    [Senate Hearing 117-403]
    [From the U.S. Government Publishing Office]

                                                        S. Hrg. 117-403

                             REPRODUCTIVE CARE IN A
                               POST-ROE AMERICA:
                           BARRIERS, CHALLENGES, AND
                           THREATS TO WOMEN'S HEALTH

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

                                    HEARING

                                    OF THE

                        COMMITTEE ON HEALTH, EDUCATION,
                              LABOR, AND PENSIONS

                              UNITED STATES SENATE

                        ONE HUNDRED SEVENTEENTH CONGRESS

                                 SECOND SESSION

                                       ON

        EXAMINING REPRODUCTIVE CARE IN A POST-ROE AMERICA, FOCUSING ON
              BARRIERS, CHALLENGES, AND THREATS TO WOMEN'S HEALTH

                                   __________

                                 JULY 13, 2022

                                   __________

     Printed for the use of the Committee on Health, Education, Labor, and
                                    Pensions

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

            Available via the World Wide Web: http://www.govinfo.gov

                                 __________

                        U.S. GOVERNMENT PUBLISHING OFFICE
    48-914 PDF                  WASHINGTON : 2023

    -----------------------------------------------------------------------------------

              COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS

                        PATTY MURRAY, Washington, Chair
    BERNIE SANDERS (I), Vermont          RICHARD BURR, North Carolina,
    ROBERT P. CASEY, JR., Pennsylvania       Ranking Member
    TAMMY BALDWIN, Wisconsin             RAND PAUL, M.D., Kentucky
    CHRISTOPHER S. MURPHY, Connecticut   SUSAN M. COLLINS, Maine
    TIM KAINE, Virginia                  BILL CASSIDY, M.D., Louisiana
    MAGGIE HASSAN, New Hampshire         LISA MURKOWSKI, Alaska
    TINA SMITH, Minnesota                MIKE BRAUN, Indiana
    JACKY ROSEN, Nevada                  ROGER MARSHALL, M.D., Kansas
    BEN RAY LUJAN, New Mexico            TIM SCOTT, South Carolina
    JOHN HICKENLOOPER, Colorado          MITT ROMNEY, Utah
                                         TOMMY TUBERVILLE, Alabama
                                         JERRY MORAN, Kansas

                         Evan T. Schatz, Staff Director
                   David P. Cleary, Republican Staff Director
                      John Righter, Deputy Staff Director

                               C O N T E N T S

                                  ----------

                                   STATEMENTS

                            WEDNESDAY, JULY 13, 2022

                                                                       Page

                               Committee Members

    Murray, Hon. Patty, Chair, Committee on Health, Education, Labor,
      and Pensions, Opening statement................................     1

    Marshall, Hon. Roger, a U.S. Senator from the State of Kansas,
      Opening statement..............................................     5

                                   Witnesses

    Brandi, Kristyn, M.D., M.P.H., FACOG, Board Chair, Physicians for
      Reproductive Health, New Jersey................................     9
        Prepared statement...........................................    10
        Summary statement............................................    12

    Taylor, Jamila, Ph.D., M.P.A., Director of Health Care Reform and
      Senior Fellow, The Century Foundation, Washington, DC..........    13
        Prepared statement...........................................    14
        Summary statement............................................    15

    Detzer, Samie, Planned Parenthood Patient Advocate, Planned
      Parenthood Federation of America, New York.....................    16
        Prepared statement...........................................    18
        Summary statement............................................    19

    Swindell, Brandi, Founder and CEO, Stanton Healthcare, Idaho.....    19
        Prepared statement...........................................    21
        Summary statement............................................    22

                              ADDITIONAL MATERIAL

    Murray, Hon. Patty:
        American Academy of Family Physicians, Prepared Statement....    53
        NARAL Pro-Choice America, Prepared Statement.................    65
    Burr, Hon. Richard:
        Statement for the Record.....................................    67
    Kaine, Hon. Tim:
        ``What Moving from Kentucky to Virginia after I was Diagnosed
          with Cancer Reveals About Roe'', article, July 7, 2022.....    68

                             QUESTIONS AND ANSWERS

    Response by Kristyn Brandi to questions of:
        Sen. Lujan...................................................    79

                             REPRODUCTIVE CARE IN A
                               POST-ROE AMERICA:
                           BARRIERS, CHALLENGES, AND
                           THREATS TO WOMEN'S HEALTH

                                  ----------

                            Wednesday, July 13, 2022

                                           U.S. Senate,
           Committee on Health, Education, Labor, and Pensions,
                                                        Washington, DC.

        The Committee met, pursuant to notice, at 10 a.m., in room
    216, Hart Senate Office Building, Hon. Patty Murray, Chair of
    the Committee, presiding.

        Present: Senators Murray [presiding], Casey, Baldwin,
    Murphy, Kaine, Hassan, Smith, Rosen, Hickenlooper, Cassidy,
    Murkowski, Braun Marshall, and Tuberville.

                      OPENING STATEMENT OF SENATOR MURRAY

        The Chair. Good morning. The Senate Health, Education,
    Labor, and Pensions Committee will please come to order. Today
    we are having a hearing on reproductive care in America
    following the Supreme Court's devastating decision in Dobbs to
    overturn Roe v. Wade. I will have an opening statement followed
    by Senator Marshall. We will then introduce our witnesses.

        After the witnesses give their testimony, Senators will
    each have 5 minutes for a round of questions. And while we are
    unable to have the hearing fully open to the public or media
    for in-person attendance, live video is available on our
    Committee website at help.senate.gov.

        The live stream will include closed captioning. If you are
    in need of other accommodations, please reach out to the
    Committee or to the Office of Congressional Accessibility
    Services. Three weeks ago, the Supreme Court and the
    Republicans who dedicated years to swinging the court
    aggressively to the right, dragged our Country back 50 years.
    They overturned Roe v. Wade ended the right to abortion and
    upended the lives of millions of people.

        The consequences have been harsh and swift. Women sobbed in
    clinics as they had their abortions canceled. Their personal
    health care decisions overruled, their futures thrown in
    jeopardy, and their control over their own bodies taken away.
    It was heartbreaking, terrifying, enraging, and barbaric.

        That was just day one. Since then, the devastating
    repercussions of Republicans' cruelty continue to crash around
    us women unable to get abortions for any reason, healthcare
    providers unable to do their jobs without risking prison,
    patients with lupus, cancer, arthritis, and more denied the
    medications that they need, complete uncertainty for people
    planning their futures as access to Plan B and IVF have been
    thrown into jeopardy, and Republicans' response to this
    devastation is to discuss how they can push even further, be
    even harsher, take even more power away from patients, and
    scare even more doctors out of their jobs.

        Some Republicans are talking about a Federal ban on
    abortion, overruling laws in states like my home state of
    Washington and ripping away rights from my constituents.
    Republicans are talking about criminal penalties for women and
    healthcare providers and about making traveling to get an
    abortion illegal.

        They are talking about everything except the actual harm
    they are causing. This is a health care crisis that was
    entirely unavoidable--or was entirely avoidable and is entirely
    their own creation. I have been warning for years about
    Republicans' attacks on reproductive rights putting lives at
    risk, and I am far from the only one. Women, providers, and
    patients across the country have all been shouting from the
    rooftops that overturning Roe would be devastating.

        But Republicans refused to listen to me or to the majority
    of people across the country who wanted Roe to stand, who
    wanted to keep their rights and preserve women's ability to
    control their own bodies. Republicans are still continuing to
    spread disinformation about the reality that we are now facing
    and about the consequences of this backward agenda.

        When the leaked decision came out, Republicans tried to say
    they weren't going to put women and doctors in jail, even as
    state Legislatures across the country were already moving to do
    just that. And they are still trying to say it won't be that
    bad, even when it is clearly devastating for women across the
    country who they are ignoring and depressing.

        Well, today we are going to hear exactly what this cruelty
    means for women seeking abortions. Women, Republicans will
    force to stay pregnant when they do not want to be. Women whose
    bodies Republicans are taking control of without their consent
    and against their wishes. And this isn't just about whether
    people want to be parents, though let me be perfectly clear, we
    must do way more than Republicans have ever dreamed of doing to
    actually support parents, childcare, paid leave, you name it.

        Republicans have blocked Democrats nonstop efforts to
    deliver for working families. But anyone who has given birth
    also knows this isn't just about whether you are ready to raise
    a child, pregnancy is a life changing medical procedure. It
    takes a physical toll. It takes a mental toll. And for too many
    women in our Country, it takes their life. No one should be
    forced to go through this against their will.

        But Republicans are going to force women to stay pregnant
    not only when they don't want to be, but even when it could
    kill them. Just ask Elizabeth, who I spoke with last week in
    Spokane. She has been pregnant four times. All planned, all
    wanted. But twice she learned her pregnancy would be fatal if
    it was not ended. In the first instance, she got the
    heartbreaking news that one of the twins that she was carrying
    had died.

        The other could not possibly survive outside the womb, and
    that her life was now in grave danger. In the second instance,
    she was told that without immediate action, she would lose too
    much blood to survive the night.

        As she told me and I quote, ``had I lived in a state
    without access to safe and legal abortion, I would have died
    bleeding out on the side of the road, trying to make it to a
    state that would help me.'' Those are the stakes. And not just
    for Elizabeth, but for many patients. About 1 in 50 pregnancies
    in our Country are ectopic. That means they are not viable, and
    without medical action, they are deadly.

        But in Republicans' post Roe world, health care providers
    aren't sure when or even if they will be able to treat ectopic
    patients without being sent to prison. Some have already been
    instructed to observe patients until they have unstable, vital
    signs before acting. Basically sit on your hands until women
    are at dire risk before you can do what is medically necessary.
    That is absolutely barbaric, and it is a policy choice that
    Republicans have made.

        Now, some may try to suggest that patients go to another
    state, but if you are in the middle of a medical emergency that
    is dangerous or--that is dangerous or impossible. Not to
    mention that some Republicans are already talking about banning
    interstate travel. And we cannot lose sight of the fact that
    some--that the same patients and providers that are hurt by
    these restrictions are on the front lines of our Nation's
    maternal mortality crisis.

        We have the worst maternal death rate in the developed
    world. And in the very states where it is the most dangerous to
    give birth, Republican legislators are now forcing people to
    give birth against their will. It doesn't take an expert to
    understand this is only going to get worse because of the
    dangerous abortion bans.

        Women will be denied the care they need, the care their
    doctors know could save their lives. states will lose maternal
    health care providers who understandably don't want to live
    where they could be jailed for doing their job. This will be
    especially hard on people in rural areas, on women of color,
    and on women with disabilities who already have a particularly
    difficult time finding a provider who takes their concerns
    seriously and understands their health care needs.

        It can be even harder still for transgender patients
    seeking reproductive care while facing stigma, discrimination,
    and bigotry. And make no mistake, this isn't just going to
    devastate patients in states with abortion bans. First off, I
    want to be very clear, Republicans have been explicit. They
    want to go further.

        They want to pass legislation to go after people who help
    patients travel for an abortion, and a national abortion ban
    that would trample the rights of patients in Washington State.
    And second, even now, health clinics are being overwhelmed. I
    was in Spokane last week only miles from the Idaho border, and
    providers there are already seeing an uptick of patients and
    preparing for a huge surge of patients seeking care when
    Idaho's extreme ban goes into effect next door.

        We are talking as many as five times more people seeking
    abortions at our clinics. They are on the front lines of a full
    blown health care crisis. And let's not forget, there are so
    many women who cannot travel to get an abortion, who don't have
    the time or the resources, who face barriers to accessible
    travel or are too young to drive themselves. There is also the
    very real risk that people with no other options will turn to
    dangerous, even deadly misinformation that is spreading on
    social media.

        Because, as I am warned before so many times, banning
    abortion doesn't stop abortions. It just stops people from
    getting safe abortions. And it is not only women seeking
    abortions who are having their lives totally upended by
    Republicans. It is women seeking birth control. Some
    Republicans have discussed going after contraception next. And
    Justice Thomas said the Supreme Court should overturn the right
    to birth control. People hoping to start a family using IVF
    could also be under threat.

        IVF providers have serious concerns about whether parents
    and providers could be punished if an embryo doesn't survive
    being thawed for implementation or for disposing unused
    embryos. That isn't idle worrying because Republicans in
    several states have already proposed extreme bills that ban
    abortions starting at conception and could impact IVF and some
    methods of birth control.

        Already, pharmacies have told patients with lupus,
    arthritis, and other conditions they can't fill their
    prescriptions due to concerns the drugs would be used for an
    abortion. And let's be clear, those drugs, the FDA approved as
    safe and effective for their condition years ago. There are
    also cancer patients who may be unable to start chemotherapy
    until they can get an abortion.

        Then there are people who have a miscarriage. Abortion bans
    could jeopardize their health and stop them from getting the
    care they need to end their miscarriage. And afterwards, they
    could still face another nightmare, being reported by someone
    who thinks they got an abortion. Imagine going through the
    heartbreak of losing your pregnancy and then being put in
    prison for it.

        This doesn't have to be an exercise in imagination. From
    2006 to 2020, over a 1,000 women in this country were
    investigated, detained, or arrested because of their pregnancy
    outcomes. That is horrific. If it is a problem, we should be
    trying to solve. And instead, thanks to Republicans, it is
    about to get dramatically worse.

        That is why people across the country are so scared and so
    heartbroken and so angry and I am, too, because the stakes
    could not possibly be higher. That is why I led Senate
    Democrats in pushing President Biden and his Administration to
    do everything they can to protect access to abortion and
    reproductive health care.

        President Biden's Executive Order on abortion last week was
    a good, important step, but this fight is far from over. As we
    continue living through a post Roe health care crisis, I am
    still urging the President to continue to fight back.

        But with limited executive authority, ultimately we need
    more pro-choice Senators in the Senate willing to waive the
    filibuster so we can protect women. If we can get that, we can
    codify Roe, as well as put in law key protections for women. It
    is as simple as that. We also need to hold Republicans
    accountable for the harsh reality they have now created. And
    that is why I am holding this hearing today.

        It Is why later this week, we will call for unanimous
    consent to pass a bill to protect women who travel to another
    state for abortion care, to show the stark contrast between
    Republicans' cruel agenda and Democrats steadfast commitment to
    making sure women can get the reproductive health care they
    need. And it is why I am going to continue standing with women
    and lifting up patients voices.

        Anyone who thinks I am going to stop, any Republican who
    thinks people will forget about this in a few months, you still
    don't get it. How do you forget being denied your prescription
    because of this or being denied your birth control? How do you
    forget having to drive across states to end a pregnancy so you
    can fight for your life against cancer?

        How do you forget being forced to choose between saving
    your patient or going to jail? How do you forget your dream of
    starting a family through IVF becoming a legal nightmare? How
    do you ever in your life forget being investigated for your
    miscarriage or driving your 10 year old daughter across state
    lines after she was raped and could not get an abortion
    otherwise?

        How little do you have to care about women to think anyone
    will forget the people who are killed by this, women who can't
    get an abortion but need one, who turn to unsafe information
    because they were denied access to safe medical care. People
    who couldn't get a prescription filled, couldn't start chemo,
    or died in a maternal health care desert since doctors don't
    want to be treated like criminals for doing their job.

        People will not forget those losses. They will sit across
    from that empty chair every day and they will sleep next to the
    empty space every night. Mark my words, they will not forget.
    Democrats are not going to let Republicans ignore them either.

        We will not let them whistling past the graveyard they have
    been--spent so long digging. And we will absolutely not stop
    fighting with everything we have got to end this chaos, save
    lives, and codify the right to abortion into law.

        We will never stop fighting for women's rights to control
    their own bodies. Never.

        Senator Marshall.

                     OPENING STATEMENT OF SENATOR MARSHALL

        Senator Marshall. Thank you, Chair Murray. Overturning Roe
    v. Wade was a historic occasion that signals a new beginning
    for millions of unborn American babies. Now the future of
    saving lives rests with the American people and their elected
    officials in the states. But this work is not finished.

        Family planning opportunities need to be expanded, and
    mothers need greater access to services that will support them
    and their baby throughout and after the pregnancy. I am looking
    forward to informing the American public why the Supreme
    Court's decision is a positive development for our Country and
    setting the medical sector straight in the face of non-fact
    based, pro-abortion fearmongering.

        I appreciate Ranking Member Burr for yielding me the
    opportunity to lead this hearing, to use my knowledge and
    background as an OB-GYN who delivered a baby nearly every day
    for 25 years, as well as held the hands of hundreds of women
    suffering miscarriages, ectopic pregnancies, infertility, and
    life threatening obstetrical complications.

        Having delivered more than 5,000 babies and started and
    supervised multiple family planning clinics, I would like to
    dispel several myths that are being heaved at the public. Myth
    No. 1, overturning Roe is a Federal ban on abortion.

        No, no, that is not true. Overturning Roe, actually sends
    the issue to elected state officials, allowing the citizens of
    each state to address a highly emotional issue via their
    elected officials. Nevertheless, we will hear this false battle
    cry multiple times this morning. Myth two, women will not have
    access to abortion. That is not true.

        Even The New York Times reported after overturning Roe,
    abortions will decrease by only 14 percent. It is also worth
    noting that after Texas passed its heartbeat law, two study
    showed that abortions fell around 10 percent. After Roe, 27
    states and Washington, DC. continue to be largely unaffected,
    while 19 states have protected limits.

        The other states will most likely fall somewhere there in
    between. Myth three, overturning Roe means health care
    professionals and hospitals cannot treat women with
    miscarriages, ectopic pregnancies, or when the mom's life is
    endangered. These are all scare tactics preying on the emotions
    of people.

        Listen, every state abortion law triggered by overturning
    Roe includes an exception to save the life of the mother.
    Treating miscarriages and ectopic pregnancies are not the same
    as performing abortions. In fact, no abortion law in any state
    in America prevents treatment for women with ectopic
    pregnancies and, or other life threatening conditions.

        I remember my first year in residency when we were learning
    about ectopic pregnancy, and our motto was to never let the sun
    set on an ectopic pregnancy. That model will be continued
    throughout America.

        Every pro-life physician I know of every physician that I
    know of, including myself, has always and will always care for
    these clinical conditions, and there are no laws that prevent
    such. This is a total fabricated myth. Myth four, I quote
    Members across the aisle on this myth. Overturning Roe is
    devastating to women's health. Members will imply today
    carrying a baby to term is more dangerous than an abortion.

        Using their logic, should we abort every baby? Should we
    stop all childbearing? Presenting abortion as the lifesaving
    solution for women facing challenging pregnancies is a warped
    view of health care. It denies the modern medical science that
    can bring both mother and baby safely through even a high risk
    pregnancy. Myth five, Americans don't support limits on
    abortion.

        A recent poll from the AP and New York Center for Public
    Affairs Research finds while 61 percent of Americans say
    abortion should be legal in most or all circumstances in the
    first trimester of a pregnancy, 65 percent said abortions
    usually be illegal in the second trimester, and 80 percent said
    that about the third trimester.

        From a June Monmouth poll, only 36 percent of Americans
    support abortions as always legal, while only 30 percent
    believe it should be legal with limitations. Myth six, many
    claim that the United States fell behind our international
    peers on abortion access. Look, only seven nations allow
    abortions beyond 20 weeks, including China and North Korea. The
    final myth I will talk about this morning. Here is the myth,
    Republicans want to end contraception and family planning.

        Nothing could be further from the truth. In my first year
    in residence, if I delivered several babies that were 13--if
    moms were 13 years of age, I made a commitment to make sure
    that there was early access to prenatal care for everybody and
    access to contraception as well, regardless of a woman's
    ability to pay in any community I practiced.

        That is why I set up and volunteered at prenatal and family
    planning clinics and residency. And that is why I oversaw three
    community health centers in rural Kansas and accepted all
    comers to our prenatal clinic. And this is why every year we
    fight for robust funding for community health centers and
    health departments. So what does obstetrical care look like
    after all? We dispelled many of the myths.

        Women with miscarriages and ectopic pregnancies will be
    treated in every state without exception. Life of the mom will
    continue to be honored, and Plan B remains over the counter.
    Republicans and Democrats must work together and continue to
    fight for more and earlier access to prenatal care and proper
    nutrition, especially in rural and urban settings, as well as
    childcare, and attending to all the social challenges that I
    have seen so many times that a young, single, or married mom
    faces.

        This is why I co-led the Preventing Maternal Deaths Acts of
    2018 and more recently worked with everyone here on this
    Committee to pass legislation, the Maternal Health Quality
    Improvement Act, which was also recently signed into law. And
    this is why I lead annual population letters supporting vital
    maternal health programs at HHS and the WIC program.

        While such centers as the Stanton Center, which you will
    soon learn about, already outnumber abortion clinics 4 to 1 in
    this country, we can and will do more to help such clinics. I
    look forward to bipartisan cooperation, to being part of the
    solution to maternity issues, which have all precipitated prior
    to this Supreme Court decision.

        Finally, we recognize family planning and access to
    contraception will be as important as ever. As I have in the
    past, I will continue to support robust funding for community
    health centers and county health departments like the ones I
    once volunteered and oversaw. Thank you, Madam Chair, and I
    yield back.

        The Chair. Thank you. We will now introduce today's
    witnesses. Our first witness is Dr. Kristyn Brandi. Dr. Brandi
    is an obstetrician gynecologist who provides abortion care in
    New Jersey. She also serves as Board Chair for Physicians for
    Reproductive Health and is an Assistant Professor at Rutgers
    New Jersey Medical School.

        In her work as a physician and researcher, Dr. Brandi has
    focused on reproductive decisionmaking and racism in
    reproductive health care. Thank you for joining us today to
    share your important perspective as an abortion provider and
    talk about how Dobbs' decision will undermine your care for
    your patients.

        Look forward to your testimony. Our next witness today is
    Dr. Jamila Taylor. Dr. Taylor is the Director of Health Care
    Reform and Senior Fellow at the Century Foundation and an
    expert in reproductive rights and maternal health.

        For over two decades, Dr. Taylor has worked to champion the
    health and rights of women of color and other marginalized
    communities, and ensure access to reproductive and maternal
    health care, including building support for insurance coverage
    of abortion.

        She also serves on the Board of Directors for the National
    Quality Forum and March for Moms on the Reproductive Freedom
    Leadership Council Advocates Advisory Board, a state innovation
    exchange, and as chairwoman of the Board of Mama Toto Village,
    an organization focused on promoting black maternal health.

        Glad you could join us today, Dr. Taylor. Look forward to
    hearing from you. Our next witness is Samie Detzer. She is an
    abortion advocate. She has been an outspoken abortion advocate
    for years, sharing both the story of her own experience getting
    an abortion when she lived in Washington State and her mother's
    story seeking an abortion back in the days before Roe v. Wade.

        She knows personally how much is at stake at this moment
    for many people across the country. Thank you for your courage
    in sharing your story today, Ms. Detzer, and speaking up on
    behalf of many women who are outraged to have their rights
    taken away. I look forward to your testimony.

        Senator Marshall, if you want to introduce our final
    witness.

        Senator Marshall. Thank you, Chair Murray, for the
    opportunity to introduce Ms. Brandi Swindell from Meridian,
    Idaho. Ms. Swindell is the Founder and CEO of Stanton
    Healthcare and Stanton Public Policy Center.

        Stanton Healthcare provides medical care, women's wellness
    care, tangible support, and hope to pregnant women, mothers,
    and their families. Stanton Public Policy Center is a woman's
    advocacy and educational group that works on issues of human
    rights and justice, with the goal of empowering and inspiring
    women.

        Ms. Swindell is a nationally known speaker and advocate for
    human rights and has been a passionate voice for women and the
    unborn. Ms. Swindell, thank you for all that you do and for
    being with us here today. Chair Murray.

        The Chair. Thank you. And now we will begin with our
    witness testimony. Again, thank you to all of you for joining
    us today. Dr. Brandi, you may begin with your opening
    statement.

    STATEMENT OF KRISTYN BRANDI, M.D., M.P.H., FACOG, BOARD CHAIR,
                 PHYSICIANS FOR REPRODUCTIVE HEALTH, NJ

        Dr. Brandi. Thank you. Good morning, Chairman Murray,
    Ranking Member Marshall, and the Members of this Committee. My
    name is Dr. Kristyn Brandi. I use she/her/a pronouns. I am a
    board certified OBGYN, a complex family planning specialist,
    and I am here on behalf of Physicians for Reproductive Health
    as the Board Chair.

        I have been providing comprehensive reproductive health
    care for over a decade, including abortion care, prenatal care,
    gynecologic procedures, and outpatient care. I am a proud
    abortion provider from the State of New Jersey.

        I became an abortion provider for the same reasons that I
    became an OB-GYN, to help historically oppressed folks access
    the care they need and deserve. Obstetrics care has always been
    stigmatized and marginalized. It is no surprise to me that the
    same places that have banned abortion also have the highest
    rates of maternal mortality.

        There are many systemic and social factors that play a role
    in this. I remember taking care of a patient with a desired
    pregnancy at 17 weeks whose fetus had not developed a brain.
    She decided she would end her suffering and that of her
    potential child by having an abortion. And her decision had
    become so stigmatized that I remember staff not even wanting to
    enter her room.

        I knew then that my career would be dedicated to ensuring
    that no patient is shamed for making the best medical decision
    for them and their families. By being a full spectrum OB-GYN, I
    could provide the best care for my patients. I am here today to
    make clear that abortion is essential health care.

        Abortion can be necessary to save someone's life, and it is
    a critical part of being an OB-GYN. National medical
    organizations have expressed outrage at the Dobbs v. Jackson
    Women's Health Decision, and National Academies of Science,
    Engineering, and Medicine put out a comprehensive report
    looking at abortion outcomes and found that abortion care has
    one of the highest safety records in medicine.

        We know that in the United States you are 14 times more
    likely to die in childbirth than you are to die of an abortion.
    And we know from the turn away study that people denied access
    to abortion have a higher chance of facing poverty and having
    worse health outcomes compared to patients that were able to
    access an abortion.

        I am a pro-abortion doctor, and I say pro-abortion not to
    be antagonistic, but to point out all the good that abortion
    can provide for people. Without autonomy, without
    decisionmaking ability, without access to abortion care, many
    people have challenging situations that could become even more
    painful or life threatening.

        For those that do not want to be pregnant for any reason,
    the ability to have an abortion gives them the freedom to
    decide if and when to become pregnant. For some, abortion is
    liberation. There is a lot of good that comes from a people's
    ability to access abortion, and I want to celebrate that.

        I firmly believe in the tenets of reproductive justice,
    that all patients have the human right to be able to decide if
    and when to become pregnant and to parent with children in safe
    and sustainable communities. I cannot separate my ability to
    provide care as a physician from my lived experiences.

        I am a cisgendered woman who could be harmed by restrictive
    abortion bans. I am also a Latina, a daughter of Puerto Rican
    and Panamanian parents. I am also a bisexual woman and deeply
    identify with the LGBTQ community, a community also in deep
    need of timely, compassionate reproductive health care.

