83a76ad6249240b3a5a08a7246cf6ef8

Drug Induced Abortions Open a Can of Worm on Campus

Wed, 29 Apr 2026 15:39:45 GMT

Published in Colorado Politics 4/22/2026

At a time of unprecedented Colorado state budget challenges, you would think state legislators would be laser focused on creating and funding those programs where there is broad public consensus and demonstrated need. They would avoid measures driven primarily by tribal and ideological considerations that would further compromise the state budget.

You would be wrong.

HB26-1335 passed its first House committee challenge on April 16 and will be soon headed for the Colorado Senate. The bill creates an unfunded mandate for state colleges and universities to establish and fund drug-induced abortion services at their campus health centers.

While the fiscal note claims there would be no cost to the state, this is ludicrous. In states like California where this has been adopted, millions of dollars were set aside to establish the programs and there was recognition that there would be a substantial long-term financial commitment by the state.

Colorado taxpayers already fund 10 to 30 percent of public university budgets . When the state imposes new mandates without funding, those costs do not disappear. In the short term, they can be either shifted to students through fees/tuition or absorbed through cuts to other critical educational services. But ultimately, they will be paid by the state in the form of increased funding.

Mandating abortion provision transforms student health centers beyond their traditional scope. Student health centers are designed for primary care, preventative services, and limited outpatient management of common diseases. They are not equipped to deal with complex reproductive health services that commonly require follow-up and surgical interventions. During the hearing on HB26-1335, there was no testimony from those institutions that are directly impacted by the measure.

Selecting eligible women for a drug-induced abortion is not as simple as it seems and introduces risk to a campus-based abortion service. Approximately 2–4% of patients may be incorrectly classified as eligible for medication abortion using self-assessment methods. To mitigate this risk, campus health centers should have ultrasound capabilities which introduces another layer of clinical expertise and cost that would be required.

Even when executed based on clinical best practices, drug-induced (mifepristone/misoprostol) abortions carry substantial risk. M ifepristone can be anticipated to cause significant adverse effects. According to the FDA package insert , 85% of women can anticipate an adverse reaction. While serious adverse effects are uncommon, the FDA cites a 0.3-0.5% requirement for transfusion, 0.2% incidence of sepsis, 2.6% requirement for surgical intervention, 2.9-4.6% utilization of Emergency Departments, and 0.04-0.6% need for hospitalization. Higher frequency and higher acuity emergencies are more common after drug induced abortions than following surgical abortion or live birth. This will impact many women seeking abortion services on Colorado campuses that are ill-equipped to deal with this level of physical harm.

The introduction of drug induced abortion services on college campuses will exacerbate an already endemic mental health crisis amongst young adults. Studies of mental health in college student populations demonstrate an alarming incidence of mental health problems. The Colorado Assembly should not be proposing mandates that are known to exacerbate existing mental health problems and precipitate problems in otherwise mentally healthy students. Recent research suggests a markedly increased incidence of hospitalization for psychiatric disorders (81% higher), substance abuse disorders (157% higher), and suicide attempts (116% higher) in women who had undergone abortion. This adds to a growing body of international literature on the adverse mental health impacts of abortion.

The bill does nothing to address the abuse of drug induced abortion by partners and sexual traffickers. HB26-1335 does not require in-person dispensing which increases the risk that coercion on campuses will not be detected and that an abortion might be the choice of partners or traffickers and not the woman.

Hemorrhage is the most common and anticipated result of the drug induced abortion procedure. They will increase the risks of biohazard exposure in college dormitories. Students and staff will be unprepared for the additional exposure to bloodborne pathogens and medical waste that accompanies drug induced abortions. This introduces a whole new source of jeopardy to the student body and increases state financial liability.

Mandated abortion services on campus draw college roommates into an emotional/physical drama without their consent. They may be woefully unprepared to deal with the sequelae.

The notion that without abortion, women’s educational and professional lives would be irreversibly impacted, has credibly been debunked by 240 professional women , scholars and feminists. College women can be better served by policies/programs that make academic and logistical accommodations for pregnant women in the academic environment.

Abortion is morally repugnant to a sizable minority of Coloradans and mandating the procedure on campuses is an affront to those sensibilities. The bill does not include conscience objections. It flagrantly violates Hippocratic tenets of medical professionals and the moral principles of approximately 40% of the state’s population.

There is no reason to make our 32 state colleges and universities purveyors of drug induced abortion when it is widely available off campus. Legislators should reject this bill which comes with both negative budgetary implications at a great personal cost to our students. Instead, let’s focus on those things we can agree on that we know lead to individual and community flourishing.

Tom Perille MD

AAPLOG Colorado

Democrats for Life of Colorado

Cognitive Disonance

Wed, 17 Dec 2025 13:56:05 GMT

Challenges to the Health and Safety of Colorado Women

Sun, 09 Nov 2025 02:47:51 GMT

The Case for Colorado Department of

Public Health and Environment Oversight

Overview of the problem

Conventional wisdom suggests that abortions are safe and there is little need for procedure specific regulations to ensure public health and safety. This is based on widely cited publications such as the National Academies Report entitled “The Safety and Quality of Abortion Care in the United States”.(1) The problem with these assessments is that they don’t differentiate risks based on gestational age or procedure type.

First trimester abortions are done almost exclusively using drugs or aspiration techniques. They represent approximately 90% of abortions in Colorado based on the latest CDPHE data from 2023. Second trimester abortions are primarily performed using Dilation and Extraction (D&E), which poses a substantially increased risk. Third trimester abortion commonly uses a variation of Dilation and Extraction (D&X) whose risks dissuade even most abortionists from attempting.

Since serious complications are uncommon in first trimester abortions, a global quantification of abortion risk will systematically understate the risk posed by second and third trimester abortions. According to the CDC, for each additional week of gestation beyond 8 weeks, the risk of dying from abortion increases by 38%.(2) The mortality from an abortion performed at 21 weeks or more is 77 times higher than the mortality from an abortion at 8 weeks or less based on data from the CDC between 1988-1997.(2) The latest CDC abortion mortality research encompassed data from 1998-2010 and confirmed the earlier findings and emphasized that gestational age was the best predictor of mortality. (3) Reviews of abortion safety commonly miss the vital fact.

One commonly repeated assertion is that “the risk of death associated with childbirth is 14 times higher than with abortion”.(33) This ignores the reality that when incorporating gestational age into the determination, the risk of dying from a second trimester abortion at 18 weeks is nearly twice as high as the risk of dying from natural childbirth.(3, 34) For abortions performed at 18 weeks or greater the mortality from abortion is 6.7 deaths/100000 abortions and the rate increases to 8.9/100000 at 21 weeks or greater. (2,3) The risk of dying during natural childbirth is only 3.6/100000. (34)

Another pertinent comparison is the risk relative to ambulatory surgical centers. The mortality rate at ambulatory surgery centers certified by AAAASF is 2/100000 based on a study from the US.(6) A survey of accredited Canadian ambulatory surgical centers indicates an even lower rate of 1/100000. (7) This suggests that late abortions are 4-8 times more deadly than ambulatory surgeries. Ambulatory surgical centers are licensed, regulated and inspected in Colorado, but second and third trimester abortion clinics are not.

Morbidity related to abortion increases exponentially by gestational age just as mortality. Minor and major complications of D&E second trimester abortions are increased for each additional week of gestation. (4) For example, each one week increase in gestation has been associated with a 7.1% increase in mean estimated blood loss. (5) This is relevant since hemorrhage is the most common cause of death in the second trimester. (2)

Abortion advocates often compare the risk of abortion to other common medical procedures to make the case that abortions are safe. But they routinely compare global mortality rates rather than gestational specific rates.

Facilities that perform colonoscopies are not regulated but they pose 1/3 the risk of 21-week abortions. (1) Plastic Surgery poses only 8-19% of the risk of late abortion and are typically performed in regulated facilities. (1) Adult tonsillectomies pose 32-70% the risk of late abortion and are performed in either a hospital or ambulatory surgical center. (1)

Assessments of abortion safety also suffer from a lack of reliable statistics since the US doesn’t have a national health registry to accurately correlate pregnancy outcomes with maternal morbidity or maternal deaths. Submission of abortion data to the CDC is voluntary and consequently incomplete. To identify abortion related deaths the CDC relies on the Pregnancy Mortality Surveillance System (PMSS) that is based on death records, media reports, and case reports from public health departments and state maternal mortality review committees. This has been shown to underestimate abortion-related mortality when compared to countries such as Finland with robust national health registries. (8) In contrast to the US, Finland has universal health coverage and can identify abortion related deaths through a comprehensive health registry that allows linkage between pregnancy, abortion, and death. If Finland relied on death records alone, which is the primary source in the US, 73% of maternal deaths from abortion would be missed.

The other common problem with publications exploring the risk of abortion is that they often rely on large medical claim databases which systematically underestimate the number of patients who have had an induced abortion and inadequately quantify complications for those that did. (9) Even with the methodological limitations of these studies, the risks of second trimester abortions are markedly higher than the risks of first trimester abortions. (10)

Second and third trimester abortion practice represents an opportunity for both prolife advocates and abortion rights advocates to find common ground. Those who follow a prolife ethic are motivated by an abiding love for both the woman and her preborn baby. They abhor abortion and don’t want to see women harmed by the procedure. Abortion rights supporters want what is best for women and don’t want access to abortion to override their concerns for the health and safety of women. Evidence-based regulation of second and third trimester abortion facilities to protect women’s lives is consistent with both ideologies.

Specific Risks of Second and Third Trimester Abortions

There were 1220 second trimester abortions and 137 third trimester abortions reported to the CDPHE in 2023. This represented 8.3% and 0.9% of all abortions in Colorado. Abortions performed after the lower limit of fetal viability numbered 468 - which represents 3.2% of all abortions.

While prospective double-blind placebo-controlled trials are considered the gold standard in establishing objective assessments of clinical risk, they aren’t feasible for abortion since it would be unethical to submit women seeking abortion to different clinical procedural arms. Consequently, to understand the specific procedure and gestational age specific risks of late abortion, the best evidence is obtained from large retrospective case series from abortion centers across the US.

