    [Senate Hearing 118-561]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 118-561

                      THE CONTINUED ASSAULT ON REPRODUCTIVE
                           FREEDOMS IN POST-DOBBS AMERICA

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

                                    HEARING

                                   BEFORE THE

                           COMMITTEE ON THE JUDICIARY
                              UNITED STATES SENATE

                        ONE HUNDRED EIGHTEENTH CONGRESS

                                 SECOND SESSION

                                   __________

                                 MARCH 20, 2024

                                   __________

                              Serial No. J-118-59

                                   __________

             Printed for the use of the Committee on the Judiciary

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

                            www.judiciary.senate.gov
                                www.govinfo.gov

                                    __________

                       U.S. GOVERNMENT PUBLISHING OFFICE
    58-675                     WASHINGTON : 2025

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

                           COMMITTEE ON THE JUDICIARY

                       RICHARD J. DURBIN, Illinois, Chair
    SHELDON WHITEHOUSE, Rhode Island     LINDSEY O. GRAHAM, South Carolina,
    AMY KLOBUCHAR, Minnesota                 Ranking Member
    CHRISTOPHER A. COONS, Delaware       CHARLES E. GRASSLEY, Iowa
    RICHARD BLUMENTHAL, Connecticut      JOHN CORNYN, Texas
    MAZIE K. HIRONO, Hawaii              MICHAEL S. LEE, Utah
    CORY A. BOOKER, New Jersey           TED CRUZ, Texas
    ALEX PADILLA, California             JOSH HAWLEY, Missouri
    JON OSSOFF, Georgia                  TOM COTTON, Arkansas
    PETER WELCH, Vermont                 JOHN KENNEDY, Louisiana
    LAPHONZA BUTLER, California          THOM TILLIS, North Carolina
                                         MARSHA BLACKBURN, Tennessee
           Joseph Zogby, Democratic Chief Counsel and Staff Director
          Katherine Nikas, Republican Chief Counsel and Staff Director

                                C O N T E N T S

                                  ----------

                               OPENING STATEMENTS

                                                                       Page

    Durbin, Hon. Richard J...........................................     1
    Graham, Hon. Lindsey O...........................................     2

                                   WITNESSES

    Duckworth, Hon. Tammy, U.S. Senator from Illinois................     4
    Fischbach, Hon. Michelle, U.S. Representative from Minnesota.....     7

    Dennard, Austin..................................................    16
        Prepared statement...........................................    44

    Heard, Jamie.....................................................     9
        Prepared statement...........................................    47

    Rivera, Lourdes A................................................    12
        Prepared statement...........................................    49

    Snead, O. Carter.................................................    11
        Prepared statement...........................................    54
        Responses to written questions...............................    96

    Wubbenhorst, Monique C...........................................    14
        Prepared statement...........................................    56
        Responses to written questions...............................   166

                                    APPENDIX

    Items submitted for the record...................................   185

                            THE CONTINUED ASSAULT ON
                            REPRODUCTIVE FREEDOMS IN
                               POST-DOBBS AMERICA

                                  ----------

                           WEDNESDAY, MARCH 20, 2024

                                  United States Senate,
                                    Committee on the Judiciary,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 2:31 p.m., in
    Room G50, Dirksen Senate Office Building, Hon. Richard J.
    Durbin, Chair of the Committee, presiding.
        Present: Senators Durbin [presiding], Whitehouse,
    Klobuchar, Coons, Blumenthal, Hirono, Booker, Padilla, Ossoff,
    Welch, Butler, Graham, Grassley, Lee, Cruz, Hawley, Kennedy,
    Tillis, and Blackburn.
        Also present: Senator Duckworth, Congresswoman Fischbach.

             OPENING STATEMENT OF HON. RICHARD J. DURBIN,
               A U.S. SENATOR FROM THE STATE OF ILLINOIS

        Chair Durbin. This hearing will come to order. Todays
    hearing is the third of the Senate Judiciary Committee that we
    held since the Supreme Court over ruled Roe v. Wade eliminating
    a womens Constitutional right to reproductive freedom.
        It was almost 2 years ago the court issued its decision of
    Dobbs v. Jackson. With a single ruling, the right-wing majority
    overruled nearly five decades of legal precedent, and revoked a
    constitutional right for the first time in history.
        In the years leading up to Dobbs, we were warned about the
    dangers of overruling Roe v. Wade. Medical experts told us it
    would unleash a healthcare crisis across America. Legal experts
    warned us that it would establish a disastrous precedent under
    which unelected judges can recklessly eliminate fundamental
    freedoms. And women across the country warned that overruling
    Roe would insert politicians and judges into the most personal
    decision imaginable, taking away their right to choose whether
    and how to expand their family.
        At the outset, I want to share a video on the state of our
    reproductive healthcare system in the post-Dobbs era.
        [Video is shown.]
        Chair Durbin. The fallout of the Dobbs decision has been
    devastating. Women with non-viable, life-threatening
    pregnancies have been denied access to medical care as we heard
    from Amanda Zurawski under oath at our last hearing. Amanda's
    testimony is seared in my memory; forced to continue a non-
    viable pregnancy due to Texas's extreme anti-abortion law,
    Amanda developed sepsis and nearly died. Amanda's healthcare
    providers wanted to provide the abortion she needed, but we now
    live in a nation where healthcare providers live in fear of
    civil and criminal liability for simply doing their jobs.
        A Nation where women suffering from miscarriages have been
    threatened with jail time, and where access to FDA-approved
    medication used safely and effectively for more than two
    decades is threatened, and a nation in which just last month a
    State Supreme Court ruled that frozen embryos are children
    under a State law, which resulted in numerous IVF clinics in
    the State halting their services for those who desperately want
    a baby, but struggle with infertility, for cancer patients who
    must safeguard future reproductive options as they undergo
    treatment, for LGBTQ couples who use IVF to expand their
    families. This ruling in Alabama was heartbreaking.
        Today, we will hear from Jamie Heard, one Alabamans
    affected by this decision. Despite State lawmakers' slapdash
    efforts to address the fallout after the Alabama Supreme Court
    decision, there remains significant concerns about the future
    of IVF in that State and others.
        Fetal personhood bills have been introduced in at least a
    dozen other States, and 125 U.S. House Republicans have co-
    sponsored fetal personhood legislation with no carve out, carve
    out to protect access to IVF or birth control. And Justice
    Thomas showed us that constitutional right to birth control is
    at risk when, in his concurring opinion in Dobbs, he called for
    the court to reconsider its holding in Griswold v. Connecticut.
        More than 25 million women of reproductive age now live in
    the States where abortion is banned, unavailable or restricted,
    and women's lives are in jeopardy. Women facing non-viable
    pregnancies are being denied emergency, life-saving medical
    treatment. Women suffering from miscarriages are being denied
    access to medication and procedures that can reduce emotional
    trauma and save their lives.
        Rape and incest survivors are being victimized by a system
    that makes it harder for them to end an unwanted pregnancy.
    Healthcare providers can no longer be able to use their best
    medical judgment to treat patients. And those who desperately
    want to become pregnant, but need IVF are facing unnecessary
    barriers to parenthood.
        Those of us who believe in a woman's right to bodily
    autonomy need to step up and stop this chaos. We must respect
    women's rights to make their own reproductive health decisions,
    but the question remains, will our Republican colleagues join
    us in this effort, and support legal access to abortion and
    reproductive freedom?
        With that, I turn to Ranking Member Graham for his opening
    statement.

             OPENING STATEMENT OF HON. LINDSEY O. GRAHAM,
            A U.S. SENATOR FROM THE STATE OF SOUTH CAROLINA

        Senator Graham. Thank you, Mr. Chairman. I appreciate it
    very much. So, we're having a hearing today about IVF
    treatments, and the opening statement was about abortion. I
    think everybody on our side supports the idea of families being
    able to access this treatment. I know Senator Baldwin staff
    members on our side have had families through this procedure
    absolutely committed to making sure this is available.
        The Alabama decision, I think, has been corrected by the
    Alabama legislature. There are a lot of questions around
    embryos and what status they should have, but I don't think you
    have any disagreement here on the Committee that IVF treatments
    should be made available. I mean, there should be reasonable
    regulation in this area, just like any other area of medicine.
        The abortion debate is one worth having, really. I think
    it's very important. What kind of country do we want to be in
    2024, and 2025, and beyond? I have been vocal about a national
    limitation; exceptions for rape, incest, life of the mother
    exceptions at 15 weeks. Fifteen weeks limitation process in
    line with the majority of the European nations. I think 47 to
    52 nations in Europe limit abortion between 12 and 15 weeks.
        The bottom line here is that you and others on your side
    have been supporting national laws that would override every
    State pro-life law on the books to replace it with rules that
    would not be Roe v. Wade. There'd be absolutely no limitations
    at all on the ability to get an abortion. Everybody in the
    media says Democrats are not for abortion on demand up to the
    moment of birth. Well, okay, what limitations do you have?
        I challenge every Member of this Committee on the
    Democratic side, pick a week in the birthing process where you
    would limit abortion. Just any week. I don't care if it's the
    last week, just pick one you want, because you can't.
    Politically, all the energy on your side is to make America
    like China, and North Korea, and Iran when it comes to
    abortion, where you can have abortion literally right up to the
    moment of birth with no exceptions at all.
        Most Americans reject that way of thinking. What States do
    after the Dobbs decision on abortion is up to them to a point.
    I always thought the pro-life movement to me was about the
    developing child. At 15 weeks, we know an unborn child can feel
    pain. You provide anesthesia to treat the child medically
    because they can feel pain, that's normal medical practices.
        So, the debate about when to intervene, if at all, on
    behalf of the unborn child is worthy of a great nation. There
    is no effort by anybody I know of in the Republican Party in
    Washington, DC to shut down fertility clinics. Quite the
    opposite. We appreciate this as a form of way of bringing life
    into the world for couples that are having a very difficult
    time conceiving a child otherwise.
        So, we will continue to have this debate, but I'm waiting
    to hear from one national Democrat in the Senate, let's just
    start with the Senate, that would tell the country at what
    point would you limit abortion on demand? Just pick a week,
    pick any exception at all, and the answer is deafening. Not one
    of you has come out that I know of with any limitation on
    abortion at all, anytime, anywhere, for any reason.
        So I am waiting to hear what you have to say. I have been
    clear about what I think, and I look forward to this
    discussion, and thank you very much.
        Chair Durbin. Thanks, Senator Graham. We'll begin with our
    witnesses when we go to the witness panel, which is the second
    group. Each member will have 5 minutes to provide their
    statement, and then 5 minutes of questioning from each Senator.
        But first, we begin with a statement from my colleague,
    Senator Tammy Duckworth, my fellow Senator from Illinois. She's
    an exceptional champion for reproductive rights and the people
    of Illinois, and I'm grateful for her joining us today.
        Tammy brings a unique perspective to this. I remember when
    she called me, and said she had news to tell me. And I said,
    ``What's up, Tammy?'' She said, ``I'm going to have a baby.'' I
    couldn't believe it after what that body of yours has been
    through that you were able to do. That was a remarkable, almost
    a miracle. Beautiful little girl, and another one following.
    It's a tribute to you, and your determination and courage
    throughout your life.
        The floor is yours.

                  STATEMENT OF HON. TAMMY DUCKWORTH,
               A U.S. SENATOR FROM THE STATE OF ILLINOIS

        Senator Duckworth. Thank you, Mr. Chairman and Ranking
    Member Graham. I am Tammy Duckworth, not Tammy Baldwin.
    Although I am honored to be mistaken for the Chairwoman of the
    Tammy Caucus, Senator Baldwin. Thank you for holding today's
    important hearing.
        As a Senator who's dream of becoming a mother was made
    possible through the miracle of that is IVF, I am uniquely
    situated to remind this Committee of a basic principle; we can
    recognize the value of potential human life, acknowledge that
    fertilized eggs are incredibly precious and valuable, and we
    can also accept the fact that an embryo is not yet a human
    being.
        No one, and I mean no one, better understands the hopes and
    dreams that viable embryos represent than an IVF patient
    struggling with infertility. No one better understands the pure
    unmitigated joy that flows when a successful transfer of
    embryos results in pregnancy.
        And sadly, for us women who have lived through the soul
    crushing, bone-deep agony of having that hope destroyed after
    completing unsuccessful rounds of IVF or of suffering a
    miscarriage, we experience in the most painful manner possible,
    the fundamental reality that while every fertilized egg is
    unbelievably precious, unfortunately not all will become a
    living, breathing child whose laughter and joy will fill our
    hearts and enrich our lives.
        Federal law wisely reflects this fact by defining the terms
    person, human being, child, and individual to only include,
    ``every infant member of the species Homo Sapiens who is born
    alive at any stage of development.'' Section 8 of Title 1 of
    the United States Code is consistent with Ranking Member
    Graham's common-sense observation that, ``Nobody's ever been
    born in a freezer.''
        Attempting to deny this reality, attempting to rewrite
    State constitutions and laws to define a fertilized egg as a
    human child, which is what the embryonic person would crusade
    achieved in Alabama is an affront to the millions of aspiring
    parents who struggle to conceive. It's a threat to the
    separation of church and state. It's a betrayal of our great
    American spirit that reveres scientific discovery and progress.
        Those seeking to ban IVF won't stop at one medical
    procedure. Their ultimate mission is to extinguish the legacy
    of American ingenuity that was born in the experiments of
    Benjamin Franklin, and continued through the groundbreaking IVF
    of conception and birth of Elizabeth Carr in December of 1981.
        Look, every American has the right to personally believe
    that an embryo is a human child and to live their life in
    accordance with such beliefs by refusing to receive, provide,
    or offer IVF services just as every American should have the
    right to decide whether, when, and how to build their family.
    But Congress must draw a line against a person or movements
    with abuse of government power to force every American to live
    their life in accordance with that movement's moral beliefs.
        Opponents of IVF are being dishonest and claiming that the
    Alabama Supreme Court never banned IVF. Defining the cluster of
    cells that comprise an embryo to be a human being, and even the
    single cell that is fertilized prior to becoming embryo,
    they're defining that as an extra-uterine child entitled to all
    the legal rights and protections of a person.
        This may not be an explicit IVF ban, but makes no sense as
    we witnessed this in Alabama, it's an awfully effective way to
    ban IVF. After all, Alabama's criminal code defines murder as
    intentionally causing the death of a person. And just like that
    one plus one equals two.
        When Alabama defined a fertilized to be a person, and their
    code defines intentionally causing the death of a person, the
    intentional disposal of an embryo, even a non-viable one that
    could cause a miscarriage if you were to implant it, which is a
    common practice in IVF, that disposal became a Class A felony.
        The flawed solution to Alabama Republicans crafted to
    restore IVF validates this suspect by branding women and
    doctors that receive or provide IVF as de facto criminals in
    need of broad criminal and civil immunity simply because they
    require medical help to start a family.
        So let me say again, the law that was passed by Alabama
    does not negate the fact that the destruction of an embryo is
    the destruction of a human being. All that law that was
    recently signed into law says is that we're just not going to
    prosecute you. The chaos, confusion, and outrage in Alabama was
    a chilling preview of the dystopian future that awaits us if
    Congress fail to pass IVF protections that are effective and
    enforceable.
        That is why any Senator that claims to support nationwide
    IVF protections to join me and the 48 Senator co-sponsoring my
    bill in voting to pass the Access to Family Building Act. Our
    pro-family, pro-freedom bill would establish a nationwide right
    for patients to receive IVF. It would allow insurers to cover
    IVF, and it would also allow doctors to provide IVF in
    accordance with, and I make it clear that we state this in the
    bill, widely accepted and evidence-based medical standards of
    care.
        Unfortunately, there's a bad faith effort to confuse the
    public about my bill using absurd hypotheticals that are an
    insult to struggling with infertility. So let's be clear, under
    S. 3612, no healthcare provider would be forced to provide IVF,
    period. That's because my bill statutory definition of
    healthcare provider excludes providers that do not provide or
    do not or seek to provide IVF.
        In addition, my bill only intends to protect IVF services
    provided in accordance with widely accepted and evidence-based
    medical standards of care. Wild-eyed hypotheticals like
    creating gene-edited designer babies, or--and I can't believe I
    have to say this, but it was brought up by my colleague who
    stood up to oppose my move for unanimous consent to pass the
    bill. She said that my bill would actually allow for the
    creation of human/animal chimera such as half human, half horse
    hybrids.
        Neither are widely accepted or consistent with evidence-
    based medical standards of care for IVF, thus S. 3612 would not
    protect such procedures. Bottom line, Congress has the power to
    prevent what happened to those families in Alabama from ever
    happening again.
        So, let's come together and achieve that goal. Let's pass
    the Access to Family Building Act, enshrine in Federal the law
    the right to receive, provide, and cover IVF so that more
    families like mine can hold their precious babies after all
    those long years of struggle of infertility, and finally have
    that child that they've dreamt of for decades. Thank you.
        Chair Durbin. Thank you, Senator Duckworth. Senator Graham,
    would you like to introduce your guest?
        Senator Graham. Yes, Mr. Chairman. And I also, I'd like to
    put into the record Senator Cindy Hyde-Smith's response to the
    bill in question if that's okay.
        [The information appears as a submission for the record.]
        Chair Durbin. Without objection.
        Senator Graham. Okay. So, Congresswoman Michelle
    Fischbach--did I get that right?
        Representative Fischbach. Yes.
        Senator Graham. Good. Welcome. The Representative of
    Minnesota's 7th District, which covers the western half of
    Minnesota. She joined the U.S. House in 2021 and serves on the
    House Ways and Means Committee, Rules Committee, Budget
    Committee, and Ethics Committee. In addition to her four
    committees, she serves as a Co-Chair of the Pro-Life Caucus.
    She introduced legislation that was passed in the House,
    Supporting Pregnant and Parent Pregnant Women Parenting
    Families Act in January.
        During her 22 years in Minnesota State Senate, including
    four as the first woman Senate President, Representative
    Fischback led multiple legislative initiatives to protect
    mothers and their unborn children. She wrote the state's
    Women's Right to Know Law and carried a number of other pro-
    life bills, including abortion clinic licensing legislation to
    let to passage.
        She continues to fight for the pro-life cause in
    Minnesota's 49th District. She received a BA in political
    Science from St. Cloud State University and a JD from William
    Mitchell College of Law. Welcome.