        People of low income, bipoc folk, queer folk, people with
    disabilities, young people, people facing incarceration or
    detention, and immigrants who have faced many barriers to
    accessing care even before Roe was overturned now face bigger
    hurdles.

        I understand deeply how restrictions on abortion and
    outright bans impact marginalized communities because they are
    my community. I am greatly concerned that abortion bans will
    tie health professionals hands when it comes to providing
    evidence based care for patients.

        It is heartbreaking to consider that the skills that I
    have, the medicines that have been proven time and again to be
    incredibly safe, will be barred from patients. I took an oath
    to care for my patients. We are supposed to bring evidence
    based care to our communities. It is unconscionable to enact
    laws that prevent health care providers from offering the
    standard of care.

        There are many urgent health care conditions that can arise
    from or be exacerbated by pregnancy for which abortion is
    indicated. There are already reports of having to wait for a
    patient become sicker and sicker before intervening.

        Future health care providers may not have access to
    training to even learn how to provide an abortion and will be
    ill equipped to act in complex situations. This is not how
    health care should work. People are being harmed without
    abortion access. In conclusion, this moment is truly
    horrifying.

        I am frightened for my patients that may be criminalized
    for making decisions and for health professionals that are
    providing high quality, evidence based care. But I won't give
    up. I will provide care like I provided last week, again and
    again. It is important because I know my patients need it.

        Please remember that there are countless people in each of
    your states that have needed and benefited from abortion. You
    all love someone that has had an abortion. They deserve your
    consideration and protection. Thank you.

        [The prepared statement of Dr. Brandi follows:]
                      prepared statement of kristyn brandi
        Good morning, Chairwoman Murray, Ranking Member Burr, and
    distinguished Members of the Committee. My name is Dr. Kristyn Brandi I
    use she/her pronouns, and I am the Board Chair of Physicians for
    Reproductive Health. I am a board-certified OBGYN and have received
    fellowship training in the subspecialty of complex family planning. I
    have been providing comprehensive reproductive health care for over a
    decade including abortion care, prenatal care, gynecologic procedures
    and outpatient gynecologic care. I am a proud abortion provider from
    the State of New Jersey.

        I became an abortion provider for the same reason that I became an
    OBGYN--to help historically oppressed folx access the care that they
    need and deserve. Obstetrics care has always been stigmatized and
    marginalized. It is no surprise to me that the same places that have
    banned abortion also have the highest rates of maternal mortality, and
    there are many systemic and social factors that play into these rates.
    I remember taking care of a patient with a desired pregnancy at 17
    weeks whose fetus had not developed a brain. She decided that instead
    of continuing that pregnancy to term she would end her pregnancy and
    end what she thought was her suffering and that of her potential child.
    Her decision had become so stigmatized that I remember the staff did
    not want to enter her room. We had to call in another nurse to make
    sure we had enough staff to take care of her. I knew then that my
    career would be dedicated to ensuring no patient is shunned or shamed
    for making the best medical decision for them and their family. I knew
    that by being a full spectrum OBGYN, providing abortion care and
    prenatal care, I could provide the best care for my patient regardless
    of what they needed from me.

        I'm here today to make clear that abortion is essential health care
    Abortion can be necessary to save someone's life. It is a critical part
    of being a an ob-gyn. National medical organizations including the
    American Medical Association unanimously have expressed outrage at the
    Dobbs v. Jackson Women's Health decision. The American College of
    Obstetricians and Gynecologists (ACOG) said in their statement about
    Dobbs ``Abortion is a safe, essential part of comprehensive health
    care, and just like any other safe and effective medical intervention,
    it must be available equitably to people, no matter their race,
    socioeconomic status, or where they reside...Allowing states to set
    individual restrictive abortion policies, including restrictions and
    outright bans on this essential component of medical care, results in
    an increase in the inequities that already plague the health care
    system and this country.'' The National Academies of Sciences,
    Engineering, and Medicine put out a comprehensive report in 2019
    looking at abortion outcomes and found that abortion care has one the
    highest safety records of all procedures in medicine. We know that in
    the United States you are 14 times more likely to die in natural
    childbirth than you are to die of an abortion. And we know from the
    Turnaway Study from the University of California at San Francisco that
    people denied access to abortion have a higher chance of facing poverty
    and having worse health outcomes in the future compared to patients
    that were able to access a desired abortion.

        I am a pro-abortion doctor. I say pro-abortion not to be
    antagonistic, but to point out all of the good that abortion can
    provide for people. I have taken care of many people with desired
    pregnancies in which their abortion was a sad event for them. But
    without autonomy, without decisionmaking ability, without access to
    abortion care, there is a chance that those situations could have been
    even more painful or more life-threatening. And for those that do not
    want to be pregnant for any reason, the ability to have an abortion
    gives them the freedom to decide if and when to become pregnant. To
    have a planned pregnancy, or not, in a time that works best for them
    emotionally, financially, and based on their health. Abortion is
    liberation for some. There is a lot of good that comes from people's
    ability to access abortion and I want to celebrate that.

        I believe firmly in the tenets of reproductive justice--that all
    patients have the human right to be able to choose if and when to
    become pregnant and to parent children in safe and sustainable
    communities. I cannot separate my ability to provide care as a
    physician from my lived experiences. I am a cis-gender woman who could
    be harmed by restrictive abortion bans if I happened to live in a state
    different than my own. I am also a Latina--the daughter of Puerto Rican
    and Panamanian parents. I identify as a bisexual woman and proud member
    of the LGBTQ+ community--a community also in deep need of timely,
    compassionate reproductive health care. So, I also understand deeply
    how restrictions on abortion and outright abortion bans impact
    marginalized communities because they are my community.

        People with low incomes, BIPOC (Black, Indigenous and people of
    color) folx, LGBTQ+ people, people with disabilities, young people,
    people facing incarceration/detention, and immigrants, who faced many
    barriers to accessing care even before Roe was overturned, now face
    even bigger hurdles. After the recent Supreme Court decision, people
    watched as their ability to access health care changed overnight.
    People were able to get care the day before the decision and the next
    day, depending on their zip code, their access to abortion care was
    gone. My biggest fear is that these people are not going to find care
    and will be forced to continue their pregnancies, putting their health,
    well-being, and security at risk. Communities of color, particularly
    Black women, are already at risk of high rates of maternal mortality--
    withholding access to abortion care will only make this dire situation
    worse.

        I want this Committee to understand the far-reaching ripple effects
    of abortion bans. I remember having a patient with a ruptured ectopic
    pregnancy, who was talking to me in the ER quickly as we were rushing
    her to the operating room for surgery. It took us only 10 minutes or so
    from meeting her to starting her surgery. Just before we began, her
    blood pressure suddenly dropped dramatically--she was dying. We rushed
    to complete her procedure safely, finding several liters of blood in
    her belly along with a ruptured fallopian tube which held her 7-week
    pregnancy. I am so glad she came to the hospital when she did, that we
    identified this ectopic pregnancy so quickly, and that we were able to
    intervene before it was too late. In urgent situations, medical
    professionals need to be able to make quick decisions about the best
    course of care. Those seconds can make the difference in preventing
    life-long impacts for a person's health or whether someone survives. We
    have heard people question whether bans on abortion will impact care
    like ectopic pregnancy management even when they shouldn't or whether
    bans on abortion will impact care such as in vitro fertilization (IVF).
    Or if miscarriage management will be allowed, which uses the same
    medicines and procedures as abortion care. Each pregnancy is unique and
    as providers we need to be able to individualize care to the person in
    front of us.

        I am greatly concerned that bans on abortion will tie health
    professionals' hands when it comes to providing evidence-based,
    quality, safe care to patients. It is heartbreaking to consider that
    the skills that I have, that I can physically provide, the medicine
    that has been proven time and again to be incredibly safe, will be
    barred from patients. As a doctor, I took an oath to care for my
    patients. I am beholden to four tenets of medical ethics--beneficence,
    non-maleficence, autonomy, and justice. We are supposed to bring safe
    evidence-based care to our patients. It is unconscionable to enact laws
    that prevent health care providers from offering the standard of care.
    There are many reasons why people need abortions. And there are many
    urgent health conditions that can arise from or be exacerbated by
    pregnancy for which abortion is indicated. There are already reports of
    having to wait for a patient to become sicker before intervening.
    Future health care providers may not have access to training to even
    learn how to provide abortion care and will be ill equipped to act in
    complex situations. This is not how health care should work. People
    will be harmed when they cannot access essential abortion care.

        This is truly a health care crisis on top of another health care
    crisis. During the COVID-19 pandemic, we saw historic losses of nurses,
    doctors, support staff within health care because of burnout and death
    from COVID-19. Bans on abortion are going to have widespread
    repercussions. There are already not enough health care providers.
    There are already not enough hospitals with labor and delivery wards.
    Health care providers will be wary of joining communities where they
    cannot provide the standard of care. For states where abortion is still
    available, some clinics have weeks long waiting times. In pregnancy
    care, delays can mean that people will not be able to get abortion
    care. Our health care system was already struggling, and we have now
    added another unjust load to bear.

        This moment is horrifying. I am frightened for patients that may be
    criminalized for making valid decisions about their health; I am
    concerned for health professionals committed to providing high quality
    evidence-based health care; I am terrified for the people that will be
    forced to continue an undesired pregnancy against their will. But I
    will not give up. I provided care last week and I will provide care
    next week and I will do it again the week after that. I won't give up
    because I know how important it is for my patients to have the care
    they need, when they need it, in the community they live in. Please
    remember that there are countless people in each of your states that
    have needed and benefited from abortion. You all love someone who has
    had an abortion. They deserve your consideration and protection.

        Thank you.
                                     ______

                     [summary statement of kristyn brandi]

        Dr. Kristyn Brandi's testimony will:

              Discuss why she provides abortion care

              Explain that abortion is essential health care

              Note the support of the medical community for
            abortion access

              Utilize the reproductive justice framework

              Explain the impacts of abortion bans on already
            marginalized communities

              Discuss the relationship between abortion bans and
            maternal health

              Note the impacts of abortion bans on the broader
            health care system

              Ask the Committee to consider and protect people
            seeking abortion care.
                                     ______

        The Chair. Thank you. Dr. Taylor. If you want to turn on
    your----

        Ms. Taylor. On now?

        The Chair. Yes.

     STATEMENT OF JAMILA TAYLOR, PH.D., M.P.A., DIRECTOR OF HEALTH
        CARE REFORM AND SENIOR FELLOW, THE CENTURY FOUNDATION,
                             WASHINGTON, DC

        Ms. Taylor. Good morning, Chairwoman Murray, Ranking Member
    Burr, and Members of the Committee. Thank you for the
    opportunity to testify today on reproductive care in a post-Roe
    America.

        I am Dr. Jamila Taylor and I serve as the Director of
    Health Care Reform and Senior Fellow at the Century Foundation,
    a 100 year old progressive think tank that conducts research,
    develops solutions, and drives policy change to make people's
    lives better.

        I sit here before you today deeply dismayed by the U.S.
    Supreme Court's decision to overturn Roe v. Wade. Not only am I
    disturbed by the impact this landmark decision will have on the
    health and well-being of millions of women and people who want
    and need abortion care, I am also frightened by the impact this
    decision will surely have on this country's ongoing maternal
    health crisis.

        U.S. maternal health outcomes are worsening at an alarming
    rate, with black women and birthing people bearing the brunt of
    this crisis. According to the most recent estimates released by
    the CDC, black women are dying of pregnancy related causes at
    three times the rates of their white counterparts. We are also
    most likely to experience severe maternal morbidity.

        For black women, pregnancy and childbirth, no matter how
    planned out or desired, puts our lives at risks. It is always
    unconscionable to force the continuation of an unwanted
    pregnancy. But for black women and other populations who have
    been historically marginalized, it is particularly immoral and
    dangerous.

        Abortion care is overwhelmingly safe. But when abortion is
    difficult or impossible to access, complicated health
    conditions can worsen and even result in death. For example,
    one study conducted by researchers at the University of
    California, San Francisco, found that women who were denied
    abortion care are more likely to experience high blood pressure
    and other serious medical conditions during the pregnancy, more
    likely to remain in relationships where interpersonal violence
    is present, more likely to experience anxiety and stress
    shortly after being denied care, and more likely to experience
    poverty.

        Research also shows that states with the most restrictions
    on abortion are precisely those with the worst maternal health
    outcomes. This is no coincidence. These states also have fewer
    supportive policies in place for parents and their families.

        Supportive policies like universal childcare, paid leave,
    affordable health care, equal access to nutritious foods, and
    adequate funding for the wraparound services low income
    families and families of color desperately need. If we want to
    actually support women and families, then equitable access to
    compassionate abortion care must be paired with policies that
    make it possible to raise a family in the first place.

        In the face of the Supreme Court's decision to overturn Roe
    and the impact it will have on the maternal health crisis in
    this country, there are many policy solutions that can help
    address these challenges.

        Congress must pass the Women's Health Protection Act,
    critical legislation to restore the Federal right to abortion,
    and it must be combined with the Equal Access to Abortion
    Coverage and Health Insurance Act, also known as EAACH, so that
    abortion care is affordable and accessible to all regardless of
    income or source of insurance.

        Last but certainly not least, Congress must pass the Black
    Maternal Health Omnibus Act, a comprehensive legislative
    package aimed at addressing various dimensions of the U.S.
    maternal health crisis among black women and ensure that
    postpartum Medicaid coverage extends to a full year for every
    birthing person in every state.

        The twin emergencies of the maternal health crisis and lack
    of Federal protections for abortion will in fact harm black
    women the most. Both crises stem from historical and ongoing
    racism tied to the legacy of reproductive control and coercion.

        Make no mistake, these disparities are rooted in racism,
    not race. This racism can be seen today in the persistence of
    discrimination, unequal distribution of resources, and
    inequitable access to care.

        With our bodies and health care decisions under
    unprecedented attack, it is critical that we finally address
    the maternal health crisis while also increasing access to
    abortion so that every black woman and every birthing person in
    this country can control their reproductive lives.

        Thank you again for the opportunity to testify and I look
    forward to your questions.

        [The prepared statement of Ms. Taylor follows:]
                     prepared statement of jamila k. taylor
        Good morning, Chairwoman Murray, Ranking Member Burr, and Members
    of the Committee. Thank you for the opportunity to testify today on
    Reproductive Care in a Roe America.

        I'm Dr. Jamila Taylor and I serve as the director of health care
    reform and senior fellow at The Century Foundation, a 100-year-old
    progressive think tank that conducts research, develops solutions, and
    drives policy change to make people's lives better.

        I sit here before you today, deeply dismayed by the U.S. Supreme
    Court's decision to overturn Roe v. Wade. Not only am I disturbed by
    the impact this landmark decision will have on the health and well-
    being of millions of women and people who want and need abortion care,
    I am also frightened by the impact this decision will surely have on
    this country's ongoing maternal health crisis.

        U.S. maternal health outcomes are worsening at an alarming rate,
    with Black women and birthing people bearing the brunt of this crisis.
    According to the most recent estimates released by the CDC, Black women
    are dying of pregnancy-related causes at three times the rate of their
    white counterparts. We are also most likely to experience severe
    maternal morbidity. For Black women, pregnancy and childbirth, no
    matter how desired or planned out--put our lives at risk. It is always
    unconscionable to force the continuation of an unwanted pregnancy, but
    for Black women and other populations who have been historically
    marginalized, it is particularly immoral and dangerous.

        Abortion care is overwhelmingly safe. But when abortion is
    difficult or impossible to access, complicated health conditions can
    worsen and even result in death. For example, one study conducted by
    researchers at the University of California San Francisco found that
    women who were denied abortion care are more likely to experience high
    blood pressure and other serious medical conditions during the
    pregnancy; more likely to remain in relationships where interpersonal
    violence is present; more likely to experience anxiety and stress
    shortly after being denied care; and more likely to experience poverty.

        Research also shows that states with the most restrictions on
    abortion are precisely those with the worst maternal health outcomes.
    This is no coincidence: these states also have fewer supportive
    policies in place for parents and their families--supports like
    universal child care, paid leave, affordable health care, equal access
    to nutritious foods, and adequate funding for the wrap-around services
    low-income families and families of color desperately need. If we want
    to actually support women and families, then equitable access to
    compassionate abortion care must be paired with policies that make it
    possible to raise a family in the first place.

        In the face of the Supreme Court's decision to overturn Roe, and
    the impact it will have on the maternal health crisis in this country,
    there are many policy solutions that can help address these challenges.
    Congress must pass the Women's Health Protection Act, critical
    legislation to restore the Federal right to abortion, and it must be
    combined with the Equal Access to Abortion Coverage in Health Insurance
    Act (also known as EACH) so that abortion care is affordable and
    accessible to all, regardless of income or source of insurance. Last
    but certainly not least, Congress must pass the Black Maternal Health
    Momnibus Act, a comprehensive legislative package aimed at addressing
    various dimensions of the U.S. maternal health crisis among Black women
    and ensure that postpartum Medicaid coverage extends for a full year
    for every birthing person in every state.

        The twin emergencies of the maternal health crisis and lack of
    Federal protections for abortion will in fact harm Black women the
    most. Both crises stem from historical and ongoing racism, tied to the
    legacy of reproductive control and coercion. Make no mistake: these
    disparities are rooted in racism, not race. This racism can be seen
    today in the persistence of discrimination, unequal distribution of
    resources, and inequitable access to care. With our bodies and health
    care decisions under unprecedented attack, it is critical that we
    finally address the maternal health crisis while also increasing access
    to abortion, so that every Black woman and birthing person in this
    country can control their reproductive lives. Thank you again for the
    opportunity to testify.

        I look forward to your questions.
                                     ______

                    [summary statement of jamila k. taylor]
        Thank you Chair Murray, Ranking Member Burr, and Members of the
    Committee for the opportunity to testify today. I sit here before you
    deeply dismayed by the decision to overturn Roe v. Wade. Not only am I
    disturbed by the impact this decision will have on the health and well-
    being of millions of women and people who want and need abortion care,
    I am also frightened by the impact this decision will have on this
    country's ongoing maternal health crisis.

        U.S. maternal health outcomes are worsening, with Black women and
    birthing people bearing the brunt of this crisis. Black women are dying
    of pregnancy-related causes at three times the rate of their white
    counterparts, and are more likely to experience severe maternal
    morbidity. For Black women, pregnancy and Childbirth, no matter how
    desired--put our lives at risk. It is always unconscionable to force
    the continuation of an unwanted pregnancy--but for Black women and
    other historically marginalized populations, it is particularly immoral
    and dangerous.

        Abortion care is overwhelmingly safe. But when abortion is
    difficult or impossible to access, complicated health conditions can
    worsen and even result in death. For example, one study conducted by
    researchers at UCSF found that women who were denied abortion care have
    worse economic and mental and physical health outcomes, and are more
    likely to remain in relationships where they experience physical
    violence, than women who received abortion care.

        Research also shows that states with the most restrictions on
    abortion are precisely those with the worst maternal health outcomes.
    This is no coincidence: these states also have fewer supportive
    policies for families--supports like universal child care, paid leave,
    affordable health care, access to nutritious foods, and wrap-around
    services low-income families and families of color desperately need. If
    we want to support women and families, then equitable access to
    compassionate abortion care must be paired with policies that make it
    possible to raise a family.

        Fortunately, there are policy solutions to address these
    challenges. Congress must pass the Women's Health Protection Act--
    critical legislation to restore the Federal right to abortion, and it
    must be combined with the Equal Access to Abortion Coverage in Health
    Insurance Act so that abortion care is affordable and accessible to
    all, regardless of income or source of insurance. Last but certainly
    not least, Congress must pass the Black Maternal Health Momnibus Act
    and extend postpartum Medicaid coverage for a full year in every state.

        Both the maternal health crisis and abortion bans will harm Black
    women the most, tied to an ongoing legacy of reproductive control and
    coercion. These disparities are rooted in racism--seen today in the
    persistence of discrimination, unequal distribution of resources, and
    inequitable access to care. With our bodies and health care decisions
    under unprecedented attack, it is critical that we finally address both
    the maternal health and abortion access crises--so that every Black
    woman and birthing person can control their reproductive lives.
                                     ______

        The Chair. Thank you.

        Ms. Detzer.

    STATEMENT OF SAMIE DETZER, PLANNED PARENTHOOD PATIENT ADVOCATE,
              PLANNED PARENTHOOD FEDERATION OF AMERICA, NY

        Ms. Detzer. Chair Murray, Members of the Committee, thank
    you for inviting me to speak with you today. My name is Samie
    Detzer and I have two stories to share. The first is fairly
    simple. On May 20th, 2015, in Seattle, I had an abortion. I was
    25 years old.

        I was pregnant and I did not want to be. It took me 5
    minutes to schedule my abortion, which was covered by
    Washington State's Apple Health Program. I received
    compassionate expert care from the providers at Planned
    Parenthood in my own city and in my own state. My abortion was
    not painful, and it was certainly not traumatic. I was not
    lonely or depressed or ashamed.

        I can remember more about the relief than the tears, more
    about the feeling of freedom than of pain. I have not
    considered what my life would be like now if I had a child, and
    I have never once agonized over my decision. That story is mine
    alone.

        No one interfered to stop me from making the best decision
    for myself. No one tried to take control of what was mine, my
    body, my freedom, or my choice. The second story is my
    mother's. She was 19 and living in San Francisco with my father
    when she got pregnant.

        They were simply not ready to be the exceptional parents
    that they would later become. It was 1968, before the Supreme
    Court's decision in Roe v. Wade guaranteed the Constitutional
    right to abortion, and her doctor informed her that the only
    way to receive a legal abortion in the United States was to
    have a team of psychotherapists deem her mentally unfit for
    parenthood.

        She agreed to this process, was three times called
    officially crazy, her words, and was granted the right to have
    a legal abortion. And this process took just shy of 20 weeks.
    She received her legal abortion, finally at 5 months pregnant.
    Unlike my experience, my mother's procedure was needlessly
    painful and was physically and emotionally traumatic for her.
    My mother was open with her three children about her
    experience, but I don't know everything about it.

        I don't know how in the world living across the country
    from her family and hiding her pregnancy from them, she was
    able to scrape together the money for three therapists and the
    abortion itself. I don't know what it was like for her to carry
    a pregnancy she did not want and to endure comments from
    strangers as she began to show. I don't know the extent of the
    judgment and shame my mother was subjected to. And
    unfortunately I can't ask her because she passed away 4 years
    ago.

        I miss my mother every day. But I am glad that she is not
    here to see this terrible moment in our Country's history. I do
    wish that she had the chance to meet her granddaughter, my 2
    year old niece, Sadie, who will devastatingly grow up with
    fewer rights than I had. I wish that I didn't need to share the
    personal details of my life, of my mother's life, with a room
    full of strangers.

        I wish that I could feel confident that my niece would grow
    up with the right to make choices about her own body. And yet,
    here I am. I am telling these two stories because of the dual
    responsibility that I feel to honor both my mother and my
    little niece, the responsibility that I have to honor the past
    and fight for a better future. The Members of this Committee,
    the Members of the Senate have a choice.

        The choice lawmakers have is how difficult you will make it
    for us to exercise our freedom. How much pain and trauma you
    will cause. How many bank accounts will be drained? And how
    many miles will be traveled? And how many tears will be shed?
    Lawmakers can decide if people in this country will be able to
    get the health care they deserve.

        They can decide if states will be allowed to create
    insurmountable barriers to abortion or ban it completely.
    Lawmakers can decide whether our Country will look like my
    mother's story or mine. What they cannot do is take away our
    freedom to our own bodies.

        No judge or justice can take away my right to decide what
    is best for me, my body, or my future. That freedom is ours and
    we will not surrender it. I hope for the sake of my mother's
    memory and for my niece's future, you will make the right
    choice. Senators, people who want or have had abortions need to
    know that they are not alone.

        We need to know that you will continue to fight for us. I
    hope that you will choose to be brave alongside those of us who
    are telling our stories and that you will use every tool you
    have to protect our right to abortion care and reproductive
    freedom. Thank you.

        [The prepared statement of Ms. Detzer follows:]
                       prepared statement of samie detzer
        Chair Murray, Members of the Committee, thank you for inviting me
    to speak with you today, my name is Samie Detzer, and I have two
    stories to share.

        The first is fairly simple, on May 20, 2015, in Seattle, I had an
    abortion.

        At 25 years old, I was pregnant and did not want to be. It took me
    5 minutes to schedule my abortion, which was covered by Washington
    State's Apple Health program. I received compassionate, expert care
    from the providers at Planned Parenthood in my own city and state.

        My abortion was not painful. It was certainly not traumatic. I was
    not lonely, or depressed, or ashamed. I can remember more about
    laughter than tears, more about freedom than my pain. I have not
    wondered what my life would be like now if I had a child. I have never
    once agonized over the decision.

        That is my story, and it is mine alone. No one interfered to stop
    me from making the best decision for myself. No one tried to take
    control of what was mine--my body, my freedom, my choice.

        The second story is my mother's.

        She was 19, and living in San Francisco with my father, when she
    got pregnant. They were both using drugs, and were not ready to be the
    exceptional parents they would later become.

        It was 1968, before the Supreme Court's decision in Roe v. Wade
    guaranteed the constitutional right to abortion.

        Her doctor informed her that the only way to receive a legal
    abortion in the United States was to have a team of psychotherapists
    deem her mentally unfit for parenthood.

        She agreed to this process, was three times called officially
    crazy, as she told me, and was granted the right to have a legal
    abortion. It took just shy of 20 weeks to navigate the process.

        She received her legal abortion, finally, at 5 months pregnant.
    Unlike my experience, my mother's procedure was needlessly painful, and
    physically and emotionally traumatic for her.

        My mother was open with her three children about her experience,
    but I don't know everything about it. I don't know how in the world,
    living across the country from her family and hiding her pregnancy from
    them, she was able to scrape together the money for three therapists
    and the abortion itself. I don't know what it was like for her to carry
    a pregnancy she did not want for five full months, to endure comments
    from strangers as she began to show. I don't know exactly the judgment
    and shame she was subjected to because the law did not honor her right
    to control her body. And unfortunately I can't ask her, because she
    passed away 4 years ago.

        I miss my mother every day, but I'm glad she isn't here to see this
    terrible moment in our Country's history. I do wish she had a chance to
    meet her granddaughter, my niece Sadie, who is 2 years old--and will
    grow up with fewer rights than I had.

        I am here today, telling these two stories, because of the dual
    responsibility I feel to honor both my mother, and my little niece. The
    responsibility I feel to honor the past and fight for a better future.

        The Members of this Committee, the Members of this Senate, have a
    choice.

        The choice lawmakers have is how difficult you make it for us to
    exercise our freedom--how much pain and trauma you cause, how many bank
    accounts will be drained, how many miles have to be traveled, and how
    many tears will be shed.

