    [Senate Hearing 113-844]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 113-844

                  S. 1696, THE WOMEN'S HEALTH PROTECTION ACT:
                     REMOVING BARRIERS TO CONSTITUTIONALLY
                         PROTECTED REPRODUCTIVE RIGHTS

    =======================================================================

                                    HEARING

                                   before the

                           COMMITTEE ON THE JUDICIARY
                              UNITED STATES SENATE

                        ONE HUNDRED THIRTEENTH CONGRESS

                                 SECOND SESSION

                                   ----------

                                 JULY 15, 2014

                                   ----------

                              Serial No. J-113-69

                                   ----------

             Printed for the use of the Committee on the Judiciary

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                                            S. Hrg. 113-844

                  S. 1696, THE WOMEN'S HEALTH PROTECTION ACT:
                     REMOVING BARRIERS TO CONSTITUTIONALLY
                         PROTECTED REPRODUCTIVE RIGHTS

    =======================================================================

                                    HEARING

                                   before the

                           COMMITTEE ON THE JUDICIARY
                              UNITED STATES SENATE

                        ONE HUNDRED THIRTEENTH CONGRESS

                                 SECOND SESSION

                                   __________

                                 JULY 15, 2014

                                   __________

                              Serial No. J-113-69

                                   __________

             Printed for the use of the Committee on the Judiciary

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                             U.S. GOVERNMENT PUBLISHING OFFICE

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                           COMMITTEE ON THE JUDICIARY

                      PATRICK J. LEAHY, Vermont, Chairman
    DIANNE FEINSTEIN, California         CHUCK GRASSLEY, Iowa, Ranking
    CHUCK SCHUMER, New York                  Member
    DICK DURBIN, Illinois                ORRIN G. HATCH, Utah
    SHELDON WHITEHOUSE, Rhode Island     JEFF SESSIONS, Alabama
    AMY KLOBUCHAR, Minnesota             LINDSEY GRAHAM, South Carolina
    AL FRANKEN, Minnesota                JOHN CORNYN, Texas
    CHRISTOPHER A. COONS, Delaware       MICHAEL S. LEE, Utah
    RICHARD BLUMENTHAL, Connecticut      TED CRUZ, Texas
    MAZIE HIRONO, Hawaii                 JEFF FLAKE, Arizona
               Kristine Lucius, Chief Counsel and Staff Director
            Kolan Davis, Republican Chief Counsel and Staff Director

                                C O N T E N T S

                                  ----------

                           JULY 15, 2014, 10:03 A.M.

                        STATEMENTS OF COMMITTEE MEMBERS

                                                                       Page

    Blumenthal, Hon. Richard, a U.S. Senator from the State of
      Connecticut....................................................     1
    Feinstein, Hon. Dianne, a U.S. Senator from the State of
      California,
        prepared statement...........................................   103
    Grassley, Hon. Chuck, a U.S. Senator from the State of Iowa......     2

                                   WITNESSES

    Witness List.....................................................    39
    Baldwin, Hon. Tammy, a U.S. Senator from the State of Wisconsin..     4
        prepared statement...........................................    40
    Black, Hon. Diane, a Representative in Congress from the State of
      Tennessee......................................................     6
        prepared statement...........................................    42
    Blackburn, Hon. Marsha, a Representative in Congress from the
      State of Tennessee.............................................     9
        prepared statement...........................................    47
    Chireau, Monique V., M.D., M.P.H., F.A.C.O.G., Durham, North
      Carolina.......................................................    14
        prepared statement...........................................    60
    Chu, Hon. Judy, a Representative in Congress from the State of
      California.....................................................     8
        prepared statement...........................................    45
    Northup, Nancy, President and Chief Executive Officer, Center for
      Reproductive Rights, New York, New York........................    12
        prepared statement...........................................    49
    Parker, Willie, M.D., Birmingham, Alabama........................    16
        prepared statement...........................................    71
    Taylor, Hon. Chris, State Representative, Wisconsin State
      Legislature, 76th District, Madison, Wisconsin.................    19
        prepared statement...........................................    98
    Tobias, Carol, President, National Right to Life Committee,
      Washington, DC.................................................    18
        prepared statement...........................................    75

                                   QUESTIONS

    Questions submitted to Dr. Monique V. Chireau by Senator Grassley   116
    Questions submitted to Nancy Northup by Senator Blumenthal.......   109
    Questions submitted to Nancy Northup by Senator Coons............   106
    Questions submitted to Dr. Willie Parker by Senator Blumenthal...   111
    Questions submitted to Dr. Willie Parker by Senator Coons........   107
    Questions submitted to Hon. Chris Taylor by Senator Blumenthal...   113
    Questions submitted to Hon. Chris Taylor by Senator Coons........   108
    Questions Submitted to Carol Tobias by Senator Graham............   117
    Questions submitted to Carol Tobias by Senator Grassley..........   114

                                    ANSWERS

    Responses of Dr. Monique V. Chireau to questions submitted by
      Senator Grassley...............................................   167
    Attachment to responses of Dr. Monique V. Chireau to questions
      submitted by Senator Grassley..................................   174
    Responses of Nancy Northup to questions submitted by Senators
      Coons and Blumenthal...........................................   118
    Responses of Dr. Willie Parker to questions submitted by Senators
      Coons and Blumenthal...........................................   133
    Responses of Hon. Chris Taylor to questions submitted by Senators
      Coons and Blumenthal...........................................   139
    Responses of Carol Tobias to questions submitted by Senators
      Graham and Grassley............................................   144

                    MISCELLANEOUS SUBMISSIONS FOR THE RECORD

    A Critical Mass: Women Celebrating Eucharist et al., July 15,
      2014, letter...................................................   339
    Abortion Care Network, Dallas Schubert, Chair, and Charlotte
      Taft, Executive Director, statement............................   209
    Abortion Care Network et al., July 14, 2014, letter..............   322
    Abortion Rights Fund of Western Mass et al., July 22, 2014,
      letter.........................................................   325
    Advocates for Youth, Washington, DC, statement...................   350
    American Congress of Obstetricians and Gynecologists (ACOG) et
      al., July 11, 2014, letter.....................................   239
    American Congress of Obstetricians and Gynecologists (ACOG), Hal
      C. Lawrence III, M.D., F.A.C.O.G., Executive Vice President and
      Chief Executive Officer, statement.............................   217
    American Congress of Obstetricians and Gynecologists (ACOG), Hal
      C. Lawrence III, M.D., F.A.C.O.G., Executive Vice President and
      Chief Executive Officer, attachment to statement...............   227
    American Journal of Obstetrics & Gynecology, September 2013,
      article........................................................   202
    Americans United for Life (AUL), Washington, DC, statement.......   358
    Association of American Physicians & Surgeons, The, et al., July
      15, 2014, letter...............................................   376
    Branstad, Hon. Terry E., Governor of Iowa, and Hon. Kim Reynolds,
      Lieutenant Governor of Iowa, July 15, 2014, joint letter.......   367
    Calhoun, Byron C., M.D., F.A.C.O.G., F.A.C.S., F.A.S.A.M.,
      M.B.A., Professor and Vice Chair, Department of Obstetrics and
      Gynecology, West Virginia University-Charleston, July 11, 2014,
      letter.........................................................   374
    California-District IX of ACOG et al., July 15, 2014, letter.....   341
    Center for Reproductive Rights, Nancy Northup, President and
      Chief Executive Officer, July 15, 2014, letter.................   238
    Concerned Women for America Legislative Action Committee
      (CWALAC), Penny Young Nance, President and Chief Executive
      Officer, July 14, 2014, letter.................................   410
    Daugherty, Hon. Duffy, New Hampshire House of Representatives,
      July 15, 2014, letter..........................................   405
    Grau, Hon. Randon J., Oklahoma House of Representatives, July 15,
      2014, letter...................................................   409
    Guttmacher Institute, Susan A. Cohen, Acting Vice President for
      Public Policy, statement.......................................   241
    Henneberqer, Melinda, Politics Daily, ``Kermit Gosnell's Pro-
      Ghoice Enablers (Is This What an lndustry That Self-Regulates
      Looks Like?),'' January 23, 2011, article......................   369
    Ibis Reproductive Health, Kelly Blanchard, President; Amanda
      Dennis, Associate; Kate Grindlay, Senior Project Manager;
      Daniel Grossman, Vice President for Research; Britt Wahlin,
      Director of Development and Communications; joint statement....   245
    Nanney, Hon. Wendy, South Carolina House of Representatives, et
      al., July 15, 2014, letter.....................................   379
    NARAL Pro-Choice America, Washington, DC, statement..............   256
    National Abortion Federation (NAF), Washington, DC, and Abortion
      Providers in Ohio, Pennsylvania, and Tennessee, statement......   307
    National Asian Pacific American Women's Forum (NAPAWF),
      Washington, DC, statement......................................   355
    National Council of Jewish Women (NCJW), Nancy K. Kaufman, Chief
      Executive Officer, statement...................................   264
    National Family Planning & Reproductive Health Association
      (NFPRHA), Clare Coleman, President and Chief Executive Officer,
      statement......................................................   352
    National Latina Institute for Reproductive Health (NLIRH),
      Jessica Gonzalez-Rojas, Executive Director, July 21, 2014,
      letter.........................................................   318
    National Latina Institute for Reproductive Health (NLIRH),
      Jessica Gonzalez-Rojas, statement..............................   332
    National Network of Abortion Funds (NNAF), Stephanie Poggi,
      Executive Director, statement..................................   269
    National Partnership for Women & Families, Debra Ness, President;
      Sarah Lipton-Lubet, Director of Reproductive Health Programs;
      Melissa Safford, Policy Advocate; statement....................   271
    National Women's Health Network, Cynthia A. Pearson, Executive
      Director, July 13, 2014, letter................................   346
    National Women's Health Network, Cynthia A. Pearson, Executive
      Director, statement............................................   347
    National Women's Law Center, Judy Waxman, Vice President for
      Health and Reproductive Rights, statement......................   276
    New York Abortion Access Fund (NYAAF), New York Abortion Access
      Fund Board of Directors, statement.............................   280
    Pence, Hon. Michael R., Governor of Indiana, July 21, 2014,
      letter.........................................................   368
    Perkins, Tony, President, Family Research Council, et al., July
      14, 2014, letter...............................................   365
    Physicians for Reproductive Health, Nancy Stanwood, M.D., M.P.H.,
      Board Chair, statement.........................................   343
    Physicians for Reproductive Health, Nancy Stanwood, M.D., M.P.H.,
      Board Chair and Associate Professor of Obstetrics, Gynecology &
      Reproductive Sciences, Yale University School of Medicine,
      statement......................................................   289
    Planned Parenthood Federation of America and Planned Parenthood
      Action Fund, Dana Singiser, Vice President of Public Policy and
      Government Relations, statement................................   286
    Planned Parenthood Federation of America and Planned Parenthood
      Action Fund, Washington, DC, attachment to statement...........   320
    Planned Parenthood of Southern New England, New Haven,
      Connecticut, statement.........................................   236
    Preterm Birth Paper Publication List (Exhibit 2), July 11, 2014,
      list...........................................................   391
    Psychological Effects Publication List (Exhibit 1), Bibliography
      of Peer-Reviewed Studies on Abortion and Psychological Health,
      July 11, 2014, list............................................   381
    Red River Women's Clinic, Tammi Kromenaker, Clinic Director,
      statement......................................................   295
    Reproductive Health Technologies Project (RHTP), Jessica Arons,
      President and Chief Executive Officer, statement...............   300
    Torres, Leah, M.D., M.S., Salt Lake City, Utah, statement........   251
    Treat, Hon. Greg, Oklahoma State Senate, July 15, 2014, letter...   407
    University of California, San Francisco, School of Medicine,
      Advancing New Standards in Reproductive Health Program
      (ANSIRH), Diana Greene Foster, Ph.D., Acting Director and
      Director of Research, statement................................   232
    Weinstein, Dana, Rockville, Maryland, July 14, 2014, letter......   304

                     ADDITIONAL SUBMISSIONS FOR THE RECORD

    Submissions for the record not printed due to voluminous nature,
      previously printed by an agency of the Federal Government, or
      other criteria
      determined by the Committee, list:.............................   411

    Case files documented August 19, 2011:
        http://www.cruz.senate.gov/files/documents/
          20141218_Stories.pdf.......................................   411

                          S. 1696, THE WOMEN'S HEALTH
                            PROTECTION ACT: REMOVING
                          BARRIERS TO CONSTITUTIONALLY
                         PROTECTED REPRODUCTIVE RIGHTS

                                  ----------

                             TUESDAY, JULY 15, 2014

                                  United States Senate,
                                    Committee on the Judiciary,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 10:03 a.m., in
    Room SD-226, Dirksen Senate Office Building, Hon. Richard
    Blumenthal, presiding.
        Present: Senators Blumenthal, Klobuchar, Franken, Coons,
    Hirono, Grassley, Hatch, Graham, Lee, and Cruz.