                 STATEMENT OF HON. MICHELLE FISCHBACH,

                  A U.S. REPRESENTATIVE FROM THE 7TH
                  CONGRESSIONAL DISTRICT OF MINNESOTA

        Representative Fischbach. Thank you very, very much,
    Senator, and thank you for the opportunity to be here today.
        You know, I have been representing Western Minnesota in
    Congress since 2021, and I represented on the State level, but
    I'm also pro-life, and have been part of the pro-life community
    helping women choose life for my entire life.
        Senators, most Americans agree that there should be
    limitations on abortion. According to the 2023 Harvard/Harris
    National Poll, 73 percent of American voters oppose abortion
    after the 15th week. Meaning, most Americans agreed there
    should be limitations on abortions. The Republican position is
    not extreme. The position of many elected Democrats, however,
    is extreme.
        Every Democrat on this committee voted for the Women's
    Health Protection Act, which would allow abortion on demand
    through all 9 months of pregnancy. Only 10 percent of voters
    support this position. The fact is that Democrats are catering
    to the voices of the extreme fringe, and are not listening to
    the American people.
        Republicans care deeply about the unborn child and the
    mother. We are looking at every opportunity to empower women to
    choose life and introducing legislation to support that aim.
    For example, this Congress, I introduced the HOPE Act. This
    bill arms women with knowledge, and helps them access the
    resources they need to confidently carry their pregnancy to
    term, and provide resources for any expectant mother to support
    them throughout and after their pregnancy, and their children.
        I also introduced legislation to ensure that TANF dollars
    could continue to go to pregnancy care centers. This bill
    passed the House, but Democrats fought against it, and it
    became clear they fought so hard because the only option they
    want women to have is abortion. The display was repugnant and
    frankly belittling to women everywhere.
        Democrats can spin their stories and can confuse the issues
    all they want. They can trust to mislead Americans into
    thinking that Dobbs has anything to do with IVF or the Alabama
    Supreme Court decision. They can try to pretend like
    Republicans are launching an assault on reproductive rights,
    but they hide behind false narratives like this to drive their
    political agenda and to conceal deeply troubling features of
    their pro-abortion agenda.
        We do not have to look any further than some of the bills
    being discussed here today, such as S. 701 and S. 3612. These
    bills would allow abortion on demand until birth. They permit
    things like human cloning and very problematic forms of genetic
    engineering. These bills also preempt all State laws, and
    completely destroy anyone's religious right not to participate
    in abortions or other practices they find to be morally
    objectionable. These measures are extreme. They put us in the
    same camp as countries like North Korea and China.
        Senators, I understand the majority here today is looking
    to paint Republicans as monsters who want to take freedoms away
    from women in this country. I assure you nothing is further
    from the truth. My Republican colleagues and those in the pro-
    life community agree with most Americans, and we deeply
    understand the challenges expectant mothers face. We stand with
    them, and are doing everything we can to empower these women to
    confidently choose life for their children.
        And I thank you for the time.
        Chair Durbin. Thank you very much, Congresswoman.
        Representative Fischbach. Thank you.
        Chair Durbin. Our first panel will please approach the
    witness table.
        We welcome Jamie Heard, who is from Alabama. She was told
    she had to put her IVF treatment on pause after the recent
    Alabama Supreme Court ruling.
        We are joined by Lourdes Rivera, president of Pregnancy
    Justice, an advocacy organization focusing on the rights of
    pregnant people. Our final majority witness is Dr. Austin
    Dennard, who has joined us from Texas. She's here to speak
    about her personal experience of being denied healthcare she
    needed. She's an OB-GYN in Dallas.
        Ranking Member Graham, would you like to introduce your two
    minority witnesses?
        Senator Graham. Thank you, Mr. Chairman. We have Dr.
    Monique--I'm going to call her Monique Wubbenhorst. Sorry, I'll
    get your name right in a minute. She's a board-certified OB-GYN
    with over 20 years of experience in patient care, teaching
    research, health policy, public health, global health, and
    bioethics.
        She graduated from Mount Holyoke College, and received her
    medical degree from Brown University. She earned her master's
    degree in public health from Harvard. She completed her
    residency in OB-GYN at Yale New Haven Hospital, and her
    postdoctoral fellowship in health services research at Sheps
    Center for Health Services Research at the University North
    Carolina Chapel Hill.
        She was a faculty member at Duke University School of
    Medicine from 2003 to 2018. She served as deputy assistant
    administrator in the Bureau for Global Health at the United
    States Agency for International Development.
        Her clinical career is focused on caring for women, and
    underserved and disadvantaged populations, especially, African
    American, and Native American communities, with a focus on
    women with medical, social, and psychiatric problems.
    Currently, she is a senior fellow at the Center for Ethics and
    Culture, University of Notre Dame.
        Next, Professor O. Carter Snead is a Charles E. Rice
    Professor of Law at the University of Notre Dame Law School,
    the director of Center for Ethics and Culture at the University
    of Notre Dame, and a concurrent professor of political science
    at the University of Notre Dame.
        He's one of the world's leading experts on public
    bioethics, and his research explores issues relating to
    neuroethics enhancement, human embryo research, assisted
    reproduction, abortion, and end of life decisionmaking. He is
    author of ``What It Means to Be Human: The Case for The Body in
    Public Bioethics,'' and has written more than 70 journal
    articles, books, chapters, and essays.
        Prior to Notre Dame, he served as general counsel to
    President George W. Bush as counsel on bioethics under Dr. Leon
    Kass, where he was the primary drafter of the 2004 report,
    ``Reproduction and Responsibility: The Regulation of New Bio
    Technologies.''
        In 2008, Professor Snead was appointed by the director
    general of UNESCO to a 4-year term on the International
    Bioethics Committee, received the JD from George Washington
    University, and a bachelor of arts from St. John's College in
    Annapolis, Maryland.
        Chair Durbin. Thank you, Senator Graham.
        I'd ask the witnesses to please stand to be sworn in.
        [Witnesses are sworn in.]
        Chair Durbin. Let the record reflect that the witnesses
    answered in the affirmative, and our first witness is Ms.
    Heard. Could you proceed with your opening statement, please?

             STATEMENT OF JAMIE HEARD, BIRMINGHAM, ALABAMA

        Ms. Heard. Thank you, Chairman Durbin, Ranking Member
    Graham, and Members of the Senate Judiciary Committee. Thank
    you for the opportunity to testify before you today.
        My name is Jamie Heard and I am from Birmingham, Alabama. I
    am here to share how the Alabama Supreme Courts decision to
    declare personhood for frozen embroys has affected me and my
    family.
        In 2012, I was diagnosed with Polycystic ovary syndrome,
    the most common cause of female infertility. I can remember my
    body feeling heavy as I listened to the doctor explain the
    challenges I would face in getting pregnant. Untimely news that
    not only changed the planned trajectory for my hopes of
    building a family of my own, but news that found me on the
    wrong side of time as we dealt with the loss of both my mother
    and my husband's father to cancer, and subsequently, the death
    of my only sibling. Our family's sorrow became the cornerstone
    of our inspiration to build and expand our family.
        As my husband and I began the journey to grow our family,
    we were met with obstacles as the doctor had previously
    prepared me for. We discussed options for having kids, but at
    the time it seemed very far-fetched because we couldn't afford
    the out-of-pocket costs of the medical treatment the doctor
    said we needed.
        But then, to our great surprise and luck, my employer
    expanded its health insurance to include fertility treatments,
    including In Vitro Fertilization. My heart was filled with so
    much joy and hope to finally have a chance to grow our family.
    This coverage was the answer to our prayers and the only way we
    would have access to the necessary medical care to treat my
    infertility.
        We continued to encounter many obstacles and heartaches as
    we went through fertility treatments, from failed attempts at
    conception to the devastating loss of an ectopic pregnancy.
    After taking a pause on further treatments for a while due to
    the emotional and physical distress, we ultimately made the
    decision to begin the journey again.
        We met with our doctor who explained that after trying
    other medical treatments that did not work, our best chance
    would be with IVF. We began with months of intensive tests and
    procedures. And while the journey through infertility
    treatments was not an easy one, we were finally blessed with
    our beautiful son through IVF. After taking our son on his
    first Disney trip, a truly magical experience, we felt so
    inspired and ready to grow our family. We decided to start the
    IVF journey again to have our second child.
        We began that process on February 14, 2024, when we met
    with our fertility doctor to put a plan together to begin that
    process, which again involves multiple tests and procedures.
    Just a few days later, we saw in the news the Alabama Supreme
    Court's ruling classifying frozen embryos as children. We later
    saw a statement from our clinic that they made the decision to
    pause new IVF treatments due to the legal risk to their clinic
    and their embryologists.
        Our hopes broke hearing the news of our clinic pausing
    treatments. My heart breaks as I hear and read comments such as
    our health conditions are nature's way of telling us we
    shouldn't have kids. I've never been actively involved in
    politics or advocacy before. I'm truly an ordinary individual
    living an ordinary life. Even to appear before you today, with
    the support of my husband and very dear friend, has brought its
    own separate challenges.
        Although I'm typically not on the front lines advocating
    for any particular cause or issue, I knew I needed to fight not
    only for my rights as a woman, but also fight for my future
    family and all those individuals who are too deep in emotional
    and physical trauma of infertility.
        Now my husband and I are filled with so much uncertainty
    about how we move forward with expanding our family without the
    risk of being prosecuted. All these questions, all these
    decisions, regarding my body and my family, being decided by
    those that aren't here with me to fight the anguish of
    infertility.
        IVF is hope for those of us struggling to conceive. IVF is
    medically necessary care due to my and many other people's
    circumstances. Access to medical treatments, without
    restrictions, is a basic human right. It is enough of a
    traumatic experience dealing with infertility and going through
    fertility treatments, to now have a basic human right being
    politicized, to further expand that trauma.
        I'm asking you to truly put families first, which begins
    with having the fundamental right to build a family and the
    access to the needed resources to do so. You play a vital role
    in fostering compassion, understanding, and support, for those
    in your communities, your neighbors, who are confronting the
    hardships of infertility.
        Daily, I look and just stare at my son, still in awe that
    I've been afforded the opportunity to be a mom to such a
    beautiful miracle. A dream that for a while I didn't think
    would come true. But it did, through IVF.
        I ask the Committee to think about the hope that IVF means
    for patients like me. Protect that hope, do not restrict it,
    but instead nurture that hope.
        Thank you again for letting me share my story.
        [The prepared statement of Ms. Heard appears as a
    submission for the record.]
        Chair Durbin. Well, you shouldn't have been nervous or
    stressed. You did just fine. Thank you so much for being here.
    Professor Snead.

