Press release, 14 April, 2015
The recently enacted novel Kansas anti-reproductive health measure known as The Unborn Child Protection From Dismemberment Abortion Act may reduce the number of pregnancy terminations performed in Kansas after 16 weeks gestation, the point at which the procedure usually changes from suction abortion to D&E. The current percentage of “elective” terminations – after 16 weeks but prior to viability, defined as 22 weeks of gestation, or 24 weeks by LMP – is very small, less than 5%, or around 200-250 per year and one third of these are performed for non-Kansas residents2. Based on the experience of abortion providers in Kansas, a significant proportion of these second trimester procedures are not actually “elective” procedures, as many complications are not detected prior to 16 weeks. This information is not reflected in annual Kansas Department of Health and Education (KDHE) abortion statistics because it is not required for procedures performed prior to fetal viability3.
Anticipated impact of this law
Pregnant women in Kansas are exposed to an increased risk of sepsis and death. Around fifty Kansas women per year2 are expected to experience a pregnancy complication known as pPROM – preterm premature rupture of the membranes4 prior to viability, when the fetus absolutely cannot survive delivery. Because of the specific restrictions in this law, definitive treatment may be delayed, increasing the risk of sepsis and death. An amendment5 designed to protect women in this potentially dire situation was proposed by Rep. Barbara Bollier (R) Johnson County6 – the only physician currently serving in the Kansas legislature – but it was voted down7.
The law specifically excludes a health exemption for suicidal ideation and self-injurious behavior meaning that a woman hemorrhaging from an attempt to induce a miscarriage will be forced to undergo a hysterectomy or allowed to bleed to death, like in the days before Roe v. Wade.
Abortion providers will use (Constitutionally required) alternatives such as digoxin prior to D&E or induction of labor. An induction procedure takes from 2-5 days to complete and requires that the patient remain at or near the treating facility, making it more expensive than a D&E procedure. The additional cost will be passed along to the patient.
Minimal reduction in the number of terminations performed beyond 16 weeks – women will travel out-of-state for needed medical care unavailable or unaffordable in Kansas.
Poor and underage women will be disproportionately affected as they will be less able to afford the higher cost or to travel out-of-state for care. The consequence will be increased financial burden on families, and on already under-funded State support systems.
More expensive legal actions against the State of Kansas by women’s health advocates regarding the unconstitutionality of anti-abortion measures which disregard the health of women.8,9
Patient confidentiality and privacy of medical records may be compromised by civil suits arising from this law.
In conclusion, this poorly-conceived attempt to ban second trimester abortion is yet another instance of anti-scientific, anti-woman political grandstanding by religious extremists in the Kansas legislature. It does nothing to protect women or their families. On the contrary, it potentially jeopardizes the health of all women of reproductive age. The cost of implementing and defending this legislation will fall on Kansas taxpayers, and as usual, the brunt of the negative impact will be borne by low-income single women and their families, those least able to afford the consequences.
Kristin Neuhaus MD, MPH provided abortion care in Kansas since completing medical training at the University of Kansas School of Medicine. A long-time associate of the late Dr. George Tiller, she was the first woman physician in Kansas to publicly provide abortion care, performing or consulting on over 10,000 procedures. She has since completed a Master’s in Public Health through the Department of Preventive Medicine and a Fellowship in Family and Community Medicine through the Department of Family Medicine at the University of Kansas.
- From Preterm Premature Rupture of the Membranes Mercer, B, Glob. libr. women’s med., (ISSN: 1756-2228) 2008; DOI 10.3843/GLOWM.10120 http://www.glowm.com/section_view/heading/Preterm%20Premature%20Rupture%20of%20the%20Membranes/item/120Final law http://www.kslegislature.org/li/b2015_16/measures/documents/sb95_enrolled.pdf
- Abortions in Kansas, 2014 http://www.kdheks.gov/hci/abortion_sum/2014_Preliminary_Abortion_Report.pdf
- Abortions in Kansas, 2014 – Appendices http://www.kdheks.gov/hci/abortion_sum/2014_Appendices.pdf
- “Preterm PROM (pPROM) is more likely to occur in populations of lower socioeconomic status and complicates one-quarter to one-third of preterm births, more than 120,000 pregnancies in the United States each year. The incidence of chorioamnionitis is approximately 15–20% overall, and 40–60% if membrane rupture occurs in the near the limit of viability.”
- Proposed amendment to protect women with pPROM http://www.kslegislature.org/li/b2015_16/measures/documents/fa_2015_sb95_h_1910.pdf
- Kansas House legislative profile for Rep. Barbara Bollier, MD http://www.kslegislature.org/li/b2015_16/members/rep_bollier_barbara_1/
- Legislative history of this law http://www.kslegislature.org/li/b2015_16/measures/sb95/
- Estimated cost for defending this new law. The cost to State of Kansas to defend previous anti-reproductive health bills now exceeds $1.3 million. http://www.kdheks.gov/hci/abortion_sum/2014_Preliminary_Abortion_Report.pdf
- Costs to the State of Kansas to defend anti-choice legislation, as of January 2014 http://cjonline.com/news/state/2014-01-22/ap-defending-kansas-abortion-laws-tops-1m