A group of women advocate for legal abortions in 1980. [Evening Standard/Getty Images, source]

Our medical students face different political atmospheres and laws that determine the legality and accessibility of abortion. This January, The University of Texas at San Antonio hosted a panel that included a local clinic staff member and two physicians that provide abortions in Texas. These professionals discussed their experiences in the US before abortion was legal and the current restrictions their practices face now that a restrictive law known as House Bill 2 has taken effect in Texas. The panel is a success for this MSFC chapter because it provided a context for understanding the effects the state’s legal changes are having on medical care.

What does abortion care look like under severe legal restriction?

In looking back on the US pre-Roe (1973), they recalled treating patients who, lacking other options, attempted self-induced abortions in response to unplanned pregnancies.

“Before Roe, the septic ward was where the abortion patients ended up. This is before renal dialysis…patients died of end organ failure a lot of time. They’d get massive pelvic infections, they’d become septic, they had kidney and liver failure and they died; they were young women…you’d ask how these things happened. There was the red rubber catheter, over the coat hanger, that was pushed up there…Lysol, I guess they would inject Lysol into the uterus, those were two very kind of popular things…We saw the septic ones; it was a pretty scary thing.”

“Before ‘73 we did terminations at the hospital…We did them because it was legal if it was to save the life of the mother. We had the psychiatry department rubber stamp those patients’ charts, that these patients were potentially suicidal…”

Things changed when abortion became legal in 1973.

“We really thought, when we opened the clinic, that maybe, maybe it would take a year. But that would be all, because doctors would incorporate [abortion] in their practice…To think, here we are 41 years later and that hasn’t happened…”

Abortion still hasn’t entered mainstream medicine education and practice. Politicians have been increasingly chipping away at women’s constitutional right to abortions by passing laws such as HB-2 in Texas that place unfair restrictions on abortion providers. What does abortion care look like under severe legal restriction?

One provider lost his partner in practice because he wasn’t able to get admitting privileges at a hospital. Another no longer feels comfortable prescribing medical abortions because patients are mandated to take the pill in front of him and are likely to abort on the way home if their drive is longer than 2 hours. All providers are affected by the changing reproductive health landscape in Texas, and all expressed worry that some other states are trying to follow suit.

“When a patient comes for an ultrasound…we have to follow a script.We have to say, ‘I am required to say this by Texas law’… My job isn’t to change her mind; my job as a physician is to provide safe, adequate care for that woman, and then here I am having to explain to this woman where the embryo or fetus is in its development, and if there’s a heartbeat…”“Here’s what is happening on the border now: women are getting Cytotec (misoprostol)… People are going to Mexico or finding it on the street…The problem is, a lot of women aren’t accurate in terms of how far along they are…if you are at 14 weeks and you think you are at 6, and you go and take Cytotec, that could be a huge problem… [Pharmacies can] give it to you but they don’t give you instructions.If you’re less than 9 weeks and you take Cytotec, the correct amount, you have about a 70% of aborting. If you do the whole regimen with Mifeprex (mifepristone), you have about 95% chance of aborting. So women are taking that chance.”

One speaker summarized the situation by reflecting that:

“If we’re going to say ‘It’s difficult to get an abortion’ I think we’ve got to be able to say, ‘But we’ve got the best family planning programs we can offer you,’ and that certainly isn’t what has happened in Texas.

This thought-provoking session reflects on practicing medicine in restricted settings that we see mirrored globally. What would a panel on local legislation regarding reproductive health look like in your country and your community? What can medical students do to facilitate safe and legal abortion provision around the world?