             OPENING STATEMENT OF HON. RICHARD BLUMENTHAL,
              A U.S. SENATOR FROM THE STATE OF CONNECTICUT

        Senator Blumenthal. Welcome to everyone. Thank you for
    joining us today. Thank you to our witnesses. Thanks to our
    Ranking Member, Senator Grassley, and most especially to
    Senator Leahy, the Chairman of the Judiciary Committee, for
    giving me this privilege of chairing this hearing.
        We are convened today to hear testimony regarding the
    Women's Health Protection Act: Removing Barriers to
    Constitutionally Protected Reproductive Rights, and our first
    panel consists of a number of our colleagues who have positions
    and views on this issue. We welcome you this morning from the
    House, as well as my colleague Senator Baldwin of the Senate,
    who is my cosponsor in the measure that is now pending before
    the Senate and who has been a leader for a long time in this
    area.
        We have support from more than 30 of our Senate colleagues,
    and my understanding is that the companion measure introduced
    by Representative Chu has 125 cosponsors in the House, or
    thereabouts.
        The reason for this bill is essentially the cascading
    avalanche of restrictions on reproductive health care around
    the country. What we see increasingly is, in effect, an
    avalanche of measures that purportedly protect women's health
    care, but in reality restrict reproductive rights. This bill is
    about stopping laws that purport to be about health when really
    they interfere with the doctor-patient relationship and have
    the effect, the very practical impact of harming women and
    limiting constitutionally protected rights. Our goal, speaking
    for myself, our goal is to stop politicians from playing doctor
    and stop public officials from interfering in significant
    medical decisions that should be made by medical experts and
    patients together.
        This legislation would eliminate limitations on access to
    abortion services and eliminate the targeting and unwarranted
    restrictions against abortion providers and clinics, no matter
    where a woman may live. In fact, more than half the States now
    have these very unwarranted and unconstitutional restrictions,
    and the majority of women in our country live in those States.
    They have passed 92 restrictions on a woman's right to choose
    in those States, since 2011 more than 100, and in 2014 at least
    another dozen of these harmful laws have been enacted. So we
    are talking about serious harassment of reproductive health
    care providers, singling them out for regulations that apply to
    no other medical services, regulations that do nothing to
    improve a woman's health or safety, and, in fact, are more
    likely to harm them. These regulations are designed to shut
    doors of vital health care providers forever, and that purpose
    has been fulfilled across the country as the availability of
    these services has been restricted.
        These regulations are in effect a pernicious charade, and
    one of the purposes that I see in this hearing is to remove the
    patina of respectability and show that they are, many of them,
    irresponsible and even reprehensible. Under the guise of
    protecting women's health care, they actually endanger it.
        I want to thank again our witnesses and my fellow members
    for making this hearing happen. We may disagree on these
    issues, but I know that we are going to have a very
    enlightening and engaging hearing. And I want to turn now to
    the Ranking Member, Senator Grassley, for his remarks.

               OPENING STATEMENT OF HON. CHUCK GRASSLEY,
                 A U.S. SENATOR FROM THE STATE OF IOWA

        Senator Grassley. Thank you to our colleagues in the other
    body that are here, as well as the Senator from Wisconsin, and
    thank you for the succeeding panel that will be here.
        Four and a half years ago, a woman walked into an abortion
    clinic with the expectations that she would have her pregnancy
    terminated and that she would walk out of that clinic without
    major side effects. She was 41 years old and 19 weeks pregnant.
    She had three children, and she was also a grandmother. She and
    her daughter entered the clinic, but she never left alive. Her
    name was Karnamaya Mongar. She was one of the many victims of
    Kermit Gosnell.
        Kermit Gosnell operated a clinic in West Philadelphia for
    four decades. He made a living by performing abortions that no
    other doctor should ever do. The grand jury report charging
    Kermit Gosnell stated, ``Gosnell's approach was simple: keep
    volume high, expenses low, break the law. That was his
    competitive advantage.'' Also according to the grand jury
    report: ``Gosnell ran a baby charnel house. It smelled of cat
    urine. Furniture and blankets were stained with blood.
    Instruments were not sterilized, and medical equipment was
    broken. He provided same-day service. Required counseling was
    ignored. The bigger the baby, the bigger the charge.
    Ultrasounds were forged so that the government would never know
    how old aborted babies truly were. Babies were born alive,
    killed after breathing on their own, by sticking scissors into
    the back of the baby's neck and cutting the spinal cord. These
    were live, breathing, squirming babies.''
        He did not care about the well-being of these aborted
    babies. He did not care about the health of the women. Women
    were put under because he disliked the moaning and groaning and
    screaming.
        This practice and his disregard for the law led to the
    death of two women, including the one that I have already
    mentioned.
        Now, Pennsylvania has a law against abortions after 24
    weeks. It also has a very commonsense law that says women
    should receive counseling about abortion procedures and they
    must wait 24 hours after the first visit to the provider in
    order to fully consider the decisions that they are about to
    make.
        While it is true that Kermit Gosnell ignored the law, these
    laws have saved lives. They have saved women from horrible,
    life-threatening procedures. They have saved babies.
        If the bill we are discussing today, the Women's Health
    Promotion Act, were to become law, Pennsylvania's laws would be
    invalidated. Abortion providers would not be required to
    counsel their patients or give them 24 hours to consider what
    they were about to do. And, more importantly, it would lead to
    inhumane, unsanitary, heinous, dangerous, shocking, and unsafe
    abortions. The law that helped convict Kermit Gosnell would be
    wiped away.
        This proposed legislation is an attempt to override U.S.
    Supreme Court precedent by severely restricting the ability of
    States to regulate abortion. It would invalidate hundreds of
    abortion-related laws, such as clinic regulations, admitting
    privileges requirements, regulations on abortion-inducing
    drugs, reflection periods, ultrasound requirements, conscience
    protections, sex-selection bans, and limitations on the use of
    State funds and facilities for abortion training.
        Now, my home State of Iowa has laws on the books to protect
    the unborn and the health of the women. For example, an Iowa
    law stipulates that when inducing an abortion by providing an
    abortion-inducing drug, a physician must be physically present
    with the woman at the time the abortion-inducing drug is
    provided. That was enacted to ensure that women were not taking
    abortion-inducing drugs via webcam and then far from a medical
    provider who may save the life if a problem came about.
        We also have a law on the books to protect the rights of
    medical professionals. Specifically, the law says: ``An
    individual who may lawfully perform, assist, or participate in
    medical procedures which will result in an abortion shall not
    be required against that individual's religious beliefs or
    moral convictions to perform, assist, or participate in such
    procedures. A person shall not discriminate against any
    individual in any way, including but not limited to employment,
    promotion, advancement, transfer, licensing, education,
    training, or granting of hospital privileges or staff
    appointments, because of the individual's participation in or
    refusal to participate in recommending, performing, or
    assisting in an abortion procedure.''
        Iowa and many other States have taken action on their own
    to make sure that abortions are done safely. They have
    protected individuals from having to kill babies against their
    own religious beliefs.
        Yet the bill before us would invalidate these laws and
    would allow abortion providers to set standards of care for
    their patients with no oversight from the States. It would
    allow health care workers to determine when a life is viable,
    ensuring that there are several and various standards across
    the country. The bill would invalidate laws enacted by 10
    States since 2010, which declare that unborn children are
    capable of experiencing pain at least by 20 weeks of fetal age,
    and that generally prohibit abortion after that point.
        If the bill before us were to be signed into law, the
    Federal Government would send a message to States that enacting
    laws to protect patients and regulate the health and welfare of
    their citizens is not one of their Tenth Amendment rights. It
    would allow Congress to intrude on States' rights and nullify
    such laws.
        This bill is a weak political opportunity before the
    midterm elections. It is unfortunate that the majority is using
    this issue to appear compassionate and concerned about women's
    rights when, in reality, the bill disregards popular and
    commonsense laws enacted in various states aimed at protecting
    women and children across this country and stopping murders
    like Kermit Gosnell. Large majorities of Americans support
    strong abortion restrictions that this bill would overturn.
        This bill will not become law because the American people
    will not support it. I thank the witnesses once again.
        Thank you.
        Senator Blumenthal. Thank you, Senator Grassley.
        We will now hear from our colleagues, and, again, my thanks
    to the Congresswomen who have come to join us. Let us begin
    with Senator Baldwin, if we may.

                    STATEMENT OF HON. TAMMY BALDWIN,
               A U.S. SENATOR FROM THE STATE OF WISCONSIN

        Senator Baldwin. Thank you, Chairman Blumenthal and Ranking
    Member Grassley and members of the Committee, for this
    opportunity. I am encouraged that the Committee is pursuing a
    constructive conversation on this issue, and I am grateful for
    the opportunity to share my work on the Women's Health
    Protection Act.
        I would also like to recognize the tireless advocacy of my
    Wisconsin State Representative Chris Taylor, who is here today
    and will be on the second panel to share her experience working
    to defend women's access to health care in Wisconsin. I thank
    her for her testimony today.
        Americans across the country expect to have access to high-
    quality, dependable health care when they and their families
    need it. Indeed, my colleagues and I have worked to reform and
    improve health care, the entire health care system, to expand
    access to quality, affordable health care options so that all
    patients have health care that meets their needs.
        Unfortunately, for women in this country, this access has
    come under attack. Over the last 40 years, politicians across
    the country have been increasingly chipping away at the
    constitutional rights guaranteed under Roe v. Wade, which
    affirmed that women have the right to make their own personal
    health care decisions and have access to safe and legal
    reproductive care.
        Since that landmark decision by our Nation's highest Court,
    too many States have been trying to turn back the clock on
    women's access to quality care.
        In just the past 3 years, States across the country have
    enacted a total of 205 provisions that restrict women's access
    to safe abortion services. This year, 13 States have been busy
    working to erode women's freedoms and have already adopted 21
    new restrictions designed to limit access to abortion.
        In my home State of Wisconsin, we are now ranked as one of
    the worst States when it comes to women's reproductive rights
    thanks to the restrictive measures enacted by our Governor and
    our legislature.
        To name just one, last year our Governor signed a measure
    forcing women--who are already required by law to make two
    separate trips to the clinic--to also undergo an invasive
    ultrasound 24 hours before receiving abortion care.
        This same law also forces health care professionals to have
    unnecessary admitting privileges at a local hospital. If it
    were not for a Federal judge temporarily blocking this
    provision, two of Wisconsin's four abortion clinics would have
    been forced to shut their doors, and others would have been
    forced to reduce services, leaving many Wisconsin women out in
    the cold.
        But women and their families should not have to rely on
    last-minute court decisions to be able to make the best
    decisions for themselves and their families.
        I recently heard from a mother in Middleton, Wisconsin, who
    was not so lucky. When she found out her baby had a severe
    fetal anomaly and would not survive delivery, she had to endure
    the consequences of the Governor's new law before the Federal
    court judge blocked the provision.
        She had to undergo an emergency termination, and a clinic
    in Milwaukee was the only place that would do the procedure.
    But because the Governor was set to sign the law imposing these
    unreasonable requirements on providers, the clinic was
    preparing to close its doors and would not schedule her
    procedure. She and her husband were forced to find child care
    for their two sons and travel out of State so she could receive
    the medical care that she needed.
        The threat in Wisconsin and in States across the country is
    clear. Some politicians are doing this because they think they
    know better than women and their doctors. And the fact is that
    they do not.
        Women are more than capable of making their own personal,
    medical decisions without consulting their legislator.
        It is not the job of politicians to play doctor and to
    dictate how professionals practice medicine. Nor is it our job
    to intrude in the private lives and important health decisions
    of American families.
        This is why I was proud to be a cosponsor of the Women's
    Health Protection Act with my colleagues Senator Blumenthal and
    Congresswoman Chu to put a stop to these relentless attacks on
    women's freedom.
        Let me conclude by briefly describing the bill.
        The Women's Health Protection Act would prohibit these laws
    that undermine and infringe on a woman's constitutional rights
    guaranteed under Roe v. Wade. Specifically, our bill would
    outlaw any mandate or regulation that does not significantly
    advance women's health or safety. Our legislation also protects
    women by invalidating measures that make abortion services more
    difficult to access and restrictions on the provision of
    abortion services that are not imposed on any other medical
    procedures.
        Congress is responsible for enforcing every American's
    fundamental rights guaranteed by our Constitution. Throughout
    history, when States have passed laws that make it harder--or
    even impossible--to exercise those rights, we have necessarily
    stepped in with Federal protections. The Women's Health
    Protection Act would ensure that every woman--no matter where
    she lives--has access to safe, quality reproductive health care
    without interference from politicians.
        I thank you for your time.
        [The prepared statement of Senator Tammy Baldwin appears as
    a submission for the record.]
        Senator Blumenthal. Thank you, Senator.
        Representative Black.

