20 Week Abortion Bans: Unnecessary and Arbitrary

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January 22, 2018 marked the 45th anniversary of the passage of the Supreme Court ruling Roe w. Wade. There’s no question that the landmark ruling is under attack; 401 abortion restrictions have passed since January of 2011.

We sit down with Dr. Jamila Perritt, an OB-GYN and fellow with Physicians for Reproductive Health, to discuss the restrictive legislation that is gaining popularity with anti-choice legislators and has already passed the House: the 20-week abortion ban.

A 20–week abortion ban is an unnecessary, arbitrary ban on one of the safest medical procedures for women. The ban is based on gestational age and limits women’s abilities to access comprehensive abortion care.

20-week abortion bans, Heartbeat bans, and other TRAP (Targeted Regulation of Abortion Providers) laws are presented to sound innocuous. Anti-choice politicians and advocates often support 20-week abortion bans by stating that such limitations improve the health and safety of women receiving the procedure, even though abortion is one of the safest procedures a woman can have. Fetal pain is also cited, but scientific evidence proves that the concept of fetal pain is untrue.

These arguments add layers of shame and stigmatization on top of the individual that has made the thoughtful decision to undergo the procedure, and many women have various personal, medical, economic, social, and geographical reasons that may contribute to their ability or inability to receive abortion care.

Individuals seek abortion at 20 weeks for a multitude of reasons. Medical causes may delay a woman’s learning of her pregnancy, while TRAP laws and personal circumstances (e.g., saving money, procuring travel to a provider, finding child care, etc.) can reduce accessibility to abortion care. TRAP laws often attack abortion providers as well, limiting their training, undermining their admitting privileges, and closing their clinics, which ultimately eliminates the ability to provide comprehensive reproductive health care.

Attacking abortion access won’t make abortion disappear, but it will make the procedure unsafe, put women’s lives at risk, and cause extreme health disparities. 

Links from this episode

Jamila Perritt, MD on Twitter
Physicians for Reproductive Health on Twitter
Physicians for Reproductive Health on Facebook
Shout Your Abortion
Advocate's for Youth's 1 in 3 Campaign Speakout

Transcript

Jennie Wetter: Welcome to rePROs Fight Back a podcast on all things repro. I'm your host Jennie Wetter. In each episode, I'll be taking you to the front lines of the escalating fight over our sexual and reproductive health and rights at home and abroad. Each episode, I will be speaking with leaders who are fighting to protect our reproductive health and rights to ensure that no one's reproductive health depends on where they live. It's time for repros to fight back.

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Jennie Wetter: Welcome to rePROs Fight Back. This week's episode comes up one week after the anniversary of Roe v Wade. Roe v Wade has been under assault across the US with over 401 new abortion restrictions having passed since January of 2011. So this week we're going to talk about one of those bans that we've been seeing spreading across the US, and it has even passed in the House of Representatives: 20 week abortion bans. So joining me this week to talk about 20 week abortion bans, I'm really excited to have Dr. Jamila Perritt an ob-gyn and fellow with Physicians for Reproductive Health. Welcome Dr. Perritt, and thanks for joining me. Um, do you first want to maybe just tell our listeners a little bit about yourself?

Dr. Perritt: Sure, sure. So I am a board certified obstetrician and gynecologist. And following my residency in ob-Gyn, I did sub specialty training in family planning. And what that means is that I focused on my women's health training really on dealing with reproductive health specifically. And that includes things like contraception and abortion.

Jennie Wetter: So let's start a little bit now and talking about what exactly is a 20 week abortion ban.

Dr. Perritt: The most important thing to know about the 20 week abortion ban really is that it's, it's an arbitrary, unnecessary ban on a really safe medical procedure. And so what we've seen, and you mentioned a little bit about the assaults that are been, that's been happening legislatively, uh, around the country and this is just one more assault. And so what's happening is that we see arbitrary, uh, gestational age limits being placed and whether it's six weeks or 12 weeks or 20 weeks, uh, the point is really to limit the ability for women to access the care that they need.

Jennie Wetter: So it's really just another way of trying to test the court to push back on Roe v Wade.