The largest series of second trimester D&E abortion complications was reported from the University of California San Francisco which is recognized as the premier center for abortion research in the country. (4) They demonstrated a 9.8% risk of any complication including cervical laceration, hemorrhage, uterine atony, anesthesia complications, uterine perforation, disseminated intravascular coagulation, and retained products of conception in over 4500 D&E procedures. There was a 1.7% incidence of serious, life-threatening complications including those requiring hospitalization, transfusion, or further surgical intervention.

Second trimester surgical abortion was associated with a 37% risk of greater than 500 ml hemorrhage and 8% risk of greater than 1000 ml in lower volume abortion centers in South Carolina. (5) (For reference, a whole unit of blood is 450 ml). Blood transfusion was administered to 3.73% of patients.

A study from our own University of Colorado demonstrated a 5.6% risk of cervical injury and a 4.2% risk of hemorrhage of greater than 500 ml in women undergoing suction D&C and D&E abortion in the second trimester. (11) There was a 2% risk for hospitalization.

Pregnancies sometimes involve complex comorbidities in the women or placental abnormalities with the fetus. This can further raise the risk from induced abortion which may not be recognized in unregulated clinic settings.

In a large high volume referral abortion clinic in New York’s, 14.2% of patients undergoing D&E abortion from 15 to 24 weeks gestation had placenta previa (PP) by ultrasound. (12) Second trimester surgical abortion was associated with a 1.3% risk of major hemorrhage requiring transfusion in those without PP but in 3.4% of those with PP. Hemorrhage greater than 500 ml was observed in 4.2% of normal patients but 12.6% of women with PP. This would be hard to manage in an unregulated, lower volume second or third trimester abortion clinic in Colorado.

Medical abortion into the second trimester is also legal in Colorado, although this represents an off FDA label use. They may be performed in unregulated abortion clinics although prudent clinicians would choose a hospital setting. They pose additional risks to the women undergoing this procedure.

Second trimester medical abortions are associated with a 33% risk of any complication and a 6% rate of serious complication based on a study from Northwestern and Rush Universities in Chicago. (13) There is a 16% risk of hemorrhage and a 2.2% risk for hemorrhage requiring transfusion. There is a 0.5% risk for ICU admission, 12% risk for retained placenta requiring surgery, and a 12% risk of infection requiring antibiotics. If there is a history of one or more prior C-sections, these risks are substantially increased – 56% risk of any complication and 19% risk of serious complication.

A second study from Rush University suggested that second trimester medical abortion was associated with a 1% risk of major hemorrhage requiring transfusion, 13% risk of hemorrhage greater than 500 ml, 17% risk of suspected infection requiring antibiotics, 6% risk of retained placenta, and overall complication rate of 17%. (14)

Another second trimester medical abortion study performed at Thomas Jefferson University Hospital in Philadelphia demonstrated a 1.6% incidence of severe hemorrhage requiring transfusion, 14% had retained tissue requiring D&C and 9.5% chorioamnionitis requiring antibiotics. (15)

A small outlier study from the Medical College of Wisconsin showed no statistically different rate of complications from D&E compared to medical induction abortions in the second trimester. (16) The complication rate ranged from 1.3 to 7% and included hemorrhage, retained tissue requiring manual or D&C removal.

There is little data on the risk of third trimester abortions since they are rare outside a handful of states that permit them, including Colorado.

Third trimester abortions (like many later second trimester abortions) involve the injection of a feticide which carries its own independent risk for adverse events. (17) Because third trimester abortions in Colorado incorporate surgical instruments as well as drugs to extract the fetus, it can be anticipated that there is substantial risk to the woman – akin to instrument augmented deliveries. (18)

Risk Beyond the Aborted Pregnancy

There are risks to women that extend beyond those which are manifest immediately post abortion. Abortion facilities still have a vital role to play by ensuring comprehensive informed consent and mitigating these more latent risks.

It is well established that women who seek abortion have a much higher antecedent history of mental health disorders than women who give birth. (22) However, it is also now clear that women seeking abortion are at increased risk for exacerbations of mental illness post abortion.

Abortion advocates primarily point to survey-based studies to bolster their claims that abortion is neutral, or even positive with regards to mental health outcomes. (21-22) However, even studies using this methodology point to a markedly increased incidence of substance abuse post abortion. (21)

The Turnaway study is most often cited by national media to dismiss concerns about the harm to women’s mental health caused by abortion. (35) It shows no negative mental health effects of abortion up to 5 years post procedure. This study is fatally flawed (like most other survey-based studies) because of its small sample size, excessive dropout, and obvious susceptibility to selection bias, response bias, reporting bias, and social responsibility bias. (36) Women with the most negative abortion experience are the least likely to participate in abortion survey-based research which predictably skews the results.

To better establish the impact of abortion on women’s mental health, national registry studies and large cohort studies that evaluate “hard” outcomes like mental health diagnoses/visits, mental health and substance abuse hospitalization, and mental health related deaths are more credible.

A large study from Canada, which was adjusted for confounding variables, showed a marked increased risk for hospitalizations for psychiatric disorders (increased 81%), substance abuse disorders (increased 157%), and suicide attempts (increased 116%) in those who had abortions rather than other pregnancy outcomes. (37) While those with an antecedent mental health disorder were most dramatically impacted, the effect was also seen in those women without a history of mental health issues. The Canadian study built on research from multiple other countries, including the US, that demonstrated that women who had abortions were at greater risk for mental health problems and death. (38-41).

In addition to concerns for mental health, there is a growing body of literature which attests to the deleterious effects of abortion on future pregnancies.

Individual studies (42-44) and meta-analysis (45-47) have demonstrated that surgical abortions are associated with premature birth in subsequent pregnancies. One of the most recent meta-analysis points to a 4.08 times increased risk for cervical insufficiency – leading to premature birth - in women who undergo surgical abortions. (48) This is important because premature birth is associated with both increased maternal and infant mortality. (49)

Induced abortion (and spontaneous abortion) has also been shown to result in abnormalities in the placement/depth of the placenta in the uterus. (50) The suspected common theme is sharp curettage and the resulting damage to the uterine wall in surgical abortions (and other uterine surgical procedures).

Studies suggest a marked increase in placenta previa and placenta accreta spectrum disorders – anywhere from a 36% increase to as much as a 190% increase. (51-55) The relationship between surgically induced abortion and placental abnormalities is significant because both are associated with markedly increased maternal and infant morbidity and mortality.

The other impact on future pregnancies may be an increased need for C-section – which was increased 44% in one study. (55) It shouldn’t be surprising that C-section rates might increase, in whole or partly, related to the impact of surgical abortion and sharp curettage on placental abnormalities.

Finally, although the literature is mixed, there is some concern that the scourge of infertility in our country and beyond could be partially related to the impact of surgically induced abortion. (56)

Reducing Reproductive Age Women’s Morbidity and Mortality is a Priority in Colorado

Maternal mortality, which includes abortion-associated and abortion-related mortality, is a scourge in our nation and in the state of Colorado. Maternal mortality includes death from any cause within one year of pregnancy. The pregnancy can end by live birth, miscarriage, stillbirth, or abortion. Pregnancy-related deaths are a subset of pregnancy associated deaths and are due directly to a complication of pregnancy/abortion or a chain of events initiated by pregnancy/abortion. These could include suicide and overdose, or the aggravation of an unrelated condition exacerbated by the physiological effects of pregnancy or abortion. As in the rest of the United States maternal mortality in Colorado disproportionately impacts people of color, individuals living in poverty, those with less than a high school education, those over the age of 40 and those living in “frontier” areas. (19)

Maternal mortality is the “tip of the iceberg” since maternal morbidity is a much larger problem. For every woman that dies as a result of her pregnancy, it is estimated that 20 or 30 more will experience significant life-long complications. (20)

The Colorado Maternal Mortality Prevention Program (MMPP) aptly states that “every person has the right to a safe and healthy pregnancy”. Unsafe second and third trimester abortion clinics are a direct challenge to this basic right.

The Colorado Maternal Mortality Review Committee (MMRC) reported 174 pregnancy-associated deaths and 80 pregnancy-related deaths between 2016 and 2020.19 These numbers include abortion associated and abortion-related deaths.

There has been significant progress made in delivery-related mortality, which is an important component of pregnancy-related mortality. There has been a uniform decrease in delivery related mortality across all racial and ethnic groups, age groups, and modes of delivery between 2008 and 2021. (20) This has been attributed to national and state strategies focused on improving maternal quality of care using evidence-based bundles during delivery related hospitalizations.

There has not been a similar national or state strategy to institute evidence-based bundles for second and third trimester abortion clinics. While some conscientious facilities may institute these best practices on their own, this represents an opportunity for the legislature to have a significant role in reducing maternal morbidity and mortality by instituting a licensing, regulatory, and an inspection regimen under the auspices of CDPHE for these clinics.

The MMRC has recommended that “health care facilities should implement evidence-based safety bundles”. (19) They add “there should be a specific focus on implementing bundles that address supporting patients with substance abuse disorders and mental health challenges.” A second recommendation is that “all health care providers should use evidence-based screening tools (e.g., PHQ-9, EPDS, C-SSRS) for mental health, substance use, suicidality, intimate partner violence, and social determinants of health including social support, housing, and barriers to care.”

These recommendations from the MMRC are particularly pertinent to abortion care since women who seek abortions have significantly more mental health disorders compared to women who seek childbirth. (21) One high quality registry study suggested that women seeking an abortion were 4 times more likely to have a mental health disorder than women before a normal delivery. (22) They are much more likely to suffer from an anxiety disorder, mood disorder, substance use disorder, and suicidal ideation. Furthermore, abortion is twice as likely to trigger a substance use disorder as compared to childbirth. (21)

Colorado has the second highest percentage (19.4%) of pregnancy-associated deaths from suicide in the country. (23) Significantly, 19.4% of Colorado’s pregnancy-associated deaths are from drug overdose and 10% from homicide. Besides standardizing the approach to anticipated complications of second and third trimester abortions (such as hemorrhage, infection, and anesthesia complications), there is a huge opportunity for abortion clinics to improve outcomes if they employ proper screening techniques and have access to a multidisciplinary team that addresses mental health, substance use disorders and domestic violence.

