Doctors say abortion ban at 15 weeks in Florida is 'bad medicine and bad policy'
A bill now before the Florida Senate to ban abortion after 15 weeks may force families to raise children with special needs and cost the state Medicaid program millions for their care, according to physicians who oppose the measure.
Expectant women who undergo screening and testing for potential fetal abnormalities through amniocentesis don't have the procedure before week 15, physicians say. That would put them beyond the time frame for an abortion under the proposed law if a genetic abnormality is found.
Families who would have ended pregnancies because of severe abnormalities will have to travel to another state where abortion is allowed later in the pregnancy, or they will be left to raise children who will require considerable medical care and dramatically change the family’s quality of life.
Proponents of the bill say birth defects like Down syndrome and cystic fibrosis don't justify abortions. There is an exception in the bill to allow for abortion after 15 weeks when two physicians certify the infant will die shortly after birth, but physicians say that is too narrow.
“There are many things considered lethal by obstetricians and geneticists that are diagnosed after 15 weeks but do not meet the bill’s definition of lethal which is ‘shortly after birth,’” Dr. Kristen Witkowski, an obstetrician/gynecologist in Tampa, said in an email.
“Some anomalies are lethal immediately; some might take days, weeks, months, or even years depending on the issue,” she said. “So I am not sure who will be deciding what lethal is: those of who actually went to medical school or our lawmakers.”
Leaders of reproductive rights’ groups and physicians are making last-ditch efforts to appeal to the Republican-controlled Legislature that the bill will do more harm than good.
Roughly 700 physicians in Florida signed an open letter to the state Legislature opposing the 15-week abortion ban, calling it an “alarming attempt to improperly insert politics into the patient-clinician relationship” and said the consequences for Floridians would be dire.
Currently, abortion is legal in Florida up to 24 weeks of pregnancy.
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“This legislation is bad medicine and bad policy, and we urge you to reject it for numerous reasons,” the letter states.
State senator Kelli Stargel, R-Lakeland, sponsor of the Senate bill and who became pregnant as a teenager with her daughter, said in a recent statement that more is known today about fetal development since Roe was passed.
“We also know that later-term abortions pose greater health risks to women,” she said. “Having once been a scared teenage mother myself, I understand the challenge and anguish of a woman facing an unplanned pregnancy, but I support life, and believe we have a duty to protect it.”
The abortion bill is in the hands of the full Senate vote where it is all but certain to pass before being sent to Gov. Ron DeSantis. The governor repeatedly has said he would support tighter abortion restrictions. The law would take effect July 1.
How many abortions are done in Florida?
Besides creating hardships for women to have an abortion because of genetic abnormalities with the fetus, the bill does not make an exception for pregnancy caused by human trafficking, rape or incest.
State data shows roughly 1,000 women had abortions last year because of rape, incest or genetic abnormality.
There were 79,648 abortions performed in 2021 in the state, of which 59,252 were listed as elective for 74% of the total, according to data from the state Agency for Health Care Administration.
State data shows 16,822 abortions were done because of social or economic reasons and 1,503 abortions were for the psychological health of the mother. Another 1,060 abortions were for the health of the mother yet not for life-endangering reasons, the data shows.
There were 757 abortions due to “serious fetal genetic defect, deformity or abnormality” and another 119 abortions were performed because of a life-endangering condition to the mother.
Under the bill, abortion after 15 weeks would be allowed in an emergency to save the woman's life or when there's risk of a physical impairment to the mother if she carried the pregnancy to full term.
The state data shows eight abortions were performed because of incest and 118 were done because of rape.
Of the 757 abortions because of serious genetic defect or some other abnormality, the state data shows 64% of them, or 484 abortions, were done in the second trimester. The second trimester starts at week 13 and ends at week 26, according to the Mayo Clinic.
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What about amniocentesis?
Testing through amniocentesis to determine if a genetic abnormality or other developmental disability is occurring is not done before 15 weeks because of the risk of losing the pregnancy, said Dr. Daniel Sacks, an obstetrician/gynecologist and medical director of Presidential Women’s Center in Palm Beach, said.
