Much has been written about abortion these past few years – especially since the reversal of Roe v Wade by the Supreme Court in 2022.
It is hard to imagine there could possibly be anything new in the abortion debate, however, with the legal efforts to curtail the availability of mifepristone and misoprostol, provider guidelines have emerged. The American College of Obstetricians and Gynecologists has dutifully come to the rescue with Committee Statement #13 entitled Self-Managed Abortion.
Apparently calling it DIY Abortion lacks the dignity ACOG so desperately strives to achieve.
In this official Committee Statement, the reality of today’s abortion landscape is presented. It is interesting, however, that neither the total number of abortions performed annually in this country (an estimated 1,038,000 in 2024) nor the estimated percentage (63% for clinician provided) of abortions attributable to pharmaceutical agents are presented as background in the statement. And of course, ACOG deftly deflects the known and previously presented risks (here and here) associated with these pharmaceutical abortifacients by ignoring them altogether and states – without supporting data – that “…the greatest risk of harm related to SMA [self-managed abortion] comes from the threat of criminalization.”
Further, in referencing a 2020 study, ACOG pointed out that “an estimated 7% of women in the United States will attempt to self-manage an abortion during their lifetime.”
In a subtle attempt to mollify and massage the known risks of DIY abortion, ACOG presents and discusses a “harm-reduction approach” to “reduce maternal morbidity and mortality related to SMA [self-managed abortion].” As presented, “a harm-reduction approach aims to reduce the negative consequences of a behavior when complete elimination of the behavior is not a realistic goal.”
The irony is too rich to ignore. Only a fool would think the greatest harm from a DIY abortion is criminalization rather than maternal mortality.
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But it gets worse
Committee Statement #13, in reality, is a roadmap for providers to assist women in avoiding criminalization.
Within the statement it reads:
“It is recommended to document only information that is necessary for the ongoing care of a patient. Health care professionals should consider whether it is imperative to document items such as the last menstrual period, which later could be used to corroborate a pregnancy…..Therefore, health care professionals should be thoughtful in determining what test are indicated in their evaluation of patients presenting for care. Tests that may be part of a ‘routine’ evaluation may not actually be necessary and could prove harmful.”
Any provider that chooses such a course of action truly places their patient at risk.
By not performing a “routine” ultrasound or repeated quantitated hCG tests (to assess for viability and the possibility of an ectopic pregnancy), a patient who presents to a health care provider with pain and or bleeding is placed in unnecessary and avoidable jeopardy.
ACOG concludes Committee Statement #13 by stating, “Rare medical complications should be managed as they would be in any case of spontaneous pregnancy loss.”
ACOG’s use of the word “rare” borders on cavalier. The Charlotte Lozier Institute has reported that “1 in 5 women will suffer a complication…and as many as 15% of women [undergoing a chemical abortion] will experience hemorrhage.”
Even though ACOG’s intent may not have been to suggest a provider’s documentation take on a creative flair, health care providers just might be tempted to document that their patient suffered a “spontaneous pregnancy loss” rather than the more accurate diagnosis of “incomplete abortion secondary to failed induced abortion.”
In any event, a self-managed abortion is hardly a spontaneous event.
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So what?
The intentional mis-documentation of a patient’s visit to the ER has been previously reported as have been the risks associated with such action.
Creative documentation by any health care provider is a risky course of action. A state’s board of medical examiners does not take such action lightly. Indeed, there are state statutes addressing such behavior. For example, Iowa Code 481-51.20(2)b “requires that a medical record be kept on every patient given treatment in the emergency service and establish the medical record documentation. The documentation should include, at a minimum, appropriate information regarding the medical screening provided.”
Elsewhere in the Iowa Code pertaining to “License discipline-criminal penalty” IC 148.6(2)a and f, it states, “The board may discipline a licensee who is guilty of any of the following acts:
a. knowingly making misleading, deceptive, untrue, or fraudulent representation in the practice of the physician’s profession…[and]…the committing by a physician of an act contrary to honesty.”
It is unfathomable that the American College of Obstetricians and Gynecologists would release a statement potentially putting a health care provider on a collision course with their state board of medical examiners and thereby risking a formal investigation and possible sanctions.
The depths to which ACOG will go clearly know no bounds. In another instance of profound irony, not only does a self-managed abortion impart to the patient a “great risk of harm” from criminalization, if the recommendations of Committee Statement #13 are followed by health care professionals, they, too, are at increased risk of criminalization from their state’s board of medical examiners.
But this issue truly goes beyond what is regulated by state statute. Has the medical profession fallen to such a level that deceit and lying is acceptable, that it’s just another day at the office?
Seemingly, it has.
Editor's note: Dr. Lloyd Holm is a retired OB/GYN and former President of the Iowa State Board of Health as well as the former Executive Director of a Pregnancy Resource Center in Wisconsin. A previous contributor to Pregnancy Help News, his writings have also appeared in The Federalist, The Omaha World-Herald, Obstetrics and Gynecology, the American Journal of Obstetrics and Gynecology, Iowa Medicine, The Female Patient, and the on-line networking platform for medical professionals, Doximity. He and his wife Gretchen live on an acreage in rural Iowa. This article is a Pregnancy Help News original.
