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Wisconsin Law Increases Abortion Delays, Risks, Providers Say

Restrictions on use of drugs to end pregnancies lead to more women having surgical procedures.

The two pregnancy tests she took early last year had come up negative, but this time a faint plus sign surfaced in the plastic window. Samantha, 21, knew immediately what she wanted to do. 

One week later, Samantha and her partner spoke to a counselor at Affiliated Medical Services, a Milwaukee clinic that provides abortions. She determined she would prefer the medication option to the surgical option. This would allow her to terminate the pregnancy earlier by taking two pills.

Carrying a 21-credit load at the University of Wisconsin-Milwaukee and working 40 hours a week at a coffee shop, Samantha hoped to obtain the abortion as quickly as possible.

But then the counselor raised a caveat.

"After she finished explaining the procedure, she hinted to us that it might be a difficult time to procure a medication abortion," said Samantha, who spoke to the Wisconsin Center for Investigative Journalism on condition that her last name not be used to protect her privacy.

Samantha later learned that state lawmakers were planning to change the rules for medication abortions, which could make it more difficult to obtain follow-up care.

"That was really scary," said Samantha, who became pregnant because of a medical condition that rendered her birth control pills ineffective. She decided to wait several weeks to have a surgical abortion as she juggled work and school. She was fatigued and depressed.

A new Wisconsin abortion law, Act 217, went into effect last April. It prompted the state’s two leading abortion providers, Affiliated Medical Services and Planned Parenthood of Wisconsin, to stop providing medication abortions that month.

Affiliated Medical Services resumed offering medication abortions in May, after a legal review. Planned Parenthood, which has filed a federal lawsuit against the law, is still not offering this option.

Billed as a way to make abortion safer for women, the law had the consequence of limiting access to medication-induced abortions, leading more women to have more invasive surgical abortions and putting some women at greater risk by increasing the wait-time for appointments.

Dr. Doug Laube, a University of Wisconsin-Madison professor and former president of the American College of Obstetricians and Gynecologists, has condemned the new law.

"I believe that this law is legislated medicine generated by political ideology and it is a dangerous barrier to women seeking safe and legal nonsurgical abortion," Laube said in a conference call with reporters, organized by Planned Parenthood in December. 

Doctors raise several safety concerns

Dr. Fredrik Broekhuizen, medical director for Planned Parenthood of Wisconsin, said surgical abortions require more time with physicians. This causes scheduling delays and increases the risk of complications. 

Planned Parenthood and Affiliated Medical Services have reported delays ranging from a few days to more than two weeks. This sometimes means that medication abortions can no longer be done.

Additionally, Broekhuizen said, surgical abortions are less safe or even impossible for women with certain medical conditions.

Others prefer medication abortions for the privacy they offer, said Nicole Safar, public policy director for Planned Parenthood Advocates of Wisconsin. Patients are generally able to take the second pill, which expels the contents of the uterus, from home.

"More than the physical piece, for many women medication abortion is the right choice for her entire self — emotionally, psychologically," Safar said. "Many women would prefer to go through the process at home, with their family."

Since the U.S. Food and Drug Administration approved mifepristone and misoprostol pills for abortions in 2000, Wisconsin women have increasingly relied on this option for abortions in the first nine weeks of pregnancy. In 2011, the state reported, 24 percent of the roughly 7,000 Wisconsin women who had abortions in the state chose the medication option.

Matt Sande, who lobbied for the bill with Pro-Life Wisconsin, said his group is pleased with the new law and not upset that providers in Wisconsin stopped offering medication abortions.

"We applauded that, naturally," Sande said. "If Planned Parenthood and Affiliated Medical Services were to permanently suspend medication abortions, it would reduce the induced abortions in Wisconsin by approximately one-fourth."

But the providers tell a different story. Rather than opting out of abortions, Safar said women are traveling out-of-state for medication abortions, or having surgical abortions instead.

Though Safar said the number of surgical abortions for 2012 will not be available until March, she said doctors have noted an increase in surgical procedures, while the total number of abortions has continued to decline as in most years in the past decade. 

Doctors at Affiliated Medical Services also provided more surgical abortions due to their roughly three-week suspension of medication abortions, according to Wendie Ashlock, the clinic’s director. In 2012, Ashlock said, they provided 1,925 surgical abortions, 68 more than the previous year. They also provided 523 medication abortions, 73 fewer than the previous year.

Telemedicine concern spurred new law

Proponents of the change say it is needed to stop doctors from prescribing abortion medication over a webcam, as has happened in Planned Parenthood clinics in Iowa.

Susan Armacost, legislative director of Right to Life Wisconsin, said she and other pro-life advocates feared this practice would spread to Wisconsin, putting women at risk. She cited FDA reports that between 2000 and 2011, 14 women died after taking the drug, though the FDA noted it did not have enough information to attribute the deaths to the medication.