        Lawmakers can decide if people in this country will be able to get
    the health care they deserve. Lawmakers will decide if states will be
    allowed to create insurmountable barriers to abortion or ban it
    completely. Lawmakers will decide whether our Country will look like my
    mother's story, or like mine.

        What they cannot do is take away our freedom to own our own bodies.
    No judge or justice can take away my right to decide what is best for
    me, my body, and my future. That freedom is ours, and we do not
    surrender it.

        I hope, for the sake of my mother's memory, and for my niece's
    future, you will make the right choice, Senators. People who want
    abortions or have had abortions need to know that they aren't alone,
    that you will continue to fight for us. I hope that you will choose to
    be brave along with those of us who are telling our stories, use every
    tool you have to protect our right to abortion care and reproductive
    freedom.
                                     ______

                      [summary statement of samie detzer]
        My name is Samie Detzer, and I have two stories to share.

        On May 20, 2015, in Seattle, I had an abortion. At 25 years old, I
    was pregnant and did not want to be. It took me 5 minutes to schedule
    my abortion, which was covered by Washington State's Apple Health
    program. I received compassionate, expert care from the providers at
    Planned Parenthood in my own city and state. My abortion was not
    painful. It was certainly not traumatic. I was not lonely, or
    depressed, or ashamed. I can remember more about laughter than tears,
    more about freedom than my pain. I have not wondered what my life would
    be like now if I had a child. I have never once agonized over the
    decision. That is my story, and it is mine alone. No one interfered to
    stop me from making the best decision for myself. No one tried to take
    control of what was mine--my body, my freedom, my choice.

        The second story is my mother's story. She was 19, and living in
    San Francisco with my father, when she got pregnant. It was 1968,
    before the Supreme Court's decision in Roe v. Wade guaranteed the
    constitutional right to abortion. Her doctor informed her that the only
    way to receive a legal abortion in the U.S. was to have a team of
    psychotherapists deem her mentally unfit for parenthood. She agreed to
    this process, was three times called officially crazy, as she told me,
    and was granted the right to have a legal abortion. It took just shy of
    20 weeks to navigate the process. She received her legal abortion,
    finally, at 5 months pregnant. Unlike my experience, my mother's
    procedure was needlessly painful, and physically and emotionally
    traumatic for her.

        My mother was open with her three children about her experience,
    but I don't know everything about it. And unfortunately, I can't ask
    her, because she passed away 4 years ago. I miss her every day, but I'm
    glad she isn't here to see this terrible moment in our Country's
    history. I do wish she had a chance to meet her granddaughter, my
    niece, who is 2 years old--and will grow up with fewer rights than I
    had.

        I am here today, telling these two stories, because of the dual
    responsibility I feel to honor both my mother, and my little niece. The
    responsibility I feel to honor the past and fight for a better future.

        The Members of this Committee, the Members of this Senate, have a
    choice. Our country can look like my mother's story, or like mine. What
    they cannot do is take away our freedom to own our own bodies. No judge
    or justice can take away my right to decide what is best for me, my
    body, and my future. That freedom is ours, and we do not surrender it.

        I hope, for the sake of my mother's memory, and for my niece's
    future, you will make the right choice, Senators. People who want
    abortions or have had abortions need to know that they aren't alone.
    Choose to be brave along with those of us who are telling our stories,
    use every tool you have to protect our right to abortion care and
    reproductive freedom.
                                     ______

        The Chair. Thank you very much.

        Ms. Swindell.

        STATEMENT OF BRANDI SWINDELL, FOUNDER AND CEO, STANTON
                             HEALTHCARE, ID

        Ms. Swindell. Chair Murray, Ranking Members Burr and
    Marshall, and Members of this Committee, thank you for giving
    me the opportunity to share today. My name is Brandi Swindell,
    and I am a fourth generation Idaho and human rights activist,
    and the CEO and Founder of Stanton Healthcare and Stanton
    Public Policy Center.

        Stanton Healthcare is a women's health care provider which
    specializes in serving women with unexpected pregnancies by
    providing professional medical care, practical and emotional
    support, women's wellness care, and an outreach to refugee and
    marginalized communities.

        We are based in Idaho with affiliates in the U.S. and
    internationally. Stanton is a part of a women's movement which
    has over 3,000 pregnancy resource centers and life affirming
    medical clinics across the Nation that outnumber abortion
    clinics 4 to 1.

        Women who walk through our doors are treated with dignity
    and equality regardless of their race, political views,
    religion, or economic situation. After the Supreme Court
    overturned Roe v. Wade on June 24th, so many have asked the
    pro-life community, are you ready to support women in a post-
    Roe America?

        I can say with certainty, thousands of pregnancy centers
    and life affirming women's medical clinics have been waiting
    and preparing for this moment for decades. We are ready to meet
    the challenge, and we are going to make sure that every woman
    facing an unexpected pregnancy in a post Roe America will have
    access to life affirming quality care, compassionate resources,
    and tangible support.

        Yesterday in my home State of Idaho, Stanton Healthcare
    organized and led a symposium called Supporting Women in an
    Abortion Free Idaho. Political, faith, and community leaders,
    educators, and organizations all came together in a nonpartisan
    way to find creative and life affirming solutions as we unite
    to support women with unexpected pregnancies.

        We are excited that other states are following Idaho's
    lead. In a post Roe America, shouldn't our Nation's goal and
    the goal of this Committee be to put aside divisions, anger,
    and partisanship, and commit ourselves to serving and helping
    women?

        As political leaders and Members of this Committee, you can
    support women with unexpected pregnancies by passing
    legislation that would provide better prenatal and medical care
    for the marginalized and women from communities of color. Paid
    maternity leave and childcare are steps in the right direction.

        Since May 2d, there have been over 60 attacks on centers
    like Stanton Healthcare. These attacks are unconscionable and
    ultimately threaten the women who attempt to walk through our
    doors seeking access to our services.

        Because of this, Stanton has had to hire private security,
    a private security firm which has cost our organization
    thousands of dollars. For those who disagree with the Supreme
    Court's decision on Roe, directing revenge and retaliation on
    centers like Stanton Healthcare is misguided, it is hateful,
    anti-women, and must be condemned and stopped immediately.

        Today, I am calling on all Members of this Committee to
    personally and publicly condemn the firebombing, violent
    attacks, and threats against life affirming charitable women's
    clinics. Congress and the Biden Administration should be a part
    of the solution and not cast blame on centers like ours.

        It is also deeply troubling members of the press,
    politicians, and media outlets refer to centers like Stanton as
    fake clinics. First, we are attacked with physical violence.
    Next, we are attacked with the violence of lies,
    disinformation, slander, and falsehoods.

        To diminish Stanton Healthcare in this way insults our
    medical directors who are highly regarded MDs, our physician
    assistants, nurses, stenographers, and others on our medical
    team who have worked so hard to receive, achieve, and maintain
    their medical credentials. But most of all, it insults the
    thousands of women and their children who have been helped by
    our clinics.

        They do not receive fake medical care or fake baby formula
    during a nationwide shortage or fake baby supplies, fake
    financial support, or fake counseling, and so much more when
    they walk through our doors. We should not be attacking clinics
    like Stanton or proposing anti-woman legislation, but rather we
    should be standing with these women who seek our services.

        It is important for this Committee to note, since 1980, the
    abortion rate has fallen by more than 50 percent. During the
    same time, women have succeeded on a variety of educational and
    economic metrics. If women are gaining educationally and
    economically at a time when abortion rates are falling, it is
    pretty clear that women do not need to rely on abortion to
    succeed.

        The overturning of Roe on June 24th sent shockwaves through
    our Nation that will take us months and perhaps even years to
    process. However, if we are truly committed to justice and
    women's rights, we can come together as a Nation and find
    creative solutions to empower and stand with women in a post
    Roe America.

        Once again, thank you for the invitation to share about the
    critical work of Stanton Healthcare and the amazing women we
    serve. Thank you.

        [The prepared statement of Ms. Swindell follows:]
                     prepared statement of brandi swindell
        Dear Chair Murray, Senator Burr, and Members of this Committee,
    thank you for giving me the opportunity to share today.

        My name is Brandi Swindell, and I am a fourth-generation Idahoan,
    human rights activist, and CEO and Founder of Stanton Healthcare and
    Stanton Public Policy Center.

        Stanton Healthcare is a women's healthcare provider which
    specializes in serving women with unexpected pregnancies by providing
    professional medical care, practical and emotional support, women's
    wellness care, and an outreach to refugee and marginalized communities.
    We are based in Idaho, with affiliates in the U.S. and internationally.

        Stanton is part of a women's movement which has over 3,000
    pregnancy resource centers and life-affirming medical clinics across
    the Nation that outnumber abortion clinics by four to one. Women who
    walk through our doors are treated with dignity and equality regardless
    of their race, political views, religion, or economic situation.

        After the Supreme Court overturned Roe v. Wade on June 24, so many
    have asked the pro-life community, ``Are you ready to support women in
    a post-Roe America?'' I can say with certainty, thousands of pregnancy
    resource centers and life-affirming women's medical clinics have been
    waiting and preparing for this moment for decades.

        We are ready to meet the challenge and we are going to make sure
    that every woman facing an unexpected pregnancy in a post-Roe America
    will have access to life-affirming quality care, compassionate
    resources, and tangible support.

        Yesterday in my home State of Idaho, Stanton Healthcare organized
    and led a symposium called, ``Supporting Women in an Abortion-Free
    Idaho.'' Political, faith, and community leaders, and organizations
    came together in a non-partisan way to find creative and life-affirming
    solutions as we unite to support women with unexpected pregnancies. We
    are excited that other states are following Idaho's lead.

        In a post-Roe America, shouldn't our Nation's goal, and the goal of
    this Committee, be to put aside divisions, anger, and
    partisanship...and commit ourselves to serving and helping women?

        As political leaders and Members of this Committee, you can support
    women with unexpected pregnancies by passing legislation that will
    provide better prenatal and medical care for the marginalized and women
    from communities of color. Paid maternity leave and child care are
    steps in the right direction.

        Since May 2, there have been over 60 attacks on centers like
    Stanton Healthcare. These attacks are unconscionable and ultimately
    threaten the women who attempt to walk through our doors seeking access
    to our services. Because of this, Stanton has had to hire a private
    security firm which has cost our organization over $6,000 to date.

        For those who disagree with the Supreme Court's decision on Roe,
    directing revenge and retaliation on centers like Stanton Healthcare is
    misguided, hateful, anti-women, and must be condemned and stopped
    immediately.

        Today, I'm calling on all Members of this Committee to personally
    and publicly condemn the fire-bombing, violent attacks, and threats
    against life-affirming charitable women's clinics. Congress and the
    Biden Administration should be part of the solution and not cast blame
    on our centers.

        It is also deeply troubling for the press, politicians, and media
    outlets to refer to centers like Stanton as ``fake clinics.'' First, we
    are attacked with physical violence. Next, we are attacked with the
    violence of lies, disinformation, slander, and falsehoods.

        To diminish Stanton Healthcare in this way insults our medical
    directors who are highly regarded MD's, our physician assistants,
    nurses, sonographers and others on our medical team who have worked so
    hard to achieve and maintain their professional credentials.

        But most of all, it insults the thousands of women and their
    children who have been helped by our clinics. They did not receive
    ``fake'' medical care, or ``fake'' baby formula during the nationwide
    shortage, or ``fake'' baby supplies, ``fake'' financial support, or
    ``fake'' counseling and so much more when they walked through our
    doors. We should not be attacking clinics like Stanton or proposing
    anti-woman legislation. Rather, we should all be standing with these
    women who seek our services.

        The overturning of Roe on June 24 sent shockwaves through our
    Nation that will take us months and perhaps even years to process.
    However, if we are truly committed to justice and women's rights, we
    can come together as a nation and find creative solutions to empower
    and stand with women in a post-Roe America.

        Once again, thank you for the invitation to share about the
    critical work of Stanton Healthcare and the amazing women we serve.
                                     ______

                     [summary statement of brandi swindell]
        Ms. Swindell will describe the work of Stanton Healthcare which
    operates life-affirming women's healthcare clinics providing a wide
    range of services to women with unexpected pregnancies including
    professional medical care and practical and emotional support. Stanton
    Healthcare also offers women's wellness services and an outreach to
    refugee and marginalized communities.

        Stanton is part of a women's movement which has over 3,000
    pregnancy resource centers across the nation--outnumbering abortion
    clinics by four to one.

        In addition, Ms. Swindell will:

        Discuss how the pro-life movement is ready to meet the challenge to
    ensure every woman facing an unexpected pregnancy in a post-Roe America
    will have access to life-affirming quality care, compassionate
    resources, and tangible support.

        Address the violence and attacks against life-affirming clinics;
    calling on all Members of this Committee to personally and publicly
    condemn the fire-bombing, violent attacks, and threats against life-
    affirming women's clinics. Congress and the Biden Administration should
    be part of the solution and not cast blame on our centers.

        Draw attention to the damaging effects of labeling life-affirming
    centers ``fake clinics.'' Doing so insults the thousands of women and
    their children who have been helped by our clinics. The women served
    did not receive ``fake'' medical care, or ``fake'' baby formula during
    the nationwide shortage, or ``fake'' baby supplies, financial support,
    counseling and so much more. We should not be attacking clinics like
    Stanton or proposing anti-women legislation. Rather, we should all be
    standing with them.

        Let's come together as a nation and find creative solutions to
    empower and stand with women in a post-Roe America.
                            About Stanton Healthcare
        Stanton International is a life-affirming movement of women's
    healthcare clinics founded in 2006 and based in Idaho's Treasure Valley
    with affiliate locations in the U.S. and internationally. Stanton
    exists to ensure women facing unexpected pregnancies have access to
    quality medical care and compassionate alternatives to abortion.

        Stanton Healthcare never discriminates in providing services based
    on race, creed, color, national origin, age, marital or financial
    status of its clients. We provide our services to a diverse demographic
    that includes; the refugee community, those struggling with economic
    challenges, and the marginalized. All services are provided at no
    charge to women, children, and families.

        Stanton Healthcare's flagship operates three licensed clinics in
    Idaho--in Boise, Meridian, and a mobile medical clinic. Every Stanton
    clinic adheres to the highest medical standards under the supervision
    of a board-certified OB/GYN and Physician Assistant.

        Stanton provides a vast array of services to the community at no
    charge, including:

              Early detection pregnancy testing

              Ultrasound/pregnancy verification

              Options counseling

              Abortion Pill Reversal (APR)

              Wellness care

              STD/STI testing and treatment

              After-abortion exams and support

              Advocacy appointments

              Maternity and baby supplies

              Lactation support

              Pre-and post-natal education

              Massage therapy

              Refugee assistance and support

              Breast cancer screening awareness and partnership
            with local mammography mobile clinics

              Fatherhood mentoring

              Mobile clinic outreach to underserved and rural
            communities

              Referrals for OB/GYN care, housing, legal assistance,
            and adoption

        A few vital statistics about Stanton Healthcare's clients:

              In 2021, 73 percent of the women we served at Stanton
            Healthcare in Idaho were considering or seeking an abortion.

              90 percent of these women reported feeling pressured
            to have an abortion by someone they trust.

              170 Stanton Babies were born in the past year.

              187 Stanton Babies are currently due to be born.

              More than 90 percent of women choose life at Stanton
            Healthcare after seeing their baby on ultrasound, talking with
            a trained advocate and medical professional, and receiving
            quality resources and support.

        In a 2021 snapshot of just one of our Stanton Healthcare clinics
    (in Meridian, Idaho) Stanton provided over $429,000 in life-affirming
    services at no charge to clients, including:

              $174,000 in baby clothing and supplies, along with 18
            months of wellness support through our StantonCare
            individualized program for moms and babies.

              348 Lab-grade pregnancy tests valued at $22,620

              618 Ultrasound exams valued at $194,670

              283 Follow-up visits valued at $31,395

              36 STD tests and follow-up care valued at $7,308

        Abortion Pill Reversal In response to the increased push of
    chemical abortions via the ``abortion pill,'' Stanton Healthcare offers
    Abortion Pill Reversal to moms who feel the sting of regret after
    taking the first abortion pill. So far, Stanton has had three babies
    born after successful reversals. Stanton provides this life-saving
    medical care because no woman should ever feel forced to complete an
    abortion when she has a change of heart.

        Contrary to claims Abortion Pill Reversal is unsafe or medically
    unsound, the only valid criticism that should be offered of Abortion
    Pill Reversal is that it is a relatively new technique yet to be
    exhaustively validated. Credible studies have shown that the oral
    treatment with progesterone (which is what Stanton administers) has a
    successful reversal rate of 68 percent. The conclusion of one such
    study: ``The reversal of the effects of mifepristone using progesterone
    is safe and effective.'' \1\ This is consistent with Stanton's own
    experience, as babies have made it to full term in good health using
    this method.
    ---------------------------------------------------------------------------
        \1\  Delgado G, Condly SJ, Davenport M, Tinnakornsrisuphap T, Mack
    J, Khauv V, Zhou PS. A case series detailing the successful reversal of
    the effects of mifepristone using progesterone. Issues Law Med. 2018
    Spring;33(1):21-31. PMID: 30831017. https://pubmed.ncbi.nlm.nih.gov/
    30831017 (retrieved July 7, 2022)
    ---------------------------------------------------------------------------
                             Funding and Resources
        In sharp contrast to abortion businesses such as Planned Parenthood
    which receive hundreds of millions of taxpayer dollars every year,
    Stanton Healthcare exists solely through the generous financial support
    of individuals, churches, and community organizations. In addition to
    our highly qualified medical and client care team, Stanton's personnel
    includes trained volunteers who in 2021 contributed 13,202 hours--
    totaling $369,656 in donated time.
                                Community Impact
        For over 15 years, Stanton Healthcare has been a powerful force for
    good in Idaho's Treasure Valley. Stanton's clinics have provided
    quality care at no charge to women seeking physical, emotional and
    practical support during an unexpected pregnancy, resulting in stronger
    families and stronger communities. Stanton clients consistently rate
    their experience with glowing reviews, regularly referring friends and
    family for services. Because of Stanton's incredible impact, support
    has come from all corners of the state and the nation--lawmakers,
    community leaders, clergy, political figures, and other prominent
    leaders have expressed their unwavering public endorsement of Stanton
    Healthcare. With confidence in our mission, Stanton Healthcare will
    continue to provide hope and help to women and their families across
    the U.S. and internationally.
                    Stanton Healthcare Client Testimonials:
        Jacey

              ``I was in a very bad place in my life when I decided to get
            an abortion.

              My mom told me she wouldn't have anything to do with my baby.
            My boyfriend was a drug addict and causing abuse in my life and
            left me, and I was diagnosed with having severe panic attacks
            and hyperemesis at just 5 weeks into my pregnancy. I was so
            sick I would throw up 20-30 times a day and had to get IV
            fluids. I thought there was no way I could do this. I was so
            sick I felt like I could die. I already had one daughter and
            didn't think anyone would love me with two. I thought my only
            option to have a future was to abort my baby.

              I drove to Planned Parenthood and saw Stanton Healthcare
            across the parking lot. I had heard about them and thought to
            myself, ``I'm going to go in there and if they can help me and
            can change my mind about getting an abortion, then so be it.
            And if not, I'm going across the parking lot to Planned
            Parenthood to get an abortion.''

              I went to Stanton Healthcare and found that they are a real
            clinic that helped me with everything I needed. They loved me
            and showed me I wasn't alone, gave me things I needed for my
            baby, counseling to get out of my life-threatening abusive
            relationship, encouraged me I could make it through having
            hyperemesis, encouraged me that I could have a life with this
            baby, encouraged me to find a church I was loved after having
            been hurt elsewhere, and gave me ultrasounds to see my baby.
            Seeing my daughter's heartbeat made me stop feeling the panic
            attacks that made me want to abort and stop feeling the
            horrible nausea and see my baby was a real person that I
            couldn't kill. It instantly made me feel attached to my baby
            and love her.

              Not only did Stanton help me decide not to abort, but they
            helped me turn my life back to God. When I lost my job after my
            baby was born, I was able to pray because the people at Stanton
            loved me in a way that turned my heart back to God. I felt led
            to start my own business and for the first time in my life, I
            can provide for my children on my own and have more than
            enough. They impacted my whole future and my children's future.

              I look at my baby and feel ashamed that I ever was going to
            abort her. I'm so glad she is in this world now and in my life
            forever because I was able to choose to keep her with Stanton's
            help. I thank God that Stanton helped me get out of fear and
            choose life.

              Now everyone loves my daughter. My mother is in her life and
            happy I had her. It impacted her, as well. My daughter has a
            sister and I found a man that loves all of us. All my fears
            were lies and had I aborted my little girl, I know it would
            have caused me to carry shame and depression.

              Thank you, Stanton, from me and my baby. She has a future to
            live because of you.''

        Audrey

              ``Throughout my pregnancy and postpartum experience, Stanton
            Healthcare has made it a priority to provide me and my family
            with quality care. From the moment we walked in, we felt taken
            care of by everyone.

              Stanton did an ultrasound of my now 3-month-old daughter and
            brought me so much peace during a stressful season. They
            provided me with all the resources I needed to get signed up
            with Medicaid, they recommended my OB (who I now recommend to
            other expecting mothers), and they provided me with lots of
            information about pregnancy because it was my first. Stanton
            made my pregnancy experience so smooth. I was in need of a lot
            of help and I am so happy that I decided to go to Stanton
            first.

              During my postpartum period, Stanton has provided me with
            countless resources, including diapers, classes, and clothes. I
            feel incredibly supported and feel I have even developed a
            friendship with some of the women at Stanton. I know they are
            an essential resource in our community and hope to give back in
            any way I can.''

        Jennifer (Abortion Pill Reversal)

              ``Finding out I was pregnant was a big surprise. I'm married,
            almost 40, and we had six other children.

              While I've always felt like people shouldn't get abortions,
            my husband was adamant in telling me we shouldn't have more
            babies.

              When we went to Planned Parenthood, they showed me a video
            about the abortion pill. Over and over, the video says after
            taking the pill, women feel a huge sense of relief. But before
            even taking the pill, I was extremely upset. In fact, I was
            sobbing uncontrollably.

              I've thought back on that so many times. Can you imagine a
            medical professional sitting in front of you while you are
            sobbing and not saying something like, ``Ma'am, I don't think
            now is the time for you to take this pill. You seem like you
            have not decided this is the best thing for you.''

              But no one said that. No one even asked if I was okay.

              After my husband filled out paperwork, I was instructed to
            take the first pill in front of the doctor. When he handed me
            the pill, I had a feeling of intimidation and vulnerability,
            but I took it.

              I kept thinking, ``I'm going to feel relief soon.'' Their
            video had assured me I would, but I didn't feel anything close
            to relief. So then I felt crazy and out of my head. Having an
            abortion was not something I wanted. I was forcing myself and
            believing the lie that I was going to feel relief.

              Planned Parenthood left me with the impression that they are
            a business, and their product is abortion, and it is just a
            money game. It wasn't to support me or help me make the best
            decision, or make sure that I was okay after I left, or
            anything like that.

              Before we left, we had paid over $1,000 for the ultrasound
            and the pills.

              That night, I couldn't sleep, so around 2 a.m. I googled: `If
            I don't take the second set of pills, will the baby be okay?
            Did I cause damage or defects?'

              That's when a phone number came up about Abortion Pill
            Reversal, which I'd never heard of, so I started texting it.
            And someone responded right away.

              Within a couple of hours, I knew I was going to be connected
            with a place that would try to help my baby and me. That same
            morning I walked into Stanton Healthcare and met the incredible
            people there. They did an ultrasound and my baby still had a
            heartbeat! They started me on a protocol to help protect my
            baby from the effects of the abortion pill, and they continued
            to provide me with caring support through the whole pregnancy,
            and beyond.

              My son is now 5 months old--completely healthy--and we could
            never imagine our lives without him! I'm super grateful for
            Stanton meeting me early in the morning on a Saturday to save
            my son. And I'm so grateful to everyone who supports Stanton so
            women like me can know this option exists and have access to
            it. It gave me the opportunity to change my mind. I would have
            missed out on life with my son and I would have regretted that
            decision forever.'''
    Stanton Healthcare's legal counsel, Michelle Adams, responds to claims
                      of Stanton being a ``fake clinic.''
        The interpretation of the word ``fake'' is not a matter of opinion.
    It means `not true, real, or genuine.'

        However, Stanton Healthcare is recognized by the State of Idaho as
    a fully licensed medical clinic, operating under all state laws and the
    licensing of its Medical Director, with all proper CLIA waivers,
    maintaining documentation of proper licensing from all its medical
    staff and volunteers, with a medical advisory team, and continuing
    education in best practices. Stanton is listed by the Idaho Department
    of Health and Welfare as a recognized provider in this field.
    Ultimately, Stanton meets or exceeds the licensing requirements of
    healthcare clinics in Idaho and has certification and standards of
    excellence beyond that of abortion providers in the state.

        It is irrational to suggest that because abortion clinics and
    pregnancy medical clinics serve a similar population--pregnant women--
    they must, therefore, offer the same set of services. It is
    presumptuous to declare which services ought to be offered at every
    establishment serving pregnant women. Stanton Healthcare offers many
    services that abortion clinics do not, but it would be illogical to
    therefore conclude that the abortion clinics are ``fake clinics.''

        The reality is that Stanton, and many of those of its type, fill a
    critical niche in our Nation that would not be served otherwise. Many
    served by Stanton are low-income and vulnerable women who would not
    receive sufficient practical or emotional assistance elsewhere. When
    politicians and media outlets cast disparaging suspicion on our
    clinics, you are steering women away from some of the places where they
    might receive such support.
                                     ______

        The Chair. Thank you. We will now begin a round of 5 minute
    questions and I ask my colleagues to please stay--keep track of
    your clock and stay within those 5 minutes. Dr. Brandi, I am
    going to start with you. Across the country, states that
    protect abortion rights are preparing for a surge in patients
    coming from states where they no longer have the right to
    access the care that they need.

        Researchers estimate that 36 million women of reproductive
    age will now live under abortion restrictions and bans. In my
    home State of Washington, clinics are expecting to see five
    times as many out of state patients. And this is really a full
    blown health care crisis that is going to cost women their
    lives and their health because they can't access the care they
    need from their own doctors in their own states.

        I want to thank you for providing such incredibly important
    care because the work you do is essential, and it saves lives.
    Talk to us about how abortion bans in other states impact your
    work as a provider in New Jersey and the care that your
    patients receive.

        Dr. Brandi. Thank you so much, Senator, for the question.
    You are right. There is going to be millions of people that
    hopefully will be able to access care, and unfortunately will
    be leaving their homes and their communities in order to do so.
    I am very fortunate to practice in New Jersey, where our
    Governor and legislators have passed proactive laws to help
    protect the care in our state.

        Unfortunately, that is not the case elsewhere. And many
    people across the country will be leaving their communities to
    get that care. What that looks like is delays in care, which
    leads to patients presenting often later in pregnancy.