            STATEMENT OF HON. DIANE BLACK, A REPRESENTATIVE
                IN CONGRESS FROM THE STATE OF TENNESSEE

        Representative Black. Chairman Blumenthal, Ranking Member
    Grassley, and Members of the Committee, thank you for the
    opportunity to testify before you today. As has been said, my
    name is Diane Black, and I am privileged to have the honor of
    serving in the House of Representatives on behalf of
    Tennessee's 6th Congressional District.
        Prior to entering public service, I built my career around
    the health care sector as a registered nurse. My career began
    as an emergency room nurse, where I spent the majority of my
    career, but I have also worked as a long-term care nurse and as
    part of an outpatient surgery team. I decided to run for office
    after I witnessed firsthand how poor public policy was directly
    impacting my ability to deliver health care and, more
    importantly, the unfortunate outcomes on the lives of my
    patients.
        Today I am here to share with you, as a colleague in the
    House, and also as a mother, a grandmother, and a nurse, my
    grave concerns with the Chairman's legislation. Although called
    ``The Women's Health Protection Act,'' this bill would nullify
    and declare unlawful any law at any level of the Government--
    whether Federal, State, or local--that presents what the bill
    deems to be an undue burden on women seeking an abortion. This
    legislation would effectively overturn the majority of State
    laws regulating abortions.
        As a nurse, I can tell you that abortion is unlike any
    other medical procedure. This is an act that does not just
    involve the mother, but the child. It takes the life of an
    unborn child and in the process imposes many serious medical
    risks to the mother.
        To be clear and transparent, I am unapologetically pro-
    life. And while I believe that the life of an unborn must be
    protected, I also believe that we must do everything in our
    power to protect any woman who decides to have an abortion,
    even though I may disagree with their choice.
        During my time in the ER, a young woman came in after
    having complications with her abortion, which had been done at
    a clinic that was not regulated properly. When the
    complications occurred, there was no answer at the after-hours
    number that she called. And by the time she reached the
    hospital, she was dying and there was nothing that I or the
    doctors could do to save her life.
        As a result of an abortion, the young woman lost her
    precious life. Her life could have been saved if proper
    regulations had been in place that protected her health and
    well-being and that held the abortionist accountable.
        Now, infections occur in 1 to 5 percent of the abortions.
    Cervical lacerations, incompetent cervix, and other injuries
    can occur to the cervix and other organs during abortion
    procedures. Worse, minors are up to twice as likely to
    experience cervical lacerations during an abortion and overall
    are even more susceptible to short-term risks than are older
    women.
        Women who have had abortions are at a 37 percent increased
    risk of pre-term birth in subsequent pregnancies, a 30 to 50
    percent increased risk of placenta previa in subsequent
    pregnancies, and 18 percent more likely to develop breast
    cancer as opposed to the average of just 12 percent. In the
    case of women with a family history of breast cancer, this
    jumps up to 80 percent.
        Abortions not only pose serious physical risks but endanger
    a woman's mental health as well. Studies show that after having
    an abortion, a woman is 81 percent more likely to develop a
    mental health issue, is at a 37 percent increased risk of
    depression, a 110 percent increased risk of alcohol abuse, and
    sadly, a 155 percent increased risk of suicide.
        After the horrific case of abortionist Kermit Gosnell,
    Americans know that even though abortions are legal, these
    procedures that are risky and must be regulated. Perhaps this
    is why 39 States require that abortions be performed by a
    licensed physician and why 26 States require abortion clinics
    to meet the same clinic standards as ambulatory surgical care
    clinics. And just as important, 42 States prohibit abortion
    after a certain point in the pregnancy, and about 9 States
    prohibit abortions at 20 weeks, or at the start of the sixth
    month of pregnancy, when medical research affirms that unborn
    children can feel pain during an abortion. We are, after all,
    discussing a medical procedure that ends a human life.
        Let us also not forget that the Supreme Court indicated in
    Planned Parenthood v. Casey that the Government has an interest
    in preserving fetal life. Senate bill 1696 represents a
    sweeping attempt to undermine dozens of measures enacted by
    States to protect women, all under the false pretense that
    abortions are safe and rare.
        My hope today is that we can reach across party lines,
    realize our preconceived notions on this topic, and see
    abortion for what they really are. Abortion is brutal--to both
    the mother and the unborn child. It is not health care. To
    reference the Supreme Court, a dilatation and extraction
    abortion, which represents the majority of abortion procedures
    in America, is as generally gruesome as partial birth abortion.
    These abortion procedures are the most common for abortions
    performed in the second trimester of pregnancy, where the
    unborn child is literally torn apart limb by limb.
        In considering this and the many health care risks that can
    occur as a result of abortions, I strongly urge you to
    reconsider advancing Senate bill 1696 and any other effort that
    would undermine current laws that exist to protect the health
    and well-being of women and unborn children at the Federal
    level, State, and local government level.
        Thank you again for the opportunity to be here today, and I
    yield back.
        [The prepared statement of Representative Diane Black
    appears as a submission for the record.]
        Senator Blumenthal. Thank you, Representative Black.
        Representative Chu.

              STATEMENT OF HON. JUDY CHU, A REPRESENTATIVE
                IN CONGRESS FROM THE STATE OF CALIFORNIA

        Representative Chu. Thank you, Chairman Blumenthal, Ranking
    Member Grassley, and Committee members for the opportunity to
    testify today. Every woman should have access to affordable and
    comprehensive health care coverage that protects her right to
    choose. This should be the case regardless of her income, the
    type of insurance she has, or the State she resides in so that
    she can make personal health decisions based on what is best
    for her and her family.
        But we are witnessing an alarming moment in time. Attacks
    on reproductive rights are intensifying. Having lost in our
    court system with Roe v. Wade, opponents of reproductive
    freedom are trying to undercut our constitutional right and
    make it increasingly difficult to access a legal abortion. They
    are trying to take us back to a time before Roe, when 1.2
    million women resorted to illegal abortions each year. Their
    goal is to take us back to a time when unlicensed doctors, in
    unsanitary conditions, performed abortions that led to
    infections, hemorrhages, and at times, death. They are taking
    us back to a time when many women knew the hazards, but risked
    all of this because they were desperate--and this was their
    only option.
        The new trend is to shut down abortion services, but this
    time State by State.
        This is happening all across the country. Individual States
    have signed into law restrictive regulations that single out
    abortion services. Between 2011 and 2013, more than two dozen
    States passed over 200 restrictions that block access to
    abortion services. This translates to more restrictions placed
    on women's health care in 3 years than in the entire preceding
    decade.
        The effect of these laws is that a woman's constitutional
    right now depends on her address. The rights of women residing
    in my home State of California now vastly differ from the
    rights of women living in Texas or Mississippi. According to
    the Guttmacher Institute, 56 percent of women--over half of
    women in our country--now live in a State that is hostile to
    abortion.
        These laws range from mandatory waiting periods to biased
    counseling requirements to the exact size requirements and
    corridor width for the offices in which the procedure is to
    take place.
        They are laws like the recent one in Texas, which make no
    sense medically. They require doctors performing abortion
    procedures to have formal admitting privileges at a hospital
    within 30 miles of their clinic, among other senseless
    requirements. We already see the effects. After the law passed,
    clinics began closing their doors. For women in Texas, this
    means longer waits, higher costs, and canceled appointments.
    Some have to travel over 150 miles to get to the nearest
    clinic. These obstacles have put many women in desperate
    circumstances, some of which may very well endanger their
    lives.
        We need laws that put women's health and safety first--not
    politics. And that is why we introduced the Women's Health
    Protection Act this Congress. We recognized that without the
    ability to access it, the right to abortion is meaningless.
    This bill would outlaw the restrictive State laws that target
    abortion services and shut down clinics across the country. The
    bill would outlaw State-mandated medical procedures such as
    forced ultrasounds, restrictions on medication abortions, and
    other onerous TRAP laws. Simply put, this bill would end
    discrimination against abortion access for women based on their
    zip code.
        I am so proud to be the lead sponsor of this bill in the
    House and to partner with Senators Blumenthal, Baldwin, and
    Congress Members Fudge and Frankel to push as hard as we can on
    this bill. We already have 124 cosponsors in the House.
        Constitutional rights should never be subject to the
    personal whims or beliefs of political leaders. Nor should the
    safety of mothers, daughters, sisters, or wives be jeopardized
    in the process.
        Thank you for the opportunity to testify, and thank you for
    holding this important hearing to discuss how we can protect
    the health, safety, and rights of all women.
        [The prepared statement of Representative Judy Chu appears
    as a submission for the record.]
        Senator Blumenthal. Thank you, Representative Chu.
        Representative Blackburn.

        STATEMENT OF HON. MARSHA BLACKBURN, A REPRESENTATIVE IN
                  CONGRESS FROM THE STATE OF TENNESSEE

        Representative Blackburn. Thank you, Mr. Chairman. I
    appreciate the opportunity to join you all. Senator Grassley,
    thank you for the invitation.
        I think that it is fair to say that every one of us at this
    table, and certainly each of you, we all want what is best for
    women. We differ on what that is, and we differ on how to get
    there. And I am very appreciative of the opportunity to be here
    and to talk with you about this legislation, the Women's Health
    Protection Act.
        In my opinion, it is something that is extraordinarily
    broad, it is loosely written, and through its wide-ranging
    words would, in my opinion, substitute the special interests of
    the abortion industry for both the well-being of women and the
    value of human life.
        The legislation would jeopardize and nullify hundreds of
    laws, as has previously been mentioned at this table, laws that
    protect both mothers and their unborn children. Among my
    concerns with the bill--and Senator Grassley mentioned several
    of these--it would render impossible efforts by the States to
    limit abortions based on the sex of the child; it would put a
    double pressure on women, who are often forced by familial or
    cultural pressures, to exercise male bias in pregnancy and
    eliminate a female child.
        Furthermore, this legislation sets a dangerous precedent
    because it would place unconstitutional limits on a State's
    ability to assure the safety of medical facilities. Abortions
    are indeed invasive medical procedures and should be regulated
    by the States as such.
        In addition, by considering this legislation, many of your
    constituents perceive that this body is out of touch with the
    consensus opinion in this country. Public opinion polls show
    time and again that the American people support limits on
    abortion. They support this. Sixty percent of Americans believe
    abortion should not be permitted in the second trimester, and
    an overwhelming 80 percent believe it should never happen in
    the third. Women hold these convictions at a higher percentage
    than men, and it is no wonder. We bear life--and we bear the
    burden when public policies fail to support women at a critical
    hour.
        The Committee would be well advised to consider how far
    this bill goes in reversing and uprooting both a long-existing
    and rising consensus. S. 1696 would attack conscience
    exemptions that have existed since the 1973 abortion decision.
    It would bar laws that provide for periods of reflection and
    consideration before an abortion is chosen. It would even
    prevent a State from assuring that a physician is physically
    present when abortion drugs are given or even that only a
    physician may perform a surgical abortion. It would make the
    abortion process less safe.
        What the Senate should be considering today is the Pain-
    Capable Unborn Child Protection Act which passed the House of
    Representatives on June 17, 2014, on a bipartisan vote, 228-
    196. The Pain-Capable Act is a piece of legislation that is
    supported by the American people. It is based in science and
    filled with compassion. The Pain-Capable Unborn Child
    Protection Act limits abortions after the 20th week of
    pregnancy except in the instances of rape, incest, or to
    protect the life of the mother. Our Nation is one of only about
    seven countries in the world to allow elective abortion to
    term, and this legislation would take one small but vital step
    to move us closer to the international norms.
        Polls by Quinnipiac University, the Washington Post, and
    the Huffington Post have all shown that a strong majority of
    people support limiting abortion after the 20th week of
    pregnancy. Quinnipiac University's poll shows that women
    support a 20-week limit in even greater numbers than men--60
    percent of women versus 20 percent in opposition--a 35-point
    margin.
        Let me give you an example of why these have changed. You
    all have an exhibit from me, and I want to show you this. This
    is a 3-D ultrasound of my grandson. It was made on March 11,
    2009, before his birth June 12, 2009. This is the wonder of
    science. And I have to tell you how exciting it was for me to
    see this ultrasound. I was thrilled. I could tell--I could
    tell--before he was born, 3 months before he was born, he had
    my eyes and nose. Now, for a grandmother, that is a really big
    deal. I could see his hands. I could see his arms. And I could
    see him peacefully resting in his mother's womb.
        That is the wonder of science. That is life. Our
    Constitution does not put a qualifier on life. The pursuit of
    life, liberty, pursuit of happiness, those protections, the
    right to life, liberty, pursuit of happiness, even in the
    mother's womb.
        I urge this Committee to reconsider this legislation. We
    have mentioned today the horrors of the Kermit Gosnell trial,
    the Philadelphia-based abortionist who ran a dangerous,
    illegal, and ghastly so-called clinic. He was tried, rightfully
    convicted for the crimes he committed and the deaths that he
    caused in that terrible place. Yet the legislation that you are
    considering, the Women's Health Protection Act, could be used
    to validate the acts that placed him behind bars and to
    invalidate the bipartisan legislation put in place.
        I find it so curious that your legislation is termed ``The
    Women's Health Protection Act.'' In my opinion, it would be
    more accurately titled ``The Removal of Existing Protections
    and Safety Measures for Women Undergoing Abortion Act.''
        I encourage you to reconsider your legislation, to take up
    the Pain-Capable Unborn Child Protection Act, and to be more in
    line with the consensus of Americans and the States who are
    making certain that abortion is indeed safe, legal, and rare.
        I yield the balance of my time.
        [The prepared statement of Representative Marsha Blackburn
    appears as a submission for the record.]
        Senator Blumenthal. Thanks to each of you, and we are going
    to move to our next panel. We really appreciate your being here
    this morning. Thanks for your excellent testimony.
        Before you get too comfortable, I am going to ask you to
    stand because the custom of our Committee is to swear in our
    witnesses. If you would please rise? Do you affirm that the
    testimony you are about to give is the truth, the whole truth,
    and nothing but the truth, so help you God?
        Ms. Northup. I do.
        Dr. Chireau. I do.
        Dr. Parker. I do.
        Ms. Tobias. I do.
        Ms. Taylor. I do.
        Senator Blumenthal. Thank you. Let me introduce our
    witnesses before they give their testimony.
        We are going to begin with Nancy Northup, who is the
    president and CEO of the Center for Reproductive Rights. She
    has worked as a constitutional litigator and Federal prosecutor
    before her appointment at the Center for Reproductive Rights,
    which is a global human rights organization that has documented
    rights abuses, brought ground-breaking cases before Federal and
    State courts, U.N. committees, regional human rights bodies,
    and has built the legal capacity of women's right advocates in
    more than 55 countries.
        Dr. Monique Chireau is an obstetrician/gynecologist in
    Durham, North Carolina, and affiliated with multiple hospitals
    in the area, including Duke University Hospital and Durham
    Veterans Affairs Medical Center. She is one of 250 doctors at
    Duke University Hospital and one of 5 at Durham Veterans
    Affairs Medical Center who specialize in obstetrics and
    gynecology.
        Dr. Willie Parker, our third witness, has over 20 years of
    experience providing comprehensive women's medical care. He is
    board certified and trained in preventive medicine and
    epidemiology through the Centers for Disease Control. Dr.
    Parker currently provides abortion care for women in Alabama
    and Mississippi.
        Carol Tobias is president of the National Right to Life
    Committee. She has held various positions at the National Right
    to Life Committee since 1991.
        Representative Chris Taylor represents Assembly District 76
    in the Wisconsin Assembly. Representative Taylor has a long
    history of working with the State legislature even prior to her
    election in 2011, and she has led numerous State and local
    coalitions in various settings around the State of Wisconsin.
        We welcome you all and thank you very, very much for being
    here this morning. Nancy Northup.