    STATEMENT OF O. CARTER SNEAD, CHARLES E. RICE PROFESSOR OF LAW,
    CONCURRENT PROFESSOR OF POLITICAL SCIENCE, DIRECTOR, DE NICOLA
     CENTER FOR ETHICS AND CULTURE UNIVERSITY OF NOTRE DAME, SOUTH
                                 BEND,
                                INDIANA

        Professor Snead. Chairman Durbin, Senator Graham, thank you
    for inviting me to testify before you-all today.
        When the Supreme Court decided in Dobbs that the
    Constitution does not preclude the people from governing
    themselves on the fraught question of abortion, it brought us
    into alignment with most nations around the world who have
    always addressed the issue through the political process, most
    of whom restrict purely elective abortion between 10 and 14
    weeks of pregnancy.
        After nearly 50 years of being deprived of the authority to
    meaningfully govern ourselves in this domain, the current
    political and legal landscape is widely varied, complicated,
    and a work in progress. But our system of federalism allows for
    divergent approaches to vexed questions.
        Some States have enacted strict limits on abortion whereas
    others have dramatically increased access. Voters have
    supported abortion rights in every State referendum since
    Dobbs, going so far in Montana as to reject a proposed law
    protecting newborns who survive abortions. A similar proposal
    was rejected by this body.
        I would like to, respectfully, make three suggestions for
    good governance in this difficult area. First, it is important
    to be clear about the complexity of the issue. It is not simply
    a variation of the health care debate, or even reducible to the
    important values of equality or bodily autonomy of women facing
    serious burdens on their health and future.
        Rather, the issue challenges us to consider how these goods
    stand in relation to the life of the unborn child, a whole,
    living, distinct member of the human species who, if all goes
    well, will move herself along the trajectory of development
    from embryo, to fetus, to newborn, provided she has the
    necessary support and sustenance in her mother's womb, the
    first place of belonging for every human being. She is not a
    trespassing stranger; she is the biological child of this
    particular mother.
        Our public debate is impoverished when those who support
    abortion rights fail to acknowledge, much less respond to this
    reality. On the other hand, our discourse suffers when pro-life
    elected officials fail to acknowledge and seek to alleviate the
    sometimes-crushing burdens of unwanted pregnancy and
    parenthood. To govern ourselves wisely, justly, and humanely,
    we must begin by articulating the problem before us in its full
    complexity, without question begging.
        Second, we must fairly and accurately characterize the
    legal landscape. Here too, we have fallen short. A recent
    Alabama case has been widely misdescribed as a theocratic power
    grab heralding the demise of IVF. In fact, the victorious
    plaintiffs there were IVF patients suing a clinic for the
    negligent destruction of their frozen embryos, using a civil
    statute that already allowed such claims for the death of
    embryos in the womb.
        The decision did not depend on and had nothing to do with
    Dobbs. In response, the conservative legislature and Governor
    moved immediately to grant blanket civil and criminal immunity
    to IVF clinics for such misconduct. Popular accounts of women
    in Texas being denied life-saving medical care are similarly
    lacking. Texas abortion law allows exceptions to protect a
    mother's life or prevent her substantial bodily impairment. But
    many of these cases involved women seeking abortions because
    their unborn child was the one to receive a heartbreaking
    diagnosis of disability or terminal illness.
        But, Texas does not authorize abortions soley because of an
    unborn baby's disability or poor prognosis. Regarding risks to
    mothers, Texas just passed a bipartisan law stating that
    previable, premature rupture of membranes and reaffirming
    ectopic pregnancies fall under the health exception. The same
    goes for miscarriage management.
        The Texas Supreme Court just declared that serious health
    risks need not be imminent to justify abortion. And the
    ``reasonable medical judgment'' standard for clinicians
    invoking such exceptions has been in place without issue since
    the passage of Texas' 20-week abortion ban in 2013. Since then,
    there have been 238 abortions performed at or after 20 weeks or
    later with zero prosecutions. This week, the Texas Medical
    Board will meet to develop clinical guidelines in this area.
        Finally, I would invite the members to reimagine the
    framing of the human context in which the question of abortion
    arises. Instead of a zero-sum conflict among strangers over the
    permissible use of lethal force, think of it instead as a
    crisis facing a mother and her child. Then, ask how we can work
    together across our differences to come to their aid not just
    during pregnancy, but throughout life's journey. Thank you.
        [The prepared statement of Professor Snead appears as a
    submission for the record.]
        Chair Durbin. Thank you very much. Next is Dr. Lourdes--or
    Ms. Lourdes Rivera.

     STATEMENT OF LOURDES A. RIVERA, PRESIDENT, PREGNANCY JUSTICE,
                           NEW YORK, NEW YORK

        Ms. Rivera. Thank you, Chairman Durbin, Ranking Member
    Graham, and Senate Judiciary Committee Members, for the
    opportunity to testify today.
        I'm Lourdes Rivera, President of Pregnancy Justice, a
    nonpartisan legal advocacy organization that for over 20 years
    has defended and advocated for the rights of pregnant people
    facing criminalization and other rights violations.
        I want to first explain what is pregnancy criminalization
    and fetal personhood, and then discuss the path to Alabama's
    IVF decision. Pregnancy criminalization is charging pregnant
    women for conduct that would not be illegal except for the fact
    that they're pregnant and regardless of pregnancy outcomes.
    This includes being charged with murder for experiencing a
    still birth or for having a miscarriage, and not knowing what
    to do with the fetal remains as if there were an instruction
    manual for that.
        We've documented over 1,800 cases of pregnancy
    criminalization in the years 1973 to 2022 from Roe to Dobbs.
    The majority, 1,400 of them, occurred in the last 15 years as
    fetal personhood had gained traction in State law.
    Unsurprisingly, those targeted are overwhelmingly poor, and
    disproportionately, people of color. The stowing legal
    personhood status on fertilized eggs, embryos, and fuses is
    what underlies these prosecutions as well as abortion bans, and
    threatens IVF and birth control.
        Attempts to define fetuses as legal persons have been
    rejected by voters in nearly every State in which it has been
    put on the ballot, including in Mississippi. Yet State
    legislatures in at least 11 States have passed broad fetal
    personhood laws before Dobbs. These laws could potentially be
    read to extend full rights to fertilized eggs. Constitutional
    protections provided by Roe v. Wade, however, meant that fetal
    personhood laws could not be fully enforced.
        But there are significant exceptions. Ten years ago, the
    Alabama Supreme Court held that embryos and fetuses are the
    same as children under the state's criminal child abuse laws,
    and that pregnant women can be charged as child abusers from
    the moment of fertilization.
        With over 600 women being charged, Alabama leads every
    State in the Nation on pregnancy criminalization. And while
    shocking, it is hardly surprising that the Alabama Supreme
    Court decided to extend its reasoning to frozen embryos.
    Alabama, along with Oklahoma, and South Carolina, whose Supreme
    Courts have also designated fetuses as children under their
    State criminal laws, accounts for two-thirds of arrests of
    pregnant people nationally, including those who experience
    miscarriage and stillbirth.
        When conduct during pregnancy or pregnancy outcomes are
    punished, pregnant people in their families suffer irreparable
    harm. This includes dire consequences, health consequences,
    incarceration, and families torn apart. Our nation is facing a
    maternal and infant health crisis in pregnant and postpartum
    people, but especially, Black women face increased risks of
    death and severe complications, including due to mental health
    conditions.
        The three States with the highest prevalence of pregnancy
    criminalization also have some of the highest rates of maternal
    mortality in the Nation. Alabama ranks fourth and has some of
    the worst infant health outcomes. Research shows that
    criminalizing pregnancy does absolutely nothing to improve
    maternal and infant health, and in fact, it does the opposite.
        Every major medical and public health association in the
    Nation opposes criminalizing pregnancy because it interferes
    with the patient-provider relationship and deters access to
    needed healthcare.
        Let me be clear. When anti-abortion lawmakers endow
    fertilize eggs with personhood rights, they seek to ban
    abortion, and IVF, and threaten contraception. As legal
    personhood advances, more pregnant people can face criminal
    charges for any conceivable risk to their pregnancies or to a
    fertilized egg before implantation. This is not hyperbole. Our
    clients are living this reality now.
        When an anti-abortion movement talks about fetal and
    embryonic personhood, it is not about protecting babies, it's
    about controlling and punishing women, pregnant people, and
    communities that are already marginalized. And the Life at
    Conception Act, if ever adopted, would ban abortion nationally,
    eliminate the right to IVF, endanger access to birth control,
    and expand the government's ability to police pregnant people,
    and criminalize pregnancy, and pregnancy outcomes.
        With these attacks and the crisis we are facing, we must
    remember that women and pregnant people must be treated as
    fully autonomous, rights-bearing persons who are entitled to
    healthcare and bodily integrity, and they must be allowed to
    make their own healthcare decisions.
        [The prepared statement of Ms. Rivera appears as a
    submission for the record.]
        Chair Durbin. Thank you very much, Ms. Rivera. Dr. Monique
    Wubbenhorst. I hope I was close in pronunciation.
        Dr. Wubbenhorst. It's phonetic. Thank you. That was good.

              STATEMENT OF MONIQUE C. WUBBENHORST, SENIOR
     FELLOW, DE NICOLA CENTER FOR ETHICS AND CULTURE UNIVERSITY OF
                    NOTRE DAME, SOUTH BEND, INDIANA

        Dr. Wubbenhorst. Good afternoon, Chair Durbin, Ranking
    Member Graham, Members of the Committee. Thank you for the
    opportunity to testify at this hearing. It is an honor to be
    here.
        Following the Dobbs decision, which returned decisionmaking
    regarding abortion to the people of the United States and
    elected representatives, there have been many opportunities to
    mitigate abortions harm to women, their children, their
    communities. And these laws protect women and children.
    Abortion is not healthcare. It not only poses risks to the
    mother, it is always lethal to an unborn child.
        These opportunities have resulted in vigorous debate on
    abortion and the humanity of the embryo of the unborn child. At
    the heart of this debate is whether or not the unborn child is
    a human being, which science clearly demonstrates. An unborn
    child is therefore not a part of the mother's body in the way
    that her heart or her pancreas are.
        Since embryos are human, they have fundamental human
    rights. One of these rights is the right to life. Yet, unborn
    children are subject to abortion even though they're the
    smallest, weakest, and most vulnerable members of the human
    family. Abortion is associated with harms to women. It is also
    not safe, and in childbirth, this false claim can be traced to
    papers published in leading OB-GYN journals, which contain
    methodological errors and did not consider the biology of fetal
    and uterine development.
        When induced abortion is compared in context to childbirth,
    it is clear that it is not safer than childbirth. In addition,
    in the United States, African American women have the highest
    rates of abortion and the highest maternal mortality. Both
    cannot be true if abortion decreases maternal mortality.
        Reproductive rights, so-called, are not human rights
    because they disappear as they dispose of the fetus. So-called
    reproductive justice is, in fact, reproductive injustice
    because it selectively destroys Black and brown babies who are
    100 percent of the future of our ethnic groups. The same
    eugenic mindset that led to the sterilization of African
    American, Native American, and Hispanic women continues in
    disproportionate rates of abortion in Black and Hispanic women.
        The issue of the humanity of the unborn child is also a
    topic of debate related to In Vitro Fertilization. And as
    noted, in 2022, three couples filed a wrongful death suit in
    Alabama regarding their frozen embryos, and the Alabama Supreme
    Court issued an opinion which has set up a national debate
    about In Vitro Fertilization. This ruling correctly assigns
    value to the embryo, but it does not prohibit IVF. It speaks
    only to whether embryos should be destroyed.
        A 2019 study found that the majority of IVF practitioners
    dispose of embryos by placing them directly in a trash can.
    They often administer alcohol or other things to try to kill
    the embryos before disposing of them. Louisiana and Germany
    have established ethics and safety standards for IVF that
    prevent embryo destruction.
        Since 1986, in Louisiana, for example, IVF protection of
    embryos has occurred side by side as embryos are recognized as
    human beings, not chattel property. In Germany, since 1990, the
    Embryo Protection Act has regulated how embryos may be handled.
    In procedures, the number of embryos fertilized or that develop
    into embryos may not exceed the number of those that are
    transferred to the woman during a treatment, no more than three
    embryos may be stored, sex selection is prohibited, and
    embryonic research is prohibited.
        Embryo destruction can be addressed in part by reducing the
    creation of excess embryos. It's not IVF that is at issue, but
    rather whether embryos should be destroyed. People can be in
    favor of IVF without agreeing to the destruction of embryos.
        The IVF industry has been described as the Wild, Wild West.
    These questions show the dilemmas associated with it and the
    need for its regulation. Anyone who knows, or has family member
    who has cared for or has undergone IVF can testify to its
    mental, emotional, and financial costs and burdens. Prospective
    parents embrace these to build their families. But are all
    aspects of the IVF process compassionate and just? There's a
    need to regulate the industry, protect children, protect
    mothers, and maintain parents' legals rights.
        In addition, when we look at fetuses with anomalies, how do
    we treat them with dignity? A developmental accident that
    resulted in disability does not make these children subhuman.
    The value of a child's life has nothing to do with how long it
    is or how he or she was conceived.
        How we treat mothers matters too. Multiple studies indicate
    that there is a psychological benefit to continuing a pregnancy
    following prenatal diagnosis of a lethal fetal defect,
    especially where there's compassion, palliative care for
    newborns with anomalies.
        The rights of a mother and those of an unborn child with an
    abnormality, or was unexpected, or ``unwanted'' are not in
    opposition. They're intertwined. Both have inherent human
    dignity, both deserve not only compassion and justice, but love
    because love seeks the highest and best for another. Both
    deserve the best of care, which excludes abortion, because
    abortion is not healthcare. It violates the bodily integrity,
    autonomy, and rights of the mother, and kills her unborn child.
        To conclude, the Dobbs decision has resulted in vigorous
    even fractious debate about abortion, but debate is positive. A
    similar debate should ensue, ensue for IVF with the view to
    better regulation. The IVF industry is concerned with the
    deepest desires of parents, and with the most vulnerable human
    beings; unborn children. Our views of human dignity along with
    compassion, justice, and scientific and clinical data, should
    inform this process. Thank you.
        [The prepared statement of Dr. Wubbenhorst appears as a
    submission for the record.]
        Chair Durbin. Thank you, Doctor. Dr. Austin Dennard.