What requirements should the state emphasize when exercising oversight of second and third trimester abortion clinics?

There is a range of premorbid conditions and abortion procedures that necessarily entail increased risk, and the state should determine which can safely be performed in an out-patient setting and which require hospital care.

Since hemorrhage is the most urgent and life-threatening complication of a second trimester abortion, the state CDPHE should develop regulations and an inspection schedule that ensures abortion patients have access to care that minimizes the risk of hemorrhage and affords prompt treatment options. Studies suggest that actual blood loss is twice as high as estimated blood loss and therefore hemorrhage can quickly result in a critically ill woman or exacerbate any antecedent medical conditions. (24-25)

Each clinic should ascertain whether the patient has a prior uterine scar, the gestational age of the fetus, the quality of cervical preparation, body mass index, procedural experience, fetal demise, and what kind of anesthesia is appropriate. (27) These all can impact the magnitude of hemorrhage following a D&E. They should have access and protocols for use of methylergonovine, misoprostol, oxytocin, vasopressin, tranexamic acid, and other novel agents to prevent or mitigate hemorrhage. Protocols to transfer patients in need of tertiary treatments such as uterine artery embolization, laparoscopy, laparotomy, or hysterectomy should be developed.

A clinic should also be adept at administering anesthesia, including conscious sedation, and responding to anesthetic complications.

They should have protocols in place to address uterine perforation and infectious complications – even if these patients are more likely to present to an emergency department or urgent care center.

Procedures/protocols that minimize forceful dilation of the cervix using osmotic dilators and prostaglandins should be instituted and monitored to mitigate the increased risk for subsequent premature birth.

Mental health should be part of preprocedural screening performed at late abortion facilities. The risk for mental health exacerbations should be stratified to target specific postprocedural mental health interventions and support. Screening should incorporate tools for domestic violence and substance abuse, besides mental health disorders.

Informed consent should reflect all the risks from late abortion – the immediate risks including hemorrhage but also the risks to the women’s health and the health of their baby during future pregnancies.

Second and Third trimester abortion facilities should be required to follow clinical best practices and conduct quality review of all cases of severe maternal morbidity and mortality. The American Association of OB/GYNs (ACOG) recommends that clinicians “characterize the events, diagnoses, and outcomes involved; and to determine if an identified morbidity is judged to have been potentially avoidable and, thus, present opportunities for system change and improved future performance.” (26)

Is a clinic regulation law simply a solution in search of a problem?

The abortion industry will argue that abortion is safe and that if there is a significant problem, it would already be obvious – despite the enumeration of the risks outlined above.

The reality is that because of the stigma from abortion, patients are unlikely to seek redress for significant complications. They may indicate (or be told to say) that they are having a miscarriage rather than an induced abortion when presenting to an emergency department with complications. And we know that even health departments and prestigious medical centers, will turn a blind eye to abortion complications in service to what they perceive as the greater good – unfettered access to abortion.

To understand the magnitude of the problem recognizing and reporting egregious public health and safety practices at abortion facilities, you simply have to peruse the details from the Grand Jury Report on Kermit Gosnell – the abortion provider currently serving time in prison for murder following decades of deplorable abortion practices. (27) The Pennsylvania Department of Public Health and Safety deliberately chose not to enforce law that would afford patients at abortion clinics the safeguards and assurances of quality care as patients of other medical providers. The Grand Jury stated that “the medical practice by which he carried out this business was a filthy fraud in which he overdosed his patients with dangerous drugs, spread venereal disease among them with infected instruments, perforated their wombs and bowels – and, on at least two occasions, caused their deaths.” “Over the years, many people came to know that something was going on here. But no one put a stop to it.”. Even the world class Hospital of the University of Pennsylvania and the Presbyterian Hospital turned a blind eye to women who presented with life-threatening complications from Gosnell’s clinic.

Gosnell is not an isolated rogue actor, since there are dozens of examples of gross medical negligence at abortion clinics from New Jersey to Florida, and from Pennsylvania to Indianna/Michigan and California. If robust Department of Public Health and Environment licensing, regulation, and inspections were in place, none of these regrettable tragedies would happen.

Here in Colorado, Mediatrackers first drew attention to the lack of regulation at abortion clinics in Colorado in 2013. (28) This was prompted by a malpractice lawsuit against Planned Parenthood of the Rocky Mountains that alleged malpractice and health standard violations. They found that Planned Parenthood abortion clinics were not held to the same standards as other facilities which are regulated by CDPHE. Planned Parenthood’s only state oversight consists of the licensure of physicians, nurses and pharmacists who must maintain the requirements of the Colorado State Board of Health, the Board of Nursing, and the Board of Pharmacy. They also operate within the constraints of OSHA (Occupational Safety and Health Administration) and CLIA (Clinical Laboratory Improvement Amendments). There is no state licensing, regulatory, or inspection requirements for public health and safety at abortion facilities in Colorado despite receiving millions of dollars of direct aid from the state.

Another factor which is underappreciated is the fact that 29% of the abortions reported to CDPHE in 2023 were performed on out-of-state residents. Colorado is obligated to ensure quality care for these women so that don’t suffer severe complications after they return home. This could delay appropriate care, worsen the severity of the complication, and have implications for their long-term health. Out-of-state women probably assume that the State of Colorado has their back with appropriate, evidence-based licensing, regulation, and inspections.

Finally, the truth is that there is a global shortage of abortion providers and few OB/GYNs wish to include abortion in their practices. (29) There is a negative public perception of abortion providers, even if the public broadly supports abortion rights. According to a recent survey conducted by KFF after the Dobbs decision, only 7% of OB/GYNs offer telehealth abortions, 14% in-person drug induced abortions, 13% aspiration abortions, and 12% D&E abortions. (30)

Dr. Warren Hern, the prominent second and third post-viability abortionist who until recently practiced (at age 86) at the Boulder Abortion Clinic acknowledges the problem of maintaining and recruiting quality abortion providers in his recent book Abortion in the Age of Unreason. (31) He lamented that there were two kinds of abortion providers. There are those motivated by “altruistic” concerns to help women and sacrifice much to deliver that care in a hostile environment. The second kind of abortion provider is the “commercial” provider who “cuts corners on patient care” and which is the “choice of many abortion providers”.

Even Planned Parenthood which has 11 clinics in Colorado isn’t immune from allegations of putting the abortion “mission” above the health and safety of women. (32) The expose reported that “Planned Parenthood has enjoyed a fund-raising boom …but little of it goes to the state affiliates to provide health care at clinics. Instead, under the national bylaws, most of the money is spent on the legal and political fight to maintain abortion rights.” They went on to observe that “employees at various affiliates said it was common to run out of over-the-counter pain medication and I.V. flushes. Salaries are so low that it is not unusual for staff members to qualify for Medicaid and federal food assistance.” As a result of high staff turnover, they say that “they did not receive adequate training for patient intake, blood draws and other tasks.” “Dozens of current and former employees also said that their complaints were met with reminders that they were in a “mission moment,” meaning a time of crisis for reproductive rights so urgent that it overshadowed their concerns.” In this kind of environment would-be whistleblowers remain silent. Women’s health and safety is a secondary consideration because as one employee observed, “we’re afraid of damaging the mission”.

Given the risks, there is a compelling argument to be made why the state must act now to ensure the health and safety of women pursuing second and third trimester abortions in Colorado. Not only is there a large risk to women who undergo late abortion in the best of circumstances, but Colorado’s proabortion environment sets the stage for poorly qualified bad actors to come to the state to pursue remuneration for abortion services without regard for the women they may injure or even kill through their negligence.

In 2025 alone, there has been at least one death of a young woman post abortion and numerable reports of emergent ambulance transfers from second/third trimester abortion facilities suggesting severe complications. There is no way to differentiate anticipated complications from a procedure known to be high risk from medical negligence/malpractice without state oversight.

Conclusion

Amendment 79 enshrined access to abortion at any time for any reason in the state constitution. Colorado voters could not imagine at the time that they might be casting a vote to undermine the health and safety of women.

Second trimester D&E abortions have a 10% complication rate and at least a 1.7% risk of severe, life-threatening complications such as severe hemorrhage and uterine perforation. At lower volume centers or using different techniques, or with underlying comorbidities and/or placental abnormalities, the complication rate can be as high as 56%. Hemorrhage is the greatest short-term risk and can be rapid and massive. Second and third trimester abortion clinics should be adequately prepared to minimize the risk for hemorrhage and mitigate its severity once established. They should be required to maintain a robust quality/peer review process. There is also an important role for screening tools given the high incidence of mental health and substance abuse disorders in abortion patients.

Oversight should not be limited to direct procedural regulations. Since late abortion not only poses an immediate risk to the health of a woman but also to the prospects of any future pregnancy and wanted child, review of the informed consent process is also crucial.

It is past time for Colorado to have CDPHE establish basic licensing, regulatory, and inspection authority over second and third trimester abortion facilities. CDPHE already has jurisdiction for other medical facilities with markedly less risk for significant morbidity and mortality.

Updated 11/8/2025

Thomas J. Perille MD FACP FHM

President, Democrats for Life of Colorado

Vice President, Colorado Chapter, AAPLOG

References

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16. Jacques L, et.al., Complication rates of dilation and evacuation and labor induction second trimester abortion for fetal indications: A retrospective cohort study. Contraception 2020; Aug:102(2):83-86.

17. Tesfaye HT, et.al., Drugs used to induce fetal demise prior to abortion: a systematic review. Contraception 2020; X2: 1-7.

18. Black M and Murphy DJ, Forceps delivery for non-rotational and rotational operative vaginal delivery. Best Practice & Research Clinical Obstetrics and Gynaecology 2019; 26:55-68.

