New Hampshire House Judiciary Committee 107 North Main Street
Concord, NH 03301
February 9, 2022
RE: Oppose HB 1477
Dear Chairman Gordon, VChairman McLean, and members of the Committee:
On behalf of the New Hampshire Section of the American College of Obstetricians and Gynecologists (ACOG) we respectfully oppose HB 1477. Our members dedicate their careers and lives to providing evidence-based care, delivered with quality, safety, integrity, and compassion. As such, the ACOG New Hampshire Section strongly opposes medically unjustified interference in evidence-based health care, including restrictions on abortion care. This legislation represents such ill-advised interference, and would be harmful to the communities in our state.
Science and medical evidence must be at the core of public health policies that affect the health and lives of the people in our state. In contrast, medically unjustified restrictions on reproductive health care replace medical facts with political rhetoric and tie the hands of health-care providers.
HB 1477 would let politicians—not pregnant people with their families and trusted loved ones— determine health care decisions and impose restrictions on our patients’ ability to access safe care in our state. It is dangerous and ill-advised, and we urge this committee to flatly reject it for the following reasons:
Abortion is health care.i
- Like all medical matters, decisions regarding abortion should be made by patients in consultation with their health care providers and without undue interference by outside parties. Like all patients, people obtaining abortion are entitled to privacy, dignity, respect, and support.
- Many factors influence or necessitate a decision to have an abortion. They include, but are not limited to, contraceptive failure, barriers to contraceptive use and access, rape, incest, intimate partner violence, fetal anomalies, illness during pregnancy, and exposure to teratogenic medications.
- Pregnancy complications, including placental abruption, bleeding from placenta previa, preeclampsia or eclampsia, and cardiac or renal conditions, may be so severe that abortion is the only measure to preserve a patient’s health or save their life.
HB 1477 is an effective abortion ban.
- Gestational age is measured from the last menstrual period, which means that, when we refer to a ban on abortion care at six weeks pregnant, it means that they are two weeks past their first missed period, the most common sign of a potential pregnancy.
- Not everyone has a regular cycle or monitors their cycle closely, so two weeks after a missed period, many patients (particularly those who are not planning a pregnancy), do not yet have reason to suspect they are pregnant. Under a six-week ban, they would be effectively foreclosed from accessing abortion care.
- Many patients experience irregular menstrual cycles due to factors including stress, higher weight, smoking, endocrine conditions, such as polycystic ovary syndrome, thyroid dysfunction, premature ovarian failure, exercise-induced amenorrhea, eating disorders, and ovarian and adrenal tumors.
- Adolescents, within the first few years of their period, may have irregular menstrual cycles or longer menstrual cycles that may be six weeks or more.
- Other patients experience metrorrhagia, or bleeding or spotting during their menstrual cycle, which can be mistaken for a period and may lead a patient to believe they did not miss a period when they are actually pregnant.
- At six weeks gestation, many may not yet know they are pregnant, but even if they do determine they are pregnant before the six-week deadline, patients in our state already face barriers to care that can delay access. This is especially true for those who already face significant barriers to accessing health care.
- Cumulatively, once a pregnant person has met delay tactics, collected financial means, secured an appointment, arranged for childcare or time off work to accommodate an appointment, and travelled to the appointment, time may already have run out under the limited constraints of this law.
HB 1477 represents gross interference in the relationship between a person and their trusted health- care provider.
- This bill would allow the government to determine when a person’s pregnancy outcomes, an extreme and dangerous political overreach.
- The practice of medicine is based upon research and carefully developed standards of care. Science, not political beliefs, should be the foundation of medical decision-making, and the patient-physician relationship is essential to the provision of safe and quality medical care. Unfounded governmental intrusion has no place in this relationship.
- Taking medical decisions out of the hands of patients and their physicians and putting them into the hands of politicians would irreparably compromise the integrity of the patient-physician relationship. It is extremely dangerous for lawmakers to presume they are better equipped than a woman and her health care provider to judge what is appropriate patient care.
- We are deeply concerned about how penalization of abortion will affect ob-gyns’ ability to make ethical and professional decisions in the best interest of their patients.
- Everyone should agree that we all deserve to enter our doctor’s office with the assurance that the options for care we receive will be informed by scientific research and experience, and not by a political mandate from the State House. Yet, HB 1477 would deny this fundamental rightto
New Hampshirites, simply because their legislators subscribe to an anti-abortion-rights ideology.
- Allowing politicians to pick and choose what evidence-based, essential health care services are available in our state sets a dangerous precedent for the practice of medicine as a whole.
HB 1477 indefensibly jeopardizes patients’ health.
- We are committed to healthy pregnancy care and to making sure that every patient can have the best outcomes for their pregnancy.
- Pregnancy can be a high risk time, and decisions about continuing a pregnancy must be in the hands of the patient. Severe medical conditions, or preeclampsia (high blood pressure due to pregnancy) can all threaten a patient’s health and life. Determining a treatment approach for these conditions should be between a patient and their health-care provider.
- This bill indefensibly jeopardizes patients’ health by requiring physicians to “wait and see” if a condition deteriorates before permitting medically indicated treatment. Physicians cannot always predict what course medical conditions or complications will take or how quickly they may lead to mild health problems, severe injury, or even death. This bill could place doctors in the untenable position of denying needed services to patients whose pregnancies threaten their health.
- A comprehensive report by the National Academies of Sciences, Engineering, and Medicine (NASEM)ii comprehensively reviewed the state of science on all methods of abortion, and confirmed once again that abortion is one of the safest medical procedures. In fact, it found that the biggest threats to the quality of abortion care in the United States are unnecessary and burdensome government regulations that undermine evidence-based care.
Patient care should never be legislated on false or inaccurate premises.
- Public and political discourse regarding abortion is all too often inaccurate and not based on medical science. Patient care should never be legislated on false or inaccurate premises.
- HB 1477 leverages language that misconstrues medical terminology and is not reflective of clinical fact. It deploys the term “heartbeat” to impose an arbitrary abortion ban that is not reflective of clinical fact. Proponents of this legislation may claim that fetal cardiac activity is an indicator that a fetus is viable. This statement misconstrues medical terminology.
- Medically inaccurate and inflammatory claims can contribute to or encourage hostility or violence toward doctors, other medical professionals, or individuals seeking or receiving health care.
Sound health policy must be based on scientific facts and evidence-based medicine. The best health care is provided free of political interference in the patient-physician relationship. As health-care providers who care for the communities in our state, and as New Hampshirites who value treating our neighbors with respect, we urge you to oppose this legislation.
Thank you for your consideration. Ellen Joyce, MD, FACOG
i ACOG Committee Opinion 815, Increasing Access to Abortion (December 2020) https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/12/increasing-access-to- abortion
ii National Academies of Sciences, Engineering, and Medicine. The Safety and Quality of Abortion Care in the United States (March 2018) at https://www.nap.edu/read/24950/chapter/1