The Supreme Court struck down key provisions of a Texas anti-abortion law in late June, but the Lone Star State still has plenty of tricks left up its sleeve.
First, the Texas Health and Human Services Commission quietly changed its rules to require that abortion providers bury or cremate fetal tissue instead of using standard medical waste disposal services.
And now, as the Texas Tribune reported Wednesday, the Department of State Health Services (DSHS) is planning a new version of A Woman’s Right to Know, a mandatory booklet that Texas women receive 24 hours before an abortion procedure that is riddled with lies. The revision also ignores recommendations made by the American College of Obstetrics and Gynecologists (ACOG), an OB/GYN professional association with over 57,000 members.
The Daily Beast reviewed both the original and revised versions of A Woman’s Right to Know, and found several inaccuracies, misrepresentations, and omissions.
“This is a draft booklet,” DSHS spokeswoman Carrie Williams told The Daily Beast in response to a detailed request for comment. “There is clearly interest in this, and we need to be very thoughtful and diligent in reviewing the comments. We’ll evaluate the feedback and make revisions as needed to make sure the booklet is clear and accurate for pregnant women."
As it stands, the revised booklet is far from accurate but it does seem clear in its intent to dissuade women from choosing abortion.
The original version of A Woman’s Right to Know claimed that “some experts have concluded that the [fetus] is probably able to feel pain” at 20 weeks.
This directly contradicts current scientific consensus. A 2005 review in the Journal of the American Medical Association concluded that “pain perception probably does not function before the third trimester [28 weeks]” and the Royal College of Obstetricians and Gynecologists found that the connections in the brain necessary to feel pain are “not intact before 24 weeks.”
Given these facts, ACOG told the Texas DSHS that the 20-week claim in the original pamphlet was “an ideological rather than scientific perspective.”
But instead of removing that claim in the proposed revision, the DSHS placed it on top of the second page in large red font: “In consideration of the potential for fetal pain, Texas law currently limits abortion to under 20 weeks.”
The revised version of A Woman’s Right to Know devotes substantially more space to detailing possible complications from abortion than it does to complications from childbirth, even though the latter are more common than the former.
On this point, the medical literature is clear. A 2012 study found that the risk of childbirth-related death was “approximately 14 times higher than that with abortion.” And a large 2014 study from UC San Francisco examined data from 50,000 women and concluded that major complications from abortion occur less than a quarter of one percent of the time, “about the same frequency as colonoscopies.”
Accordingly, ACOG instructed the DSHS to note that the “risks of abortion are less than the risks of carrying a pregnancy to term and delivering” in the revised pamphlet. The DSHS did not follow through on that recommendation.
Abortion and Breast Cancer
The previous version of A Woman’s Right to Know misleadingly linked abortion to breast cancer but it at least noted that “some studies have found no overall risk.”In response, ACOG told the DSHS that this oft-touted link is not supported by “current and relevant science,” citing an extensive report from the National Cancer Institute (NCI), which concluded that “having an abortion or miscarriage does not increase a woman’s subsequent risk of developing breast cancer.” As the NCI discovered, studies on a possible association between abortion and breast cancer were “inconsistent” until the mid-1990s but more recent studies with larger samples and better methodologies have “consistently showed no association.”
Not only did the DSHS keep the section on abortion and breast cancer in the revised booklet, the department deleted the earlier reference to studies that found “no overall risk.” Instead, the department claims that “doctors and scientists are actively studying the complex biology of breast cancer to understand whether abortion may affect the risk.”
There is no reference to the NCI report.
Abortion and Infertility
The proposed draft of A Woman’s Right to Know changes but does not eliminate a section which raises fears about abortion’s possible impacts on future childbirth.
“Some complications associated with an abortion, such as an infection, a cut or a torn cervix, may make it difficult or impossible to become pregnant in the future or to carry a pregnancy to term,” this section warns under the ominous heading of “Future Infertility.”
What the booklet fails to note is the extreme rarity of these complications. According to an ACOG FAQ, the risk of injury to the uterus or other organs is “less than 1 in 1,000” during a second-trimester abortion. Complications like these are not necessarily irreversible, either, as infections can be treated with antibiotics and uterine perforations can be surgically repaired.
The childbirth section of A Woman’s Right to Know acknowledges in a handful of bullet points that complications of vaginal delivery and Caesarean section can affect future fertility, too, but nowhere in this section is there a separate heading entitled “Future Infertility.”
The revised version of A Woman’s Right to Know also keeps a section in place which mentions that women have reported experiencing “regret,” “grief,” “lowered self-esteem,” “sexual dysfunction,” “avoidance of emotional attachment,” and “substance abuse” after an abortion.
There is no citation for this section.
As ACOG pointed out in its letter to the DSHS, that may be because it is “not based on scientific evidence.” In fact, a 2015 study in PLOS One which surveyed over 600 women over three years concluded that “the predicted probability of [women] reporting that abortion was the right decision was over 99 percent at all time points over three years.” Some women did experience negative emotions but these “declined over time” and as ACOG noted, many of the same emotions can also occur “after a miscarriage, and even after a healthy delivery.”
The Texas booklet does contain a section on postpartum depression but it also says that women can experience “great surges of joy and happiness, feelings of contentment and fulfillment” after birth.
Left unmentioned in the revised booklet is the fact that women also experience positive emotions like happiness and relief after abortion, as the 2015 PLOS One study also found. The old version of A Woman’s Right to Know half-heartedly acknowledged this possibility, noting that some women “may feel relief that the procedure is over.”
That language is conspicuously absent from the revised version.