By Marshall F. Goldberg / For The Herald
Washington should become a sanctuary for those denied reproductive freedom in other states.
It already leads the nation when it comes to being proactive in response to the recent devastating reversal of Roe v. Wade. Thanks to the foresight of the governor, and the Legislature, steps have been taken to ensure the availability of mifepristone, the medication used in half of the nation’s induced abortions, and to “shield” abortion care providers in Washington from prosecution by states that ban or severely prohibit such practice.
Washington has a long and strong history of paving the way for reproductive choice. In 1970 with Referendum 20, it became one of the first states before Roe v. Wade to decriminalize abortion. In 1991 Initiative 120 was passed which ensured that the “state may not deny or interfere with a pregnant individual’s right to choose to have an abortion prior to viability of the fetus, or to protect her life or health.” In 2018 The Reproductive Parity Act became law, which specified that health plans may not limit abortion services, and that if health coverage included maternity care, it must also provide coverage permitting abortion. In 2022 The Affirm Washington Abortion Access Act was passed, which expanded the list of providers statutorily authorized to terminate pregnancies and ensured that abortion care providers would be able to serve any person who came to the state of Washington seeking abortion services.
My history as an obstetrician-gynecologist dates to the start of the Roe v. Wade era with the beginning of my clinical training in July of 1973. I was among the first resident physicians in the country to be formally trained in first and second trimester pregnancy termination techniques. Care for abortion patients was considered essential by my program director. Every resident was expected to participate at some level because patients with miscarriages — i.e., spontaneous abortions — would be seen in an OB-GYN practice, and it was important to know how to manage them. Because of Roe v. Wade, I would not see a single patient suffer the deadly consequences of a septic illegal abortion, either in my residency or in all the years of my clinical practice.
Like many physicians of my generation, and those that followed, I took for granted the availability of induced abortion as a back-up for unintended or unwanted pregnancies. While there were effective methods for birth control available, none of them were perfect. When screening for birth defects that were incompatible with life or marked by significant disease/disability, it was a given that pregnancy termination was an available remedy. In other specialties, where radiation or chemotherapy was needed, abortion prevented a pregnancy coming to term that might be severely affected by those treatment modalities. When patients were inadvertently exposed to medications that can cause birth defects in early pregnancy, abortion prevented a tragic outcome.
The U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, in June, 2022, shook the very core of reproductive health care in this country by reversing Roe v. Wade. No longer was access to legal abortion a constitutional right. While states hostile to abortion services had endeavored in the past to make such care more difficult to obtain, it was the first time in nearly 50 years that they could systematically ban it. Subsequently, 26 states were able to enforce laws already in place or planned to enact laws outlawing or severely restricting the practice. In all, these actions could affect 58 percent of people capable of pregnancy in this country.
Since that fateful day, the impact on women’s health care has been substantial and continues to expand. As examples, in states where abortion has been outlawed or markedly restricted, pregnant women with miscarriages or very early preterm rupture of membranes, who are at risk for severe bleeding or infectious complications, respectively, are not necessarily getting the timely interventions they need if fetal heartbeats are detected. Health care providers, confused by the variable interpretations of these abortion laws, are worried that they might be subject to criminal prosecution if they intervene prior to fetal demise. Women now wanting to terminate their pregnancies face many more hurdles, not the least of which is the ever-growing need to travel out-of-state with its attendant costs. If these same states greatly curtail access to abortion medications, by whatever means, this predicament will only get worse.
The availability of abortion in Washington state is attracting residents from other states. In just the six months following the Dobbs decision, the number of patients seeking abortion has increased significantly in the state, and many of these patients are coming from nearby Idaho where abortion is now banned.
Given the dire circumstances, and what’s at stake for those capable of pregnancy, it is imperative that Washington become and promote itself as a “sanctuary state” for reproductive health care. This means providing medical and surgical abortions, and the resources needed to access these services, for all pregnant people, even those who are not residents of the state. It also means providing educational opportunities for those out-of-state physicians, nurse practitioners and physician assistants who need or desire training in abortion care. This will be necessary until the right to an abortion is once again the law of the land and access to it is readily available to all those in need.
Marshall F. Goldberg is a retired board-certified obstetrician-gynecologist, who practiced for 35 years, and provided abortion care where and when it was appropriate for the patient community he served. He lives in Oak Harbor.
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