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[Senate Hearing 118-465]
[From the U.S. Government Publishing Office]

                                 ______

                                                        S. Hrg. 118-465
 
                    THE ASSAULT ON WOMEN'S FREEDOMS:
                     HOW ABORTION BANS HAVE CREATED
                        A HEALTH CARE NIGHTMARE
                             ACROSS AMERICA

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

                                HEARING

                                 OF THE

                    COMMITTEE ON HEALTH, EDUCATION,
                          LABOR, AND PENSIONS

                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             SECOND SESSION

                                   ON

  EXAMINING WOMEN'S FREEDOMS, FOCUSING ON ACCESS TO ABORTIONS ACROSS 
                                AMERICA

                               __________

                              JUNE 4, 2024

                               __________

 Printed for the use of the Committee on Health, Education, Labor, and 
                                Pensions
                                
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        Available via the World Wide Web: http://www.govinfo.gov
        
        
        
                          ______

             U.S. GOVERNMENT PUBLISHING OFFICE 
 57-241 PDF          WASHINGTON : 2024   
        
        
        
                 BERNIE SANDERS (I), Vermont, Chairman
PATTY MURRAY, Washington             BILL CASSIDY, M.D., Louisiana, 
ROBERT P. CASEY, JR., Pennsylvania       Ranking Member
TAMMY BALDWIN, Wisconsin             RAND PAUL, Kentucky
CHRISTOPHER S. MURPHY, Connecticut   SUSAN M. COLLINS, Maine
TIM KAINE, Virginia                  LISA MURKOWSKI, Alaska
MAGGIE HASSAN, New Hampshire         MIKE BRAUN, Indiana
TINA SMITH, Minnesota                ROGER MARSHALL, M.D., Kansas
BEN RAY LUJAN, New Mexico            MITT ROMNEY, Utah
JOHN HICKENLOOPER, Colorado          TOMMY TUBERVILLE, Alabama
ED MARKEY, Massachusetts             MARKWAYNE MULLIN, Oklahoma
                                     TED BUDD, North Carolina

                Warren Gunnels, Majority Staff Director
              Bill Dauster, Majority Deputy Staff Director
                Amanda Lincoln, Minority Staff Director
           Danielle Janowski, Minority Deputy Staff Director
                            C O N T E N T S

                              ----------                              

                               STATEMENTS

                         TUESDAY, JUNE 4, 2024

                                                                   Page

                           Committee Members

Sanders, Hon. Bernie, Chairman, Committee on Health, Education, 
  Labor, and Pensions, Opening statement.........................     1
Murray, Hon. Patty, U.S. Senator from the State of Washington, 
  Opening statement..............................................     2
Cassidy, Hon. Bill, Ranking Member, U.S. Senator from the State 
  of Louisiana, Opening statement................................     5

                               Witnesses

Anderson, Madysyn, Abortion Patient, Houston, TX.................     8
    Prepared statement...........................................    10
    Summary statement............................................    11
Verma, Nisha, M.D., MPH, Fellow, Physicians for Reproductive 
  Health, Atlanta, GA............................................    11
    Prepared statement...........................................    13
Lopez, Destiny, MPA, Acting co-CEO, Guttmacher Institute, 
  Washington, DC.................................................    15
    Prepared statement...........................................    16
    Summary statement............................................    18
Linton, Allison, M.D., MPH, Chief Medical Officer, Planned 
  Parenthood of Wisconsin and Fellow, Physicians for Reproductive 
  Health, Milwaukee, WI..........................................    18
    Prepared statement...........................................    20
    Summary statement............................................    22
Francis, Christina, M.D., Chief Executive Officer, American 
  Association of Pro-Life Obstetricians and Gynecologists, Fort 
  Wayne, IN......................................................    23
    Prepared statement...........................................    25
    Summary statement............................................    36
Ohden, Melissa, MSW, Founder and Chief Executive Officer, The 
  Abortion Survivors Network, Kansas City, MO....................    36
    Prepared statement...........................................    38
    Summary statement............................................    47

                          ADDITIONAL MATERIAL

Statements, articles, publications, letters, etc.
Murray, Hon. Patty:
    Clear and Growing Evidence That Dobbs Is Harming Reproductive 
      Health and Freedom, Guttmacher Institute...................    74
    In Our Own Voice, National Black Women's Reproductive Justice 
      Agenda.....................................................    79
    National Council of Jewish Women, Statement for the Record...    83
    National Partnership for Women & Families, Statement for the 
      Record.....................................................    85
    Power to Decide, Statement for the Record....................   103
    Reproductive Freedom for All, Statement for the Record.......   106
    The American College of Obstetricians and Gynecologists, 
      Statement for the Record...................................   110
Cassidy, Hon. Bill:
    Op-Ed written by Kelly Crawford, Founder & Executive Director 
      of Abel Speaks.............................................   114

                    THE ASSAULT ON WOMEN'S FREEDOMS:

                     HOW ABORTION BANS HAVE CREATED

                        A HEALTH CARE NIGHTMARE

                             ACROSS AMERICA

                              ----------                              

                         Tuesday, June 4, 2024

                                       U.S. Senate,
       Committee on Health, Education, Labor, and Pensions,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 10 a.m., in room 
216, Hart Senate Office Building, Hon. Bernie Sanders, Chairman 
of the Committee, presiding.

    Present: Senators Sanders [presiding], Murray, Casey, 
Baldwin, Murphy, Kaine, Hassan, Smith, Lujan, Hickenlooper, 
Markey, Cassidy, Murkowski, Marshall, Tuberville, Mullin, and 
Budd.

                  OPENING STATEMENT OF SENATOR SANDERS

    The Chair. The Senate Committee on Health Education, Labor, 
and Pensions will come to order. Two years ago, six Supreme 
Court justices all nominated by Republican Presidents, decided 
to overturn Roe v. Wade abolish the constitutional right for 
women to have an abortion and to give politicians in state 
government the right to control the bodies of women in state 
after state.

    This morning, we will be holding a hearing to take a hard 
look at how this Supreme Court decision, the Dobbs decision, 
has impacted women, physicians, and healthcare providers 
throughout our Country.

    In a few minutes, I am going to be handing the gavel as 
Chair of the Committee to Senator Patty Murray, because given 
the subject matter, I think it's appropriate for a woman to 
Chair this important hearing. And this is an issue that Senator 
Murray has been deeply and passionately involved in for many, 
many years.

    But before I hand the gavel over to Senator Murray, let me 
say a few words on a subject I feel very, very strongly about. 
It is no secret to anyone, that throughout our Country's 
history, women have had to fight for their basic human rights 
against all forms of patriarchy and sexism, no great secret.

    Women had to struggle and some died in order to achieve the 
right to vote, something which they did not receive until 1920. 
Women had to struggle for the right to get the education that 
they wanted. All over America, women wanted to go to this 
school, wanted to do that, couldn't get into the door, because 
they were women.

    Women had to struggle to get banks to lend them the money 
they needed to buy a car or start their own business. In fact, 
up to 1974, banks in America could legally refuse to issue a 
credit card to a woman simply because she was a woman.

    Women struggled to get to choose the careers they wanted. 
In the 1950's, it was legal for employers to fire women for the 
crime of getting married, to get fired because she chose to get 
married. Up until 1964 it was legal for employers in America to 
reject a job applicant, simply because the applicant was a 
woman.

    The struggle for equal pay, for equal work, continues to 
this day. In America today, women working full-time make just 
84 cents on the dollar compared to men. And on and on it goes, 
women struggling with their basic human rights.

    Then on January 22nd, 1973, after decades and decades of 
struggle, women in America finally won the right to control 
their own bodies, as a result of the Supreme Court decision in 
Roe v. Wade. No longer would state governments be able to tell 
women what they could or could not do with their own bodies.

    When we talk about the history of how all of these 
happened, let's not ignore the lack of political representation 
that women had.

    In 1987, not so many, many years ago, there were 2 women in 
the U.S. Senate and 98 men. Those are the folks all over this 
country who are making the decision. The truth is that men 
would not tolerate them being subject to government decisions 
regarding how they can control their own bodies.

    I am not aware of any state in this country that has ever 
restricted the right of a man to get Viagra or any other 
medication prescribed by a doctor. I'm not aware of any state 
in this country that has prevented a man from getting a 
vasectomy or any other medical procedure that men choose to get 
that has been approved by a doctor.

    We hear a lot of talk about freedom in this body, freedom 
to do what you want to do, and yet right now we are living at a 
time when half of our population or more has lost that freedom.

    By the way, when I talk about the right of women to be able 
to control their own bodies, it's not just me talking, it's 
what the American people believe, in poll after poll, in state 
election, after state election.

    People are saying, we may disagree politically, we may 
disagree on this or that issue, but very strongly, the American 
people believe it is women, not the government that has a right 
to control their own body.

    Senator Murray, the gavel is yours.

                  OPENING STATEMENT OF SENATOR MURRAY

    Senator Murray. [Presiding.] Chairman Sanders, thank you so 
much for your statement, and thank you for letting me Chair 
today's hearing on a topic that is deeply important to me. And 
I want to thank all of our witnesses for joining us here today.

    Today, we take a close accounting of the trauma Republicans 
are inflicting on women and families across our Country, and 
the damage they are doing to basic reproductive healthcare 
through their horrific anti-abortion crusade. The issue here is 
simple and it cuts to the core of American values. Freedom.

    Many women every day experience the joy of becoming 
pregnant and raising a family. They were able to make that 
decision for themselves, but no woman, no one should be dragged 
through a pregnancy against their will.

    But right now, in America, more than a third of women of 
reproductive age live in states where they essentially do not 
have the choice to end a pregnancy if they need to.

    Instead, Republicans have made the choice for them, with 
extreme abortion bans and cruel restrictions on access to care. 
With these policies, they have told women in no uncertain 
terms, you don't control your body, we do. That is horrifying. 
Think about what it means, what it really means to be told 
someone else can decide you have to stay pregnant no matter the 
circumstances.

    Think about how little power that gives a woman over her 
own life and her own health. And think about how much power 
that gives, not just politicians, but any man who knows he can 
get a woman pregnant, force her to stay pregnant so he can have 
control over her or even get revenge for the rest of her life.

    To every Republican who hopes this issue will go away or is 
hoping the post Dobbs reality will become settled, status quo. 
Listen, you never forget and you never just get used to someone 
else taking control of your body, your medical decisions, your 
plans for your family or your future.

    You never forget a politician rescinding your right to make 
decisions about something as personal as your own pregnancy, 
and imposing his will instead, especially when you live with 
the consequences every day. And the consequences of the post 
Dobbs abortion bans are so much broader and so much more 
devastating than any one story or hearing can ever do justice.

    There are stories that get a lot of attention that are 
shocking almost beyond belief. Stories of women denied care for 
a miscarriage because of abortion bans. Women turned away from 
hospitals because their doctor's hands were tied until they 
lost over half of their blood, until their husband found them 
unconscious, until the only option was an emergency 
hysterectomy or tragically until it was simply too late.

    Or stories of children, who can't get abortion care after 
being raped. Some kids may be able to get across state lines to 
get the care they need. Other children have been forced into 
motherhood by Republican politicians. One teenager delivered a 
baby while clutching a teddy bear.

    These nightmares are happening across our Country as a 
direct result of Republican abortion bans. And there are so 
many other stories that go untold.

    Women who do not want to be pregnant for whatever reason, 
maybe they can't afford to have another child right now. Maybe 
they are in an abusive relationship, maybe they just don't want 
a kid right now, period. But they are told by politicians, they 
have no say in the matter, not unless they have the time and 
resources, often thousands of dollars to travel in some cases, 
hundreds, and hundreds of miles.

    It is harrowing to think that we live in a reality where 
forced pregnancy has become so widespread and so rampant that 
only the most dystopian stories get national attention. But the 
stories of all the other women who were confronted by these 
bans, their pain, their heartbreak, their anger, and fears are 
also horrific, valid and an important part of the conversation. 
A forced pregnancy does not have to make headlines to make 
someone's life a living hell.

    Let's be clear about a few more things before we get 
started. Republican attacks are not only hurting people in the 
states where they banned abortion. They're not only hurting 
women who need an abortion, and their attacks on our rights are 
not stopping at an abortion.

    When it comes to states like mine where abortion is legal, 
providers are being stretched beyond capacity by women in 
desperate need of abortion care they can no longer get at their 
home.

    When it comes to women who aren't even seeking an abortion, 
bans are hollowing out healthcare for women in general, 
especially for those who already face some of the biggest 
challenges getting care.

    Women of color, Indigenous women, those in rural 
communities, because in a surprise to no one, healthcare 
providers do not want to work in states where politicians get 
between a doctor and their patient and threaten providers with 
jail time, and the loss of their medical license if they dare 
to help patients get the care they need.

    In states with extreme abortion bans, we are seeing 
healthcare providers closing their doors and shutting down 
their practices, new doctors staying away, and fewer options 
for patients to get a whole range of necessary healthcare 
services. The consequences extend far beyond abortion. And when 
it comes to what is next, well, Republicans have already made 
it painfully clear they want a national abortion plan.

    No matter what they're saying now, we can just look at the 
record. Look at how many Republicans have co-sponsored national 
abortion bans. Look at the Life at Conception Act. That is a 
bill that is supported by more than half of the House 
Republican Conference that would enshrine fetal personhood 
nationwide.

    Let's be clear what that would mean. Not just an abortion 
ban. It would mean that women and doctors will be charged with 
murder for an abortion making them eligible for the death 
penalty in their states. It would mean emergency contraception 
like Plan B, outlawed. And it would mean IVF ripped away from 
people who are trying to start a family.

    This is not theoretical. We saw how much chaos this 
dangerously extreme ideology already caused for families in 
Alabama. And yet there are Republican states and Republican 
Members of Congress, including the Speaker of the House, who 
support making fetal personhood the law of the land. That is in 
the extreme, but in the face of all this horror, we've also 
seen an outcry from women and men who refuse to let Republicans 
keep dragging our Nation backward and stripping away our basic 
rights.

    Every time abortion rights have been on the ballot, since 
Dobbs, every single time, abortion rights have won. People are 
standing up and they're speaking out and Democrats are proud to 
stand with them.

    Democrats are going to make sure women's voices are heard 
in our Nation's capital, including at hearings like this one. 
And we're going to keep fighting to pass the Women's Health 
Protection Act and restore the basic and fundamental right of 
women to control their own bodies.

    While former President Trump continues to brag about how he 
overturned Roe, and makes clear he will go even farther to 
restrict and ban abortion if given the chance, Democrats have 
been clear. With a pro-choice majority in the House and Senate 
and Joe Biden in the White House, we will restore and protect 
abortion rights for every woman in America. Thank you.

    With that I look forward to hearing from all of our 
witnesses, but first, I will turn it over to Senator Cassidy 
for his opening statement.

                  OPENING STATEMENT OF SENATOR CASSIDY

    Senator Cassidy. Thank you, Senator Murray.

    Let's table-set. It's an election year in which a 
Democratic incumbent President is running behind. So, a 
decision has been made to raise abortion to a high profile to 
change the setting, to invite a lot of folks to put us on TV. 
It's partisan politics being played out in a Committee hearing, 
but let me point out as well, it's not entirely partisan.

    Louisiana's pro-life law was written by a female Democratic 
State Senator and written and signed into law by a Democratic 
Governor. And that female Democratic state senator was 
reelected with wide margins. So, there is a breadth across the 
political spectrum of people who have a different way of 
framing this.

    My Democratic colleagues want you to think that Republicans 
believe terrible things, they'll attempt to normalize a 
decision to abort a child. But a Republican would say that you 
can't normalize a procedure, at least this Republican, in which 
the intent is to end a life. Don't be misled. This is a life. 
This is a life because can anyone say that child is not a life. 
How could you not?

    I'm a doctor. I see that you have to take care of that 
mama. You have to take care of that mama, but you have to 
recognize that there is another life there as well. This is not 
just a collection of cells. This is a child that if delivered 
will live, and maybe this one too, and that one as well. So, 
let's have a national dialog. Let's actually explore this as 
opposed to exploit it for political advantage.

    In medical school, I was taught, to care for every patient 
who walks in the door, and to recognize that when a woman is 
pregnant, there are two patients there.

    The second that baby gets there, it doesn't matter how 
small and how vulnerable, how unsustainable, how weak. The 
doctors, the nurses, the institution does everything they can 
to save their life. And by golly, don't you want them to do 
that? Don't you want the people who are entrusted with the 
healthcare to have that ethic?

    I believe that the responsibility to protect and say the 
child shouldn't be determined by the arbitrary difference of 
being inside or outside the womb. I'm unapologetically pro-
life. Scientifically and morally, there's no difference in the 
value of a child, whether she is in her mother's arms or 
whether she is in her mother's womb.

    The science is clear. This is just not a clump of cells and 
this is a difficult poster to look at. I can tell you it's 
difficult. The reason it's difficult is because you recognize, 
that by their policies, it should be legal to abort that child. 
It is difficult, but let's frame it for what it is. How can we 
dehumanize this? And yet this is what it's an attempt to do. At 
what point do my Democratic colleagues believe that a child 
deserves to live?

    It does a disservice to the mother to dehumanize the unborn 
child and discuss this issue as only the right to abort or not 
to abort. This is one of the most significant decisions a woman 
will ever make. We should not trivialize.

    Now I understand and accept the need for exceptions, the 
laws that regulate abortion under certain circumstances. But 
unlike some of our testimony here, terminating life does not 
spare a woman from potential grief. This should never be an 
easy decision, if so, we've lost our moral compass.

    I just want people to read the entire testimony of Dr. 
Francis in which she refutes a lot of what was said, kind of 
blithely, and she actually puts scientific data behind it.

    As a physician, fear mongering, I find it infuriating. A 
woman experiencing, the emotionally and physically painful 
experience of miscarriage or an ectopic pregnancy is already 
grappling with a loss of our unborn child, and yet this 
Committee hearing would take this vulnerable moment of that 
woman's life and misrepresented, and use it for political gain.

    There is no law in any state preventing a doctor from 
treating a patient going through a miscarriage or an ectopic 
pregnancy or from preventing the saving of the life of a 
mother. That is called healthcare. That is not an abortion.

    One of the most inspirational medical professors said, that 
in healthcare and medicine, our highest calling is truth. And 
frankly, that's why I find it frustrating that fellow 
physicians are misleading on these facts and corrupting truth 
for political viewpoint.

    While it's disappointing that my colleagues would say 
things that are not true, deceiving Americans about Republicans 
stand on the issue is also reprehensible that they mislead 
Americans on the Democrats own extreme views.

    Now, Democrats will say that they want to codify Roe v. 
Wade. That's not true. The truth is, is that the democratic 
policies go beyond Roe. Their marquee legislation will legalize 
late term abortion and every state aborting this child, ban 
states that prevent coerced abortion, allow strangers to 
convince an underage child to get an abortion without notifying 
the parents that she is pregnant.

    Perhaps that pregnancy was due to abuse, shouldn't the 
parents know? Why should the parents' rights be obligated and 
eviscerate the conscience rights of healthcare professionals 
who have moral or religious objections to abortion? Speak about 
driving people out of the healthcare field.

    Now, Senator Kaine has a bill that explicitly codifies Roe 
into law. The only Democrats willing to co-sponsor are Senator 
Sinema and Manchin, neither one of whom call themselves 
Democrats by now. So, it begs the question, why does Senator 
Kaine bill to codify Roe not have more Democratic support? 
Well, it makes a good rallying cry, the policy of codifying Roe 
is too conservative for the fringes that now define the debate 
in the Democratic party.

    There are nine states plus Washington DC, whose laws right 
now allow, allow for abortion up to parturition. The child can 
be ready to go through the birth canal and abortion is 
legalized. Not because of the life of the mother, just to 
legalize it. That is where the Democratic party has gone. That 
should give us all a moral pause.