             STATEMENT OF NANCY NORTHUP, PRESIDENT, CENTER
              FOR REPRODUCTIVE RIGHTS, NEW YORK, NEW YORK

        Ms. Northup. Thank you, Senator Blumenthal, and thank you,
    Ranking Member Grassley, for having us here today for this
    important hearing. I am Nancy Northup, and I am president and
    CEO of the Center for Reproductive Rights.
        Today, one of our most basic protections of our
    Constitution--the right to make for ourselves the important
    decisions of our lives--is under assault for women throughout
    vast swaths of the Nation. There have been over 200 State laws
    passed in the last 3 years designed to make it harder or
    impossible for women to access abortion services in their
    communities. And we are not blocked by courts. This new wave of
    restrictions is shutting down clinics, closing off essential
    services, and harming women.
        This is the newest tactic in a four-decade campaign to
    deprive women of the promise of Roe v. Wade. There have been
    during those four decades terrorizing physical attacks; clinics
    bombed, vandalized, and torched; doctors and clinic workers
    murdered; and clinics blockaded. Twenty-five years ago, I
    locked arms with members of my church and concerned citizens in
    Baton Rouge to form a human chain of protection around a
    reproductive health care clinic as hundreds of Operation Rescue
    protesters descended, intent on obstructing patients from
    entering. This scene was played out over and over again across
    the Nation. Federal action was needed and taken in 1994, with
    Congress' passage of the Freedom of Access to Clinic Entrances
    Act.
        Today, women's access to abortion services is being blocked
    through an avalanche of pretextual laws that are designed to
    accomplish by the pen what could not be accomplished through
    brute force--the closure of facilities providing essential
    reproductive health care to the women of this country.
        At an alarming rate, States are passing laws that single
    out reproductive health care providers for excessively
    burdensome regulations designed to regulate them out of
    practice under the false pretense of health and safety.
        When Mississippi enacted such a law in 2012, a State
    Senator put it quite plainly: ``There is only one abortion
    clinic in Mississippi,'' he said. ``I hope this measure shuts
    that down.'' Right now, Mississippi's sole clinic is holding on
    by virtue of a temporary court order.
        Even when not flatly stated, the true purpose of these laws
    is evident. Abortion is one of the safest medical procedures,
    yet it is being singled out for burdensome restrictions not
    placed on comparable medical procedures. For example,
    obstetricians who perform miscarriage completions in their
    office practices are not subject to these onerous requirements,
    despite the fact that they are performing virtually the same
    medical procedure as abortion providers, who are subject to
    these requirements.
        The American Medical Association and the American College
    of Obstetricians and Gynecologists have gone on record against
    many of these laws. And, indeed, you have their testimony
    before you today for the ACOG. Courts have found some so at
    odds with medical standards that they can serve no purpose but
    to prevent women from ending a pregnancy.
        But the road blocks keep coming. A year ago, Texas passed a
    sweeping set of restrictions to devastating effect. At least
    one-third of that State's clinics have been forced to stop
    providing abortion care. There is no clinic left in the Rio
    Grande Valley, an impoverished area with over 1.3 million
    residents. If the final requirement of Texas' restrictions is
    allowed to go into effect in September, the number of clinics
    will plummet to less than ten to serve a sprawling State of
    over 260,000 square miles and 13 million women.
        Even before this new law, a 2012 study in Texas found that
    7 percent of women reported attempts to self-abort before
    seeking medical care. Now women are crossing the border into
    Mexico to buy miscarriage-inducing drugs at flea markets or off
    the shelves at pharmacies--and then seeking needed emergency
    care back in Texas.
        Like all of us here, I come to the issue of abortion rights
    with my own set of life experiences, personal commitments, and
    religious beliefs. As the Supreme Court wisely noted over 20
    years ago in Planned Parenthood v. Casey, men and women of good
    conscience can disagree, and probably always will, about the
    moral and spiritual implications of ending a pregnancy. In
    reaffirming the basic tents of Roe v. Wade, the Court reminded
    us that ``it is a promise of the Constitution that there is a
    realm of personal liberty which the government may not enter.''
    The most fundamental decisions about our reproductive health
    and lives are for each of us to make, and not for the
    government.
        One in three women in the United States makes the decision
    at some point in her life that ending a pregnancy is the right
    choice for her. That decision is based on her individual
    circumstances, her health, and her life. None of us walk in her
    shoes. None of us know the factors that lead to her decision.
        And when a woman makes that decision, she needs good, safe,
    reliable care from a health care provider she trusts, in or
    near the community that she calls home.
        But today a woman's ability to do so increasingly depends
    on the State in which she happens to live. Like 20 years ago,
    Congress needs to take action to ensure that women's
    constitutional rights and their ability to make the most
    personal of decisions is not taken from them.
        Thank you.
        [The prepared statement of Nancy Northup appears as a
    submission for the record.]
        Senator Blumenthal. Thank you, Ms. Northup.
        Dr. Monique Chireau.

                 STATEMENT OF MONIQUE V. CHIREAU, M.D.,
                         DURHAM, NORTH CAROLINA

        Dr. Chireau. Yes, thank you. It is an honor to be here
    today, Senator Blumenthal, Senator Grassley. My name is Dr.
    Monique Chireau. I am on the faculty of the Duke University
    Medical School. I am also a practicing obstetrician/
    gynecologist and a clinical researcher.
        S. 1696 could reasonably be interpreted to invalidate
    virtually any type of current State laws which place
    restrictions or regulations on abortion. It would also endanger
    health care providers' freedom of conscience and would prohibit
    the future enactment of such protective laws.
        The stated purpose of the bill, as we have understood it,
    is to protect women's health by ensuring that abortion services
    will continue to be available. Implicit in this stated purpose
    of the bill are the four following assumptions: number one is
    that abortion is good and safe for women; number two, that
    State abortion restrictions and regulations are medically
    unwarranted; number three, that access to abortion is important
    to women's health; and, number four, that the State has no
    interest in protecting unborn children. I will address each of
    these in turn.
        The Centers for Disease Control define an induced abortion
    as ``an intervention performed by a licensed clinician that is
    intended to terminate a suspected or known intrauterine
    pregnancy and produce a nonviable fetus at any gestational
    age.'' The U.S. Supreme Court has repeatedly acknowledged that
    abortion is inherently different from other medical procedures,
    because no other procedure involves the purposeful termination
    of a potential life, and that the abortion decision has
    implications far broader than those associated with other
    medical treatment.
        Assumption number one is that abortion is good for women.
    However, a substantial body of literature indicates that
    induced abortion is associated with significant risks and
    potential harms to women. It is stated to be very safe at early
    gestational ages; however, in a very large study from Finland
    of 42,619 women, the maternal mortality rate from abortion was
    14.1 per 100,000. Approximately 20 percent of the women in this
    study experienced severe adverse events, such as hemorrhage and
    infection.
        This study included both surgical and medical abortions.
    These statistics represent a significant burden of disease, and
    if they were extrapolated to the United States, that would
    translate into 260,000 adverse events per year.
        Further research has also demonstrated that the risk for
    abortion performed at greater than 21 weeks is greater--is
    greater when performed at 21 weeks than at lower gestational
    ages. The risks for death ranged from about 0.1 to 0.4 per
    100,000 to 8.9 per 100,000. However, because of problems with
    the denominator of this study, the results cannot easily be
    extrapolated. The point is that late abortion carries a 77
    times increased risk for mortality compared with early
    abortion, and that is a significant issue. This is mortality.
    This is not morbidity. This is death.
        Other complications can occur following abortion. Induced
    abortion of a first pregnancy, as we have heard earlier,
    increases the risk of subsequent preterm birth. There is also a
    robust literature on mental health problems following abortion.
    These mental health problems include anxiety, depression, and
    so on.
        Assumption number two is that State abortion restriction
    regulations are medically unwarranted. States have a compelling
    interest in protecting the health of their citizens, and they
    have the authority to do so within regulatory frameworks,
    including State medical boards and departments of health.
    Historically, States have regulated medical procedures and
    clinics by establishing standards for training and
    credentialing. These standards protect patients from injury and
    death.
        This is important because the fact of the matter is that
    patient-physician interactions do not occur within a vacuum.
    The issue of whether patients have access is a two-sided issue,
    a two-edged issue. This is because access can be--you can have
    access to care which is inadequate, being performed by
    incompetent practitioners, or you can have access to good care.
        And zip codes do matter. In many zip codes in the United
    States, patients have access to care which is inadequate, which
    endangers their health. This bill would not protect the rights
    of patients because it would remove the ability of States to
    regulate the practice of medicine.
        In addition, the scope of practice for different types of
    clinicians is carefully defined. Recently, there have been
    attempts by mid-level practitioners in several States to assume
    the role of providing abortions. Again, this particular bill
    would remove the ability of States to monitor and supervise the
    practice of medicine through abortion.
        One of the questions that comes up in any of these
    discussions regarding the need for improved regulation,
    including monitoring of the access to clinics, widths of
    hallways so that emergency personnel can enter buildings, is,
    what is there to fear from complying with the law? If laws are
    enacted in order to protect the health of patients and--the
    health of patients and to protect really practitioners as well
    by providing them with the appropriate conditions to practice
    in, what is there to fear in this circumstance?
        The question really is, To what extent are we willing to
    surrender States' ability to regulate laws regarding the
    provision of medical care?
        Finally, the fact that the State does have an interest in
    protecting unborn life is not acknowledged in this particular
    bill. There is no mention of unborn children at all, in spite
    of the fact that the purpose of the bill is to eliminate most
    regulations or restrictions on abortion. The Supreme Court has
    recognized since Roe v. Wade that States have a compelling
    interest in the potentiality of unborn life throughout the
    pregnancy. This is because unborn children and their mothers
    are vulnerable to injury, exploitation, and social
    disadvantage. We care about whether a nurse who is mixing
    chemotherapy is exposing her fetus to potentially carcinogenic
    or teratogenic drugs, and this relates to the interest around
    when pregnancy begins. If we do believe that pregnancy begins
    at conception rather than at implantation, which is our
    standard medical definition, we need to begin to consider how
    to best protect the fetus at early gestational ages. Similarly,
    neonatologists are pushing back the boundaries of neonatal
    viability. This bill does not take into account these
    scientific advances because it removes restrictions on
    abortions at various gestational ages.
        So in conclusion, I would like to say that S. 1696 is a
    measure that seeks to overturn longstanding State restrictions
    on abortion that have been supported in the courts. It ignores
    not only widely supported policies and scientific evidence, but
    also prior Supreme Court rulings, and clearly targets State
    regulations which protect the health of our most vulnerable
    citizens--pregnant women and their unborn children. All access
    is not equal. Zip codes do matter, because we want patients'
    zip codes to provide--practitioners within zip codes to provide
    care that is sensitive, affordable, comprehensive, and
    competent.
        Thank you.
        [The prepared statement of Dr. Monique Chireau appears as a
    submission for the record.]
        Senator Blumenthal. Thank you, Dr. Chireau.
        Dr. Parker.

                   STATEMENT OF WILLIE PARKER, M.D.,
                          BIRMINGHAM, ALABAMA

        Dr. Parker. Good morning, Senators. I consider it a real
    privilege to speak before this body this morning. My name is
    Dr. Willie Parker, and I am here to today to offer testimony in
    support of the Women's Health Protection Act.
        I have devoted my whole career to helping women have the
    families that they want by providing them with prenatal care
    and delivering their babies, as well as providing them with
    medically accurate sex education, contraception, and, when they
    need it, safe abortion care.
        If there is a war to defend the right to safe and legal
    abortion, then Mississippi, where I practice, is on the front
    line. The State recently passed laws restricting the provision
    of abortion to obstetrician/gynecologists and those with
    hospital admitting privileges. Now, this law, which is
    completely medically unnecessary, would shut down the one
    remaining clinic in that State, and thereby would effectively
    deny women in that State access to abortion. On top of this,
    the State also has mandated delays that are both costly and
    burdensome to the women seeking this care. A woman's access
    should not be denied to her simply because she lives in the
    State of Mississippi, or anywhere else, for that matter. The
    thing that should determine the care that a woman receives, it
    should be determined by medical evidence and not by her zip
    code.
        Now, the proponents of these laws would say that they are
    protecting the health of women, and they are within their right
    to believe that, but the truth would suggest otherwise. Here
    are the facts in Mississippi: there are far too many teen and
    unintended pregnancies; the infant mortality and maternal
    mortality rates are extremely high; and there are far, far too
    many Mississippians living in abject poverty. These realities
    confront every woman whether she has an undesired pregnancy or
    a wanted but fatally flawed one. What women in Mississippi need
    is safe, compassionate medical care, and that need is urgent,
    and that care should include abortion. Because of these facts,
    I made what I consider to be the moral decision to provide
    abortion care in this State.
        Now, invariably, given the climate around abortion in this
    country, I field questions from people regarding that decision,
    and the most frequently asked question is: Why? Why do you do
    this? Well, the short answer is because if I do not, who is
    going to do it?
        If women in Mississippi and States surrounding can find a
    way to travel from rural areas under hostile circumstances to
    access the abortion care that they are entitled to, then I made
    a personal decision that I wanted there to be someone at that
    clinic to meet them when they came.
        One patient that I often think of as I think about the work
    that I do is one of the first patients I took care of in
    Mississippi, who was a 35-year-old pregnant woman with five
    children, the youngest of whom had recently died the year
    before from cancer. This woman found herself with an unplanned
    pregnancy, and she confided in me that at this particular point
    in her life she could not care for another child, either
    economically or emotionally.
        Now, she had already traveled an extensive distance to come
    to the mandated counseling that she was required to receive.
    And while she was completely resolute when she walked in the
    door and knew what was best for her and her family, she was
    still required to be delayed in her decision for political
    reasons that had nothing to do with her or her medical care.
        Other women that I saw on that same day were returning for
    their procedure after having made the mandated wait, and they
    had recently completed a second trip from hours away to receive
    their care. These women made it to the clinic despite distance,
    work considerations, child care obligations, and travel costs.
    These women typify the hardships that Mississippi women and
    many other women around this country face as they endure the
    barriers created by the present laws.
        In the 24 years that I have practiced medicine, I have
    learned a few things, and this is what I can tell you. Every
    patient is unique. Every woman is different. And when it comes
    to abortion, every one of them is grappling with a dilemma. I
    define a dilemma as a situation in which one has to make a
    decision between two undesirable outcomes, and yet one does not
    have the luxury of not making that decision.
        While the stories of the women that I see might differ,
    what they all have in common is that for them it is
    increasingly difficult for them to access abortion. So as I
    said earlier, people ask me, ``Why do you do it?'' Well, I
    think the answer is very simple. I want for women what I want
    for myself. I want a life of dignity, good health, self-
    determination, and I want the opportunity to excel and to
    contribute in the manner that I best can.
        We know that when women have access to abortion,
    contraception, and medically accurate sex education, they
    thrive in just the matters that I mentioned. It should be the
    same for all women, no matter where they live, because the
    ability to live the life that you imagine should not be limited
    by your zip code.
        Thank you.
        [The prepared statement of Dr. Willie Parker appears as a
    submission for the record.]
        Senator Blumenthal. Thank you, Dr. Parker.
        Ms. Tobias.

