[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
                                
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                    U.S. GOVERNMENT PUBLISHING OFFICE                    
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          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
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  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.
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    \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.
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    \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\
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    \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 [email protected].

            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
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                                 ______
                                 
       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.]

                                  [all]