    Now I ask my Democratic colleagues, can you designate a 
point at which a pregnancy should not be terminated unless for 
the life of the mother or instead of some extenuating 
circumstances? Can you tell me if it's here or here or here? I 
think that's a fair question. I invite everybody to be a doctor 
who's trying to balance the needs of the unborn child with that 
of the mom.

    My Democratic colleagues may also claim that abortions are 
low risk procedures, claiming that they're so safe, they can be 
done without medical supervision. Not entirely accurate, 
minimizing the potential complications. But that's the way you 
can kind of feel better about this. And again, I refer people 
once more to Dr. Francis' complete testimony, not just the 5-
minutes she'll give today.

    Now, demagoguing and fear mongering on access to treatment 
for miscarriages and ectopic pregnancies, cast in a decision to 
abort or not to abort as an easy one, is a tremendous 
disservice. I have supported postpartum coverage for women in 
Medicaid. I've worked on serious legislation to advance 
maternal health like the Connected Moms Act with Senator Maggie 
Hassen, which lets physicians remotely monitor pregnant women 
for potential complications.

    From my practice in Louisiana, a woman who's eight and a 
half months pregnant, using public transportation in August in 
Louisiana, you can empathize for her and understand that if you 
can remotely monitor her, her life is so much better. Senator 
Bob Casey and I led legislation now law to ensure that pregnant 
women are entitled to reasonable accommodations in the 
workforce.

    There is much more we can do to support the woman who's 
pregnant, but we should debate and advance legislation so that 
we are not leaving them without solutions when they're faced 
with a very difficult, traumatic, and complex question.

    We want women, moms to be healthy, successful, and 
prosperous. And the human life inside a woman triggers the 
double line--the human life, do a pregnancy test, those double 
lines come up. Those double lines should not represent a burden 
as the other side would like to cast. It should represent a 
gift, but there's things that we can do to make her life 
easier.

    I'm open to the tough conversations. I think we should all 
be, but we shouldn't minimize by dehumanizing. And it must be 
with respect for both the mother and the defenseless and 
voiceless unborn child that are participating in that debate. 
This is too personal for too many Americans.

    With that I yield.

    Senator Murray. We will now introduce today's witnesses and 
move to testimony. Today, we'll be hearing from Madysyn 
Anderson. She's a young woman from Texas who was forced to 
leave her state and travel hundreds of miles to get the 
abortion care she needed after Texas passed its draconian 
abortion ban.

    Dr. Nisha Verma, an OB-GYN, an abortion provider in 
Georgia, and a fellow with Physicians for Reproductive Health. 
Destiny Lopez, acting CEO of the Guttmacher Institute. And Dr. 
Allison Linton, Chief Medical Officer of Planned Parenthood of 
Wisconsin. She's also an OB-GYN, an abortion provider, and a 
fellow with Physicians for Reproductive Health. I will turn it 
over to Ranking Member Cassidy to introduce his witnesses.

    Senator Cassidy. Yes, I introduce Dr. Christina Francis. 
She is a board-certified OB-GYN, working as OB-GYN hospitalist, 
treating women with both high and low risk pregnancies who are 
hospitalized. She is a board member of Indiana Right to Life. 
And she is the CEO of the American Association of Pro-Life 
Obstetricians and Gynecologists.

    I'll also introduce Ms. Melissa Ohden. I have that right, 
Ohden? Yes, who was the founder and Chief Executive Officer of 
the Abortion Survivors Network. Melissa will tell us of her 
story about surviving a failed saline infusion abortion in 1977 
that was intended to end her life. We're fortunate that Melissa 
has made this her life's work and runs the Abortion Survivors 
Network, a group providing support to other abortion survivors 
and mothers who have experienced a failed abortion. I look 
forward to hearing from you today, Melissa, and thank you for 
sharing your powerful story.

    Senator Murray. Again, thank you to all of our witnesses. 
We will begin with Ms. Anderson.

  STATEMENT OF MADYSYN ANDERSON, ABORTION PATIENT, HOUSTON, TX

    Ms. Anderson. Thank you, Senator Chair Sanders, Senator 
Murray, Ranking Member Cassidy, and Members of the Committee. 
My name is Madysyn Anderson, and I live in Houston, Texas.

    Two years ago, during my senior year at the University of 
Houston, I had just come out of a 2-year long relationship. 
After a couple weeks of nausea, not sleeping or eating, I took 
a pregnancy test. I called a friend to bring me more tests 
because I was in disbelief. At one point. I had five tests in 
front of me and there was no disputing I was pregnant.

    This was just 2 weeks after the Texas abortion ban, known 
as S.B 8, went into effect banning abortion after 6 weeks. I 
knew almost immediately that abortion was the right choice for 
me. I called and got an appointment at the local Planned 
Parenthood just 5 minutes away from me for later that week. I 
thought I was early enough to be able to get my abortion that 
week, but at my appointment, my pregnancy measured 11 weeks.

    I was shocked, I couldn't get an abortion in Texas. I 
called 20 different clinics after my first visit. Yes, 20 I 
called surrounding states and even as far as the Dakotas, no 
one could see me right away. The earliest I could be seen was 2 
weeks later at Jackson Women's Health Organization in 
Mississippi. This was before the Dobbs v. Jackson Women's 
Health decision that would take away the Federal constitutional 
right for abortion, and before 20 more states would ban 
abortion, and before wait times and states that didn't have 
bans would stretch longer and longer.

    My dad took off work, and we drove a total of 720 miles 
round-trip, and spent 13 hours on the road. We spent 5 hours in 
a hotel trying to sleep before my first appointment just to 
turn right around and go back home.

    Here's the thing. Because of unnecessary restrictions on 
abortion care in Mississippi, I would have to make the trip all 
over again. The state essentially puts patients in a timeout 
because they don't trust people to know what is best for their 
health or lives. When I got this news, I was angry, and sleep 
deprived, and starving, and never more certain of my decision. 
That certainty never faltered.

    The following week, my mom was able to find us affordable 
tickets, and we flew out to Jackson. The start of our day was 
at 7am to make it to my 1.30pm appointment. After my procedure, 
I went in the recovery room for about 20 minutes before having 
to hop in the car and make my flight back home.

    I want to talk for a minute about money. As a college 
student who took out multiple student loans and was counting 
every penny I had to pay for my first appointment in Houston, 
my first appointment in Mississippi, and the abortion itself. 
Then gas and a hotel for the first trip. And then flights for 
the second trip. I missed 20 hours each of work and a mandatory 
internship for my school, a total $2,850.

    There is no dollar value I can put on the stress of 
managing everything. The despair of having to go to such 
lengths for basic healthcare that was legal just weeks before I 
needed it.

    The gut-wrenching reality of having to disclose something 
so personal to my boss, professors, and anyone in a position of 
authority for fear of losing my job, of failing every class 
that semester due to all of the class time and assignments that 
I was forced to miss.

    I felt so much anger that the politicians in Austin thought 
that they had the right to make this decision for me. I'm one 
of thousands of people that have now gone through this. Every 
day that we go without the right for abortion, there will be 
more of us. More savings accounts drained, more classes and 
shifts missed, more choices on which bills to skip paying.

    If I had found out I was pregnant last year or last month, 
Jackson Women's Health would not have been there for me. The 
people who cared for me that day cannot care for abortion 
patients today. I have to go to New Mexico, Kansas, or as far 
as Illinois to make that decision.

    Today, we talk about abortion and it is easy to get stuck 
in theoreticals, but I am a real person. The lives of abortion 
patients are not theoretical. People will continue to get 
pregnant when they're not ready or just simply don't want to 
be. We will always need abortions. This is simply no place for 
a politician to decide for us. Thank you for inviting me here 
today and letting me share my story with you.

    [The prepared statement of Ms. Anderson follows.]
                 prepared statement of madysyn anderson
    Chair Sanders, Senator Murray, Ranking Member Cassidy, Members of 
the Committee:

    My name is Mady Anderson, and I live in Houston, Texas.

    Two years ago, during my senior year at the University of Houston, 
I had just come out of a 2-year relationship. After a couple weeks of 
nausea and not sleeping or eating, I took a pregnancy test.

    I called my friends to bring me more tests because I was in 
disbelief. At one point I had five positive tests in front of me.

    I was pregnant.

    This was just 2 weeks after Texas's abortion ban, known as S.B. 8, 
went into effect, banning abortion after 6 weeks.

    I knew almost immediately that abortion was the right decision for 
me.

    I called and got an appointment for the following week at my local 
Planned Parenthood, 5 minutes away. I thought I was early enough to be 
able to get my abortion that week. But at my appointment my pregnancy 
measured at 11 weeks.

    I was shocked. I couldn't get an abortion in Texas.

    I called 20 different clinics after that first visit. Yes, you 
heard correct. 20.

    I called surrounding states and even as far as the Dakotas; no one 
could see me right away. The earliest I could be seen was 2 weeks 
later, at Jackson Women's Health Organization in Mississippi.

    This was before the Dobbs v. Jackson Women's Health decision that 
would take away the Federal constitutional right to abortion. Before 20 
more states would ban abortion. Before wait times in states without 
bans grew longer and longer.

    My dad took off from work, and we drove a total of 720 miles 
roundtrip, and spent 13 hours on the road. We spent 5 hours in a hotel 
trying to sleep, before going to my first appointment--just to turn 
right around and head back home.

    Here's the thing: Because of medically unnecessary restrictions on 
abortion care in Mississippi, I would have to make the trip all over 
again. The state, essentially, put patients in a time-out because they 
don't trust people to know what is best for our own health and lives. 
When I got this news, I was angry, sleep-deprived, and starving--and as 
certain as I ever was that I wanted an abortion. That certainty never 
faltered.

    The following week my mom was able to find us affordable tickets, 
and we flew back to Jackson. We started our day at 7 a.m. for my 1:30 
p.m. appointment. After my procedure, I waited in the recovery room for 
about 20 minutes, before hopping in a car to make my flight back home.

    I want to talk for a moment about money. As a college student who 
took out multiple student loans, I was counting every penny.

          I had to pay for the appointment in Houston.

          Then gas and hotel for the first trip to Mississippi.

          Then the first appointment in Mississippi.

          Then plane tickets for the second trip to 
        Mississippi.

          Then the abortion itself.

          Then I missed 20 hours of work.

          And 20 hours of my mandatory internship program.

          The total? $2,850.

    There is no dollar value I can put on the stress of managing all of 
this. The despair of having to go to such lengths for basic, safe 
health care that was legal just weeks before I needed it. The gut-
wrenching reality of having to disclose this deeply personal thing that 
should be private to professors, my boss, and anyone else in a position 
of authority over me for fear of not only losing my job but also 
failing out of all my classes due to all the classes and assignments I 
missed.

    I felt so much anger that politicians in Austin thought they had 
the right to make this decision for me.

    I am one of thousands of people who have now gone through this. 
Every day, every month we go without a Federal right to abortion, there 
will be more of us. More savings accounts drained, more classes and 
shifts missed, more choices about which bill to skip paying.

    If I had found out I was pregnant last year or last month, Jackson 
Women's Health wouldn't have been there for me. The people who cared 
for me that day cannot care for abortion patients in Mississippi. I 
would have had to go to New Mexico, Kansas, or as far as Illinois.

    When we talk about abortion, it's easy to get stuck talking in 
theoreticals.

    But I am a real person.

    The lives of abortion patients are not theoretical. People will 
continue to get pregnant when we don't want to be. We will always need 
abortions.

    There is simply no place for politicians to decide for us.

    Thank you for inviting me here today and letting me share my story.
                                 ______
                                 
                [summary statement of madysyn anderson]
    My name is Mady Anderson, and I live in Houston, Texas. Two years 
ago, during my senior year at the University of Houston, I had just 
come out of a 2-year relationship. After a couple weeks of nausea and 
not sleeping or eating, I took a pregnancy test. I was pregnant.

    This was just 2 weeks after Texas's abortion ban, known as S.B. 8, 
went into effect, banning abortion after 6 weeks.

    I knew almost immediately that abortion was the right decision for 
me. I called and got an appointment for the following week at my local 
Planned Parenthood, 5 minutes away. I thought I was early enough to be 
able to get my abortion that week. But at my appointment my pregnancy 
measured at 11 weeks. I couldn't get an abortion in Texas.

    The earliest I could be seen was 2 weeks later, at Jackson Women's 
Health Organization in Mississippi. This was before the Dobbs v. 
Jackson Women's Health decision that would take away the Federal 
constitutional right to abortion. Before 20 more states would ban 
abortion.

    My dad took off from work, and we drove a total of 720 miles 
roundtrip, and spent 13 hours on the road. Because of medically 
unnecessary restrictions on abortion care in Mississippi, I would have 
to make the trip all over again.

    The following week my mom was able to find us affordable tickets, 
and we flew back to Jackson. We started our day at 7 a.m. for my 1:30 
p.m. appointment. After my procedure, I waited in the recovery room for 
about 20 minutes, before hopping in a car to make my flight back home.

    As a college student who took out multiple student loans, I was 
counting every penny. I had to pay for the appointment in Houston. Then 
gas and hotel for the first trip to Mississippi. Then the first 
appointment in Mississippi. Then plane tickets for the second trip to 
Mississippi. Then the abortion itself. Then I missed 20 hours of work. 
And 20 hours of my mandatory internship program. The total? $2,850. 
There is no dollar value I can put on the stress of managing all of 
this.

    I am one of thousands of people who have now gone through this. 
Every day, every month we go without a Federal right to abortion, there 
will be more of us. More savings accounts drained, more classes and 
shifts missed, more choices about which bill to skip paying. The lives 
of abortion patients are not theoretical. People will continue to get 
pregnant when we don't want to be. We will always need abortions. There 
is simply no place for politicians to decide for us.
                                 ______
                                 
    Senator Murray. Thank you very much.

    Dr. Verma.

  STATEMENT OF NISHA VERMA, M.D., MPH, FELLOW, PHYSICIANS FOR 
                REPRODUCTIVE HEALTH, ATLANTA, GA

    Dr. Verma. Good morning, Chair Sanders, Senator Murray, 
Ranking Member Cassidy, and distinguished Members of the Senate 
HELP Committee. My name is Dr. Nisha Verma, and I'm a board-
certified, fellowship-trained obstetrician and gynecologist, 
providing full spectrum reproductive healthcare. I'm a fellow 
with Physicians for Reproductive Health, and I'm also a proud 
Southerner.

    I was born and raised in North Carolina. I currently 
provide care in Georgia, and I've lived in the southeast for 
most of my life. I made a commitment when I became a doctor to 
care for people without judgment throughout their lives. For 
me, that commitment holds whether I'm talking a young person 
through a first pap smear, delivering a couple's highly 
anticipated third child, or supporting a patient and her family 
as they decide to continue or end a pregnancy.

    However, after the Supreme Court's Dobbs decision, with 
Georgia enacting a law that bans most abortions in our state 
very early in pregnancy, I struggle every day to provide 
necessary lifesaving medical care. I've seen young moms with 
worsening medical conditions that make their pregnancies very 
high risk, and couples whose deeply desired pregnancies are in 
the process of miscarrying, be turned away or forced to leave 
their communities to access needed healthcare.

    As a doctor, I have the immense privilege of sitting with 
patients and learning about their lives. For me, these patient 
stories are a powerful reminder that abortion is not an 
isolated political issue, and today I want to provide a glimpse 
of what access to abortion care means for real people.

    Shortly after Georgia's 6-week abortion ban went into 
effect in 2022, I saw a young woman who had just started her 
junior year of high school, and despite using her birth control 
correctly, realized after missing her period that she might be 
pregnant.

    She called to make a clinic appointment for an abortion 
right away, but when she came to see me, she unfortunately was 
just a couple days past George's arbitrary cutoff, which bans 
most abortions after just 2 weeks from the first missed period.

    I had to tell her that even though I have the skills to 
help her, I can no longer perform her abortion in our state. 
She returned to rural Georgia where she lives and I didn't see 
her again until a few weeks ago. At our most recent visit, she 
told me that she was unable to find the resources and support 
to get out of state for abortion care.

    She also couldn't find a doctor in her part of the state 
that took her insurance Medicaid for many months, and so even 
though she was forced to continue her pregnancy against her 
will, she couldn't get prenatal care. After delivering her 
baby, she struggled with postpartum depression and had to move 
out of her home, drop out of school and work a minimum wage job 
to try to make ends meet.

    She told me that she loves her son, but this is not the 
life she wanted or planned for herself. I have thought about 
this patient every day since she came back to my clinic. I know 
it was Georgia's laws that prevented me from providing her with 
the medical care she needed and deserved, but I still feel like 
as her doctor, I failed her.

    This patient's story, while heartbreaking, is not unique. 
We know that bans and restrictions have forced many people to 
stay pregnant, and we know the harm that people experience when 
they're unable to get this care. They're more likely to face 
long-lasting economic hardship, to stay in contact with a 
violent partner and to develop serious health problems.

    Mental health conditions like the postpartum depression 
that my patient experienced, are the leading cause of pregnancy 
related deaths in this country.

    We also know that abortion care is incredibly safe. In 
fact, in 2022, over 75 major professional societies 
representing the overwhelming consensus of the science-based 
medical community came together to reaffirm that abortion is 
safe, essential healthcare.

    As patients face a growing wave of abortion restrictions, 
many describe feeling betrayed by a government and healthcare 
system that is supposed to serve and protect them. Doctors too 
feel betrayed by our government. Many of my colleagues are 
overwhelmed by laws that threaten to make us criminals for 
providing evidence-based, life-saving care to our patients, and 
are leaving their states. And places like Georgia, where 
already over 50 percent of counties have no OB-GYNs, these 
worsening workforce shortages are devastating for all aspects 
of reproductive healthcare.

    I understand that abortion care can be a complicated issue 
for many people, just like so many aspects of healthcare and 
life can be. I also know that abortion is necessary 
compassionate essential healthcare, and that patients are 
capable of making complex, thoughtful decisions about their 
health and lives. No law should prevent them from doing so.

    I urge you to listen to the stories of people who provide 
and access abortion care. I hope these stories help you to see 
how profoundly restrictions on abortion access harm all of our 
communities. Thank you for having me today and I look forward 
to your questions.

    [The prepared statement of Dr. Verma follows.]
                   prepared statement of nisha verma
    Good morning Chair Sanders, Senator Murray, Ranking Member Cassidy, 
and distinguished Members of the Senate HELP Committee. My name is Dr. 
Nisha Verma, I use she/her pronouns, and I am a board-certified, 
fellowship trained, obstetrician and gynecologist providing full-
spectrum reproductive health care. I am a fellow with Physicians for 
Reproductive Health, and I am also a proud Southerner--I was born and 
raised in North Carolina, I currently provide care in Georgia, and I 
have lived in the Southeast for most of my life.

    I made a commitment when I became a doctor to care for people, 
without judgment, throughout their lives. For me, that commitment holds 
whether I am talking a young person through a first pap smear, 
delivering a couple's highly anticipated third child, or supporting a 
patient and her family as they decide to continue or end a pregnancy. 
However, after the Supreme Court's Dobbs decision, with Georgia 
enacting a law that bans most abortions in our state very early in 
pregnancy, I struggle every day to provide necessary, life-saving 
medical care. I've seen young moms with worsening medical conditions 
that make their pregnancies very high risk and couples whose deeply 
desired pregnancies are in the process of miscarrying, be turned away 
or forced to leave their communities to access needed health care.

    As a doctor, I have the immense privilege of sitting with patients 
and learning about their lives. For me, these patients' stories are a 
powerful reminder that abortion is not an isolated political issue, and 
today, I want to provide a glimpse of what access to abortion care 
means for real people.