Dr. Perritt: Absolutely. Absolutely. I think that what politicians know at this point is that the public really is overwhelmingly in favor of maintaining access to abortion, uh, for lots of different, different reasons. And so there's not a lot of political capital, uh, to be gained by trying to go after Roe directly. And so these arbitrary bans, these gestational age bans are another way to get around it, right? And so limiting when individuals can go and get the care that they need without saying explicitly that they're trying to overturn Roe versus Wade.

Jennie Wetter: So we've heard a number of different possible justifications being thrown out there. Maybe we want to talk a little bit about what are some of the reasons that proponents of 20 week bans are giving to say they support these bands?

Dr. Perritt: The number one and most, uh, agregious reason is the argument that it improves the health of the women that I take care of, right? So safety concerns. But the science shows and the evidence shows and those of us who provide care every day know that abortion at whatever the gestational age is one of the safest medical procedures that a woman can have. So just like the other laws that are aimed at restricting access to care, which we call TRAP laws, right? Targeted restriction of abortion providers, laws that limit things like the size of the hallways and mandate that facilities that that perform abortions do so in compliance as if they were a surgical center or a hospital. These, gestastational age bans are the same thing, right? And so they are designed to limit access to care. And so the argument for those other laws was that well, we're trying to make it safer for the women that we take care of. And the same thing with these gestational age bans. And we know that this is just not the case at all. And for those who are really interested in helping individuals who need abortions be safe and making care safer for women, they really should be focusing on things like improving prenatal care. And making sure that people have access to the insurance coverage that they need. Making sure that women are able to get the providers that they, get to the providers they need to get to when they do.

Jennie Wetter: Yeah. I feel like, uh, the 20 ban along with TRAP laws are kind of designed to sound innocuous and sound like you said, they're trying to protect women's health or that there are good things. I mean, like 20 weeks, right? Like that's plenty of time. And so people don't necessarily think about what that means for the woman, or just in terms of what's going on in people's lives, or what could come around and influencing that decision.

Dr. Perritt: Definitely. And that's the really tricky part. The way that they're presented is in a way that is seemingly innocuous. And until you've been in the situation where you need to access care, then it's hard to make that judgment about a, when someone should have been able to show up. We know that lots of women have all kinds of issues and in their lives and even medical issues that may delay their ability to even identify that they're pregnant in the first place. Right? And so if you're already dealing with maybe something like PCOS right? So women who don't articulate very regularly, may not get a regular period, by the time you recognize you're pregnant, then you're always already may be well into first trimester. And so again, just thinking about all of the things that it takes to be able to get into get care, we know that majority, the vast majority of states are unfavorable for abortion access. And so what if you don't have a provider in your state? Then you're traveling across state lines. Most individuals who have abortions already are parents. And so you know, you're finding childcare for your children. Often you're working at a low wage job and so you're having to take off work, you have to find transportation. All of these things contribute to an individual's ability to get in and get care. And when we think about all the other barriers that have been put in place, the TRAP laws, the gestational age bans, they do exactly what they're designed to do. And that's eliminate access to abortion care.

Jennie Wetter: Absolutely. I mean, you're seeing on top of that waiting periods. So now you have to make multiple trips and find childcare multiple times and make that drive or find transportation multiple times. And that's another thing that can, you know, push off.

Dr. Perritt: That's a great example. And, and the um, the disrespect that is contained in the waiting period laws, to me, is something that's amazing. As if the individual presenting for the abortion doesn't already know what they're there for. So we want to send you home and wait for one day or in most egregious cases, three days before you can come back and make your decision. So how many barriers can we put in place to eliminate access to this care?

Jennie Wetter: I mean, it just feels so patronizing. Like little women go home and you know, think about it before you make this, you know, big decision. Assuming that people haven't thought about it and already made their decision before they made the appointment.

Dr. Perritt: I agree. And I really believe and you know, I've been providing this care for a long time, and I really believe that the women that I take care of are capable of making thoughtful decisions about their lives and their families without the influence of those who think they know better.

