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New Hampshire’s abortion limits, defunding carry side effects for health care system

Valley News Staff Writer
Published: 9/17/2021 9:49:40 PM
Modified: 9/17/2021 9:49:47 PM

LEBANON — While the national debate this summer has focused on Texas’ controversial abortion restrictions, Republicans in New Hampshire also have worked to tighten access to abortion in the Granite State.

Upper Valley health care providers said the results likely will create barriers to health care for low-income women as well as interfere with complex medical decision-making that is best left to doctors and patients.

“(This) is altering access to quality health care for the entire state of New Hampshire,” said Dr. Ilana Cass, chairwoman of Dartmouth-Hitchcock Medical Center’s department of obstetrics and gynecology.

This past Wednesday, the state’s five-member Executive Council, which has final say over most state contracts, rejected a six-month extension to agreements with seven family planning clinics throughout the state, including the Planned Parenthood clinic in Claremont. The money would have funded services, including birth control and screening for sexually transmitted infections and cancer for thousands of low-income residents, according to information state health officials provided to executive councilors ahead of the vote. By law, the state funds cannot go toward abortion services.

The four Republican councilors who rejected the contracts cited concerns that the funds would mingle with other clinic revenue used to support abortion, in spite of a recent state audit that found that the clinics keep family planning and abortion funds separate.

The Planned Parenthood clinic in Claremont affected by the decision does not perform abortions.

Outside of DHMC, Upper Valley women seeking abortions may go to the White River Junction Planned Parenthood clinic. That clinic offers medication or in-clinic abortions up to 11 weeks and six days of gestation.

Gifford Medical Center in Randolph, the only hospital other than DHMC in the Upper Valley that still delivers babies, does not perform abortions.

Dr. Pat Glowa, a semi-retired Dartmouth-Hitchcock family physician, said the rejection of the contracts combined with a ban on abortions after 24 weeks’ gestation that goes into effect on Jan. 1 will have a “significant impact for public health.”

The contracts are aimed at making reproductive health care accessible and affordable even for people with low incomes, Glowa said. They also aim to ensure that the clinics have capacity to meet patients’ needs. For example, Planned Parenthood’s award amount for the six-month period would have been $238,464, or about $47,693 for each of the organization’s Granite State health centers, according to a news release.

“What do you do if you can’t get an appointment because the center is overloaded?” Glowa said.

The ban on abortions after 24 weeks was especially troubling to DHMC’s Cass, who said such procedures are “exceedingly uncommon” and are sought by patients in difficult circumstances.

Such procedures are only called for when the mother’s health is threatened, the fetus will not survive on its own or when a woman is a victim of rape or incest, she said. The new law includes an exception to the 24-week ban if the mother’s life or health is threatened but not for a fetal abnormality nor rape or incest.

Cass estimates in the past 15 years, just 10 patients have sought to terminate a pregnancy after 24 weeks’ gestation at Dartmouth-Hitchcock Medical Center.

Both Cass and Glowa said the law sets a troubling precedent for health care in the state that may discourage providers from coming to New Hampshire to train or practice.

“Seeking a late abortion for a lethal fetal anomaly generally arises out of compassion for preventing inevitable suffering and ultimately death for an affected fetus,” Glowa said. “These are not casual decisions. They’re not made lightly.”

After Jan. 1, such patients, except those whose own life or health is threatened by a continued pregnancy, will need to seek an abortion outside of New Hampshire, Cass said. Her department will likely refer women to academic medical centers in neighboring Vermont and Massachusetts.

The law also requires that health care providers perform ultrasounds to determine a fetus’ gestational age before any abortion, which Cass said is not always necessary.

For example, an ultrasound may not be needed to determine the age of a fetus when a woman seeking an abortion is very sure of her last normal menstrual cycle, has very regular cycles and is early in the pregnancy, she said.

“A politician has no place to question that literature, experience and best practice,” Cass said.

If doctors fail to comply with the new law, they could face a prison sentence of as much as seven years and a fine of as much as $100,000. The law also allows the husband of a patient who receives an abortion after 24 weeks and the parents of a patient under 18 who receives an abortion after 24 weeks to sue for “appropriate relief,” including monetary damages for psychological and physical injuries resulting from the abortion.

“When you have felony penalties ... then it has a substantially chilling effect on people’s ability to practice their skills and their knowledge,” Glowa said.

Cass said she is concerned that this has the effect of criminalizing elements of best practice as determined by medical organizations and thinks legislators have overstepped their bounds by dictating how doctors provide care.

“That is absolutely not within their training,” Cass said. “That’s a philosophical gateway to something that is a sci-fi novel.”

New Hampshire has already seen a consolidation in obstetric and gynecologic care in recent years, as maternity wards at most small hospitals have closed due to costs outstripping revenues and difficulties finding providers.

Cass said she’s concerned that the new law and the penalties for breaking it will discourage obstetricians from coming to or staying in New Hampshire.

The Executive Council did approve contract extensions on Wednesday for four other family planning service providers — none of which are in the Upper Valley — that do not provide abortion care.

Gov. Chris Sununu, a Republican, who signed the 24-week abortion ban into law this summer, expressed disappointment in the Executive Council’s vote last week on the clinic contracts.

Meanwhile, Sununu, who stands by the 24-week ban, expressed a willingness to revisit the issue of the ultrasound requirement in an interview with NHPR last week.

“If they’re too onerous or if they don’t make sense, then absolutely, I’m always willing to go back and look at changing that, and I suspect we’ll be doing that in the next couple of months,” Sununu told NHPR.

A spokesman for Sununu told New Hampshire Bulletin this month that as a supporter of abortion rights, he wouldn’t sign a bill like Texas’ new one.

About 2,200 abortions were performed in New Hampshire in 2017, the most recent year for which data was available from the Guttmacher Institute, a New York-based nonprofit abortion policy group. There was a 12% decrease in the abortion rate in New Hampshire from 2014 to 2017, from 10.4 to 9.2 abortions per 1,000 women of reproductive age, according to the institute.

Vermont, where 1,300 abortions were performed in 2017, saw a 5% decrease in its abortion rate from 2014-2017.

Abortion-rights supporters in Vermont are moving forward with Proposal 5, also known as the Reproductive Liberty Amendment, that would enshrine abortion rights in Vermont’s constitution.

Following initial passage by the Senate and House in 2019, Proposal 5 was again passed by a freshly elected Senate earlier this year. If it passes the House during the upcoming session slated to begin in January, it would go on the ballot in November 2022 for voters to approve, VTDigger reported this month.

In New Hampshire, abortion is already somewhat restricted. The state requires that patients under 18 get parental permission for an abortion, Glowa said. In addition, New Hampshire Medicaid does not cover abortions.

The “most economically strapped have to pay out of pocket for an abortion in New Hampshire,” she said.

Cass warned it may be difficult to quantify the broader effects the new restrictions may have on patients and their health, as it will be hard to account for those who opt not to seek care.

“This will be one more barrier,” she said. “One more pebble on their path to exercising their right.”

Nora Doyle-Burr can be reached at or 603-727-3213.

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