    Shortly after Georgia's 6-week abortion ban went into effect in 
2022, I saw a young woman who had just started her junior year of high 
school, and despite using her birth control correctly, realized after 
missing her period that she might be pregnant. She called to make a 
clinic appointment for an abortion right away, but when she came to see 
me, she unfortunately was just a couple days past Georgia's arbitrary 
cutoff, which bans most abortions after just 2 weeks from the first 
missed period. I had to tell her that, even though I have the skills to 
help her, I could no longer perform her abortion in our state. She 
returned to rural Georgia, where she lives, and I didn't see her again 
until a few weeks ago. At our most recent visit, she told me that she 
was unable to find the resources and support to get out of state for 
abortion care. She also couldn't find a doctor in her part of the state 
that took her insurance, Medicaid, for many months, and so even though 
she was forced to continue her pregnancy against her will, she couldn't 
get prenatal care. After delivering her baby, she struggled with 
postpartum depression and had to move-out of her home, drop out of 
school, and work a minimum wage job to try to make ends meet. She told 
me that she loves her son, but this is not the life she wanted or 
planned for herself.

    I have thought about this patient every day since she came back to 
my clinic. I know it was Georgia's laws that prevented me from 
providing her with the medical care she needed and deserved, but I 
still feel like, as her doctor, I failed her.

    This patient's story, while heartbreaking, is not unique. We know 
that bans and restrictions have forced many people to stay pregnant. 
\1\ And we know the harm that people experience when they are unable to 
get this care--they are more likely to face long-lasting economic 
hardship, to stay in contact with a violent partner, and to develop 
serious health problems. \2\ Mental health conditions, like the 
postpartum depression my patient experienced, are the leading cause of 
pregnancy-related deaths in this country. We also know that abortion 
care is incredibly safe--in fact, in 2022, over 75 major professional 
societies representing the overwhelming consensus of the science-based 
medical community, came together to reaffirm that abortion is safe, 
essential health care. \3\

    \1\  See #WeCount Report, SOC. OF FAM. PLANNING (May 14, 2024), 
https://societyfp.org/wp-content/uploads/2024/05/WeCount-report-6-May-
2024-Dec-2023-data-Final.pdf.

    \2\  See See Diana Greene Foster, Turnaway Study: Ten Years, A 
Thousand Women, and the Consequences of Having or Being Denied an 
Abortion, ANSIRH (2020), https://www.ansirh.org/research/turnaway-
study.

    \3\  More than 75 Health Care Organizations Release Joint Statement 
in Opposition to Legislative Interference, AM. COLL. OF OBSTETRICIANS 
AND GYNECOLOGISTS (July 7, 2022), https://www.acog.org/news/news-
releases/2022/07/more-than75-health-care-organizations-release-joint-
statement-in-opposition-to-legislative-interference.

    As patients face a growing wave of abortion restrictions, many 
describe feeling betrayed by a government and health care system that 
is supposed to serve and protect them. Doctors, too, feel betrayed by 
our government. Many of my colleagues, overwhelmed by laws that 
threaten to make us criminals for providing evidence-based, life-saving 
care to our patients, are leaving their states. In places like Georgia, 
where already over 50 percent of counties have no OB/GYNs, these 
worsening workforce shortages are devastating for all aspects of 
reproductive health care. \4\
---------------------------------------------------------------------------
    \4\  See Stephanie Colombini, Turning Away Patients Every Day: 
Georgia OB-GYN on the Effects of Abortion Bans, HEALTH NEWS FL (May 16, 
2024), https://health.wusf.usf.edu/health-news-florida/20240516/
turning-away-patients-every-day-georgia-ob-gyn-on-the-effects-of-
abortion-bans; Adrienne D. Zertuche, Georgia's Obstetric Crisis: 
Origins, Consequences, and Potential Solutions, GA. SENATE STUDY CMTE 
ON WOMEN'S ADEQUATE HEALTHCARE (Oct. 26, 2015), https://
www.senate.ga.gov/committees/Documents/
Oct%2026%20Ga%20Maternal%20Health%20%20Infant%20Research%20Group%20-
%20Dr%20Zertuche.pdf.

    I understand that abortion care can be a complicated issue for many 
people, just like so many aspects of health care and life can be. I 
also know that abortion is necessary, compassionate, essential health 
care, and that patients are capable of making complex, thoughtful 
decisions about their health and lives--no law should prevent them from 
---------------------------------------------------------------------------
doing so.

    I am unwavering in my commitment to support people in my home in 
the South. It shouldn't have to be this way. I urge you to listen to 
the stories of people who provide and access abortion care. I hope 
these stories help you to see how profoundly restrictions on abortion 
access harm all of our communities.

    Thank you for having me today, I look forward to your questions.
                                 ______
                                 
    Senator Murray. Thank you.

    Ms. Lopez.

   STATEMENT OF DESTINY LOPEZ, MPA, ACTING CO-CEO GUTTMACHER 
                   INSTITUTE, WASHINGTON, DC

    Ms. Lopez. Thank you, Chair Sanders, Ranking Member 
Cassidy, Senator Murray, and the distinguished Members of the 
Committee for the opportunity to highlight the clear and 
growing evidence that the Dobbs decision is harming 
reproductive health and freedom.

    My name is Destiny Lopez, and I am the acting co-CEO of the 
Guttmacher Institute, a leading research and policy 
organization committed to advancing sexual and reproductive 
health and rights worldwide.

    For decades following the 1973 Roe v. Wade decision, anti-
abortion advocates worked strategically to make abortion harder 
to get and highly stigmatized. Public support for abortion's 
legality has remained high and consistent. But the sheer number 
of state-level abortion restrictions ensured that abortion 
became inaccessible for many, even with Roe in place.

    The Dobbs v. Jackson Women's Health Organization decision 
was an inflection point, unleashing chaos and fear across the 
Nation. Our experts are constantly assessing this changing 
landscape and the increasingly robust body of evidence that 
illustrates the harms caused and exacerbated by Dobbs decision.

    Two years after the decision, here is what we know: Access 
to abortion care is severely restricted in many parts of the 
country. 14 states are now enforcing total abortion bans with 
very limited exceptions, and many more have other new 
restrictions in place. The total number of brick-and-mortar 
clinics providing abortion care in the U.S. declined by more 
than 40 between 2020 and early 2024.

    Banning abortion does not stop the need for abortion 
access. Which is why many people seeking abortions post-Dobbs 
must overcome huge financial and logistical barriers to get 
care, especially those in states with total or early 
gestational bans.

    The number of Americans traveling out of state for 
abortions doubled from 81,000 in 2020 to more than 170,000 in 
2023. States that border states with total abortion bans saw 
the sharpest increases in out-of-state patients.

    No one should have to travel to another state to access 
basic healthcare. And in fact, those who can't overcome the 
burdens of traveling for care, which for some might mean 
crossing multiple state lines, may be forced to stay pregnant 
against their will. Others may decide to self-manage their 
abortion.

    Decades of research have documented that the majority of 
people obtaining abortions have few financial resources, are 
people of color, and are already parenting. They are the ones 
most harshly impacted by bans and restrictions.

    We also know that providers are resilient and adapting to 
meet patient needs. While brick-and mortar facilities provide 
more than three-quarters of all abortions, online clinics are 
expanding care options by offering medication abortion services 
via telehealth. Research by the Society for Family Planning 
shows that virtual-only telehealth abortions accounted for 
almost one in five abortions from October to December 2023.

    There are many other important ways Dobbs is interfering 
with reproductive health care across the Nation that I don't 
have time to discuss in detail today, from current and future 
OB-GYNs not wanting to practice in ban states to impacts on 
maternal health and people facing obstetric emergencies.

    What does all this mean? Overturning Roe did not resolve 
the debates on abortion that have characterized U.S. politics 
for the past 50 years. Instead, it enabled policies that have 
significantly worsened the harms faced by individuals who are 
most marginalized in our health care system.

    Still, despite these immense hardships and many people 
being denied care, there were more than one million clinician-
provided abortions in 2023, a 10 percent increase from 2020. 
This is a testament to the heroic efforts of providers, 
abortion funds and other support networks, to the resilience 
and determination of people seeking care, and to the centrality 
of abortion in peoples' lives. And it explains why the anti-
abortion movement and their political allies are doubling down 
on even more repressive policies.

    For instance, this year, four states introduced legislation 
and one passed a law criminalizing adults who support 
adolescents seeking abortion care in another state. Earlier in 
the year, the Alabama Supreme Court's decision to classify 
frozen embryos as ``children'', wreaked havoc on fertility 
treatment services while advancing the anti-abortion movement's 
long-term goal to enshrine fetal personhood in both law and 
policy.

    These attacks on bodily autonomy, coupled with two major 
abortion cases currently before the Supreme Court, signal that 
the policy and legal landscape will continue to shift.

    The full damage caused by Dobbs will not be clear for years 
to come, but the evidence suggests it will not be easy to 
repair. That's why it is imperative that policymakers at all 
levels of government champion a bold vision of abortion care 
that goes beyond what Roe promised.

    Only policies rooted in evidence and human rights will 
guarantee that all people have meaningful access to high-
quality, affordable abortion care where they live and via the 
method they choose. Thank you.

    [The prepared statement of Ms. Lopez follows.]
                  prepared statement of destiny lopez
    Thank you, Chair Sanders, Ranking Member Cassidy, Senator Murray 
and the Members of the Committee for the opportunity to highlight the 
clear and growing evidence that the Dobbs decision is harming 
reproductive health and freedom. My name is Destiny Lopez, and I am the 
acting co-CEO of the Guttmacher Institute, a leading research and 
policy organization committed to advancing sexual and reproductive 
health and rights worldwide.

    For decades following the 1973 Roe v. Wade decision, anti-abortion 
advocates worked strategically to make abortion harder to get and 
highly stigmatized. Public support for abortion's legality has remained 
high and consistent. But the sheer number of state-level abortion 
restrictions ensured that abortion became inaccessible for many--even 
with Roe in place.

    The Dobbs v. Jackson Women's Health Organization decision was an 
inflection point, unleashing chaos and fear across the Nation. Our 
experts are constantly assessing this changing landscape and the 
increasingly robust body of evidence that illustrates the harms caused 
and exacerbated by Dobbs. Two years after the decision, here is what we 
know. \1\
---------------------------------------------------------------------------
    \1\  Information throughout this testimony is referenced here: 
Baden K, Dreweke J and Gibson C. Clear and Growing Evidence That Dobbs 
Is Harming Reproductive Health and Freedom, Guttmacher Institute, 2024, 
https://www.guttmacher.org/2024/05/clear-and-growing-evidence-dobbs-
harming-reproductive-health-and-freedom.

    Access to abortion care is severely restricted in many parts of the 
country. Fourteen states are now enforcing total abortion bans with 
very limited exceptions, and many more have other new restrictions in 
place. The total number of brick-and-mortar clinics providing abortion 
---------------------------------------------------------------------------
care in the U.S. declined by more than 40 between 2020 and early 2024.

    Banning abortion does not stop the need for abortion access. Which 
is why many people seeking abortions post-Dobbs must overcome huge 
financial and logistical barriers to get care, especially those in 
states with total or early gestational bans. The number of Americans 
traveling out of state for abortions doubled from 81,000 in 2020 to 
more than 170,000 in 2023. States that border states with total 
abortion bans saw the sharpest increases in out-of-state patients.

    No one should have to travel to another state to access basic 
healthcare. And in fact, those who can't overcome the burdens of 
traveling for care, which for some might mean crossing multiple state 
lines, may be forced to stay pregnant against their will. Others may 
decide to self-manage their abortion. Decades of research have 
documented that the majority of people obtaining abortions have few 
financial resources, are people of color, and are already parenting. 
They are the ones most harshly impacted by bans and restrictions.

    We also know that providers are resilient and adapting to meet 
patient needs. While brick-and-mortar facilities provide more than 
three-quarters of all abortions, online clinics are expanding care 
options by offering medication abortion services via telehealth. 
Research by the Society for Family Planning shows that virtual-only 
telehealth abortions accounted for almost one in five abortions from 
October to December 2023.

    There are many other important ways Dobbs is interfering with 
reproductive health care across the Nation that I don't have time to 
discuss in detail today, from current and future OB-GYNs not wanting to 
practice in ban states to impacts on maternal health and people facing 
obstetric emergencies.

    What does all this mean? Overturning Roe did not resolve the 
debates on abortion that have characterized U.S. politics for the past 
50 years. Instead, it enabled policies that have significantly worsened 
the harms faced by individuals who are most marginalized in our health 
care system.

    Still, despite these immense hardships and many people being denied 
care, there were more than one million clinician-provided abortions in 
2023--a 10 percent increase from 2020. This is a testament to the 
heroic efforts of providers, abortion funds and other support networks, 
to the resilience and determination of people seeking care, and to the 
centrality of abortion in peoples' lives. And it explains why the anti-
abortion movement and their political allies are doubling down on even 
more repressive policies.

    For instance, this year four states introduced legislation--and one 
passed a law--criminalizing adults who support adolescents seeking 
abortion care in another state. Earlier in the year, the Alabama 
Supreme Court's decision to classify frozen embryos as ``children'' 
wreaked havoc on fertility treatment services while advancing the anti-
abortion movement's long-term goal to enshrine fetal personhood in both 
law and policy. These attacks on bodily autonomy, coupled with two 
major abortion cases currently before the Supreme Court, signal that 
the policy and legal landscape will continue to shift.

    The full damage caused by Dobbs will not be clear for years to 
come, but the evidence suggests it will not be easy to repair. That's 
why it is imperative that policymakers at all levels of government 
champion a bold vision of abortion care that goes beyond what Roe 
promised.

    Only policies rooted in evidence and human rights will guarantee 
that all people have meaningful access to high-quality, affordable 
abortion care where they live and via the method they choose.

    Thank you.
                                 ______
                                 
                  [summary statement of destiny lopez]
    Destiny Lopez is the acting co-CEO of the Guttmacher Institute. Her 
testimony will focus on what the research tells us about the impact of 
Dobbs, 2 years after Roe was overturned. Ms. Lopez will share the state 
policy landscape as it relates to abortion access, including that 14 
states are now enforcing total abortion bans. Her testimony will 
include data about people traveling out of state for abortion care and 
why the lack of abortion access in communities exacerbates inequities 
and falls hardest on certain groups. Ms. Lopez's testimony emphasizes 
the resilience of providers, support networks and patients in finding 
ways to provide and access care--including the increased use of 
telehealth to access medication abortion, but makes clear that the 
landscape is fraught with chaos, hardships and many people being denied 
abortion care. She also notes that the policy and legal landscape 
continue to shift--with attacks on IVF and two abortion-related cases 
before the Supreme Court--as the anti-abortion movement doubles down on 
more repressive policies.
                                 ______
                                 
    Senator Murray. Dr. Linton.

STATEMENT OF ALLISON LINTON, M.D., MPH, CHIEF MEDICAL OFFICER, 
    PLANNED PARENTHOOD OF WISCONSIN, FELLOW, PHYSICIANS FOR 
               REPRODUCTIVE HEALTH, MILWAUKEE, WI

    Dr. Linton. Chair Sanders, Senator Murray, Ranking Member 
Cassidy, Members of the Committee, my name is Dr. Allison 
Linton. I'm a board-certified obstetrician and gynecologist as 
well as a board-certified complex family planning specialist.

    I completed my medical school training, a residency in 
obstetrics and gynecology, a complex Family Planning fellowship 
and a master's of public health at Northwestern University. I'm 
now an assistant professor of Obstetrics and Gynecology in 
Milwaukee, as well as Chief Medical Officer of Planned 
Parenthood in Wisconsin and a fellow at Physicians for 
Reproductive Health.

    I have spent my life learning how to provide the highest 
standard of care possible to my patients, but because of 
decisions made by people in power in rooms similar to this in 
Washington and across the country, my colleagues and I can no 
longer provide the care we know our patients need.

    For the past 711 days since the Supreme Court took away the 
constitutional right to abortion, my patients and my colleagues 
have been existing in a state of chaos, confusion, and fear.

    In my home State of Wisconsin, a statute from 1849 remained 
on our books that seemed to ban abortion from the moment of 
conception. A law written before the Civil War in the abolition 
of slavery, before women had the right to vote, before the 
discovery of penicillin.

    We had questions about the enforceability of the law, but 
without Federal protections, the penalties a $10,000 fine and 6 
years in prison were too severe to risk.

    All providers in Wisconsin stopped providing abortions 
immediately after the Dobbs decision, with the exception of if 
an abortion ``is necessary'' or is advised by two other 
physicians is necessary to save the life of the mother per the 
statute.

    For those who have no understanding of the complexities of 
the human body or the perils of pregnancy, this exception might 
seem self-explanatory. I'm here to inform you Members of the 
Committee that it is not.

    On one hand, we risk medical malpractice and harming a 
patient if we don't act soon enough. And on the other, we risk 
criminal prosecution, if a prosecutor feels that we acted too 
early. What about a patient with a newly diagnosed breast 
cancer at 8 weeks of pregnancy, who cannot start chemotherapy 
or radiation while she is pregnant. Is delaying her treatment 
until after delivery a risk to her life?

    What about a patient with a blood clotting disorder where 
pregnancy will further increase their risk of a pulmonary 
embolism or stroke. Is the risk of a blood clot enough or do I 
have to wait until the actual stroke occurs? What about a 13-
year-old who's the victim of incest. Is the psychological and 
physical trauma of carrying a child in her barely pubescent 
body enough to justify ending her pregnancy?

    What about a mother of three who cannot emotionally or 
financially support another child? She is making a loving 
decision for the children she already has. Shouldn't she have 
just as much right to and control over her body and future as 
any other person who needs an abortion?

    Regardless of the reason, these are not rhetorical 
questions. These are real patients that I encountered and tried 
to care for in Wisconsin. In reality, any law that tries to 
delineate when an abortion is or is not permitted will never be 
able to fully account for the complexities of our patient's 
health and our patient's lives.

    Each patient's situation is unique and regardless of their 
reason for needing an abortion, they deserve healthcare. Since 
June 24th, 2022, pregnancy in the United States is far more 
dangerous for patients with medical complexities, yes, but also 
for people with abusive partners, for people who may not 
understand what is happening to their bodies.

    For Black women who die from pregnancy and childbirth, 
three times as often as white women. And it will only get more 
dangerous. The fear of not being able to provide care for 
patients as leading practitioners, to move away from states 
with abortion bans and restrictions, or to stop treating 
pregnant patients.

    It's made recruiting providers more difficult. I have had 
students request transfer to another state to finish their 
training. This means that there is less sexual and reproductive 
healthcare where it is most desperately needed.

    After a ruling from a state judge on our 1849 law, we 
started providing abortion again in Wisconsin in late 2023, but 
we still work under medically unnecessary restrictions. These 
restrictions include a 24-hour waiting period, a same provider 
requirement and a ban on telemedicine abortion. They do nothing 
but make it harder for patients to get the care they need, 
especially those that live in rural areas of the state.

    Abortion bans mean that there is no longer a standard of 
care for pregnant patients. They are getting the care based on 
the state that they live in, in the wealthiest country in the 
world, this is what we're subjecting pregnant people to: chaos, 
confusion and fear. My patients deserve so much better. Thank 
you.

    [The prepared statement of Dr. Linton follows.]
                  prepared statement of allison linton
    Chair Sanders, Senator Murray, Ranking Member Cassidy, Members of 
the Committee:

    My name is Dr. Allison Linton. I am a board certified obstetrician 
and gynecologist as well as a board certified complex family planning 
specialist.

    I completed my medical school training, a residency in obstetrics 
and gynecology, and Complex Family Planning fellowship and Masters of 
Public Health at Northwestern University in Chicago, Illinois. I 
subsequently moved to Milwaukee, Wisconsin, where I am an Assistant 
Professor of obstetrics in gynecology, as well as the Chief Medical 
Officer of Planned Parenthood of Wisconsin, and Fellow at Physicians 
for Reproductive Health.