     TESTIMONY ON AUSTIN DENNARD, DOCTOR OF OSTEOPATHIC MEDICINE,
         FELLOW OF THE AMERICAN CONGRESS OF OBSTETRICIANS AND
                      GYNECOLOGISTS, DALLAS, TEXAS

        Dr. Dennard. Chairman Durbin, Ranking Member Graham, and
    Members of the Senate Judiciary Committee. Thank you for having
    me here today.
        My name's Austin Dennard. I'm a mother, a Texan, and a
    practicing OB-GYN. I'm here today to describe what life has
    been like in Texas since the Federal right to abortion was
    taken away by the Supreme Court, and the State began
    criminalizing and banning abortion care.
        Nothing brings me more joy than being a mother to my three
    children, but a close second is being an OB-GYN. I get to be
    present for the most incredible moments. There's nothing quite
    like the moment when a baby is born and a family is created.
    I've delivered thousands of babies and it still takes my breath
    away.
        But intertwined in these celebrations are also moments of
    complete heartbreak; pregnancy loss, a devastating diagnosis,
    infertility. Since SB8 was enacted and the Dobbs decision came
    down in 2022, those tough moments have become even more tragic.
    In Texas, where my husband and I both practice medicine, we
    live in fear, as physicians and as patients. I can speak to
    both of those perspectives because I am a Texan and OB-GYN who
    needed an abortion in Texas and could not get one.
        After careful consideration and many prayers, my husband
    and I were delighted to find out that we were pregnant again in
    the summer of 2022. Between our two toddlers and growing
    surgical practices, we were feeling really busy, but also very
    blessed. But at 11 weeks of pregnancy, I had a routine
    ultrasound that changed the course of my family's life forever.
    The brain and skull had not formed. It was anencephaly. The
    most severe neural tube defect, 100 percent fatal.
        I will never forget looking up at the ultrasound screen in
    complete disbelief and devastation. I needed an abortion, but
    would need to flee my State to get one, Texas, where I've lived
    for six generations, where I practice medicine and where I am
    raising my family.
        My mind began to spin. Where would I go? Who would take
    care of me? Who will take care of my children? What about my
    patients? And what if this is the last time I ever get to be
    pregnant? Because of Texas's new laws, we were afraid to use
    credit cards or even tell people why we were traveling to the
    East Coast so suddenly. I was terrified my husband would be
    arrested for aiding and abetting my abortion just for traveling
    with me.
        And under Texas's new laws, the penalties were so severe, a
    hundred years in prison, huge fines, a loss of our medical
    license. It was humiliating through it all. I felt so broken
    and abandoned by my home State. But at the same time, I had
    never seen my luck and privilege with more clarity. What would
    other people do in my place who could not afford the extensive
    costs and lost wages? No one should have to be lucky to access
    essential medical care.
        As heartbreaking and traumatizing as that was for me, it is
    even more disturbing to be a working OB-GYN in Texas, trying to
    abide by these paralyzing punitive laws while still providing
    timely compassion, compassionate, and ethical care for my
    patients. Conversations in my office are different now. Couples
    arrive for their pregnancy confirmation visits filled with
    worry. They know how much is at stake. What if it's an ectopic?
    What if I start bleeding? What if I become really, really sick?
        I have the same answer for all of them, that I will do
    everything in my power to keep them safe. But still, we
    collectively hold our breath as we pass the pregnancy
    milestones because my patients know that lawmakers have
    stripped away their rights to make decisions about their own
    health, their own body, and their own family.
        So long as they remain on Texas soil, their pregnancies
    belong to the State. Exceptions are said to exist in the laws,
    but in reality, it's fiction. These bans have stolen so much
    from us. I have spent a greater part of my life dedicated to
    becoming the best doctor I know how to be. Yet, lawmakers are
    making decisions about my body and my practice as if they know
    better.
        I've never wanted to be a public person, but I can't be
    silent anymore. The silence is too painful. These cruel laws
    have to change. Texas women deserve better, Americans deserve
    better, and my 4-year-old daughter deserves so much better.
    Thank you.
        [The prepared statement of Dr. Dennard appears as a
    submission for the record.]
        Chair Durbin. Thank you, Doctor. We'll have 5-minute rounds
    of questions. I'm trying to resolve in my mind these two issues
    of abortion and IVF. I understand the premise. If you start
    with the premise that life begins at conception, that it
    certainly is reasonable, I suppose, to follow that through to
    the conclusion that no abortion is warranted, and to want to
    overturn Roe v. Wade, which is what one group of thinkers in
    this country arrived at.
        But then for the same people to say, but, I'm all right
    with IVF. It seems to me to be inconsistent because we know
    during the IVF procedure, we run the risk, if not the reality,
    that there will be embryos created that will not be implanted.
    So, is this the end of a life? How can you reconcile those two
    positions? I find it difficult, very difficult.
        Professor Snead said we're going through a work in progress
    since Dobbs. It sure is a work in progress when you hear Dr.
    Dennard and others, Ms. Heard, describe what they've been
    through. But it's a work in progress that I think is
    fundamentally ignoring the obvious. Ms. Rivera, this notion of
    personhood, how would you describe it?
        Ms. Rivera. Thank you for your question, Senator. I think
    you are absolutely right. These reproductive health issues do
    not exist in silos. And the problem is that if you define
    fertilized eggs, embryos, and fetuses as legal persons with
    independent rights, it's going to affect everyone. It's going
    to affect abortion, it's going to affect access to IVF, it's
    going to affect contraception, and it's going to affect the
    quality of healthcare that pregnant women and pregnant people
    are entitled to. So, you are absolutely right.
        Chair Durbin. So, they wanted to overturn Roe v. Wade to
    take away the right of a woman to decide to end her pregnancy.
    Now, there are some who want to outlaw IVF and deny a woman the
    right to start a pregnancy. A common notion here is the woman
    is just a vessel, is not a participant in this decisionmaking
    process, either for her own health or the future of her own
    family. Dr. Dennard, is that what you discovered?
        Dr. Dennard. Thank you so much for bringing this up. When I
    was pregnant in my State, I felt exactly how you describe. I
    felt like a vessel. And when I looked up at that ultrasound
    screen and saw that I was growing a pregnancy that had no skull
    or brain, but had no way of making any decision on my health,
    it's exactly how I felt. And that's exactly how my patients
    feel when they're in similar situations. We've lost our ability
    to make any decisions about our bodies, and it is harming
    women, and it is harming families.
        Chair Durbin. There was a report on national public radio
    just yesterday that said, ``The dangerous disruption of
    standard of care for pregnancy in the State of Louisiana in
    wake of the Louisiana abortion ban.'' The story noted that
    women in that State had been forced to undergo a cesarean
    section when their water breaks early in pregnancy before the
    fetus is viable instead of receiving an abortion procedure or a
    medication, which is standard medical practice.
        One doctor explained the C-section was done to, ``Preserve
    the appearance of not doing an abortion.'' And even more
    galling, the patients aren't even given a choice. As I
    understand it, a C-section is much more serious and not as safe
    procedure as ordinary vaginal abortion. Equally troubling, the
    NPR story reports that OB-GYNs in Louisiana are now delaying
    routine prenatal care until patients reach 12 weeks, a serious
    deviation from standard medical practice. Can you speak to how
    these restrictive abortion bans affect the ability of OB-GYNs
    to practice the standard of care that you learned in medical
    school?
        Dr. Dennard. Thank you for this question. At this point in
    my State, I feel like Ken Paxton himself is standing in each
    and every one of my office rooms when I see patients. Because
    now, individuals are having to change the way that they
    practice medicine. Individuals are having to change the way
    that they counsel patients due to all of the fear that has
    paralyzed our care. So much so that women who are living in
    Texas and other States where abortion bans exist, their lives
    are at stake and they are not receiving the same medical care
    that individuals are in States where the restrictions are not
    so severe.
        There are so many rippling effects of this. There have been
    migrations of physicians to different States. Patients have
    been abandoned in certain States because of this, and we're
    losing physicians that have the ability to do procedures
    including abortion care because of these restrictions.
        Chair Durbin. Senator Graham.
        Senator Graham. Thank you, Mr. Chairman. Professor Snead,
    you mentioned something in your testimony that most western
    nations limited abortion from 10 to 14 weeks. Is that correct?
        Mr. Snead. That's correct.
        Senator Graham. I think 47 or 52 European Union nations
    have a limitation below 15 weeks. Is that correct?
        Mr. Snead. That is my understanding, Senator.
        Senator Graham. Why is that?
        Mr. Snead. Well, one major difference between European
    nations is that they have resolved these questions through a
    political process in which they have come up with laws that
    balance the judgment of the people in an appropriate way, the
    important goods of autonomy, and health, and equality for women
    on the one side, but also respecting the intrinsic equal value
    of every human being for conception.
        Senator Graham. My point is, elected officials do this.
        Mr. Snead. Absolutely. We are unique in that we are the
    only country that I'm aware of in which for 50 years, the
    Supreme Court set our national abortion policy as opposed to
    the people themselves.
        Senator Graham. Now, after the Dobbs decision, elected
    officials at every State level decide matters of when you can
    have abortion limits, if any. Is that correct?
        Mr. Snead. That is correct.
        Senator Graham. And that's in line with most of the
    civilized world in terms of having elected officials do this.
        Mr. Snead. In most cases, it's decided by the people
    through their elected officials. Yes, Senator.
        Senator Graham. So, let's talk a little bit about IVF
    treatment. Doctor, can I call you Monique? Great. And say
    Monique, you mentioned Germany. They have laws regulating IVF
    treatments. Is that correct?
        Dr. Wubbenhorst. Yes, Senator.
        Senator Graham. Is that true of most Western Nations?
        Dr. Wubbenhorst. I'm not as familiar with the overall
    landscape----
        Senator Graham. What about Professor Snead?
        Professor Snead. Yes. It is the case, and the country that
    pioneered IVF, the United Kingdom, has an elaborate scheme of
    regulation of IVF and embryo research.
        Senator Graham. And we don't?
        Professor Snead. We are unique in that way. We do not have
    an overarching scheme.
        Senator Graham. Okay. So, let's talk a little bit about the
    embryo. In Germany, there are limits on how many embryos you
    can create. Is that correct, Monique?
        Dr. Wubbenhorst. That's correct.
        Senator Graham. All right. I guess the reason for that is
    this ethical debate we have. What is an embryo? Is it a person?
    I don't know of anybody who's been born that wasn't at one time
    an embryo, we all have that in common, to kind of deal with
    what we're talking about. Is that right, Professor Snead?
        Professor Snead. Yes, that's correct, Senator.
        Senator Graham. Okay. So, I'm very open-minded about this
    in this regard. I want every family to be able to have a child,
    and if science can help, that great. IVF treatments have been a
    blessing to many families. The idea of what legal protection to
    provide when I think should be done by elected officials. So,
    I'd like to get us kind of in line with the rest of the world
    on this area, if that's even possible.
        We have tax credits for children. Well, I think everybody
    up here is for tax credits for children. Should we have a tax
    credit for people trying to have a child through the IVF
    process because it's very expensive? Maybe we should. The point
    I'm trying to make is that all of us are for life. There's just
    a different opinion of when the law should intervene.
        Some people say you have no rights until you are actually
    born. Other people believe that the day before you're born, you
    should have some rights. It's all a balancing act here. Right?
    And what I'm trying to do, Mr. Chairman, is if we don't have
    any national standards about IVF treatment, should we? Monique?
    What do you think?
        Dr. Wubbenhorst. I think that it's very important to open
    the debate and to have national standards, as I've said even
    people related to the industry say it is like the Wild West.
        Senator Graham. Do you agree with that, Professor Snead?
        Professor Snead. Yes, Senator. There's a statute that you-
    all passed in 1992, your colleague, Senator Wyden, called the
    Fertility Clinic Success Rate and Certification Act, which
    began as a sort of consumer protection law. But it's proven to
    be inadequate to even protect the interest of families that are
    seeking IVF.
        And I think it would be a great opportunity as the
    President's Council on Bioethics recommended to take up the
    question to see how moms, and babies, and families can be best
    protected who are seeking fertility care.
        Senator Graham. So, I'd like to sit down with you and
    anybody else try to find out a way to see if we can get America
    united on this topic. Creating life is a good thing. IVF is a
    good thing. Like every other practice that needs to be
    regulated, what happens when the clinic negligently destroys an
    embryo that is yours, part of you. These are decisions that we
    need to talk about.
        And Mr. Chairman, I'm hopeful that over the arc of time,
    maybe we can find a way to create an environment in this
    country where we support IVF, not only just through regulation.
    Make sure it's ethical, make sure it's done right, but maybe we
    should encourage people to use this process through tax
    credits. Somebody's got to pay my Social Security, the more
    children, the better.
        Chair Durbin. Senator Butler.
        Senator Butler. Thank you, Mr. Chair. Thank you for having
    such a timely hearing. Thank you all for being witnesses here
    today to help us all learn and understand the very perspectives
    across a really rich issue environment.
        Professor Snead, there's an exchange between you and
    Senator Graham about the state of IVF and other countries
    around the world where you talked about the regulatory
    framework that other countries around the world have relative
    to IVF and as well as like the gestational periods, and correct
    me if I'm getting any of your testimony incorrect. Can you
    speak to the state of paid medical family leave or paid medical
    leave in those countries as well?
        Professor Snead. That's an excellent question, Senator. And
    I think in many of those countries, there's more support for
    people who have families. And I've argued in print and
    elsewhere, that if a person wants to be comprehensively pro-
    life, that has to be part of the picture. You have to provide a
    safety net and support for moms, and babies, and families.
        Senator Butler. Totally appreciate you raising that point
    because my next question is going to be about the State of
    childcare in those countries, and we can go down the list. All
    of those countries also have a higher minimum wage than $7.25.
    All of those countries also allow workers to unionize without
    intimidation from their employer. All of those countries also
    provide comprehensive healthcare and retirement security for
    the residents in those countries. Am I characterizing that
    accurately?
        Professor Snead. It's obviously a complicated question
    because we're talking about a lot of countries, but I think
    that there are many instances in which they do better than we
    do in those respects. Yes, ma'am.
        Senator Butler. I appreciate you helping me to bring this
    into perspective and really try to understand the juxtaposition
    of the tension that we find ourselves in this sort of
    uniqueness in spaces. I think that's the word we use, the sort
    of U.S. uniqueness, as there are many other ways in which the
    U.S. is unique in ways that it is not advancing the equivalent
    supports for families, for life, as those other countries that
    are being that are being compared to.
        There's an interesting other sort of irony that I wanted to
    call forth in the sort of pro-life argument as it's being
    presented here. And that is the irony of that argument sort of
    juxtaposed with the criminalization of patients and physicians.
        I find it ironic, and I direct this to you Dr. Dennard and
    Ms. Rivera, find it ironic that the folks who are doing their
    best by way of presenting as patients in need of a healthcare
    procedure, a full spectrum of healthcare procedures that women
    often need, that are different, that then the punishment is a
    criminal record, years in prison, and losing your livelihood to
    provide for the family that is a demonstration of this value of
    life.
        You spoke a little bit, Dr. Dennard, about the trends that
    you're seeing in the OB-GYN space in Texas. I wonder if you
    could offer just quickly a little bit more of what you are
    seeing. What are OB-GYNs talking about? Are there more medical
    school students, for example, that are choosing to on match day
    practice in the OB-GYN space?
        Dr. Dennard. Thank you so much for bringing this up, and
    you speak so eloquently. You take the words out of my mouth,
    really, when it comes to the irony that we're all facing. We're
    seeing that States like Texas are less desirable for medical
    students that are coming out of their training because the
    training is different now in our State due to these ridiculous
    regulations, to be quite honest.
        And when I went to medical school, I went because I wanted
    to take care of people. I didn't think I was going to have to
    worry about being criminalized or being thrown in jail. I just
    want to take good care of my patients. They're like family.
        I see patients who come to me in college wanting to talk
    about contraception, and then the next year they come back,
    they've met someone, they're getting married, they want to talk
    about starting a family. And then we go through pregnancy
    together, and it's a really, really important relationship that
    we have with our patients. But it's becoming really
    traumatizing.
        Senator Butler. Thank you so much. And Mr. Chair, if I
    might just close. I do look forward to working with my
    colleagues to make sure that we repeal the Trump tax cuts for
    the wealthy so that we could actually do some of the things
    that other countries are doing to wrap around the kind of full
    service of life and protection of life that other countries
    around the world are doing.
        Thank you all so much. Thank you, Mr. Chair.
        Chair Durbin. Thank you, Senator Butler. And Senator
    Kennedy.
        Senator Kennedy. Thank you, Mr. Chairman. Ms. Rivera, if
    you were queen for a day and you had unfettered discretion to
    establish a national rule on abortion for America, what
    restrictions, if any, would you implement with respect to
    abortion?
        Ms. Rivera. Thank you for your question, Senator. I would
    so the American College of Obstetricians and Gynecologists
    opposed restrictions that are not based on medicine, right?
    People need to be able to make their own reproductive
    healthcare decisions, and having arbitrary restrictions lead to
    the situations like we've been hearing about, like Kate Cox and
    others who are not able to get the healthcare they need during
    obstetric emergencies. We know the majority of people access--
    --
        Senator Kennedy. Yes, ma'am. Maybe I wasn't clear because
    I've got to ask each of our witnesses here. Just tell me if you
    could implement any rule, what restrictions, if any, you would
    put on abortion?
        Ms. Rivera. Senator, arbitrary restrictions put women's
    health in danger.
        Senator Kennedy. So that means no restrictions?
        Ms. Rivera. Senator, healthcare needs to be driven by
    medical practice and medical standards of care.
        Senator Kennedy. I agree. You don't believe in any
    restrictions on abortion?
        Ms. Rivera. Healthcare needs to be driven by medical
    standards of care.
        Senator Kennedy. Well, your website says you support
    abortions at all gestations.
        Ms. Rivera. That is correct, because----
        Senator Kennedy. You support abortion----
        Ms. Rivera. Abortion needs to----
        Senator Kennedy [continuing]. Without any restrictions.
        Ms. Rivera [continuing]. Be based on medical standards of
    care.
        Senator Kennedy. How about could you give it if the
    mother's healthy and the baby's healthy? Would you support an
    abortion the day before birth?
        Ms. Rivera. Actually, that is not how abortion care works.
        Senator Kennedy. Would you support that. You say no
    restrictions.
        Ms. Rivera. That is called labor and delivery, Senator.
        Senator Kennedy. But you support no restrictions.
        Ms. Rivera. Senator that is not how abortion care works,
    Senator.
        Senator Kennedy. The question is really simple, would you