"We thought the doctor should at least see her and give her a physical exam," Armacost said. 

But officials at Planned Parenthood say they had no plans to use teleconferences for medication abortions in Wisconsin.

Similar “telemedicine”-targeted laws have been passed in eight other states, but Wisconsin is the first in which Planned Parenthood has responded by suspending medication abortions.

In December, Planned Parenthood of Wisconsin filed a lawsuit in federal court seeking to get Act 217 either clarified or struck down. They specifically challenge two of the requirements in the law for being “unconstitutionally vague.” Violations of the law may lead to civil and criminal penalties, including jail time, for doctors.  

First, Act 217 requires the physical presence of a doctor when the medication is "given." Broekhuizen, a plaintiff in the lawsuit, said it’s unclear whether the physician must be with the patient when she takes the second pill, traditionally at home.

Second, the law requires that the physician determine the patient is not being coerced, but Broekhuizen said it does not provide clear enough guidelines for doing so.

“I do not understand what is permitted and what is illegal,” Broekhuizen wrote in a court document. “It is unclear to me what a physician must do to ensure compliance.” 

Abortions now harder to obtain

 Before Act 217, Planned Parenthood and Affiliated Medical Services already required medication abortion patients to come to a clinic for a physical exam and counseling 24 hours before receiving the pills. As mandated by Wisconsin law, this includes options for continuing or terminating a pregnancy.

The patient swallowed the first abortion-inducing pill at the clinic, took the second at home, and scheduled a third visit to confirm the termination of the pregnancy.

Sande said he hopes by making the same physician present for verifying the woman’s consent and giving her the abortion-inducing pills, a woman will be more likely to change her mind or reveal that she is being coerced if that is the case.

Vicki Saporta, president of the National Abortion Federation, of which Affiliated Medical Services is a member provider, said this requirement is unnecessary and burdensome. She said it has caused delays in scheduling appointments.

Saporta said this can even result in some women not having abortions — the ultimate restriction on their ability to choose.

“Sometimes, it could be the one more hoop they’re not able to go through,” Saporta said. “Most women are able to find a way, but some are not.”

This story was distributed by the nonprofit Wisconsin Center for Investigative Journalism collaborates with Wisconsin Public Radio, Wisconsin Public Television, other news media and the University of Wisconsin-Madison School of Journalism and Mass Communication.

All works created, published, posted or disseminated by the center do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