    I have had the opportunity to teach dozens of ob-gyn residents and 
hundreds of medical students over the past 7 years. I have had the 
opportunity to work with community partners, expanding access to 
contraception and sexually transmitted infection testing and treatment 
in multiple Milwaukee health departments. I have given lectures and 
trainings across the Midwest in both academic and community settings.

    But most of all, I have been honored to take care of patients. I 
see them annually for Pap tests and breast cancer screening exams, 
catching up on their new jobs, where their kids are going to college, 
or what vacation they have coming up. I see them as adolescents when 
they have questions about how their body is changing. I see them for 
STI testing, discussions of birth control, irregular periods, and 
chronic pain symptoms. I sit with them for hours on labor and delivery 
as they push to bring a new baby into the world. And I cry with them 
when something changes in their life or a new diagnosis is made and 
they are forced to make decisions they never thought they would have 
to.

    Sometimes they come alone. Sometimes with a partner or a friend. 
But we are always with them. Their doctors, their nurses, their health 
care teams--we support them in every situation, giving them all the 
information we can, and trusting them to make the decision that is best 
for them.

    Unfortunately, our ability to do our job changed 2 years ago. On 
June 24, 2022 at 9:10 a.m. Central Time, the Dobbs v. Jackson Women's 
Health Organization ruling sent reproductive health care into a 
tailspin. For the past 711 days, my patients and my colleagues have 
been existing in a state of chaos, confusion and fear.

    In my home state of Wisconsin, a statute from 1849 remained on our 
books, which seemed to ban abortion from the moment of conception. A 
law written before the Civil War and the abolition of slavery, before 
women had the right to vote, before the discovery of penicillin. While 
there were certainly questions about the enforceability of this law, 
due to the harsh penalties associated with violating it--$10,000 fine 
and 6 years in prison--all abortions in the state were immediately 
ceased. There was only a narrow exception for an abortion that ``is 
necessary, or is advised by 2 other physicians as necessary, to save 
the life of the mother.'' No exceptions for rape or incest. No further 
language to help clarify. Just that one sentence.

    For those who have no understanding of the complexities of the 
human body or the perils of pregnancy, this exception may seem self-
explanatory. I have heard some say that physicians should know which 
cases meet this exception and which don't. That it is up to our best 
medical judgment and it's the physician's fault if a patient suffers 
from not receiving appropriate care.

    As a practicing physician, I can tell you this is NOT self 
explanatory. Deciding whether something is or is not necessary to 
``save the life of the mother'' is not clear. Phrases like ``threat to 
maternal life'' are not a medical diagnosis, and adding phases like 
``imminent death'' or ``direct threat'' do not help to clarify. 
Medicine is complex and rapidly changing. It is an art where physicians 
must take all the information presented and try to predict a prognosis 
or outcome. And we are not infallible. Our tools are not infallible. 
Telling a physician to ``do our best'' under threat of felony charges 
if someone doesn't agree with our best medical judgment is not fair and 
it is not appropriate.

    As physicians, we are trained to make decisions based on the 
medical evidence in front of us. We are taught to minimize risk to our 
patients, discuss all medically appropriate options, including their 
relevant risks and benefits, and honor patient autonomy when they 
choose the treatment that is best for them. As of June 24, 2022 at 9:10 
a.m. Central, we were no longer able to do this.

    When would an abortion be necessary ``to save the life of the 
mother''?

    What about a patient who presents with heavy bleeding in the first 
trimester, but there is still fetal cardiac activity on ultrasound--can 
I remove the pregnancy to stop her bleeding? Do I have to wait for a 
certain amount of blood loss? Do I have to wait for her vital signs to 
change, or until she needs a blood transfusion, or until she bleeds so 
much that she can no longer clot her own blood?

    What about a pregnancy affected by a lethal fetal diagnosis such as 
anencephaly where the top of the fetal head fails to develop or renal 
agenesis where the fetus's lungs cannot develop. Continuation of 
pregnancy will never lead to a live child, so is the risk of pregnancy 
without any potential benefit enough to justify an abortion?

    What about when the bag of water breaks before the fetus can 
survive outside the womb? Or a pregnant patient with unresolved 
congestive heart failure from her last pregnancy that puts her at a 
higher risk of dying in this pregnancy--what percent chance of death 
does she need?

    What about a patient with newly diagnosed breast cancer at 8 weeks 
of pregnancy who cannot start chemotherapy or radiation while she is 
pregnant? Is delaying her treatment until after delivery a risk to her 
life?

    What about a patient with a blood clotting disorder where pregnancy 
will further increase their risk of a pulmonary embolism or stroke? Is 
the risk of a blood clot enough, or do I have to wait until the actual 
stroke occurs?

    What about a 13 year old who is the victim of incest? Is the 
psychological and physical trauma of carrying a child in her barely 
pubescent body enough to justify ending the pregnancy?

    What about a mother of three who cannot emotionally or financially 
support another child? She is making a loving decision for the children 
she already has. She should have just as much control over her body and 
future as any other person who needs an abortion, for any reason.

    These are not rhetorical questions. They are real patients that my 
colleagues and I have encountered and tried to care for in Wisconsin.

    In reality, any law that tries to delineate when an abortion is or 
is not permitted will never be able to fully account for the 
complexities of our patients' health and their lives. Each patient's 
situation is unique, and regardless of their reason for needing an 
abortion, they deserve health care. These decisions are deeply 
personal, and my job is to make sure my patients have all the 
information they need to make the best decision for themselves, their 
families, and their futures.

    Under the 1849 law, instead of being able to follow the medicine--
offering patients all their options and letting them choose--we would 
call additional colleagues asking their opinions, we would discuss 
cases with our hospital's lawyers. And far too often, we would have to 
look our patients in the eye and tell them that despite having the 
medical training to help them and knowing that an abortion was a safe 
and medically appropriate option, we couldn't help them in their home 
state due to a law written over 170 years ago by legislators who likely 
had no medical training and certainly had no understanding of modern 
medicine.

    The consequences of this confusion and fear went beyond what many 
would typically consider abortion-related. I received calls from 
colleagues asking if they could provide care for a patient who had 
experienced a miscarriage. I received calls from colleagues in Illinois 
and Minnesota who were seeing patients with ectopic pregnancies who had 
been told they could not receive care in Wisconsin.

    Of course my first thought was frustration and concern for patients 
that were not receiving the standard of care due to fear and 
misunderstanding. But you must remember we are physicians--not lawyers. 
These physicians were afraid, trying to interpret an archaic, non-
medical law through a modern medical lens. They feared a threat of 
prosecution, loss of their medical license, loss of their livelihood 
and career. You cannot blame physicians for being afraid when you have 
forced them to go against the core tenants of their medical training.

    Shortly after the Dobbs decision, my partners and I discussed our 
concerns of covering labor and delivery due to fear of what clinical 
scenarios may present. We feared being forced to go against our medical 
training of providing the standard of care OR providing the standard of 
care and putting ourselves at risk of criminal prosecution. I had 
similar discussions with my colleagues in the Emergency Department and 
institutions across the state. We all felt we were left with an 
impossible choice--risk of malpractice and harming a patient or risk of 
criminal prosecution?

    Since June 24, 2022, pregnancy in the United States is far more 
dangerous. For patients with medical complications, yes, but also for 
people with abusive partners. For people who may not understand what is 
happening to their bodies. For Black women, who die from pregnancy and 
childbirth three times as often as white women.

    It will only get more dangerous: The fear of not being able to 
adequately care for patients has led some practitioners to choose to 
move out of their home states or to stop caring for pregnant patients. 
It has also made it more difficult to recruit new providers to move 
into states where they may face criminal prosecution for providing the 
standard of care. In many areas of the country with maternity care 
deserts, including Wisconsin, this difficulty retaining and recruiting 
providers will only worsen our maternal health crisis. There is less 
sexual and reproductive health care where it is most desperately 
needed.

    In the wake of Dobbs, I learned of several residents and medical 
students inquiring about transferring to another state for the 
remainder of their training. Speaking to one student, they voiced 
concerns not just about not being able to receive adequate training to 
provide comprehensive care to their patients after graduation, but 
given that they too were of reproductive age, they worried about their 
health if they or their partner were to experience a medical 
complication during pregnancy.

    Unfortunately, confusion and fear was not isolated to physicians 
and health care providers. While Wisconsin's 1849 law only threatened 
prosecution of the person who performed an abortion and not the patient 
themselves, patients were still afraid. I met with patients who told me 
they were afraid to come to the emergency room when they were 
experiencing medical complications in early pregnancy, concerned they 
would be denied care or accused of doing something to themselves to 
harm the pregnancy. I spoke with a patient who told me she thought she 
wasn't allowed to discuss her thoughts about terminating her pregnancy 
with her own family, being under the impression that they could be 
charged with a crime if they knew what she was considering. Despite 
trying our best as a medical community to reassure patients that they 
could trust their health care team and should feel safe seeking help, I 
have no doubt that many patients did not receive the care they deserved 
due to confusion and fear stopping them from disclosing information to 
their providers.

    After a ruling from a state judge on our 1849 law, we started 
providing abortion again in Wisconsin in late 2023. Now, the lower 
court's ruling is making its way through the appeals process. Because 
we don't have any affirmative state-wide protection, there is 
uncertainty about the future of abortion access in Wisconsin. And we 
still work under medically unnecessary restrictions. These 
restrictions, including a mandatory 24-hour waiting period, with a 
same-provider requirement for medication abortion, and a ban on 
telemedicine abortion, do nothing but make it harder for patients to 
get the care they need--especially those who live in rural areas of the 
state.

    I'm glad to see the Senate taking action, from Senator Baldwin's 
legislation to help restore the Federal right to abortion, to moving to 
pass the Right to Contraception Act and ensuring the right to IVF. All 
of this will not fix what has been broken by the Dobbs decision, but it 
is a step in the right direction.

    Abortion bans mean there is no longer a standard of care for 
pregnant patients--they're getting care based on the state they live 
in. In the wealthiest country in the world, this is what we're 
subjecting pregnant people to: chaos, confusion, and fear.

    My patients deserve so much better.
                                 ______
                                 
                 [summary statement of allison linton]
    My name is Dr. Allison Linton. I am a board certified obstetrician 
and gynecologist as well as a board certified complex family planning 
specialist.

    I completed my medical school training, a residency in obstetrics 
and gynecology, and Complex Family Planning fellowship and Masters of 
Public Health at Northwestern University in Chicago, Illinois. I 
subsequently moved to Milwaukee, Wisconsin, where I am an Assistant 
Professor of obstetrics in gynecology, as well as the Chief Medical 
Officer of Planned Parenthood of Wisconsin and Fellow at Physicians for 
Reproductive Health.

    As physicians, we are trained to make decisions based on the 
medical evidence in front of us. We are taught to minimize risk to our 
patients, discuss all medically appropriate options, including their 
relevant risks and benefits, and honor patient autonomy when they 
choose the treatment that is best for them. As of June 24, 2022 at 9:10 
a.m., we were no longer able to do this. For the past 711 days, my 
patients and my colleagues have been existing in a state of chaos, 
confusion and fear.

    In my home state of Wisconsin, a statute from 1849 remained on our 
books, which seemed to ban abortion from the moment of conception. A 
law written before the Civil War and the abolition of slavery, before 
women had the right to vote, before the discovery of penicillin. While 
there were certainly questions about the enforceability of this law, 
due to the harsh penalties associated with violating it--$10,000 fine 
and 6 years in prison--all abortions in the state were immediately 
ceased with the exception of if an abortion ``is necessary, or is 
advised by 2 other physicians as necessary, to save the life of the 
mother.''

    For those who have no understanding of the complexities of the 
human body or the perils of pregnancy, this exception may seem self-
explanatory. As a practicing physician, I can tell you this is NOT self 
explanatory. Telling a physician to ``do our best'' under threat of 
felony charges if someone doesn't agree with our best medical judgment 
is not fair and it is not appropriate.

    In reality, any law that tries to delineate when an abortion is or 
is not permitted will never be able to fully account for the 
complexities of our patients' health and their lives. Each patient's 
situation is unique, and regardless of their reason for needing an 
abortion, they deserve health care. These decisions are deeply 
personal, and my job is to make sure my patients have all the 
information they need to make the best decision for themselves, their 
families, and their futures.

    After a ruling from a state judge on our 1849 law, we started 
providing abortion again in Wisconsin in late 2023. But we still work 
under medically unnecessary restrictions, and we don't have any 
affirmative state-wide protection.

    Abortion bans mean there is no longer a standard of care for 
pregnant patients--they're getting care based on the state they live 
in. In the wealthiest country in the world, this is what we're 
subjecting pregnant people to: chaos, confusion, and fear.
                                 ______
                                 
    Senator Murray. Dr. Francis.

STATEMENT OF CHRISTINA FRANCIS, M.D., CHIEF EXECUTIVE OFFICER, 
      AMERICAN ASSOCIATION OF PRO-LIFE OBSTETRICIANS AND 
                 GYNECOLOGISTS, FORT WAYNE, IN

    Dr. Francis. Thank you. Chairman Sanders, Ranking Member 
Cassidy, and Senator Murray, and Members of the Committee. 
Thank you so much for the opportunity to speak to you today. As 
a board-certified OB-GYN hospitalist, who manages both high and 
low risk pregnancies and has delivered thousands of babies, I 
really do have the best job in the world.

    Not only do I have the distinct honor and privilege to be 
with women and their families during the most exciting, 
challenging, and sometimes heartbreaking times of their lives. 
Not only do I get to help usher little lives into the outside 
world for the first time, but I also serve as an advocate for 
both my maternal and fetal patients.

    One of the reasons those of us at this table likely chose 
the specialty of obstetrics was because of the challenge of 
taking care of two patients at once. Induced abortion, which 
intentionally ends the life of one of those patients is not 
healthcare. It is not performed by the vast majority of OB-GYNs 
and it actively harms our patients.

    Thankfully, in most circumstances, the lives of our two 
patients benefit one another and our mantra of healthy mom, 
healthy baby, is a reality. There are, however, still 
situations in which a pregnancy complication can endanger the 
mother's life. While these most often occur after the point of 
fetal viability, currently approximately 22 weeks of pregnancy, 
they can occur before this point.

    The decision to intervene in these situations is extremely 
difficult, and not one that any of us take lightly. I have sat 
on the edge of my patient's bed crying with her as we discussed 
why we couldn't wait even one or two more weeks when her baby 
might survive to deliver her. In these discussions, we 
recognize that our intent in intervening is to save the 
mother's life, with the unintended consequence of our fetal 
patient losing his or her life.

    An induced abortion occurs when the goal is to end our 
fetal patient's life. In my nearly two decades of practice, I 
have never performed an induced abortion, and have also seen 
most of my colleagues provide excellent care to women even in 
difficult circumstances without abortion as well.

    There's been a lot of false information being spread that 
laws limiting abortion will prevent these lifesaving 
treatments. But honestly, this is absurd. Not only do no state 
laws prohibit these treatments, but even state laws restricting 
abortion before Roe allowed for them.

    There are more than 7,000 members of AAPLOG, along with the 
remainder of the 93 percent of OB-GYNs who do not perform 
abortions, know that induced abortion does not need to be legal 
in order to ensure we can provide our patients with excellent 
healthcare. Women deserve fully informed consent and ongoing 
medical care. This is yet another point of agreement we should 
have at this table.

    However, the same abortion advocates who are positing that 
women will die from ectopic pregnancies if states restrict 
abortion, are the people who have for the last several years, 
been advocating for women to receive abortion drugs without 
first being seen by a physician. Which is critical to ensure 
they do not have an ectopic pregnancy, which occur in one in 50 
pregnancies and are the leading cause of maternal mortality in 
the first trimester.

    This is not good medical care and women seeking abortions 
deserve the same level of healthcare as any other woman. 
Induced abortion has no health benefits to our patients. It 
ends the life of one and often causes significant harm to the 
other.

    For example, there are more than 160 studies that show an 
increased risk of preterm birth in future pregnancies after 
surgical abortions. Having sat with a patient during the loss 
of her fifth child, due to extreme prematurity after having 
surgical abortions with her first two pregnancies, I can tell 
you that this is devastating for women and their families.

    Abortion also leads to a significant increased risk of 
adverse mental health outcomes. The vast majority of the 
literature on this issue shows long lasting mental health 
effects from abortion, including depression, anxiety, drug 
abuse, and suicide for at least 20 to 30 percent of women.

    When our Country is already facing a mental health crisis, 
we should be minimizing things that contribute to this, not 
encouraging them. As OB-GYNs, we love caring for both our 
patients. We all desire for women to have the best possible 
healthcare and for them and their children to have the best 
chance to pursue their goals and dreams.

    Pro-life laws have not created a women's healthcare 
nightmare. The idea that induced abortion is the only way women 
can be successful or healthy has. We now have the opportunity 
to change course.

    I invite my colleagues at the table, the thousands of OB-
GYNs across this country and you Senators, to lead the way as 
we empower women with accurate information as exceptional 
healthcare and better solutions for our maternal patients than 
ending the lives of their own children.

    [The prepared statement of Dr. Francis follows.]
                prepared statement of christina francis
GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT
                [summary statement of christina francis]
    As a board-certified OB/GYN Hospitalist who manages both high-and 
low-risk pregnancies and has delivered thousands of babies, I have the 
distinct privilege to be with women and their families during the most 
exciting, challenging, and sometimes heartbreaking times of their 
lives. I am also here as an advocate for my patients.

    With the advancements in medical technology and understanding over 
the last 50+ years, it is now undisputed fact that, at the moment of 
fertilization, a distinct, living and whole human being comes into 
existence.

    While most pregnancy complications threatening the mother's life 
occur after the point of fetal viability (currently approximately 22 
weeks of pregnancy), they can occur before this point. The decision to 
intervene in these situations, especially preterm, is extremely 
difficult and not one that I take lightly. These interventions are not 
induced abortions.

    There has been a lot of false information being spread that laws 
limiting abortion will prevent these life-saving treatments, but this 
is simply untrue. Not only do NO state laws currently on the books 
prohibit these treatments, but even state laws restricting abortion 
pre-Roe allowed for them. The more than 7,000 members of AAPLOG, the 
American Association of Prolife OB/GYNs, along with the remainder of 
the 76-93 percent of OB/GYNs who do not perform abortions, know that 
induced abortion does not need to be legal in order to ensure we can 
provide our patients with excellent healthcare.

    In fact, excellent healthcare does not include induced abortion at 
all. Induced abortion has no health benefits to my patients--it ends 
the life of one and often causes significant harm to the other. For 
instance, there are more than 160 studies that show an increased risk 
of preterm birth in future pregnancies after surgical abortion.

    Abortion also leads to a significant increased risk of adverse 
mental health outcomes. The vast majority of the literature on this 
issue shows long-lasting mental health effects from abortion including 
depression, anxiety, drug abuse and suicide for at least 20-30 percent 
of women. One large study showed that women who had abortions had a 7x 
increased risk of suicide compared to women who carried their 
pregnancies to term.

    The other witnesses and I have something essential in common. I 
assume we all desire for women to have the best possible healthcare and 
for them and their children. Prolife laws have not created a women's 
healthcare ``nightmare''--the idea that induced abortion is the only 
way women can be successful or healthy has. We now have the opportunity 
to change course--and tens of thousands of physicians across the 
country who do not perform induced abortions are ready to lead the way 
as we empower women with accurate information and excellent healthcare.
                                 ______
                                 
    Senator Murray. Ms. Ohden.

 STATEMENT OF MELISSA OHDEN, MSW, FOUNDER AND CHIEF EXECUTIVE 
    OFFICER, THE ABORTION SURVIVORS NETWORK, KANSAS CITY, MI

    Ms. Ohden. Chairman Sanders, Ranking Member Cassidy, and 
Members of the Committee, thank you for inviting me to today's 
hearing. I am Melissa Ohden, the survivor of a failed saline 
infusion abortion, and the founder and CEO of the Abortion 
Survivors Network.