Jennie Wetter: Um, okay. So we talked a little bit about the, the one of the reasons they say for 20 week ban is a women's health trying to preserve women's health. I feel like another justification I hear is a fetal pain. Do you maybe want to tackle, a little bit about why that's not real? The science is against that as well.

Dr. Perritt: It's simply just untrue. There's a lot of evidence out there that, that proves that this is something that is completely made up. And that's one of the dangerous things about having those who are not medical experts, making laws that overstep medical boundaries. So those of us who provide this care, those of us who've done the research, those of us who are familiar with the research, medical experts know that this fetal pain is not, it's not a thing. It's something that's completely made up and it's proven not to be true.

Jennie Wetter: I mean I feel like it goes into this just much larger story of just an attack on science.

Dr. Perritt: Absolutely.

Jennie Wetter: You see arguments saying that you know, IUDs caused abortion or you know, the morning after pill is abortion, or all of these things that are just not true and attacking the basic understanding of what we know.

Dr. Perritt: And, and it's really frustrating for scientists who have been doing this research for, who've been dedicating our lives to being able to support, to find evidence, to support the work that we do. And so to have someone come in and just make up what they, what they want to fit their bill is frustrating to say the least.

Jennie Wetter: Well now you think about the women who are hearing this and you know, find, find this an extra stressor at a time when they're already probably pretty stressed about what's going on. We know whether that's trying to arrange the childcare or just trying to make time and jump through all these hurdles to add this extra stress or on top of it.

Dr. Perritt: And the point really is, is to shame and stigmatize the individual who's making this decision, this decision that they have thought about, that is best for them, that's best for their family. They made it in consultation with their health care provider, often their partner, if their partner is involved and other support people. And so it's a really just adding another layer of shame and stigma to say, look at this, look at what you are doing.

Jennie Wetter: Um, so maybe we want to talk about a little bit about, um, why women are seeking abortion at 20 weeks. I know it's complicated, but maybe, um, I think some people just don't understand why it could be that late.

Dr. Perritt: I'll give you a really good example. I saw a patient not too long ago that had come into the office and she, um, had, was pregnant and when she first presented for her, uh, her prenatal appointment, she was already about 13 or 14 weeks. She was someone who was very much like the, uh, had the medical problem that I mentioned before. So she didn't have regular periods. She didn't know that she was pregnant, but this was a pregnancy that she did desire. And when she went in for her prenatal appointment, everything was going fine. At about 18 to 19 weeks is when you get an ultrasound. And typically that's the ultrasound that we use to tell you, are you having a girl or a boy? Right. But this ultrasound found that the baby that she was carrying really had some abnormalities and these abnormalities we're not compatible with life. And that meant that should she carry the baby to term, if she was able to carry the pregnancy to term, then it certainly would not survive the delivery. And so she made the decision to terminate the pregnancy. And so for someone like her, who had presented late to care, later than those who are judging the situation, presume she should have, right, but absolutely normal in the case of the medical condition that she had, and then found out later in the pregnancy, during her ultrasound appointment that this was an abnormal, although desired pregnancy. And so that's one good reason, but there are lots of other reasons. There are barriers that are put in place and we've talked about that. So, um, Texas has a really great example of where we see this, but Texas isn't the only one. We also see it in Ohio and Pennsylvania and, and Florida and Virginia. So lots of laws that are out there that really create barriers. So imagine if you present you, you know that you don't want to carry this pregnancy to term. And we talked about all the other things that come up, whether it's childcare or being able to find an abortion provider in your city, much less your state. So you're traveling across state lines. So there are lots of reasons, some that are medical reasons that cause women to present um, later in their pregnancy and other logistical reasons, um, that are circumstances of an individual's life or put in place by these laws that are passed.

Jennie Wetter: You may have women worrying about saving up money for an abortion and you know, if that takes a little while then all of a sudden they're later in their pregnancy and the price just went up because it's, they can't get a medication abortion. Now they need to get a surgical abortion and then they have to save more money. And you have a waiting period. And just all of these things interact to make it so much more complicated.

