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The Evidence in the State’s “Woman’s Right To Know” Booklet is Lacking

By TxPEP Investigator Daniel Grossman

Featured in the Austin-American Statesman, August 5, 2016

The day after the Supreme Court ruled that parts of Texas’s abortion law, known as House Bill 2, was unconstitutional, the Department of State Health Services (DSHS) unveiled a revised version of the “Woman’s Right To Know” booklet — a document that physicians are required by law to give to women seeking an abortion that provides them with accurate information to help inform their decision.

DSHS states on its website that “[r]evisions to the booklet will be guided by peer-reviewed scientific and medical literature, resources from professional medical organizations, and government health sources.” 

But rather than ensuring that the information in the booklet is based on the best scientific evidence, DSHS seems to have gone in the other direction. 

There are few references to peer-reviewed medical articles in the document, and some of the articles that are referenced are out of date. Many of the statements contradict those of major medical organizations, including the American College of Obstetricians and Gynecologists and the American Medical Association.

Several of the statements in the “Woman’s Right To Know” booklet seem designed to confuse women, if not outright trick them.  Take, for example, the information provided about the risk of death with abortion compared to the risk with continuing a pregnancy to term.  Fortunately, dying is very rare after both events.  But the best medical evidence—which was quoted in the Supreme Court ruling—indicates that death related to childbirth is at least twelve times more common than abortion-related death.

That is not what a woman would take away from reading the state’s booklet. 

First, the national statistics cited for abortion-related death are out of date. The most recent statistics estimate a lower risk of death associated with second-trimester abortion compared to the statements in the booklet. If DSHS wanted to give women a Texas-specific idea of the risk of death from abortion, they should have said that it approaches zero, since the last death occurred in 2008.

On the other hand, the booklet paints a very rosy picture of childbirth. DSHS presents the risk of death with vaginal delivery as 1 in 500,000 and the risk with cesarean as 1 in 45,500.  Of course, women rarely get to choose the kind of delivery they will have, so a more informative statistic would combine these risks.

According to national data from the US Centers for Disease Control and Prevention, in 2012 there were 15.9 pregnancy-related deaths per 100,000 live births.  Maternal mortality in Texas is a bit higher, possibly due to better reporting.  According to the DSHS vital statistics data for 2013, the maternal mortality rate in Texas is 40 deaths per 100,000 live births—meaning that 1 pregnant woman dies for every 2,500 live births in the state each year.  Women considering their options with an unplanned pregnancy have a right to know this sad and surprising statistic.

The booklet contains other inaccuracies as well.  Statements that fetuses may feel pain early in pregnancy or that abortion may cause breast cancer are not supported by medical evidence.  According to the “Woman’s Right To Know” booklet, a whole host of ills from depression to substance abuse may result from terminating a pregnancy.  A recent large study comparing outcomes of women who obtained an abortion to those who wanted one but were unable to get it because they were just past the clinic’s gestational age limit has provided rigorous data about mental health after abortion.  The many published papers from this study indicate that negative mental health outcomes are not more common among women who obtain an abortion compared to those who initially seek an abortion and continue the pregnancy to term. 

Informed consent is the foundation upon which the ethical practice of medicine is based.  As physicians, we must counsel our patients about the risks and benefits of any treatment based on the best medical evidence.  Just think how hamstrung Texas doctors must feel when they hand out the “Woman’s Right To Know” booklet, knowing that the information it contains is inaccurate, out of date and misleading.  In order to fulfill its responsibility as a public health agency, DSHS should revise the booklet to contain only medically accurate information that is informed by the most up-to-date scientific evidence.

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