             STATEMENT OF CAROL TOBIAS, PRESIDENT, NATIONAL
                RIGHT TO LIFE COMMITTEE, WASHINGTON, DC

        Ms. Tobias. Mr. Chairman, Senator Grassley, and members of
    the Committee, thank you for giving me this opportunity to
    testify. I am Carol Tobias, president of the National Right to
    Life Committee. NRLC is a nationwide federation of 50 State-
    affiliated right-to-life organizations. We are the Nation's
    oldest and largest pro-life organization.
        We find the formal title or marketing label, ``Women's
    Health Protection Act,'' to be highly misleading. The bill is
    really about just one thing: stripping away from elected
    lawmakers the ability to provide even the most minimal
    protections for unborn children, at any stage of their
    development. The proposal is so sweeping and extreme that it
    would be difficult to capture its full scope in any short
    title. Calling it the ``Abortion Without Limits Until Birth
    Act'' would be more in line with truth-in-advertising
    standards.
        In its 1980 ruling in Harris v. McRae, upholding the Hyde
    amendment, the U.S. Supreme Court said: ``Abortion is
    inherently different from other medical procedures, because no
    other procedure involves the purposeful termination of a
    potential life.''
        Even many Americans who identify as ``pro-choice'' struggle
    with the abortion issue because they see it as a conflict
    involving life itself. Many, while not fully sharing our view
    that the unborn child should be directly protected in law,
    nevertheless support the kinds of laws this bill would strike
    down, laws that take into account what most Americans recognize
    as a life-or-death decision.
        In contrast, the drafters of S. 1696 apparently believe
    that any woman considering abortion must be shielded from any
    information that may cause her to change her mind.
        Under S. 1696, elective abortion would become the procedure
    that must always be facilitated, never delayed, never impeded
    to the slightest degree.
        What types of laws would the bill invalidate? The list
    includes limits on abortions after 20 weeks, past the point at
    which unborn children can experience pain, which are supported
    by sizable majorities nationwide; laws limiting abortion after
    viability; laws protecting individuals or private medical
    institutions from being forced to participate in abortion,
    which about three-fourths of the people support, and which the
    great majority of States have enacted; laws requiring that
    information be provided regarding alternatives to abortion,
    which 88 percent of the public supported in a Gallup poll; laws
    providing periods for reflection; laws prohibiting abortion
    because of the child's sex, which over 85 percent support. All
    these would be invalid.
        Having failed in many cases to persuade the Federal courts
    to strike down the laws they dislike, the extreme abortion
    advocates now come to Congress and demand that this Federal
    pro-abortion statutory bulldozer be unleashed to scrape
    everything flat.
        The bill would subject any law or Government policy that
    affects the practice of abortion, even indirectly, to an array
    of sweeping legal tests, designed to guarantee that almost none
    will survive. The general rule would be that any law that
    specifically regulates abortion would be presumptively invalid.
    The same would be true of any law that is not abortion-specific
    but has the effect or claimed effect of reducing access to
    abortion.
        It is apparent that those who crafted this bill believe
    that where abortion is involved, immediate access to abortion
    at any stage of pregnancy is the only thing that matters.
        Mr. Chairman, in a November interview with the newspaper
    Roll Call, you said, ``As the election approaches, I think the
    voters are going to want to know where legislators stand on
    these issues.'' But to know where every Senator stands on S.
    1696 would require a vote by the full Senate. By all means, let
    us see where they stand.
        But in the spirit of ``pro-choice,'' how about giving the
    Senate a choice as well? On May 13, Senator Graham proposed an
    agreement under which S. 1695, which has 35 cosponsors, would
    receive a vote of the full Senate, along with a separate vote
    on his Pain-Capable Unborn Child Protection Act, S. 1670, which
    has 41 cosponsors. The Pain-Capable Unborn Child Protection Act
    would protect unborn children in the sixth month and later,
    with narrow exceptions. By this stage in their development, if
    not sooner, there is abundant evidence that unborn babies will
    experience great pain as their arms and legs are wrenched off
    by brute force in the common second-trimester dismemberment
    procedure known as D&E.
        Mr. Chairman, in your response to Senator Graham's
    proposal, you made clear your opposition to his bill. But you
    went on to say, and I quote, ``I am more than happy to cast a
    vote on it along with the Women's Health Protection Act, and I
    hope they will be considered. This issue deserves to be before
    this body.''
        We agree. We challenge you and the leadership of the
    majority party to allow the American people to see where every
    Senator stands on both of these major abortion-related bills.
    Let the American people see which bill reflects the values of
    each member of the U.S. Senate: life or death for unborn
    children. Thank you.
        [The prepared statement of Carol Tobias appears as a
    submission for the record.]
        Senator Blumenthal. Thank you, Ms. Tobias.
        Ms. Taylor.

    STATEMENT OF HON. CHRIS TAYLOR, STATE REPRESENTATIVE, WISCONSIN
          STATE LEGISLATURE, 76TH DISTRICT, MADISON, WISCONSIN

