislature

Dear Texas Legislature,

It is my understanding, based on recent statements of yours, that you are concerned about the health of women, and this concern has led you to propose legislation which imposes new regulations on physicians who perform induced abortions and the facilities in which they are performed. In order to better protect the health and safety of women, there are numerous other regulations which should be imposed, not on induced abortions, but on many aspects of the entire pregnancy. Most importantly, no pregnant woman should be allowed to live more than thirty miles away from an ambulatory surgical center.

This may, to some, appear rather draconian; what could possibly justify that a woman be forced to either abandon her family for the duration of her pregnancy or uproot the family and move to a temporary location far away from their home? Do women, or entire families for that matter, not possess the right to choose their own home? These are, perhaps, legitimate questions; however, it is a simple logical consequence of your proposed new abortion regulations that pregnant women must relocate, and if you are sincere in your stated concern for the health and safety of women, I urge you to act with utmost haste to enact these regulations on pregnant women.

I should perhaps explain why these regulations are, in light of your concern for the health and safety of women, so urgently necessary.

The Texas Statutes, Health and Safety Code (hereafter “H&SC”), Chapter 244 (“Birthing Centers”) states (244.002(1)) that the term “Birthing Center” does not include the residence of the woman giving birth; a woman is, evidently, free to give birth in her own home, either by herself or with the assistance of others.

I have gathered here, for easy comparision, a few of the existing and proposed regulations regarding abortion.

• H&SC 171.003 states “An abortion may be performed only by a physician licensed to practice medicine in this state.”
• Texas House Bill 2 of the 83rd Texas Legislature Special Session (hereafter “HB2”) would require, among other things, that “a physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced” (proposed 171.0031).
• HB2 would require that an “abortion facility”, including the office of a licensed physician^[1], satisfy “the minimum standards adopted under Section 243.010 for ambulatory surgical centers.”

It may be tempting to think that, because an induced abortion is a medical procedure, it is more dangerous than a live birth, a natural process, and therefore additional regulations are required in the interests of the safety of the woman. However, not only is that false, but the opposite is true, and quite dramatically: live birth is fourteen times more likely to kill the mother than is an induced abortion (8.8 deaths per 100000 live births, 0.6 deaths per 100000 abortions); these data are from a study published in 2012, in the very reputable peer-reviewed journal “Obstetrics & Gynecology”. (See reference [RG2012], below, for how to find the published study, should you wish to read it for yourselves.)

As Figure 1 in that same study shows, every potential complication of induced abortion or live birth occurs at a lower rate from induced abortions than from live birth; in other words, live birth is, in every possible manner, more likely than induced abortion to cause death. Furthermore, as the same figure shows, the complications from abortion requiring immediate care — those involving hemorrhage — are almost vanishingly small, both relative to live birth and as risk factors inherent to induced abortions; in other words, induced abortion almost never requires emergency care, and certainly much less than live birth.

If the almost vanishingly small risk associated with immediately life-threatening complications of induced abortion justify that they be performed not merely within thirty miles of a hospital, but by a physician with active admitting privileges to such a hospital, and in a facility that satisfies the requirements of an ambulatory surgical center, then, surely, the very significant risk of those same complications during a live birth would justify that the birthing occur under the same, if not stricter, regulations.

However, merely regulating birthing facilities is not sufficient. Indeed, there is a significant chance of spontaneous abortion (also known as a “miscarriage”) at any time during pregnancy, and there are various other complications, some life-threatening, that can occur during pregnancy. Simply put, pregnancy and childbirth are significantly riskier than induced abortion.

Please, in the interests of the health and safety of the women of Texas, I implore you to pass, as soon as possible, a law forbidding pregnant women from living more than thirty miles from a hospital. Please!

Sincerely,

The Canadian Curmudgeon

p.s. I commend you on your passage, during the regular session, of HB308, which specifies precisely three winter-holiday greetings that students and staff are allowed to use (“Merry Christmas”, “Happy Hanukkah”, and “happy holidays”), simultaneously restricting the freedom of speech^[2] and establishing a religion. That's an impressive piece of legislation — I'm not aware of any other legislation that violates the First Amendment to the United States Constitution two different ways in one sentence.

Bibliography
• [RG2012] The study, available freely online, is Raymond, Elizabeth G. MD, MPH; Grimes, David A. MD. “The Comparative Safety of Legal Induced Abortion and Childbirth in the United States,” Obstetrics & Gynecology Vol. 119 Issue 2, Part 1, February 2012, pp. 215-219. doi: 10.1097/AOG.0b013e31823fe923

Notes
1. ^The statute H&SC 245 is a bit unclear on this matter, as it contains two different versions of section 245.004, “Exemptions From Licensing Requirement”.
2. ^The text of the legislation says “including: (1) "Merry Christmas"; (2) "Happy Hanukkah"; and (3) "happy holidays."”. Note it says “including”, not “including but not limited to”. This can be interpreted as an explicit exhaustive list; see ejusdem generis and inclusio unius est exclusio alterius, though I should note that I am not a lawyer and this is not legal advice.