J. B. Schmidt January 28, 2013 at 05:44 PM
@Randy That's anecdotal, please provide proof that all that was happening at the rate you claim. Why not a slave? She was convinced that a pill was going to take care of her. She was convinced that since she was granted that right over her own body (slavery in its self since she never need that right granted to her) and thus was protected. She was then forced to take multiple pregnancy test because the pill and her newly granted rights to her body put her in a situation that lead to increased risk. Sounds like a great life. Thank you feminism.
J. B. Schmidt January 28, 2013 at 05:46 PM
@Bren Now you are issuing threats. Way to stay civil.
Greg January 28, 2013 at 05:52 PM
Kathy, The article was not about Samantha not being able to get an abortion of her choice, it was about convenience. "Abortion is legal. It is a woman's right." fine and well, but just because you want an abortion it does not mean that it has to be un-regulated. There are regulations for Samantha getting a tattoo, it's her body, she should be able to get a tattoo when and where she wants, correct? She doesn't have time, between her classes and her job, to get her tramp stamp at a licensed parlor. It's all about convenience.
Randy1949 January 28, 2013 at 05:54 PM
@J.B. Schmidt -- You know nothing. And yet you opine.
J. B. Schmidt January 28, 2013 at 05:58 PM
@Randy Thanks. I had forgotten you were one of the enlightened.
CowDung January 28, 2013 at 06:00 PM
Was the 'debt' finally settled? I thought I saw Keith post that the check was in the mail. I haven't heard from Hoffa acknowledging the receipt of it though...
Hakkimnrobi January 28, 2013 at 06:00 PM
This mean Patch hide real truth.
Bob McBride January 28, 2013 at 06:06 PM
We can't talk about that anymore, CD. Please stick to topics nobody ever gets sick of hearing about, like ALEC and the Koch Bros and Ayn Rand and the like.
Lyle Ruble January 28, 2013 at 06:13 PM
@J.B. Schmidt....You demonstrate that you know absolutely nothing of what was going on prior to the 1960s. Back then things went on just like they do today but they were like cats in a sandbox, covering their s..t up. One of the things that came out of the 60s was less hypocrisy and more transparency. You also need to take into account a nation less than half the size that it is now.
J. B. Schmidt January 28, 2013 at 06:18 PM
@Lyle Where is your proof? Since roe v wade, nearly 55 million abortions have occurred. Please provide proof that comparable amounts of cat s--t was buried in the 50's and earlier?
Greg January 28, 2013 at 06:24 PM
I just honestly posted what was on my mind, saying hi and asking a simple question of my neighbor and Patch friend, about a promise that was made in a recent post. From now on I will attempt to not post about things that Bren wearied of long ago. Not that I fear the "penalty box", but Bren please don't associate me with WPN1488, that is insulting. I just may have to flag that comment.
Jay Sykes January 28, 2013 at 06:24 PM
Do you think the un-intended consequences of being 'known' as the 'Tattle-Tale in Residence' are greater than not settling-up on a financial commitment? :::Beware of the tattle-tale:::
Bob McBride January 28, 2013 at 06:29 PM
Interesting question, Jay. I guess we'll find out, won't we? One might even be tempted to wager...
Lyle Ruble January 28, 2013 at 07:05 PM
@J.B. Schmidt....You ask the impossible. Since the nation was in denial, records were not kept, especially for abortions that were illegal at the time. You are bemoaning that the nation's dirty little secrets have been exposed. All sorts of negatives were kept under wraps including: drug addiction in housewives, the levels of mental illness, domestic violence, child abuse and neglect, etc. It wasn't the Land of Oz.
J. B. Schmidt January 28, 2013 at 07:13 PM
@Lyle Then it is your word that we use to determine the health of the country?
Randy1949 January 28, 2013 at 07:31 PM
Better the word of people who were around at the time than the credulous illusions of someone who wants to believe the picture of American life we saw on Leave It to Beaver was the norm.
J. B. Schmidt January 28, 2013 at 07:48 PM
@Randy Right, because you and I don't have different impression of the 80's in which we both lived. How small do I look with perched up on that horse of yours?
Steve ® January 28, 2013 at 08:03 PM
You're not by buddy pal
Greg January 28, 2013 at 08:07 PM
This self-righteous person posted NOTHING about saving fetuses, now did I? The point was about the process and the hypocrisy of the left, as was pointed out a few posts down. So how many doctors have been prosecuted? The abortions are happening, as the article pointed out. You are doing a good job stomping your feet for PP, but you have no answers.
@-;-'---- Rose January 28, 2013 at 08:53 PM
Donny...and sometimes the law is a ass. I'm OK with sarcasm as one of my sons uses it profusely. He informs me that sarcasm is one of his many services. See I'm trying to lighten up.
Hakkimnrobi January 28, 2013 at 10:59 PM
Life is about choices. Government should not allow bad choice. Murder very very bad choice.
Kathy January 29, 2013 at 02:21 AM
I think condoms should be regulated too. It's a crime to kill them little sprinters. It's just way to easy to walk into a drug store and buy rubbers. What we have here is too many people with emotional prejudices judging on something that has little no effect on their lives, BUT under a guise of individual morals too many feel the need to be right to make anyone disagreeing wrong. Most of my comments are snarky and sarcasm. Shaking my head at some of the comments. Libtards is especially offensive. Liberal and retards as two words to form Libtards is thoughtless and childish.
Kathy January 29, 2013 at 02:39 AM
@JB Schmidt and whoever - When man can get knocked up, deliver and thus not be the one with the physical and mental stress of an unplanned pregnancy (especially if one particpating party does not want child) then by all means I'm all for men having a say in what is to be of the pregnancy. For now though, there is no way to safely DNA test for paternity (during pregnancy) so no way to claim anything. Real catch 22 for you boys. Guess maybe keep it in your pants VS worrying if she's educated enough to know if her birth control is working. I'm just tired of the woman always being blamed for the unwanted pregnancy. IT TAKES TWO.
Kathy January 29, 2013 at 02:52 AM
Judy: I reckon you can make that comment because you kept you're legs closed and never had premarital sex? Or wait you are still a virgin. Ya Okay. *cough* Don't Judge because last time I checked no law regulating sex. *burp*
Liberalism is a mental disease January 29, 2013 at 02:52 AM
And Kathy, when thrice divorced broads like you can reproduce with the help of what the man provides, then you can also have 100 say in the outcome of the human life and being that is created.
Greg January 29, 2013 at 02:53 AM
I will still be Bren's buddy.
Greg January 29, 2013 at 02:57 AM
I agree, the "knuckle dragging neanderthals" are thoughtless and childish.
Kathy January 29, 2013 at 03:03 AM
@ Liberalism is a mental disease (as a forum name is a mental disease) WOW! Thrice divorced broad like me eh? I'm 48. I am in the midst of my first divorce. I'm a bit old now to have children,besides Im still in treatment for breast cancer. Assumptions are the termites of everything in life. Ya took my banter a bit too serious m'dear, step away and get some air hun.
Kathy January 29, 2013 at 03:31 AM
@ Greg I imagine you pounded chest when clicking submit? ah0oooo-ga *sticks tongue out*
Greg January 29, 2013 at 03:55 AM
Does it make you hot? Me Tarzan...

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