        Ms. Taylor. Thank you so much. Good morning. My name is
    Chris Taylor, and I am a State representative from the great
    State of Wisconsin, representing the 76th Assembly District. I
    so appreciate the opportunity, Chairman Blumenthal, to testify
    in strong support of the Women's Health Protection Act, and I
    thank Ranking Member Grassley and Committee members for this
    opportunity today.
        I also want to thank my Senator, Tammy Baldwim, whom we are
    very proud of in Wisconsin, for leading the way in cosponsoring
    this important bill.
        I am also the former public policy director for Planned
    Parenthood of Wisconsin. I have been for over a decade
    monitoring, advocating for, and attempting to get passed good
    public policy on reproductive health care.
        There is a consensus in Wisconsin about what Wisconsinites
    want the State legislature to focus on, and it is not abortion
    restrictions. It is on the critical economic issues that face
    our State. We have a stagnant economy in Wisconsin. We have
    stagnant wages. Working families are struggling. Those are the
    issues that Wisconsinites want the State legislature to focus
    on. But, unfortunately, that has not been the focus over the
    last 3 years, and Wisconsin has become one of the many
    battleground States where fights over a woman's ability to
    access abortion care are being waged.
        We have only a few health centers in Wisconsin that provide
    abortions, and we have over a dozen abortion restrictions which
    have nothing to do with the health and safety of women and
    everything to do with politics.
        Wisconsin is on the verge of becoming a State like
    Mississippi where abortion is simply not accessible. A woman's
    ability to access safe, legal abortion should not be dependent
    on where she lives or subject to the political whims of her
    State legislature, and that is why I am urging you to pass the
    Women's Health Protection Act.
        Since 2011, we have seen a proliferation of abortion
    restrictions in Wisconsin, including restrictions on medication
    abortion, banning telemedicine, and requiring physicians who
    perform abortions to have hospital admitting privileges within
    30 miles of their practices. We also have a forced ultrasound
    law. The hospital admitting privileges mandate is only imposed
    on physicians who provide abortions.
        I am very fortunate to serve on the Health Committee in the
    State Assembly. There was no medical evidence or testimony
    presented that the admitting privileges status of a woman's
    abortion provider in any way enhances the health and safety of
    women who have abortions. In fact, there was no health care
    provider or health care organization who advocated for this law
    at all.
        In contrast, the medical community vocally opposed this
    mandate, including the Wisconsin Academy of Family Physicians,
    the Wisconsin Hospital Association, the Wisconsin Public Health
    Association, and the Wisconsin Medical Society that stated,
    ``This requirement interferes with the patient-physician
    relationship and places an unneeded and unprecedented burden on
    Wisconsin physicians and women.''
        The effect of the hospital admitting privileges law is
    going to be to shut down one of four health centers that
    provides abortions because the two physicians at this center
    are ineligible for these admitting privilege requirements. That
    means that over one-third of the women who seek abortions in
    Wisconsin are going to have to go elsewhere. The effect of that
    is to increase waiting times at the three remaining health
    centers. Currently, there are delays of 3 to 4 weeks to obtain
    an abortion in Wisconsin. With the closure of this clinic,
    those delays would be extended to 8 to 10 weeks.
        Finally, we would have no health care provider providing
    abortions post 18 weeks, and so women who have complications or
    tragedies in pregnancy past 18 weeks are going to have to go
    elsewhere. A delay of this magnitude clearly impacts all
    Wisconsin women seeking abortion care, but it has particular
    devastating effects on low-income women who rely on public
    transportation and cannot afford uncompensated work time and
    travel costs. So for poor women, these additional barriers may
    be insurmountable.
        The same law that requires admitting privileges also forces
    a woman seeking abortion to undergo an ultrasound 24 hours
    before the procedure. The provider must also describe and
    display the image to the woman. This is the most humiliating
    and degrading law that I have seen in Wisconsin. It is
    certainly the Government at its biggest and most intrusive.
    Women are not able to refuse in most cases what is an invasive
    vaginal ultrasound. Physicians have no ability to tailor their
    medical care to the unique situation of each individual woman
    or adopt the best standard of care.
        The medical community in Wisconsin also vocally opposed
    this restriction. They said that the mandatory performance of
    an ultrasound before an abortion is not an accepted medical
    practice or standard of care. This practice does not add to the
    quality or safety of the medical care being provided. Simply
    put, ultrasounds are being used in Wisconsin as political
    bludgeons.
        Unfortunately, my Republican colleagues did not listen to
    the Wisconsin medical community. They did not listen to their
    own Democratic colleagues. We have 18 women in my caucus, in my
    Democratic caucus. As we talked about these issues prior to the
    debate, we realized we all had our own experiences that caused
    us to make very personal decisions about reproductive health
    care. We had members who had experienced pregnancy loss,
    miscarriage, stillbirths, high-risk pregnancies, and sexual
    assault. And we are just a microcosm of all the women in
    Wisconsin who we represent.
        We decided that though we might be ignored by our
    colleagues on the other side of the aisle, that we would never
    be silent, and we decided to tell our own personal stories
    about why these laws are so harmful to women and have nothing
    to do with the reality of women's lives and experiences.
        It is not my role as a legislator to dictate the most
    personal private decisions of my constituents. I have no
    business as a legislator dictating insupportable medical
    practices to a physician who is ethically obligated to provide
    the best care for women, and patients. But I am in the business
    of ensuring that the people in my district, the people I
    represent, are able to exercise their most fundamental,
    personal decisions about their lives. As it stands, with States
    legislating away those rights, we need the Women's Health
    Protection Act more than ever. Wisconsin women and women
    throughout this country simply cannot wait.
        Thank you.
        [The prepared statement of Hon. Chris Taylor appears as a
    submission for the record.]
        Senator Blumenthal. Thank you very much to all of our
    witnesses. I am going to ask, without objection, that all of
    your full statements be entered in the record, along with a
    statement from our colleague, Senator Feinstein.
        [The prepared statement of Senator Dianne Feinstein appears
    as a submission for the record.]
        Senator Blumenthal. And to begin the questions. A number of
    our colleagues have votes at noon, so we will try to move along
    as quickly as we can.
        Ms. Northup, there have been some very dismaying and
    sweeping claims about the breadth of this proposed legislation.
    Ms. Tobias referred to it as the ``Abortion Without Limits
    Act.'' In fact, it is narrowly targeted to certain kinds of, in
    effect, bogus legislation, legislation that masquerades as
    health protection but really is designed to prevent access to
    abortion services that are constitutionally protected.
        So I wonder if you could speak a little bit to the limited
    nature of this legislation, the fact, for example, that it
    specifically prohibits restrictions--and I am quoting from the
    Act--that ``are more burdensome than those restrictions imposed
    on medically comparable procedures.'' In other words, it sets
    medically comparable procedures as the criteria for preventing
    certain kinds of bars to access to abortion services. Could you
    speak to that issue?
        Ms. Northup. Yes, Senator Blumenthal. Thank you for that
    question, because I think we did hear a lot this morning about
    the alleged sweep of this law. But, in fact, it is very
    targeted to what is happening right now in the country. It is
    very targeted to this new tactic of the last several years in
    which State legislatures have been passing laws that purport to
    be about health and safety but are not. And that has been shown
    to be defied in many ways.
        I would definitely recommend everyone read the testimony
    submitted for the record for today's hearing from the executive
    vice president and CEO of the American College of Obstetricians
    and Gynecologists, and that, of course, is the well-respected
    organization to which the vast majority of OB/GYNs belong in
    this country. And in that testimony, they make quite clear--and
    I am quoting--``The American College of Obstetricians and
    Gynecologists strongly support S. 1696, the Women's Health
    Protection Act.'' And they do so because from a scientific and
    medical perspective, these laws are not warranted.
        And I think what is really critical about the bill, which
    you pointed out, Senator, is right from the start, if this is
    something that is treating medically similar practices and
    procedures and services the same, there is no objection.
    Nothing is going to be struck. So that is the starting point.
        Second, if there is a substantial safety basis for the
    regulations, well, then, it is not a law that is unwarranted.
    That law will stand.
        So if it is treating similar medical procedures similarly,
    if it actually advances a safety basis, then that law is going
    to stand. And I think that is important, and there are factors
    that courts would look at in that. But that is what is really
    critical. If it is a true safety law, if it is not about
    singling out abortion provision for the motive of shutting down
    clinics, then that law stands.
        Senator Blumenthal. In fact, a number of the regulations
    that have been claimed to be struck down by this legislation
    the Act specifically says would not be affected, for example,
    funding or insurance or parental consent, other kinds of
    regulations that are now on the books.
        Let me ask you, in terms of these regulations, many have
    been struck down by the courts. Many have been found to be
    unconstitutional. Why a Federal Act that prevents these laws
    from being passed as a matter of statute as opposed to simply
    having the jurisprudential route work its way?
        Ms. Northup. Well, we are here today because we have just
    said 200 of these underhanded laws have been passed, and it is
    not right that women should have to go to court year after year
    after year to get the medical services that the Constitution
    guarantees them. So I think it is important that it be made
    clear what kind of these are already on record. As I said, the
    American Medical Association is on record against many of these
    laws, ACOG is on record against many of these laws, and courts
    are finding many of these laws unconstitutional. It should not
    be a charade every year where women are under threat of losing
    access to services. And we need to make sure that we have
    strong protections because what is happening right now, we
    talked about Texas, which will go down to ten clinics in
    September if that law goes into effect. We have talked about
    Mississippi. We talked of Dr. Parker's practices hanging on by
    a court order. And the unfairness of these laws--in
    Mississippi, the hospitals would not consider giving admitting
    privileges, not based on medical competency but based on their
    opposition or other reasons that have nothing to do with the
    competency of the doctors.
        So we need to make sure that there are strong protections,
    that we do not have this happen every year, and that women can
    be assured that, wherever they live, their personal, private
    decision is going to be respected.
        Senator Blumenthal. While they are on the books, they have
    a very practical impact on women's lives and a very severely
    restrictive impact on their legal rights and a very invasive
    and intrusive consequence for their exercise of personal
    choice. Is that correct?
        Ms. Northup. That is absolutely correct.
        Senator Blumenthal. Let me ask you finally on this round of
    questioning, the issue of admitting privileges, why are
    admitting privileges unnecessary, irrelevant, and in many
    instances found to be unconstitutional?
        Ms. Northup. Well, thank you. That is a very important
    question because that is one of the underhanded tactics that
    has been sweeping the Nation. And, again, I would commend the
    testimony that has been filed by the American College of
    Obstetricians and Gynecologists where they oppose those. It is
    also the case that the American Medical Association and ACOG,
    in a brief in the Fifth Circuit as one example, went on record
    to talk about how there is no medically sound basis for that
    requirement.
        And what is really, I think, important for us to keep in
    mind is--and the AMA and ACOG talk about this in their briefs--
    abortion is safe, one of the safest procedures. And an example
    of how this underhanded tactic has closed a clinic in El Paso,
    Texas--it is not open now because of it--17,000 patients were
    seen in that clinic in 10 years, and not one of those had to be
    taken to a hospital or transferred by the clinic.
        So these laws are unwarranted, and they are unfair. And I
    know that many of us here disagree about the constitutional
    issues around abortion, about the moral issues around it. But I
    would hope that we could agree that State legislatures should
    be transparent in their laws; they should not pretend to be
    about one thing when they are actually about another, because
    to do so undermines our faith in the rule of law. It is unfair,
    it is undemocratic, and it is unconstitutional.
        Senator Blumenthal. Thank you very much. My time has
    expired.
        All of the documents that you referenced will be made a
    part of our record, without objection.
        [The information referred to appears as a submission for
    the record.]
        Senator Blumenthal. Senator Grassley.
        Senator Grassley. Yes, Ms. Tobias, you heard me mention
    Kermit Gosnell in my opening statement. We have the grand jury
    report reconstructing how he had been engaged in an enterprise
    to kill babies, even violate the law, and I think obviously
    violating the trust of his patients.
        State laws were in place in that State, but as the grand
    jury report says, authorities did not do inspections for fear
    it would be seen as ``putting barriers up to women seeking
    abortions.''
        So my question: Wouldn't this particular piece of
    legislation make it easier for these types of individuals to
    continue to operate with impunity?
        Ms. Tobias. This legislation would make it easier for them
    to operate. The law actually says--this legislation actually
    says that if a provision would single out abortion, it would be
    invalid, or if it would impede access to abortion. And one of
    the factors to help determine whether or not it impedes access
    to abortion is allowing the abortion provider to determine
    whether or not the new law, any law, would impede his ability
    to render services.
        So, yes, abortionists like Kermit Gosnell would be able to
    continue to practice, to set up shops. Actually we did see that
    many of the State health departments decided, after hearing
    about Gosnell and realizing that they as well as Pennsylvania
    had not done any kind of inspection of the clinics, went in and
    started doing them, and they were finding some horrible
    situations, and some clinics have been shut down because of
    that.
        But this law would say that if a law is specific to
    abortion, it is invalid, or if it would impede access to
    abortion. And then even then, from there it has to go on to
    whether or not the State can prove that it is going to improve
    access for women, health benefits for women, and even then, if
    it would be yes, then is it the narrow means possible? There
    are so many layers set up in this legislation that practically
    any law dealing with abortion or impeding access in any way to
    abortion would be considered invalid.
        Senator Grassley. Dr. Chireau, some States have laws on the
    books that would require providers of abortion to be located
    near a health facility in the event that medical care is
    needed, and that would probably involve the life of a woman.
    Some States also require abortion providers to have admitting
    privileges to hospitals.
        First of all, do you agree with the laws? And then, second,
    could you elaborate on why they make sense in your expert
    medical opinion and tradition?
        Dr. Chireau. Yes, thank you for the question. So all too
    often--and this has been my experience as a practitioner--when
    abortion complications occur, patients are told to present to
    the emergency room. They are not given any documentation. No
    one is told what was done and what the complications were. This
    has happened to me in practice. A patient experienced
    perforation of her uterus during a late abortion, had a very
    complicated hospital course, and I called the abortionist and
    asked, ``Why did you do this? You knew that you perforated her
    at the time.'' And essentially what he told me was that he knew
    that he did it, but that he did not want to send her to the
    emergency room. And I said, ``That is really malpractice. It is
    not appropriate.'' And, again, his response was, ``Well, she
    started moving.'' I said, ``That is your issue. If a patient is
    moving during a procedure, that is your issue. You should be
    performing the procedure in such a way that it is
    comfortable.''
        But to get to--more directly to respond to your question, I
    do believe that physicians should have admitting privileges
    because that is part of the standard of care. If you perform a
    procedure on a patient, if you are caring for a patient, you
    need to be able to followup on the complications of that
    procedure. That is a surgical maxim. As an OB/GYN or a general
    surgeon or whatever surgical specialty you happen to be in, you
    need to take responsibility for that patient, if they have a
    complication, to either admit them to the hospital and care for
    them yourselves or arrange for transfer to the hospital so that
    that patient can be taken care of. Transfer agreements are very
    important because they provide for continuity of care, and this
    is why I believe that physicians (a) need to have admitting
    privileges and (b) need to be located within a hospital so that
    patients can be managed. So there are a couple of issues here.
        Number one, admitting privileges imply a level of
    competence in clinical practice on the part of physicians. If
    physicians cannot obtain admitting privileges, there are
    reasons why, and that is why peer review is generally the rule
    when patients are applying for privileges. When physicians
    cannot get privileges, it is most often because there are
    issues of competence; they have a trail in their background of
    malpractice events that causes their peers at the hospital to
    say this person is not someone that we want to be on the
    medical staff.
        Hospital credentialing protects patients. Hospital
    credentialing requires that a physician has demonstrated
    competence in doing specific procedures and that they are not
    running from medical boards or running from adverse actions on
    behalf of their licenses.
        Physician-to-physician communications improve the process