        It means patients may not be able to get to us because all
    of the logistics of travel like childcare, like making sure
    people have days off of work, they have gas so they can get to
    their appointments, all lead to people not being able to access
    the care. And we know that disproportionally impacts people of
    color and other people that are marginalized.

        People that live in states that the care is protected
    often--are anticipating enough flow and people. People are
    going to be having to wait that live in those communities for
    weeks. And we are already seeing that in certain communities
    that appointments are taking two, 3 weeks to be able to get
    that appointment.

        Unfortunately, in pregnancy care, weeks matter. And that
    may create further barriers to people being able to access the
    care that they need and deserve.

        The Chair. Thank you. Ms. Detzer, thank you for sharing
    your story and your mom's. I know it takes a lot of courage to
    speak out about a personal situation, and I am really grateful
    that you were willing to do that today.

        You spoke really powerfully about your mom's experience
    before Roe and what happened to her, and your experience in
    what you--happened in a world where we had Roe. Talk to me a
    little bit about what abortion rights means in your life.

        Ms. Detzer. Thank you, once again, for the opportunity to
    share my story, Senator. The first thing that comes to mind for
    me is that what a person does with their life after they have
    an abortion need not be exceptional for that abortion to be
    necessary.

        What they do with their life after that should be the same
    as the choice to have an abortion, entirely up to them.
    However, in my case, I am pretty proud of the things that I
    have done in my life after having an abortion. Most importantly
    to me, having an abortion allowed me to be a support system for
    my brother and my sister when they became parents, when they
    chose to become parents.

        I would say probably most importantly to me, that having an
    abortion allowed me the time and resources to care for my
    mother as she got sick with cancer and eventually died. And so
    I am deeply grateful for the abortion that I had that allowed
    me to live my life as I wanted it to.

        The Chair. Thank you. Dr. Taylor, as you mentioned, this
    crisis is not being felt equally. Black and Native American
    women, for example, continue to experience disproportionately
    higher rates of death related to pregnancy or childbirth. How
    will the overturning of Roe exacerbate the maternal mortality
    crisis in our Country?

        Ms. Taylor. Thank you for the question, Senator Murray. You
    know, it is going to greatly exacerbate our maternal mortality
    crisis in this country. You know, based on research that was
    conducted not too long ago, we know that the fall of Roe will
    cause our overall maternal mortality rate to go--to increase by
    20 percent. For black women, it will increase by 40 percent.

        I think it is important to talk about the maternal
    mortality issue in this context, because it is bigger than even
    the conversation we are having today. Black women
    disproportionately are impacted not only by the maternal
    mortality crisis, but also unable to access abortion even
    before Roe.

        These challenges are going to be basically insurmountable
    in a lot of ways. But as I mentioned in my testimony, there are
    solutions that can be implemented to address the issue.

        The Chair. Thank you very much. My time is up.

        Senator Marshall.

        Senator Marshall. Thank you again, Chair Murray. You may
    hear the abortion lobby say that maternal mortality is up to 14
    times more for carrying a pregnancy to term as opposed to an
    abortion. But in absolute terms, the chances of dying from
    pregnancy is approximately 0.024 percent, which, let me be very
    clear, is unacceptable. It is too high of a rate. Before Dobbs
    or after Dobbs, it is too high.

        Let me also point out that more women ages 20 to 44 die
    each year from trauma, cancer, heart disease, suicide,
    homicide, liver disease, diabetes, and stroke than pregnancy
    related complication. Finally, this, please realize that HHS
    does not require actual reporting of abortion complications.

        While the abortion industry is quick to claim that
    eradicating all protections from the only--from the unborn is
    the only way to lower maternal mortality rates, abortion is not
    the solution to this crisis. Rather, the Nation should focus on
    addressing the underlying causes that lead to maternal
    mortality.

        Here in our Nation's capital, for example, has the fewest
    laws protecting life in the womb compared to the other 50
    states, but its mortality rate of 36 per 100,000 means that
    women in D.C. are 50 percent more likely to die from pregnancy
    related causes as women in the rest of the Nation.

        For black mothers, the situation is even worse. And
    according to maternal mortality report of 2019, black women
    accounted for 90 percent of all pregnancy related deaths in the
    districts. The maternal mortality rate for black mothers in
    D.C. is 71 per 100,000, dwarfing, tripling the national
    average.

        It is especially a problem here in D.C. Ward 7 and 8. If I
    describe this particular geographical area, they have no
    hospitals with birth wards. They only have three grocery stores
    and drastically fewer pharmacies than the other wards. These
    are issues we can and must address.

        Each time we spend taxpayer dollars funding the abortion
    industry, we take away money and resources from providing real
    solutions for mothers and our Nation's most valuable resource,
    our children.

        Ms. Swindell, if you had a clinic in D.C., in this high
    mortality rate, how could you impact the maternal mortality
    rate?

        Ms. Swindell. Oh, we would definitely have an impact. Thank
    you for that question. You know, Stanton Healthcare, we are a
    nonprofit, life affirming women's medical clinic. We don't
    charge for any of the services that we provide.

        We have a very high focus on pre and post-natal education,
    a very high focus on quality prenatal care, and then also
    putting together an individualized care plan for every woman
    who walks through our doors. And so we make sure that she has a
    solid support system, that she has all of the resources that
    she needs, that there is a plan in place.

        Our program runs the duration, not--its 9 months of
    pregnancy, whatever that point is that she comes to our center,
    and then a minimum of 9 months after that. So it is an 18 month
    program, and it even goes beyond that. We have moms that come
    in that their children, their babies, they're Stanton babies,
    as we call them, are 10 years old now, 5 years old.

        They still come in and we are that support and resource for
    them. So we are seeing very good results through our
    individualized care program. Again, it is that focus on pre and
    post-natal education and good prenatal care.

        Senator Marshall. Yes, thank you for that answer. I want to
    keep on this topic of this ill-conceived concept about abortion
    being safer than pregnancy. You know, first of all, stating the
    obvious, the mortality rate for the unborn baby is almost 100
    percent and abortions and very low in childbirth.

        We also believe that continuing pregnancy is very
    protective of the mother and child, particularly when we think
    about suicide rates of women that have had babies versus the
    abortion, women that have had abortions.

        We think about even higher incidences of trauma and murder
    for women have had abortions as opposed to women who have bore
    their pregnancy and had children. Do you see many problems with
    that post-abortion syndrome, emotional distress, suicidal
    because of the abortion?

        Ms. Swindell. Thank you, Senator. Yes, we do. In fact,
    Stanton Healthcare runs an after abortion care program, and
    that support program is always full. We have women that walk
    through our doors that are very traumatized after having
    abortion. Most women experience both short term and long term
    physical and emotional challenges after an abortion.

        In fact, studies show that one in four women that undergo
    an abortion express feelings of depression, anxiety, regrets,
    things that follow along with that, substance abuse to try and
    numb the pain, hallucinations of their child, nightmares. Women
    experience things like being very stressed out at a certain
    time on the clock because that is when the baby--when the
    abortion happened, and the baby was killed.

        My own mother suffered from the pain of a past abortion. In
    fact, she only became suicidal after she had an abortion. She
    was never suicidal before that. She also, may she rest in
    peace, passed away in 2016.

        But she always regretted her abortion, and she became a
    very big supporter of Stanton Healthcare so that other women
    wouldn't have to go through the same experience she did.

        Senator Marshall. Thank you so much. I yield back.

        The Chair. Senator Hassan.

        Senator Hassan. Thank you, Chair Murray and Ranking Member
    Marshall. I want to thank all of our witnesses for being here
    today. We know that the end of Roe is not the final goal of
    anti-choice extremists. Their ultimate objective is to ban
    abortion nationwide. We have to hold the line against any
    efforts to enact a nationwide abortion ban and keep fighting to
    protect a woman's fundamental freedom.

        This is, after all, about whether women are allowed to make
    their own complex life and health decisions. Dr. Brandi, in the
    wake of the Supreme Court's decision, we are hearing extremely
    concerning reports about women experiencing difficulty getting
    critical emergency care related to pregnancy.

        As Senator Murray mentioned in her opening statement, 1 in
    50 women experience an ectopic pregnancy, a life threatening
    condition. Doctor, can you walk through what an ectopic
    pregnancy is, how it develops, and how it is treated, please?

        Dr. Brandi. Absolutely. Thank you for the question. As you
    stated, ectopic pregnancy affects about 2 percent of all
    pregnancies, and an ectopic pregnancy is a pregnancy that is
    implanted outside of the uterus, most often in the fallopian
    tubes. But it can be in the ovaries, it can be in the abdomen.

        This condition will never continue on to a normal
    pregnancy, and often it is life threatening for the person that
    has that condition. I will tell a quick story that I had a
    patient recently in the ER with an ectopic pregnancy, and
    minutes are critical in that--in the ability to take care of
    that person.

        I talked to them in the ER, they were walking around a
    couple of minutes, and then 20 minutes later by the time we are
    in the operating room, they were critical. Their vitals were
    dropping. We had to emergency do their surgery to in order to
    save their life. I am really glad that we were able to provide
    that care in such a quick fashion. But we have seen a chilling
    effect in other states.

        It was reported in the New England Journal of Medicine how
    providers in Texas after SB-8 were confused. They didn't know
    what was safe, they didn't know what was--they had to make
    decisions about whether or not to follow their oath or protect
    themselves against potential litigation and criminal action.

        It is really heartbreaking to consider as a physician that
    I would have to hold back what I know is evidence based care to
    intervene right at that moment because I am worried about
    calling my lawyer and making sure that I can do that before I
    intervene.

        Senator Hassan. Right. And it is--so as you point out, it
    is both the uncertainty created along with the reality that
    seconds count when you are caring for a patient with an ectopic
    pregnancy.

        Dr. Brandi. Exactly right.

        Senator Hassan. Well, it is clearly--a treatment for an
    ectopic pregnancy is clearly lifesaving medical care. And
    politicians have no place in the doctor's office or in the
    operating room where a doctor should be able to provide care
    quickly and safely based on best medical guidance.

        One more question for you, Dr. Brandi. The Supreme Court's
    decision created countless legal questions that have brought
    uncertainty into hospitals and clinics, as you have just
    pointed out.

        Reports indicate that confusion has interfered with
    treatment for a number of conditions, ranging from rheumatoid
    arthritis and IUD insertions to miscarriages. Dr. Brandi, could
    you outline why this confusion is harmful in a medical setting?

        Dr. Brandi. Sure. We spend years and years of our lives as
    physicians training on the right management for the right
    condition, to be able to diagnose and intervene right at the
    minute that patient needs that care. Medications are
    complicated and can treat multiple disease processes.

        For example, as you mentioned, methotrexate, which is a
    medication we use to treat ectopic pregnancies, and back in the
    day used to use for abortion care, also treat things like
    rheumatoid arthritis and lupus, which disproportionately impact
    women. And so there is confusion now between providers or
    pharmacists about what medications they can provide for
    patients.

        There is a lot of overlap, for example, on miscarriage
    management. It is the exact same medicines, the exact same
    procedure as abortion care. And so it is unclear if providers
    can provide that care under these very confusing regulations.

        Senator Hassan. Thank you very much. And thank you, Madam
    Chair. I think it is clear that these decisions are best left
    to women and their health care providers. Thank you.

        The Chair. Thank you.

        Senator Cassidy.

        Senator Cassidy. Thank you all. It is kind of with--you
    know, I am a physician, and it is kind of with grief that I
    come to this because there is so much misinformation put out.
    But let me first say that we have a lot of common ground here.
    A lot of common ground.

        First, let me just say, what has actually been accomplished
    are things that I personally I have been involved with. I have
    lived in has been signed into law the John Lewis National
    Institute on Minority Health and Health Disparities Research
    Endowment Vitalization Act, and Maternal Health Quality
    Improvement Act.

        Two things designed to address disparity. Working on
    legislation called the Connected Mom. Allowing a woman on
    Medicaid to be at home and have her vital signs measured
    remotely as opposed to perhaps taking public transportation to
    and from the physician.

        We have worked--we have worked significantly on what to do
    about addiction services, knowing that many women who die a
    year, within a year after a pregnancy die of addiction. Working
    on--we just passed a major suicide bill, a mental health bill,
    which, again, since many women who die post pregnancy die of
    suicide. So, but we there is more to do. I emphasize that
    because there is common ground, and the common ground gets kind
    of lost in the midst of a cloud of misinformation.

        Now, again, I am going to speak as a physician because I
    found that when patients came to me in a panic, the first thing
    I had to do was kind of dispel their fears that were not the
    case, and to try instill facts where there was instead this
    kind of, oh, my gosh.

        First, I think Dr. Marshall did a wonderful job of pointing
    out that he as a pro-life physician, takes care of patients
    with ectopic pregnancies, period, end of story. So we hear
    dialog that somehow a woman with an ectopic pregnancy will not
    get her care. It is just not true. Can we dispel that? And when
    folks say, oh, those states that have the highest--the most
    restrictive abortion have the highest maternal mortality.

        No one speaks of Washington, DC, which has the highest
    maternal mortality and has absolutely no limit upon abortion
    access, up to the point of parturition. The baby can be coming
    through the birth canal here in Washington, DC. and can be
    aborted.

        Five minutes, it would be a child in someone's arms, and
    instead 5 minutes early is dismembered, his skull crushed, and
    they have the highest maternal mortality in the Nation. And my
    gosh, if there is anything to fear, Ms. Swindell, in my home
    state, I happened to visit one of the crisis pregnancy centers.

        It is amazing the good work they do. And people come there
    voluntarily. They can leave at any time. They elect to stay.
    And when I went there, they had a whole closet full of clothing
    and formula. I said, well, this is--I thought you were
    prenatal. And they said, no, we continue to care for the family
    of the child after the child is born, and we have all these
    that are here for that family.

        Now, there is Federal legislation being introduced that
    would shut down crisis pregnancy centers, that would say, Ms.
    Swindell, no matter what your good work, Washington, DC. is
    going to shut you down. I will also say, my gosh,
        there is all this kind of implication that Washington, DC.
    is bearing down on people's lives. There is Federal legislation
    to ban crisis pregnancy.

        Democrats want to force pro-life physicians and nurses to
    either do abortions or lose their license or have--face civil
    penalties. Dr. Marshall, you are pro-life. If you decided, no,
    the heavy hand of Washington, DC. is going to come in and
    snatch your license away or subject you to civil penalties.

        That is concerning. Can anyone--now next, can anyone name a
    state in which there is a law saying that if the life of the
    mother is at risk, the woman does not have a right to an
    abortion? You can't because there is no state. Every state
    allows an exception for the life of the mother.

        There is this kind of, frankly, misinformation that is not
    the case. I am going to speak as a physician. There is a lot of
    common ground. Let's do something about maternal mortality. But
    let's don't hide our efforts in a cloud of misinformation,
    suggesting for a fact that aborting every baby is the way to
    protect mamas' lives.

        When we see here in Washington, DC, with the most liberal
    law in abortion in the Nation having the highest rate of
    maternal mortality. Now, let's suggests that a mama is going to
    have her life placed at risk because of these or because of an
    ectopic pregnancy, she can't have her abortion addressed. And
    the richest was a transgender are somehow going to be affected.

        There is not a law out there related to abortion that also
    relates to transgender. I usually ask questions, but here I
    just had to say, let's all think like doctors who really want
    to lower maternal mortality, but also calm everybody down with
    facts, not with misinformation. With that, I yield.

        The Chair. Senator Smith.

        Senator Smith. Thank you, Madam Chair, Ranking Member
    Marshall. Dr. Taylor, I want to just turn to you quickly. Could
    you quickly respond to this myth, of course, about post-
    abortion trauma and suicidal thoughts? Maybe also just quickly
    address some of the systemic causes for the vast disparities in
    maternal mortality in this country.

        Ms. Taylor. Sure. Absolutely. You know, based on how I talk
    about maternal mortality, I center around black women in the
    work that I do. And the maternal health crisis is the root of
    that is racism. How we see structural racism not only show up
    in the health care system, but I think also broader society.

        We know that racism, particularly the experience of it for
    black people, causes us to be more susceptible to disease,
    mental health challenges, in addition to physical health
    challenges. And so we do see that show up sometimes in the
    context of the care that pregnant women may be undergoing.

        I think a part of it is to black women also have reported
    experiencing not being listened to by their health care
    providers. So when they express pain or discomfort in some of
    their exchanges with physicians, that is sometimes ignored.

        We even saw Serena Williams share her own story of what
    happened to her and not being listened to shortly after having
    her daughter. And so to me, those are some of the root causes
    of the maternal mortality crisis.

        Look, I recognize that pregnancy in and of itself, no
    matter how you decide to move forward, that is the decision
    based on the woman and her family in consultation with her
    physician.

        That can spark some challenges for her mentally because it
    is a difficult decision. But I don't think that it is true to
    say that for the most part, women who stand firm in their
    decision to have abortion are regretting that or experiencing
    mental health challenges because of that.

        Senator Smith. It is fundamentally a question of who has
    the decision and the ability to control your own decisions in
    your own life is really what this is about, it seems to me. I
    would like to turn to you, Dr. Brandi, and turn to the question
    of medication abortion.

        Medication abortion has been a safe and effective way of
    terminating a pregnancy in the first 10 weeks. For nearly 20
    years, a provider can safely prescribe medication abortion
    through telehealth in most cases, and it can be delivered to
    the male also. Slightly over half of abortions in this country
    are done with medication now.

        But now that the Supreme Court has overturned Roe, this
    medication will be a crucial access point for many women. We
    cannot allow Republican politicians to spread misinformation
    about this medication, which is happening, or to erect
    unnecessary hurdles, unnecessary hurdles to stop women from
    access.

        Dr. Brandi, can you just tell us, is medication abortion
    safe and effective for women to use in the first 10 weeks of
    pregnancy?

        Dr. Brandi. Senator. That is an easy one. Absolutely.

        Senator Smith. Thank you. And can you just walk through a
    little bit of the process for how providers determine whether
    medication abortion is effective for a person?

        Dr. Brandi. Sure. When I see a patient that is seeking
    abortion, I always go through all the options and talk about
    risks and benefits.

        Particularly around medication abortion, there are very
    rare contraindications to receiving medication abortion, but
    generally it is incredibly safe. It is anywhere between 95 and
    99 percent effective in ending a pregnancy up to 10 weeks. And
    it is something that requires very few interventions from the
    health care system.

        Many people can determine based on their last menstrual
    period when they became pregnant, and based on that and their
    symptoms, a patient can be provided this medication over the
    phone via telehealth.

        Senator Smith. It is not medically necessary for a person
    to be prescribed this medication by a physician in an office?

        Dr. Brandi. Not in an office setting, no.

        Senator Smith. Thank you. I want to just be clear about
    this. Medication abortion cannot alone undo the damage done by
    Republican politicians who are taking away women's freedom. And
    today, we know that there are states that are undermining the
    capacity of people to access medication abortion, but it is an
    important access point to protect access where we can and to
    actively fight this misinformation, I think, is an important
    thing for us to do here.

        I am sorry that I am out of time here, but I want to just
    follow-up briefly on the question, the line of questions that
    Senator Hassan asked, which was to really--really to illustrate
    the chaos that is ensuing around this country as a result of
    this extremist Supreme Court decision to take away this
    fundamental freedom of people.

        What we see from Republican lawmakers determined to control
    the decisions that women want to make based on where you live,
    the right and freedom of women to get an abortion, to manage
    their miscarriages, to treat an ectopic pregnancy is now
    severely compromised.

        This legal chaos, which has ensued, means that your doctor
    may not even believe that they have the autonomy to decide and
    to make it into practice based on what their best medical
    information is and what they believe is best for their patient.
    So let's be clear. Let's be clear. Republicans are responsible
    for this chaos.

        They created this health care crisis because they believe
    they know better than women whose lives and stories they will
    never know. They believe that they know better. They believe
    that they should control.

        That is what we are now faced with. That is what we are now
    working to fix. We will not stop working until women's freedom
    can be exercised equally in all parts of this country. Thank
    you, Madam Chair.

        The Chair. Senator Braun.

        Senator Braun. Thank you, Madam Chair. Listening to Senator
    Smith's point of view there, I think as we do give it, this is
    a topic that I think for 49 years has been in one place. It has
    now come to another. I think we have got to be careful that we
    don't get too caustic in either point of view.

        Right now, the Supreme Court says it is back with the
    states. I have been a believer on this issue from the get-go.
    You do not demonize the folks you disagree with, and you make
    sure that in this case, when we have returned this to the
    people, we make the right decisions at the state level. I am
    going to have the same question and I am going to start with
    Ms. Detzer.

        You were quoted on September 17th, `21 on Fox 13, Seattle
    News that you have not looked back except in celebration and
    deep appreciation for your choice. And again, respect that. I
    would like to ask you, though, when it comes to, when your
    state grapples with it, at what age do you think gestationally
    it is no longer appropriate to have an abortion.

        Just a simple question. I think that any of us, if we are
    out here talking about the issue, especially in states where it
    may go beyond where it is commonly accepted, I would like to
    know your opinion.

        Ms. Detzer. Sorry, Senator, could you repeat your question,
    please?

        Senator Braun. You and your--some of the organizations you
    support, support abortion, I believe, up until the moment of
    birth. I would like to give you the chance to clarify that if
    you think that is still where it should be, or if there is an
    age beyond which you would not be comfortable with an abortion.

        Ms. Detzer. I am not a medical provider. I have no standing
    to make any statements about medical limits. What I am here to
    do is to share with you all my personal story of abortion
    access and to highlight how my mother story of abortion access
    was so very different, and how much changed in just one
    generation between us.

        Senator Braun. Putting a medical issue aside and assuming
    there was none, is there an age beyond which you would be
    uncomfortable with an abortion?

        Ms. Detzer. I am sorry. Are you asking me to consider an
    abortion not a medical procedure? Because I believe that it is.
    It is health care.

        Senator Braun. Taking the inherent risks of an abortion
    aside, and if it is minimal, do you think there is an age
    beyond which you would be uncomfortable with it?

        Ms. Detzer. I am sorry. Could you please repeat that
    question? I am not sure how to separate health care from an
    abortion.

        Senator Braun. You are making that point, and I will let
    you rest on it. I will go to Ms. Brandi with the same question.

        Dr. Brandi. Excuse me, Senator. Are you asking me a
    question or----?

        Senator Braun. Same question I asked Ms. Detzer.

        Dr. Brandi. I apologize. I was confused. I am Dr. Brandi.
    Thank you. I think what you are trying to bring up is abortion
    care later in pregnancy. I understand people have very
    different opinions about what that looks like and how they feel
    comfortable regarding different gestational age limits.

        But I think talking about these hypothetical scenarios
    doesn't actually respect the pregnant people that I take care
    of every day that have varying circumstances. And as a
    physician, I think the most prudent thing is to listen to their
    stories, assess their own medical risks, depending on where
    they are in pregnancy, and help them decide what's best for
    them.

        I think bans based on a gestational age, whatever that
    gestational age is, just create barriers to care and don't
    actually improve the safety of care, which is what I care about
    most for my patients.

        Senator Braun. You know, being a doctor, I think you may
    have a better way to answer the question in the sense that I
    know there is medical risk in doing anything. At the point you
    can't eliminate risk, but were--say there would be as little as
    you could determine at the time, do you still think it is
    appropriate for someone to choose an abortion up to the point
    of birth?

        Dr. Brandi. Senator. Again, that hypothetical that I think
    is brought up quite a bit actually is not what abortion care
    looks like on a day to day basis. Abortion care after 20 weeks
    is about 1 percent of pregnancy. I think by focusing on that,
    you de-legitimize and you disrespect a lot of the patients that
    are seeking this care for very legitimate and important
    reasons.

        Senator Braun. Ms. Swindell, would you like to weigh in?

        Ms. Swindell. Sure. I believe in what all the medical
    textbooks say. I am not a medical professional, but life begins
    at the beginning. And there is an amazing spark that occurs
    when the sperm and the egg meet, and a new embryo is formed.

        I believe in respecting all stages of life and development.
    I think that is an important part of human rights and also
    women's health care. And so I believe in what the medical
    textbooks say. I believe in biology. I believe in science. And
    frankly, it is not rocket science.

        Life begins at the beginning. And abortions at any stage
    take the life of an innocent human being, and that is a grave
    human rights violation. I was born after 1973. I was born in
    1976, aging myself here. I was open prey in my mother's womb.

        My Government decided that I had no Constitutional rights
    or human rights or civil rights. And it is a new day, and it is
    a new era. And pre-born children, their humanity is being
    respected. And it is a great thing.

        Senator Braun. Thank you. I respect all of your opinions
    and ask the question because of how difficult it is to answer.
    And why they should be left with the states, with the people
    within the states to make that decision. When you look at----

        The Chair. Senator Braun, your time----

        Senator Braun. Yes, and I will finish up here in just a
    moment, with that diversity of opinion. So thank you for your
    answers.

        The Chair. Senator Hickenlooper.

        Senator Hickenlooper. Thank you, Madam Chair. I thank all
    of you for your service and your willingness to come here
    today. You know, I grew up--I was born in 1952 so the issues
    around abortion were of intense discussion, obviously, in those
    days. And my mother was a single mother, raised four kids by
    herself and we discussed frequently the issues surrounding
    abortion.

        This was kitchen table discussions. It was my mother's--no
    matter how lean our household budget may have been, she tried
    to give every year some donation to Planned Parenthood.

        Some years it was $10. But she felt that a woman who was
    forced to carry a child to birth, that they were not ready for,
    that they didn't intend, was being forced to give up part of
    their life and to have challenges and obstacles that would make
    their achievements in life far, far more difficult and
    oftentimes would lead to devastating results.

        Colorado State where we are--we proudly support a woman's
    right to access, the right of access to health care. But we are
    surrounded by states on three sides that have either or are
    going to or are expected to enact abortion bans. And we will
    certainly see a large influx of patients. I think this can
    stretch the providers in Colorado and other states that are
    already quite thin.

        It is going to impact access not just to abortion, but to
    other reproductive services. Dr. Brandi, I will start with you.
    How are these abortion bans impacting access to other
    reproductive health services like contraceptive care, cancer
    screening, etcetera?

        Dr. Brandi. Thank you, Senator, for the question. You are
    right that while abortion bans on face value just impact
    abortion, they impact so much of reproductive health care and
    care that is entirely unrelated to reproductive health care.

        Things like, we mentioned earlier different immunologic
    diseases can be impacted because treatments are very similar.
    Or, for example, cancer cases where people may get delays in
    their care or may have contraindications to certain types of
    birth control that may not be accessible to them.

        There are so many ways that this is impacted, ways that
    medical physicians and other health care professionals knew
    about, and we are seeing through Texas. But every day I am
    hearing a new report about a different medication, a different
    patient scenario, because every patient is unique.