    have a rule saying that if a healthy mother or a healthy baby
    wanted to have an abortion the day before birth, would it be
    okay with you?
        Ms. Rivera. Senator that is not how abortion care works.
    And it's really dangerous. That rhetoric is really dangerous
    for the people who are coming----
        Senator Kennedy. It would be okay with you, wouldn't it?
        Ms. Rivera. That is called labor and delivery, sir.
        Senator Kennedy. It would be okay with you.
        Ms. Rivera. That is called labor and delivery, sir.
        Senator Kennedy. I find that astonishing.
        Senator Kennedy. On your website----
        Ms. Rivera. Senator, that is really offensive----
        Senator Kennedy [continuing]. You issued a press release.
    You don't refer to mothers. You say at your organization, you
    don't refer to mothers. You call them birthing people. Is that
    right?
        Ms. Rivera. That is among the language that we use, yes.
        Senator Kennedy. Now, what's the difference?
        Ms. Rivera. A birthing person is someone who's in labor and
    delivery.
        Senator Kennedy. Okay. That's a mother. Right?
        Ms. Rivera. So for sure, the majority of people who are
    pregnant are cisgender women. And at the same time, we have to
    acknowledge that trans people and non-binary people do and can
    become pregnant, and it's really important not to misgender
    them in law and health because it is really dangerous to them.
        Senator Kennedy. You were invited here by my Democratic
    colleagues today?
        Ms. Rivera. That is correct.
        Senator Kennedy. Okay. Dr. Dennard, if you were Queen for a
    day, what restrictions, if any, would you place on abortion?
        Dr. Dennard. Well, if I was Queen for a day, I would use
    shared decisionmaking between myself and my patients so I could
    take really, really good care of them.
        Senator Kennedy. So, you don't think there ought to be any
    restrictions?
        Dr. Dennard. You know, that's not really how abortion care
    works. We need to be able to take----
        Senator Kennedy. Yes, ma'am, but I'm trying to understand
    your position first. Do you support any restrictions in
    abortion?
        Dr. Dennard. I support my patients, I trust women, and I
    know that they're going to make the right decision for
    themselves.
        Senator Kennedy. Okay. And you were invited here today by
    the Democrats?
        Dr. Dennard. Correct.
        Senator Kennedy. Okay. Professor Snead--well, let me back
    up. I don't have much time left. How would you change Texas
    law? Are you suggesting that Texas should adopt a law saying
    there should be no restrictions on abortion?
        Dr. Dennard. Are you asking me?
        Senator Kennedy. Yes, ma'am.
        Dr. Dennard. Yes. If I could change Texas' laws, I would be
    able to take care of my patients if they're in need without
    restrictions.
        Senator Kennedy. I just find it extraordinary that neither
    you nor Ms. Rivera are willing to say what you believe, which
    is clearly that you don't think there ought to be any
    restrictions on abortion. You think it's okay. You want society
    to adopt a rule that says if a healthy mother with a healthy
    child wants to have an abortion, maybe she wants a different
    gender the day before birth, that that's okay. It's clear
    that's what you believe. Why don't you say it?
        Dr. Dennard. With all due respect, I've been to medical
    school, I've done multiple years of training, delivered babies,
    and done thousands of surgeries for over a decade, and you are
    describing a clinical situation that just doesn't exist.
        Senator Kennedy. Ma'am, you're wrong. You are wrong, and
    you know you're wrong. Do you perform abortion, Dr. Dennard?
        Dr. Dennard. I'm not an abortion provider.
        Senator Kennedy. Okay. Have you ever done an abortion?
        Dr. Dennard. I have never done an abortion, but I take care
    of my patients who are actively having miscarriages.
        Senator Kennedy. Okay. I think I'm over. Thank you for your
    indulgence, Mr. Chairman.
        Chair Durbin. Senator Ossoff. Wait a minute, is it Ossoff?
    Senator Ossoff.
        Senator Ossoff. Thank you, Mr. Chairman. Senator Welch, if
    you are in a big hurry.
        Senator Welch. No, no.
        Senator Ossoff. Okay.
        Chair Durbin. Looks like my Chairmanship is in doubt.
    Proceed.
        Senator Ossoff. Dr. Dennard thank you for joining us and
    sharing your story with us. I want to talk about the
    availability of OB care, particularly in parts of the country
    with extraordinarily high rates of maternal mortality and
    shortages of qualified obstetric clinicians.
        In the State of Georgia, just for context, half of our
    counties have no OB-GYN at all. We have one of the highest
    maternal mortality rates in the country, and I hear
    consistently in rural communities--and in fact just a few days
    ago on a defense installation in Georgia speaking with service
    members and military spouses--just how dire this lack of access
    to obstetric care is. And of course, it's not just OB-GYNs, it
    is obstetric nurses, it is midwives, with sometimes deadly
    consequences for women who are unable to access perinatal
    healthcare.
        Georgia has passed one of the most extreme abortion bans in
    the country at 6 weeks before many women even know they're
    pregnant. One of the things that I'm hearing is that the fear
    of criminal prosecution of doctors deters OB-GYN residents from
    pursuing training in States with those kinds of extreme
    abortion bans. And I think as the clinicians here probably know
    from their experience, my understanding is that doctors are
    much more likely to stay in practice where they've trained.
        The question for you is, based upon your experience as a
    doctor, what's the impact on local communities when there are
    no OB-GYNs or the nearest qualified provider is 90-minute drive
    away?
        Dr. Dennard. Thank you for highlighting this really
    important issue. Personally, I practice in a large metropolitan
    area in Texas, but what I can say is that many medical journals
    will show, it's no surprise that when there's lack of access to
    care, there are very poor outcomes.
        And patients have to travel. They have to travel around to
    get the care that they need, and that distance is becoming
    further and further for them. So, what happens is the areas
    that have lack of access to care, patients travel and overwhelm
    other areas where there is more access to care and there are
    bad outcomes. So, it's quite devastating to the women in our
    country, and it's negatively affecting my specialty
    significantly.
        Senator Ossoff. Thank you, Dr. Dennard. And Ms. Heard, I've
    heard, my office has heard in the last few weeks from a huge
    number of Georgians who are scared that the direction my State
    is on, the direction the country is on could deny Georgia
    families access to IVF. We saw what happened in Alabama. We see
    more and more extreme policies, a 6-week ban, for example, far
    out of the mainstream opposed by most Georgians deterring OB-
    GYNs from practicing in the State. We see more and more of this
    being pushed across the country since the Dobbs decision.
        And so, families are afraid that they may not have access
    to IVF. They may not therefore have the opportunity to achieve
    the blessing and responsibilities of parenthood. What is your
    message for families in Georgia and across the country who feel
    fear right now that their path to conception and parenthood may
    be closed to them by political extremists?
        Ms. Heard. Thank you, Senator, for asking that question. I
    think I mentioned in my testimony that I've never advocated for
    anything before, and me being here today is completely new
    territory for me.
        But when everything kind of took place in Alabama, I felt
    attacked. I felt like my family was being attacked, my future
    family was being attacked. And I know so many other women
    personally that are going through the process that, you know,
    unfortunately haven't had success as of yet.
        But I knew that I needed to step up and let my voice be
    heard. Not just for me and my experience, but also for all
    those others that don't have the ability to let their voice be
    heard to fight for our rights and to continue to have access to
    those treatments that we need.
        So, my message to them is, you know, I understand that
    infertility is such a personal trauma and it's hard to talk
    about. It's hard to speak about, but I empower them to get
    active. Let your voice be heard, let your story be shared
    because the more that we speak up, the more that we share our
    story, the more that we can bring awareness and understanding
    to what the IVF process is, the better, you know, hopefully
    that we can see change through that.
        Senator Ossoff. Thank you for your courage. Thank you all.
        Senator Coons [presiding]. Senator Tillis.
        Senator Tillis. Thanks, Mr. Chair. Thanks, everybody, for
    being here. Ms. Heard, I know this is a unique experience for
    you, but thank you for being here. I'm sorry about the
    challenges you went through. And Dr. Dennard, did you not speak
    before a judiciary hearing in the past?
        Dr. Dennard. I did.
        Senator Tillis. I thought so. I remember your testimony. I
    think you were sitting at the far left in that hearing, if I
    recall. I'm Thom Tillis from North Carolina. I was Speaker of
    the House before I came up here to the Senate. And I remember
    when I decided to run for the Senate, I had been Speaker, and
    we'd passed some pro-life bills. They returned at the time,
    radical pro-life bills.
        In North Carolina, they said now that you're running for
    Senator against the Democrat pro-choice incumbent how are you
    going to deal with your record? I said, you're asking a
    question as if I'm going to run from my record. I intend to run
    on my record.
        And Ms. Heard, and Dr. Dennard, both, I'm very sorry for
    the experiences that you went through, but this hearing isn't
    about coming up with a common-sense solution or maybe striking
    balance that I heard in Professor Snead's comments. This is
    about it's about political points.
        So I'm sorry that you have to be a part of this, but if
    you'll indulge me, I won't go over my time. But the reality is,
    the reason I wasn't concerned with my radical position on pro-
    life is because I was consistent with the majority of North
    Carolinians. It was even better numbers probably back at the
    time.
        We're not talking about--we get into this argument and we
    shout over everyone because we talk about the extreme position
    as if I would have supported the extreme. What I argue was an
    extreme judgment in Alabama, but the fact of the matter is
    Professor Snead did a pretty good job of under of explaining
    how that whole process went into place. And then the Alabama
    legislature fixed that one.
        Having said that, I for one, think that policies that the
    Alabama legislature proposed on abortion restrictions are a bit
    extreme. And ultimately, over time, I don't think that they
    will win the day in terms of public opinion. Maybe the same
    could be argued for some of Texas's policies, although they've
    addressed some of the concerns that may have made the
    experience that you went through go differently.
        But when people go out of this Committee and they hear the
    narrative of a Republican's extreme policies, vast majority of
    the Republicans extreme policies are in alignment with the
    Western world. They would be out of alignment with countries
    like China and North Korea. They're not extreme. It's not
    extreme to say late trimester abortions have to have some
    reasonable limits, including exceptions that would not have
    been an impediment to Dr. Dennard's abortion.
        I think that there's a happy middle ground that most
    Americans will accept, but they don't get a chance to have that
    discussion because what we have here are policy-driven hearings
    that really drowned out those in the middle who think that
    there probably is a common-sense middle ground. I think this is
    pretty close to it. Maybe we could have a debate about it.
        Let me tell you what's not mainstream policy. A vote that
    we had on the floor that every Member who was in Congress, a
    Democrat Member, voted for. And every Member in this Congress
    has co-sponsored a Democrat Member. It's a pretty extreme
    policy. And I told my staff, you better fact check this three
    ways to Wednesday, because it is factually what was voted on
    the floor.
        And I had somebody call into my office saying, Senator,
    tell us you have to support that vote on the floor because it's
    just codifying Roe v. Wade. He did not know who I was. I told
    my staff, if you get calls like this, tell them that the
    Democrats are voting on a policy that would use taxpayer
    dollars to compel a religious institution to perform an
    abortion on a minor, not necessarily with a doctor, a
    physician's assistant without the knowledge and consent of
    their parents.
        That is not hyperbole, that is not exaggeration. That is
    the text of the bill that my colleagues voted on, and then they
    come to a hearing like this and suggest that we have the
    radical position. This is rejected by a vast majority of the
    American people. So, if we want to have a hearing, educating
    people on radical, that is radical. That is a law that was
    voted on the floor is now co-sponsored by my Democrat
    colleagues.
        So, I look forward as somebody who's worked on a lot of
    bipartisan bills. I look forward to having an honest discussion
    where Ms. Heard's experience can be taken into account, Ms.
    Dennard's experience can be taken into account, and the
    extremes at either end which are preventing any sort of
    certainty that I think every expected mother deserves or any
    aspiring mother deserves.
        You are collateral damage for the political games that we
    play here in these Committee hearings, and this is an example
    of one that has nothing to do with a reasonable bipartisan
    outcome. Thank you all for being here.
        Chair Coons. Senator Whitehouse.
        Senator Whitehouse. First of all, thank you all for being
    here. I know these are very difficult issues, and very often,
    very personal issues. In my meetings with the OB-GYN community
    in Rhode Island, the doctors are horrified and furious at what
    they're hearing from their colleagues in other States who have
    to make the awful decision to not provide the standard of care
    that they are trained to because a bunch of characters in the
    State legislature wrote over what medical science knows to be
    best practices.
        And that's particularly concerning when a pregnancy begins
    to be troubled, and now you've got the mother's health at risk
    as well. So, I am very, very sorry for your experience, Dr.
    Dennard, and I'm really grateful that you took the trouble to
    come here and share it.
        Chair Durbin opened up with the observation that if you
    come to this with the belief that life begins at conception,
    not only is taking away women's rights to make a choice about
    abortion, something you want to get rid of, but IVF has to go
    too because it necessarily involves embryos. It's hard to have
    one theory apply in one case, but not in the other.
        I'm a little bit concerned that that also would apply to
    mifepristone, a perfectly legal drug that is sold by regular
    pharmacies and can often be delivered through the mail. You are
    a doctor who practices in this area. Do you see the drug
    mifepristone as being in the crosshairs of this theory that
    life begins at the moment of conception?
        Dr. Dennard. Thank you so much, Senator Whitehouse.
    Mifepristone has been so regulated and it's so difficult to
    obtain in the State of Texas that I really don't have personal
    experience administering it or prescribing it for patients. I
    think it's really important----
        Senator Whitehouse. You presumably don't take it until a
    pregnancy has commenced until there is an embryo, right?
        Dr. Dennard. I'm sorry, could you say that again?
        Senator Whitehouse. It presumably is prescribed once there
    is an embryo?
        Dr. Dennard. Correct?
        Senator Whitehouse. Yes. So, it would seem that
    mifepristone is next in the cross hairs of things to be taken
    away, and I don't know if contraception is next. That used to
    be an issue in this battle, and maybe that's where we go next.
    It just doesn't seem to make any sense any longer in this
    context of fetal personhood.
        I just really hope that to follow Senator Tillis's remarks
    that as we go through this, we can bear in mind just what evil
    this has worked in the medical profession when hard family
    choices have to be made with the life and safety of the mother
    at risk, the life and safety of the fetus at risk, and a doctor
    doing their very best, using the very best standard of care
    that they've been trained to all their professional lives,
    trying to advise through that very, very difficult and painful
    situation.
        And the notion that some force from the State legislature
    is suddenly in that room with that family and trying to give
    directions to the doctor and to the mom about all of this. I
    mean, talk about having the person who is least likely to make
    the right decision in that place. So, God bless you for what
    you've done, and thank you for being here today.
        Chair Durbin. Senator Blackburn.
        Senator Blackburn. Thank you, Mr. Chairman, and thank you
    all for being here today. I appreciate it.
        And I'm going to pick up kind of where Senator Tillis left
    off because this hearing today is really a distraction from the
    discussion that we ought to be having. And as he said, my
    colleagues across the dais have supported the Women's Health
    Protection Act is really something that goes so far beyond
    codifying Roe v. Wade.
        It goes so far. It is that bill that is abortion on demand
    from conception to birth. That's what that bill does. Partial
    birth abortions, it permits. It even goes so far as to
    supersede State laws, Federal and State laws that are
    conscience laws, and that protect healthcare providers who
    choose not to perform abortions for moral or religious reasons.
        And the policies that the Democrats have laid out hardly
    get covered by the mainstream media, but I can guarantee you
    that media will cover this hearing today because they want to
    say, Republicans are anti-IVF, and we know that's probably what
    they're going to say now. And we know they'll use fear tactics
    and try to paint Republicans as anti-IVF so that they can scare
    families.
        Well, just for the record, and here's the reality. I
    support IVF. I support fertility-related services. I'm a mom
    and a grandmom. Have plenty of friends that have used IVF and
    these services. I think that having children is one of the
    greatest blessings that God gives us. I want Tennesseans to
    have the right to rear that family, and I will always oppose
    efforts that are going to block IVF because it is a service
    that many people need.
        So I think it is long past time that we hold our
    colleagues, our friends across the aisle to account for what
    the Women's Health Protection Act would actually do and the
    radical nature of that.
        And Dr. Wubbenhorst, thank you for being here today. I
    spoke a little bit about that, Women's Health Protection Act,
    and how far it goes beyond codifying Roe v. Wade. And one of
    the most reprehensible provisions that is in that legislation
    is the ban on informed consent, and the fact that those
    requirements are banned. You couldn't give the woman the
    opportunity to view the image of an unborn child or to hear the
    heartbeat of an unborn child.
        I am the sponsor of the Women's Right to Know Act. I think
    women need that opportunity to experience what that life in the
    womb is really about, and to know that. And I would just like
    for you to weigh in, in the minute I've got left, about what
    women have a right to know, about that, about the dangers that
    are there with abortion, the medical complications. So, I'd
    like for you to speak.
        Dr. Wubbenhorst. Yes. Thank you so much for the opportunity
    to speak. I do think that the ability to see your baby's
    heartbeat and hear it is extremely important. And I think one
    of the reasons for the opposition is that there are some
    studies that show that about, at least, 60 percent of women who
    actually do that will choose to keep their baby and parent
    their baby. So that shows the power of what you see and what
    you hear as overcoming the idea that, okay, this is just a
    clump of cells. This is not really a human being.
        I think that the other points that you're making are very
    important about the safety of abortion. Abortion is associated
    with significant harms to women. And I do want to correct
    something. You know, it's not true that abortions do not occur
    very, very late. Dr. Warren Hern does abortions very far into
    the third trimester. And that is not the same as labor and
    delivery, because the goal of labor and delivery is a living
    child. The goal of an abortion is a dead child. And in fact, if
    an abortion is not successful, that is called a failed
    abortion. So those two things are not equivalent.
        In addition to that, both medical and surgical abortion are
    associated with complications and women deserve to know what
    those are. They need to understand that these procedures have
    important consequences for them, including hemorrhage,
    infection, damage to the uterus. I personally cared for women
    who had abortion complications, in particular, needing ICU
    stay, needing a couple of surgeries after their mid-trimester
    abortion.
        Senator Blackburn. Thank you. Thank you, Mr. Chairman.
        Chair Durbin. Thank you. Senator Coons.
        Senator Coons. Thank you, Chairman Durbin, and thank you to
    all of our witnesses, and my colleagues.
        The Supreme Court's decision at Dobbs v. Jackson Women's
    Health 2 years ago overturned roughly 50 years of settled