    of care. One of the major problems with morbidity and mortality
    in any surgical specialty, medical specialty, is the hand-off.
    It is like a baton hand-off in a race. If you fumble the hand-
    off, you lose the race. If you fumble the hand-off in medicine,
    patients are injured.
        Admitting privileges allow for discipline. If physicians
    are practicing outside the scope of practice, if their skills
    begin to deteriorate after time, admitting privileges provide
    for a regulatory framework where physicians who are in trouble
    or causing problems with patients can be disciplined. And this
    is one of the reasons why I think many people in the abortion
    industry oppose credentialing, because it exposes the fact if
    they are not competent, if they have had excessive numbers of
    complications, if they have a trail of injured patients and
    lawsuits, this is going to be exposed. And then, finally, I
    think that it establishes the fact that if you cannot get
    privileges, you cannot meet the standards for medical practice.
        Finally, an important issue is that being on a hospital
    staff or being on a medical--part of a medical society implies
    that you are part of the medical community. If you are outside
    of that medical community, then clearly something is wrong;
    there is some issue going on.
        I hope I have answered your question.
        Ms. Tobias. Senator Grassley, excuse me. I have an article
    by Melinda Henneberger that talks about what happens when the
    abortion industry is allowed to regulate itself. I would like
    to request that this be added into the permanent record.
        Senator Blumenthal. Without objection.
        [The article referred to appears as a submission for the
    record.]
        Senator Blumenthal. And Senator Grassley has some documents
    he would like to enter.
        Senator Grassley. Yes, I have 15 different--but I would
    just like to mention five: Concerned Women of America,
    Legislative Action Committee, a group of 30 female State
    legislators across the country, the Association of American
    Physician Surgeons, the American Association of Pro-Life
    Obstetricians and Gynecologists, and, last, several OB/GYN
    physicians, including John Thorpe, North Carolina; Steven
    Calvin, Minnesota; and Byron Calhoun of West Virginia.
        Thank you.
        Senator Blumenthal. Thank you. All those documents will be
    made a part of the record, without objection.
        [The information referred to appears as a submission for
    the record.]
        Senator Blumenthal. Senator Hirono.
        Senator Hirono. Thank you, Mr. Chairman.
        I represent a State, Hawaii, that has been a leader in
    protecting women's health and safety. And, in fact, in 1970, we
    were, I believe, the first in the country to decriminalize
    abortion, a woman's right to choose, and, therefore, protecting
    a woman's right to choose.
        And I also want to mention by background that the State
    senator who led the charge to provide women in Hawaii the right
    to choose was a practicing Catholic, and the Governor of the
    State of Hawaii, who allowed this bill, this very important
    bill, to become law to protect a woman's right to make that
    choice, was a practicing Catholic who went to Mass every single
    day. We in Hawaii understand the separation of church versus
    state.
        Now, I do agree that abortion is a different procedure from
    other medical procedures because its foundation is a
    constitutional right. So in my view, there should be a high
    burden on laws that limit or abridge such a constitutional
    right.
        We have heard a lot of testimony from our panel members, so
    I wanted to ask Ms. Northup: Because the right to make this
    kind of a choice is based on a constitutional right, do you
    think that anti-choice laws should be based on medical
    necessity?
        Ms. Northup. Absolutely, and I want to just say again all
    that this bill is about is being sure that women's critical
    access to reproductive health care, including abortion
    services--and as I said in my testimony, that is an issue for
    one in three women in the United States. That is women in every
    State, every congressional district, every city, and every
    town, and her health care is important to her.
        But this bill is about making sure that because State
    legislatures cannot just blatantly ban abortion, which is the
    desire of some people who sit in them, and some States have
    certainly been pushing that envelope. North Dakota has banned
    abortion at essentially 6 weeks, and that is now in the courts.
    Of course, it has been enjoined because it is blatantly
    unconstitutional. The State in its responsive briefs in the
    case said they basically thought Roe v. Wade should be
    overturned. So you have that battle going on.
        But you also have this, you know, underhanded attempt to do
    what they cannot do by the front door by the back door. And so
    it is important that you make sure that regulation of abortion
    is not just about singling out abortion providers, but is
    actually based on good medical practice and scientific
    evidence.
        So the response to even Dr. Chireau's statement is, look,
    if outpatient doctors who are doing, you know, outpatient
    surgeries need to have admitting privileges, that is fine. You
    know, let that be the medical standard that is applied across
    the board. No objection to that. This bill has nothing to say
    to that----
        Senator Hirono. I do not mean to cut you off, Ms. Northup,
    but I do have a question for Dr. Parker--my time is limited.
        Dr. Parker, you provide abortion services in Mississippi
    even if you do not even live there. I understand that you were
    denied hospital privileges in Mississippi. Is that correct?
        Dr. Parker. Great to see you again, Senator.
        Senator Hirono. Aloha.
        Dr. Parker. As you know, I used to live in Hawaii and
    enjoyed serving under your leadership.
        With regard to my decision to travel to Mississippi to
    provide abortion care, it is in part in response to the fact
    that well over 85 percent live in a county where there is no
    abortion provider, and so as I said earlier, my decision to go
    there was based on the fact that if nobody else will go, who is
    going to go?
        Senator Hirono. Yes, I understand.
        Dr. Parker. When I made that decision, the regulations
    changed in the State of Mississippi to require hospital
    privileges. I made an effort to apply to all of the hospitals
    in the given area, and many of the hospitals declined to
    evaluate my application. So why they chose to do that I am not
    sure, but in order to meet the law, I was about to--I was
    unable to do so because there were hospitals who simply
    declined to evaluate my credentials. I am not sure why they did
    that.
        Senator Hirono. I think your experience just points out how
    difficult these laws make it for women in certain States to
    have access to certain kinds of health care services.
        Ms. Northup, I would imagine that these kinds of
    restrictions would disproportionately impact certain
    populations such as low-income women, women of color, and
    immigrant women. Would that be the case?
        Ms. Northup. That is absolutely the case, and I gave the
    example in my testimony that in the Rio Grande Valley, which is
    one of the poorest areas in the Nation, the clinic in McAllen,
    Texas, that had been providing good care for a long time to
    those residents had to close. And, again, it was under those
    circumstances where the doctors were not allowed to get their
    privileges.
        Senator Hirono. Thank you. I just have one question for Ms.
    Tobias. Do you believe that Roe v. Wade should be overturned?
        Ms. Tobias. Yes, I believe----
        Senator Hirono. Thank you.
        Thank you, Mr. Chairman.
        Ms. Tobias. The answer is yes. I believe unborn children
    should be protected.
        Senator Blumenthal. Thank you.
        Senator Graham.
        Senator Graham. Thank you very much, Mr. Chairman. I want
    to thank you for having the hearing because I think it is an
    important topic, and I would like to join with Ms. Tobias'
    recommendation that we have a hearing on my bill, which is the
    Pain-Capable Unborn Child Protection Act, S. 1670, and have a
    joint vote on the Senate floor and see where everybody falls
    out on it, because it is a subject worthy of debate.
        Let us see if we can find some common ground here about how
    these laws work. Ms. Tobias, is it your understanding that S.
    1670 would prevent a ban on third trimester abortions that
    protect--with exceptions for the life of the mother and rape
    and incest?
        Ms. Tobias. S. 1670?
        Senator Graham. Excuse me. The other one, S. 1696.
        Ms. Tobias. The one today?
        Senator Graham. Yes, ma'am. I am sorry.
        Ms. Tobias. Yes, this bill would limit--would prevent a ban
    on abortion in the last trimester. It would prevent----
        Senator Graham. Could you--Ms. Northup, do you agree with
    that?
        Ms. Northup. The bill has provisions that track the
    constitutional standard that do say that post-viability there
    needs to be an exception for a woman's life and health, as the
    Supreme Court has said.
        Senator Graham. So could a State pass a law that banned
    abortion in the last trimester except for life of the mother
    and rape and incest? Your answer would be no?
        Ms. Northup. The standard would have to be the one the
    Supreme Court has recognized.
        Senator Graham. What do you say, Ms. Tobias?
        Ms. Tobias. Well, I think probably one of the best examples
    would be when the sponsor of the bill, Chairman Blumenthal, was
    asked if this bill would ban abortions. It talks about life or
    health, and he said that the health exception makes no
    distinction between physical or psychological health. So it
    would be very difficult--it would be impossible under this bill
    to ban abortions for health if psychology and psychological
    health is going to be comparable.
        Senator Graham. Thank you. There are 13 States that ban
    elective abortions after 20 weeks except in the case of rape,
    incest, and the life of the mother. Would this bill strike
    those laws down?
        Ms. Tobias. Yes, it would.
        Senator Graham. Do you agree with that, Ms. Northup?
        Ms. Northup. Like the Ninth Circuit did with Arizona's 20-
    week ban, yes, it would be unconstitutional, and this bill
    tracks the U.S. Constitution standards.
        Senator Graham. Thank you. States that have waiting
    periods, requiring a waiting period before the abortion is
    performed, would this bill strike that down?
        Ms. Tobias. Yes, this bill would say that if you impede
    access to abortion in any way, it would be struck down.
        Senator Grassley. Do you agree with that?
        Ms. Northup. I do not. It depends on what the court would
    look at. So, again, as we were talking about before----
        Senator Graham. So you do not know how the bill works?
        Ms. Northup. Oh, yes, I do. It is that the first question
    would be, is this type of waiting period something that is also
    imposed on similar----
        Senator Graham. Well, the ones that are on the books, the
    ones that you are familiar with, can you name one State law
    with a waiting period that you think would survive?
        Ms. Northup. Well, I would say that I think it is important
    that we look at the factors in the bill. Does it apply to
    similar services?
        Senator Graham. Can you name one State with a waiting
    period requirement that you think would survive scrutiny under
    this bill?
        Ms. Northup. Well, if it were able to say that it did not
    significantly impede access to services, if it was a waiting
    period that is not a particularly long one----
        Senator Graham. So you cannot give an example.
        Ms. Tobias, does this bill ban States' requirements that a
    person can exercise their conscience about not performing an
    abortion? There are laws on the books that say that, right?
        Ms. Tobias. Yes. If someone says that, according to their
    conscience, they cannot take the life of an unborn child, that
    would be impeding or reducing access to abortion, which would
    be invalid----
        Senator Graham. Would this legislation invalidate those
    laws?
        Ms. Tobias. Yes, it would.
        Senator Graham. Do you agree with that, Ms. Northup?
        Ms. Northup. I do not agree. This legislation does not
    address the issue of conscience objection.
        Senator Graham. Should it? Would you accept an amendment
    offered by me to make sure people of conscience do not have to
    do something like this?
        Ms. Northup. Well, I think we have important laws that are
    on the books that respect people's rights of conscience, and
    so----
        Senator Graham. Well, do you--as to this issue, would you
    accept an amendment by me to this bill to exempt conscience?
        Ms. Northup. Well, I am not elected to make those
    decisions.
        Senator Graham. I got you. Fair enough.
        Ms. Northup. I think this bill clearly does not cover that.
        Senator Graham. Fair enough. I think the answer would be
    no.
        So, Dr. Parker, is it standard medical practice for
    physicians operating on a child at 20 weeks to provide
    anesthesia to that child?
        Dr. Parker. Well, Senator, I am not well versed in fetal
    surgery because most surgeries at 20 weeks would have to occur
    in utero.
        Senator Graham. Right, it would. Ms. Chireau, are you
    familiar with what would be the standard of care there?
        Dr. Chireau. Yes, it is, and that is because when fetal
    surgery is done--and I am very well aware of the fetal surgery
    landscape. Initially, when fetal surgery was being done,
    fetuses reacted very strongly to incisions, to placement of
    catheters, so----
        Senator Graham. Is it standard medical practice to provide
    anesthesia when you operate----
        Dr. Chireau. Yes.
        Senator Graham [continuing]. On a baby at 20 weeks?
        Dr. Chireau. Yes.
        Senator Graham. Medical encyclopedias--and I am sorry I am
    running over; I will wrap it up here--encourage parents to talk
    to the baby at 20 weeks. They can hear sounds. They react to
    your voice. They can hear your heartbeat as a mother. They can
    hear your stomach growling, and they can react to loud noises.
    Does that make sense to you, Ms. Chireau?
        Dr. Chireau. Yes, it does.
        Senator Graham. Okay. Has anyone ever been born at 20 weeks
    that survived?
        Dr. Chireau. As far as I am aware, no.
        Dr. Parker. Not to my knowledge.
        Senator Graham. I can show you twins. Thanks.
        Senator Blumenthal. Senator Hatch.
        Senator Hatch. Well, thank you, Mr. Chairman.
        You know, Congress has a few times told the States that
    they had to pass certain legislation, but only as a condition
    of receiving Federal funds of some kind. Now, I am in my 38th
    year here in the U.S. Senate, and on this Committee, and I do
    not recall Congress ever passing a law that prohibited States
    from enacting entire categories of laws simply because Congress
    says so. I do not recall that.
        Can anyone on this panel give me an example of that? And if
    not, why is abortion so unique that Congress has this authority
    in this area but not in any other? Anybody care to take a crack
    at that? I do not see it, personally.
        Well, let me ask a question to you, Ms. Tobias. States have
    been passing laws regarding abortion for almost 200 years. The
    Supreme Court took over in its Roe v. Wade decision, and since
    1973 the United States has had the most permissive abortion
    laws in the world today. But most Americans have always opposed
    most abortions, and the vast majority of Americans support
    reasonable and commonsense abortion regulations. At least that
    has been my experience, and I do not think it is a false
    experience.
        This bill attempts to wipe it all out to eliminate even
    minimal regulations that most Americans support and that the
    Supreme Court has already said are constitutional.
        Now, I opposed this kind of legislation more than 20 years
    ago when I was Ranking Member of what is considered today the
    HELP Committee. This bill would not regulate abortions. It
    would regulate the States telling them what laws they may or
    may not pass.
        How does Congress have the authority to do that?
        Ms. Tobias. Currently the law--other than what the Supreme
    Court will or will not allow--has the State legislatures
    elected by the people setting the laws for their States. I
    think that is actually a very good way to handle this. The
    States have been dealing with the conscience clauses, setting
    up the waiting periods, informed consent provisions, and the
    courts have been allowing these to stand. So it is difficult to
    say that a law that the Court has upheld is unconstitutional.
    So we certainly think that Congress would be overstepping in
    passing a law that would completely override a procedure that
    the Supreme Court has said is different.
        Senator Hatch. This bill would prohibit restricting
    abortions based on the reasons for the abortion. The way I read
    the bill, neither States nor the Federal Government could
    prohibit abortions performed because, for example, a child is a
    girl or because the child has a disability. Is that the way you
    understand it?
        Ms. Tobias. Yes.
        Senator Hatch. Dr. Chireau, this bill sounds like it is
    very deferential to medical judgment and that abortion should
    be treated like any other medical procedure. But under this
    bill, politicians, lawyers, and judges would make final
    decisions on such things such as which medical procedures are
    ``comparable,'' which tasks doctors may delegate to other
    personnel, which drugs may be dispensed, which medical services
    may be provided through telemedicine, how many visits to a
    medical facility are necessary, the relative safety of abortion
    services, which methods advance the safety of abortion or the
    health of women more or less than others.
        Now, from your perspective as a doctor, doesn't this bill
    actually compromise the practice of medicine?
        Dr. Chireau. I think it does compromise the practice of
    medicine, and I believe that is on two levels: number one, for
    the reasons that you have enumerated; number two, because I do
    believe that current legislation in the States to set clinic--
    specify access to clinics and so on and so forth is protective
    to patients. So I think that it is doubly a problem, number
    one, for those reasons that you have listed and also because
    the regulations that have been enacted were enacted in an
    attempt to prevent abortion providers from being exempted from
    the same sorts of regulatory frameworks that other medical
    practitioners have to operate within.
        Senator Hatch. This bill would prohibit restrictions on
    abortions that are not also imposed on what it calls
    ``medically comparable procedures.'' Now, that is just one of
    the key terms in this bill that are brand new and completely
    undefined. But this bill makes a pretty clear statement that
    there is nothing unique about abortion, nothing that makes it
    different from any other medical procedure. And that, of
    course, is not true.
        Dr. Chireau. That is correct.
        Senator Hatch. Whether you are pro-abortion or anti-
    abortion. Even in Roe v. Wade, the Supreme Court said that the
    State has unique reasons for restricting abortion because it
    involves what the Court called ``potential human life.'' And in
    Harris v. McRae, the Supreme Court in 1980 held that the
    abortion ``is inherently different from other medical
    procedures because no other procedure involves the purposeful
    termination of a potential life.''
        I do not think that we need the Supreme Court to tell us
    that, but there it is. Doesn't that settle this question and
    completely undercut the entire theory behind this bill?
