We are writing as part of a group of 12 concerned doctors, nurse practitioners and nurse midwives working in New England. We studied and trained for many years to be able to provide our patients with safe, effective and compassionate health care. Politicians did not. Yet, they are the ones making health care decisions in statehouses, not health care providers in clinics, medical offices or hospitals.
Even though we practice in states with less restrictive laws, these state-level protections are tenuous without the federal protection of Roe v. Wade. In Maine this November, every seat in the Legislature will be determined by your vote. This means that current state laws protecting reproductive choice and providers like us (such as L.D. 227, the so-called "shield law") are subject to change or even repeal based on who you choose to represent you in Augusta.
ABOUT THE AUTHORS Amy Harris, MS, RN, CNM, is a certified nurse midwife with a Master of Science in Maternal and Child Health from the Harvard Chan School of Public Health. She has worked in women's reproductive health, served as a board member of SAFE Maine's Abortion Fund, and is now a women's health writer. Sarah H. Reich, MD, graduated from Boston University School of Medicine and completed a residency in pediatrics at Tufts Medical Center. She has been practicing pediatrics since 2009.
We want to give you the facts so you can make an informed voting decision - just as we provide our patients with the necessary information before consenting to medical procedures. We talk honestly about risks. Depending on the November election results at both the federal and state levels, the health and well-being of anyone who could become pregnant will be at risk.
Maternal death rates were 62% higher in the 26 states with more restrictive abortion laws from 2018-2020, even before states were able to pass total abortion bans. Abortion restrictions threaten not only mothers' lives but also their infants' lives. In 2019 - three years before total abortion bans went into effect in some states - more infants died in their first year of life in states with abortion restrictions than in states with fewer abortion restrictions.
Why are we seeing these increases in maternal and infant deaths? Because our health care colleagues who practice in the 24 states with abortion restrictions are being forced to decide between providing life-saving medical care and going to jail or not following the standard of care and doing what is best for their patients.
Abortion care is health care. Consider that 1 in 4 pregnant people miscarry in their lifetime. States with abortion restrictions now compound miscarriage's emotional burden by making it harder for people to access prompt, safe and medically necessary care. Some states prohibit the use of the same medications used for medication abortion (mifepristone and misoprostol) for treatment of miscarriage and pregnancies outside of the uterus (an ectopic pregnancy). Misoprostol and mifepristone have been shown to reduce the risks of hemorrhage, infection or incomplete emptying of the pregnancy after miscarriage. Without quick access to specialized early pregnancy care, people with ectopic pregnancies risk losing their future fertility as a result of ruptured fallopian tubes or emergency hysterectomies.
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Because it saves lives in cases of hemorrhage during a miscarriage, labor and postpartum, one of these medications, misoprostol, is kept on emergency "hemorrhage carts" on labor and delivery floors and in ERs nationwide. Except in Louisiana. This September, legislators removed misoprostol from hemorrhage carts statewide because they classified misoprostol as a "dangerous controlled substance." In Louisana and other states, ER doctors report having to wait for a person miscarrying to hemorrhage to the point of a "life-threatening medical emergency" so they are protected from legal prosecution.
Now imagine that there is no hospital providing obstetrical care (thus no skilled providers trained in caring for high-risk pregnancies, miscarriage management or obstetrical emergencies) within a safe travel distance to you or your loved ones. Abortion restrictions have exacerbated maternity care deserts because doctors, nurse practitioners and midwives are leaving states with abortion bans because they are afraid. Maternity care deserts (counties without a birthing unit or obstetrical providers) now exist in one out of every three counties in the U.S. That means women, mothers and their babies, especially those living in more rural areas of our country, like Maine, now have to travel longer and unsafe distances for care.
This Election Day, you have a choice. Other people in this country do not. We ask you to consider the avoidable tragedies people have suffered since politicians started deciding what only a patient and their health care providers should decide. Use the clear and convincing evidence of the harmful consequences of abortion restrictions to make an informed decision when you vote on Nov. 5.
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