19. Maternal Mortality in Colorado, 2016-2020. Colorado Department of Public Health and Environment. 2023

20. Fink DA et.al., Trends in Maternal Mortality and Severe Maternal Morbidity During Delivery-Related Hospitalizations in the United States, 2008-2021. JAMA Network Open 2023; 6(6):e2317641.doi:10.1001/jamanetworkopen.2023.17641.

21. Steinbarg JR, et.al., Abortion and Mental Health: Finding from the National Comorbidity Survery-Replication. Obstetrics & Gynecology 2014; 123(201): 263-270.

22. Munk-Olsen T et.al, Induced First-Trimester Abortion and Risk of Mental Disorder. NEJM 2011; 364:332-339.

23. Wallace ME, et.al., Pregnancy-Associated Mortality Due to Homicide, Suicide, and Drug Overdose. JAMA Network Open 2025;

8(2):e2459342/dpo”10.1001/jamanetworkopen.2024.59342.

24. Serapio ET, et.al., Estimated versus measured blood loss during dilation and evacuation: an observational study. Contraception 2018; 97(5): 451-455.

25. Kaur, S et.al., Management of blood loss in second trimester abortion. Curr Opin Obstet Gynecol 2024; 36:408-413.

26. ACOG, Severe Maternal Morbidity: Screening and Review. Obstetric Care Consensus Number 5, September 2016. Accessed 2/13/2025 https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2016/09/severe-maternal-morbidity-screening-and-review.

27. Kermit Gosnell Grand Jury Report, First Judicial District of Pennsylvania, Criminal Trial Division 2008.

28. Mediatrackers, Planned Parenthood Clinics Not Regulated by Colorado Health and Medical Standards. March 18, 2013.

29. Merner B et.al., Health providers’ reasons for participating in abortion care: A scoping review. Women’s Health 2024; 20:1-25.

30. Kaiser Family Foundation. A National Survey of OBGYNs’ Experiences After Dobbs. Accessed February 13, 2024. https://www.kff.org/report-section/a-national-survey-of-obgyns-experiences-after-dobbs-report/. Published Jun 21, 2023.

31. Hern W, Abortion in the Age of Unreason. Page 223. Routledge Publishing 2025.

32. Benner K, Botched Care and Tired Staff: Planned Parenthood in Crisis. New York Times, February 15, 2025. Accessed February 15 at https://www.nytimes.com/2025/02/15/us/planned-parenthood-clinics.html.

33. Raymond EG and Grimes DA, The Comparative Safety of Legal Induced Abortion and Childbirth in the United States. Obstetrics & Gynecology 2012; 119: 215-219.

34. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, Obstetrics & Gynecology, Safe Prevention of the Primary Cesarean Delivery 2014; 123:693-711.

35. Biggs MA, et.al., Women’s Health and Well-being 5 Years after Receiving or Being Denied an Abortion, JAMA Psychiatry 2017; 74(2): 169-178.

36. Reardon RC. Turnaway Study Report Unethically Violated Participants’ Privacy and Misleads Public with a Non-representative Sample, Selective Reporting and Overstated Conclusions. Issues in Law & Medicine 2024; 39(2): 140-169.

37. Auger N, et.al., Induced abortion and implications for long-term mental health: a cohort study of 1.2 million pregnancies. Journal of Psychiatric Research 2025; 187: 304-310.

38. Gissler M, et.al., Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. European Journal of Public Health 2005; 15(5): 459-463.

39. Reardon DC, et.al., Deaths associated with pregnancy outcomes: a record linkage study of low-income women. Southern Medical Journal 2011; 95(8): 834-841.

40. Coleman PK. Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009. British Journal of Psychiatry 2011; 199: 180-186.

41. Mota NP, et.al., Associations between abortion, mental disorders, and suicidal behavior in a nationally representative sample. Can J Psychiatry 2010; 55(4): 239-247.

42. Klemetti R et.al., Birth Outcomes after induced abortion: a nationwide register-based study of first births in Finland. Hum Reprod 2012: 27(11): 3315-3320.

43. Bhattacharya S et.al., Reproductive Outcomes following induced abortion: a national register-based cohort in Scotland. BMJ Open 2012:2:e000911.doi:10.1136/bmjopen-2012-000911.

44. Oliver-Williams C, et.al., Changes in Association between previous therapeutic abortion and preterm birth in Scotland, 1980-2008: A Historical Cohort Study. PlOS Med 10(7): e1001481.doi10.1371/journal.pmed.1001481

45. Shah PS, et.al., Induced termination of pregnancy and low birthweight and preterm birth: a systematic review and meta-analysis. BJOG 2009; 116(11): 1425-1442.

46. Saccone G, et.al., Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metanalysis. Am J Obstet Gynecol 2016; 214(5): 572-591.

47. Lemmers M, et.al., Dilation and curettage increases the risk of subsequent preterm birth: a systematic review and meta-analysis. Hum Reprod 2016; 31(1): 34-45.

48. Brittain JJ, et.al., Prior spontaneous or induced abortion is a risk factor for cervical dysfunction in pregnant women: a systematic review and meta-analysis. Reproductive Sciences 2023; 30: 2025-2039.

49. Czarny H, et.al., Associations between periviable and preterm birth and severe maternal morbidity and mortality. O&G Open 2025; 2: 1-11.

50. Fan D., et.al., Factors and outcomes for placental abnormalities: An umbrella review of systematic reviews and meta-analyses. Journal of Global Health 2024; 14: 0413.

51. Yang R. et.al., Risk of Placenta Accreta Spectrum Disorder after Prior Non-Cesarean Delivery Uterine Surger. Obstetrics &Gynecology 2025; 145: 628-638.

52. Jenabi E, et.al. The risk factors associated with placenta previa: An umbrella review. Placenta 2022; 117:21-27.

53. Karami M and Jenabi E, Placenta Previa after prior abortion: a meta-analysis. Biomed Res Ther 2017; 4(7): 1441-1450.

54. Johnson LG, el.al., The relationship of placenta previa and induced abortion. Int J Gynaecol Obstet 2003; 81(2): 191-198.

55. Zhang S, et.al., The association between a history of induced abortion for nonmedical reasons and maternal and neonatal perinatal outcomes: a retrospective cohort study. Journal of Maternal Fetal & Neonatal Medicine 2025; 38(1): 2466207.

56. 56. Tu P and Pei K, Prior surgical uterine evacuation of pregnancy and infertility: protocol for systematic review and meta-analysis. BMJ Open 2020; 10:e034837.doi:10.1136/bmjopen-2019-034837.

Second and Third Trimester Abortion Facility Awareness

Wed, 29 Oct 2025 19:40:46 GMT

Understanding the threats to Women's Health and Safety

We live in a state with a radical libertarian streak which impacts both Democrats and Republicans. The zeal for personal autonomy overshadows the reality that we are each inexorably dependent on each other. It makes solidarity a principle which always is relegated to the shadows.

As DFLCO members, we aspire to promote a different cultural reality. Autonomy is important but not our overriding principle. Rather than seeking our own self-interest, we choose to promote the common good. We recognize the inalienable rights so eloquently outlined in our national founding documents. We promote the value and dignity of every human life from conception to natural death. Age, race, ethnicity, sex, sexual orientation, cognitive/physical abilities, or wealth do not determine one’s value.

There is no better example of the conflict between autonomy and solidarity than with abortion – especially late abortions. In mid to late second trimester abortions, we sacrifice the life of vital, viable human beings at the altar of personal autonomy. Abortion advocates manipulate the media and appropriate science to achieve their ideological goals. They advance false narratives such as abortion is “healthcare”, that abortion is “safe”, and that a women’s education/career are ruined if they are faced with an unplanned pregnancy. Rather than empower women, abortion advocates suggest that women are too weak to rise to the challenge of an unexpected pregnancy. They advance a very patriarchal view of human progress. They would have us believe that unless a woman can divorce herself from her fertility – like a man – she cannot flourish.

That abortion advocates don’t primarily care about women’s health and safety is most vividly illustrated by their visceral opposition to second and third trimester abortion facility regulation. Most recently, every Democrat on the House Health and Human Services Committee voted against HB25-1252 which would have instituted prudent health/safety regulations for these facilities. They ignored the fact that the state’s Department of Public Health and Environment provides oversight for every medical facility that performs complex medical/surgical procedures. The only exception has been and continues to be abortion facilities.

As DFLCO members, we are challenged to steer the Democratic party away from one of its most egregious errors in the history of the party (other than the 1800s era endorsement of slavery). Rather than stand up for the most vulnerable and marginalized, when it comes to abortion, the current Democratic party targets these individuals. One of the most effective ways to change Democratic hearts is to expose them to the reality of abortion – especially how late abortion harms women and kills a precious young human being.

DFLCO has elected to draw attention to the two third trimester abortion facilities in Colorado – A Women’s Choice Healthcare Clinic in Aurora and the RISE Collective in Boulder. (There are a host of other abortion facilities that perform abortions beyond the lower limit of fetal viability which is 21 weeks). We are developing a strategy to educate Coloradoans to the risks to women’s lives posed by these facilities.

To this end, DFLCO is one of the organizers of an educational event in Boulder on November 9. The event will be held in the Canyon Theater at the Main Boulder Library at 2PM. In lieu of our regular bimonthly meeting, DFLCO members are encouraged to attend this event which features Colorado based and national speakers. DFLCO President, Tom Perille MD, will be among those speaking.

Fiscal malpractice to support Planned Parenthood

Sun, 24 Aug 2025 18:20:40 GMT

No matter what the Planned Parenthood minions in the Colorado legislature want you to believe about SB25B-002 to subsidize the Planned Parenthood business, these are the facts:

1) The bill will increase state expenditures by 4.4 million dollars per year at a time the state is trying to close a 783-million-dollar budget deficit. This is fiscal malpractice.

2) Planned Parenthood of the Rocky Mountains received 58 million dollars in contributions and grants in 2022 and 35 million dollars in 2023. They have a large donor base and don’t need state money to pad their balance sheet.