    precedent, and was a forceful abrasion act of conservative
    judicial activism. As we've heard today from a number of my
    colleagues and several witnesses, the predictions about Dobbs'
    aftermath and its potential impact on women's health have
    unfortunately, in many cases, all too many cases come true.
        Women across our Nation have lost the autonomy to make
    their own decisions about their body, their care, when and how
    to have a family. And the recent attack on fertility treatments
    proves that this issue may not stop at abortion. Contraception
    in different forms, IVF, IUDs are on the front lines. Every
    woman in America deserves the freedom to make her own
    reproductive choices regardless of where she lives, and every
    American family should have the right to decide whether when to
    become a parent.
        Ms. Rivera, it's good to see you again. As President Biden
    said during the State of the Union, we've seen an assault on
    reproductive freedom. Unfortunately, the administration's taken
    action to protect reproductive care through litigation,
    challenging some of the State bans and executive orders. The
    administration has prioritized patient privacy protections and
    expanding access to contraception.
        What additional actions should the Federal Government
    consider to protect women in States with significant barriers
    to reproductive care, and what rights and protections might be
    at risk under a future administration that doesn't share the
    same commitment to protecting access to reproductive health?
        Ms. Rivera. Thank you, Senator. I mean, I think one of the
    things that can be done is passing the Momnibus Act, which is,
    you know, to address maternal healthcare, particularly, for
    Black women who are facing maternal mortality at
    disproportionate rates.
        The other one is making sure that States are actually
    expanding Medicaid so that people can get the healthcare they
    need. One of the alarming things that we're seeing right now
    is, you know, the attacks on mifepristone, and I just want to
    say that mifepristone, right now, and medication abortion,
    right now, is what's keeping America from looking like pre-Roe
    America, where our emergency rooms were filled with women who
    had to resort to unsafe abortion. But right now, they're able
    to access safe abortion, but mifepristone is being attacked
    right now in a current Supreme Court case. So that's one thing.
        And I think that investing--I think there should be, you
    know, better time and resources spent investing in expanding
    access to services, expanding access to prenatal care, to
    substance use treatment for pregnant women because there's a
    dose of it right now. And this is the number one thing that I
    think can help us result in much better reproductive health
    outcomes.
        Senator Coons. Thank you. I think all of us who support
    healthy families and healthy children should support the
    legislation, the expansion of access to care that you
    referenced.
        But one of the issues that's been battered around quite a
    bit in today's hearing is the impact of the Alabama Supreme
    Court's decision in LePage v. Center for Reproductive Medicine,
    where they held that embryos are extra-uterine children.
        Ms. Rivera. Yes.
        Senator Coons. The Alabama legislature says their new law
    protects, fully, access to IVF in their State. Is that true? Is
    the Alabama statute sufficiently comprehensive?
        Ms. Rivera. There are a lot of questions remaining. This
    legislative fix at, I think, at best is temporary and narrow.
    So, for example, it talks about protecting patients from
    liability. Well, what happens when somebody's no longer a
    patient? So, there's a big question there. And there's a big
    question about what happens when somebody else brings a
    challenge under the rationale of the State Supreme Court and
    under the State Constitution.
        I really want to bring attention to the chief justice
    concurring opinion which people should read because it's very
    alarming just under religious freedom grounds. But the opinion
    basically says that the State legislature can do what it wants,
    but it has to comply with the State's constitutional language
    which includes the Sanctity of Life Act. So that's a really big
    concern. And, you know, there's a parallel with the life at
    Conception Act which Congress is considering right now, which
    can make nationally look like Alabama.
        Senator Coons. Thank you. Ms. Heard, if I might briefly
    thank you for sharing how this Supreme Court decision in
    Alabama on fetal personhood affected you and your family. I
    joined my colleague Senators Duckworth, Murray, and others in
    introducing and supporting a bill to protect IVF nationwide. It
    was blocked on the floor. What would it mean for you personally
    and for families across our Nation if Congress were to pass a
    law actually protecting access to IVF treatment across our
    country?
        Ms. Heard. Thank you, Senator, for asking. It would mean
    everything. It would make me and my husband feel very much
    supported by this great State that we live in, great country
    that we live in. There are so many like myself that are
    experiencing infertility, and IVF is the only way that we can
    expand our family. So, if we can get something passed that
    protects our access to that, it would absolutely mean a lot.
        Senator Coons. Thank you. Thank you to all our witnesses
    today. Thank you, Mr. Chairman for indulgence.
        Chair Durbin. Thank you, Senator Coons. Senator Cruz.
        Senator Cruz. Thank you, Mr. Chairman. We are witnessing
    today an act of political misdirection by the Democrats on this
    Committee. I'm going to start with three propositions that are
    indisputably true and should be unassailable.
        Proposition number one. The question of abortion is a
    question that is hotly contested in this country. Reasonable
    people of good conscience and good morals can disagree on the
    question, and they do. In every State in the union, there are
    sharp, passionate, emotional, personal disagreements on this
    issue that people rightly care very deeply about.
        That's precisely why the U.S. Supreme Court in Dobbs said
    an issue like this that divides the American people should be
    decided by the American people. It should not be nine unelected
    judges decreeing the rules for everyone to obey, but rather the
    voters should make those determinations.
        My Democrat colleagues are fond of beating their breast and
    saying we must defend democracy except when the voters vote for
    things they dislike. As long as the voters cooperate and vote
    for a left-wing Democrat agenda, they like democracy in that
    instance. If they ever vote for anything to the contrary, few
    things horrify my Democrat colleagues more than actual
    democracy.
        What is the State of law in America right now? Each State
    determines what the rules are that shall govern abortion, and
    the rules that they adopt reflect the values and mores of those
    citizens. We would expect the people of Texas to adopt
    different rules than the people of California. That is
    perfectly okay, and that is the beauty of our Federalist system
    that welcomes diversity.
        But here's the second proposition that is equally
    unassailable. The position of today's elected Democrats in
    Congress on abortion is wildly out of step with the American
    people. It is a radical proposition. Every Democrat in the
    Senate, every single one, has voted for legislation that would
    strike down every single common-sense restriction on abortion
    adopted by every State in America.
        The position of the Democrats is they would strike down
    every law, they would legalize abortion up until the very
    moment of birth. They would legalize partial birth abortion.
    They would strike down every law providing for parental
    notification or parental consent. If your daughter gets a
    tattoo or a piercing, a mom or dad has a right to know about
    that, but the Democrats would strike down a law that entitles
    the parents to know before an abortion is given to their
    daughter.
        The position of the Democrats is not a mainstream position.
    Indeed, national polling shows roughly 9 percent of Americans
    agree with that position. Ninety-one percent of Americans
    disagree with the position of every single elected Democrat in
    this body. Understand, I'm not ascribing that view to them.
    They have voted for legislation that would strike down those
    common-sense restrictions.
        And that leads to the third proposition that is
    indisputable. IVF is fully protected in law. It should be fully
    protected in law, and it'll remain 100 percent fully protected
    in law. Every Democrat knows that. Out of 100 Senators, 100
    Senators in this body support IVF treatments. I strongly
    support IVF treatments.
        In fact, the State of Texas IVF treatments are protected in
    law. And in fact, since 1987, Texas has mandated IVF coverage
    for many group health insurance plans. The Democrats know this.
    It's a lot of focus on the Alabama Supreme Court decision. The
    Alabama Supreme Court decision was not a decision striking down
    IVF.
        In fact, it was a case brought by parents seeking IVF
    against a clinic that had negligently cared for the embryos. It
    was a decision in defense of preserving IVF, but a whole lot of
    partisan elected officials and a whole lot of partisans in the
    media immediately seized on that decision to say, aha, IVF will
    be struck down. Well, I will say the State of Alabama acted
    promptly, bright red. Ruby red Alabama acted promptly to say,
    no, IVF is protected.
        Right now today, roughly 2 percent of live births are
    brought into the world through IVF. IVF is a wonderful gift
    that lets parents who want to welcome a son or daughter, a
    child to love, lets them welcome that child into the world. But
    understand why we're having a hearing on IVF, not because
    there's any threat to IVF, but because the Democrats cannot
    defend their position on abortion. They have not convened a
    hearing on whether the country should adopt the Democrat
    position and allow partial birth abortion in all 50 States.
    That is their position, but it's wildly unpopular.
        So, for any mom or dad at home looking to have a child
    through IVF, understand IVF is 100 percent protected in law. It
    should be, it'll be, I strongly support it. And so does every
    other Member of this body.
        Chair Durbin. Senator Klobuchar.
        Senator Klobuchar. Thank you very much, Chairman. I think
    I'm going to ask some experts questions here. Ms. Rivera, in
    June, the Supreme Court shredded nearly five decades of
    precedent protecting June of 22, protecting a woman's right to
    make her own healthcare decisions. What has happened? Governors
    race to the State capitals in certain States to pass laws that
    completely restricted a woman's right to make her own
    decisions, leaving it to politicians.
        Now, 21 States we have seen bans, partial bans, you name
    it. Can you talk about the chaos and cruelty the Dobbs decision
    has unleashed?
        Ms. Rivera. Thank you, Senator. We are experiencing an
    American dystopia with abortion bans preventing people from
    getting access to care as early as they need it where they
    live. And so, for those who can, they have to travel hundreds
    of mines, and there are many people who can't. So, they're not
    getting access.
        Women's and pregnant people's obstetric crises are not
    getting the standard of care because doctors fear getting
    arrested and going to jail like in Texas for a hundred years.
    So, this is the kind of landscape, and the backdrop of this is
    the U.S.s' internal mortality rate that exceeds that of other
    industrialized nations. And criminalization contributes to that
    disparity, contributes to poor maternal and infant health
    outcomes.
        Senator Klobuchar. Thank you for bringing up some of these
    other problems that have been spawned by this. I would say one
    of them is the fact that we're starting to see less people
    going into OB-GYN. Dr. Dennard as of last year, both the number
    of OB-GYN medical students applying to residencies in States
    with abortion bans dropped by over 10 percent. Dr. Dennard, as
    both a practicing OB-GYN and a woman who sought abortion care
    in a State with strict abortion laws, how do you think these
    restrictions harm both patients and providers?
        Dr. Dennard. Thank you for that question. I love Texas. My
    family's there. I love practicing medicine, but it is becoming
    so difficult to do so in my State. There are, as you said,
    residents who are choosing to move, medical students who are
    choosing not to match to programs in my State, and it's causing
    incredible health crisis for pregnant people.
        I'd like to also comment on what Dr. Wubbenhorst had said
    previously. She mentioned how dangerous abortion is. Abortion
    is not dangerous. Abortion is safe, and abortion is essential
    healthcare. What is really dangerous is pregnancy, and
    especially pregnancy without access to abortion care. Medical
    situations are complicated. There is an art to practicing
    medicine. This is not a black or white issue. It's not a yes or
    no answer. We need to be able to take care of women in each and
    individual situation.
        Senator Klobuchar. Okay. Ms. Rivera, on Tuesday, the
    Supreme Court will hear oral arguments in the Texas medication
    abortion case. As you know, this is about mifepristone. We know
    that this drug is safe. American Medical Association has stated
    that, ``There is no evidence that people are harmed by having
    access to this safe and effective medication.'' It's been on
    the market for within two decades. In 2023, it accounted for 63
    percent of all abortions in the U.S. It's been approved in
    dozens and dozens of countries. How would a decision whereby
    justices on the Supreme Court second guess scientists and
    experts at the FDA impact women throughout the United States,
    and really, how has the Texas decision already impacted them?
        Ms. Rivera. Thank you, Senator. Well, luckily the Supreme
    Court has maintained the status quo----
        Senator Klobuchar. Yes.
        Ms. Rivera [continuing]. Until the case is heard or
    decided. It would have a devastating impact on access to care,
    quality of care, and reproductive health outcomes if medication
    abortion is scaled back, which is what this case could result
    in even in States where abortion is accessible and legal. So,
    this basically would have national impact on abortion care as
    well as the reproductive health status of pregnant people.
        Senator Klobuchar. Just a last question to respond to some
    of what Senator Cruz has said. We'd be here for quite a while
    if you were to respond to all of it. But could you respond to
    the fact that, in fact, the Alabama Supreme Court did cite the
    Dobbs decision and that cases like this in other areas have
    been unleashed since that decision came out from the U.S.
    Supreme Court?
        Ms. Rivera. Absolutely. So, while the Dobbs decision, its
    holding, did not rely on fetal personhood, but it basically
    opened the door and invited States to define embryos, fetuses,
    and fertilize eggs as persons if they so choose. And so Alabama
    cited to the Dobbs decision in making and redefining child to
    include a frozen embryo.
        And so, I think this is the tip of the iceberg. There are
    11 States with broad fetal personhood laws that have yet to be
    interpreted, and so I think this is the tip of the iceberg. And
    the legislation that Alabama adopted, as I said, it could be
    temporary, and it's very narrow, and it may not survive the
    next challenge when somebody takes it up to the State Supreme
    Court again.
        Senator Klobuchar. Thank you. And I think it's one of the
    reasons so many of us are devoted to codified Roe v. Wade into
    law which, of course, does allow for restrictions as the case
    had in the third trimester as long as the women's health and
    life is protected. So that, again, something in response to
    something Senator Cruz said.
        But it's very, very important that we do this for the
    Nation and not have a patchwork of laws across our country for
    IVF, for mifepristone, or any of the issues we've discussed
    here today. And that's my last question. Just one answer. Would
    you agree?
        Ms. Rivera. Absolutely. And there's been a lot of
    mischaracterization today about the Women's Health Protection
    Act.
        Senator Klobuchar. Thank you.
        Chair Durbin. Thank you, Senator Klobuchar. Senator
    Blumenthal.
        Senator Blumenthal. Thanks, Mr. Chairman. When I first
    introduced the Women's Health Protection Act, now about 12
    years ago, we never thought we would be here. We never thought
    that Roe v. Wade would be overturned. We never thought that IVF
    would be under threat. We never thought that speeches would be
    made like Senator Cruz telling us that everything's okay with
    IVF. No reason to worry because the State of Texas protects
    IVF.
        Well, here we are, Dobbs has overturned Roe v. Wade, and
    for reasons that you've just described so forcefully, Dobbs has
    opened the door to a panoply of evils. It has unleashed from
    that Pandora's box, a collection of threats to women's
    reproductive rights.
        I would like you to comment on why those kinds of State
    laws that Senator Cruz referred to, whether it's Texas or
    elsewhere, fertility treatment protection laws, and the Alabama
    statute that you mentioned are really inadequate to protect
    those rights. Building on the question that Senator Klobuchar
    just asked you.
        Ms. Rivera. Thank you, Senator Blumenthal. I think we have
    to step back and look at the bigger picture here. The
    overarching goal here is to establish fetal personhood under
    the 14th Amendment of the Constitution. I think that is the
    real danger. And all of these laws that recognize legal rights
    for embryos, and fetuses, and fertilized eggs in State law are
    paving the path to that.
        And all of these services are in danger because if you
    believe a fertilized egg is legally a person with all the same
    rights as everybody here in this room, then it endangers IVF
    contraception and any medical care that would ``endanger'' that
    fertilized egg, embryo, or fetus, including people who are
    begging to have their humanity, their healthcare needs met, and
    saving their bodily organs and lives in emergency rooms because
    their health is deteriorating.
        The other case being considered by the Supreme Court is the
    EMTALA challenge, which the Federal EMTALA statute is meant to
    prevent people's health from deteriorating. But what Idaho is
    arguing that their State law should override EMTALA until
    somebody's health has deteriorated to be staring death in the
    face before they can get access to healthcare.
        Senator Blumenthal. And the Women's Health Protection Act
    would provide a guarantee of rights against those State laws,
    personhood laws, restrictions on clinics, and whatever other
    kinds of inadequate conditions are placed on the exercise of
    these reproductive health rights. Would it not?
        Ms. Rivera. Yes. And I also want to correct some
    mischaracterizations about the Women's Health Protection Act.
    What the Women's Health Protection Act would do is it would
    establish a national floor for access, because what had been
    happening for over years and years are layers upon layers upon
    layers of restrictions to shut down abortion clinics and
    abortion health providers. So the Women's Health Protection Act
    would restore that access.
        Senator Blumenthal. And there's nothing about the Women's
    Health Protection Act that requires anybody to be in favor of
    abortion or seek an abortion. Correct?
        Ms. Rivera. Absolutely not.
        Senator Blumenthal. And there's nothing in it that requires
    someone to engage in IVF?
        Ms. Rivera. Absolutely not. The point is that individuals
    should be able to make their own reproductive healthcare
    decisions.
        Senator Blumenthal. Dr. Dennard, you said I think that
    what's dangerous is not pregnancy, but the lack of access to
    abortion where a woman chooses to have it. And I guess the way
    I'd put it is what's really dangerous is lack of access to
    healthcare, because abortion is a form of healthcare. And I
    think that when we recognize that reproductive rights are
    women's rights, are human rights, are healthcare rights, we
    have a frame to protect these rights from the kinds of
    deceptive and misleading attacks on them. Would you agree?
        Dr. Dennard. Absolutely. I would agree with what you're
    saying.
        Senator Blumental. Thank you.
        Dr. Dennard. I've been pregnant six times and I have three
    children. That is because the road to becoming a parent is not
    always straightforward. Every person's journey to becoming a
    parent is different. There are lots of twists and turns. I've
    had abortions, I've had miscarriages, and I have three healthy
    children. And in order to have those three healthy children, I
    needed access to, as you describe, basic medical care. And
    that's what my patients need. That's what I need to be able to
    provide them good care.
        Senator Blumenthal. Thank you. Thanks, Mr. Chairman.
        Chair Durbin. Senator Hirono.
        Senator Hirono. Thank you, Mr. Chairman. One of the reasons
    that I was very much awakened to politics as a way to support
    social changes was on the issue of abortion. I was in college
    when the State legislature in Hawaii took up the issue of
    abortion rights. And in fact, the State of Hawaii was the first
    State to decriminalize abortion before Roe v. Wade.
        This is an issue that is very fundamental. What could be
    more fundamental than a person's right to control her own body
    and to make decisions relating to her body? What could be more
    invasive than to force us to have babies? I can't think of a
    similar thing that we do basically to men that is as invasive
    as a bunch of politicians saying to a male person, you have to
    do this. I can't think of an instance. And yet, something as
    invasive and fundamental as a woman's right to control her own