    Babies survived abortions before Roe v. Wade. We survived 
during Roe v. Wade, and babies are still surviving abortions no 
matter where or how the abortion is performed. These 
experiences highlight the fundamental and undeniable humanity 
of the pre-born and the needs, fears, and experiences of their 
mothers. I appreciate this opportunity to have a serious 
conversation about this issue and for stories that highlight 
the impact of abortion to be told.

    Earlier this year, The Washington Post wrote a story about 
a woman named Evelyn that I want to share with you today. 
Evelyn's trips to abortion clinics ended differently than 
expected. Two separate attempts where medication abortion 
failed, and she was found to be too far along to abort a third 
time. If we're going to talk about women's experiences with 
abortion, then we need to include these stories in this 
discussion as well.

    I empathize with Evelyn, shocked at discovering that her 
first medication abortion failed. As directly quoted, she 
fainted when she saw that there was a heartbeat on the 
ultrasound and was in and out of consciousness for about 5 
minutes.

    As a journalist Amber Ferguson wrote with an honesty I 
appreciate, ``Evelyn says she didn't know that the pills 
sometimes didn't work''. She later learned that 3 percent of 
medication abortions fail when the gestation reaches 70 days or 
10 weeks according to the American College of Obstetricians and 
Gynecologists.

    I can tell you that the Abortion Survivors Network hears 
these stories from women time and again. They're shocked to 
discover they're still pregnant with the baby they attempted to 
abort. They try to keep it a secret and often navigate it 
alone.

    Whether they continue the pregnancy or attempt another 
abortion or multiple abortions as Evelyn did. As directly 
quoted, desperate Evelyn found a website aid access that 
shipped abortion medication across the country.

    After speaking with a doctor by phone and paying $150, she 
waited for pills that were being mailed from India. This second 
course of abortion drugs also failed to end her pregnancy. 
Evelyn's story and her daughter's life wasn't over yet. As the 
article continues, she found a clinic in Albuquerque that 
offered second trimester abortions. She was approaching the 
third trimester.

    The clinic staff warned about the health risks of having a 
surgical abortion so late in her pregnancy, but helped connect 
her to two abortion organizations that covered the cost of her 
plane ticket, hotel food, and the $12,000 procedure. We need to 
pause here and truly consider Evelyn and her daughter.

    The support she was offered after the failure of two 
medication abortions was to pay for a plane ticket, lodging, 
food, and a $12,000 abortion that posed risks to her health. 
This is an abysmal response to Evelyn and her baby. Evelyn 
needed emotional support, medical and mental healthcare, 
financial assistance. Evelyn's baby like me, deserved more than 
to be subjected to yet another attempt to end her life.

    Could you imagine a child in your own life being subjected 
to so-called medical interventions intended to weaken, starve, 
burn, or dismember them limb by limb until they die? This is 
the reality of abortion and we should be ashamed of it. Evelyn 
was found to be 32 weeks pregnant.

    According to Southwestern Women's Options, the clinic's 
doctors aren't trained to perform abortions after 24 weeks. 
Evelyn soon thereafter gave birth to her daughter and she made 
an adoption plan, an option they both can live with.

    The nightmare here is not abortion bans. The nightmare is 
that abortion continues to be aggressively promoted, so that it 
is seen as the only option, like a plane ticket and $12,000 for 
a late-term abortion.

    I ask each of you to consider how different women's and 
children's lives, families, our society could be, if just as 
much money was spent to provide financial assistance, housing, 
education, and employment support, childcare, medical, and 
mental health care. This would lead to a new era of women's 
empowerment that ends the generational trauma of abortion. This 
doesn't have to be a dream. We can make it a reality.

    [The prepared statement of Ms. Ohden follows.]
                  prepared statement of melissa ohden
    Chairman Sanders, Ranking Member Cassidy, and Members of the 
Committee, thank you for inviting me to today's hearing.

    I am a survivor of a failed saline infusion abortion and the 
Founder and CEO of The Abortion Survivors Network, which has connected 
with over 700 survivors of abortion procedures. Babies survived 
abortions before Roe vs. Wade, we survived during Roe vs. Wade, and 
babies are still surviving abortions, no matter where or how the 
abortion is performed, as I'll be sharing today. These experiences 
highlight the fundamental and undeniable humanity of the preborn and 
the needs, fears, and experiences of their mothers.

    I appreciate the opportunity to have a serious conversation about 
this issue and for stories that highlight the impact of abortion to be 
told. My hope is that today's discussion is the catalyst for 
intellectual honesty, deeper conversations and understanding, and 
collective support across the aisle for women, children, and families.

    Earlier this year, the Washington Post wrote a story about a woman 
named Evelyn. Evelyn was young and pregnant, and the article chronicled 
her decision to obtain an abortion and end her pregnancy. This is a 
common and familiar story, but this story had a plot twist. Her first 
abortion failed, her second also failed, but she persevered and sought 
a late-term abortion but was denied it. This, too, may be part of the 
familiar narratives. However, the redemption in her story is evident, 
as she decided to place her child for adoption and now has a 
relationship with her daughter and the woman who raises her. \1\ Her 
story is one of a failed abortion, one that I am very familiar with but 
many try to deny or hide. When the term ``abortion survivor'' is 
dismissed as ``fake news,'' women like Evelyn and my birth mother, 
Ruth, are also being dismissed, their experience erased and denied with 
the experiences of those who survived--like Evelyn's daughter and me.
---------------------------------------------------------------------------
    \1\  Ferguson, Amber. ``After abortion attempts, two women now 
bound by child.'' Apri l6 2024. The Washington Post.

    If we are going to talk about women's experiences with abortion and 
the nightmare of abortion, then we need to include these stories in the 
---------------------------------------------------------------------------
discussion, as well.

    While Evelyn's trips to abortion clinics ended differently than 
expected--two separate attempts with medication abortion failed, and 
she was found to be too far along to abort a third time--they stand as 
proof that a pregnancy can continue after an abortion. Some of the most 
powerful words in this article came from the journalist, who expanded 
on and called attention to women's healthcare in America. Let me be 
clear: Women in America and around the world deserve better than 
abortion.

    I empathize with Evelyn's shock at discovering that her first 
medication abortion failed. When a family friend and nurse arranged for 
bloodwork and an ultrasound at a hospital after months passed without 
her menstrual cycle returning, as directly quoted, she ``fainted when 
she saw that there was a heartbeat, and was in and out of consciousness 
for about 5 minutes'' (1).

    As the journalist Amber Ferguson wrote with an honesty I 
appreciate,``Evelyn says she didn't know the pills sometimes didn't 
work. It is a rare occurrence, but she later learned that 3 percent of 
medication abortions fail when gestation reaches 70 days, or 10 weeks, 
according to the American College of Obstetricians and Gynecologists. 
The odds of failure increase if the patient waits longer than 
prescribed to take the second dose of the medication, several medical 
experts said'' (1).

    Abortion bans have not ended abortion--we've merely seen a shift to 
abortion pills. These pills have a lower success rate and result in 
women becoming their own DIY abortionist. The results of this access to 
abortion are staggering, nearly 1-8 percent of abortion pills fail, 
which means that women are still facing the same challenges as before, 
and put themselves and their child at risk for repeat abortion attempts 
(2345).

    How could Evelyn know this when women aren't told this information? 
The Abortion Survivors Network hears these stories from women time and 
time again--they are shocked to discover they are still pregnant with 
the baby they attempted to abort. They are unaware that abortion 
procedures, including medication abortion, can fail. They feel shame 
and guilt, uncertainty and fear about their baby's future. They try to 
keep this a secret and often navigate it alone--whether they continue 
the pregnancy or attempt another abortion--or multiple abortions--as 
Evelyn did.

    Women nationwide could identify with Evelyn's experience because it 
weaves several threads of an abortion experience. ``Desperate, Evelyn 
found a website, Aid Access, that shipped abortion medication across 
the country. After speaking with a doctor by phone and paying $150, she 
waited for pills that were being mailed from India. Evelyn had told the 
doctor she wasn't sure the date of her last period'' (1).

    Shocking as it was for Evelyn, this second course of abortion drugs 
also failed to end her pregnancy.

    This was not what Evelyn was told would happen. It must have been 
agonizing when she realized that not one, but now two medication 
abortions failed to end her pregnancy. But her story, and her 
daughter's story--her daughter's life--wasn't over yet.

    As the article continues, ``She found a clinic in Albuquerque that 
offered second-trimester abortions. She was past the halfway point in 
her pregnancy and approaching the third trimester, but she still had 
time, Evelyn told herself. The clinic staff warned about the health 
risks of having a surgical abortion so late in her pregnancy but helped 
connect her to two abortion organizations that covered the cost of her 
plane ticket, hotel, food and the $12,000 procedure . . . '' (1).

    We need to pause here and truly consider Evelyn and her daughter.

    The support she was offered after the failure of two medication 
abortions was to pay for her plane ticket, lodging, food, and the 
$12,000 abortion that posed risks to her health.

    This is an abysmal response to Evelyn and her baby. Evelyn needed 
emotional support, medical and mental health care, financial 
assistance, and answers to the questions she had about the impact 
medication abortion attempts had on her developing baby. Evelyn's baby 
deserved more than to be subjected to yet another attempt to end her 
life. Can you imagine a child in your own life subjected to so called 
``medical treatments'' intended to weaken, starve, burn or dismember 
them limb by limb until they die?

    This is the reality of abortion. And we should be ashamed of it.

    Yet this story did not end in an abortion clinic. `I'm so sorry,' 
Evelyn remembers the nurse telling her, looking at the screen.`You are 
too far along, 32 weeks pregnant,' she said, pausing before adding, `We 
can't help you.' The clinic's doctors aren't trained to perform 
abortions after 24 weeks, according to Southwestern Women's Options.

    ``Suddenly out of options for ending the pregnancy, Evelyn began to 
consider a future that had once seemed impossible. She would be giving 
birth'' (1).

    In Deaths and severe adverse events after the use of mifepristone 
as an abortifacient, \2\ the researchers found that in 452 patients 
with ongoing pregnancy after the use of mifepristone--102 (22.57 
percent) chose to continue the pregnancy, 148 (32.74 percent) 
terminated again, one miscarried and 201 (44.7 percent) had unknown 
outcomes. Although there are a number of ways to interpret these 
statistics, for today's hearing to I want to emphasize the researchers' 
concluding concern:
---------------------------------------------------------------------------
    \2\  Aultman, Kathi et al. ``Deaths and Severe Adverse Events after 
the use of Mifepristoneas an Abortifacient from September 2000 to 
February 2019.'' Issues in law & medicine vol. 36,1(2021):3-26.

        ``The significant number of women who chose to continue their 
        pregnancy after initially choosing termination raises concerns 
        regarding pre-abortion counseling and informed consent they 
        received . . . Additionally, the high percentage of women with 
        ongoing pregnancies for whom there is no follow-up or known 
        outcome is concerning. As health care providers, we are to 
        continue to care for our patients and manage any complications 
        yet in the AER's (Adverse Event Reports) we reviewed this was 
        not the case for the abortion provider. Furthermore a Federal 
        directory of known outcomes and birth defects is imperative'' 
---------------------------------------------------------------------------
        (2).

    This hearing purports that abortion bans have caused a nightmare 
for pregnant women who are facing an unplanned, unwanted, or a 
complicated pregnancy. I want to correct that false narrative and 
remind you all that the nightmare existed before any bans took effect. 
The nightmare is that women have been made to believe that pregnancy is 
a problem. The nightmare is that women are told abortion will solve 
that problem.

    The nightmare is that this ``solution'' continues to be 
aggressively promoted so that it is seen as the only solution--like a 
plane ticket and $12,000 for a late-term abortion. I ask you to 
consider how different women's lives, children's lives, families, our 
society could be if just as much money was spent to provide financial 
assistance, housing, education and employment support, childcare, and 
medical and mental health care. This would lead to a new era of women's 
empowerment,that ends the generational trauma of abortion--if that too 
pricey, then perhaps, we are spending too much money helping women get 
abortions.

    When women know there is support available to them outside of 
seeking an abortion, then they are empowered and will make choices that 
everyone can live with. Evelyn's story proves this can happen. My 
story, and countless others, are proof this is an attainable reality in 
America, it is not just a dream.
GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT
                                 ______
                                 
                  [summary statement of melissa ohden]
    Babies survived abortions before Roe vs. Wade, we survived during 
Roe vs. Wade, and babies are still surviving abortions, no matter where 
or how the abortion is performed. These experiences highlight the 
fundamental and undeniable humanity of the preborn and the needs, 
fears, and experiences of their mothers.

    Earlier this year, the Washington Post wrote a story about a woman 
named Evelyn. Evelyn was young and pregnant, and the article chronicled 
her decision to obtain an abortion and end her pregnancy. Her first 
abortion failed, her second also failed, but she persevered and sought 
a late-term abortion but was denied it. If we are going to talk about 
women's experiences with abortion and the nightmare of abortion, then 
we need to include these stories in the discussion, as well.

    Abortion bans have not ended abortion--we've merely seen a shift to 
medication abortion. These pills have a lower success rate and result 
in women becoming their own DIY abortionist. The results of this access 
to abortion are staggering, nearly 1-8 percent of abortion pills fail, 
which means that women are still facing the same challenges as before, 
and put themselves and their child at risk for repeat abortion 
attempts.

    This hearing purports that abortion bans have caused a nightmare 
for pregnant women who are facing an unplanned, unwanted, or a 
complicated pregnancy. The nightmare is that women are told abortion 
will solve that problem. The nightmare is that this ``solution'' 
continues to be aggressively promoted so that it is seen as the only 
solution--like a plane ticket and $12,000 for a late-term abortion.
                                 ______
                                 
    Senator Murray. Thank you to all of our witnesses. We will 
now begin a round of 5-minute questions and I'll ask my 
colleagues to keep track of your clock and stay within those 5 
minutes.

    Mady, I want to start with you. First off, thank you so 
much for being here today, telling your story. I know it is not 
easy and it takes a lot of courage to be here in front of all 
these people to talk about something so personal to you. We 
really appreciate it.

    You touched upon in your remarks many hoops that you had to 
jump through just to be able to get your abortion, including 
traveling, I think you said, over 700 miles round trip away 
from your home in Texas to Mississippi. Talk a little bit about 
how you felt when you were forced to drive 13 hours, out of 
state, to get care. What was going through your head?

    Ms. Anderson. Thank you so much for that question, Senator. 
There was a lot going through my mind when I was having to go 
through the travel. Like I said in my testimony, I was 
extremely anxious and sleep deprived, so a little bit delirious 
in the part of just wanting to sleep and feel relaxed. I felt 
very on edge, constantly fearing what would be thrown at me 
next.

    Senator Murray. How'd you feel after receiving care in 
Mississippi, on the way back home?

    Ms. Anderson. When I was able to get my abortion and 
receive care, that was the first time I was able to sleep more 
than 3 hours and I woke up and I looked at my mom and I started 
crying. Because I was like, I got to sleep, I can finally 
breathe, and this huge weight just lifted off my chest.

    Senator Murray. It's your life and your choice.

    Ms. Anderson. Absolutely.

    Senator Murray. Dr. Francis, I have a question for you and 
I want a simple yes or no. Do you believe that women should 
have access to plan B? Yes, or no?

    Dr. Francis. I believe women deserve to have accurate 
information about their healthcare.

    Senator Murray. I'm not asking you that question. Do you 
believe that women should have access to plan B?

    Dr. Francis. I think that women should be given any 
medication under the supervision of a physician.

    Senator Murray. You support access to plan B?

    Dr. Francis. I support women having access to accurate 
information and care from a physician.

    Senator Murray. Do you believe that women should have 
access to medication abortion? Just yes or no.

    Dr. Francis. Chemical abortion are dangerous high-risk 
drugs.

    Senator Murray. No. Do you believe women should have access 
to IUDs? Yes, or no?

    Dr. Francis. I believe that again, women should receive 
comprehensive healthcare access under the direction of a 
physician.

    Senator Murray. Access to IUDs. Do you believe women should 
have access to IUDs? Yes, or no?

    Dr. Francis. I believe that women should have access to OB-
GYN physicians who can counsel them about all of their options.

    Senator Murray. I take that as a no. And I want to ask you 
for the record today, do you think that IUDs and emergency 
contraceptives are abortifacients? Yes, or no?

    Dr. Francis. If you look at the package inserts for such as 
the copper IUD, it actually clearly states that they do prevent 
implantation, even if fertilization has occurred, which would 
classify that as an abortive for patients--per the package 
insert.

    Senator Murray. Okay. I just want to, for the record, Dr. 
Francis, your organization has taken the mind-boggling position 
in defiance of nearly all medical experts that abortion is 
never necessary to save a woman's life. According to resources 
that were put out by your organization, you recommend that in 
cases of dangerous pregnancy complications, like a massive 
placental abruption, women should be forced to labor for 24 
hours, even if that means being treated with blood transfusions 
in intensive care, and even if their pregnancy is non-viable in 
the first place, just so they can deliver an ``intact'' fetus.

    It has also been well-documented how your organization is 
working behind the scenes with Republican lawmakers to redefine 
certain kinds of contraceptives as abortions, so you can 
ultimately ban those types of contraception. I think that is 
incredibly alarming.

    It's really important for people to understand the 
Republican minority has specifically invited you to this 
hearing today, despite those dangerous positions.

    For the information of all Senators, we are going to be 
voting this week on the right to contraception. And I hope 
everyone truly thinks about what that means for women and how 
it would change our entire country and our women's rights 
moving forward across the board. So, I just wanted to make that 
very clear.

    I just have a few seconds left, Dr. Verma really quickly. 
Many states, yours included, require many, a lot of time, a lot 
of consulting, a lot of multiple trips to doctors. How does 
that affect the healthcare system in general?

    Dr. Verma. It immensely affects the healthcare system to 
make basic medical decisions about whether we can provide care 
to a patient in front of us. We're often having to involve 
legal representatives, hospital administration, that creates 
delays in care instead of just being able to provide the care 
that we know is right for the patient sitting in front of us.

    Senator Murray. Thank you. And I am out of time, so I will 
turn it to Senator Cassidy.

    Senator Cassidy. I'll defer to Senator Mullin.

    Senator Mullin. Thank you. And thank you, Chairwoman. I 
just want to actually commend everybody for actually having a 
good conversation here. I expected this to actually be pretty 
rambunctious, and so for that, I'm probably going to leave a 
lot of my questions out because I came here to be punchy.

    [Laughter.]

    Senator Mullin. I think it's important that I share a 
story. And then I do have a couple of questions too, because I 
do appreciate everybody's opinion. And that's what this is 
about, is about having a conversation. And I think put in a 
context of why I'm so pro-life may help a little bit of the 
understand our positions, right?

    I've been married for 27 years. I got married when I was 
19. My wife was 18. First question my father-in-law asked me 
when I asked to marry my wife, Christie is, is she pregnant?

    I was like, no, I don't think so. And at 7 years later, we 
were still trying to have kids. And my wife had endometriosis, 
and it took a long time to have kids. We went through 
everything you can think of in vitro, through shots, through 
you can imagine. And then she got pregnant, and that was my 
Christmas gift, 1 year I got out of my stocking.

    It was quite an exciting time and we went through the 
pregnancy and we went to the first doctor visit and how excited 
it was. And then we went later on and we heard the heartbeat 
the first time. And I'm going to tell you, that was a child to 
me. I mean, I was so excited. We were thinking them names. We 
were going through the whole process. And man, I can't tell you 
the excitement I had.

    I literally, I'm not even a crier at that time. Now, I talk 
about my kids, I cry all the time. But I remember getting 
emotional for the first time and I was thinking, what is this 
inside of me, a tear about to drop out of my eyes.

