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Physicians Consider Ohio’s Latest Proposed Abortion Law “Pure Science Fiction”

Lauren Sega Lauren Sega Physicians Consider Ohio’s Latest Proposed Abortion Law “Pure Science Fiction”Photo via Flickr.
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The Ohio legislature is considering its fourth abortion restriction in just six months. 

Aimed at blocking private insurance companies from covering abortions, the bill is getting attention from physicians in Ohio and beyond for including misinformation about ectopic pregnancies, a serious, life-threatening condition that is a leading cause of maternal mortality.

If passed, House Bill 182, sponsored by Rep. John Becker (R-Union Township), would strip private insurance coverage from abortions, unless performed to preserve the life of the mother. 

In the case of ectopic pregnancies — in which the fertilized egg implants outside the uterus — the bill allows an exception for a procedure “intended to reimplant the fertilized ovum into the pregnant woman’s uterus,” a procedure that medical professionals say does not exist.

“There is no role for removal of an ectopic pregnancy with re-implantation of that pregnancy into the uterus,” says Erika Lena Boothman, an OBGYN Resident in Columbus. “Once a pregnancy has implanted somewhere in the body, it cannot be re-implanted and continue to become a normal, healthy, viable pregnancy. This is a common question that I hear from patients.”

Catherine Romanos, a family doctor and a member of the Physicians Action Network, says ectopic pregnancies are extremely difficult to diagnose, even for the most experienced clinicians.

“And partly because of that, it is one of the leading causes of maternal mortality,” Romanos says. “Any barrier to care in the setting of suspected ectopic can lead to infertility or death for a patient.”

The vast majority of ectopic pregnancies are located in the Fallopian tube, though some can occur in the abdomen, cervix, ovary and cesarean scar (of the uterus). These pregnancies are the cause of 4% of maternal deaths.

There are two ways to treat ectopic pregnancies: with medication (a single or multiple injections of methotrexate) or with surgery. The surgery involves either opening the Fallopian tube, removing the ectopic pregnancy, and then repairing the Fallopian tube; or by removing part or all of the Fallopian tube with the ectopic pregnancy. The latter provides more definitive management, says Boothman, because there is a much lower chance of leaving ectopic pregnancy tissue behind. If left behind, that tissue can continue to grow and cause life-threatening bleeding.

San Francisco-based Dr. Daniel Grossman, MD, a clinical and public health researcher on abortion and contraception, took his own stance on Ohio’s bill. In an eight-tweet thread directed at Representative Becker, Grossman explains the same science laid out by Boothman and Romanos, adding that ectopic pregnancies occur 1% – 3% of the time and estimating that at least 2,000 Ohio women have one each year. 

“I was concerned to see HB182 removes insurance coverage for this treatment [for ectopic pregnancies],” Grossman tweeted. “Unfortunately, an ectopic pregnancy cannot be ‘reimplanted’ into the uterus. We just don’t have the technology. So I would suggest removing this from your bill, since it’s pure science fiction.”

Controversy around the bill goes beyond its misinformation on ectopic pregnancies, though; it also targets long-acting reversible contraceptives (LARCs), including copper IUDs (commonly called ParaGard). Per the bill, private insurance companies would be prohibited from covering “nontherapeutic abortion,” which in the bill includes “drugs or devices used to prevent the implantation of a fertilized ovum.”

Boothman has two qualms with the wording of this provision, first with its use of the term “nontherapeutic abortion.”

“Differentiating between the terms ‘therapeutic’ vs ‘nontherapeutic’ abortion is controversial in medicine,” she says. “Technically, all procedures that a patient wants or needs, are ‘therapeutic,’ just like performing an appendectomy for a patient with appendicitis could be considered a ‘therapeutic appendectomy.’ Language obviously matters a lot in these situations. The word ‘abortion’ actually just refers to a pregnancy that ends prior to 20 weeks gestation. The medical phrase for miscarriage is actually ‘spontaneous abortion.’”

Then there’s the bill’s apparent misunderstanding of pregnancy itself, which Boothman says Becker is incorrectly defining as simply a fertilized ovum, “whereas medical professionals define pregnancy as a fertilized ovum that has implanted.”

Boothman says Becker’s incorrect definition of pregnancy would classify ParaGard IUD’s, which prevent implantation of a fertilized egg, as an abortifacient, meaning women who rely on them to prevent pregnancy could lose their ability to pay for them.

House Bill 182 follows three other abortion restrictions passed by the Ohio legislature: a 20-week ban passed in November, an attempted ban on a common second trimester abortion procedure, D&E, in December, and a six-week ban last month. It has been introduced in the House and has had a hearing in the House Insurance Committee. Along with Becker, 19 other representatives have signed on to the bill. 

View the full bill here.

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