    body is under assault.
        So here comes Dobbs. I never thought I'd live to see the
    day when we have a Supreme Court majority that just summarily
    decides that something that I had taken as a constitutional
    right for almost 50 years, a constitutional right, where they
    just say, well, it's no longer a constitutional right. What
    kind of Supreme Court is that if the ultimate arbiters of what
    is constitutional or not constitutional decides that this
    right, that I had for almost 50 years no longer exists, and you
    leave it to the politicians in each State to make that
    decision.
        I have no words to express what an assault this is on women
    in our country to force us to have babies. And now even for the
    women who want to have babies, IVF is under assault. So I say,
    if you don't support abortion, don't get one, but leave the
    rest of us alone.
        There are good-hearted people, fair-minded people on both
    sides of the abortion issue. I acknowledge that. And that is
    why it should never be a decision that is left up to a bunch of
    politicians. It's a decision that is so personal and so
    fundamental that it should be left to the person, individual,
    and her doctor if she so chooses.
        So, the ripple effects of Dobbs never ending, and we know
    that already people are making decisions as to what States
    they're going to live in, because if they live in one of the
    many States that that criminalize abortion, they have to travel
    out of State to get the kind of reproductive healthcare that
    they need. And not all women, or not all families have that
    capability.
        So once again, like the, so-called right to abortion. If
    you were a poor person that lived in a State that did not
    provide funding or Medicaid abortions, you're pretty much out
    of luck. Hawaii was one of the few States that provided, that
    paid for Medicaid abortions because that is a constitutional
    right if that right to be exercised depending on your economic
    situation.
        So, we now have the circumstance where after Dobbs
    individuals have to travel out of State to get their abortion
    care and other reproductive care that they need. And don't tell
    me that IVF is legal everywhere. So why did Alabama have to
    pass a law that so-called legalizes IVF in that State? And even
    that is not protective enough, because if I were a clinic
    providing IVF care, I would definitely not want to take the
    chance that that Alabama law is going to protect me.
        Just as in Texas, their law protects the--if the life of a
    woman is endangered, she can get an abortion. Oh, really? I
    don't think that's the case because what doctors or providers
    are going to take the chance that maybe they did not determine
    that correctly, and that they have to wait till the woman is
    practically on deaths door in order to deem the protection of
    her life to be one that would enable her to get an abortion.
        So, you know, the Dobbs decision has so much negative
    effects. Mifepristone. Oh yes, we have a Supreme Court that is
    about to determine whether or not a medication that more than
    half of people resort to legally in order to have an abortion.
    That could very well be banned because we have a Supreme Court
    that seems perfectly willing to just eliminate what was deemed
    a 50-year constitutional right.
        So I came down to who's going to make the decision on
    whether or not a woman has a right to make reproductive
    decisions, bodily autonomy. Is it the woman, or should it be a
    bunch of us, or State legislators? It is so clear to me who
    should have that decisionmaking. And all of these bills, all of
    these efforts, and all of these ways that--and really to say
    that this is an issue that good-hearted and right-minded people
    have very--you know, they come to different conclusions. And I
    say that's right, and that is why we should have bodily
    autonomy.
        If you don't support abortion, don't get one. Leave the
    rest of us alone. Thank you, Mr. Chairman.
        Chair Durbin. Thanks, Senator Hirono. Senator Booker.
        Senator Booker. Thank you, Mr. Chairman. Ms. Rivera, Dobbs
    has really created this patchwork of laws all across the
    country that make it very difficult for people to access what
    is really important in terms of their healthcare. But on IVF in
    particular, it's created real challenges on sort of this
    patchwork on affecting women depending on where they live. Can
    you discuss that for a minute for me and let me know more
    specifically what's that doing to the profession as a whole?
        Ms. Rivera. Thank you, Senator. I think, you know, the
    Alabama situation is the tip of the iceberg, and we'll have to
    see how the rest of it plays out. There are these 11 States
    with very broad fetal personhood laws. They haven't yet been
    fully enforced.
        So, we'll have to see what challenges are brought, what
    those State Supreme Courts decide, but that's the point.
    Senator Hirono has a point, right? What's happening is that
    it's been kind of left to the States to decide--women's
    fundamental freedoms are being left to be decided State by
    State.
        Senator Booker. Let me just drill in for this for a second,
    because many people don't realize that this insecurity or
    uncertainty is affecting women's access to reproductive care.
        Ms. Rivera. Yes.
        Senator Booker. And so, let's be very specific. Are there,
    yes or no, doctors, OB-GYNs leaving certain States to go to
    other states, leaving these holes in the kind of care that
    individuals can get, that women can get in their communities?
        Ms. Rivera. Yes. One of the impacts in the post-Dobbs
    environment is that OB-GYNs that are leaving States in areas
    that are already extremely underserved. So, there are
    increasing OB-GYN deserts that's happening.
        Senator Booker. And are those in wealthy communities? What
    are those communities look like that these deserts exist?
        Ms. Rivera. Is that disproportionate impact is in
    communities of color, let's be very clear. In rural areas, in
    communities of color who already have trouble accessing
    appropriate reproductive healthcare. So and this, all of this,
    we are going to have to watch the maternal mortality rate very
    carefully and who it's going to be impacting, because I think
    it's going to be increasing over time. It already is
    increasing. And for the first time in 2021, Latinas had high
    maternal mortality rates than White women.
        Senator Booker. And so let's just, I mean, jump into the
    outrage of this. The United States of America has one of the
    highest maternal mortality rates writ large of other industrial
    nations. Correct?
        Ms. Rivera. That is correct.
        Senator Booker. And that's for the whole country. But when
    you start looking at it by race, you see for African American
    women that there is almost a four times higher maternal
    mortality rate. And what you're saying right now that these
    laws that are creating this patchwork are further exacerbating
    the access to maternal healthcare of African American women and
    low-income women.
        Ms. Rivera. That is correct, and I'll say two more things.
    One is that there's a big overlap in the worst maternal
    mortality and infant mortality rates with abortion ban States.
    And second, that criminalization of pregnancy contributes to
    these poor health outcomes because it deters people from
    accessing care.
        Senator Booker. And so, Black women who are most at risk in
    dying for a childbirth, Black women who are most at risk for
    having low birth weight babies, Black women who are most likely
    to have fetal deaths in giving birth are now being put in a
    situation where their lives are greater at risk, where their
    babies are at greater risk, where their long-term healthcare is
    at greater risk because of all of these laws that are being
    passed that are restricting access to not just maternal care,
    but even to OB-GYNs in the first place.
        Ms. Rivera. Let me put it this way. Black women in this
    country are the ones most likely to be staring death in the
    face during pregnancy. And so, it's so important and critical
    for them to be able and be in the driver's seat, to be making
    their own reproductive healthcare decisions.
        Senator Booker. And this is the last point. The outrage is
    that a lot of these laws, the women that are both most being
    scrutinized over miscarriages, the women that are being more
    scrutinized over the idea that their lives are threatened
    because of their pregnancy, you see disproportionately, is it
    true or not, that these are African American women and low-
    income women.
        Ms. Rivera. So, on the criminalization of pregnancy Black
    women are certainly overrepresented in the number of people who
    are being charged with crimes. But the biggest impact--we
    actually have more poor White women who are being charged and
    arrested for supposed harm to fetuses. So, this is also a
    situation of poverty, right, of who is poor and who is a person
    of color.
        Senator Booker. So, people of color, low-income women, poor
    women----
        Ms. Rivera. Yes.
        Senator Booker [continuing]. Are facing the brunt of these
    laws that are often ending up putting their lives, their
    health, and their well-being, greater at risk, and also putting
    them at greater risk for low-birth-weight babies, fetal deaths,
    as well as maternal mortality?
        Ms. Rivera. That is correct, and also being criminalized
    and put in prison.
        Senator Booker. Thank you, Mr. Chairman.
        Chair Durbin. Thank you, Senator Booker. Senator Padilla.
        Senator Padilla. Thank you, Mr. Chair. I do have at least
    one a question I'd like to get to, but first thing I want to do
    is associate myself with Senator Booker's comments, line of
    questioning on the equity, racial and otherwise element of this
    important conversation.
        And second, Mr. Chairman, I can't help but feel the need to
    respond to some of the comments I heard earlier from Republican
    Members of this Committee. So let me clarify that first of all,
    Democrats are not trying to deflect here. We're not trying to
    mislead here. We're trying to stand up for what's right, and
    what stood as a right for half a century in the United States
    of America. And we're not afraid of democracy. You want to hear
    who's afraid of democracy? Those who were more than just
    disappointed by the outcomes of elections in a number of
    States.
        Folks, this question has been on the ballot since the Dobbs
    decision. Questions put before voters whether or not to make
    access to reproductive healthcare more restricted or to
    strengthen access. And State after State, the public has sided
    with more access, not just in the State of California, which is
    considered, oh, it's a deep blue State. I'm talking States like
    Virginia and Michigan, very purple States by some people's
    measure, but also States like Missouri, Ohio, Kentucky.
        So we're not afraid of democracy, but we do believe that
    there are some issues that rise to the level that warrant
    national Federal protections. It would be wrong to suggest that
    there shouldn't be any for the whole country and just let each
    State do what they want.
        Now, I do believe that some of our colleagues who would
    like to leave a question of things like marriage equality to
    the States, and we shouldn't have Federal protections. We
    should, and we do. I'm sure there's some of my colleagues who
    would rather return the question of interracial marriage to the
    States, and we shouldn't have Federal protections. We should,
    and we do. So, I'm sure there's some of my colleagues who think
    there shouldn't be Federal protections for our fundamental
    right to vote out. We should, and we kind of do. That's some
    unfinished business, but that may be a topic for a hearing on
    another day.
        And the question of Alabama, the way we have portrayed the
    decision by the Alabama Supreme Court relative to IVF is
    actually right on point. It's why former President Trump has
    tried so quickly to distance himself from that decision. And
    when people call--Republicans called on the Alabama legislature
    to respond to it.
        And my colleague on this Committee says, well, you are
    wrong, you're wrong, you're wrong, but it should be fixed and
    it will be fixed. You can't have it both ways. It was right.
    Or, it's wrong. Clearly, the Alabama Supreme Court got it
    wrong, and the Alabama legislature was put in the position of
    having to rectify.
        Now, to today's hearing. Since the decision by the Supreme
    Court to overturn Roe v. Wade, thousands of women have been
    forced to travel outside of their home State, sometimes
    hundreds of miles to access the reproductive healthcare that
    they need.
        California's among several States, that has seen a
    significant rise in out of State women seeking essential care.
    And it's more critical now than ever that all women are able to
    freely travel to access the reproductive healthcare that they
    need.
        It's equally important to ensure that States like
    California also are supported with the adequate resources to
    provide women with that quality care regardless of where they
    come from.
        Ms. Rivera, we keep turning to you for your tremendous
    perspective and expertise here. How has the influx of out-of-
    state women seeking care impacted healthcare systems in States
    like California where abortion remains legal?
        Ms. Rivera. Thank you for your question, Senator. So,
    States like California, a number of States have really stepped
    up and expanded access to abortion care because of the
    anticipation that more people will need it, which is great.
        On the other hand, it strained those systems in the State
    so people inside those States have longer waiting periods, for
    example because it's harder to get an appointment because of
    the influx of people from other States. So, on one hand, it is
    great that States like California are able to serve people
    coming from out of State, and at the same time, it really is
    taxing the health system in in your State.
        Senator Padilla. Okay. Thank you very much. Thank you, Mr.
    Chair.
        Chair Durbin. Thanks, Senator Padilla. Senator Welch.
        Senator Welch. Thank you, Mr. Chairman. I want to thank the
    witnesses. Just to comment about this decision by the Supreme
    Court in Dobbs, which I think was profoundly cynical based on
    ``originalism'' and that's in the mind of the Supreme Court
    Justices who wanted to overturn what had been settled doctrine.
        And the second thing, so disturbing about this, and I'm
    sorry, Senator Cruz isn't here, the idea that the privacy
    rights that were enshrined in Roe v. Wade, that value that we
    placed constitutionally uncertain realms of decisionmaking that
    belonged to the individual person is challenged, and then is
    turned over to a political process.
        Senator Hirono said it best, you make your own decision.
    You respect the decision another person makes because that's
    her, right? That's all upside down now, and it's unleashed this
    whirlwind where States are having bans from the moment of
    conception where a personhood of--where IVF is threatened,
    where every right that we've had is thrown into turmoil.
        And it's all on the basis of the Supreme Court rejecting
    the notion that there are certain spheres where it is the
    individual who has the freedom to make the decision that is
    best for her and not impose her decision on others and will
    reap in the whirlwind.
        And I just want to express to you, Ms. Heard, thank you so
    much for coming in. I can't believe what you went through, and
    you and your husband, in the effort to create a family. And my
    apologies to you that your court has done to you what it did.
        I do want to ask a question, just on a practical level,
    about what's the implication on the cost to a family who wants
    to have IVF. Ms. Rivera, could you talk about that? What's the
    implication here about an already expensive procedure? What's
    it going to cost a family, like the Heard family, if they want
    to do this?
        Ms. Rivera. I am not an expert on this, Senator Welch, but
    I can tell you that anything that makes it harder for an
    already emotionally and physically taxing process where people
    have out-of-pocket costs, depending on insurance coverage, for
    example. And timing is everything from what I understand with
    IVF, and anything that makes it more difficult just creates
    enormous barriers.
        Senator Welch. Okay. And, Doctor, I want to give you a
    chance to respond to some of the questions that Senator Cruz
    was asking about late-term abortion. And my understanding is
    that late-term abortions are very rare, and it's almost always,
    really, probably always where there's a medical emergency and
    the life of the woman is imperiled.
        And if we as U.S. Senate try to figure out what should be
    done in that moment, in circumstances that we know nothing
    about, that's going to jeopardize, in my view, very much the
    life of the mother. Now, can you speak about the agony of the
    decision that has to be made and what the considerations are?
        Dr. Dennard. Of course, and thank you for that question.
    Like I've said before, medicine is not black and white. It's
    not straightforward, and abortion access and the ability for an
    individual to receive an abortion is basic healthcare and
    medical care.
        I invite you, Senator Welch, or Senator Cruz, if he wants
    to come back, to follow me around in the hospital and really
    see what it's like to take care of patients, and to see what it
    could potentially be like to try to have an exception for a
    patient who's critically ill, what that really looks like,
    because I haven't seen it work yet. I've seen patients on
    mechanical ventilation, patients who have active cancer,
    patients who are extremely ill, none of them have received
    abortions, they've remained pregnant.
        So, the whole idea of--I don't even know what a late-term
    abortion is, to be quite honest. The vast majority of abortions
    occur in the first trimester, but that's not really the point.
    The point is that it needs to be a decision for an individual
    after shared decisionmaking and good counseling by a provider
    so that they can make the best decision for themselves.
        Senator Welch. Thank you very much. I yield back.
        Chair Durbin. I want to thank the panel. I have two things
    I'd like to raise, and you've been very patient to this point.
    But going back to Senator Cruz's statements, I listened to him,
    and then I read some information given to me by my staff. What
    are the reasons for really late-term abortions? Well, there are
    three, and the information I'm reading from comes from the
    Center for Disease Control.
        ``Why Women need access to abortion; latent pregnancy,
    maternal health, endangerment, diagnosis of severe fetal
    abnormality which didn't show up or develop until late in the
    pregnancy, restrictive State laws that made it difficult for a
    woman to get an abortion early in her pregnancy.''
        And we're talking about 1 percent of all abortions. I do
    politics for a living. So, if you want to make your case, you
    make it in the extreme. ``The day before she gave birth.''
    Should she get an abortion then because she didn't like the
    gender of the baby that's going to be born? That was one of the
    examples that was used by one of the Senators here. And you
    think to yourself, does that really happen? Could it happen?
    Well, it might, in the extreme case, in the exceptional case.
        What they're really getting to is they don't trust the
    woman to make the decision. Implicit in that statement is the
    notion they're going to get it wrong, or they're going to do
    something stupid and this innocent baby that might've been born
    is not going to be born. It hardly ever happens, and the
    reasons are set out by the CDC in extreme cases.
        And I trust women a lot more than I trust the politicians
    of Alabama or even Illinois to make that same decision for that
    woman. I think that's the bottom line is as far as the late-
    term is concerned.
        And the other thing, you look at the bills that many of my
    Republican colleagues have on the subject of abortion, and many
    of them have exceptions for IVF. They say so when they come to
    the Committee hearing. We're not arguing about IVF. We have
    difference of opinion on abortion.
        Here's the fundamental problem I see. If you believe that
    life begins at the moment of conception, if that is your
    premise for your policy and your law, how are you going to
    explain IVF? Because at the end of the day, there are going to
    be embryos that are not implanted and something has to happen
    to them. And if they're treated as humans, persons, whatever
    you characterize them as they worried about in Alabama, you're
    drawn to one conclusion.
        If you think that life begins at the moment of conception,
    you have to do something to protect that embryo. But I have to
    tell you, I don't believe that. I don't believe that is the
    premise that we should start off on because it takes us to a
    place that is impossible to live with. As far as I'm concerned
    with the extraordinary circumstances that face many people.
        I hope that there will be some people as a result of this
    hearing who will think a little bit more on the subject. I will
    certainly think a little bit more. We had an excellent turnout
    by the Committee because the issue is not only topical, but
    it's real, and it's human, and we all know somebody like Ms.
    Heard, whose life has been positively impacted by IVF. Thank
    you so much for bringing your experience to it, and thanks to
    all the witnesses.
        The hearing will remain open for 1 week for submission of
    additional materials for the record. And with that, the hearing
    is adjourned.
        [Whereupon, at 5:01 p.m., the hearing was adjourned.]
        [Additional material submitted for the record follows.]
        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                A P P E N D I X