    But then while through the pregnancy, she went back in and 
she had a miscarriage. That was a death to us, hundred percent 
death to us, so no one will say that wasn't a death. That was a 
child when I heard the heartbeat, and it was a death when we 
didn't hear the heartbeat. And it was extremely difficult for 
my wife and I.

    Fortunately, literally, the month that child was due to be 
born, we found out we were pregnant again. And his name is Jim 
Martin Mullin, and after my dad.

    15 months later, we had another one because people that 
tell you, you can't get pregnant when breastfeeding, lies, 
because you can. And his name is Andrew Daniel Mullin.

    Three years later, after the doctor said she couldn't get 
pregnant anymore, and she was going to have to have a 
hysterectomy, we had another one. And her name is Larra, and 
she's 15, Larra Mullin, and lord, she's 15. And love her to 
death.

    Then my wife and I decided we were not going to have kids 
anymore, and I got a vasectomy and she got an ablation. And yet 
we still collected three more kids. Because there were three 
kids that deserved a home and two mothers that loved those 
children so much instead of aborting them, they were brave 
enough to carry them.

    Gave Christie and I an opportunity to love these three 
wonderful kids, two twins named Ivy and Lynette that we'd 
adopted when they were 2 years old, and now they're 13. And 
Jace, who is wrestling at Oklahoma State as we speak, I was in 
Ohio with him this week. And his mother was just barely 20 
years old. And the twins' mother was 15 when she got pregnant.

    I thank God every day, literally every day that those 
mothers gave Christie and I an opportunity to be blessed and be 
loved by these three kids.

    There's options. What's sad is when you look at 
statistically speaking is that, over 50 percent of the 
pregnancies inside the United States is unplanned, but 50 
percent of all pregnancies also end in abortion. That's sad. I 
mean, you're lucky to be born right now, and inside DC its 51.5 
percent of all pregnancies, meaning we end more pregnancies 
here in Washington DC than we actually have. Something's wrong.

    Abortion has become almost a point of convenience. While we 
understand it's unplanned, but that child deserves an 
opportunity to be in a loving home, just like my three kids 
are. I tell everybody we had three, we got stuck with, and 
three we chose. Which ones do you think we love the most?

    I'm blessed, Christy and I are blessed, but we got to talk 
about the reality here. And we're not talking about rape and 
incest and high-risk births. Those account for less than 9.5 
percent of all births out there. 8 percent are high risk, 1 
percent are rape, point less than 0.5 percent of from incest. 
We're not talking about those abortions; we're talking about 
others.

    Guys, we can do better as a country. And that's what this 
conversation is about. We have to talk about it. Just give 
these kids an opportunity to live. They'll bless somebody, 
because Our kids bless us every single day. With that I yield 
back.

    Senator Murray. Senator Sanders.

    The Chair. Let me thank all of the panelists for their 
testimony. I think we can all agree that the issue we're 
discussing today is an emotional issue. It is a difficult 
issue. And sincerely people have different points of view on 
the issue.

    I would like to direct my questioning to doctors Verma and 
Linton, and ask them this. No doubt you have experienced women 
and their partners who have jumped for joy when they learned 
that they were pregnant and that you did everything you could 
to make sure that the pregnancy was successful.

    I suspect you have also met with many women who, for a 
variety of reasons, whatever they may be, health reasons, 
economic reasons did not jump for joy when they learned that 
they were pregnant.

    My question to you is a pretty simple one. I'm assuming 
that you have worked with people in all walks of life, all the 
economic levels, races, so forth. Who do you think is best 
prepared to make the decision about the future of that 
pregnancy? Is it people in a legislature, generally speaking 
often dominated by men, or would it be the people who are 
feeling the impact of that pregnancy?

    Understanding, I would suspect you've never told anybody 
they should not have an abortion, right? We respect people's 
different points of view. Who should make that decision based 
on your experience? Dr. Verma.

    Dr. Verma. Yes. Thank you for that question. Based on my 
experience, people are the experts in their own lives and are 
able to make these really complicated decisions about their own 
lives.

    I want to say I appreciate Senator Mullin sharing that 
story. I, myself have struggled with infertility, and I've 
experienced a first trimester miscarriage that I found 
devastating. And so, I am not at all saying that pregnancies 
don't have value. That value is different for different people, 
and the way that people connect with their pregnancies is 
different.

    Each person is capable of making these really important, 
sometimes complex, sometimes difficult decisions about their 
healthcare and their life. Even if that sometimes means ending 
a pregnancy.

    The Chair. Dr. Linton on this enormously personal decision, 
should it be a state legislature that makes it for every woman 
in the state, or should it be the woman herself?

    Dr. Linton. I agree wholeheartedly with Dr. Verma. I think 
this is a decision that only the patient can make. Every single 
patient situation is unique. Our patients live very complicated 
lives. And I think that we have to trust them.

    Our job as physicians is to meet patients where they are, 
provide them the information that they need, and then support 
them in whatever decision they make for themselves and for 
their futures.

    The Chair. All right, let me ask the doctors again. If you 
were a young physician wanting to practice medicine, would you 
gravitate to a state which has a harsh anti-abortion law?

    Dr. Verma. Thank you. This is really difficult for me. I'm 
from the south. I love the south. It is my home, and it has 
been really hard to grapple with wanting to serve my community, 
but being in an environment where I have to face threats of 
criminal prosecution, of having my license removed for simply 
providing medicine.

    I have had thoughts about leaving, even though I love my 
home and my community, and I talk to medical students and 
residents every day who are in that same position. They love 
the south, they're from the south, but are choosing to leave 
because they can't get the training and they can't practice in 
the way that they want to.

    The Chair. A time when there is already a shortage of 
physicians in that area. Correct?

    Dr. Verma. Yes. And in Georgia, 50 percent of counties do 
not have an OB-GYN. And as doctors leave, that doesn't just 
affect access to abortion care, it affects access to all types 
of care, to prenatal care, to miscarriage management.

    Already at the hospital I work at, I see patients coming to 
labor and delivery who have received no prenatal care because 
they haven't had access to that care that's just going to get 
worse and worse and make pregnancy riskier and more dangerous.

    The Chair. Excellent. Your experience regarding that?

    Dr. Linton. I would agree. I think that the concerns that I 
hear from trainees are sort of twofold. The first is similar to 
what Dr. Verma was speaking about, wanting to make sure they 
receive that comprehensive training. They want to be able to go 
into practice and feel prepared that they can provide whatever 
care is necessary to serve their patients.

    But I think it's also important to remember most of our 
trainees are of reproductive age, and they also need to think 
about what would happen if they experienced an unintended 
pregnancy or an unexpected health outcome. So, yes, I have 
heard from many of my trainees concerns about staying in state 
or certainly about thinking about these restrictions when 
deciding where they aim to practice in the future.

    The Chair. Thank you.

    Senator Murray. Senator Cassidy.

    Senator Cassidy. Thank you, Madam Chair. Ms. Ohden, thank 
you for sharing your story. Thank you all. This is a very 
difficult topic and this is part of that dialog and so, so 
thank you all. Ms. Ohden, I understand that you have a child 
with special needs. Can you relate the counseling you received 
where you suggested that you get an abortion or how can you 
relate that?

    Ms. Ohden. I do appreciate everyone sharing such personal 
stories. I think this is part of what we need to do is share 
our stories more, but listen more as well. No matter what side 
of the aisle we're sitting on.

    Not only am I someone who survived an attempt to end my 
life at approximately 31 weeks gestation by a saline infusion 
abortion, I'm also a woman who has had a first trimester 
miscarriage and have felt that pain. And not just myself, my 
husband as well. I remember his pain so distinctly.

    I also have a child who was born with complex medical 
needs. I was 36 years old, fast approaching 37. And so even 
prior to finding out that my daughter had a prenatal diagnosis, 
I was being pressured time and time again with conversations 
about abortion because of my advanced maternal age at 36.

    To the point that even prior to my 20-week ultrasound, I 
had to call up the OB-GYN's office and let them know that I 
found it so offensive for them to continue to state abortion 
time and time again based on my own personal history that I was 
asking, they not do it again, or I would need to go to another 
practice.

    I can tell you my daughter is almost 10. She is an 
incredible young woman who has overcome a lot. And as she is 
raised, to know that she has the same dignity and value as 
everyone else in the room. That everyone is made differently. 
And yes, some of us see different doctors for different health 
issues at different times, but she is someone who experiences 
incredible joy and is living a great life.

    Senator Cassidy. Thank you. Dr. Francis, I think that 
Senator Murray was suggesting that you were trying to duck her 
question when you said that people needed to be counseled, but 
your testimony is very nuanced.

    Now, some of the testimony we've heard has suggested 
somehow that women, particularly minority women, particularly 
African American women, and their long-term health outcome is 
hurt by not having ready access to abortion.

    Yet you quote data, and I just compliment you on just how 
this is chockfull of references and studies, it's like a white 
paper. Can you give a little bit more nuance about how someone 
should be counseled that abortion does not necessarily save a 
life? In some ways, it brings further complications.

    Dr. Francis. Yes, absolutely. Thank you, Senator Cassidy, 
for that question. As you said, we do see disparate health 
outcomes in this country, unfortunately especially in minority 
women. But we also see that Black women have a much higher rate 
of abortion than do white women.

    This has not improved their health outcomes. In fact, their 
maternal mortality rates are worse. Their preterm birth rates 
are worse. And, as I stated, there are more than 160 studies 
that show a link between surgical abortions and preterm birth. 
In fact, the patient whose story between----

    Senator Cassidy. Wait, surgical abortion and preterm birth?

    Dr. Francis. Yes, preterm birth in future pregnancies. In 
fact, the Institute of Medicine has acknowledged that surgical 
induced abortions are an immutable risk factor for preterm 
birth in future pregnancies.

    Senator Cassidy. The increased loss of unborn or 
miscarriage children in some, may be, you're saying there may 
be a causation associated with their previous history of 
abortion.

    Dr. Francis. Correct. That's what the studies suggest.

    Senator Cassidy. Is there academic literature supporting 
that?

    Dr. Francis. 100 percent. There are very large systematic 
reviews, and as I said, the Institute of Medicine has 
acknowledged this as well.

    Senator Cassidy. When you say in response to Senator Murray 
that someone should be counseled, they should be counseled!

    Dr. Francis. Absolutely. In fact, that patient that I sat 
with who had lost her fifth child due to a condition called 
cervical insufficiency, where her uterus literally could not 
hold a baby in, to the point of viability anymore. One of the 
things I thought about is, let me just----

    Senator Cassidy. Just because we have limited time, and you 
also quote data showing that in countries that have prohibited 
abortion after previously not allowing it, maternal mortality 
has not worsened. Suggesting that this kind of idea that 
abortion saves women's lives has not been borne out by empiric 
experience.

    Dr. Francis. Correct.

    Senator Cassidy. Dr. Linton. In your testimony, you say 
something along the lines that suggesting that there shouldn't 
be any restriction, but I go back to that child. Now we know 
it's rare for someone late term without a reason to have a 
child like this aborted, but it does occur. And in nine states 
plus a city in which we are currently, it's allowed.

    Does this child really have no rights whatsoever? I mean, 
should that child, knowing I'm giving you the hypothesis, the 
mama does not have a risk, this is just a decision to abort.

    Is there no consideration to be given of this? Because I 
have to understand, we have to have a dialog, but I'm seeing if 
there's actually a common ground here. Your mic, please.

    Dr. Linton. Thank you, Senator Cassidy for that question. I 
think that these sorts of extreme hypotheticals really give 
no----

    Senator Cassidy. No, these occur and it's legal. And this 
side, the Democratic aisle actually wants that to be the law of 
the land.

    Dr. Linton. I think what you are describing is----

    Senator Cassidy. My question is--because now I'm going to 
just say Senator Murray thought Dr. Francis was trying to duck. 
Maybe it's a yes or no. If it's not for the health of the mama, 
the life of the mama, et cetera, should this child have no 
rights in the decision to abort at week 40 when otherwise if 
the child was delivered, the child would be alive.

    Dr. Linton. Senator Cassidy, respectfully, I don't think 
this is a question that we can whittle down to a yes or no. I 
think pregnancy is much more complicated than that.

    Senator Cassidy. Do they have a right?

    Dr. Linton. I would say that every situation is unique. And 
when a patient presents----

    Senator Cassidy. I will say at this point, the inability to 
answer that is troubling. And with that I yield, because I'm a 
minute over. I'm sorry.

    Senator Murray. Senator Casey.

    Senator Casey. I was going to ask a question to Dr. Verma. 
Dr. Linton, anything else you wanted to say in response?

    Dr. Linton. Thank you, Senator. No, I was simply going to 
say that I think every situation is unique and our job as 
physicians is to take all of the information that a patient 
provides us and give them the option to decide what is best for 
themselves and for their bodies. Thank you.

    Senator Casey. Thank you. And I'll start with Dr. Verma. I 
want to go to Dr. Verma in page one of your testimony, you say, 
and I quote, I've seen young moms with worsening medical 
conditions that make their pregnancies very high risk. And 
couples whose deeply desired pregnancies are in the process of 
miscarrying, be turned away or forced to leave their 
communities to access needed healthcare.

    Tell me how that reality that has surfaced most recently. 
Tell me how that reality has affected your ability to care for 
your patients, No. 1. And No. 2, how has your relationship with 
those patients changed?

    Dr. Verma. Thank you for that question. It has been 
devastating to have to look at patients and say, I can't help 
you. I can't provide this care, or I have to wait for you to 
get sicker before I can potentially provide this care.

    It creates a huge amount of mistrust that patients have for 
both the healthcare system and the government. There is not a 
line in the sand where someone goes from being totally fine to 
acutely dying. It's often a continuum. And even when state laws 
like Georgia's have exceptions for things like medical 
emergency, it's unclear to us as the doctors when we can 
intervene.

    If I could just take a second to go back to Dr. Cassidy's 
point here. I just really want to highlight that the situation 
of doing an abortion at the moment of birth doesn't happen. As 
a doctor who provides full spectrum reproductive healthcare, 
including OB care, I love taking care of people on labor and 
delivery. I provide abortion care. That doesn't happen.

    It is a false hypothetical that is meant to create 
additional stigma around abortion care. If a patient comes in 
at 40 weeks, their options are a C-section and a vaginal 
delivery. And this misinformation is really dangerous to our 
patients.

    I also just want to highlight that 90 percent of abortions 
in this country occur in the first trimester, and less than 1 
percent are occurring after 20 weeks, when in most cases, 
something has gone terribly wrong with the patient or the 
pregnancy. And that person really needs that care for some 
reason.

    Senator Casey. Doctor, thank you. And I want to turn to Dr. 
Linton for her to make reference to her testimony. I'm looking 
at both pages. The bottom of page 2 and the top of page 3. On 
page 2, you pose this question, ``When would an abortion be 
necessary, quote, to save the life of the mother?''

    You point to a couple of examples. ``What about a patient 
who presents with heavy bleeding in the first trimester, but 
there is still fetal cardiac activity on ultrasound. Can I 
remove the pregnancy to stop the bleeding? Do I have to wait 
for a certain amount of blood loss?''

    Then you continue at the top of the page with a few more 
examples. ``A pregnant patient with unresolved congestive heart 
failure from her last pregnancy that puts her at higher risk of 
dying in this pregnancy. What percent chance of death does she 
need?''

    Next question. ``What about a patient with a newly 
diagnosed breast cancer at 8 weeks of pregnancy who cannot 
start chemotherapy or radiation while she's pregnant, is 
delaying her treatment until after delivery a risk to her 
life?''

    Finally, at least of the examples I'm pointing out, ``What 
about a patient with a blood clotting disorder where pregnancy 
will further increase the risk of a pulmonary embolism or 
stroke? Is the risk of a blood clot enough, or do I have to 
wait until the actual stroke occurs?''

    You go on from there with other examples and you say, 
``These are real patients that my colleagues and I have 
encountered.'' I'd ask you the same question. How has that 
reality since the Dobbs decision changed your ability to care 
for your patients and your relationship with your patients?

    Dr. Linton. Thank you for that. I think I would go back to 
that same idea of this culture now of confusion and fear. All 
of those cases that I mentioned in my oral and written 
testimony, those are real patients that I have encountered, 
that my partners and I debated, did we meet this, arbitrary 
phrase from an 1849 law or not? Do we need to call lawyers? Do 
we have to consult other physicians?

    We were not able to just follow the medicine in these 
cases, and adding words such as imminent death or immediate 
death, that doesn't help clarify anything further. So, I would 
reiterate what Dr. Verma said. These are impacting our ability 
to care for the patients in front of us in a timely and 
appropriate way.

    Senator Casey. Thank you.

    [Technical problems]

    Senator Murkowski. I want to thank you all for being here 
for your testimony and for sharing deeply personal stories. As 
has been repeated here, and we know to be true, access to, to 
reproductive care, the issue of abortion itself, decision to 
terminate a pregnancy is deeply, deeply personal. It's 
complicated.

    Clearly there are views that Americans have on this issue 
that present deep and conflicting convictions. And so just the 
ability, the opportunity to have true discussion and 
conversation about it, I think is important.

    I have been pretty clear where I stand on this issue. I 
think the choice to have an abortion should ultimately be in 
the hands of the woman, of the individual, not the government. 
But I also believe that it's reasonable not to require those 
who are firmly opposed to abortion to support it with their 
income tax dollars, and that providers who do not wish to be 
involved in abortion should not be forced to do so.

    That's why I've worked with several other colleagues here. 
Senator Collins, Kaine, Sinema, and I have this bipartisan 
legislation to ensure that the rights that women have relied on 
for the past 50-some-odd years, those that were set out Roe and 
in Griswold are protected. I think that they should be 
protected.

    We establish a Federal right to choose and reaffirm the 
right to contraceptive access without raising concerns about 
religious freedom and provider conscience protections. So, my 
position on this is clear, but I'm also pretty clear-eyed in 
recognizing that it's unlikely that the Congress is going to 
pass legislation that would establish clearly that right to 
abortion, certainly in this Congress.

    But I will tell you, I continue to hear from so many in my 
state, women in Alaska who are concerned about access to 
abortion, access to reproductive services, even while we are a 
state where we have included in our state's constitution, a 
right to privacy that protects that access to abortion.

    But what we have seen from decisions across the country in 
the lower 48, is a ripple effect that has come all the way up 
to the North. Planned Parenthood in South Soldotna Alaska 
location closed in anticipation of the trigger laws that were 
coming online that would require more resources in other 
states.

    We think that we are far enough that we're protected, that 
access is protected, but there are implications that move 
beyond those state boundaries. And so women are asking me about 
access. We are a very, very rural state in the first place. 
Access to providers is limited in the first place. And 
certainly, access to abortion has also been limited.

    I am going to throw this out to anybody on the panel. What 
can we do practically, right now, to help ameliorate some of 
what we are seeing with the impact of the Dobbs decision to 
ensure that women do have access to the care that they need 
now.

    I wasn't here when you presented your testimony Ms. 
Anderson, but I can't imagine how difficult, when you're 
already in a very stressful situation, the thought that I might 
have to travel hundreds of miles, extraordinary expenses to 
travel, but the access to care is so limited. I've given you no 
time to answer, but does anybody have anything, Ms. Lopez, go 
ahead.

    Ms. Lopez. I'm happy to answer. Thank you for the question 
and for the describing the experience in Alaska. I mean, I 
think one of the things we can do, Senator, is ensure that we 
can maintain access to medication abortion, right? Medication, 
abortion now accounts for two-thirds of all abortions in this 
country as of 2023.

    In rural areas like yours, it's incredibly important to 
have that option via telehealth for folks who can't reach a 
provider or when they live in communities as the doctor said, 
that don't have providers given the limited access to providers 
that they have. And so maintaining access to a method that we 
know is safe and effective based on decades of widespread use 
and study I think becomes critically important.