3) According to Planned Parenthood of the Rocky Mountains’ (PPRM) testimony on the bill on August 21, 2025, 11,000 Colorado Medicaid patients receive services from PPRM. This represents 0.9% of all Medicaid members in Colorado as of April 2025. This tiny fraction of Medicaid members can easily be absorbed by other Colorado Medicaid providers.

4) PPRM characterizes the loss of Medicaid reimbursement as driving an unacceptable breach in continuity of care. The reality is that Medicaid and non-Medicaid Coloradans commonly are required to change providers because of changes in insurance plans. Disenrollment in the individual (ACA) market average is approximately 13.8% per year, in the group (employer) market 2.1% per year, in Medicare Advantage (such as Kaiser) 2-4% per year, and in Medicaid it can be anywhere from 5% to 20%. By comparison, the number forced to switch because of PPRM’s loss of Medicaid is very small (0.9%).

5) Federal Quality Health Centers (FQHCs) are Colorado Medicaid providers. In 2024 they served 648,045 unique Colorado patients at 265 locations. During testimony on HB25B-1006 on August 21, 2024, we heard that they now serve 850K patients. The 11K Planned Parenthood Medicaid patients can easily be absorbed by FQHCs alone since it would only represent a tiny fraction of their patient population – 1.3%. And there are many other high quality comprehensive primary care Medicaid providers – Kaiser Permanente alone serves 63K Medicaid members.

6) Planned Parenthood of the Rocky Mountains’ Jack Teter, testified August 21 in the Senate hearing that they are the “Medical Home” for 5K patients and loss of Medicaid funding would seriously disrupt continuity of care. PPRM does not advertise primary care services on their website, and they don’t deliver them. Colorado’s PCMPs (the medical-home providers in the Accountable Care Collaborative managed by a Regional Accountable Entity - RAEs) are expected to provide or coordinate comprehensive primary care (preventive, acute, chronic disease management), access/after-hours coverage, care coordination, data reporting, and quality improvement. It could be Medicaid fraud to characterize yourself as a Medical Home when you don’t meet most of the criteria. PPRM offers only niche reproductive healthcare services. Their patients would receive a higher quality of care in an actual Medical Home structure from other Medicaid providers in Colorado.

7) PPRM does not release public reports of their service breakdown. However, National Planned Parenthood’s 2024 report lists 5% of their affiliate medical services as cancer screenings and prevention. The other 95% of services reflect only reproductive healthcare and not primary care (54% STI testing and treatment, 24% contraception, 4% abortion services). [Note: Planned Parenthood divides their services in each patient encounter to increase the total number of services reported– an abortion patient will typically be billed for a pregnancy test, STI screen, ultrasound, counseling, and the abortion. This underweights the primary service rendered – abortion - and makes it appear that their primary clinical role is other reproductive services.]

8) During Senate testimony on the bill, Planned Parenthood representative Jack Teeter suggested that PPRM provides unparalleled access for their Medicaid patients. He said they can be seen on Saturdays to address their needs. Somebody better tell him that their largest flagship facility in Park Hill is closed on Saturdays (and always on Sundays).

9) During Senate testimony, Planned Parenthood’s Jack Teter suggested that Planned Parenthood served locations where there is little access to healthcare services. This is not true. Most PPRM clinics are in urban or suburban counties (Denver, El Paso, Jefferson, Arapahoe, Boulder, Larimer, Weld, Routt, etc.). The March of Dimes classifies these counties as NOT maternity care deserts – which is a surrogate marker for access to women’s health services. None of the 15 locations publicly advertised are located in maternity deserts and only one is located in an at risk county – Cortez.

10) If the state really has millions of dollars of discretionary money to spend, they should consider increasing reimbursement for pregnancy services in rural Colorado which the Denver Post cited as a primary reason that 37.5% of Colorado counties are maternity deserts. There is also an urgent need for improving mental health services. We should not use precious Medicaid dollars on services that could be covered by the federal government.

11) The Colorado public may be majority prochoice, but they don’t want legislators wasting money on services the federal government would normally pay. They would embrace Medicaid providers with a better care delivery model that delivers comprehensive primary care.

Tom Perille MD

President, Democrats for Life of Colorado

Demsforlifecolorado@gmail.com

How to navigate polarizing issues - Exhibit A - Abortion

Sat, 26 Jul 2025 21:54:40 GMT

Clarifying values and finding common interests

It seems that we live in an era of Rorschach tests. You only have to say one word and you will create a predictable and visceral response depending on where you lie in the political spectrum. Migrants. Gender. Ukraine. Gaza. Guns. And one of the most enduring triggers and divisive words is abortion.

How do we navigate in a world characterized by such extreme polarization and tribal political organization? Is abandoning efforts to engage with those who possess a different worldview the most logical and realistic path? Should those who hold the majority view simply squash those with a dissenting view? Or is there something fundamentally lost in society when we relinquish our innate human desire for solidarity with those in our community -even when they may harbor radically different perspectives. Can a democracy survive such division? Is there a way to model a different approach?

Addressing abortion in a constructive way can be the prototype for a host of other heated, if less contentious issues.

It seems the first principle of engagement should be to assume that those with an opposing view aren’t ignorant or evil but rather sincere and motivated by a desire to make the world a better place. Second, we need to look beyond the propaganda on both sides of an issue, to create space for dialogue. It isn’t necessary to agree on the veracity of all the published information pertaining to the topic, but we should be prepared to establish a set of underlying moral principles/values that best reflect the differing views. Lastly, it is important to acknowledge the very real differences in our beliefs but focus on finding common and overlapping interests. It is never necessary to abandon firmly held moral principles to forge policy and programs that appeal to those with opposing views. And establishing a relationship with someone you adamantly disagree with doesn’t mean you subscribe to moral relativism.

For abortion, we first must acknowledge that many of those with the most emotional responses to the issue have either had an abortion or their sexual partner had an abortion. Some will be asserting the righteousness of their abortion decision and others may be reacting with guilt/shame to the memory of their abortion. If we aren’t sensitive to these emotions, it will be hard to move towards a productive dialogue. And we should recognize that both prolife and prochoice adherents deeply care for the health/life of women.

The prolife movement bends the truth to advance their cause. You often hear prolife advocates state, “that abortion is never medically necessary”. This is more a semantic error than a factual error. For many, induced abortion is so morally abhorrent that they prefer to use the term “separation” or “premature delivery’ in the case of a medically indicated abortion. A medically indicated abortion refers to the previable termination of a pregnancy to prevent maternal organ damage or preserve the life of the mother with the unintended, but foreseeable, death of the developing human embryo or fetus. (In contrast, in an elective induced abortion, the expressed intent is to end the pregnancy by killing the embryo/fetus with the manner of fetal death and the gestational age being immaterial.) Medically indicated abortions are rare. Abortion to preserve the life or prevent serious bodily injury represents approximately 0.05% of abortions based on a high-quality registry study from the UK where reasons for abortions are tracked. (The US does not track indications for abortion). “Therapeutic abortions” were part of medical reality long before Roe was decided in 1973 and were incorporated into the medical repertoire of every OB/GYN for decades, including the prolife clinician.

Prochoice advocates also sow confusion to promote their cause. They propagate the myth that “nobody can definitively know when human life begins”. The fact that a new human life begins at fertilization dates back to the first scientific observation of sperm and egg fusion in 1876 by Oscar Hertwig. To argue that a human life begins at birth is an antiquated religious view not based on science or biological expertise.

What prochoice adherents may mean is that a human being doesn’t have value, dignity, or legal rights till they are born – but that is an entirely different argument. They may believe that the moral significance of fetal life is not biologically determined, but socially or philosophically constructed. Nonetheless, they need to acknowledge that assigning differential value to distinct groups of human beings based on immutable characteristics such as age, sex, sexual orientation, physical/mental abilities, race, or ethnicity has been a fraught topic throughout human history.

Those who promote abortion as a moral response to an unexpected pregnancy sometimes obscure the humanity of the developing embryo and fetus with dehumanizing language. Examples include describing a sophisticated human embryo as a “cluster of cells” in the New York Times or a second trimester fetus as “pregnancy tissue“ on the Rocky Mountain Planned Parenthood webpage. This stands in contrast to the language that is commonly used by every expectant mother and her obstetrician who routinely describes the “wanted” embryo/fetus as a “baby”. For the purposes of engagement, abortion proponents and opponents should avoid using loaded language that is intended to manipulate rather than clarify.

The last domain of obfuscation pertains to the conflation of miscarriage and stillbirths with induced abortion. Miscarriages and abortion may require the use of the same medications and surgical procedures but that is where the similarity ends. In miscarriage or “spontaneous abortion”, the embryo and fetus suffer a tragic, but natural, death. A medical or surgical procedure may be necessary to remove any remaining fetal or placental remains to prevent infectious and hemorrhagic complications. Pregnancy has already terminated naturally; thus, this is not an induced abortion.

In elective induced abortion, a medical or surgical procedure is performed to terminate the pregnancy explicitly by killing the embryo or fetus. Laws that restrict elective induced abortion have no medical or legal bearing on the treatment of miscarriage. Medical malpractice rather than anti-abortion laws drives much of what the mainstream media cites as evidence to the contrary. The primary reason that any doubt exists in the minds of inexperienced clinicians is the misdirection by professional medical abortion advocates such as ACOG (American Association of Obstetricians and Gynecologists).

After peeling away the spin/propaganda from either side of the abortion debate, you have a much simpler discussion: when is it permissible to kill a dependent human being to respect a woman’s bodily autonomy and free her from the physical, social, emotional, and economic demands of pregnancy and childcare. Prolife advocates need to aggressively address the needs of the woman and not focus exclusively on the fetus. Prochoice advocates need to explicitly address the biological reality and moral relevance of the developing human and not focus exclusively on the woman.

Framed this way, the potential for finding common ground dramatically increases. Prolife advocates can agree that there is real, albeit very rare, medical indications for abortion. They can work with prochoice advocates to ensure that all medical professionals address the needs of both of their patients while working vigorously to save the life of the mother when pregnancy complications would jeopardize the lives of both.