Dr. Perritt: It definitely is the case and we've, we've seen the access to medication abortion improve following the change in the FDA regulations. But prior to that, in places like Arizona and Texas where anti-choice folks really seized on to the opportunity to limit access, they went after medication abortion in that way. And allowing individuals to get access to care earlier in the way that fits them best. Um, is one way to decrease the likelihood that someone does have to deal with all of the concerns that come along with trying to find a provider. Um, after, the first trimester.

Jennie Wetter: You know, we talked a lot about some of the different abortion restrictions that can cause a delay for 20 weeks, but is there anything else that we need to kind of think about that would, would push that and just how women are making this choice?

Dr. Perritt: One thing that really can inhibit an an individual's ability to get access to care is a lack of providers. So lots of the laws that we've seen passed really are going after providers like me, people who have committed themselves to providing care for women in a safe and compassionate way. So legislation that limits training of abortion providers, whether it's in medical school or residency programs, that limits the ability of providers to get admitting privileges to hospitals where they're practicing. So going directly after abortion providers is another really underhanded way that we see this legislation being pushed. So, you know, I didn't grow up thinking that I was going to be an abortion provider. I knew I was going to be a doctor. I was one of those really obnoxious kids that would have walked around with the plastic stethoscope and the fake doctor's bag. And so I always planned on going to medical school and when I was an undergrad I began volunteering a Planned Parenthood. And that was my early exposure to compassionate reproductive health care provision. And it changed the course of my career because I thought, wow, this is something that's amazing. This is care that individuals need, and it's being done in a way that is holistic and respectful. And this is something that I, I'm going to commit myself to doing. And so when we see legislation that limits access to training from medical students and residents and then also advanced practice clinicians, right? So nurse practitioners and midwives and PAs and all of those individuals who are passionate about providing comprehensive reproductive health care. Because that's what abortion care is. It's health care, it's comprehensive reproductive health care. And so eliminating the opportunity to be exposed to that training in medical school, and then limiting the opportunity for providers who want to be able to provide this service from being able to, whether it's in their institution or their office or their state, is another really dangerous and underhanded way that we see abortion being attacked in the United States.

Jennie Wetter: Yeah, so I'm from Wisconsin, I think I mentioned. And this is something you're seeing right now with the state interfering in how the University of Wisconsin, they're, I think blocking them from working with Planned Parenthood and letting residents go there for any training. Again, that just makes it harder. So closing clinics but now blocking training of people that could provide those services and that's going to create a problem further down the road.

Dr. Perritt: Absolutely. And can you imagine any other profession where the, the politicians would come in and say, you can't learn how to do this part of your work. Right? This is something that is absolutely unique to women's health care and specifically targeted on reproductive health care and rights.

Jennie Wetter: And I think another thing you mentioned was kind of getting into a little bit of the TRAP laws where we talked about, you know, transfer agreements or admitting privileges. Again, these are things that I think when the average lay person hears it, they don't sound horrible. They sound like maybe reasonable things to do because people don't necessarily understand how complicated that is. Hospitals just don't give everybody admitting privileges. It's a business they need to bring them, um, business and abortion is so safe that you're not sending people to the hospital.

Dr. Perritt: Exactly. And if you live in a state that is hostile to abortion care, then you won't get admitting privileges. Right. We acknowledge that you don't need them as an abortion provider because it's so safe and you, we don't have complications to the same degree that people who are doing other outpatient case cases may. But if you live in someplace like Mississippi and we saw this with, uh, with Dr. Parker in the clinic in Mississippi and denial of admitting privileges because you are an abortion provider, then then even there's even less of a likelihood that you'll be able to get, um, the licenser that you need and be able to provide the care for women in the state or city that you practice in.

Jennie Wetter: I mean, and these laws are really targeted at forcing the clinics to close and they've been very successful.

Dr. Perritt: That is the point. That is absolutely the point. And so, and that's why it's important, I think that we, we say that loudly and as often as possible. This is not about preserving the safety of the women that I take care of. This is absolutely about removing the access to legal and safe abortion for women in this country.