If it is done in week 16 or later, and the results take 10 days, that pushes the mother well beyond the abortion cut-off unless two physicians certify there is a fatal fetal abnormality, he said.
That’s not the majority of genetic or other developmental abnormalities so families who may want to terminate a pregnancy will not be able to do so or have to go out of state, Sacks said.
John Stemberger, an attorney and president of the Florida Family Policy Council, said the bill does not prohibit amniocentesis at any stage of a pregnancy.
“So it clearly does not make this test for genetic abnormalities more challenging,” he said.
“The new law would prohibit the abortion of unborn children after 15 weeks just because they have Down syndrome or other similar non-fatal ‘defects,’” he said. “The destruction of a child in utero because they have a ‘defect’ or ‘abnormality’ is a barbaric policy and should never be tolerated in a civilized society.”
In the unfortunate case where a child is diagnosed with a terminal or fatal condition, then the bill does allow for that exception, he said.
Sacks estimates roughly 2,000 babies will be born each year in the state with genetic abnormalities or other developmental disabilities and who will have diminished quality of life and where the families otherwise would have chosen to end the pregnancies.
“They live but they will not have quality of life, and neither will their families,” he said. “The families are going to be devastated.”
Sacks said he tried to explain the issues to a state senator who responded that the state plans to increase funding for the care of children with special medical needs.
“That’s total garbage,” he said.
Sacks estimates hospitals will face millions more in neonatal intensive care unit costs because of care the infants will need, and the state Medicaid expenditures will increase by millions as many pregnant women and their children are on Medicaid.
Stemberger said there is no evidence that Medicaid costs will skyrocket as a result of this new law.
“Many other states prohibit abortions where the unborn child has a disability, and there has been no financial impact that has not been easily absorbed,” he said. “Further, it is ethically problematic and offensive to argue for the destruction of children with disabilities simply because of an economic impact to the state.”
Witkowski, the OB/GYN in Tampa, said the bill is devastating to patients and their families.
“This bill is cruel and there is no other word for it,” she said. “The definition of 'dying shortly after birth' is far too narrow to encompass the complexity of some of the diseases or anomalies we are diagnosing.”
Witkowski said she would like to know which lawmakers voting for the bill have had to “quit their job, drastically reducing income, to care for their child who needs 24-hour care?” she said.
“If these lawmakers really cared about value and dignity of human lives, they would be passing laws that increase access to health care and prenatal care and birth control,” she said. “Most of the supporters of this bill are not interested in that.”
The Florida chapter of the American College of Obstetricians and Gynecologists said the certification by two physicians of an expected fatal fetal abnormality may be challenging in some care settings and in rural or poorer communities where there may only be one physician in a care setting.
“Requiring a second physician to verify a diagnosis in order to provide medically necessary and potentially life-saving care creates unnecessary, harmful red tape,” the group said in its statement.
Bill harmful to low income and rural residents
The letter that hundreds of Florida physicians signed and sent to state lawmakers against the legislation said it will inflict harm to residents already facing barriers to care, including people of color and those in rural communities.
“Our patients here in Florida would be forced to travel an average of 570 miles farther to the nearest clinic, significantly increasing both the cost and the risks associated with pregnancy, particularly for those patients with high-risk pregnancies,” the letter said.
There are 12 rural counties where no abortions were provided for most of 2021, according to state data.
Sacks, the Palm Beach physician, said he gets patients from Jacksonville and the Panhandle for abortions.
“Now we are getting them from Texas,” he said, referring to the law that took effect last September prohibiting abortion after about six weeks of pregnancy.
The Florida bill condemns pregnant women, especially Black, Indigenous and low-income women to carry unwanted pregnancies to term, said Amber Gavin, vice president of advocacy and operations at A Woman’s Choice in Jacksonville.
Some patients with the resources will have to travel to another state to access care after 15 weeks of pregnancy but others will be in a bind, she said.
“Many will be forced to take time off from work, find child care, and find the resources to cover travel, lodging and the cost of the procedure,” she said.