        Dr. Chireau. Yes, I believe that it does, and I think that
    the issue of comparable procedures is really false. I believe
    that abortion is a unique procedure. As you have said, it is
    the only procedure that terminates a human life.
        In addition, from the technical perspective, an abortion is
    a very different procedure from, say, completing a miscarriage
    or doing a dilation and curettage on an non-pregnant woman.
        Senator Hatch. Mr. Chairman, could I ask just a couple more
    questions?
        Senator Blumenthal. Sure.
        Senator Hatch. I know that there are just two of us here.
        Senator Blumenthal. We are approaching a vote, and Senator
    Cruz is here, so----
        Senator Hatch. Oh, I did not see Senator----
        Senator Cruz. Take all the time you----
        Senator Hatch. Well, let me just ask one more.
        The Supreme Court created one set of rules in 1973 for
    evaluating the constitutionality of abortion regulations. Then
    the Court changed the rules in 1992. Now, this bill creates yet
    another standard: prohibiting regulations that a State cannot
    show by clear and convincing evidence significantly advanced
    the safety of abortions.
        Now, it is bad enough that the Supreme Court sometimes does
    Congress' job, but here is Congress attempting to turn around
    and do the Court's job.
        But it gets worse. This bill applies its rules and
    regulations to all State and Federal statutes, to all State and
    Federal regulations in the past, in the present, and in the
    future. Does this mean, for example, that States would be
    required to repeal any laws or regulations already on the books
    that do meet these new rules?
        Dr. Chireau. Yes, sir, I think that that is a very
    important point. I think that essentially this law guts States'
    rights with respect to abortion. It creates abortion as a
    special protected class of procedure and abortion providers as
    a special protected class of providers.
        Senator Hatch. Well, I cannot imagine why any State
    legislature would support this, no matter their position on
    abortion. Now, I am having real trouble here with this
    approach, but at least I wanted to raise these issues because I
    think they are important issues.
        Thank you, Mr. Chairman.
        Senator Blumenthal. Thank you.
        Senator Hatch. Sorry to impose on Senator Lee and Senator
    Cruz.
        Senator Blumenthal. Senator Cruz, Senator Lee was here
    earlier, so I am going to call on him at this point. Thank you.
    Thanks, Senator Hatch.
        Senator Lee. Thank you, Mr. Chairman. Thanks to all of you
    for joining us today.
        There was a time when the humanity of an unborn child could
    plausibly be dismissed as philosophical conjecture. Today we
    know it is a biologic fact. For every excited announcement,
    every baby shower, every ultrasound image posted on Facebook,
    all of this attests to this scientifically confirmed, very deep
    human truth. The only difference is that unborn boys and girls
    are small and they are helpless and they are mute. They cannot
    speak for themselves. They rely on strangers. They rely on us
    to speak for them.
        I believe in the innate dignity of every human life, and I
    believe every human society is rightly judged by how it treats
    its most vulnerable members--the aged, the poor, the sick, the
    disabled, the abused, the homeless, the widowed, and the
    orphaned, the pregnant mother in crisis, and, of course, the
    unborn child in the womb.
        Neither our society at large nor our laws have to pit the
    vulnerable one against another. We can choose instead, we have
    the power to choose instead to welcome and to love and to
    protect all, even and especially the weakest among us. Making
    that choice presents an enormous challenge to all of us as
    policymakers, as citizens, as neighbors and friends, as parents
    and children ourselves.
        But the challenge of life is, after all, why we are here:
    to use our strength in defense of the weak. We should choose to
    embrace that challenge and to do so with love and with open
    arms. We can choose life, and when this debate finally 1 day
    ends, I think we will. I think we will choose life.
        So let me start with a couple of questions for Ms. Tobias,
    if I might. At a rudimentary level, does S. 1696 even consider
    the possibility that there might be more than one life involved
    and at stake when a woman seeks an abortion?
        Ms. Tobias. No, it does not.
        Senator Lee. And yet this proposed legislation would have
    far-reaching effects, potentially not just for one life but for
    two, in any given instance. Isn't that right?
        Ms. Tobias. For every abortion that is performed, there is
    a human life that is destroyed. This bill does not mention it,
    treating the child as a tumor instead.
        Senator Lee. So in that respect, it is very different than
    other legislation that might just affect one person, might just
    affect the health of one person. This one involves the
    potential in each instance for the destruction of one person's
    life, its complete termination.
        Ms. Tobias. Yes.
        Senator Lee. Many medical experts and health providers have
    strong moral and ethical concerns, as they have every right to
    have, with providing abortions. And yet this bill, as I
    understand it, would have the Federal Government telling the
    States that they, the States, may not protect the rights of
    conscience for medical providers. My own State, for example,
    guarantees the right of a medical provider to refuse to
    participate, admit, or treat for an abortion based on moral or
    based on religious grounds. These laws matter. I can point to
    several instances in which, absent such laws, university or
    hospital policies would have forced medical personnel to
    perform abortions, notwithstanding and against serious moral or
    religious objections.
        So, Ms. Tobias, let me just ask, what role do freedom-of-
    conscience laws currently play? And what effect would this bill
    have on those laws? And what concerns should we have and would
    you have with such an outcome?
        Ms. Tobias. A lot of people go into the medical field
    because they want to take care of people. They go into
    obstetrics and gynecology, they become delivery room nurses
    because they want to take care of pregnant women and babies,
    and they do not want to kill unborn children. If they are told
    that they have no choice, that they will have to perform or
    participate in the performance of an abortion procedure, they
    will either be doing something that is very strongly, deeply
    offensive to them, or they will leave the field, which means we
    would have a lot of wonderful doctors and nurses who could be
    helping pregnant women and their children, finding something
    else completely to do. I think that would actually be a huge
    detriment to the medical community. This bill would strike down
    conscience laws because those laws would impede or reduce
    access to abortion.
        Senator Lee. Thank you. Thank you for your answers.
        I see my time has expired. Thank you, Mr. Chairman.
        Senator Blumenthal. Thank you.
        Senator Cruz.
        Senator Cruz. Thank you, Mr. Chairman. I want to thank each
    of the witnesses for coming and joining us today.
        The legislation this Committee is considering is extreme
    legislation. It is legislation designed to eliminate reasonable
    restrictions on abortion that States across this country have
    put in place. It is legislation designed to force a radical
    view from Democrats in the Senate that abortion should be
    universally available, common, without limit, and paid for by
    the taxpayer.
        That is an extreme and radical view. It is a view shared by
    a tiny percentage of Americans, although a very high percentage
    of activists in the Democratic Party, who fund and provide
    manpower politically. And it is also a very real manifestation
    of a war on women given the enormous health consequences that
    unlimited abortion has had, damaging the health and sometimes
    even the lives of women.
        I have with me 317 statements from Texas women who have
    been hurt by abortion, along with letters from Texans opposing
    this bill, along with letters from pro-life doctors, nurses,
    lawmakers across the United States that, with the Chairman's
    permission, I would like to have entered into the record.
        Senator Blumenthal. Without objection.
        [The information referred to appears as a submission for
    the record.]
        Senator Cruz. A number of the restrictions that this
    legislation would invalidate are restrictions, commonsense
    restrictions, that the vast majority of Americans support, for
    example, restrictions on late-term abortions. The overwhelming
    majority of Texans do not want to see late-term abortions
    performed except in circumstances when necessary to save the
    life of the mother. And yet the United States' laws and the law
    that would be reflected in this bill is extreme by any measure.
        Today the United States is one of seven countries in the
    world that permits abortion after 20 weeks. We are in such
    distinguished company as China, North Korea, and Vietnam--those
    known paragons of human rights.
        If you look at some other countries across the world, in
    France abortion is prohibited after 12 weeks. In Italy abortion
    is prohibited after 12\1/2\ weeks. In Spain abortion is
    prohibited after the first trimester. In Portugal abortion is
    prohibited after 10 weeks. This is the norm across the world,
    and yet this legislation would say that the 23 States who have
    enacted limits on late-term abortion, their laws would be set
    aside.
        A question I would ask Dr. Parker: Is it your view that
    these nations--France, Italy, Spain, Portugal--that they are
    somehow extreme or manifest a hostility to the rights of women?
        Dr. Parker. Senator Cruz, thank you for your question. I am
    not an international human relations expert. I can tell you
    that when abortion is legal and safe that the known mortality
    related to women taking desperate measures when abortion is
    illegal is greatly minimized, as demonstrated by what happened
    in this country after 1973.
        I do know that internationally in a country like Ghana,
    where I have traveled, whereas they have made great strides
    toward reducing their maternal death rate by having better
    access to maternal care, despite the fact that abortion is
    legal, because it is so heavily stigmatized when women do not
    access that care, that--the major cause of maternal mortality
    in Ghana is related to unsafe abortion.
        So if access to legal and safe service being a reality for
    women with an unplanned or wanted pregnancy or a lethally
    flawed pregnancy reflects human rights values, then countries
    that restrict that, we would have to question their commitment
    to the humanity and safety of the women in their populations.
        Senator Cruz. Well, thank you for your views, Dr. Parker. I
    would note that the suggestion that somehow France or Italy or
    Spain or Portugal or much of the civilized world is somehow
    insensitive to the rights of women is rather extraordinary. And
    the idea that America would rush out to embrace China and North
    Korea for the standard on human rights is chilling.
        I would note that this law would also set aside State laws
    prohibiting taxpayer-funded abortion. Thirty-two States have
    laws to do that. This law would also imperil State laws
    providing for parental notification if your child needs an
    abortion that at a minimum before that serious medical
    treatment that a parent has a right to be notified. Thirty-
    eight States have that law, and yet this extreme bill in
    Congress would imperil every one of those laws.
        And, finally, if I may have another 30 seconds to just
    share some of the stories from women in Texas:
        Nona submitted this story. She said, ``I was told I just
    had a blob of tissue by Planned Parenthood after they did my
    pregnancy test and then referred me to a nearby abortion
    clinic. I was not given the option of having a sonogram. I was
    not given the option of hearing my baby's heartbeat. Had I been
    given the opportunity of seeing my baby and hearing the
    heartbeat, I can assure you that I would not have chosen
    abortion. I would have chosen life instead of death. How can
    anyone believe that abortion should be legal after seeing a
    baby living in the womb of its mother on a sonogram and hearing
    the heartbeat of that baby? I felt I was pressured by Planned
    Parenthood because they told me that the best thing I could do
    was have an abortion since I was so young. I was 15 years old
    and still in high school. That abortion ruined any chance of me
    giving birth. As a result, I have had five miscarriages, three
    of them have been tubal pregnancies requiring emergency surgery
    and were very near death experiences. I have suffered from
    bouts of depression and attempted suicide, self-mutilation. My
    experience of emotional trauma after abortion is the same as
    millions of other women and their families.''
        I have 317 statements, each as powerful as that in terms of
    the human consequences of what this legislation would produce.
        Thank you, Mr. Chairman.
        Senator Blumenthal. Thank you.
        Ms. Northup, would this legislation prohibit the use of
    ultrasounds when a patient requests them?
        Ms. Northup. Oh, no, not at all. This law again is just
    very focused on those underhanded type of restrictions that are
    treating abortion not like similarly situated medical practices
    that do not advance health and safety and are harming access to
    services.
        Senator Blumenthal. In essence, it would be irrelevant to
    the instance that Senator Cruz has just described.
        Ms. Northup. Yes, absolutely. It also very explicitly does
    not cover the question of insurance funding. It is not
    addressing that. It would not invalidate those laws. It has
    nothing to do with minors. It specifically says it does not
    address issues about parental consent and notification laws.
        Senator Blumenthal. Dr. Chireau, have you ever performed an
    abortion?
        Dr. Chireau. No, I have not.
        Senator Blumenthal. Dr. Parker, how many abortions have you
    performed?
        Dr. Parker. I do not have the numbers right off, but I can
    tell you that over 20 years of patient care, I have seen
    thousands of women, and some of those women have needed
    abortion care.
        Senator Blumenthal. And in your experience--over how many
    years?
        Dr. Parker. Twenty.
        Senator Blumenthal. Twenty years--has the width of a
    hallway in those clinics where you have performed your medical
    services affected the quality or expertness of those medical
    services?
        Dr. Parker. No, Senator.
        Senator Blumenthal. Has the admitting privileges within
    that State affected the quality or effectiveness of your
    medical services?
        Dr. Parker. Only to the extent that they prevented me from
    providing care to women.
        Senator Blumenthal. They have barred you entirely, but
    admitting privileges are irrelevant to the quality and
    excellence of your medical services because anyone in need of a
    hospital will be admitted to that hospital.
        Dr. Parker. Correct, Senator.
        Senator Blumenthal. And the waiting period, is that
    relevant to the quality or effectiveness of your medical
    services?
        Dr. Parker. The reality, Senator, is that women are
    extremely thoughtful, and most women that I meet, when they
    present to me to be counseled about their options, they have
    been thinking about what they are going to do about their
    pregnancy from the minute that they found they were pregnant.
    So I know women to be extremely thoughtful, and I have not seen
    any woman's ability to make this complex decision enhanced by
    being forced to wait longer than she has already thought about
    it.
        Senator Blumenthal. Thank you.
        Ms. Northup, in response to a number of Senator Graham's
    questions, you essentially said that the limits embodied and
    incorporated in this bill were the constitutional standards. Is
    that correct?
        Ms. Northup. That is correct. For example, most States
    under the Supreme Court's constitutional rulings can ban
    abortion later in pregnancy, and do. And as long as they have
    an exception for women's health and life, those laws are on the
    books now, and they would still be on the books.
        Senator Blumenthal. In effect, this law basically enforces
    the Constitution.
        Ms. Northup. Absolutely enforces every woman's
    constitutional right to make the important decisions for
    herself.
        Senator Blumenthal. And, finally, in those countries--and a
    reference was made to a number of them--where abortion is made
    illegal, is it made safer?
        Ms. Northup. No. Around the world many of the places where
    abortions happen, women are terminating pregnancies where it is
    illegal and it is unsafe. And whether you see this country
    before Roe v. Wade or you look at places in Latin America and
    Sub-Saharan Africa today, when women do not have access to safe
    and legal abortion, they are harmed.
        Senator Blumenthal. You made reference, speaking about the
    State of Texas, to women in Texas going across the border to
    Mexico so that they could buy at a flea market drugs necessary,
    they thought, for abortions because they could not get that
    service in the United States?
        Ms. Northup. Yes. As the clinics have been shrinking in
    Texas because of laws that--again, I commend the American
    Medical Association's brief in the Fifth Circuit talking about
    the medically unnecessary laws that have been passed in Texas.
    That is the AMA, a very mainstream medical opinion. Because it
    is taking clinics from three dozen, cut by a third, and it will
    be down to less than ten if it is allowed to go into effect,
    women have been going over the border in Mexico. They have been
    buying medication on the black market. They have been trying to
    self-abort. And the situation is going to be worse. Women are
    hurt when they cannot get the medical care that they need.
        Senator Blumenthal. Ms. Taylor, in your experience in
    Wisconsin, have the restrictions on women's access to
    reproductive rights made abortions safer?
        Ms. Taylor. No, Mr. Chairman, they have not.
        Senator Blumenthal. Have they created confusion, in fact,
    discouraged women from seeking to exercise their right?
        Ms. Taylor. Absolutely, and they have sent women out of
    State.
        Senator Blumenthal. Thank you.
        We are voting, so I apologize. I am going to have to close
    the hearing. My colleagues are on their way there. I want to
    enter into the record, without objection, various statements,
    including Planned Parenthood in Southern New England, a
    statement that has been submitted for the record.
        As is our custom, our record will remain open for 1 week in
    case my colleagues have additional questions, and I again
    really want to thank every one of our witnesses for
    participating in this very, very important hearing. Thank you
    all for attending.
        [Whereupon, at 12:08 p.m., the Committee was adjourned.]
        [Additional material submitted for the record follows.]

                                A P P E N D I X

                  Additional Material Submitted for the Record

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                     Additional Submissions for the Record

    A list of material and links can be found below for Submissions for the
     Record not printed due to voluminous nature, previously printed by an
     agency of the Federal Government, or other criteria determined by the
                                   Committee:

        Case files documented August 19, 2011:
            http://www.cruz.senate.gov/files/documents/20141218_Stories.pdf

                                     [all]