Jennie Wetter: Absolutely. And you've seen the effects. You've seen, what are we at three states now that only have one clinic? Um, other states that are getting very small. I think I've seen, what is it? We're at 20 some states where more than 50% of the women in the state live in a county without an abortion provider. And it's very hard for women to access this care. Dr. Perritt: It is, it's very difficult. And we, and for, for those of us who are committed to providing this care, we're worried about this. How can we continue to take care of people? We know there's a lot of evidence from, from countries around the world that looks at what happens when abortion is restricted. What happens when abortion is legal? Abortion is very safe in this country because it is legal.

Jennie Wetter: We can, you can ban abortion, you can make it illegal, but it's not gonna stop. You'll stop safe abortion and women will die. Absolutely. And that's the bottom line.

Dr. Perritt: It is. And, and, and, you know, it's frustrating for me, um, who, who's taken an oath to care for people to see legislative interference in my exam room. Someone coming in and things like forced speech that we see in lots of states. And not just forced speech in general, but just flat out lies. Things that are not supported by medical evidence, forcing health care providers to lie to their patients about complications and risks that don't exist or are not associated with abortion. And so the legislative of interference just through both the laws that are passed and then also the mandates that come down that get in between me and my patients is really frustrating and awfully disrespectful.

Jennie Wetter: I'm just trying to think of any other medical specialty where you see a politician all of a sudden in the exam room with the doctor they're getting between that relationship.

Dr. Perritt: The only other one, the only other place that occurs is with the gun lobby. And so they have eliminated the ability for physicians to screen for guns in the home. So those are the two places that we see at most.

Jennie Wetter: That's crazy.

Dr. Perritt: Yes. Yes it is. And for pediatricians in particular, because it's part of our screening. Alright. Part of the screening for providers, do you have a gun in your home? And so the difference there of course is they're not forced to tell their patients, oh, guns are safe, there's nothing that you need to worry about. Leave your gun unlocked, right. The lies that are being forced to be told to women around their reproductive health is, is a huge difference there.

Jennie Wetter: And you really see it, the stark difference, and it really depends on where you live and that it's just kind of, again, that's just really unsettling to think that, okay, so I decided to live in Alabama and all of a sudden that means I can't access this care as easily as somebody who lives in California.

Dr. Perritt: It's justice by geography. Yeah. So your access is limited depending on your zip code. And even in California, depending on your socioeconomic status. Yeah. And so for those places that are on the coast that are blue states and seemingly liberal, we also still see lots of limits. Here in Washington DC we see limited access to care even though it's the nation's capital, even though it's a state that is favorable and liberal and progressive, sort of all of the catch phrases that we use to, to describe ourselves. We see that there are huge disparities in the care that individuals are able to obtain overall. And abortion care is no different. Organizations like Planned Parenthood and Whole Women's Health and, and other organizations that really seek to support the community, um, are really critical to providing a safety net for reproductive health care overall, and specifically for abortion care.

Jennie Wetter: I mean you see that disparity to access to reproductive health really playing out in the maternal mortality rates. And you see that black women have such a higher, what was it three times? Is that the most recent number I saw?

Dr. Perritt: It's, I mean, it's astronomical, astronomical. And here in DC, our maternal mortality rate is two, twice the national average. Right? So the disparities are really significant and unsafe abortion absolutely contributes to that. And it's not race that's making a difference. When we're thinking about maternal mortality, it's racism and health disparities and economic inequality, right? All of the things that ensure that you don't have access to the health care that you need, that you don't or you aren't able to see a quality provider, that limit your ability to get effective contraception, that, that of your choosing. All of those things contribute to reproductive health disparities and we see it in abortion care as well.

Jennie Wetter: Okay. So one other thing we should touch on. So we talked about a 20 week ban. One of the things you are seeing has passed in a couple of states, um, and it also was being considered in the House of Representatives is a so called heartbeat ban. Um, do you want to talk a little bit about what those are?

Dr. Perritt: Another ban on abortion at any gestational age. And so if we can't get it, get you later, then we'll certainly get you earlier. And that really is the plan. Any arbitrary ban on abortion based on gestational age or really anything else does nothing to, um, to improve the safety of the care that we provide. And it is solely designed to limit access to safe and legal abortion in the United States.

Jennie Wetter: Absolutely.

