NH’s abortion limits, debt relief, have side effects for the health system Local news


LEBANON – While the national debate this summer focused on controversial Texas abortion restrictions, New Hampshire Republicans have also worked to tighten access to abortion in Granite State.

Healthcare providers in the Upper Valley said the results are likely to create barriers to health care for low-income women and interfere with complex medical decisions that are best left to doctors and patients.

“[This] is changing access to quality health care for the entire state of New Hampshire, ”said Dr. Ilana Cass, Chair of the Department of Obstetrics and Gynecology at Dartmouth-Hitchcock Medical Center.

Last Wednesday, the state’s five-member Executive Board, which has the final say on most state treaties, rejected a six-month extension of agreements with several family planning clinics across the state, including Planned Parenthood of Northern New England, which operates centers in Keene, Claremont and Brattleboro. The money would have funded services including birth control and screening for sexually transmitted infections and cancer for thousands of low-income residents, according to information provided by state health officials to executive boards prior to the vote. The law does not allow government funds to be used for abortion services.

The four Republican councilors who rejected the contracts raised concerns that the funds would mix with other clinic revenues used to support abortion, despite a recent state audit found that the clinics are keeping family planning and abortion funds separate.

Outside of Dartmouth-Hitchcock Medical Center, Upper Valley women seeking an abortion can visit the Planned Parenthood White River Junction Clinic in Vermont. This clinic offers medication or inpatient abortions for up to 11 weeks and six days of pregnancy.

Gifford Medical Center in Randolph, Vt., The only hospital other than Dartmouth-Hitchcock Medical Center in the Upper Valley that still gives birth, does not perform abortions.

Dr. Pat Glowa, a half-retired family doctor from Dartmouth-Hitchcock, said the rejection of contracts linked to a post-24 week abortion ban that comes into effect Jan. 1 will “have a significant public health impact. ”

The contracts aim to make reproductive health care accessible and affordable for people on low incomes, Glowa said. They also aim to ensure that clinics are able to meet patient needs. According to a press release, the Planned Parenthood award amount would have been $ 238,464, or approximately $ 47,693 for each of the organization’s Granite State health centers, for the six-month period.

“What if you don’t get an appointment because the center is overloaded?” Said Glowa.

The 24-week ban on abortions was particularly worrying for Cass of Dartmouth-Hitchcock Medical Center, who said that such procedures are “extremely rare” and sought after by patients in difficult circumstances.

Such procedures are only required if the mother’s health is threatened, the fetus cannot survive on its own, or a woman becomes a victim of rape or incest, she said. The new law provides an exception to the 24-week ban when the mother’s life or health is threatened, but not because of a fetal abnormality, rape, or incest.

Cass estimates that in the past 15 years only 10 patients have attempted to terminate pregnancy at Dartmouth-Hitchcock Medical Center after 24 weeks of gestation.

Both Cass and Glowa said the bill sets a worrying precedent for health care in the state that could deter providers from coming to New Hampshire to exercise or practice.

“Finding a late abortion for a fatal fetal abnormality generally arises out of compassion to prevent inevitable suffering and eventual death of an affected fetus,” said Glowa. “These are not random decisions. They are not made easy. “

After January 1, such patients, except for those whose own life or health is threatened by continued pregnancy, will need to have an abortion outside of New Hampshire, Cass said. Your department will likely refer women to academic medical centers in neighboring Vermont and Massachusetts.

The law also requires health care providers to do ultrasound scans to determine the gestational age of a fetus before any abortion, which is not always necessary, according to Cass.

For example, an ultrasound may not be needed to determine the age of a fetus if a woman seeking an abortion is very sure of her last normal menstrual cycle, has very regular cycles, and is early in the pregnancy, she said.

“There is no place for a politician to question this literature, experience and good practice,” said Cass.

If doctors fail to comply with the new law, they face a prison sentence of up to seven years and a fine of up to $ 100,000. The law also allows the husband of a patient who has an abortion after 24 weeks and the parents of a patient under 18 who has an abortion after 24 weeks to seek “reasonable relief”, including financial compensation for mental and physical harm that resulted from the demolition.

“If you are punished with criminal offenses … it has a significant chilling effect on people’s ability to practice their skills and knowledge,” said Glowa.

Cass said she was concerned that this would lead to the criminalization of elements of good practice as set by medical organizations and believes lawmakers have exceeded their limits in dictating how doctors provide care.

“That’s absolutely not in their training,” said Cass. “This is a philosophical gateway to what is a science fiction novel.”

New Hampshire has already seen a consolidation in obstetric and gynecological care in recent years as maternity wards in most small hospitals closed due to costs that exceeded revenue and struggled to find providers.

Cass said she was concerned that the new law and penalties for violating it will deter obstetricians from coming or staying in New Hampshire.

The Executive Council on Wednesday approved contract extensions for four other family planning service providers – none of which are in Obertal – that do not offer abortion care.

Governor Chris Sununu, a Republican who signed the 24-week abortion ban this summer, expressed disappointment at last week’s executive board vote on clinic contracts.

Sununu, who is sticking to the 24-week ban, recently agreed in an interview with NH Public Radio to take up the issue of mandatory ultrasound again.

“If they’re too troublesome or don’t make sense, then by all means I’m always ready to go back and try to change that, and I suspect we’ll be doing that in the next few months,” Sununu told NHPR.

A Sununu spokesman told NH Bulletin this month that as a proponent of abortion law, he would not sign a bill like the New Texas one.

About 2,200 abortions were performed in New Hampshire in 2017, the last year for which data was available from the Guttmacher Institute, a New York-based nonprofit abortion policy group. According to the institute, the abortion rate in New Hampshire fell 12 percent from 2014 to 2017, from 10.4 to 9.2 abortions per 1,000 women of childbearing age.

Vermont, where 1,300 abortions were performed in 2017, saw the abortion rate decrease by 5 percent from 2014 to 2017.

Proponents of abortion rights in Vermont are moving forward with Proposal 5, also known as the Reproductive Liberty Amendment, which would enshrine abortion law in the Vermont Constitution.

After being passed for the first time by the Senate and House of Representatives in 2019, proposal 5 was passed again by a newly elected Senate at the beginning of this year. If it were to happen to the House during the upcoming session, due to begin in January, it would go to the electoral vote in November 2022, VTDigger reported this month.

Abortion is already somewhat restricted in New Hampshire. The state requires that patients under the age of 18 seek parental permission for an abortion, Glowa said. In addition, New Hampshire Medicaid does not cover abortions.

“The economically weakest have to pay for an abortion out of their own pocket in New Hampshire,” she said.

Cass warned that it might be difficult to quantify the broader impact of the new restrictions on patients and their health, as it will be difficult to explain to those who choose not to receive treatment.

“This will be another barrier,” she said, “another pebble on her way to exercising her right.”

This article is shared by a partner in The Granite State News Collaborative. For more information, see Collaborativesh.org.

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