        Every patient is an individual. And we in medicine have to
    be creative sometimes when we take care of patients, find new
    ways to treat different diseases. And when our hands are tied,
    when there are certain bands that just create a law without
    thinking about the people that it impacts, it is really
    challenging for physicians to be able to meet that
    individuality of patients and give them the appropriate care
    that they need.

        Senator Hickenlooper. All right. Thank you very much. Dr.
    Taylor, I wanted to ask you also, in your opinion, what does
    this notion of Government mandated pregnancy or enforced
    pregnancy, what kind of outcomes is that going to lead to and
    what kind of health outcomes is that going to lead to for
    women?

        Ms. Taylor. Absolutely. Thank you for the question,
    Senator. First of all any time we are forcing a person to
    continue with a pregnancy that they would like to terminate, it
    could impose various issues for that individual, whether it is
    stress, anxiety, mental health challenges.

        I think in addition to that, if we put this in the context
    of the maternal health crisis in this country, it could mean
    that individual may not keep up with their prenatal care
    appointments. They may also struggle financially if they have
    to continue with a forced pregnancy.

        We also know that even if you look at something like higher
    education we know that for a woman who can access an abortion,
    a college age woman, that she is more likely to finish school.
    And so it really has an impact on the broader consequences of
    that person. I think another point I will add too is that about
    60 percent of people who have abortions are already parents.

        Not having the opportunity to terminate a pregnancy for a
    woman and her family could mean that she is unable to care for
    and support the children that she already has. It could impose
    additional economic challenges for the broader family, and it
    could even lead to health challenges for the children that she
    already has.

        It really is a broader issue that can impact various
    aspects of a woman's life.

        Senator Hickenlooper. All right. Thank you very much. And
    just one last very brief question, if I can. I saw a number,
    heard a number last week that almost half of all pregnancies in
    America are accidental or unintended. Is that true? Do any of
    you have that accurate number on that?

        Dr. Brandi. I can speak to that. Yes, about 45 percent of
    pregnancies are unintended and about 40 or about half of them
    end in abortion. And so even though we talked earlier about
    percentages being very small, if you think about percentages on
    the broader sense, like the 14 percent of people, that is
    actually equitable to thousands of people that can become
    pregnant in our Country. And so that is a huge impact for
    people across our Country.

        Senator Hickenlooper. Right. Thank you all. Thank you.

        The Chair. Thank you.

        Senator Murkowski.

        Senator Murkowski. Madam Chairman, thank you for the
    hearing today. And to our witnesses, thank you. I have had an
    opportunity to read your stories in your testimony that you
    have provided to the Committee.

        I have heard many stories from Alaskans, most notably in
    this past couple of weeks, from women who are really very
    distraught about the Supreme Court ruling in the Dobbs case.

        But the stories that you have shared from a personal
    decision to terminate a pregnancy and to the challenges that
    parents or family members face in accessing care, to the
    stories that women who visited clinics such as Stanton and
    decided to continue a pregnancy, I think they all demonstrate
    how these are very deeply, deeply personal, deeply complicated
    and of course, incredibly challenging decisions that far too
    many women face each year, and clearly that Americans hold deep
    and conflicting convictions over.

        When it comes to decisions that are so personal, that are
    so complex, and have such an impact on a person's lives, I
    think that choice must ultimately be in the hands of the
    individual and not in the Government.

        That is where I came down on vaccine mandates. It is where
    I come down on abortion. But I think that like so many other
    areas there, there are nuances, there are gray areas. Many
    Americans, myself included, believe that it is reasonable to
    not require those who are firmly opposed to abortion to support
    it with their tax dollars, and that providers who do not wish
    to be involved in abortion should not be forced to be.

        What I would hope that we can agree on is that it is in the
    best interests of everyone to create a system where fewer women
    face this choice in the first place because everybody has
    adequate access to and knowledge about contraceptives and
    because women and families have the support that they need.

        But ultimately, I believe in limited Government, individual
    liberty. I support a woman's right to make her own health care
    decisions and that means reproductive health care. I am working
    with a small bipartisan group to ensure that the rights that
    women have relied on for the last 50 years as established in
    Roe and in Casey and in Griswold, that these are protected.

        I hope that at a minimum our legislation will demonstrate
    that there is a majority in the U.S. Senate that supports these
    basic rights. I know that folks are all like, well, how are we
    going to get this legislation passed? And so kind of the knee
    jerk response here is to take on the filibuster.

        I want to just raise this because I think that it is
    tempting to call for the removal of the filibuster so that we
    can do something. But I would ask my colleagues to take the
    longer view and think about what elimination of the filibuster
    would mean for both sides and for our Country in the future.

        In the recent years, the filibuster has been used multiple
    times to block attempts to restrict access to reproductive
    health care. Three times, in 2015, 2018, and then again in
    2020, pro-choice Senators used the filibuster to block a 20
    week abortion ban. It was used to stop a blanket ban on funding
    for Planned Parenthood in 2015.

        There were numerous other times to prevent the erosion of
    reproductive rights. I think we have got to look at this again
    down the road. The balance of power in Congress moves back and
    forth. Without the filibuster, do we really think, do we really
    believe that a different majority would not seek a nationwide
    ban on abortion and find a way to succeed in enacting it?

        The filibuster is really one of the few mechanisms that
    protects the rights of the minority. I raise this because I
    think we need to be looking long term at this. Now, this
    hearing is about reproductive care in a post Roe world. I want
    to ask you, Dr. Taylor, what does this mean?

        What are the downstream impacts that we should expect on
    access to care outside of abortions, even in states where the
    Dobbs decision will not have an effect? In Alaska, our courts
    have held that our state Constitution protects access to
    abortion. But at the end of May, Planned Parenthood clinic in
    Soldotna closed its doors.

        They do not provide abortions. The Dobbs decision again is
    not going to impact our state. But what we heard was a Planned
    Parenthood spokesman said that the closure was a result of
    review by Planned Parenthood that led to the closure of five
    clinics nationwide. They are basically looking to reduce their
    budget to prepare for changes in states with trigger laws. We
    don't have one of those.

        Now, the closest Planned Parenthood location to Soldotna is
    in Anchorage, it is 3 hours away. The closest source of Title X
    comprehensive reproductive care is Homer, 2 hours away. So we
    are seeing changes like this in a state like Alaska that is
    supposedly not going to be impacted because of our
    Constitutional provision.

        But you have got trigger laws in states like Kentucky and
    Idaho that are driving a reduction of access to birth control
    and reproductive care as far away as a state like Alaska. I
    haven't allowed much time for the response here. But it is a
    concern to me that the reduction to access in care is going to
    result in more and not fewer unplanned pregnancies.

        The Chair. Senator Murkowski----

        Senator Murkowski. I ask the question of Dr. Taylor----

        The Chair. Dr. Taylor has left momentarily. She will be
    right back. We can ask her for a response in writing or attempt
    Dr. Brandi.

        Senator Murkowski. Maybe Dr. Brandi can address that. Thank
    you. I didn't realize that she had vacated the Chair there.

        Dr. Brandi. Sure. Thank you for the question and happy to
    answer. You are absolutely right that there will be downstream
    effects, and we will not know truly all of the effects that
    will impact things like maternal morbidity and mortality,
    unplanned pregnancy rates for--we won't know that for years to
    come.

        But I think it is important to name that we have a health
    crisis on top of already, a health crisis through COVID. That
    many labor and delivery wards across the country, for example,
    have closed because they were unable to keep their doors open.

        Thinking about an influx of people that may be seeking
    maternity care, do we have the support systems? Abortion and
    maternity care are not mutually exclusive. And I am an OBGYN. I
    take care of both patients.

        Not often patients are the same patient. And so it is
    important to recognize that things like maternity care, labor
    and delivery, and having access to nearby clinics in the
    communities that are needed are both issues that need
    addressing and will have long term impacts.

        The Chair. We have gone way over time on Senator Murkowski,
    so I am going to move on to then----

        Senator Murkowski. Thank you, Madam Chair.

        The Chair. Thank you.

        Senator Rosen.

        Senator Rosen. Thank you, Chair Murray. You know, this
    hearing really comes at a critical time. I appreciate the
    thoughtfulness of the Senator from Alaska, how she is working
    on a bipartisan way to help us move forward on this.

        Thank you. But nonetheless, the Supreme Court's decision to
    overturn Roe v. Wade, it does take away a woman's right over
    her own body and it is going to hand it to anti-choice
    politicians. In states like Nevada, access to reproductive
    care, it remains--to health care remains protected. But the
    threat of a nationwide ban is real. And it will have, it will
    have dire consequences.

        It is why I am going to continue to call on President Biden
    to take all executive actions he can to protect reproductive
    rights, to protect women's lives, and it is why we need to
    ensure a total ban on abortion never becomes Federal law. And
    so all of us here have been discussing extreme abortion bans
    and anti-choice politicians rolling out these rigid bans across
    the country, forcing women to carry pregnancies against their
    will.

        We have seen some laws so extreme they don't even have
    exceptions for rape or incest. I know we are at the end of a--
    toward the end of a long hearing, and I have a few questions.

        Dr. Brandi, maybe we will just have a discussion about how
    the lack of, total lack of exceptions, these very rigid state
    laws, how it is harmful to women, how it creates a unique
    burden on someone like you, an OBGYN, the patient and the
    doctor, waiting until somebody is moments, perhaps from death
    in order to take care of them.

        Can you just speak a little bit about that? I have a few
    other questions on this. I thought we maybe have a discussion.

        Dr. Brandi. Thank you, Senator. I would love to have a
    discussion on this. I think it is--it was mentioned before that
    there are exceptions for the life of a mother. And so, of
    course that is okay.

        That is great for our patients, make sure that they are
    safe. But the problem with the very few restrictions, or the
    very--sorry, the very few allowances for being able to provide
    abortion care is that it doesn't take into account the
    individual circumstances of that person.

        What we are seeing across the country now in places where
    abortion is banned, except for life of the mother clauses, is
    that people don't know what that means on the ground. Doctors
    don't know what that mean.

        Ideally, as a physician, if I have a patient that has an
    illness, a condition, I want to be able to treat her right then
    and there. I don't want to wait a couple of hours or a couple
    of days for conditions to get worse. And many doctors across
    the country are asking, how bad does it have to be?

        Senator Rosen. Where is this thin line? And where is the
    thin line between life and death for both, for both the mother
    and the fetus? You talk about this. What about in cases of
    severe anomaly where someone is forced to carry a pregnancy?
    Can you talk about that and what--how you are going to deal
    with that? Fetuses with a severe fetal anomaly, pregnancy isn't
    viable, and it is really a threat to the physical and mental
    health of the woman.

        Dr. Brandi. Sure. I think you bring up a good point around
    viability, which is a very common conversation about having
    gestational age bans, for example. That every pregnancy is
    different. Some pregnancies may be viable at certain
    gestational ages. Some pregnancies where the fetus has some
    type of anomaly may never be viable.

        I have patients that have that situation where they have a
    fetus with anomalies, it is always a nuanced conversation about
    what are their goals for this pregnancy and what are their
    goals for their potential child? Do they want to continue a
    pregnancy and deliver and go through a labor process and watch
    that fetus when it is delivered, watch their baby die shortly
    after?

        Or do they want to have an abortion and end the pregnancy
    earlier? I think that decision should be that individual
    person's decision. I don't think I am able to make that
    decision for them. I am hopeful that people outside of their
    families, people like politicians, won't be able to make that
    decision for them either.

        Senator Rosen. Again, it is about individual liberties and
    right to privacy. But sadly, in some states, women can face
    jail time, steep financial penalties, possibly the physicians,
    the nurses, friends or neighbors or family members who may help
    you. So, what impact do you think these threats of jail time on
    everyone are going to impose on people?

        Dr. Brandi. Thank you for that question. I think--I assume
    that most doctors didn't go to medical school to wait to take
    care of patients, to delay care. All of us want to provide the
    standard of care. We want to provide evidence based medicine
    and help our patients with whatever care that they need.

        Now physicians are being put in an impossible situation
    where they have to decide whether or not they want to follow
    their oath, to do no harm, to protect our patients, or protect
    ourselves and protect our families and protect our licenses.
    That is an impossible decision.

        Doctors care so deeply for our patients. I know I care so
    deeply for my patients. And it is incredibly hard to think
    about being in that position where I can't intervene because I
    have to call my lawyer force to make sure that it is okay, or
    that I am going to wait and wait and wait until someone gets
    sicker and sicker because I don't know what that law means.

        We are seeing that across the country. I am hearing stories
    from all over, from physicians that are withholding lifesaving
    care because they don't want to go to jail. And that is really
    not how health care should work.

        Senator Rosen. An incredible burden on, you are right, for
    the physicians and health care providers who care so deeply,
    and of course, for a woman and her family's right to privacy in
    these choices. Thank you, Madam Chair.

        The Chair. Thank you.

        Senator Murphy.

        Senator Murphy. Thank you very much, Madam Chair. Thank you
    all for your testimony today. And thank you for this hearing.
    In states across this country that have imposed trigger laws
    and some of the most intense restrictions on abortion, there
    also tend to be the fewest services available for women and
    families.

        Run through the list of states that are in the midst of
    criminalizing abortion and you will run into states that have
    refused to expand Medicaid under the Affordable Care Act,
    leaving women and families without access to the basic health
    care that is necessary to raise a child today.

        Survey the states that have had on the books these trigger
    laws and you will find states that have not passed any
    meaningful family leave or medical leave legislation, leaving
    parents with no option but to have a baby and to immediately go
    back to work, to be able to afford that health care that isn't
    being paid for because of the lack of Medicaid expansion.

        Dr. Taylor, could you just talk for a second about the
    consequence of a policy of forced pregnancy in states that
    provide no meaningful access to health care and parental leave.
    The kind of policies that you would think states that are so
    interested in more pregnancies would have invested in. What is
    the consequence of that?

        Ms. Taylor. Sure. Absolutely. I think the consequences that
    we leave moms and their families out to dry. You know, as you
    have mentioned, it is so essential for a family to have access
    to affordable childcare, affordable health care access to
    nutritious foods. I mean, we can run down the list.

        And unfortunately, in these states that are also banning
    abortion, they don't have those supports available to these
    families. I think another point to lift up here, too, is that
    these are all situations that are going to disproportionately
    impact women of color and who are already experiencing
    challenges, whether it is in terms of their financial outlook,
    housing, insecurity, poverty.

        I think the conversation around providing services or
    providing diapers or maybe even formula, if you can get your
    hands on it in this moment temporarily, is not going to do
    anything to support those families over the long term.

        Senator Murphy. Dr. Brandi, I wanted to talk to you about
    another issue, an issue that the Senate may take up later this
    week. Listen, this is all about putting Government in a
    position of control over women and their bodies.

        But apparently it is not enough to tell women when they can
    bear a child. It is not enough to dictate to women when and how
    they can access health care. Now, we are going to also dictate
    to women where they can travel to get health care.

        Because all throughout the country there are state
    Legislatures getting ready to take up pieces of legislation
    that would eliminate the ability of individuals, in this case
    women, to be able to travel where they want for health care in
    this country, just another mechanism of controlling the
    decisions that women make, Government being in charge.

        One piece of legislation in Missouri contemplates legal
    liability for anyone involved in interstate health care travel,
    including the person who works at the call center to help set
    up your appointment would now be legally liable, would
    potentially be dragged into court after higher up lawyers in
    order to protect themselves. So I am interested in your
    perspective as a provider, right.

        This world that we are entering into in which all of a
    sudden not only are you not going to be able to travel across
    state lines to obtain health care, but that everybody in the
    business of health care is now going to have to shut their
    doors to people who simply want to travel ten miles from one
    state to another in order to get health care. What does that
    world look like?

        Ms. Taylor. Thank you for the question, Senator. I think it
    is a really scary world, what that potentially will look like.
    We are already seeing now that people are trying to travel to
    get care. I don't want to be checking people's licenses to
    confirm their address and know where they come from before I
    can intervene.

        Doctors, health care providers just want to do our jobs. We
    just want to take care of people, whoever shows up at our door.
    But at the same time, we want to make sure that our clinics and
    our staff are protected from these arbitrary laws that are
    trying to chill our ability to provide health care to people.

        I am also just heartbroken that people have to leave their
    communities to get the care that they need, not just for those
    people that are traveling thousands of miles, if they can even
    travel at all, but also for my friends, my colleagues that are
    out of jobs right now, that are--that have the skills, they
    have the medicines to be able to take care of people in their
    communities and are not allowed to. All of that is
    heartbreaking. And that is all not how health care should work.

        Senator Murphy. Thank you, Madam Chair.

        The Chair. Thank you.

        Senator Baldwin.

        Senator Baldwin. Thank you, Madam Chair. I would like to
    use some of my time this morning to highlight the words of Dr.
    Christine Lyerly, who is a board certified OB-GYN and abortion
    care provider in Green Bay, Wisconsin.

        She says, imagine sitting in an exam room with your doctor
    explaining a very personal problem that is affecting every
    aspect of your life. And your doctor looks you in the eye and
    says, I know how to help you, but I can't because the
    politicians in our state won't let me.

        Physicians in Wisconsin have been forced to stop practicing
    medicine because of our state's restrictive abortion ban. It
    was signed into law in 1849. You didn't hear me wrong, 1849.
    That was 70 years before women even had the right to vote.

        Instead of providing care to patients, they have to turn
    patients away or consult with their lawyers, delaying critical
    care and wasting precious time. Dr. Brandi, what is the impact
    of delaying care in these critical situations?

        Dr. Brandi. Thank you for the question. Delaying people's
    ability to access that care or delaying interventions in life
    saving situations can be the line between life and death for
    some people.

        As stated earlier, it is very unclear what these laws mean
    for providers on a day to day basis. For example, and I
    apologize for getting too technical, but let's use the example
    of someone breaks their water at 18 weeks, 19 weeks. It is very
    unlikely that pregnancy will continue to term or will have a
    good fetal outcome.

        But it is unclear based on this law with protections for
    the life of the mother, when are we allowed to intervene? Is it
    at that moment when typically I would have a conversation
    about--with that patient about what they want to do? Is it when
    that broken water creates an infection?

        Is it when that patient becomes septic, when they are in
    the ICU in shock? It is not written down anywhere what we do
    because we want to follow the standard of care, and that would
    be to intervene at that moment. But these laws don't really
    specify, and it is very confusing for the people on the ground.

        They are trying to figure out, well, when can I intervene?
    And while waiting, this patient is getting sicker and sicker
    when they don't have to. That is not evidence based care, and
    that is a scenario that many doctors are in right now.

        Senator Baldwin. Thank you. Dr. Taylor, can you describe
    how barring physicians from providing abortion care impacts
    access to other sexual and reproductive health care services?
    So, for example, how does this affect families and affect those
    who are pregnant or looking to become pregnant?

        Ms. Taylor. Sure. Absolutely. You know, what comes to mind
    with this question is you do have some providers that are in
    situations where they are providing maternity care as well as
    abortion care. And so if they have to shutter, that means that
    the women in that community will not have access to the
    prenatal care that they need. You know, we have seen this at
    the Century Foundation in particular.

        You know, we work with community based organizations that
    are actually run and led by you know, women of color serving
    the community on the front lines. And some of those
    organizations are providing services on both for abortion and
    maternity care.

        Facility that has to shutter its doors, that is going to
    impact the comprehensive set of services that are available to
    folks in those communities.

        Senator Baldwin. Thank you. Dr. Brandi, this is for you
    again. Wisconsin's law provides that when an abortion is
    necessary to save a patient's life, this decision must be
    signed off on by two additional physicians. I will add that in
    Wisconsin, not even a cancer diagnosis or treatment for cancer
    falls under the exception for saving the life of the mother.

        That means in Wisconsin, three physicians have to come
    together, possibly in an emergency situation, to decide if a
    woman's life is worth saving because it is now required by the
    Legislature in the State of Wisconsin.

        On Monday, the Biden Administration released updated
    guidance on the Emergency Medical Treatment and Act of Labor
    Act, or EMTALA, reminding doctors that they must terminate a
    pregnancy if doing so is necessary to stabilize a patient in an
    emergency medical situation.

        I want to thank the Administration for this guidance, but I
    know that it is not a complete solution for the political
    interference that doctors are experiencing, and we need
    legislation for that. Dr. Brandi, can you explain why
    burdensome requirements to administer emergency care are so
    harmful?

        Dr. Brandi. Thank you for the question. And just to briefly
    explain, EMTALA protects patients from being turned away from
    hospitals and emergency care settings, historically to protect
    people that were unable to pay.

        The requirement requires emergency physicians to be able to
    assess a patient and potentially stabilize that patient if it
    is an emergency situation or transfer, if that patient is
    unable to be get the proper care in that setting.

        The problem with EMTALA and its use right now within the
    abortion bans that exist is one, religious hospitals that may
    not provide abortion care can refuse and do not fall under the
    restrictions of EMTALA.

        Many people seek care in these facilities. And even if they
    have a life threatening situation like breaking water early,
    hemorrhage, they don't necessarily have to fall under those
    rules.

        The other thing with EMTALA is that, again, we are in the
    scenario that doctors are going to have to figure out among
    themselves, and it may be different depending on what hospital
    you are in, what is the stabilizing condition, how sick does
    someone have to be to consider that--if they fall under EMTALA
    or not?

        There are going to be different scenarios, just like you
    are explaining, that many doctors would have to come to
    together and decide and figure that out. But it is unclear if
    we will be protected. Like how will we know if we are making
    the wrong choice?

        The Chair. Senator Kaine.

        Senator Kaine. Thank you, Chair, and thank you to each of
    the witnesses. Sharing your own personal experiences and
    stories is very important. I want to share a story. I won't do
    as good a job as you because this is a Virginian story, but it
    is not mine. But I want to share it. It was a news article.
    Madam Chair, I would like to ask to be introduced in the record
    from NBC News last week.

        The Chair. Without objection.

        [The following information can be found on page 68 in
    Additional Material.:]

        Senator Kaine. Jamie Abrams, and I will read an excerpt
    from this. What moving from Kentucky to Virginia after I was
    diagnosed with cancer reveals about Roe.

        After teaching Roe v. Wade as a family law professor, I
    experienced the stunningly painful irony of reading the leaked
    Supreme Court opinion in Dobbs on the day I was diagnosed with
    invasive breast cancer.

        Overnight at age 44, I became a person who would need an
    abortion if pregnant because cancer treatments would compromise
    a healthy birth and delay needed cancer care. I also became
    someone like other hormone positive breast cancer patients who
    was advised to discontinue hormonal contraception because it
    could stimulate the growth of cancer cells.

        In the aftermath of Roe's being overturned, supporters of
    the move want to pretend that abortion access can be surgically
    extracted from women's health care decisionmaking as a whole.

        Nothing can be further from the truth. Since the Dobbs'
    leak, which has made it clear what the conservative leaning
    court was poised to do, I have switched gears rapidly between
    being a reproductive rights scholar and a breast cancer
    patient. I also switched employment from Kentucky to Virginia
    at a time when a woman's Constitutional right to bodily
    autonomy has been stripped away.

        This move across state lines and into a different area of
    women's health care has revealed a searing reality. We now live
    in a world of vastly divergent health care systems for women.
    When I was diagnosed with cancer, the last thing on my mind
    were pregnancy, birth control, and abortion.

        Yet nearly all of my medical appointments, tests, and
    surgery itself were predicated on controlling reproduction and
    being able to terminate a pregnancy if needed. Cancer care also
    requires that I share my reproductive medical history about
    prior pregnancies, the number of live births I have had, the
    medications I have taken, what surgical procedures I have had,
    and who my other providers are.

        I answered honestly, not worried now whether my answers are
    under surveillance by regulators or law enforcement. As a
    breast cancer patient in Northern Virginia, I have thankfully
    found unbounded compassion, empathy, dignity, privacy, and
    vital rising human connection.

        But according to Kentucky's trigger law banning abortion, I
    would lose all decisionmaking autonomy and be subject to a
    doctor's discretion about whether an abortion was necessary to
    prevent the substantial risk of death. Is stage one breast
    cancer enough?

        Stage two? What relevance are my two children for whom I
    desperately seek the best prognosis and longevity for myself?
    Does the law require me to endure the state for compelled
    progression of cancer?

        The answers to these questions would be entirely unclear.
    In reality, doctors would treat me under an amorphous cloud of
    state imposed liability because the Kentucky law makes it a
    Class D felony to provide abortions outside these exceptions.

        I would like to ask you, Dr. Brandi, this--I was very, very
    struck by this. And it strikes me that this is probably not an
    unusual concern or case.

        Dr. Brandi. Thank you, Senator, for the question. And you
    are absolutely right, that I think many people before all of
    this happened didn't really understand the full impact of how
    this is going to radically change health care and put our
    health care system potentially into chaos.

        I know as a doctor, I live in the gray, meaning that
    patients don't read the textbook. They don't come in with a
    very clear cut answer as far as what to do. All of our care is
    tailored to that individual person, and conditions like cancer
    have a unique treatment based on that individual person.

        That involves a conversation about pregnancy options and
    whether or not to delay pregnancy, or whether or not a patient
    should terminate a pregnancy if they are diagnosed with cancer
    or wait several months to get treatment.

        Senator Kaine. The notion that we would say to someone with
    a cancer diagnosis, hey just move to another state. I mean,
    just move to another state. This author could do that. A lot of
    people can't. People of low income can't. People of color would
    have a harder time doing that.

        The notion of the court in Dobbs that we will just rely on
    your state Legislatures, state Legislatures, that where women
    are dramatically underrepresented, where people of color
    dramatically underrepresented. In Congress right now, 26
    percent of Congress is women. That ranks us 76th in the world.

        We are below the global average of women in Congress. So
    the notion to tell somebody who is politically less powerful,
    oh, just rely on your Legislature. Well, that is not going to
    give you comfort. That is why the 14th Amendment was passed to
    protect people who the majority would not protect.

        Equal protection, even if the majority won't give it to you
    in a Legislature, you are entitled to it. Protection of your
    liberty. Even if the Legislature won't give it to you, as an
    American, you are entitled to it.

        I can't imagine a scenario where we are just going to be
    casually telling cancer patients and those with other
    conditions, they just have to lump it and move to another
    state.

        The Chair. Senator Casey.

        Senator Casey. Chair Murray, thanks very much. Thank you
    and the Ranking Member for the hearing. I know we are out of
    time because the--are getting close to the time the vote has
    expired so I will be very brief.

        Dr. Taylor, I wanted to start with you and in particular
    wanted to cite directly from your testimony. In the third
    paragraph of your written testimony you say, and I am quoting,
    ``black women are dying of pregnancy related causes at three
    times the rate of their white counterparts.

        We are also most likely to experience severe maternal
    morbidity.'' That is what you said in those two sentences. How
    are these Americans impacted by the Dobbs decision?

        Ms. Taylor. Thank you for the question, Senator Casey. You
    know, black women are, as you mentioned from those stats, more
    likely to experience maternal health challenges in this
    country.

        I think the Dobbs decision is only going to exacerbate
    that. You know, for black women who may choose to terminate a
    pregnancy, they may be living in states where abortion is
    banned, and they are not able to do that.

