The Trump administration’s announcement that it will prohibit federal funding to any medical entity that provides or refers women for abortion care — the gag rule — is a straight-up attack on low-income women. And it is an attack on my obligation as a physician to give my patients unbiased advice on their health care options.
The gag rule, which the Department of Health and Human Services is now collecting public comment on, is little more than an extension of the Hyde amendment. The Hyde amendment bars Medicaid coverage for low-income women seeking abortion care.
Its author, Henry Hyde, said in 1977, "I certainly would like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle-class woman, or a poor woman. Unfortunately, the only vehicle available is the…Medicaid bill."
So, it’s all about punishing the poor women — the women who can least afford another child. Meanwhile, the government cuts back on social services including healthcare, childcare, education — all the financial help to encourage stable, thriving families.
Withholding information from patients who seek care at clinics and facilities that receive Medicaid or Title X funding creates a two-tiered system that prohibits poor women from receiving the same legally-required and medical-ethics driven concepts available to women of means: patient-centered, non-directional, options counseling and informed consent.
Prohibiting full disclosure of women's health-care options in publicly funded clinics would force clinicians to provide substandard care and treat patients differently based on their geography and finances.
As a physician, my obligation is to providing the information a person needs, to make an autonomous decision based on what is known, without withholding information, giving misinformation, or creating bias. That includes medically-accurate information on carrying a pregnancy to term, or terminating the pregnancy if the patient chooses.
Isn’t that what we all want? We want our health professionals to help us make decisions, not tell us what to do. So why is the Trump Administration telling low-income women what to do by withholding information?
The impact will inevitably be punishing poor women and their families, pushing them farther to the economic margins. A study published in the American Journal of Public Health in January 2018, as Reuters reports, found “Women who want an abortion but are denied one are more likely to spend years living in poverty than women who have abortions...Carrying an unwanted pregnancy to term quadrupled the odds that a new mother and her child would live below the federal poverty line.”
The 2012 turn away study from Advancing New Standards in Public Health found that not only were women denied an abortion more likely to be living in poverty, “women who were turned away were more than twice as likely to be a victim of domestic violence as those who were able to abort.”
There’s also a substantial health risk in forcing women to carry a pregnancy to term. Overall, any woman is about 14 times more likely to die in childbirth than from an abortion. And the risk of childbirth-related death skyrockets if she is African-American. Abortion is medical care. Where abortion is legal maternal mortality plummets and families are healthier.
One in five pregnancies ends by induced abortion in the United States. One in four American women will have an abortion. The typical patient is in her early to mid twenties, with one or more children, and about 70 percent are poor or near-poor. More white women have abortions than any other racial or ethnic group; the distribution of religious affiliation reflects America today, including a growing number who are not religiously-affiliated.
Women who seek abortion are not a marginal group of careless teens, selfish career women, or uneducated poor women. They reflect all American women. The alternative to abortion is forced childbirth — and a violation of a Constitutional right established in Roe v Wade.
The Trump administration’s gag rule rule is about controlling and punishing women — for being women. As a woman, as a physician who follows a code of patient-centered ethics, and as an abortion provider, it is an affront to all of us.
Sara Imershein M.D. MPH was a generalist OBGYN in Washington D.C. for more than 30 years. She works at two local women’s health clinics, teaches OBGYN residents, medical and public health students and fights for women’s health and access. She is the vice chair of the D.C. section for the American College of Obstetricians & Gynecologists, Associate Clinical Professor of OBGYN at The George Washington University School of Medicine and serves on the Board of NARAL ProChoice America Foundation.