    Senator Murkowski. Thank you for saying that. I absolutely 
agree. Thank you, Mr. Chairman. Thank you.

    Senator Murray. Thank you.

    Senator Murphy.

    Senator Murphy. Thank you, Senator Murray. Thank you all 
for being here today for your testimony. In Connecticut we 
often hear from our physicians that we should not labor under 
the belief that there are safe states, right? Connecticut is a 
state today that protects the right to full reproductive 
healthcare for women, for families.

    But we know what the agenda is. We know that the agenda of 
Republicans in the Senate and Congress is to pass a national 
abortion ban, and we are potentially months or years away from 
losing those protections in Connecticut.

    But the doctors in my state tell me that this myth of the 
safe state is also due to the fact that the bans that are being 
passed in states that aren't Connecticut are fundamentally 
changing the practice of medicine and medical knowledge in the 
United States. And so, Senator Sanders started to explore, I 
think this really important issue, but I wanted to build on his 
questioning. I think I have two questions to ask, and maybe 
I'll pose the first one to Dr. Verma and Dr. Linton.

    What does it mean that we now have a growing number of 
states that are not training physicians in the suite of 
services related to pregnancy loss?

    What does it mean that we have physicians today that are 
emerging from education in those states that potentially do not 
have the full scope of training on how to manage medical 
challenges like miscarriages or complications such as 
infections or hemorrhaging that could stem from pregnancy loss? 
This seems like a significant challenge for our Country.

    How is medical education changing when you have so many 
residents and medical students who are simply not getting the 
same kind of comprehensive education around reproductive 
healthcare?

    Dr. Verma. Thank you for that question. Over 50 percent of 
OB-GYN residencies are in states that have enacted bans or very 
restrictive abortion laws, and that's absolutely affecting 
resident training and medical student training. I think it's 
important to highlight here that it's the same procedures, the 
same medications that we use when we're providing abortion care 
that we also use when someone comes in experiencing a 
miscarriage or experiencing a pregnancy loss.

    It's very concerning that more and more doctors are not 
going to be able to provide all options for care to someone who 
comes in, for example, at 14 weeks bleeding after breaking 
their water and is sick and needs care.

    I absolutely think this is going to affect the ability for 
people to get all types of care across the country. It's 
particularly going to affect women in rural areas in certain 
parts of the country. And I think that's really devastating 
when we're already experiencing such a healthcare crisis and 
maternal mortality crisis.

    Senator Murphy. Dr. Linton.

    Dr. Linton. I agree with Dr. Verma, I will say immediately 
after the Dobbs decision, there are certain requirements that 
trainees have to achieve or things that they have to learn in 
order to satisfy the requirements of residency training, 
specifically in OB-GYN.

    I can tell you that in the immediate after fact of 
aftermath of Dobbs, trying to find places for those learners to 
go and receive that training was incredibly difficult. As you 
mentioned, one of the safe states or haven states not only are 
these states being asked to take care of an influx of patients, 
we are also asking them to take care of an influx of learners. 
And all of that is just being compounded and compounded.

    I agree with Dr. Verma. I am concerned about the future of 
our ability of our workforce to be able to care for patients in 
a variety of settings.

    Senator Murphy. Well, Ms. Lopez, let me ask you that 
question about the broader workforce challenge, because our 
state reports that we are seeing an influx of individuals for 
training, but what we also know is that in states that have 
passed these abortion bans, they have seen a 10 percent decline 
in applications for OB-GYN residencies.

    We're not seeing a 10 percent increase in our states, in 
part because we have a set number of residency slots that's not 
going to change overnight. And so, the net effect here at a 
moment when we were already desperate for more individuals to 
go into this care, seems to be a doubling down of a workforce 
crisis that is going to affect every woman and every family 
across this country, no matter which state you live in.

    Ms. Lopez. Absolutely. Thanks, Senator, for that question. 
Absolutely. And these folks are not just providing abortion 
care, right? They're providing the full range of reproductive 
care, which means that if you are seeking prenatal care or 
contraception or IVF or any of the number of reproductive care 
options, you will not have those providers available.

    We already have maternity care deserts around this country. 
Those will only increase as well. And I think it also forces 
doctors to think about, do they want to risk criminalization 
for providing this standard medical care, this basic medical 
care.

    Senator Murray. Thank you.

    Senator Budd.

    Senator Budd. Thank you, Madam Chair. Thank the panel and 
for your stories and testimoneys. So, after the Biden 
administration's FDA, it ended in-person dispensing 
requirements. As I understand, chemical drugs are now routinely 
available without any medical supervision.

    Dr. Francis, can you tell us about abortion reversal pills 
and why it's important for states to make sure that pregnant 
women have access to information about these pills? 
Particularly those women who are considering abortion? Dr. 
Francis.

    Dr. Francis. Thank you, Senator Budd, for your question. If 
I can first just highlight the dangers of the, the FDA's 
decision to lift that in-person dispensing requirement, because 
that will tie into abortion pill reversal as well.

    What that removes from women is any kind of medical 
oversight. It removes the opportunity to document how far along 
in their pregnancy they are. Many women are wrong about how far 
along in their pregnancy they are. And we know that the farther 
along in pregnancy a woman takes those drugs, the higher the 
risk of complications.

    It also removes the possibility of adequately screening for 
ectopic pregnancy. And it also removes the real possibility for 
a woman to receive fully informed consent. That's a really 
important part of ensuring that before a woman takes these 
drugs, that she is in fact not only sure of her decision, but 
aware of the potential risks that she's facing by taking those 
drugs.

    We know that now women are receiving less counseling, more 
and more women are deciding after taking that first drug, the 
mifepristone pill, that they regret their decision and they 
desire to save their child's life.

    I know this because I'm a member of the Abortion Pill 
Reversal Network. I'm a provider of that treatment, which 
involves giving a woman natural progesterone, which can 
counteract the effects of the first mifepristone.

    It's essential that women are aware of this, not only 
because they're not receiving adequate counseling now before 
they receive these drugs, but so that they know if they make 
the choice, if we really are supportive of women having 
choices, we should support their choice if they decide that 
they regret their abortion and, and would like to save their 
child's life.

    Senator Budd. Thank you. So, you're saying that there's 
more dangerous health outcomes with the lifting of the medical 
supervision, correct?

    Dr. Francis. Absolutely. So, even according to the FDA's 
own data, 1 in 25 women who take these drugs even with medical 
supervision, will end up in the emergency room. But I can tell 
you, having gone down to the emergency room in my own hospital 
many times to care for women who are facing life-threatening 
complications after taking these drugs, it is more common now 
that they're not being seen in person first.

    Senator Budd. What's the window of time from taking the 
chemical abortion drugs to the reversal?

    Dr. Francis. It's most effective if it's taken within the 
first 72 hours, but especially within the first 24 hours. So, 
it's imperative that women have this information so that they 
know if they change their mind that there is a treatment that 
they can access.

    Senator Budd. In light of FDA ending in-person dispensing 
requirements for these drugs, could you talk about how human 
traffickers are exploiting the lack of protections that used to 
exist for women?

    Dr. Francis. Well we certainly know that there's a link 
between human trafficking and forced abortions that's been 
shown very clearly. And it's also been shown that one of the 
main points of contact for a trafficking victim to get help is 
actually with a medical professional.

    What we've done now is we have removed that point of help 
for a woman, and we've also allowed for traffickers, a way for 
them to be able to access these drugs online. It's been well 
documented that women who are not pregnant are receiving these 
drugs after going online and ordering them.

    I personally talked with a woman who is in her sixties who 
got these drugs. She just wanted to see if she was able to get 
it, and she was able to get these drugs. So, it is now possible 
for anyone to go online, get these drugs. Traffickers could 
stockpile them so that they could force them on their victims, 
to force abortions as they have in the past.

    Senator Budd. Can you walk me through some of the 
ramifications of S. 4381 given that it waives protections from 
the Religious Freedom Restoration Act? This is the 
Contraception Legislation that's before us right now. So, I 
believe it's S. 4381 and it waives protections from the 
Religious Freedom Restoration Act.

    Dr. Francis. Thank you for the opportunity to also clarify, 
I think one misunderstanding of my organization's position on 
contraception. So, we actually don't take an official position 
on contraception.

    However, we would support the right of any physician to 
abstain from prescribing any medication or participating in any 
procedure that violated either their religious beliefs or 
violated their own conscience. And if they feel that it 
violates the oath that they took as a physician, then we would 
support the right for any physician to be able to abstain from 
prescribing those medications.

    Senator Budd. Thank you, thank you panel.

    Senator Murray. Senator Hassan.

    Senator Hassan. Well, thank you very much, Senator Murray, 
and to the Chair, and Ranking Member Cassidy. Thank you for 
this hearing, and to all of the witnesses, thank you for being 
here today. I've received thousands of messages from 
constituents in New Hampshire urging me to protect reproductive 
freedom since the Supreme Court overturned Roe v. Wade.

    On that day, the women of America lost a fundamental 
freedom. Every woman should have the right to control her own 
life, and that includes the right to make her own healthcare 
decisions. And with deep respect for my colleagues on the other 
side of the dais, women know what a pregnancy is.

    I too in response to Senator Mullin, I had a miscarriage at 
12 weeks in a pregnancy between the birth of my son and the 
birth of my daughter. It was as devastating for me and my 
husband and our family as Senator Mullin described the 
devastation that he and his family experienced.

    Right now, though, women are facing a danger in our Country 
that is real and it is grave. And that includes women like one 
of my constituents, who was carrying twins and discovered in 
the third trimester that one of the twins could prove fatal to 
the other.

    Now, think about the decision that she and her physicians 
had to make as they grappled with this very rare, very 
difficult medical challenge and the impact of the abortion ban 
in New Hampshire on her and her physician as they tried to 
figure out what to do.

    A few questions. Dr. Linton, abortion bans are impacting 
multiple facets of women's healthcare. Miscarriage is common, 
and as we've just talked about, it can be devastating. One in 
five pregnancies in the United States results in miscarriage. 
In places where abortion bans are in place, some women 
experiencing miscarriages who need immediate medical attention 
are being denied the healthcare that they need because doctors 
fear criminal penalties if they treat these women.

    Can you discuss how abortion bans are jeopardizing the 
health of women who are having miscarriages?

    Dr. Linton. Thank you for that question. Yes. I think that 
it goes back again to this idea of confusion. These laws are 
not written by physicians. Many of them are written before the 
era of modern medicine, before we had ultrasounds and modern 
diagnoses that we use today. So, asking a physician to 
interpret a law, not only through a medical lens, but through a 
modern lens, can be very difficult.

    We are physicians. We are not lawyers. We did not go to 
medical school to make very intricate legal decisions. And so 
as much as sometimes I obviously--my biggest concern is for the 
patient in that situation. And yet at the same time, I can't 
necessarily blame the physician for having this fear over 
confusion of whether or not they can provide care. We need to 
focus on letting physicians make medical decisions to be able 
to care for the patients in front of them.

    Senator Hassan. Thank you. Dr. Verma, abortion bans and 
restrictions are even making it harder for women to get 
prenatal care that supports the wellbeing of women and their 
babies. It's harder than ever to recruit obstetricians, as you 
all have talked about and, gynecologists, to practice in rural 
areas across the country, especially once you factor in 
abortion bans, including those that could put doctors and their 
patients in jail.

    Dr. Verma, what is the impact of abortion bans on doctors 
who are trying to do their jobs? In particular, how are these 
bans limiting women's access to care in rural areas?

    Dr. Verma. Absolutely. Thank you for that question. Even 
pre--Dobbs I was seeing patients in Georgia that were traveling 
significant distances to get to a hospital where they could get 
prenatal care to get to a doctor who took Medicaid, if that is 
their insurance.

    There are multiple barriers that women are already facing. 
What we're seeing is as more doctors leave these states because 
of abortion bans, those distances that patients are having to 
travel are getting further and further.

    Patients are also scared. One of the things I do in my 
practice is I do preconception counseling visits where I sit 
down with a patient who wants to get pregnant and talk to them 
about how to optimize that pregnancy. So, starting a prenatal 
vitamin, getting off any medications that are dangerous for the 
pregnancy.

    Since Dobbs, I'm hearing again and again, patients are 
asking, what happens if I get pregnant and something goes 
wrong? And these are patients with desired pregnancies. They 
are so afraid that something is going to go wrong and they 
won't be able to get the care that they need. And it's 
affecting people's decisions about whether to expand their 
family, even if that's something they want.

    Senator Hassan. Absolutely. Thank you. I am almost out of 
time. So, a quick question for Ms. Lopez. Since Roe v. Wade was 
overturned, it's more critical now than ever that women can 
access contraception. Most forms of health insurance cover 
birth control.

    However, there are nearly 1 million women of reproductive 
age who are enrolled in Medicare because of a disability, and 
they don't have guaranteed access to contraception. I'm working 
on a bill that will close this contraception coverage gap by 
requiring Medicare to cover all forms of contraception, 
allowing women with disabilities to get the type of 
contraception they want and need. Can you speak to the 
importance of requiring Medicare to cover contraception?

    Ms. Lopez. Thank you. And thank you for your championship 
of that legislation. Yes. It's critical for all people who can 
become pregnant to have access to contraception, so that, they 
can plan their families appropriately. So, that they can 
determine if, when, and how they want to start a family. And 
that includes folks on the margins, including disabled people. 
So, thank you again.

    Senator Hassan. Thank you very much. Thank you.

    Senator Murray. Thank you.

    Senator Marshall.

    Senator Marshall. Thank you, Madam Chair. Dr. Linton, how 
many babies have you delivered in the past month or two?

    Dr. Linton. I would say probably in the tens to twenties. 
Okay.

    Senator Marshall. Dr. Verma, how many babies have you 
delivered in the past month or two?

    Dr. Verma. That's a good question. I'm terrible at 
estimating, but over my career, thousands.

    Senator Marshall. You're still active, you're still 
actively delivering babies.

    Dr. Verma. Oh, yes, yes, I do labor and delivery shifts 
every week.

    Senator Marshall. How often or what type of range would you 
do sonograms on a pregnant woman, let's say before their fourth 
month or pregnancy, hardly ever, a lot, sometimes?

    Dr. Verma. Yes, I see patients with all kinds of 
pregnancies. Sure. And usually when a patient comes in and is 
has a positive pregnancy test, I talk to patients that want to 
continue this pregnancy----

    Senator Marshall. Like, my question is, how often do you 
use sonograms on your routine prenatal visits? Before 16, 8 
weeks or so?

    Dr. Verma. We usually do an initial ultrasound to confirm 
that the pregnancy is there.

    Senator Marshall. Prenatal pregnancy, first visit, usually 
you're doing a sonogram to confirm the pregnancy. Dr. Linton, 
how often are you doing sonograms in the first, trimester or 
early second on a routine OB situation?

    Dr. Linton. To be very clear, I work on labor and delivery 
and I deliver babies, but I do not provide prenatal care.

    Senator Marshall. Thank you. So then, Dr. Linton, do you 
deliver a 23-24-week baby, I'm sure before?

    Dr. Linton. Yes.

    Senator Marshall. When that baby's delivered, you call in 
anesthesia, you call the NICU, you call everybody you can in to 
help that baby, right?

    Dr. Linton. It depends on the clinical scenario. But yes, 
if it's a desired pregnancy and the patient has voiced the 
desire for resuscitation, then we have NICU present at that 
delivery.

    Senator Marshall. You've also done abortions at 23, 24 
weeks as well?

    Dr. Linton. In my training, I provide the standard of care 
in line with medical law.

    Senator Marshall. I'm just asking that. I'm not sure. 
You're not ashamed of it. You've done abortions with the baby's 
23, 24 weeks.

    Dr. Linton. I provide the care that I'm trained to do based 
on the state laws where I live in.

    Senator Marshall. Dr. Verma, you've done abortions and 
you've delivered babies at 23, 24 weeks, full resuscitation, at 
the same time you've done abortions on those as well.

    Dr. Verma. I think what you're highlighting here is the 
complexity of what we do.

    Senator Marshall. No, that's not my question. I get to ask 
the question here. I'm not asking for a lecture. Is there any 
distress in your mind or your heart after doing an abortion? On 
the one hand, you're delivering a baby at 23 weeks and--all out 
resuscitate the baby, you feel horrible. It doesn't make it, 
then you do an abortion on that same--how does that make you 
feel?

    Dr. Verma. I appreciate the question. I think it's a great 
question. And again, like I was saying, this is why this is so 
complicated. I feel that complexity, like I said, I've 
experienced a first trimester loss myself, and I found that 
loss devastating. So, this is complicated, but I also know that 
my patients are able to make these really complicated decisions 
about their health and lives.

    Senator Marshall. Thank you very much. Dr. Linton, what 
pregnancy category of drug is mifepristone?

    Dr. Linton. I'm sorry, Senator. Off the top of my head, I 
can't tell you the class.

    Senator Marshall. Dr. Verma, do you know what type of 
pregnancy category drug mifepristone is?

    Dr. Verma. I know mifepristone is incredibly safe based on 
decades of data about----

    Senator Marshall. Do you know that what category of drug 
that is in pregnancy?

    Dr. Linton. I can tell you we use Misoprostol for a variety 
of reasons, including for desired pregnancies, on labor and 
delivery every day.

    Senator Marshall. They're both category X drugs. Okay. I'm 
going to tell you the answer. They're both categories. So, you-
all are prescribing these drugs and you don't know what 
category of drug it is. And why is it a category X drug? 
Because it causes fetal malformations, right? So, it causes 
fetal malformations.

    Dr. Verma. Those categories that you're describing are 
actually based on politics. The mifepristone is safer than 
Tylenol and Viagra.

    Senator Marshall. You're saying that FDA is based upon 
politics. The FDA is saying this is a category X drug. Would 
you agree with me that these abortion pills are less effective 
at 14 weeks as opposed to 8 weeks? Dr. Linton.

    Dr. Linton. Yes. I would say that our data does support 
with increasing gestational ages, that sometimes we have to 
modify the protocol, but generally they're more effective at 
earlier gestational ages, depending on the protocol you use.

    Senator Marshall. What I'm confused about is, and I've 
never prescribed this drug, I've taken care of lots of patients 
that have complications from these drugs.

    I'm confused why you do a sonogram in a routine pregnancy 
to establish gestational age. That's the only main reason 
you're doing pregnancies in the first trimester, early second 
trimester. Because the spine is not developed, the heart is not 
developed. So, you're basically doing it for gestational age.

    You're recognizing that so many women come in and they're a 
month off of their gestational age. So, why wouldn't you want 
to do a sonogram on every person you see before you prescribe 
this drug, realizing that it has decreased effectiveness at 14 
weeks than at 10 weeks, so therefore, you're prescribing a 
category X drug to a pregnancy that has a possibility of not 
being aborted.

    You're increasing the risk of fetal anomalies. It just 
doesn't add up to me. Why are you scared to do a sonogram? 
Wouldn't you think if you were doing an abortion procedure on a 
12-weeker versus a baby, that's actually 20 weeks that it would 
change everything? I'm just appalled that why you all are so 
afraid of doing sonograms. Thank you so much. And I yield back.

    Senator Murray. I'll allow you time to answer that 
question, Dr. Verma.

    Dr. Verma. Thank you. And I will say, as a doctor who 
actually does provide this care to patients and is currently 
practicing, we actually often do sonograms if there's any 
questions.

    When we see a patient and we're providing medication 
abortion via telemedicine, we go through screening 
questionnaires, and if there's any concern, we absolutely do a 
sonogram. So, that isn't really an accurate representation of 
how this practice of medicine works.

    Senator Murray. Thank you.

    Senator Smith.

    Senator Smith. Thank you so much. Welcome everybody. I'm 
appreciating very much all of you being here. I want to just 
follow-up a little bit on the question about medication 
abortion. So, mifepristone has been lawfully prescribed to 
patients since 2000. I'll just ask Dr. Verma, how safe is 
medication abortion and how effective is it?