        If you think about that in the context of the fact that
    they are also more likely to die from pregnancy related causes
    this decision is going to be incredibly dangerous for them, and
    not only for them, but also for their families.

        Another thing that I mentioned earlier today in the hearing
    is the fact that 60 percent of people who have abortions are
    already parents. Many of these women are already parents. And
    so this also has implications for their families.

        We also know that when a woman in the postpartum period,
    when she is able to access the health care that she needs,
    prenatal care that she needs she is also more likely to have
    healthy children and healthy infants.

        This is really something that is going to impact the black
    family overall, any other family who may be in a situation
    where they would have chosen to terminate a pregnancy, but they
    are forced to continue on with that pregnancy.

        Senator Casey. Thank you, doctor. I will maybe submit a
    question for the record for Dr. Brandi regarding miscarriage
    management and how this decision will affect your ability to
    treat the people that you treat. In particular, the
    relationship with your patients, including for pregnancy
    related care. If you want to respond briefly, but you can
    certainly amplify it for the record in writing if you want.

        Dr. Brandi. Sure. Happy to respond now or in writing. I
    will briefly say that, again, the management for miscarriage is
    the exact same management for induced abortion, same medicines,
    same procedure.

        If there are restrictions about what type of procedure to
    offer or what type of medication is allowed, it just--it
    doesn't impact just induced abortion. It impacts all kinds of
    pregnancy care. I want to be able to offer the standard of
    care, the evidence based treatment that my patients deserve.

        I don't think that legislation should be able to interfere
    with that, because that is what our patients need.

        Senator Casey. Thank you, doctor.

        The Chair. Senator Marshall, do you have any closing
    comments or questions?

        Senator Marshall. Yes, I would like to ask a couple more
    questions, if I could. Thank you so much, Madam Chair. Ms.
    Swindell, for years Planned Parenthood has claimed that they
    are not focused on abortion but provide a slate of services for
    women.

        Why then has Planned Parenthood closed a clinic in your
    home State of Idaho and has plans to do so in other states that
    have passed laws or planned to pass laws to prohibit abortions?

        Ms. Swindell. Great question, Senator. Yes, I think there
    has been at least 60 Planned Parenthood and abortion clinics
    nationwide that have closed since the overturning of Roe v.
    Wade, which is interesting when you hear the argument that they
    are all about helping women and providing all these other
    services and abortion is just less than 3 percent of what they
    do.

        Well, then why are they closing all their clinics down?
    Wouldn't you want to stay open to help women, whatever they are
    going through with an unexpected pregnancy and to help navigate
    the current climate or perhaps provide all those other services
    that you claim to provide? So the reality is they are in the
    abortion business. That is what they want women to choose.

        I think that is being exposed right now. My home State of
    Idaho, yes, the Planned Parenthood in Boise, right next door to
    one of our Stanton Healthcare clinics closed down. I do want to
    say that in Idaho, we have eight pregnancy resource centers and
    life affirming clinics throughout the State of Idaho.

        Now there are two Planned Parenthoods and I think maybe one
    other abortion clinic. So if anybody would like some helpful
    advice on how to have enough accessibility for women facing
    unexpected pregnancies, you can look to the pregnancy care
    center movement and centers like Stanton.

        Again, nationwide, we outnumber abortion clinics 4 to 1. So
    if you want accessibility look to us, look to what we are
    providing. And also, it makes the charges against our centers
    and wanting to shut us down--I think Senator Elizabeth Warren
    said, let's go after clinics like Stanton Healthcare with
    $100,000 fines to shut down what we are doing.

        How can you want more care for women in one breath,
    abortion care, and explain all these scenarios where women are
    underserved and marginalized, and then go after the exact
    clinics that are providing those services very well in our
    Nation.

        Senator Marshall. That is great. Ms. Swindell my job is to
    be a voice for Kansans. And one of your jobs today is to be a
    voice for your patients.

        Ms. Swindell. Yes.

        Senator Marshall. What would you like to share, that if
    your patients were here today, what would you share with us
    that you would think it would be important for Senators to
    know?

        Ms. Swindell. Well, I would like to share with you, if I
    may, one of our client stories. She gave it to me, and I said I
    would do my best to share it. You have it in your written
    testimony that I submitted. I just highlighted a few parts to
    save time. But if I may, this comes from a Stanton client, J.C.

        I was in a very bad place in my life when I decided to get
    an abortion. My mom told me she wouldn't have anything to do
    with my baby. My boyfriend was a drug addict and causing abuse
    in my life and left me. I was diagnosed with having severe
    panic attacks. I drove to Planned Parenthood and saw Stanton
    Healthcare across the parking lot.

        I went to Stanton Healthcare and found that they are a real
    clinic that helped me with everything I needed. They loved me
    and showed me I wasn't alone, gave me things I needed for my
    baby, counseling to get out of my life threatening, abusive
    relationship, and encouraged me that I could have a life with
    this baby.

        Seeing my daughter's heartbeat made me stop feeling the
    panic attacks that made me want to abort and stop feeling the
    horrible nausea and see my baby as a real person that I
    couldn't kill. I instantly--it instantly made me feel attached
    to my baby and love her. I felt led to start my own business.

        For the first time in my life, I can provide for my
    children on my own and have more than enough. They impacted my
    whole future and my children's future. I am so glad she is in
    this world now and in my life forever because I was able to
    choose to keep her with Stanton's help.

        I thank God Stanton helped me get out of fear and choose
    life. My mother is in her life and happy I had her. It impacted
    her as well. My daughter has a sister, and I found a man that
    loves us all. All my fears were lies. I aborted my little girl,
    I know it would have caused me to carry shame and depression.
    Thank you, Stanton, for me and my baby. She has a future life
    because of you.

        This story to me is important. No. 1, it shows the hope
    that a woman found, quality care and services. But it also
    shows that abortion isn't the solution. She got out of an
    abusive relationship. She got out of an economic situation
    where she was lower income. She was able to start her own
    company.

        The depression and the anxiety went away. This became a
    catalyst for hope in her life because she had the care and the
    support that she needed. 50 years of unfettered access to
    abortion has not solved broken systems and throwing abortion at
    women does not fix their problems.

        What she found at Stanton Healthcare is what changed things
    in her life. Thank you.

        Senator Marshall. Thank you. Madam Chair, may I have a
    closing remarks then?

        The Chair. Very shortly. We have a vote and I have a
    closing statement.

        Senator Marshall. All right. Well, thank you, Madam Chair,
    hosting this Committee. Thank you so much, Ms. Swindell, for
    giving us a message of hope, a message that this world greatly
    needs today.

        Like everybody in this room, we are glad that our moms
    chose life. I want to publicly, No. 1, is condemn all violence,
    vandalism, threats, and attacks. There has been at least 40
    attacks of violence and vandalism against pregnancy centers and
    churches, like in Kansas, in Overland Park, at the Church of
    Ascension.

        That is certainly not the answer. Next, I want to point out
    my concern that last week the White House is hosting Kansas
    Legislatures in an attempt to interfere with the Kansas Value
    Them Both amendment.

        The Biden White House has created enough hardships for
    Kansans like the price of gasoline and groceries. We don't want
    them forcing their radical values on the people of Kansas. I
    will close with this. I have spent my entire career,
    professional career, fighting to protect the life of moms and
    babies in the delivery room, in the emergency room, and in the
    halls of Congress.

        Protecting their lives and well-being will be continue to
    be a priority for me, to ensure that women have access to
    family planning services, contraception, and birth control, to
    make sure that every woman has care during, before, and after
    the pregnancy. But we will need collaboration.

        I am committed to continue to work across the aisle to
    provide these services and to improve our maternal mortality
    rates. Indeed, abortion is not the solution. Thank you, and I
    yield back.

        The Chair. Thank you. You know, as we conclude this
    hearing, I would like to once again thank all of our witnesses
    for being here. But I want to make clear, we have seen attempts
    from Republicans to distract people from the truth.

        To say that they don't want to control women's bodies even
    as abortions are being canceled and women are forced to stay
    pregnant and give birth against their will. To continue saying
    it won't be that bad, even as people are now losing access to
    lifesaving medications. And of course, Republicans are still
    trying to push this ridiculous, patently false notion that they
    aren't oppressing women, so much as leaving it to states and
    local officials and politicians to oppress them.

        That is dishonest. They know full well many women are not
    able to travel. They don't have time off. They don't have
    childcare. And they don't have the funds. They know that these
    cruel bans are already creating overwhelming demand from states
    like mine that have the protected right to abortion.

        Washington State health care clinics are already preparing
    to treat patients who are fleeing from states like Idaho to get
    the health care that they need. And what is more, Republicans
    are already talking about stopping those patients from
    traveling to get an abortion and stopping people from helping
    others to travel to get an abortion.

        We all heard former Vice President Pence call for a Federal
    ban, a call that other Republicans are continuing to echo. That
    is not empowering local decisions when you are overwhelming and
    overruling states like mine.

        If you want to be honest about this, about making it local,
    it should be local. Leave it to the patient and their health
    care provider. The willful ignorance of how deadly these
    policies are, even when these courageous witnesses today are
    doing everything they can to tell their story and make us
    listen, is not unexpected, but it is very disappointing.

        You can't spin away ripping away someone's rights, taking
    control over their body, denying someone medication, or taking
    away their plans for their future. You can't spin putting
    someone's life in jeopardy.

        That is why we have seen a lot of clumsy attempts to change
    the subject. And let me be perfectly clear, we are not changing
    the subject. Not as long as I have anything to say about it.
    Women should have the right to make their own health care
    decision with their family, their doctor, and their faith.

        That is what I will continue to fight for. I would like to
    ask unanimous consent to add two statements to the record about
    the impact of Dobbs on women's health. So ordered.

        [The following information can be found on pages 53 and 65
    in Additional Material.:]

        For any Senators who wish to ask additional questions,
    questions for the record will be due in 10 business days, July
    27th, 5 p.m. With that, the Committee is adjourned.

                              ADDITIONAL MATERIAL

                                    American Academy of
                              Family Physicians (AAFP),
                                                         July 13, 2022.
    Hon. Patty Murray, Chair,
    Hon. Richard Burr. Ranking Member,
    U.S. Senate Committee on Health, Education, Labor, and Pensions,
    Washington, DC. 20510
        Dear Chair Murray and Ranking Member Burr..

        On behalf of the American Academy of Family Physicians (AAFP) and
    the 127,600 family physicians and medical students we represent, I
    write in response to the hearing ``Reproductive Care in a Post-Roe
    America: Barriers, Challenges, and Threats to Women's Health'' to share
    the family physician perspective and the AAFP's Federal legislative
    recommendations.

        Primary care physicians are often a patient's first point of
    contact with the health care system, with more than half of all office
    visits made to primary care physicians. \1\ Family physicians are
    integral to the reproductive health of adolescents, teens, and adults,
    providing preventive health, chronic disease management, family
    planning, preconception counseling, pregnancy, postpartum, and
    menopausal care for patients across the gender spectrum throughout
    their reproductive years. While some patients seek care from
    pediatricians or obstetrician-gynecologists (OB/GYNs), in rural and
    underserved areas, family physicians are often the primary or sole
    providers of reproductive health care. \2\ The AAFP believes that
    pregnancy and reproductive health services are essential to general
    health care. \3\
    ---------------------------------------------------------------------------
        \1\  National Center for Health Statistics. National Ambulatory
    Medical Care Survey: 2018 National Summary Tables. https://www.cdc.gov/
    nchs/data/ahcd/namcs--summary/2018-namcs-web-tables-508.pdf
        \2\  Fryer GE, Green LA, Dovey SM, Phillips Jr RI. (2001). The
    United States Relies on Family Physicians Unlike Any Other Specialty.
    Am Fam Physician, 63(9): 1669. https://www.aafp.org/pubs/afp/issues/
    2001/0501/p1669.html
        \3\  American Academy of Family Physicians. (2022). Reproductive
    and Maternity Health Services. https://www.aafp.org/about/policies/all/
    reproductive-maternity-health-services.html

        The AAFP is concerned by the Supreme Court's ruling on Dobbs v.
    Jackson Women's Health. This consequential ruling struck down the
    longstanding protections afforded by Roe v. Wade and Planned Parenthood
    v. Casey, jeopardizing the health and reproductive autonomy of patients
    across the country. The decision limits the ability of physicians in
    many states to provide safe, evidence-based medical care and erodes the
    patient-physician relationship. In response to the Dobbs ruling, the
    AAFP joined with the American College of Obstetricians (ACOG), the
    American Medical Association (AMA), and 75 other health care
    organizations in releasing a statement unequivocally opposing
    legislative interference in the patient-physician relationship. \4\
    ---------------------------------------------------------------------------
        \4\  American College of Obstetricians and Gynecologists. (2022).
    More Than 75 Health Care Organizations Release Joint Statement in
    Opposition to Legislative Interference. https://www.acog.org/news/news-
    releases/2022/07/more-than-75-health-care-organizations-release-joint-
    statement-in-opposition-to-legislative-interference?utm--
    medium=social&utm--source=twitter&utm--campaign=acog2022-advocacy&utm--
    content=joint-statement-legislative-interference

        The AAFP's policy on reproductive and maternity health services
    states, ``The AAFP supports access to comprehensive pregnancy and
    reproductive services, including but not limited to abortion, pregnancy
    termination, contraception, and surgical and non-surgical management of
    ectopic pregnancy, and opposes nonevidence-based restrictions on
    medical care and the provision of such services.'' \5\ In the case of
    Dobbs v. Jackson Women's Health Organization, the AAFP joined the AMA
    and other leading medical societies in filing an amicus brief
    articulating our position that "laws regulating abortion should be
    evidence-based, supported by valid medical or scientific justification,
    and designed to improve - not harm - women's health," and we maintain
    that position. \6\
    ---------------------------------------------------------------------------
        \5\  American Academy of Family Physicians. (2022). Reproductive
    and Maternity Health Services. https://www.aafp.org/about/policies/all/
    reproductive-maternity-health-services.html
        \6\  American Academy of Family Physicians, et al. (2021). Amicus
    Brief: Dobbs v. Jackson Women's Health Organization. https://
    www.aafp.org/dam/AAFP/documents/advocacy/amicus--brief/AB-
    DobbsVJacksonWomensHealth-092021.pdf

        Without the Federal protections afforded by Roe, numerous states
    have already enacted laws banning or unduly restricting access to
    abortion, and more are considering similar measures. These laws
    jeopardize the health of our Nation and will surely worsen health
    disparities. In addition to undermining patients' bodily autonomy and
    potentially endangering their health and well-being by precluding or
    delaying access to induced abortions, the Dobbs decision may also
    jeopardize access to certain forms of contraception and negatively
    affect medically necessary maternity care.
     Violating the Patient-Physician Relationship and Interfering with the
                              Practice of Medicine
        Family physicians are trained to care for their patients throughout
    the life cycle and appreciate the challenges that adolescence,
    sexuality, family planning, balance of family life and career, and
    aging have on their patients, in addition to socioeconomic and
    community factors such as environmental quality, income and education
    level, housing availability, neighborhood safety, and social-
    connectedness health. Because of this, family physicians are able to
    provide evidence-based medical care personalized to meet each patient's
    unique health needs. The AAFP maintains that physicians should be free
    to have open and honest communication with patients about all aspects
    of health and safety. The AAFP staunchly opposes legislation that
    infringes on the content or breadth of information exchanged within the
    patient-physician relationship and legislation that interferes with the
    provision of evidence-based medical care, either of which can harm the
    health of the patient, the family, and the community. \7\, \8\
    ---------------------------------------------------------------------------
        \7\  American Academy of Family Physicians. (2021). Infringement on
    Patient Physician Relationship. https://www.aafp.org/about/policies/
    all/infringement-patient-physician-relationship.html
        \8\  Group of Six. (2022). Legislation to Criminalize Physicians,
    Jeopardize Patient-Physician Relationship Have No Place in Health Care.
    http://www.groupof6.org/dam/AAFP/documents/advocacy/prevention/women/
    ST-G6-OpposingCriminalizationOfCare-040822.pdf

        While only a minority of physicians--roughly 3 percent of family
    physicians and 24 percent of OB/GYNs--perform abortions, nearly every
    clinician who cares for patients of reproductive age and practices in a
    state where abortion is banned is affected by the Dobbs decision. \9\9,
    \10\ Since June 24, the AAFP and its state affiliates have received
    inquiries from members who are unclear about the definitions and
    requirements of their new or pending state laws. Below are some common
    topics of confusion and concern.
    ---------------------------------------------------------------------------
        \9\  Patel P, Narayana S, Summit A, et al. Abortion Provision Among
    Recently Graduated Family Physicians. Fam Med. 2020;52(10):724-729.
    https://doi.org/10.22454/FamMed.2020.300682.
        \10\  ANSIRH. (2019). More U.S. obstetrician-gynecologists are
    providing abortion now than in 2019. https://www.ansirh.org/research/
    research/more-us-obstetrician-gynecologists-are-providing-abortion-now-
    2009

              Treatment of ectopic pregnancies, pregnancies of
            unknown location, and complicated spontaneous abortions (i.e.,
            miscarriages). Many state laws create ambiguity about whether
            treatment for ectopic pregnancy is considered abortion,
            creating physician or hospital fears of violating laws and
            setting the stage for disagreements in clinical judgment, which
    ---------------------------------------------------------------------------
            can lead to delays in critical and medically necessary care.

              Molar pregnancy. This type of genetically abnormal
            pregnancy cannot end in fetal viability, but in some rare
            instances the abnormal fetus can have detectable cardiac
            activity, leading to confusion over whether ``heartbeat laws''
            allow physicians to treat with a dilation and curettage (D&C).

              Preterm premature rupture of membranes. When
            membranes rupture prematurely prior to viability, the standard
            of care is to deliver the fetus with surgery or induce labor,
            which may be considered illegal in some states, even though the
            fetus cannot possibly survive. Failure to do so could lead to
            dire consequences for the patient such as intrauterine
            infections which could become life-threatening.

              Cancer treatment for patient with pre-viable
            pregnancies. Some cancer treatments require pregnancy
            termination before beginning, and others carry an increased
            risk of morbidity and mortality without immediate termination
            and surgical removal. Disagreements in clinical judgment or
            fears of violating laws can lead to delays in cancer care or
            incomplete counseling on treatment options. Abortion-ban laws
            and proposed bills in some states allow abortions only in
            severe, life-threatening emergencies. It is unclear if, under
            such laws, termination of a pregnancy is legal in these cases,
            delaying the pregnant patient's access to lifesaving treatment
            until after a pregnancy is carried to term.

              Use of emergency contraception and IUDs. Confusion
            over whether statutory definitions of ``personhood'' outlaw the
            use of emergency contraception, and if contraception methods
            which interrupt the implantation of a fertilized egg will be
            considered an abortion under certain state laws, is fueling
            misinformation and fear and limiting access to contraception.
            Issues so far include pharmacists refusing to dispense
            prescriptions for ulipristal or stock/sell over-the-counter
            oral emergency contraception, hospitals discontinuing provision
            of emergency contraception to rape victims, and physicians
            being unsure about or unwilling to place copper IUDs as
            emergency contraception.

              Dispensing of medications to manage miscarriages or
            treat other conditions unrelated to pregnancy. Pharmacists
            refusing to dispense or delaying filling misoprostol
            prescriptions can lead to additional burden for the prescribing
            physician and delays in needed care for patients. In addition
            to inducing abortion, this drug is commonly used in the
            treatment of ulcers, miscarriages, and post-delivery bleeding.
            There have also been reports of pharmacists refusing to fill or
            physicians stopping prescribing methotrexate, which is commonly
            used to treat rheumatoid arthritis and psoriasis. \11\
    ---------------------------------------------------------------------------
        \11\  Arthritis Foundation Statement on Methotrexate Access.
    (n.d.). Arthritis Foundation. Retrieved July 11, 2022, from https://
    www.arthritis.org/about-us/news-and-updates/statement-on-methotrexate-
    access

              Treatment of infertility. Patients and physicians
            alike are confused over whether statutory definitions of
            ``personhood'' will impact infertility treatments and assisted
            reproductive technology such as in vitro fertilization (IVF).
            Regardless of whether state laws intend to interfere with
            infertility care, the lack of clarity is already hindering
            patients' reproductive decisions. In this instance, abortion
            bans may have the unintended consequence of preventing patients
            who want to become pregnant from being able to grow their
    ---------------------------------------------------------------------------
            families.

        In 2018, the AAFP, the American Academy of Pediatrics (AAP), ACOG,
    and the American College of Physicians (ACP) adopted joint principles
    for protecting the patient-physician relationship in response to the
    growing number of policy proposals that inappropriately interfered in
    the practice of medicine. \12\ Our organizations and the more than
    400,000 physicians and medical students we represent call on
    policymakers to put patients first by taking these actions.
    ---------------------------------------------------------------------------
        \12\  Group of Six. (2018). Joint Principles for Protecting the
    Patient-Physician Relationship. http://www.groupof6.org/dam/AAFP/
    documents/advocacy/legal/ST-Group6-LegislativeInterference-052318.pdf

        1. Support participation of any qualified provider in federally and
    state-funded programs. Medicaid's ``any willing provider'' and
    ``freedom of choice'' protections are enshrined into law to ensure that
    an adequate number of clinicians participate in the Medicaid program to
    care for beneficiaries. Evidence has demonstrated that restricting
    participation of qualified providers results in loss of access to
    critical care for our most vulnerable patients. \13\, \14\
    ---------------------------------------------------------------------------
        \13\  Stevenson AJ, Flores-Vazquez IM, Allgeyer RL, Schenkkan P,
    Potter JE. Effect of Removal of Planned Parenthood from the Texas
    Women's Health Program. N Engl J Med. 2016 Mar 3;374(9):853-60. doi:
    10.1056/NEJMsa1511902
        \14\  National Women's Law Center (2012). Turning to Fairness:
    Insurance Discrimination Against Women Today and the Affordable Care
    Act. http://www.nwlc.org/sites/default/files/pdfs/nwlc--2012--
    turningtofairness--report.pdf.
    ---------------------------------------------------------------------------
        2. Maintain coverage of evidence-based essential health benefits
    such as maternity coverage and women's preventive services without
    cost-sharing, including contraception. Preserving access to this
    existing coverage is critical to ensuring that American women and
    families have access to the care they need.

        3. Ensure that evidence-based Federal programs, including Title X
    and the Teen Pregnancy Prevention Program (TPPP), receive continued
    Federal funding and preserve evidence-based program requirements. Title
    X is the only Federal program exclusively dedicated to providing low-
    income and adolescent patients with essential family planning and
    preventive health services and information. Evidence-based sexuality
    education programs help young patients achieve their educational and
    professional goals by educating them about sexual health, including
    preventing unintended pregnancy and family planning. These and other
    Federal programs must continue to provide non-directive, comprehensive,
    medically accurate information.

        4. Reject government restrictions on the information our patients
    can receive from their doctors. Patients expect medically accurate,
    comprehensive information from their physicians. This dialog is
    critical to ensuring the integrity of the patient-physician
    relationship. When outside entities restrict the information that can
    be given to patients of reproductive age or force physicians to provide
    them with medically inaccurate information, it can result in increased
    rates of unplanned pregnancy, pregnancy complications, and undiagnosed
    medical conditions.
                            Patient Safety Concerns
        Family physicians are concerned about how overturning Roe will
    impact their practices. First and foremost, however, they are concerned
    about the health and safety of their patients and their patients'
    families. The AAFP believes that high-quality health care in family
    medicine is the achievement of optimal physical, mental, and behavioral
    health outcomes through accessible, safe, cost-effective, equitable
    care that is based on the best evidence; responsive to the needs and
    preferences of patients and populations; and respectful of patients'
    families, personal values, and beliefs, adapting their care to meet the
    unique needs of their patients and communities. \15\ Laws that unduly
    restrict, criminalize, or penalize the provision of safe, confidential,
    evidence-based medical care are a threat to patient safety. Such laws
    not only interfere with the prevention, diagnosis, and treatment of
    health conditions but also prevent family physicians and their staff
    from adapting their care to meet the unique needs of their patients and
    communities.
    ---------------------------------------------------------------------------
        \15\  American Academy of Family Physicians. (2020). Quality Health
    Care in Family Medicine. https://www.aafp.org/about/policies/all/
    family-medicine-quality-health-care.html

        Anecdotes and research on the impacts of institutional abortion
    restrictions offer evidence for how such restrictions put patients'
    health and lives at risk. \16\, \17\ Physicians in these settings
    recount cases in which abortion was medically indicated according to
    their clinical judgment but, because of an ethics committee's ruling,
    care was delayed until fetal cardiac activity was no longer detectable
    or in some cases the patient had to be transported to another facility.
    What is clear is that the patient-physician relationship, patient
    safety, and patient comfort are compromised by arbitrary restrictions
    that force clinicians to act contrary to the medical standard of care.
    ---------------------------------------------------------------------------
        \16\  Redden M. (2016). Abortion ban linked to dangerous
    miscarriages at Catholic hospital, report claims. The Guardian. https:/
    /www.theguardian.com/us-news/2016/feb/18/michigan-catholic-hospital-
    women-miscarriage-abortion-mercy-health-partners
        \17\  Lori R. Freedman, Uta Landy, Jody Steinauer, When There's a
    Heartbeat: Miscarriage Management in Catholic-Owned Hospitals, American
    Journal of Public Health 98, no. 10 (October 1, 2008): pp. 1774-1778.
    ---------------------------------------------------------------------------
        As confusion over new state abortion laws and anxiety about legal
    liability grow, cases such as these, in which patients experience delay
    or denial as they seek critical and in some cases lifesaving care, will
    multiply. The result will be worse health outcomes and greater health
    disparities nationwide.

        The AAFP advocates for the development and use of patient-centered,
    evidence-based clinical practice guidelines that adhere to principles
    based on the National Academy of Medicine Standards for Trustworthy
    Guidelines. \18\ The AAFP opposes enshrining non-evidence based medical
    guidelines into Federal or state law.
    ---------------------------------------------------------------------------
        \18\  American Academy of Family Physicians. (2018). Clinical
    Practice Guidelines Policy. https://www.aafp.org/about/policies/all/
    clinical-practice-guidelines-policy.html
    ---------------------------------------------------------------------------
                Criminalization and Penalization of Medical Care
        The AAFP takes all reasonable and necessary steps to ensure that
    evidence-based medical decisionmaking and treatment, exercised in
    accordance with evidence-based standards of care, does not become a
    violation of criminal law. \19\
    ---------------------------------------------------------------------------
        \19\  American Academy of Family Physicians. (2022).
    Criminalization of the Medical Practice. https://www.aafp.org/about/
    policies/all/criminalization-medical-practice.html

        Recently, the AAFP, AAP, ACOG, ACP, the American Osteopathic
    Association (AOA), and the American Psychiatric Association (APA)
    issued a statement opposing the criminalization of health care: ``We
    are deeply concerned that legislation and legal opinions across the
    country will endanger patients and clinicians by allowing private
    citizens and policymakers to interfere in health care decisionmaking.
    The patient-physician relationship, not politics, is the backbone of
    medicine.'' \20\
    ---------------------------------------------------------------------------
        \20\  Group of Six. (2022). Legislation to Criminalize Physicians,
    Jeopardize Patient-Physician Relationship Have No Place in Health Care.
    http://www.groupof6.org/dam/AAFP/documents/advocacy/prevention/women/
    ST-G6-OpposingCriminalizationOfCare-040822.pdf

        In the wake of the Supreme Court's Dobbs ruling, physicians in
    states that restrict abortion face a perilous new legal reality.
    Physicians who perform abortions risk violating the law, being sued,
    losing their medical license, and going to jail. In some extreme
    instances, even counseling patients who want an abortion, including
    those facing pregnancy complications, could expose the physician to
    ---------------------------------------------------------------------------
    criminal charges.