It is possible to imagine that an agreement to limit late abortion on healthy women carrying healthy fetuses’ post-viability could be achieved. Restrictions of abortion techniques which are especially inhumane, such as D&E, which involves the systematic dismemberment of a pain capable fetus, may be another area of agreement. There shouldn’t be controversy making high risk second and third trimester abortions safer through state licensing, regulation, and inspection of late abortion facilities since the health/safety of women drive both perspectives.

Prochoice advocates should support medical professionals who have conscientious objections to participating in abortion since elective induced abortion involves intentionally taking the life of another human being. This is not a trivial or arbitrary moral decision. It reflects their sincere commitment to foundational secular humanist or religious principles.

Prochoice advocates who believe that abortion must be a free choice, should find common cause with prolife advocates to prevent the social/economic coercion that commonly drives an abortion decision. Both could embrace a parallel interest in reducing the asymmetrical burden of human reproduction.

This may be accomplished through a variety of initiatives. Joint efforts to improve accommodations for pregnant women in education and the workforce would become a major priority. Supporting/expanding paid family leave programs and subsidized daycare would be another. Publicizing government/private non-profit programs that provide counseling and material support to pregnant women and their families – including Pregnancy Resource Centers (PRCs) – would be a third.

Ameliorating the financial burden of pregnancy that disproportionately falls on women would need to be addressed. Expanding male partner prenatal/postnatal financial support is one tool. Making birth (prenatal, birthing services, and post-partum care) free through a combination of government/private insurance programs is essential.

Men should not be able to avoid the financial burden of human reproduction by avoiding child support or purchasing “skinny” health insurance without pregnancy coverage. Conservative prolife legislators should eschew their aversion to insurance mandates to serve a greater goal. It is a matter of reproductive equity.

PRCs offer millions of dollars of uncompensated assistance to pregnant women and their families. However, those expressing prolife beliefs undermine their dedication to women and their preborn children when they refuse to acknowledge the role of government in setting policies and supporting programs that address their additional needs.

There are already recent examples of legislative efforts that demonstrate how prolife and prochoice advocates can work together for the common good without compromising their sincerely held beliefs regarding abortion. At the federal level, Senators Hyde-Smith (R), Kaine (D), Hawley (R), and Gillibrand (D) recently introduced the “Supporting Healthy Moms and Babies Act” which would make birth free. In Colorado, Senator Jeff Bridges (D) sponsored SB25-144 which extended family leave for mothers of very premature babies that require prolonged neonatal intensive care. He also sponsored SB25-118 which took a small slice out of the prenatal care cost burden in Colorado.

Unfortunately, there are many more examples where this kind of dialogue is considered too politically risky. A very sad example was the recent defeat of a bill (HB25-1252) to allow the Colorado Department of Public Health and Environment (CDPHE) to regulate second and third trimester abortion facilities using evidence-based best practices– as they do with other medical facilities with lower or similar risks. It was killed in the House Health and Human Services Committee along tribal ideological lines.

It is past time to bridge the ideological and political divide. Let partisans on either side of a hotly contested issue commit publicly to constructive engagement. No longer should we treat people with opposing views as “enemies”. Collaboration should be the norm in our communities and state/federal legislatures rather than the exception.

When you seek to identify core values, you can invariably find overlapping interests. There isn’t an issue that doesn’t lend itself to this approach. This is good for our communities, good for our nation, and good for democracy writ large.

Ultimately, it may even move the culture towards the morally correct position.

Tom Perille MD

President, Democrats for Life of Colorado

A 21- week aborted fetus - not "pregnancy tissue" but a distinct human being.

Hern Closes Late Abortion Clinic

Wed, 30 Apr 2025 02:08:02 GMT

After 50 years of unimaginably painful deaths to thousands of viable fetuses

This is cause for celebration.

Warren Hern was an outlier in the field of medicine that itself is an outlier. It is the only medical specialty that is devoted to killing human beings rather than restoring health or ameliorating suffering.

Hern famously compared humans to a spreading “cancer” on the earth. It is not surprising that he devoted his career to using abortion as a form of population control. He considered pregnancy a disease and felt that no justification was needed to pursue abortion at any time for any reason. The fact that 70% of his late abortion practice targeted healthy women carrying healthy fetuses was often underappreciated or misrepresented by the media.

One can hope that the fact that he could not find another physician to assume his grisly late abortion practice may be a sign of hope that the era of unlimited, unrestricted, and unregulated abortion may be nearing an end.

Open Letter to Govenor Polis on Public Medicaid Funding for Elective Abortions

Tue, 22 Apr 2025 02:39:01 GMT

Millions of dollars of Medicaid funds will be diverted to pay for elective abortions at a time that there are already substantial budgetary constraints.

April 17, 2025

Governor Polis,

Democrats for Life of Colorado implores you to consider the fiscal implications of signing SB25-183 into law. Research from the Guttmacher Institute published in 2024 demonstrates that in states where Medicaid pays for elective abortions, 62% of abortions are Medicaid abortions. If you apply this figure to Colorado, this means that SB 183 will create a huge financial liability for the Colorado Medicaid system at a time when the state is straining to contain a greater than 1-billion-dollar budget deficit.

CDPHE reported that there were 10,368 abortions on in-state residents in 2023. The legislative council’s fiscal note on SB 183 estimates a $800 Medicaid reimbursement for medication abortions and a $1300 Medicaid reimbursement for surgical abortions. The legislative fiscal note also divides abortions into 50% medication and 50% surgical in calculating the state’s financial commitment. This would translate into a total cost of $6,749,568 for the estimated 6428 abortions (using the 2023 CDPHE numbers). If you use Guttmacher estimates for the number of abortions in Colorado, the number would be at least 40% higher.

The fiscal liability doesn’t stop with the monetary payment for elective Medicaid abortion, since the Legislative Council adds the loss of $1,721,497 federal matching dollars. This will make the total estimated state’s obligation at $8,471,865 using the more conservative CDPHE numbers.

And you can’t count on the misleading Legislative Council analysis for cost savings from “averted births”. This is an overly simplistic analysis for many reasons.

Up to 20-30% of miscarriages occur after 6 weeks. This means that many of these “averted births” would have ended in miscarriage and not cost the state the cost for funding an abortion. Most births won’t be “averted” because these women will go on to have pregnancies that go to term later in their reproductive life. We know that the risks of pregnancy complications correlate directly with maternal age. These “delayed” rather than “averted” births, will increase Medicaid costs because of the increased risk of gestational diabetes, preeclampsia, and premature births in these later pregnancies. It is also well established that surgical abortions increase the risk for premature birth in subsequent pregnancies, including extreme premature births. To the extent that this legislation increases surgical abortions, it will markedly increase Medicaid Neonatal Intensive Care Unit costs. Furthermore, there is good data that suggests that women undergoing abortions seek mental health services at a much higher rate, which also will increase Medicaid costs.

There is evidence that subsidizing abortions for lower income women, increases abortion rates which will, in turn, increase Medicaid abortion costs. The Legislative Council used a tiny study from Louisiana to estimate the number of additional abortions that will be performed when public funding is available. The Louisiana study demonstrated that only 1% of Medicaid eligible women who were pregnant (and didn’t already abort) would have considered abortion if the state had providing funding. This means the immediate impact on increasing abortion access will be extremely small but likely increase over time.

The Legislative Council failed to acknowledge that Louisiana low-income women have very limited access to private abortion funding. This is in stark contrast to the robust private funding for abortion from the Cobalt Fund and the National Abortion Federation funds here in Colorado. Consequently, you can’t rely on the experience in Louisiana to project Colorado’s costs. SB 183 will simply be shifting abortion costs for low-income women from private sources (Cobalt/NAF) to Colorado taxpayers.

We are very concerned that Medicaid already fails to reimburse pregnancy services adequately which results in maternity deserts. This new elective abortion financial obligation will likely further compromise pregnancy services and other higher Medicaid priorities.

The multimillion-dollar increase in state funding that is necessary to pay for elective Medicaid abortions stands in contrast to the “zero” fiscal impact that Amendment 79 was purported to have based on the Bluebook verbiage. If voters understood that they were voting for a multimillion-dollar tax increase to pay for abortion, it is safe to say that more than 38% of the Colorado electorate would have voted against the amendment.

We are opposed to using public funds for elective abortions. However, even if you thought this was required for “equity” purposes, this is not the time or the fiscal circumstances that justify such an expensive measure.

Thanks for your consideration.

Thomas J. Perille MD FACP FHM

President, Democrats for Life of Colorado

Will paying for abortion save the state money?

Mon, 24 Mar 2025 14:04:43 GMT

Senate Bill 25 - 183

The campaign to use public taxpayer funds to pay for elective Medicaid abortions has been a sham from the beginning.

During the Amendment 79 campaign for the constitutional right to abortion, the Legislative Council’s Blue Book disingenuously stated that “the measure will have no fiscal impact”. This was an attempt to deliberately mislead Coloradans.

Now the pièce de resistance, SB25-183 claims that by paying for elective Medicaid abortions, the state will save hundreds of thousands of Medicaid dollars from “averted births”. The Legislative Council made their projection based on a tiny study from Louisiana where 12 pregnant Medicaid women said that lack of public funding was “part of why (they) have not had an abortion”. The Council ignored the fact that only two of these 12 (1.2% of all Medicaid women interviewed for the study), would have still considered abortion if the state paid. Furthermore, in contract to Louisiana, Colorado has generous private funding available for both in-state and out-of-state women seeking abortion.

The Legislative Council analysis was clearly designed to produce the desired “cost savings” reported. They offset the millions of dollars of abortion costs with the money from “averted births”. However, they ignored critical facts in this oversimplified analysis.

The principal flaw is that “averted births” are illusory since most Medicaid women will simply pursue births later – when the risks of complications and associated Medicaid costs will be higher. It also ignores the number of pregnancies that would have ended in natural miscarriage, the increased costs for premature birth in subsequent pregnancies for women who had surgical abortions, and the increased cost of mental health treatment for those who seek abortion rather than childbirth.

