Texas Gov. Greg Abbott (R) last week signed a bill that will increase medically unnecessary reporting requirements for abortion providers. Supporters of the new regulations say they are needed to ensure the accuracy of data collected by the state.
Anti-choice lawmakers and activists have a complicated relationship with truthful facts and figures, as pro-choice advocates have shown.
Reproductive rights advocates contend that the Texas GOP law is part of a national effort by anti-choice activists to manufacture evidence to support the claim that abortion care is unsafe, despite the overwhelming evidence that abortion is a safe and heavily regulated medical procedure.
‘The Data Shows Abortion Is Safe’
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When Abbott called lawmakers back to Austin for a special session, he included legislation aimed at “strengthening the laws applicable to the reporting of abortions and abortion complications” on his priority agenda.
The bill defines what qualifies as an abortion complication with a long list of adverse outcomes: shock; uterine perforation; cervical laceration; hemorrhage; aspiration or allergic response; infection; sepsis; damage to the uterus; incomplete abortion; an infant born alive after the abortion; or the death of the patient.
A facility that violates this law would be subject to a civil penalty of $500 for each violation, and a third violation could result in the revocation or suspension of the facility’s license.
Under prior Texas law, each facility that provides abortion services must submit an annual report to the Department of State Health Services (DSHS). These reports document each abortion performed at the facility— including patients that experienced complications.
Since 2013, Texas has required facilities that provide abortion services to report the occurrences of complications from abortion. The data shows that complications are exceedingly rare. There were 25 complications out of 54,310 procedures in 2015; 22 complications out of 53,882 procedures in 2014; and 30 complications out of 61,912 procedures in 2013.
This low rate of complications from abortion care raised questions about the intent of the Republican-backed legislation. During a committee hearing on the bill, Rep. Jessica Farrar (D-Houston) cited the low rate of complications from abortion in the state and asked Capriglione, “what problem you’re trying to get at.”
“We don’t really have unbiased or complete information when it comes to abortion complications,” Capriglione said.
Andrea Ferrigno, corporate vice president of Whole Woman’s Health, told Rewire that claims made by GOP lawmakers and anti-choice activists were based on the “biased assumption” that abortion is not a safe medical procedure.
“Just because the data shows information that you don’t agree with doesn’t mean that it’s incorrect,” Ferrigno said. “The data shows abortion is safe with a very low complication rate, and just because you don’t like that outcome doesn’t mean it’s incorrect.”
Capriglione and other lawmakers claim the state’s abortion statistics are biased or incomplete. There is, however, a bevy of regulation and oversight over the reporting and collection of the data. DSHS officials conduct annual on-site inspections of each abortion clinic licensed by the state, and these inspections include an audit of the clinic’s records and documents.
Ferrigno said that the clinic staff’s interactions with state officials can vary, and there are inconsistencies with how the state’s surveyors conduct on-site inspections and audits.
“We have to pay attention and be aware that there may be an attitude during the inspection, depending on the comfort of that surveyor in coming into an abortion clinic,” Ferrigno said.
While some of the state’s surveyors are “incredibly professional,” Ferrigno said that sometimes surveyors who appear to be personally opposed to abortion rights can attempt to penalize the clinic for violations that do not exist in the regulations.
“They tend to be very aggressive, they tend to be incredibly rude,” Ferrigno said. “We oftentimes have to notify our attorneys right away because we’ve experienced a lot of inappropriate behavior from surveyors in the past.”
‘It’s About Trying to Couch Abortion as Dangerous’
Abbott was joined by GOP lawmakers last Tuesday for a private ceremony to sign a pair of anti-choice bills passed during the special session. The governor said in a statement that HB 13 would result in more accurate data.
“The health and safety of women is of the utmost importance, and we must have the most accurate data available in order to create good policy,” Abbott said. “This bill is an important step toward providing Texas with critical information when abortions are performed.”
Abbott’s comments echoed the rhetoric Texas lawmakers used to justify the passage of the anti-choice omnibus law known as HB 2, a law that would eventually be partially struck down by the U.S. Supreme Court. However, for abortion providers these regulations are not about the “health and safety of women,” but about increasing the regulatory burden for providers and choking off access to abortion care.
“There are all these administrative requirements that are just meant to further stigmatize abortion care, and to add administrative obstacles that at the end of it all add no benefit to the practice of medicine,” Ferrigno said. “Abortion is one of the safest medical procedures. This type of reporting doesn’t prove anything. It doesn’t identify any trends that would bring any type of medical benefit to the practice of abortion care.”
Ferrigno said the legislation is duplicative since Whole Woman’s Health and other abortion providers in Texas already report complications from abortion to the state. “The time frame might be different, but the cases are reported nonetheless,” Ferrigno said.
