The Risks of a New Norm

An Arizona doctor explains why non-surgical abortion is important to women—and what will happen if they can’t access it.

Just weeks ago, the Center filed suit against Arizona because of a new law that we believe will deny women the many advantages of having a safe non-surgical, or medication, abortion early in a pregnancy. The law prohibits the practical administration of the medication that has gained nearly unanimous acceptance and application by doctors across the nation. That practice has become so widely used because of an enormous amount of evidence to its safety and effectiveness.

We’re representing an OB/GYN in the case who has been serving Arizona women for decades. [He has asked to remain anonymous.] He provides the full range of reproductive health care for women, prescribing contraception, delivering babies, offering abortions, and much more. We asked him to explain what’s at stake with this lawsuit—why non-surgical abortion is a fundamental component of delivering safe, high-quality abortion care.

Before we could even begin an interview, the doctor asked us to google “abortion pill online.” What appeared on the screen was a blitz of ads and offers and links to the medications used in a non-surgical abortion. All could be had without a doctor’s supervision. One ad was from an online veterinary products company. His concerns became immediately apparent.

Q: How did you come to start providing abortion care? Why did you feel it was important?

A: The way it started was that during my residency, there was a patient who came in in the middle of the night. She was hemorrhaging blood because of a spontaneous abortion (a miscarriage). No one in the hospital could complete the abortion safely to save her life except for one doctor. I approached the physician who had those skills because I wanted to be more proficient. I just want to be able to address that situation if it comes up again.

When I moved to Arizona, I realized that because it was so conservative, there were few physicians who knew how to provide abortion care here. The office that hired me had the necessary equipment to do abortions. And I had some patients who became pregnant but didn’t want to go through with it. So I performed abortions for them early in their pregnancy.

Eventually, others in the office found out about it, and I was called on the carpet. I didn’t realize what a problem it was until that time.

[Our client soon set up his own OB/GYN practice. One day, he saw that Planned Parenthood was looking for a medical director.]

That’s where the activist element took root. Before that I felt like any competent OB/GYN should know how to perform an abortion. 

I have two stepdaughters of reproductive age, and I view this issue through their filter. I don’t want them to be in the situation where, if they were considering abortion, they wouldn’t be able to make that choice.

Q: Why did you get involved with this lawsuit?

A: I think it’s ridiculous for the Arizona legislature to tell doctors how to practice medicine. But there’s a bigger reason. It’s tremendously easy for women to bypass these laws and use these medications without any medical supervision.

The more barriers we place, the more difficult we make it for women to get safe, legal medical service, the more attractive it is for them to bypass the whole issue and buy stuff right online.

Why don’t people frame their opposition around this problem? That’s my biggest concern.

Q: Why is non-surgical abortion such an important element of reproductive health care?

A: Well, there are medically driven reasons and patient-driven reasons.

Some women have physical problems that might make a surgical abortion a problem. There could be a number of possible circumstances. For example, intravenous access for the medications needed during surgery might be a problem.

But the most frequent reasons are patient-driven. For some patients, it’s easier not to undergo an invasive procedure. For some women, it’s psychological. It’s easier to wrap their minds or hearts around a non-surgical abortion. It might feel more like a miscarriage.

And some women want to control the environment in which it happens. They decide how it’s going to play out and who will be with them.

It’s possible to have a medical abortion without anyone knowing. That could be really important for someone in an abusive relationship.

Q: What do you think the consequences will be for women should they not have the procedure available to them?

A: The real answer is I don’t know. There will be more people who choose surgery, but based on what’s available online, I’m not sure how true that will be.

I think that the only way to address the issue of unplanned pregnancy is to know who’s having abortions and why.  I think people are going to go online and then we’re not going to know what the real ramifications are.

I don’t care how it affects my practice. What I’m worried about is that women will say, “Because of this law, why should I even have to deal with this at all?”

For people who are truly concerned about women, whether they’re pro- or anti-choice, maybe they need to look at this. Do you really want to make it so that ordering pills online, and taking them without a doctor’s supervision, is the new norm?