Aside from the moral issue, the state will suffer the fiscal consequences of the ill-advised public funding of elective abortion.

Outrage after Abortion Advocates Vote Against Women's Health and Safety

Thu, 20 Mar 2025 20:57:39 GMT

House Health and Human Services Rejects HB25-1252

I am angry. More than angry, I am sad that our state legislators place allegiance to their “tribe” over the health and safety of the women of Colorado.

On Tuesday, March 11, the House Health and Human Services Committee rejected HB25-1252 which would have instructed the Colorado Department of Health to develop evidence-based guidelines to ensure the health and safety of women seeking high risk second and third trimester abortions.

The committee heard testimony that 10% of second trimester abortions have complications and 1.7% suffer serious, life-threatening complications. They heard that one in 50 women who had second trimester abortions through the University of Colorado required hospitalization. They heard that mid second and third trimester abortions are riskier than natural childbirth. They heard that the risks of dying from a late abortion are greater than the risk from dying from a procedure at an ambulatory surgical center.

Every healthcare facility that poses this kind of risk to women is licensed, regulated, and inspected by the Colorado Department of Health. Late abortion is the only exception.

The most heart wrenching testimony concerned the February death of an 18-year-old woman, Lexie. She died of complications from her second trimester abortion at the Fort Collins Planned Parenthood. At this same facility, 911 records documented at least three other emergency transfers already this year.

My fel low Democrats have no problem regulating the energy/gas industry to safeguard the health of Coloradans. Do they only regulate industries with which they aren’t politically aligned?

Tom Perille MD

Statement on the Passage of Amendment 79 - The Right to Abortion in Colorado

Thu, 14 Nov 2024 21:23:15 GMT

DFLCO will continue to fight for basic human rights

We want to extend our sincere appreciation for the thousands of people who came together for a cause greater than themselves.

The diverse group that opposed unrestricted, unregulated abortion reflected the broad-based coalition formed by Prolife Colorado that defies any simple characterization. We are Democrats, Independents, and Republicans from every race, and ethnicity. We are young and old, rich and poor, native and immigrants, religious and secular. We are defined by our common belief in the value and dignity of every human being and not by any demographic.

Amendment 79 passed but that does not mean we failed. We have begun the long and arduous task of educating Coloradoans about the reality of abortion in our state. Few knew that abortion late in pregnancy on healthy women with healthy babies was common. Few knew that high risk second and third trimester abortion clinics were unregulated in our state and that women’s lives are in jeopardy. Few realized the implications of unrestricted abortion on the privileged relationship between parents and their teen daughter. Many underappreciated the fiscal impact of using public funds to streamline access to abortion through all nine months of pregnancy.

Our only regret is that we didn’t have the money to share our message more broadly so that every Coloradoan could make an informed choice. The proponents of the measure raised 18 times the money we did largely from the abortion industry and wealthy out-of-state donors. They used their money to spread the myths that “abortion was healthcare” and that abortion saved women’s lives. They frequently tried to conflate elective induced abortions with miscarriages, ectopic pregnancies and treatment for life-threatening complications of pregnancy. We know that not a single women’s death has been the result of abortion restrictions and that recent highly publicized deaths in Georgia and Texas reflect the anticipated complications of drug-induced abortions compounded by physician negligence.

We will continue to build a culture that respects every human life here in Colorado and envision a future where women are offered the support and the resources, they need to choose life. Women without financial resources and women of color should not feel that their only path to a successful life is through abortion. We will fight to remove the inequities in pregnancy care throughout our state and remove barriers for women facing unplanned pregnancies during their education and early careers.

And yes, we look forward to the day when Coloradoans will vote to remove Amendment 79 from our constitution. Because life matters.

What is "progressive" about Amendment 79?

Tue, 29 Oct 2024 15:58:43 GMT

Prioritizing abortion access over women's health/safety and parental involvement

It is becoming more common for ideologues to gaslight the American public to promote their agenda. The latest example is the abortion industry’s attempt to have Coloradoans suspend their common sense, human decency and compassion to place Amendment 79 into the Colorado constitution. State law already protects access to abortion, but they would have us believe it is “progressive” to endorse this constitutional amendment.

Amendment would enshrine unrestricted, taxpayer funded abortion into the state constitution. It would prohibit the government from “denying, impeding or discriminating” against the right to abortion. This goes far beyond Roe which was overturned by the Dobbs decision. Roe permitted regulation of abortion in the second trimester to ensure the health and safety of women and allowed states to recognize their compelling interest in protecting the life of a viable baby in the third trimester. Amendment has neither of these important features.

If abortion is considered a fundamental constitutional right (unlike any other medical procedure), then a fetus, wanted or unwanted, has no constitutional rights under Amendment 79. Nobody could infringe on the exercise of abortion – no matter the circumstances.

Late abortions are common in Colorado. While abortions after the limit of fetal viability only represent 3.2-3.4% of abortions each year, they account for hundreds of abortions. And we know that approximately 70% of these late abortions are performed on healthy women with healthy babies. Amendment 79 would prevent legislators from ever curtailing abortion late in pregnancy for social and economic reasons. The amendment does nothing to address the real needs of women facing financial challenges that forces them to consider late abortion. It leaves them only one regrettable choice. Is it progressive to focus solely on abortion access and forego the hard work necessary to make pregnancy more equitable for low-income women?

The Colorado Department of Public Health and Environment licenses, regulates, and inspects thousands of health care facilities in the state to ensure public health and safety. The striking exception is second and third trimester abortion clinics. Abortion extremists pejoratively refer to any laws that regulate abortion clinics as TRAP laws. In their worldview the only motivation for such laws is to impede abortion access. They ignore the fact that second trimester abortions have a 10% complication rate and pose a 1.7% risk of life-threatening complications. While first trimester abortions are relatively safe procedures, the risk of dying from abortion increases by 38% for every additional week of gestation beyond 8 weeks.

You would think we would have learned the danger of unregulated/uninspected abortion clinics from the Gosnell tragedy. Dr. Kermit Gosnell was responsible for the injury and death of countless women spanning decades because of the lack of governmental oversight at his Philadelphia abortion clinic. If Amendment 79 passes, legislators will be precluded from instituting prudent health/safety regulations for abortion clinics in Colorado. There would be nothing preventing a Gosnell-like horror in our state. Is it progressive to prioritize abortion access over the lives of women?

A 22-week baby born prematurely enjoys all the rights and benefits of other Colorado citizens. Yet, a 22-week, pain-capable fetus in utero can be literally torn apart limb by limb during the D&E procedure favored by most abortionists in Colorado. Later in the second trimester and during the third trimester that fetus can be killed by poisoning before it is extracted during a D&X procedure. Digoxin is commonly utilized. Digoxin can cause hours of agonizing nausea, vomiting, and delirium before eliciting death. Is it progressive to define a human’s value and dignity based solely on their location or to sanction such excruciating deaths?

Parental notification prior to a minor’s abortion is current law in Colorado. Guttmacher and other abortion advocacy organizations consider parental notification laws as impediments to abortion access. Amendment would eliminate this.

The adolescent brain is still developing prefrontal connections that help modulate their subcortical emotional and impulsive responses to stressful situations, such as unplanned pregnancies. Without parental notification, our teen daughters may face these challenges with more input from their peers, teachers, or counselors than from the parents who love and know them best. And if parental notification is eliminated, sex traffickers will have an easier time eluding law enforcement as they coerce their young victims to have abortions. Is it progressive to remove parents from the most consequential decisions in their daughter’s lives or enable human traffickers?

With Amendment 79 in the state constitution, abortions for any reason would be legal. Studies from the US and other countries document the extent that sex selection abortions occur, A Colorado late abortionist recently admitted that he has performed sex selection abortions. Is it progressive to allow abortion for blatantly sexist reasons?

We know the answer. No, it is not progressive to promote unrestricted, unregulated abortion in Colorado. Abortion access is already ensured in Colorado. Amendment 79 is unnecessary, inhumane and potentially dangerous.

Frances Rossi and Tom Perille MD - Founding members of Democrats for Life of Colorado

Abortion Overkill

Tue, 22 Oct 2024 19:38:00 GMT

This piece was originally published in the Colorado Springs and Denver Gazette Perspective Column September 22, 2024 by Tom Perille MD (DFLCO President) and Wendy Smith

What would it mean if the only medical intervention that is recognized in the Colorado Constitution’s Bill of Rights was abortion? And what would it mean if abortion was the only medical intervention that couldn’t be constitutionally excluded in private and public health insurance? Not access to basic medical care. Not pregnancy care. Not life-saving cancer treatments. Not mental health treatment. Not care for those addicted. Not affordable pharmaceuticals. Only abortion. That is what those who are pushing Amendment 79 (“Right to Abortion”) hope to accomplish.

Not only would abortion at any time in pregnancy for any reason using any method become a fundamental right, but anything that “impeded” or “discriminated” against access to abortion would be prohibited. The people of Colorado have a right to know the profound and dangerous implications of such a measure which won’t be reflected in the Blue Book language.

In a poll conducted in July by the Strategy Group, 71% of Colorado voters were unaware that abortion is currently legal under all circumstances in our state. Abortion access is guaranteed in Colorado law. Amendment 79 would do nothing to change that reality. Coloradoans have the right to know that with the amendment in the constitution, the people of Colorado and those working for them in the legislature could do nothing to regulate or restrict abortion in the future– even if those changes represented the overwhelming consensus of Coloradoans and protected the health and safety of women.