        The AAFP has heard from family physicians in states that have
    banned or restricted abortion, and in states that have not, that they
    are worried about their own legal safety. It is clear that the
    criminalization and penalization of patients and clinicians disrupts
    and detracts from medical care

        Physicians and hospital administrators worried about the threat of
    lawsuits or criminal charges for violating a state's abortion ban may
    be inclined to practice ``defensive medicine,'' ordering unnecessary or
    excessive tests or procedures in order to thoroughly demonstrate that a
    patient meets the narrow definition for an allowable exception to an
    abortion ban. Evidence suggests that defensive medicine does not make
    patients any healthier but can lead to increased health care costs.
    \21\ Family physicians have also shared concerns that having to wait on
    extraneous tests and second opinions can delay critical care in urgent
    and life-threatening situations.
    ---------------------------------------------------------------------------
        \21\  Frakes MD, Gruber J. (2018). Defensive Medicine: Evidence
    from Military Immunity. National Bureau of Economic Research.

        Family physicians report that they have received mixed or
    incomplete legal guidance from their employers in the past several
    weeks, leading to confusion or even confrontation among clinicians who
    are unsure of their standing or disagree about the best way to treat a
    patient while complying with new legal requirements. Small and solo
    physician practices do not have the luxury of in-house or contracted
    legal support to help them navigate rapidly changing state laws. Many
    of them are turning to their state and national medical societies, such
    as the AAFP, which typically lack state-specific legal expertise or are
    ---------------------------------------------------------------------------
    prohibited from offering individual legal advice.

        Legal threats to the practice of medicine are also increasing
    physicians' administrative burden and practice expenses. As a means of
    proactive legal defense, many hospitals, clinics, and health systems
    are advising or mandating that their clinicians enhance their medical
    documentation for reproductive health care and related services. \22\
    This can mean changes to electronic medical records (EMR) systems and
    processes, which are costly, time-consuming, and add to physicians'
    administrative burden. Smaller practices rely on off-the-shelf EMR
    systems and cannot readily automate new documentation requirements,
    meaning they must spend additional time conducting manual data entry.
    ---------------------------------------------------------------------------
        \22\  Casteel K. (2022). Fetal heartbeat law leaves South Carolina
    doctors in dangerous limbo. Greenville News. https://
    www.greenvilleonline.com/story/news/local/south-carolina/2022/07/07/
    fetal-heartbeat-law-leaves-sc-doctors-dangerous-limbo-abortion-roe/
    7759896001/

        Additionally, physicians and hospital administrators are worried
    that if they opt not to provide specific care based on their
    understanding of state abortion restrictions, they could face liability
    and/or violate Federal requirements under the Emergency Medical
    Treatment and Labor Act (EMTALA). state laws that allow only narrow
    abortion exceptions when the mother is at risk of dying are at odds
    with the EMTALA standard, which focuses on conditions that seriously
    jeopardize health, bodily, or organ function. \23\
    ---------------------------------------------------------------------------
        \23\  Cornell Law School Legal Information Institute. 42 U.S. Code
    ' 1395dd - Examination and treatment for emergency medical conditions
    and women in labor. https://www.law.cornell.edu/uscode/text/42/1395dd

        The AAFP is concerned about high rates of professional burnout
    among physicians in the U.S., which negatively affects the quality of
    patient care and can result in physicians leaving practice. \24\ The
    costs and anxiety associated with abortion-related legal issues are
    negatively impacting the well-being of family physicians and will only
    compound physician burnout. \25\ If not addressed, this will ultimately
    lead to more physicians leaving the profession or moving into non-
    patient-facing roles, worsening health care workforce shortages and
    patients' access to care.
    ---------------------------------------------------------------------------
        \24\  American Academy of Family Physicians. (2017). Family
    Physician Burnout, Well-Being, and Professional Satisfaction (Position
    Paper). https://www.aafp.org/about/policies/all/family-physician-
    burnout.html
        \25\  AHRQ. (2017). Physician Burnout. https://www.ahrq.gov/sites/
    default/files/wysiwyg/professionals/clinicians-providers/ahrq-works/
    impact-burnout.pdf
    ---------------------------------------------------------------------------
      Disrupting Medical Education and Exacerbating Health Care Workforce
                                   Shortages
        The AAFP recommends that all medical students and family medicine
    residents receive comprehensive training in reproductive decision-
    making. \26\ Family medicine residency programs teach clinical skills
    to provide counseling, screening and diagnostic testing, treatment, and
    appropriate referrals provided to patients during menarche,
    contraception, pregnancy, lactation, and menopause. This includes
    performing routine gynecologic procedures, patient-centered
    contraceptive counseling, placement of long-acting reversible
    contraception (LARC), preconception counseling, diagnosis of pregnancy,
    counseling for unintended pregnancy, assessment and management of
    complications and symptoms in the first trimester, pregnancy risk-
    factor screening, miscarriage management and referral for surgical
    intervention when indicated for complicated miscarriages, D&C
    procedures, and assessment and management of obstetrical and other
    medical complications during pregnancy including consultation with
    obstetricians/medical subspecialists. \27\, \28\
    ---------------------------------------------------------------------------
        \26\  American Academy of Family Physicians. (2022). Training in
    Reproductive Decisions. https://www.aafp.org/about/policies/all/
    reproductive-decisions-training.html
        \27\  American Academy of Family Physicians. (2018). Recommended
    Curriculum Guidelines for Family Medicine Residents: Women's Health and
    Gynecologic Care. https://www.aafp.org/dam/AAFP/documents/medical--
    education--residency/program--directors/Reprint282--Women.pdf
        \28\  American Academy of Family Physicians. (2018). Recommended
    Curriculum Guidelines for Family Medicine Residents: Maternity Care.
    https://www.aafp.org/dam/AAFP/documents/medical--education--residency/
    program--directors/Reprint261--Maternity.pdf

        Because family physicians are trained to provide such a wide range
    of reproductive health services, they are well positioned to provide
    early abortion care to their patients in the primary care setting,
    which can enhance continuity of care, offer increased access for
    patients, and reduce stigma. The AAFP recommends that family medicine
    residents have access to opt-out abortion training, to support
    widespread access to comprehensive training in reproductive decision-
    making while ensuring that no physician or health care professional is
    required to perform actions that violate personal beliefs. \29\ In
    addition to providing physicians with the critical procedural and
    counseling skills to care for patients who have induced abortions,
    abortion training also helps prepare physicians to meet patients' other
    obstetric needs, such as direct counseling, uterine evacuation and
    miscarriage management. \30\, \31\
    ---------------------------------------------------------------------------
        \29\  American Academy of Family Physicians. (2022). Training in
    Reproductive Decisions. https://www.aafp.org/about/policies/all/
    reproductive-decisions-training.html
        \30\  Dalton VK, Harris LH, Bell JD, Schulkin J, Steinauer J,
    Zochowski M, Fendrick AM. Treatment of early pregnancy failure: does
    induced abortion training affect later practices? Am J Obstet Gynecol.
    2011 Jun;204(6):493.e1-6. doi: 10.1016/j.ajog.2011.01.052.
        \31\  Horvath S, Turk J, Steinauer J, Ogburn T, Zite N. Increase in
    Obstetrics and Gynecology Resident Self-Assessed Competence in Early
    Pregnancy Loss Management With Routine Abortion Care Training. Obstet
    Gynecol. 2022 Jan 1;139(1):116-119. doi: 10.1097/AOG.0000000000004628.

        The Society of Teachers of Family Medicine strongly opposes
    restrictions on educating family medicine trainees on the full scope of
    clinical care and advocates that Congress and federal agencies should
    not legislate or mandate restrictions on the educational content of
    training programs. \32\ Such restrictions limit and adversely affect
    medical education. In a statement following the Supreme Court's
    decision to overturn Roe, the Association of American Medical Colleges
    asserts, ``It is crucial that physicians have comprehensive training in
    the full spectrum of reproductive health care, since similar medical
    procedures address many health conditions.'' \33\
    ---------------------------------------------------------------------------
        \32\  Society of Teachers of Family Medicine. (2022). Society of
    Teachers of Family Medicine Statement on the Physician-Patient
    Relationship and Reproductive Health Care. https://www.stfm.org/about/
    governance/statements/
        \33\  American Association of Medical Colleges. (2022). AAMC
    Statement on Supreme Court Decision in Dobbs v. Jackson Women's Health
    Organization. https://www.aamc.org/news-insights/press-releases/aamc-
    statement-supreme-court-decision-dobbs-v-jackson-women-s-health-
    organization

        As states enact or contemplate laws banning or restricting
    abortion, medical schools, residency training programs, and educators
    are grappling with how to reconcile these laws with medical
    accreditation requirements. The Accreditation Council for Graduate
    Medical Education (ACGME) requires access to abortion training for all
    OB/GYN programs. While access to training is not required for Family
    Medicine programs, some offer integrated abortion training or local
    elective options, and ACGME does clearly require comprehensive
    reproductive health and contraception education as part of Family
    Medicine training. \34\, \35\, \36\ A recent paper analyzing current
    OB/GYN residency programs found that around 45 percent are in states
    that have banned or are likely to ban abortion, and at least three
    family medicine residency programs offering integrated abortion
    training are in states that have banned the procedure in the wake of
    the Supreme Court's Dobbs decision. \37\, \38\
    ---------------------------------------------------------------------------
        \34\  Accreditation Council for Graduate Medical Education. (2017).
    Clarification on Requirements Regarding Family Planning and
    Contraception: Review Committee for Obstetrics and Gynecology. https://
    www.acgme.org/globalassets/pfassets/programresources/220--obgyn--
    abortion--training--clarification.pdf
        \35\  ACGME Program Requirements for Graduate Medical Education in
    Family Medicine. (2022). ACGME. https://www.acgme.org/globalassets/
    pfassets/programrequirements/120--familymedicine--2022.pdf
        \36\  Family Medicine Residencies with Abortion Training--RHEDI.
    (n.d.). Retrieved July 10, 2022, from https://rhedi.org/resources/
    residency-training/
        \37\  Vinekar, K., Karlapudi, A., Nathan, L., Turk, J. K., Rible,
    R., & Steinauer, J. (2022). Projected Implications of Overturning Roe v
    Wade on Abortion Training in U.S. Obstetrics and Gynecology Residency
    Programs. Obstetrics & Gynecology. doi: 10.1097/AOG.0000000000004832
    https://journals.lww.com/greenjournal/Fulltext/9900/Projected--
    Implications--of--Overturning--Roe--v--Wade.449.aspx
        \38\  Family Medicine Residencies with Abortion Training--RHEDI.
    (n.d.). Retrieved July 10, 2022, from https://rhedi.org/resources/
    residency-training/

        In response, residency programs facing new state restrictions are
    considering providing their residents with access to clinical training
    in other jurisdictions without legal restrictions on abortion. However,
    requiring or facilitating travel rotations to receive abortion training
    is unlikely to be feasible on a widespread scale, given the resources
    required and the disruptions to clinical care that resident absences
    cause. Additionally, family planning clinics that often precept medical
    residents on rotation from other areas are already beginning to cut
    back on training because they are grappling with huge influxes of
    patients and lack the staff capacity to provide both patient care and
    medical education. \39\, \40\
    ---------------------------------------------------------------------------
        \39\  Knox, L. (2022, July 7). Medical schools adapt to the Dobbs
    abortion decision. Inside Higher Ed. https://www.insidehighered.com/
    news/2022/07/07/medical-schools-adapt-dobbs-abortion-decision
        \40\  Anderson, N. (2022, June 30). The fall of Roe scrambles
    abortion training for universities. The Washington Post. https://
    www.washingtonpost.com/education/2022/06/30/abortion-training-upheaval-
    dobbs/

        In addition to disrupting training for current medical students and
    residents, state abortion restrictions are likely to have a significant
    impact on future trainees. Students intending to provide family
    planning as part of their medical practice who are applying to medical
    school and residency programs will have to decide whether they are
    willing to risk being trained in a state that does not provide abortion
    care. \41\41 Experts predict that medical schools and residency
    programs in those states will see fewer applicants, whereas programs
    located in states that still allow abortion care will be inundated.
    \42\ In the short term, this will worsen the problem of unmatched
    medical students. Over time this will exacerbate maternity care
    shortages and intensify the maldistribution of physicians.
    ---------------------------------------------------------------------------
        \41\  Chapman, G. (2022, July 8). It's incredibly far-reaching':
    medical students on the Roe reversal. The Guardian. https://
    www.theguardian.com/us-news/2022/jul/08/roe-v-wade-reversal-medical-
    students
        \42\  Knox, L. (2022, July 7). Medical schools adapt to the Dobbs
    abortion decision. Inside Higher Ed. https://www.insidehighered.com/
    news/2022/07/07/medical-schools-adapt-dobbs-abortion-decision

        Experts also predict that physicians in states with abortion bans
    will begin to leave because they do not wish to practice in a place
    where they are not able to provide comprehensive, patient-centered care
    without government intrusion. Given the current geo-political divide in
    the U.S., this will worsen access to care for rural communities and
    increase rural health disparities.
                       Jeopardizing Contraception Access
        Health promotion--including screening, counseling, and
    vaccination--is a foundation of family medicine, and for much of their
    reproductive lives most women try to prevent pregnancy, which is why
    the AAFP believes physicians should counsel their patients to decrease
    the number of unwanted pregnancies, and why the AAFP advocates for
    public and private health plans to provide coverage and not impose
    cost-sharing for all Food and Drug Administration-(FDA) approved
    contraceptive methods, sterilization procedures, and patient education
    and counseling for all patients with reproductive capacity, including
    contraceptive methods for sale over the counter. \43\
    ---------------------------------------------------------------------------
        \43\  Coverage, Patient Education, and Counseling for Family
    Planning, Contraceptive Methods, and Sterilization Procedures. (2020).
    AAFP. https://www.aafp.org/about/policies/all/coverage--family--
    planning.html--Coverage,--20Patient--20Education,--20and--
    20Counseling--20for--20Family--20Planning,--20Contraceptive--
    20Methods,--20and--20Sterilization--20Procedures

        Confusion over whether statutory definitions of ``personhood''
    outlaw the use of emergency contraception, and if contraception methods
    that interrupt the implantation of a fertilized egg will be considered
    an abortion under certain state laws, is fueling misinformation and
    fear and limiting access to contraception. In one example, the AAFP
    heard from a family physician who, after their state enacted its
    trigger law banning abortion without exception for rape or incest, saw
    hospitals in their city temporarily stop offering emergency
    contraception to rape victims, despite the fact that clinical
    guidelines for treating sexual assault victims call for it to be
    ---------------------------------------------------------------------------
    provided.

        The AAFP applauds recent actions by the Administration, including
    the July 8 Executive Order reaffirming the Affordable Care Act's
    guarantee of insurance coverage for women's preventive services,
    including birth control and contraceptive counseling, and directing the
    Centers for Medicare and Medicaid Services (CMS) to ensure patient
    access to family planning care and protect clinicians providing family
    planning services. \44\
    ---------------------------------------------------------------------------
        \44\  FACT SHEET: President Biden to Sign Executive Order
    Protecting Access to Reproductive Health Care Services. (2022, July 8).
    The White House Briefing Room. https://www.whitehouse.gov/briefing-
    room/statements-releases/2022/07/08/fact-sheet-president-biden-to-sign-
    executive-order-protecting-access-to-reproductive-health-care-services/

        We urge Congress to pass legislation to protect and expand
    patients' access to FDA-approved contraception methods and
    comprehensive, evidence-based contraception counseling. The AAFP has
    endorsed the Affordability Is Access Act (S. 4347/H.R. 7394) and the
    Access to Birth Control Act (S. 3223/H.R. 6005). The AAFP also urges
    Congress to ensure robust and sustained Federal funding for Title X
    family planning programs.
         Potential for Abuse of Patient Data and Violation of Patient
                                Confidentiality
        A confidential relationship between patient and physician is
    essential for the free exchange of information necessary for sound
    medical care. Only in a setting of trust can a patient share the
    private feelings and medical, social, and family histories that enable
    the physician to properly counsel, prevent, diagnose, and treat. The
    AAFP believes that patient confidentiality must be protected. \45\
    ---------------------------------------------------------------------------
        \45\  Confidentiality, Patient/Physician. (2022, July). AAFP.
    https://www.aafp.org/about/policies/all/confidentiality-patient--
    physician.html--Confidentiality,--20Patient/--20Physician

        The AAFP's policy on data stewardship, which addresses how de-
    identified clinical and administrative data derived from physicians'
    EMRs are collected and used by third parties, states that submission of
    data from physician practice to third parties must be voluntary, third
    parties must provide written policies detailing the intended uses of
    such data, and data storage must adhere to industry and regulatory
    standards for confidentiality. \46\
    ---------------------------------------------------------------------------
        \46\  Data Stewardship. (2019). AAFP. https://www.aafp.org/about/
    policies/all/data-stewardship.html

        The Supreme Court's Dobbs decision has raised questions about
    whether and how technology companies should protect their users' data,
    particularly when the user is seeking reproductive health care. Experts
    believe that the United States' lack of strong digital privacy
    protections is likely to have profound implications on how state laws
    that ban or restrict abortion are enforced. \47\ While clinicians and
    health care organizations must follow the Health Insurance Portability
    and Accountability Act (HIPAA)'s Privacy Rule, which protects against
    disclosures of protected health information (PHI), other entities and
    data that do not qualify as PHI are not bound by the same rules. Police
    and prosecutors could potentially obtain extremely detailed information
    about individuals from technology companies, including internet search
    histories, communications, finances, and location information and use
    that information to surveil or charge them for violating state abortion
    law. In the case of laws such as Texas' S.B. 8, which allow private
    citizens to sue suspected abortion patients and providers, such data
    could also be used to enable vigilante interference.
    ---------------------------------------------------------------------------
        \47\  Crockford, K., & Freed Wessler, N. (2022). Impending Threat
    of Abortion Criminalization Brings New Urgency to the Fight for Digital
    Privacy. ACLU. https://www.aclu.org/news/privacy-technology/impending-
    threat-of-abortion-criminalization-brings-new-urgency-to-the-fight-for-
    digital-privacy

        The AAFP applauds HHS for issuing guidance clarifying how Federal
    laws and regulations protect patients' PHI and the circumstances under
    which the HIPAA Privacy Rule permits disclosure of PHI without the
    patient's authorization. However, because HIPAA does not generally
    protect the privacy and security of individuals' personal information
    stored on cell phones or gathered by search engines and third-party
    applications, the AAFP calls on Congress to further examine the
    implications of overturning Roe on patient privacy and to enact laws to
    protect patients from inappropriate exploitation of their data,
    including criminal or civil punishments for seeking medically
    ---------------------------------------------------------------------------
    appropriate health care.

        The AAFP has endorsed the Health and Location Data Protection Act
    (S. 4408), which prohibits data brokers from selling and transferring
    customers' health and location data and requires the Federal Trade
    Commission to promulgate rules to implement and enforce these
    protections.
      Exacerbating Health Disparities Experienced by Marginalized Patients
        The Supreme Court's decision to overturn Roe will make it even more
    difficult for patients to access high-quality health care in the U.S.
    The risks will be felt most acutely by people of color, from low-income
    backgrounds, and who live in rural areas. \48\, \49\
    ---------------------------------------------------------------------------
        \48\  Gilbert, K., Sanchez, G., & Busette, C. (2022, June 30).
    Dobbs, another frontline for health equity. Brookings. https://
    www.brookings.edu/blog/how-we-rise/2022/06/30/dobbs-another-frontline-
    for-health-equity/
        \49\  Zephyrin, L., & Blumenthal, D. (2022, June 24). Loss of
    Abortion Rights Will Send Shockwaves Through U.S. Health System.
    Commonwealth Fund. https://www.commonwealthfund.org/blog/2022/loss-
    abortion-rights-will-send-shockwaves-through-us-health-care-system

        According to analysis by the Guttmacher Institute, nearly one in
    four women in the U.S. has an abortion by age 45. \50\ While the
    abortion rate has been declining over the past four decades, it remains
    a common procedure; however, abortion rates vary considerably by
    patient income and race and ethnicity. \51\
    ---------------------------------------------------------------------------
        \50\  Wind, Rebecca. (Oct. 19, 2017). Abortion is Common Experience
    for U.S. Women, Despite Dramatic Declines in Rates. Guttmacher
    Institute. https://www.guttmacher.org/news-release/2017/abortion-
    common-experience-us-women-despite-dramatic-declines-rates
        \51\  U.S. Abortion Patients. (2016). https://www.guttmacher.org/
    sites/default/files/infographic--attachment/aps--demographics.pdf

        Nearly half of all patients who have an abortion have incomes below
    the Federal poverty level, and Black and Hispanic patients have
    abortions at considerably higher rates than non-Hispanic white
    patients. \52\ There are many reasons for these disparities, but
    studies show that Black and Hispanic patients are less likely to have
    access to health care--including access to high-quality contraceptive
    services--and are more likely to face racism and report negative
    experiences when they do seek health care. \53\ People of color are
    also more likely to live in high-poverty neighborhoods and less likely
    to move out of poverty in adulthood than their white counterparts, due
    in large part to systemic racism and generational barriers. \54\ Black
    women are three times as likely as white women to experience and
    unintended pregnancy, and Hispanic women are twice as likely. \55\
    Research has also found that low-income Black children are less likely
    to receive formal sex education, \56\ and Black women also experience
    the highest rates of intimate partner and sexual violence, which can
    contribute to reproductive coercion. \57\
    ---------------------------------------------------------------------------
        \52\  Wind, Rebecca. (Oct. 19, 2017). Abortion is Common Experience
    for U.S. Women, Despite Dramatic Declines in Rates. Guttmacher
    Institute. https://www.guttmacher.org/news-release/2017/abortion-
    common-experience-us-women-despite-dramatic-declines-rates
        \53\  Cohen, S. A. (2008, August 6). Abortion and Women of Color:
    The Bigger Picture . Guttmacher Institute. https://www.guttmacher.org/
    gpr/2008/08/abortion-and-women-color-bigger-picture
        \54\  Butler, S. M., & Grabinsky, J. (2020, November 16). Tackling
    the legacy of persistent urban inequality and concentrated poverty.
    Brookings. https://www.brookings.edu/blog/up-front/2020/11/16/tackling-
    the-legacy-of-persistent-urban-inequality-and-concentrated-poverty/
        \55\  Cohen, S. A. (2008, August 6). Abortion and Women of Color:
    The Bigger Picture . Guttmacher Institute. https://www.guttmacher.org/
    gpr/2008/08/abortion-and-women-color-bigger-picture
        \56\  Brinkman, B. G., Garth, J., Horowitz, K. R., Marino, S., &
    Lockwood, K. N. (n.d.). Black Girls and Sexuality Education: Access.
    Equity. Justice. Retrieved July 10, 2022, from https://
    www.gwensgirls.org/wp-content/uploads/2019/10/BGEA-Report2--v4.pdf
        \57\  Jain, M. (2017). The National Intimate Partner and Sexual
    Violence Survey: 2010-2012 State Report. CDC, 2010--2012. https://
    www.cdc.gov/violenceprevention/pdf/NISVS-StateReportBook.pdf

        Restricting abortion without addressing geographic, economic, and
    cultural barriers to comprehensive health care and family planning will
    worsen racial health disparities and perpetuate cycles of disadvantage
    for women of color. \58\, \59\
    ---------------------------------------------------------------------------
        \58\  Dehlendorf C, Rodriguez MI, Levy K, Borrero S, Steinauer J.
    Disparities in family planning. Am J Obstet Gynecol. 2010
    Mar;202(3):214-20. doi: 10.1016/j.ajog.2009.08.022. PMID: 20207237;
    PMCID: PMC2835625
        \59\  Tarzia, L., & Hegarty, K. (2020). Causal mechanisms of
    postnatal depression among women in Gondar town, Ethiopia: application
    of a stress-process model with generalized structural equation
    modeling. 18, 87. https://doi.org/10.1186/s12978-021-01143-6

        The United States' maternal mortality rate is alarmingly high and
    reveals faults that exist within the current health care system.
    Approximately 700 women die from pregnancy-related complications
    annually in the United States. \60\ There are numerous factors
    influencing pregnancy-related mortality and morbidities, such as
    advanced maternal age, education attainment, and underlying health
    status. \61\ Large disparities in maternal health outcomes exist
    between women who belong to racial and ethnic minority groups and white
    women. The U.S. Centers for Disease Control and Prevention's (CDC) 2019
    Morbidity and Mortality Weekly Report stated that non-Hispanic Black
    (Black) and non-Hispanic American Indian/Alaska Native (AI/AN) women
    experienced higher pregnancy-related morbidity ratios (40.8 and 29.7,
    respectively) than all other racial/ethnic populations. (White PRMR was
    12.7, Asian/ Pacific Islander PRMR was 13.5, and Hispanic PRMR was
    11.5.) \62\ Disparities for pregnancy outcomes also exist when
    comparing women living in rural areas with those living in urban areas.
    \63\
    ---------------------------------------------------------------------------
        \60\  U.S. Centers for Disease Control and Prevention, May 2019
    Vital Signs, Pregnancy Related Deaths Fact Sheet, accessed online:
    https://www.cdc.gov/vitalsigns/maternal-deaths/index.html
        \61\  Vilda, Dovile et al. Income inequality and racial disparities
    in pregnancy-related mortality in the U.S. SSM--population health vol.
    9 100477. 28 Aug. 2019, doi:10.1016/j.ssmph.2019.100477
        \62\  Petersen EE, Davis NL, Goodman D, et al. Racial/Ethnic
    Disparities in Pregnancy-Related Deaths--United States, 2007--2016.
    MMWR Morb Mortal Wkly Rep 2019;68:762--765. DOI: http://dx.doi.org/
    10.15585/mmwr.mm6835a3
        \63\  American College of Obstetrics and Gynecology, 2014, https://
    www.acog.org/clinical/clinical-guidance/committee-opinion/articles/
    2014/02/health-disparities-in-rural-women

        Black and low-income patients and patients from rural communities
    are more likely to live in states that have banned or are likely to ban
    abortion since the Supreme Court overturned Roe. A recent study
    estimating the mortality impact of a total abortion ban, due to
    increased deaths from unterminated pregnancies, would increase
    pregnancy-related deaths, most acutely for Black women. \64\
    ---------------------------------------------------------------------------
        \64\  Amanda Jean Stevenson; The Pregnancy-Related Mortality Impact
    of a Total Abortion Ban in the United States: A Research Note on
    Increased Deaths Due to Remaining Pregnant. Demography 1 December 2021;
    58 (6): 2019--2028. doi: https://doi.org/10.1215/00703370-9585908

        According to the AAP, laws that restrict access to reproductive
    health care also have a disproportionate impact on adolescents and
    teenagers, who typically do not have the resources or freedom to travel
    to another state to receive safe, legal health care. \65\ Family
    physicians are optimally trained, qualified, and experienced in
    evaluating and addressing the complex medical and behavioral health
    care needs of adolescents. The AAFP3values the sexual health of
    adolescents and advocates for access to comprehensive medical and
    behavioral health care, evidence-based sex education, and increasing
    awareness of risks and signs of sexual abuse and trafficking, and
    supports a trauma-informed approach to health care. 1A\66\, \67\, \68\
    That is why the AAFP joins the AAP in affirming strong support for
    adolescents and teens to receive comprehensive evidence-based
    reproductive health care services, including abortion.
    ---------------------------------------------------------------------------
        \65\  American Academy of Pediatrics. (2022). AAP Supports
    Adolescents' Right to Comprehensive, Confidential Reproductive Health
    Care. https://www.aap.org/en/news-room/news-releases/aap/2022/aap-
    supports-adolescents-right-to-comprehensive-confidential-reproductive-
    health-care/
        \66\  American Academy of Family Physicians. (2020). Adolescent
    Health Care, Sexuality and Contraception. https://www.aafp.org/about/
    policies/all/adolescent-sexuality.html
        \67\  American Academy of Family Physicians. (2017). Children's
    Health. https://www.aafp.org/about/policies/all/childrens-health.html
        \68\  American Academy of Family Physicians. (2021). Trauma-
    Informed Care. https://www.aafp.org/about/policies/all/trauma-informed-
    care.html--::text=Family--20physicians--20should--20approach--
    20TIC,incorporate--20TIC--20into--20clinical--20practice.