Dr. Perritt: And we talked a bit about, you know, being able to figure out that you're pregnant early on and how, how difficult that is for lots of individuals. And so by um, setting this gestational age with these bans, it means that eliminates access almost universally. You have to have missed a period and then get your abortion.

Jennie Wetter: So many women maybe don't know or are in denial or wouldn't have had time to think about what they would want to do at that point. It would be so quick.

Dr. Perritt: It is, it is. And, and we know that abortion is safe. We know that women are making thoughtful decisions. We know that individuals have complicated lives. And so coming in and putting in any kind of arbitrary gestational age band, whether it's at six weeks or 16 weeks, is unreasonable.

Jennie Wetter: So again, these are all just the myriad of ways that a Roe has been under is under attack and will continue to be under attack, particularly under this current environment.

Dr. Perritt: Absolutely. It's a slow chipping away at reproductive rights. And that is the point.

Jennie Wetter: Okay. So now that people know about some of the many ways that uh, abortion rights are being attacked in the US, what are some of the things that people can do to get involved and make a difference?

Dr. Perritt: The most important thing I would say, or one of the most important things is to contact your legislator, let your voice be heard. It matters. It matters for your senator or your congressman or your, um, those in your, your state and federal offices for you to reach out and say, listen, I am a constituent and I do not support this. I want you to vote this way. So whether it's organized letter writing or calling your legislator, then absolutely take this personally. You should because this is the beginning of a really aggressive attack and we're, you know, we think that, wow, we're, we're neck deep, deep in it already, but we have not seen anything yet. This is definitely going to continue. So the louder we shout, the more we make our voices heard, the more critical it is for us to be able to push back on these attacks. The other thing that I would say is to tell your story. Storytelling has become a huge part of, um, advocacy efforts overall in organizations like Advocates for Youth who does the one in three campaign and shout your abortion and lots of other people that are saying, listen, you can't push us to the sidelines. One in four women will have an abortion in their lifetime. So this is somebody that, you know, and so being able to speak up and push back when that shame and stigma, let's legislators know that you will not be silenced, we will not be silent and we want them to vote in line with their constituents.

Jennie Wetter: Absolutely. And I think you made a really great point. It's calling your representatives, not just federally, but calling your state representatives. Because you know when I talked about that 401 new abortion have been passed since 2011 those are state level restrictions. So the calls to your state representatives is so important.

Dr. Perritt: It's critical because again, if we go back to the Roe versus Wade legislation, that's federal legislation and so we can't get that. What else can we do? And so we go for the state level restrictions. Admitting privileges, laws come down at the state levels, TRAP laws come down at the state level. So going in and contacting your state representatives are really critical to say we will not exempt, we will not accept this. And so both for patients and then also for providers, I think it's easy for us to stay in our offices and just to see our patients and to say, you know, wow this is really terrible. I can't believe what they're doing. What organizations like Physicians for Reproductive Health has a voices of courage campaign for example, where providers are speaking up and we're saying this is who we are, this is what we do and this is why. It helps connect individuals to the stories that are out there and put a face on the numbers. So what does it mean to say that one in four women have an abortion in their lifetime? Who are these women and what do they look like? What are their experiences like? So being able to connect individuals both on the, on the state level and a on a policy level and also to public on a public level, so individuals to stories is really critical to making sure that we can rally the support that we need to make sure that abortion stays safe and legal.

Jennie Wetter: I think stories have been one of the great things that have come out of the this real attack on reproductive health recently is not just the individual stories, but the providers' stories and really seeing everybody speak up and add their voice and telling what their abortion story is, what their patients have gone through. And I think there's just something so powerful in that.

Dr. Perritt: Absolutely. It's hard to ignore a person, right? It's, it's easy to fall in to the rhetoric, but that rhetoric is so far from the reality of the lives that individuals lead, that it's really dangerous and it's allowing this legislation to move forward.

Jennie: Well, thank you so much for being here, Dr. Perritt I really appreciate it.

Dr. Perritt: It was my pleasure. Thank you for having me.

Jennie Wetter: For more information, including show notes from this episode and previous episodes, please visit our website reprosfightback.com you can also find us on Facebook and Twitter at rePROs Fight Back. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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