    Dr. Verma. Thank you for that question. Medication abortion 
is incredibly safe and effective. In a recent study of 20,000 
patients that have undergone medication abortion, the rate of 
adverse events was 0.38 percent. So, very, very low. Only about 
1 percent of those patients came to the emergency room after 
the process. And of those people, about 40 percent didn't need 
any treatment.

    We know that medication abortion is incredibly safe and 
effective. And I also want to highlight how dangerous 
misinformation about the practice of medicine is for our 
patients, for physicians.

    The American Board of OB-GYNs, which is the board that 
certifies all of us OB-GYNs at this table, has asserted that 
abortion care is safe, is effective, that medication abortion 
is safe, that abortion reversal is not something that we can, 
in good faith offer to our patients because it can cause 
serious risks of bleeding and hemorrhage.

    That abortion care does not cause preterm birth. And so I 
just want to highlight some of that misinformation that we've 
heard today because it can be very dangerous and contradicts 
what the American Board of OB-GYNs and American College of OB-
GYNs asserts.

    Senator Smith. We've heard a few things also today about 
abortion reversal drugs, saline abortions, is there any 
misinformation that you'd like to clear up there as well?

    Dr. Verma. Yes, thank you for that question. Saline 
abortions is not something that is done in the practice of 
modern medicine. I have been practicing for about a decade, 
have never seen or heard of it. So, that is not a practice that 
is done.

    For abortion reversal, my colleagues and I actually studied 
whether this is a treatment that we could offer to our 
patients, because if it was a safe treatment and a patient 
wanted it, I'd be happy to offer it. I am happy to support my 
patients who want to continue a pregnancy, end, a pregnancy, 
whatever is right for them.

    We found we had to stop that study early because people 
were experiencing significant bleeding and were at risk. And 
so, it is not a safe treatment that is available to patients, 
that is misinformation.

    Senator Smith. Thank you. And maybe I'll ask Dr. Linton 
this. I'd like to ask you this question about whether 
telemedicine for medication abortion is also safe and 
effective.

    Dr. Linton. Thank you for that. I would reiterate what Dr. 
Verma said. When we are thinking about providing medication 
abortion via telemedicine, we have screening questions. And if 
there are any red flags, if someone does not have a regular 
menstrual cycle, if somebody is concerned about bleeding or 
cramping, then they are not eligible for a medication abortion 
via telemedicine.

    Of course, our utmost priority in every single patient 
encounter is patient safety.

    Senator Smith. Thank you. Ms. Lopez, thank you so much for 
being here. As you all know, Louisiana recently enacted a law 
that adds mifepristone and misoprostol, which is another drug 
used to manage abortion to the state's controlled substances 
list.

    This law would criminalize anyone who possesses the drug 
without a valid prescription, and it puts it in the same 
category as opioids.

    [Laughter.]

    Senator Smith. I'm just wondering, is there any reason, I 
mean, what do you make of that? And do you believe that 
medication abortion should be put in the same classification as 
other dangerous controlled substances?

    Ms. Lopez. The easy answer is no. And I think my colleagues 
have really reiterated how safe and effective medication 
abortion is. We have two decades of widespread use of study of 
this drug. So, we know that it is safe and effective both here 
and globally.

    It has also become an incredibly important option for folks 
to access abortion care. Two-thirds of abortions are now via 
medication abortion. And so any effort to restrict it further 
is simply an effort to make abortion more difficult to obtain.

    Senator Smith. What impact does that have on women, for 
example, living in rural communities, people who struggle 
already to get access to care, including women who are 
marginalized in so many other ways and don't get access to 
care?

    Ms. Lopez. Yes. The folks who are most impacted by all of 
these abortion restrictions are folks who are already 
marginalized by our healthcare system. So, folks of color, the 
underinsured young folks, LGBTQ folks and folks who, as you 
said, Senator, live in rural communities. And so it makes it 
harder to get.

    We know now that one in five abortion seekers, is traveling 
out of state to get care. So, it means they're leaving their 
home communities at significant financial, logistical, and 
emotional cost to themselves and their families.

    Senator Smith. Thank you, Chair Murray.

    Senator Murray. Well, as Senator Baldwin is settling in, I 
just want to ask unanimous consent to enter into the record 
seven statements in support of abortion access and reproductive 
freedom. Without objection.

    [The following information can be found on page 74 in 
Additional Material:]

    Senator Murray. Senator Baldwin.

    Senator Baldwin. Thank you. I want to thank you, Senator 
Murray, and Chairman Sanders, for holding this hearing. Because 
in the wake of the overturning of Roe, I think we must keep 
drawing attention to the dire consequences on women's health 
across this country, and particularly in my home state, States 
like Wisconsin.

    Before the Supreme Court overturned Roe v. Wade, 
generations of women in this country had only known a country 
with the right to abortion care. And they only knew a country 
where every woman had the freedom to make their own choices 
about if and when to start a family. But when those freedoms 
were stripped away, Wisconsinites were sent back to the year 
1849. They live under a pre-Civil war criminal ban on abortion 
care.

    I've heard such horrifying stories since that ban went into 
effect, about women bleeding out, about contracting life-
threatening infections before receiving care, about women 
forced to travel hours and hours away from their families and 
support systems to receive care for an unviable pregnancy.

    Thankfully, more recently Wisconsin has been able to take 
important steps to restore abortion services in three 
communities, three counties. We have 72 counties. However, 
without access to care statewide, too many Wisconsinites must 
still drive hours, take time off work, arrange for childcare 
and face medically unnecessary barriers before getting the 
healthcare they need. And while some people, say it should be 
the state or the Federal Government who should decide abortion 
rights, I believe it's women who should decide about these 
issues.

    That's why we must pass the Women's Health Protection Act 
which I author, ensuring that women have the right to make 
healthcare decisions and freedom to access abortion care no 
matter where they live. Dr. Linton, and I'm so glad that you 
are here today to share your experience about providing care in 
Wisconsin.

    Your testimony highlights the impossible landscape that you 
and other providers have been forced to navigate in the wake of 
the Dobbs decision and the effects on real patients in the 
State of Wisconsin. These stories aren't hypotheticals. They're 
about real people, and I wanted you to tell us a little bit 
more about how patients in Wisconsin were affected immediately 
after Dobbs.

    How was the Dobbs decision and Wisconsin's archaic 1849 
law, and how that has harmed Wisconsinites? And I imagine there 
were people who had appointments for care on the day that the 
Dobbs decision came out.

    Dr. Linton. Absolutely. Thank you, Senator Baldwin. So, 
yes, you're exactly right. Because of the 1849 law, this was 
not a law that if Dobbs was passed, then we had 30 days or 90 
days or whatever. It was of course, as we've mentioned a couple 
times, there have been questions about the enforceability, but 
because of the risks of $10,000 fines in 6 years in prison that 
went into effect for us immediately.

    At 9:10 am, on the 24th of June, we ceased providing care 
at that moment. We had patients in our clinic, we had patients 
scheduled the next day, and staff members had to go out into 
the lobby and tell them, because of something that just 
happened states away, you cannot receive care here today. And 
it was, it was incredibly difficult for patients and staff to 
try to figure out next steps to help them get healthcare.

    Senator Baldwin. Thank you. I've introduced legislation 
that I just described, the Women's Health Protection Act. This 
bill would guarantee that doctors have the freedom to provide 
abortion care and give patients the ability to receive the care 
they need nationwide. How would passage of that act impact in 
Wisconsin and improve care for patients right now?

    Dr. Linton. Thank you. And as a Wisconsinite, I do want to 
thank you very much for your leadership on this issue. As I 
mentioned, we have and as you mentioned, we've resumed abortion 
care in Wisconsin, but the future of abortion access in 
Wisconsin is anything but clear.

    Even as we are providing abortion care right now, we are 
still practicing under medically unnecessary restrictions, 
including 24 hour waiting periods, ban on telemedicine, 
parental consent law, mandatory ultrasounds, et cetera.

    As a physician who sees the impact of these restrictions 
every single day, I can tell you that Federal protections for 
abortion access will only improve the care that we can provide 
our patients in Wisconsin.

    Senator Baldwin. Thank you. And what do you want us to know 
about the current state of--tell us how these barriers that you 
just described that are in part of state law, how do they 
affect patients that you see?

    Dr. Linton. I think first and foremost, they delay care. We 
know, as you mentioned, abortion is only accessible in 
Wisconsin right now in three counties. Our state is a lot 
bigger than three counties, so patients are already having to 
travel long distances.

    We know that 24-hour bans are often not 24 hours. We have a 
same physician law in the State of Wisconsin. So, the patient 
has to see the same physician for a counseling appointment, to 
receive their medication abortion. So, oftentimes between those 
two appointments, it can be a week or plus before they can come 
back. And abortion is an incredibly time sensitive procedure.

    All of these additional restrictions are creating hoops and 
barriers for patients to receive routine or what should be 
routine healthcare.

    Senator Baldwin. Thank you.

    Senator Murray. Thank you.

    Senator Kaine.

    Senator Kaine. Thank you. Well, like many who spoke of 
today, I think the Dobbs decision was a disaster, both in terms 
of the human consequences of it, but also the radical nature of 
undoing not just 50 years of Roe v. Wade, but a hundred years 
of 14th Amendment precedent, that began with cases like whether 
parents should be able to make their own choices about whether 
their kids go to parochial schools or not, should parents be 
able to make their own choices about educating their children 
to speak German, should people be able to marry who they want. 
And the Supreme Court's decision to cast out, not just Roe, but 
then jeopardize all of these other rights that we've taken for 
granted for a century, has had just a set of horrible 
consequences.

    I think we need a national protection. I have a bipartisan 
bill that would protect both Griswold and Roe and restore to 
where we are, pre-Dobbs, and make plain, that your rights 
shouldn't depend on what zip code you live in. Your rights 
shouldn't depend on who your state legislature is.

    The notion in Dobbs at the Supreme Court said, but don't 
worry, you can go to your state legislature, when most of the 
state legislatures in the country, I mean, look at Congress, 
that's 26 percent women. That's called comfort, to say women's 
rights, well you can just count on the legislature to do it 
right, when women are so underrepresented in most of our 
legislatures, and that's why we have a constitution.

    The Constitution and the Bill of Rights is designed to 
protect core freedoms. Even if the majority is against you, 
there's something that you should get living in this country, 
even if you're just one person that the majority can't trample 
upon.

    Virginia, thank goodness, is one of the few states that 
essentially still follow Roe. There was the basic framework 
established by Roe, minimal regulation of abortion, pre 
viability, some more significant regulation, post-viability. 
That's where Virginia is. Not everybody likes that. For some 
it's not enough, for some, it's too much.

    But Virginia has basically done that, and that has put 
Virginia in an unusual position because we're the last state in 
the South that really still provides women and all the rights 
that Roe guaranteed to them for half a century.

    Ms. Lopez, you alluded to this in your testimony, but 
there's an unusual burden in these instances where states like 
Virginia are protecting reproductive freedom, but surrounded by 
others that aren't.

    There was a story in the Washington Post recently, and I 
mean, here's an example. A woman drove from Houston, Texas to 
Fort Lauderdale, an 18-hour drive to access reproductive care. 
She hadn't heard that the Florida 6-week ban had gone into 
effect, so with no other option and 9 weeks pregnant, she then 
drove an additional 12 hours to Virginia to receive care.

    After she legally was able to terminate her pregnancy at 9 
weeks, she then had a 17-hour drive home back to Texas. I think 
it's just outrageous that we're making people do that. But talk 
a little bit about the burden with this patchwork of some 
states protecting women's reproductive freedom and many states 
not.

    Ms. Lopez. Yes. Thank you, Senator, for the question. And 
as I stated in my testimony now one in five abortion seekers 
are traveling outside of their state to places like Virginia to 
seek care, which----

    Senator Kaine. You said it was 160,000. 80,000 before 
Dobbs, 160,000 since.

    Ms. Lopez. Yes. And what we know is that increases in 
places like your state, and for our providers, that increases 
the number of patients they're getting. So, both the residents 
that they're serving within their own state, and now this 
influx of patients, which means that there's going to be an 
increased waiting time.

    If you think about all of the barriers, that someone having 
to leave their home community, figure out how they're going to 
pay for the procedure, take off work, find childcare, because 
most people who seek abortion are also parents themselves. Go 
to an unfamiliar place probably have to wait. And then also 
have costs on the ground, the financial, logistical, and 
ultimately the emotional barriers are ridiculous and sometimes 
insurmountable, and ultimately could be forcing some people to 
carry pregnancies to term.

    Senator Kaine. Then finally, this is a hearing that is 
about how abortion bans have created a health care nightmare. 
That's the title of the hearing. But the Dobbs decision also 
impacted a whole lot of other rights.

    Again, this whole 14th amendment jurisprudence since the 
mid 19-teens, including the right to contraception in Virginia, 
because of the logic of the opinion Virginia legislators see a 
price. And Ghazala Hashmi, two friends of mine in the Virginia 
General Assembly introduced a contraception protection in 
Virginia law that was passed overwhelmingly by the legislature, 
but our Governor vetoed it.

    Are you seeing other states taking the green light of 
Dobbs, to put into question contraception, in vitro and other 
important health care services?

    Ms. Lopez. Absolutely. Senator, not just contraception, but 
efforts to defund Planned Parenthood continue, to limit or 
defund Title X, access to contraception for everyone, other 
restrictions on minors' access to care, IVF.

    Then we're also seeing kind of similar efforts around 
transgender and gender affirming care. Those are all 
interrelated and all efforts to limit access to basic 
reproductive healthcare.

    Senator Kaine. Well, just as I conclude, to my colleagues, 
Elizabeth Carr, the first child born via IVF in the United 
States was born in Virginia in 1981. And I had her as my guest 
at the State of Union. And she said, when the Alabama Supreme 
Court rendered the ruling that then led the Alabama health care 
providers to stop IVF, she said, for the first time in my life, 
I felt like an endangered species. No one should be made to 
feel that way.

    Thank you. I yield back.

    Senator Murray. Thank you. That will conclude our hearing 
for today. I will give you a closing statement. I want to thank 
everybody who's joined us in this discussion. Senator Cassidy, 
I'll allow you the closing remarks, and I have not yet voted, 
so keep it short.

    Senator Cassidy. First, I'd like to ask unanimous consent 
to enter into the record an Op-ed written by Kelly Crawford, 
founder and executive director of Abel Speaks, an organization, 
created in memory of her son who was diagnosed with Trisomy 18. 
The organization supports families. I think they would feel, 
just as Senator Kaine, they feel as if the children who were 
born with trisomy 18, are being selectively aborted. And that, 
of course, makes them feel like their lives are threatened.

    [The following information can be found on page 114 in 
Additional Material:]

    Dr. Verma, just a quick question. You rightly point out 
that rarely is this done. Would you agree, therefore, that it 
would be reasonable to restrict late term abortions?

    Dr. Verma. First, late term abortion is not a medical term. 
We tend to say abortion later in pregnancy.

    Senator Cassidy. Just this, would you find it reasonable 
that after some week, that it would be reasonable to restrict 
an abortion after a certain period of week, given that it saves 
life the mother and such like that. Because I think that's 
really the crux.

    Is there any kind of limit that will be placed, if you say, 
this hardly ever happens or never happens, I think was your 
words. Would it be reasonable then to restrict when this would 
occur?

    Dr. Verma. When I provide abortion care later in pregnancy, 
I want you to envision a patient who has a nursery designed, a 
name picked out, who Is diagnosed with a terrible fetal anomaly 
or a worsening health condition----

    Senator Cassidy. This is not a theoretical, I'm just saying 
if the child is otherwise well, and the mother's health is 
well, since you are saying this hardly ever happens, is it 
reasonable to have----

    Dr. Verma. I would say abortion at the moment of birth does 
not happen. I also take care of patients who need abortion care 
later in pregnancy for many different reasons----

    Senator Cassidy. I respected, by the way, I really did 
respect you speaking of that tension between the week 23 that 
you would abort and the week 23 threes that you would 
resuscitate. I don't mean to be confrontative, but you're 
avoiding the dialog here.

    Dr. Verma. No, no, I totally hear you. And I'm not trying 
to be confrontational. I'm just trying to highlight what these 
situations actually look like. So, for example, getting an 
abortion care later in pregnancy for someone----

    Senator Cassidy. I'm sorry. I'm not going to get an answer 
that. Dr. Francis, will you just finish up on that question, 
please?

    Dr. Francis. Absolutely. Well I think certainly beyond the 
point where a child can survive outside of his or her mother, 
there would never be a reason you would need to intentionally 
end that child's life. You would simply deliver that baby, 
you'd take care of mom, and you'd take care of baby in an 
appropriate way. And I think that's something that I would hope 
that all of us at this table could agree upon.

    Senator Cassidy. With that I yield. Thank you.

    The Chair. Let me just give Dr. Verma, I don't think that 
Senator Cassidy gave you the opportunity to respond 
effectively. Take 2 minutes to respond and say what you wanted 
to say.

    Dr. Verma. I appreciate it. I was just trying to paint a 
picture as a doctor who's actually sitting with these patients 
and providing this full spectrum of care, what this care 
actually looks like. So, when I'm providing care for a patient, 
for example, that comes in later in pregnancy, a lot of times 
that's a patient who's received a terrible fetal diagnosis and 
is having to make that difficult, difficult decision. They have 
a nursery set up, they have a name picked out, and what they 
need from me as their doctor is support.

    I have some patients that choose to continue that pregnancy 
and deliver at term and other patients who say, that's too 
traumatic. I can't do that. And my job is to support them in 
both of those situations with whatever is right in their life.

    I think as doctors, we all recognize that providing 
lifesaving care sometimes means ending a pregnancy. And to call 
that care something besides an abortion is an issue of 
semantics to further a political agenda.

    The care that we're referring to that sometimes means 
ending a pregnancy, that is abortion care, and that is what we 
are talking about here. And is sometimes necessary lifesaving 
care for our patients who come in needing this care for a 
variety of reasons.

    Senator Murray. Thank you for that comment. And I'll just 
say that as Dr. Verma said, abortion up until the moment of 
birth doesn't happen. Abortions that are later in pregnancy are 
extraordinarily rare, and they occur essentially only when a 
pregnancy is non-viable and the mother risks severe injury or 
death by remaining pregnant.

    The Democratic position on abortion is simple and 
mainstream. We want to ensure that every woman has the right to 
receive abortion care, should she need it. The decision to have 
an abortion is extremely personal, and that should be made in 
every instant by the patient and their doctor, not by 
politicians. That is our position.

    With that, I just want to end this hearing by saying that 
this is the truth. This is a topic that is absolutely not going 
to go away, because women are going to continue suffering under 
Republican's extreme abortion bans. They're going to continue 
to have to travel, thousands of miles, and scrape together 
thousands of dollars to get the care when they need an 
abortion.

    Pregnant women are experiencing health emergencies and will 
continue being turned away from hospitals because politicians 
have made doctors wait until women get sicker and sicker before 
they're allowed to treat them.

    More and more women will continue being forced to stay 
pregnant, forced into motherhood against their will. This is 
not something you forget. It's not a reality that you ignore. 
It's not a status quo you get used to. And make no mistake, 
women are standing up, they are speaking out, and they're 
fighting back to defend their rights that have been ripped 
away.

    Democrats are going to continue to stand with women, lift 
their voices up like today, and push with everything we've got, 
to restore every woman's right to access abortion care in this 
country.

    With that, for any Senators who wish to ask additional 
questions, questions for the record will be due in 10 business 
days, June 18th, by 5 p.m.
    Senator Murray. The Committee stands adjourned.

    Thank you.

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    [Whereupon, at 12:16 p.m., the hearing was adjourned.]

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