Dr. Jennifer Villavicencio

On December 31, our state’s six-year ban on medication abortion via telemedicine is set to expire. At least it was, until two weeks ago, when a Michigan Senate committee heard testimony on SB 1198, a bill to make this medically unsound ban permanent. The bill’s proponents announced a hearing on the bill with less than an hour’s notice, excluding experts from the medical community from testifying. The only witness to present before the committee represented an anti-choice lobbying group. A little more than 24 hours later, SB 1198 passed the full state Senate. The House followed the Senate’s lead, rushing the bill through committee and to a full vote as soon as process allowed.

I am a practicing OBGYN in Michigan, an abortion care provider, and a regional leader in the American College of Obstetricians and Gynecologists (ACOG). After being excluded from the surprise Senate hearing, I was resolved to do everything in my power to make my voice heard in the House and cleared my schedule to testify. But legislators again eluded me by moving the hearing up 24 hours, when I was out of town for work. After much scrambling, one of my colleagues was able to rearrange her professional and personal commitments to go in my place. Ob-gyns spend eight years training—the House Health Policy Committee allotted 2 minutes for her speak.

Abortion, like pap smears, and prenatal care, is essential healthcare. Legislating the practice of medicine with no regard for input from medical experts, who know the science and who care for patients, is dangerously irresponsible policymaking. Michigan’s legislature made no time for substantive expert testimony, so instead I will outline what my testimony would have been here.

What is medication abortion?

I would have begun by explaining that medication abortion is the use of medications, not a procedure, to end an early pregnancy. I would have described that telemedicine allows a doctor to dispense the pills remotely, usually over video or phone conference.

I would have clarified that, contrary to anti-abortion rhetoric, the safety of medication abortion via telemedicine has been established repeatedly. I would have cited findings from peer-reviewed studies, including a study that found no differences in the outcomes of nearly 20,000 patients treated in person or via telemedicine; or the study that evaluated telemedicine abortion data from across the country and found no difference in safe outcomes by region, and that women overwhelmingly reported satisfaction with their experience. Given the chance, I would have noted that numerous organizations including the National Academies of Science, Engineering and Medicine, the American Medical Association and my own professional organization, ACOG, affirmed the safety and efficacy of medication abortion.

I would have made it clear that the medical community is deliberate and comprehensive when determining whether any health care delivery method is safe and using telemedicine for medication abortion is no different.

Rural Michiganders need this option

If asked about why access to telemedicine services is important to my patients, I would have explained that pregnancy is a time-sensitive period in a woman’s life and timely access to care, regardless of her decision to continue the pregnancy or not, is essential. Telemedicine prevents delays in care, reducing risk of complications. I would have pointed out, that the benefit of telemedicine across Michigan, a state with many rural areas, is widely understood and supported in every other area of care. There is no medically supported reason to single out abortion care and deny my patients the benefits of these innovations.

To help them understand this in real terms, I would have told them the story of one of my patients. She’s a mother of three and lived in a rural area of the state that is an 8-hour drive from the clinic. When she needed an abortion, she stated a clear preference for a medication abortion, in order to be home with her family. But Michigan’s law prevented me from providing this care remotely, and by the time she arranged time off from work, childcare, and travel, her pregnancy had progressed too far to receive the medication abortion. Her preferences were not honored because of this medically unjustified ban.

Now, the state legislature will, of course, never hear my expert testimony explaining scientific evidence, standards of care, and patients’ experiences. The bill is on its way to Gov. Rick Snyder to sign. I urge him to listen to objective and expert clinical perspectives and veto this bill.

The best health care policy is evidence based and improves health care outcomes. This ban is neither. Elected officials need to listen to experts and stay out of the exam room.

Dr. Jennifer Villavicencio is an OBGYN in Ann Arbor.