    The following submissions are available at:

      https://www.govinfo.gov/content/pkg/CHRG-118shrg58675/pdf/CHRG-
        118shrg
        58675-add1.pdf

    Submitted by Chair Durbin:

     American Society for Reproductive Medicine (ASRM), statement.....     3

     Disability Rights Amicus in Z-v-TX-11-23, court document.........    12

     Guttmacher Institute, testimony..................................    61

     Manian, Professor Maya, testimony................................    64

     Mutcherson, Kimberly, testimony..................................    76

     Planned Parenthood (PPFA), statement.............................    88

     Reproductive Freedom for All, statement..........................    91

     RESOLVE, The National Infertility Association....................    95

     Ziegler, testimony...............................................    97

    Submitted by Ranking Member Graham:

     The Abortion Absolutist, The Atlantic, article...................   109

     Abortion and Maternal Mortality..................................   128

     Addressing the U.S. Maternal Mortality Crisis, On Women's Health.   140

     Brief of Biologists as Amici Curiae in Support of Neither Party..   186

     Embryo Ethics....................................................   237

     Guttmacher Institute, Is Pregnancy Really Normal?................   251

     HEINONLINE, The Scientific Consensus on When a Human's Life
        Begins........................................................   258

     Hyde-Smith, Senator Cindy, objection.............................   273

     Life Begins at Fertilization with the Embryo's Conception........   274

     Mode of Delivery After a Previous Cesarean Birth, and Associated
        Maternal and Neonatal Morbidity...............................   276

     MDs Not Practicing in Pro Life States............................   285

     Morbidity associated with cesarean delivery in the United States:
        Is placenta accreta an increasingly important contributor?....   290

     No, Maternal Mortality Did not Spike in Texas after Funding Cuts
        to Abortion Clinics, The Washington Post......................   301

     2024 NRMP--Main Match Results by State Specialty and App-Type....   305

     Perceiving and Addressing the Pervasive Racial Disparity in
        Abortion......................................................   323
     Systematic Review, The maternal mortality myth in the context of
        legalized abortion............................................   327

     Trends in Maternal Mortality and Severe Maternal Morbidity During
        Delivery, Related Hospitalizations in the United States, 2008-
        2021..........................................................   340

     When Does Human Life Begin? The Scientific Evidence and
        Terminology Revisited.........................................   356

     Why We Need Federal Limits on Late Abortion to Protect Both
        Mother and Child..............................................   394

     Worldwide Decline of IVF Birth Rates.............................   401

     Wubbenhorst, Dr. Monique, Amendment to Written Testimony.........   408

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