        The AAFP recognizes sexual assault as a serious public health issue
    and supports the rights of survivors of sexual assault, sexual
    violence, and all sexual crimes. \69\, \70\ The AAFP calls for
    prioritization of the survivor's well-being, emphasizing the need for
    compassionate treatment, and supports a legal framework that codifies
    the rights of, and protections for, survivors of sexual assault. \71\
    Rape is a cause of many unwanted pregnancies, with an estimated one in
    20 women between the ages of 12 and 45 becoming pregnant due to rape.
    \72\ Rape is traumatic and often has long-lasting physical and
    psychological health consequences. Laws that ban abortions without
    exception for rape and incest contradict the AAFP's policy on trauma-
    informed care and place rape victims at higher risk for future medical,
    psychological, and socioeconomic challenges. \73\
    ---------------------------------------------------------------------------
        \69\  American Academy of Family Physicians. (2020). Rights,
    Protections, and Support for Survivors of Sexual Assault. https://
    www.aafp.org/about/policies/all/rights-survivors-sexual-assault.html--
    Rights,--20Protections,--20and--20Support--20for--20Survivors--20of--
    20Sexual--20Assault
        \70\  American Academy of Family Physicians. (2020). Sexual Assault
    as a Public Health Issue. https://www.aafp.org/about/policies/all/
    sexualconsent-publichealth.html--Sexual--20Consent--20as--20a--
    20Public--20Health--20Issue
        \71\  American Academy of Family Physicians. (2020). Rights,
    Protections, and Support for Survivors of Sexual Assault. https://
    www.aafp.org/about/policies/all/rights-survivors-sexual-assault.html--
    Rights,--20Protections,--20and--20Support--20for--20Survivors--20of--
    20Sexual--20Assault
        \72\  Holmes MM, Resnick HS, Kilpatrick DG, Best CL. Rape-related
    pregnancy: estimates and descriptive characteristics from a national
    sample of women. Am J Obstet Gynecol. 1996 Aug;175(2):320-4; discussion
    324-5. doi: 10.1016/s0002-9378(96)70141-2. PMID: 8765248.
        \73\  American Academy of Family Physicians. (2021). Trauma-
    Informed Care. https://www.aafp.org/about/policies/all/trauma-informed-
    care.html--::text=Family--20physicians--20should--20approach--
    20TIC,incorporate--20TIC--20into--20clinical--20practice.

        Family physicians report that, in states with abortion bans that
    allow exceptions in cases of rape or incest, eligible patients still
    face barriers to timely access to care. In order to qualify for an
    exception, patients and/or their clinician usually must provide a
    police report documenting the offense. Surveys indicate that fewer than
    a quarter of rape survivors report assault, and experts estimate the
    percentage is much lower for children, adolescents, and youth in foster
    care and juvenile systems. \74\ Family physicians who care for victims
    of rape cite family and domestic violence and economic insecurity as
    possible response for non-reporting. Requiring victims of rape and
    incest and their treating clinicians to jump through legal and
    administrative hurdles to document eligibility for a legal exception
    delays access to time-sensitive abortion care.
    ---------------------------------------------------------------------------
        \74\  Kimble C. (2018). Sexual Assault Remains Dramatically
    Underreported. Brennan Center for Justice. https://
    www.brennancenter.org/our-work/analysis-opinion/sexual-assault-remains-
    dramatically-underreported

        The AAFP acknowledges that LGBTQ+ individuals, youth in foster care
    or the juvenile justice system, and incarcerated individuals face
    exceptional hardships when attempting to access health care and are at
    greater risk for adverse medical and mental health outcomes and
    recognizes that state laws banning and restricting access to abortion
    will undoubtably exacerbate the health disparities experienced by these
    vulnerable populations. We urge policymakers to study the implications
    of federal and state policy changes on these unique populations in
    order to develop appropriate solutions to mitigate the serious
    challenges they encounter.
         Underscoring the Need for Universal Access to Health Care and
                    Addressing Social Determinants of Health
        The AAFP recognizes health as a basic human right for every person,
    regardless of social, economic or political status, race, religion,
    gender, or sexual orientation. The right to health includes universal
    access to timely, high-quality, and affordable health care services.
    \75\ We continue to call on Congress to pass legislation to expand
    access to comprehensive, affordable health care, including by expanding
    Medicaid and CHIP coverage to 12 months postpartum, ensuring 12 months
    of continuous eligibility for children enrolled in Medicaid and CHIP,
    closing the Medicaid expansion coverage gap, and making the American
    Rescue Plan's enhanced marketplace subsidies permanent. Family
    physicians understand that the health of their individual patients and
    communities is affected by social determinants of health, which is why
    the AAFP urges lawmakers to adopt a "health in all policies" approach
    that considers the broad health implications of policies not
    traditionally discussed as health care-related (such as housing and
    urban development, transportation, education, etc.). Expanding health
    coverage and addressing social determinants of health will undoubtably
    reduce unintended pregnancies, improve maternal and child health
    outcomes, and ultimately improve the health and productivity of our
    nation.
    ---------------------------------------------------------------------------
        \75\  American Academy of Family Physicians (2020). Health Care is
    a Right. https://www.aafp.org/about/policies/all/health-care-right.html

        The AAFP has called on HHS and other Federal agencies to use every
    available lever to protect patient safety, support family physicians
    and other clinicians, and strengthen timely access to reproductive
    health care, including medication abortion and contraception, in
    accordance with Federal law. \76\
    ---------------------------------------------------------------------------
        \76\  American Academy of Family Physicians. (2022). AAFP Letter to
    HHS on Reproductive Health and the Patient-Physician Relationship.
    https://www.aafp.org/dam/AAFP/documents/advocacy/prevention/women/LT-
    HHS-DobbsImpact-070522.pdf

        We now urge Congress to take swift legislative action and utilize
    its Federal oversight authority to restore, protect, and improve
    patients' access to timely, comprehensive reproductive health care and
    ---------------------------------------------------------------------------
    clinicians' ability to provide evidence-based medical care.

        The AAFP has endorsed the House-passed Women's Health Protection
    Act (S. 4132), and we continue to urge the Senate to pass this critical
    legislation to codify federal protections for reproductive health care.
    \77\ The AAFP also supports the Ensuring Access to Abortion Act (H.R.
    8297) which protects patients' rights to travel across state lines to
    seek abortion services. Absent federal law guaranteeing all patients
    have the right to abortion, it is imperative that patients be able to
    travel to seek safe, quality medical care without threat of penalty of
    persecution.
    ---------------------------------------------------------------------------
        \77\  Joint Letter to Senate in Support of the Women's Health
    Protection Act. (2022). In Letter. https://www.aafp.org/dam/AAFP/
    documents/advocacy/prevention/women/LT-Senate-WHPA-051022.pdf

        The AAFP stands ready to partner with the Committee to protect the
    patient-physician relationship and reproductive health care. Should you
    have any questions, please contact Erica Cischke, Director of
    ---------------------------------------------------------------------------
    Legislative and Regulatory Affairs at ecischke@aafp.org.

                Sincerely,
                                   Ada D. Stewart, M.D., FAAFP,
                                                           Board Chair,
                                 American Academy of Family Physicians.
                                     ______

                 prepared statement of naral pro-choice america
        Thank you for the opportunity to submit a statement to the
    Committee on this critical issue. NARAL Pro-Choice America is a
    national advocacy organization dedicated to protecting and advancing
    reproductive freedom. For over 50 years, NARAL has fought to protect
    and advance reproductive freedom at the Federal and state levels--
    including access to abortion care, birth control, pregnancy and post-
    partum care, and paid family leave. Through education, organizing, and
    influencing public policy, NARAL and our 4 million members from every
    corner of the country work to guarantee every individual the freedom to
    make personal decisions about their lives, bodies, and futures, free
    from political interference. For this reason, we are submitting this
    statement to highlight the far-reaching public health impact of the
    U.S. Supreme Court decision to end the constitutional right to abortion
    and to call on Congress to use its authority to remedy the abortion
    rights and access crisis and reinstate and safeguard access to abortion
    care nationwide.

        Abortion rights and access are facing a crisis in the United
    States. Despite overwhelming public support for the legal right to
    abortion, we're in the midst of an all-out assault on reproductive
    freedom. The U.S. Supreme Court's decision in Dobbs v. Jackson Women's
    Health Organization overturned Roe v. Wade, ending the constitutional
    right to abortion as we know it and signaling an ominous sign for the
    future of abortion rights in this country. The Court's ruling has
    empowered extremist state lawmakers to enforce total bans on abortion--
    several of which are now in place--and over half of the states in our
    Country are at risk of doing so.

        The negative impact this cruel Supreme Court decision is inflicting
    cannot be overstated. This horrifying rollback of our fundamental
    rights is causing immediate and devastating harm to millions of people
    across the country who can no longer access the care they need in their
    own communities. Bans on abortion most harm those already marginalized
    at every turn by our systems and institutions, and losing Roe only
    compounds this. Women; Black, Indigenous, and other people of color;
    those working to make ends meet; the LGBTQ+ community; immigrants;
    young people; those living in rural communities; and people with
    disabilities are disproportionately impacted by these attacks on
    reproductive freedom.

        This decision is set against a backdrop of increasingly cruel and
    draconian restrictions and bans as extremist anti-choice politicians
    have escalated their quest to end legal abortion. It is part of a
    decades-long campaign waged by the anti-choice movement and the
    politicians that did its bidding to end Roe and decimate reproductive
    freedom. Even before Roe was overturned by the Court, though it has
    long not been a reality for millions of people across the country, the
    further evisceration of abortion access had ramped up. State lawmakers
    seeking to advance their agenda of power and control have passed
    hundreds of state-level attacks on abortion access over the last decade
    that have made care extremely difficult, if not impossible, to access
    for many people across the country. According to the Guttmacher
    Institute, over 500 restrictions on abortion access have been
    introduced at the state level this year, \1\ and now that Roe has
    fallen, we can expect to see even more. These systematic attacks on
    reproductive freedom and abortion access intentionally push access out
    of reach, and some go as far as criminalizing pregnant people and
    doctors who provide abortion care. Now, more than ever, the anti-choice
    movement is advancing its extremist agenda in plain sight.
    ---------------------------------------------------------------------------
        \1\  Elizabeth Nash, Lauren Cross, and Joerg Dreweke, 2022 State
    Legislative Sessions: Abortion Bans and Restrictions on Medication
    Abortion Dominate, GUTTMACHER INSTITUTE, (Mar. 2022), https://
    www.guttmacher.org/article/2022/03/2022-state-legislative-sessions-
    abortion-bans-and--restrictions-medication-abortion

        The interrogation and punishment of people who are pregnant is not
    far-fetched--it is already happening. People across the country are
    already being charged or prosecuted for pregnancy outcomes including
    pregnancy loss, self-managing abortion care, or even the suspicion of
    it. \2\ Criminalizing people for having an abortion, experiencing a
    miscarriage or stillbirth, or any other pregnancy outcome only
    exacerbates racial inequities and is just one of the many ways that
    Black, Indigenous, and other people of color have been criminalized.
    ---------------------------------------------------------------------------
        \2\  Texas Prosecutor Drops Murder Charge Against Woman Arrested
    for Self-Induced Abortion, CBS NEWS, (Apr. 10, 2022), https://
    www.cbsnews.com/news/lizelle-herrera-abortion-texas-murder-charge--
    dropped/

        What we're seeing take place in the aftermath of the Jackson
    Women's Health decision is only the beginning. We know that those
    hostile to abortion never intended to stop with ending Roe--all of our
    most cherished rights and freedoms are also at risk. Anti-choice
    politicians have only been emboldened by watching the Supreme Court
    disregard the health and well-being of millions of Americans. Already,
    Republican lawmakers in Congress have floated the idea of enacting a
    nationwide abortion ban. Never in our Country's history has such a ban
    existed, and the consequences on our lives and our freedoms would be
    ---------------------------------------------------------------------------
    catastrophic.

        The threat to our fundamental rights does not stop there. The same
    anti-choice, anti-freedom extremists working harder than ever to roll
    back abortion rights and access are also targeting our other
    fundamental freedoms, including birth control access, our freedom to
    vote, LGBTQ+ rights, civil rights, and more. There's simply no low they
    won't sink to in order to advance their quest for control and political
    gain.

        We did not get here by accident. The threats that our most
    cherished rights and freedoms face is the result of a decades-long far-
    right strategy to advance a radical and out-of-touch ideological
    agenda. In the late 1970's, radical conservatives weaponized the
    formerly non-political, back-burner issue of abortion rights as
    political cover for their efforts to maintain white patriarchal control
    amidst diminishing support for racist policies like school segregation,
    which had previously been the backbone of their movement. In the years
    immediately preceding and following Roe v. Wade, Evangelical
    Christians, who now form the backbone of the GOP, were overwhelmingly
    indifferent on the issue of abortion. But through the carefully crafted
    messages of Paul Weyrich, Jerry Falwell, and other architects of the
    Radical Right, abortion became the political tool of choice for a
    movement determined to maintain control in a changing world, and the
    trojan horse for a far-reaching array of ideologies meant to thwart
    social progress. \3\
    ---------------------------------------------------------------------------
        \3\  Randall Balmer, The Real Origins of the Religious Right,
    POLITICO MAGAZINE (May 27, 2014), https://www.politico.com/magazine/
    story/2014/05/religious-right-real-origins--107133.

        In the intervening years, opposition to abortion has become a
    litmus test in far-right circles for a host of political and judicial
    positions. In order to advance their agenda--one that has always stood
    in direct opposition to the values of the majority of Americans--they
    developed and implemented a strategy for capturing and maintaining
    minority rule. This strategy included pushing regressive boilerplate
    legislation chipping away at access to abortion through state
    legislatures and Congress, as well as stacking the Federal judiciary
    ---------------------------------------------------------------------------
    with anti-choice ideologues.

        Anti-choice activists have spent decades building their influence
    over the Federal judiciary through well-funded, secretive networks like
    the Federalist Society. Conservative activists have never been shy
    about the fact that their takeover of the Federal judiciary is part of
    a broad strategy to quell the majority and cement minority rule, but
    the election of Donald Trump took this tactic to new heights.

        In May 2016, Trump pledged to only nominate anti-choice judges, a
    promise he doubled down on in 2020. \4\, \5\ And with the help of Mitch
    McConnell, Trump installed anti-choice Federal judges with lifetime
    appointments at a breakneck pace. More than a quarter of currently
    active Federal judges are now Trump appointees, including Supreme Court
    justices Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett-tipping
    the balance of the Court to a supermajority unmistakably hostile to
    reproductive freedom. \6\ Now, the work of these extremists has
    culminated in the end of Roe v. Wade and an anti-choice majority on the
    Court that poses a threat to all of our most fundamental freedoms.
    ---------------------------------------------------------------------------
        \4\  Trump Letter on Pro-Life Coalition, Sept. 2016, https://
    www.sba-list.org/wp--content/uploads/2016/09/Trump-Letter-on-ProLife-
    Coalition.pdf.
        \5\  Pro-Life Voices for Trump 2020, Sept. 3, 2020, https://
    cdn.donaldjtrump.com/public--files/press--assets/pro-life-letter-
    potus.pdf.
        \6\  John Gramlich, How Trump compares with other recent presidents
    in appointing Federal judges, PEW RESEARCH CENTER (Jan. 13, 2021),
    https://www.pewresearch.org/fact-tank/2021/01/13/how-trump--compares-
    with-other-recent-presidents-in-appointing-Federal-judges/

        All people--no matter who they are or where they live--should have
    the freedom to make their own decisions about whether to start or grow
    a family, free from political interference. While the Court's egregious
    decision in the Jackson Women's Health case is nothing short of
    devastating, the fight for reproductive freedom is far from over. The
    vast majority of Americans are with us. Polling shows that 8 in 10
    Americans support the legal right to abortion. \7\ Lawmakers who
    interfere with our reproductive freedom do not represent the values of
    the overwhelming majority of people in this country.
    ---------------------------------------------------------------------------
        \7\  Megan Brenan, Record-High 47 percent in U.S. Think Abortion Is
    Morally Acceptable, GALLUP, (Jun. 19, 2021), https://news.gallup.com/
    poll/350756/record-high-think-abortion-morally--acceptable.aspx
    ---------------------------------------------------------------------------
                                     ______

           prepared statement of senator richard burr, ranking member
        I have often said that being a father is the most important title I
    will ever have. Fatherhood--and being a grandfather--have given me a
    deep appreciation for the value of human life and the need to cherish
    and protect it. I have long believed that life begins at conception,
    and unborn children should be protected.

        With the ruling in Dobbs v. Jackson Women's Health Organization,
    the Supreme Court rightly determined that Roe v. Wade lacked legitimate
    constitutional grounds and returned decision-making to the people and
    their elected representatives. The Court's responsibility under our
    constitution is to say what the law is, and they have done so
    appropriately with this decision.

        We now have an opportunity. An opportunity to protect the sanctity
    of life and provide life-affirming support to women and their unborn
    children. We have an obligation to improve maternal and infant health,
    which this Committee has taken steps to do. And we have a challenge--to
    find better ways to support families with young children as Sen. Romney
    and I have proposed in the Family Security Act 2.0.

        I am thankful for women like Brandi Swindell, and the many
    advocates like her, who provide support to women who find themselves
    facing an unexpected pregnancy. Stanton Healthcare, the organization
    founded by Ms. Swindell, provides pregnancy care and resources to
    pregnant women. Stanton Healthcare compassionately welcomes women at
    all stages of their pregnancy, and ensures that they are treated with
    dignity.

        Despite Stanton's work in building stronger families and
    communities, pregnancy resource centers are under threat all across the
    country. These organizations have been targeted with intimidation, and
    I am deeply disturbed about past and future violence committed by
    radical, pro-abortion activists.

        I am thankful for Senator Roger Marshall's expertise and his
    willingness to share both the facts and his vision for the future with
    the Senate HELP Committee today. I am also grateful to Ms. Brandi
    Swindell for being here today to provide an example of how we can
    provide positive, life-affirming support to women who need it, both
    during and after pregnancy.

                             QUESTIONS AND ANSWERS

            Response by Kristyn Brandi to Questions of Senator Lujan

                                 SENATOR LUJAN

        Question 1. Is there a relationship between restricted
    access to abortion services and increased maternal mortality?
    What does that association look like for Tribal, Hispanic,
    Black, rural, and other minority populations, respectively?

        Answer 1. Yes, restrictions on abortion care have far
    reaching consequences both deepening existing health and
    socioeconomic inequities and worsening health outcomes for
    pregnant people and people giving birth. For example, women who
    were denied abortion care are more likely to experience high
    blood pressure and other serious medical conditions during the
    end of pregnancy; more likely to remain in relationships where
    interpersonal violence is present; and more likely to
    experience poverty. These are all factors that contribute to
    poor maternal health outcomes. Furthermore, research clearly
    shows that states with higher numbers of abortion restrictions
    are the same states with poorer maternal health outcomes. We
    also know that while most people will have healthy pregnancies,
    some will experience illness or conditions where pregnancy can
    cause serious health problems. When abortion is difficult or
    impossible to obtain, complicated health conditions can worsen
    and even result in death.

        Furthermore, Black, Indigenous, Latino/a/x, people of
    color, folks living in geographically isolated areas, LGBTQ+
    people, and people with disabilities already experience the
    most barriers to health care. And because of this pregnancy can
    be less safe for some than others. The cause of the worsening
    maternal mortality crises in this country is a persisting
    legacy of discrimination, unequal distribution of resources,
    and inequitable access to health care. These challenges can be
    mitigated by eliminating discriminatory care, moving to solve
    lack of resources, and providing health coverage.

        Question 2. One of the greatest challenges facing patients
    in New Mexico is a shortage of health care providers. Of the 33
    counties in New Mexico, only three are home to clinics that
    provide abortion services. In your experience, how has a
    shortage of abortion providers impacted the health of your
    patients? How detrimental is physical distance from abortion
    providers?

        Answer 2. Health care shouldn't work like this. People
    should be able to access the care they need in their own
    communities without fear or discrimination. The health care
    provider shortage is a real threat to equitable access to care,
    and that is compounded when it comes to the abortion provider
    shortage and the uneven distribution of abortion provider
    density dependent upon region. There are many providers that
    want to provide this care to patients, but either face threats
    to themselves or their families in doing so or lack training in
    their areas--both will likely increase as a result of Roe being
    overturned.

        Forcing people to travel to get care can mean the
    difference between being able to get the care they need or
    being forced to remain pregnant. When people are forced to
    travel for care it means they have to take time off of work,
    arrange for childcare, and arrange for transportation and other
    accommodations, raising the costs and pushing care further and
    further out of reach. Lack of abortion coverage for people
    facing the most barriers because of restrictions like the Hyde
    Amendment means the cost of obtaining the procedure is already
    prohibitively expensive for those with the fewest resources.
    When we force people to travel for care what we are doing is
    reinforcing the two-tier system of health care in this country.
    We are reinforcing the stigma around abortion that it is
    ``other'' care when in fact it is routine, safe and common
    health care. What we are doing is denying dignity, autonomy,
    and well-being to those facing the most barriers because of
    systemic inequities.

        Question 3. Do you think there is a role for the Federal
    Government in addressing the shortage of health care providers
    capable of providing abortion services?

        Answer 3. Yes, the Federal Government can pass laws that
    protect providers abilities to do their jobs and care for their
    communities. The violence and harassment abortion providers
    across this country experience on a daily basis makes it
    difficult for abortion providers to care for their communities.
    Furthermore, hostile, anti-abortion state laws that force
    clinics to close also contribute to a lack of abortion
    providers available in any given community. Congress must pass
    the Women's Health Protection Act and other bold policies that
    would help ensure people can get the care they need. They can
    also remove restrictions where only physicians can provide this
    care--other advanced practice clinicians (APCs) are fully
    capable of providing safe, compassionate care and having APCs
    providing abortion care would increase the number of providers
    available to serve communities.

        Question 4. In states where abortion care has been
    decimated, what is the impact on medical education for
    providers, especially in high risk patients?

        Answer 4. The Supreme Court's decision allowing states to
    ban abortion entirely will make it difficult for many providers
    to learn to perform abortions, and it will also affect other
    forms of medical training including miscarriage management,
    which uses the same procedures/medicines as an abortion,
    counseling patients about the full scope of pregnancy options,
    and emergency care. Right now, nearly half of OB/GYN residency
    programs are located in states that have or are likely to ban
    abortion care. Without this training, they will be providing
    sub-standard types of care that goes against decades of
    evidence--this is not how health care should work. We are doing
    a deep disservice to the future generations of providers who
    will not have the opportunities to receive training that they
    deserve. And we are harming our communities by all but
    guaranteeing there will be some providers who do not have the
    skills necessary to provide the care they need.

        Question 5. An alarming consequence of this war on
    reproductive freedom is the climate of fear that has been
    cultivated around accessing abortions--even in states like New
    Mexico where abortion services remains legal. Can you speak to
    the importance of combatting misinformation surrounding access
    to abortions, especially in communities where English is not
    spoken as a first language?

        Answer 5. Misinformation and disinformation about abortion
    access is a serious problem that jeopardizes people's health
    and well-being. Abortion care is extremely safe, and in many
    places across the country abortion is still legal. While we are
    certainly in an access crises it is imperative that people are
    given full, accurate information about their reproductive and
    sexual health care options, and that includes information being
    given in the language that is best for them. This means having
    resources for multi-lingual staff, translation services, and
    community-centered resources for counseling, scheduling,
    receiving care, and accurate information available in multiple
    languages online.

        Question 6. As national attention turns to states,
    including New Mexico, that have protected a women's right to
    make her own health care decisions, there is a growing concern
    about threats to the safety of both patients accessing
    abortions and the health care providers working around the
    clock to meet the need. What resources from the Federal
    Government are needed to ensure that providers such as yourself
    are able to continue to safely provide abortions?

        Answer 6. Following the Supreme Court's decision gutting
    the constitutional right to abortion, providers have
    experienced, and are preparing to continue dealing with, an
    uptick in violence and harassment against themselves and their
    patients. A report released Friday, June 24, 2022 by the
    National Abortion Federation found that abortion providers
    faced significant increases in violence and disruption to their
    work last year compared to the previous year including
    stalking, invasions, assault, and battery. Providers would
    benefit from additional support from the Federal Government to
    increase safety and security of their data, their places of
    work, and their personal safety. They also need Federal
    protection of abortion access to ensure they are able to do
    their jobs and care for their communities free from government
    interference.

                                    ------

        [Whereupon, at 12:12 p.m., the hearing was adjourned.]

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