Abortion clinics today are required to submit an abortion complication report within 30 calendar days after the complication is discovered. This report must include detailed information about the patient, the facility, and the types of complication.
Under the new law, physicians will be required to submit abortion complication reports by the “third business day after the date on which the complication is diagnosed,” and abortion clinics and other medical facilities will be required to submit a complication report within 30 days after the complication was diagnosed.
These layers of reporting requirements will require that a single abortion complication be documented in least three separate reports.
‘Well Beyond Any Public Health Purpose’
Capriglione and other lawmakers repeatedly called into question the accuracy not just of the data collected by the state of Texas, but also data collected by research organizations and federal agencies.
The U.S. Centers for Disease Control and Prevention (CDC) in 1969 began compiling abortion statistics to document the number and characteristics of pregnant people who obtained legal induced abortions. The CDC does not track the number of abortion complications, but the agency’s annual surveillance report does track the “relatively small number” of abortion-related deaths.
The Guttmacher Institute, which independently surveys abortion providers throughout the country, also compiles and publishes data on abortion.
Elizabeth Nash, senior state issues manager at the Guttmacher Institute, told Rewire that the abortion statistics produced by the CDC and the Guttmacher Institute are “quite accurate,” and that there are very few other medical procedures that have the kind of data that is available for abortion.
Nash points to data from both the federal and state level that proves the safety of abortion care. “There are some states that do require reporting for complications, and you can look at the data coming from those states and also see that abortion is very safe.”
Nash told Rewire that after abortion was legalized in the United States, collecting data on abortion served a real public health purpose. But in recent years abortion opponents have proposed new laws that significantly increase reporting requirements for abortion providers.
“What we’ve seen recently, and what we’ve seen proposed by abortion opponents, has gone well beyond any public health purpose,” Nash said. “It’s about targeting providers. It’s about trying to couch abortion as dangerous.”
Forty-six states require medical facilities and physicians that provide abortion services to submit regular reports to state agencies, and 27 states require providers to report post-abortion complications, according to the Guttmacher Institute.
Many of the provisions in these laws are similar to those found in model legislation by Americans United for Life (AUL), the self-described “legal architect” of the anti-choice movement. The organization creates copycat legislation and distributes the anti-choice proposals to state lawmakers, who then push the measures through legislatures.
The organization advocates for a federal law to create a national database of abortion statistics and for increased reporting requirements for states.
Denise Burke, vice president of legal affairs at AUL, told Rewire in an email the voluntary reporting system used by the CDC results in “inaccurate, unreliable, and incomplete” data, and that reporting requirements are needed to “facilitate reliable scientific studies and research” about the safety of abortion care.
Lawmakers in states across the country have introduced dozens of bills to increase reporting requirements for abortion providers, and in recent years lawmakers have passed various types of reporting requirements in states such as Arkansas, Florida, Georgia, Indiana, Oklahoma, Tennessee, and Utah.
In 2010, the GOP-controlled Arizona state legislature was among the first states to pass legislation requiring abortion providers to report abortion complications and submit annual reports to the state and requiring the state Department of Health Services to publish an annual report.
The data published in the state’s annual report shows there have been very few complications resulting from abortion procedures reported in the state: From 2011-2015, less than 1 percent of abortions procedures in the state resulted in complications.
Arizona reported that 82 patients experienced complications out of 12,479 abortion procedures in 2015; 137 patients experienced complications out of 12,747 abortion procedures in 2014; 102 patients experienced complications out of 13,254 abortion procedures in 2013; 76 patients had complications out of 13,129 abortion procedures in 2012; and 60 patients experienced complications out of 14,401 abortion procedures in 2011.
The most recent data by states that require abortion providers to report abortion complications— including Ohio, Oklahoma, Michigan, Minnesota, Mississippi, Nebraska, Oregon, Pennsylvania, South Dakota, and Wisconsin—reveal consistently low rates of complication.
‘They’re Putting Paper Before People’
Nash told Rewire that the Supreme Court’s decision in Whole Woman’s Health v. Hellerstedt showed that “evidence matters,” and the state of Texas did not present evidence that the restrictions benefited the health and safety of abortion patients.
“Part of the motivation in further trying to identify complications from abortion could be that they are trying to develop an evidence base to try to show that restrictions are working,” Nash said.
Laws that target abortion providers with excessive regulations force physicians to spend more time on administrative issues and less time with patients, which may have a negative impact on health-care outcomes.
“You’re trying to add administrative work for physicians, who should be focused on patient care,” Ferrigno said. “The physicians want to spend time with patients talking about what matters most to them, what are their concerns, what are their health-care outcomes.”
Ferrigno told Rewire that laws like HB 13 are just another example of lawmakers undermining the “health and safety of women” they claim to protect.
“This legislation is trying to put barriers between the doctor and patient,” Ferrigno said. “They’re putting paper before people, and that is not patient-centered care.”