Personal View: Why this abortion ban is a threat to women's health
Authors: Marvin Buehner
Journal: BMJ (2006)

In the spring of this year the legislature of US state South Dakota passed, and the governor signed, House Bill 1215, which bans virtually all abortions in the state except for circumstances in which the procedure is necessary to “prevent the death of the mother.” South Dakota had already enacted some of the most restrictive abortion statutes in the nation, and has the second fewest abortions in the US. However, obstetricians in this rural state now face felony indictment for the termination of any pregnancy in which maternal death is not clearly averted by its performance.

I am an obstetrician and gynaecologist who has practised in Rapid City in western South Dakota since 1993. Even then elective abortions were performed only in a single Planned Parenthood clinic in Sioux Falls on the far eastern end of this 400 mile long state. This is not only because of legislative restriction, but also the continuous intimidation of women's healthcare providers by antiabortion activists, supported by the churches of the religious right.


My public posture regarding the ban has been rewarded with a daily parade of protesters


The abortion issue first surfaced in my practice in 1996, when I offered to induce the labour of a preterm patient with fetal anencephaly at our community hospital. The board of trustees for the hospital was struggling with a pregnancy termination policy when antiabortion protesters began daily vigils, including one ghoul on stilts in grim reaper garb. The hospital ultimately adopted a restrictive policy advanced by antiabortion physicians who did not even provide women's health care. My patient had to cross the state to have a dilatation and extraction procedure.

As the antiabortion forces continued to make advances in the political arena, the South Dakota state legislature continued to make abortions here even more difficult to obtain. There is a mandatory waiting period, mandatory parental notification for minors, and a mandatory physician reporting process for every pregnancy termination regardless of the means or indications. And most remarkably, there is an informed consent process that requires physicians to inform the patient that every abortion “terminates the life of a whole, separate, unique, living human being.” Failure to comply with any of these or many other requirements can result in stiff fines and sentences. Neither HB1215 nor any of these prior statutes provides penalties for pregnant patients, only for their physicians.

Those of us caring for pregnant women in western South Dakota have found ways to continue to provide termination options for women with serious medical complications and lethal fetal anomalies despite the restrictive legal climate. These medical interventions could result in felony prosecution under HB1215. But the environment of intimidation here is still so pervasive that neither I, nor my colleagues, nor our state medical association spoke in objection when the legislature proposed a sweeping abortion ban, vetoed in 2004, or when it was reintroduced this year.

This bill represents an unconcealed attempt by its sponsors to challenge the United States Supreme Court ruling in Roe v Wade, which effectively created the right to abortion in the United States in 1973. But the law's supporters did not anticipate the subsequent backlash from South Dakota citizens. More than 38 000 signatures (approximately 5% of the state's entire population) were collected to refer the law to a public vote in November.

Since then I have testified before legislative committees that this law does great harm to women with complicated pregnancies, written columns for the local newspaper, and appeared on local television. I became involved with the South Dakota State Medical Association, which has now expressed serious concerns about the law to its members. And we have collaborated with the American College of Obstetricians and Gynecologists on a comprehensive statement opposing the law for its horrific medical consequences. Though neither I nor any of my partners perform abortions in our clinic, my public posture regarding the ban has been rewarded with a daily parade of protesters outside my office.

Polling data show that 70% of physicians in the state oppose the law, and that the public is poised to reverse this draconian bill in a November referendum primarily because there are no exceptions for victims of rape or incest. If the law is overturned, the battle over abortion will rage on in the United States. But perhaps the defeat of HB1215 will allow more reasonable voices to be heard over the harsh rhetoric of extremists such as the old man outside my office who told the young daughter of one of my pregnant patients, “If your mother is going to see Dr Buehner, you're lucky to be alive.”