There were between 468-486 late abortions after the limit of fetal viability (21 weeks) reported to the CDPHE in 2022 and 2023. Guttmacher estimates that there were 71% more abortions in 2023 than CDPHE reported making 500 a conservative estimate of the total number of post-viability abortions each year in Colorado. These babies can “kick” their mother, respond to her voice/touch, acquire her taste preferences, and feel pain while in the uterus. They can survive if born prematurely. Babies born at 22-weeks and later can be found lovingly cared for in neonatal intensive care units and nurseries across the state. Based on research from Boulder abortionist, Dr. Warren Hern, 70% of his late abortions are performed on healthy women with healthy babies. That translates into an estimated 350 healthy babies aborted late in pregnancy each year in Colorado for financial and social reasons. Coloradoans have the right to know that Amendment 79 does nothing to address the real needs of these women and simply streamlines access to one, tragic and regrettable choice. With Amendment 79 in place, legislators would be unable to restrict even the most extreme abortions on healthy women with healthy babies in the third trimester.

Colorado parents are currently notified at least 48 hours in advance of their minor teen’s pending abortion. The abortion industry, their research allies (Guttmacher), and aligned medical professional organizations (ACOG) all consider parental notification before a minor teen’s abortion to be an impediment to abortion access. Coloradoans have the right to know that banning parental notification would be one of the most immediate consequences of Amendment 79. In practical terms, this means that the people that know and love the teen the most may be unaware of their pending abortion and unable to support their daughter. Even worse, teens may be pressured by peers or an abortion clinic counselor to pursue an action that is inconsistent with their wishes and core values. Parents may be blindsided by the potentially severe physical and mental health consequences of their teen’s abortion. And sex traffickers would be able to hide their nefarious trade by pursuing abortions for their teenage victims without the safeguard of parental notification.

Trafficking is a multi-million-dollar criminal enterprise in Colorado. Victims rarely self-identify. Anyone who works with domestic minor sex trafficking knows that the very definition of trafficking involves force, fraud and/or coercion. It is also well known that girls who are trafficked often view their trafficker as their “boyfriend”, lacking the maturity and discernment to know they are being trafficked and in danger. If they refuse to do what the trafficker wants, they are often subject to physical and mental abuse until they submit. There is a growing concern over forced abortion, especially with the availability of medication and telehealth abortions. These girls are not free to choose. Without the safeguard of parental notification, minors may be exposed to continued risk. Keep in mind, minors can be brought across state borders by anyone for abortion, just to be released back to the trafficker/perpetrator. For this reason, parents have a right to know when their daughter is considering abortion so that they can seek help and intervene.

Most states have regulations that pertain to abortion clinics and promote the health and safety of women. Colorado is not one of them. The abortion industry pejoratively refers to any regulation that specifically applies to abortion providers as TRAP laws. They view them as impediments to abortion access. Even though thousands of medical facilities and agencies are licensed, regulated and inspected by the Colorado Department of Public Health and Environment, second and third trimester abortion clinics are the glaring exception. This omission is especially perplexing since second trimester abortions have a 10% overall complication rate and 1.7% life-threatening complication rate. The risk of having a complication increases for each additional week of gestation. Furthermore, the risk of dying from an abortion increases 38% for each week of gestation beyond 8 weeks. We should heed the lesson from other states that have tragically witnessed the maiming and death of women when government oversight is lax or non-existent – such as Pennsylvania and Dr. Gosnell. Coloradoans have a right to know that if Amendment 79 passes, the state will be unable to impose prudent health and safety regulations for abortion clinics which may jeopardize women’s health and lives.

Another goal of Amendment 79 is to facilitate publicly funded abortions. Currently, Colorado Medicaid only pays for abortions in circumstances of rape, incest, and threats to the life of the mother. If Amendment 79 passes, the prohibition against public funding in the constitution will be removed and the state will be able to underwrite elective abortions for Medicaid patients. In states where public funding for abortion is already law, they spend millions of dollars subsidizing abortion for in-state and out-of-state women. Coloradoans have the right to know that this may take precious tax dollars away from other medical priorities like pregnancy services and mental health. It may even divert money from non-medical budgets for education, affordable housing, and the environment.

There is already inadequate private and public support for pregnant women in our state. One of the few shining exceptions is the 58 pregnancy resource centers. They provide millions of dollars of uncompensated care to women during and after challenging pregnancies. However, because they typically don’t offer abortion services or refer for abortions, the abortion industry has been targeting these charitable organizations. Coloradoans have the right to know that the ability of pregnancy resource centers to assist pregnant women in need may be jeopardized by the passage of Amendment 79.

Under Amendment 79, the right to abortion would become absolute. Coloradoans have the right to know the implications of such an extreme position. It would strip all rights and protections from the developing fetus, even those that are wanted. The legislature couldn’t proscribe abortion methods that are especially cruel such as second trimester D&E (dismemberment) abortions on pain capable fetuses. It would jeopardize the conscious rights of medical professionals across the state who maintain medical/scientific, moral or religious objections to elective induced abortions. Since the amendment forbids “discriminating” against a woman’s desire for an abortion, even physicians and nurse practitioners who perform abortions would be unable to refuse abortions for reasons they may view as morally repugnant – such as aborting a fetus solely because of their sex (which is already occurring) or because of the ethnicity/race of their father.

Abortion access is already guaranteed in Colorado law. Making the right to abortion the only medical procedure recognized in our constitution is extreme and ties the hands of Colorado citizens and legislators. It goes far beyond the abortion rights promulgated in the Roe decision. Coloradoans have the right to know that Amendment 79 would have these many unintended consequences. Given the facts, we hope that Coloradoans reject Amendment 79.

Colorado Needs to rethink changes to Assisted Suicide Law

Fri, 01 Mar 2024 14:52:34 GMT

Science is not immune from politics and ideology

Wed, 31 Jan 2024 14:29:47 GMT

We should recognize ideological conflicts of interest in clinical research just as we recognize financial conflicts of interest in clinical research. It doesn't negate the studies, but tells us about potential biases and requires us to look more closely at the methodology and reporting.

Please read the latest opinion piece from DFLCO published in Colorado Politics.

https://www.coloradopolitics.com/opinion/science-gets-politicized-in-abortion-debate-podium/article_...

Post Roe in Colorado - Initiative 89 and the right to unrestricted abortion

Tue, 23 Jan 2024 04:25:56 GMT

How abortion advocates mislead Coloradans

Cobalt and other proabortion organizations are currently circulating petitions to have Initiative 89 appear on Colorado 2024 ballot. They have the money to pay circulators to get the necessary signatures so there is little doubt it will be on the ballot in November.

The ballot initiative is deceptively drafted to make it appear that the primary issue is correcting an “unintended consequence” of Amendment 3. Colorado constitutional Amendment 3 narrowly passed in 1984. It prohibited the use of state public funds for induced abortions unless the life of the mother was in jeopardy.

Initiative 89 backers are highlighting the lack of funding for state employees for abortions in cases of rape, incest, issues that “gravely endangers the patient’s health” or when there is a “fatal fetal condition”. They also point out the lack of an exception for state Medicaid funding for issues that “gravely endangers a patient’s health” or for a “fatal fetal condition”.

What are they not saying? There already is an exception for the pregnant woman’s life which would encompass anything that “gravely endangers the patient’s health”. They are trying to blur the line between an exception for a condition that jeopardizes a woman’s life and any complication that requires treatment during pregnancy but does not threaten her life. Similarly, Medicaid already offers reimbursement for abortions related to rape or to save the mother’s life. It does not have an exception for the nebulously defined “health” of the mother, which can be treated in the normal course of obstetric practice, or for fetal conditions.

A “fatal fetal condition” is a pejorative phrase with little resemblance to reality. For instance, Trisomy 18 is often referred to in this manner. The problem arises because the condition may be as much as 90% survivable if treated with standard interventions (employed on infants without Trisomy 18 diagnoses). It doesn’t mean that there aren’t life threatening fetal conditions or that some infants will have significant disabilities but describing these fetuses as “fatal” is a way to dehumanize them and justify the abortion decision.

If they were really motivated to remove the barriers to the < 4% of abortions that occur for reasons of rape, incest, life of the mother, and life-limiting fetal conditions, why doesn’t Initiative 89 simply ask Coloradans add these exceptions to Amendment 3s language? The answer is clear. They want to evoke an emotional response which will override Coloradans’ qualms about unrestricted abortion.

Their arguments gloss over the main purpose of Initiative 89 – to make abortion access a constitutional right without any gestational limits for any reason and to use public funding to subsidize it. They would like the public to be unaware of the fact that hundreds of healthy viable (>21 weeks) fetuses gestating in healthy women are currently aborted in Colorado. And that at least one late term abortionist (Warren Hern) has publicly acknowledged that he does abortions for absolutely any reason – including for sex selection.

If the public had an inkling of the magnitude of the slaughter of prenatal humans purely for social and economic reasons, they would be appalled. There are so many other legislative initiatives that could be undertaken to provide support for pregnant women and their families so that they don’t feel compelled to consider abortion. Why don’t we focus our efforts on these life-affirming alternatives to the violence of abortion?

DFLCO will be participating with Pro-Life Colorado, the state-wide umbrella organization uniting prolife groups, to defeat Initiative 89. DFLCO members should begin talking to their prochoice friends and writing letters to the editor of local media shedding light on the deceptive nature of Initiative 89 and the Trojan horse it represents for constitutionally protected unrestricted abortion. If your contacts don’t recoil at the reality that hundreds of healthy viable fetuses are being aborted for reasons as abhorrent as sex selection, then Colorado is in worse shape than any of us recognize.

Initiative 89 should have no place in Colorado.

Exploiting rare tragic pregnancies to justify a Colorado constitutional right to abortion - Initiative 89

Wed, 10 Jan 2024 22:34:25 GMT

Initiative 89 should have no place in Colorado.

Is abortion the right response to a baby with a potentially life-limiting diagnosis? The case of Kate Cox and her Trisomy 18 child.

Wed, 13 Dec 2023 05:12:58 GMT

The pregnancy of Kate Cox, the Dallas-area women who sought an abortion in Texas because her fetus was diagnosed with Trisomy 18, raises numerous emotionally charged issues.

She is 31 years old and has had two previous C-section deliveries and two healthy children. Texas has enacted abortion restrictions which prompted her to sue the state to procure an abortion after 20 weeks gestation.

This is a tragedy for Ms. Cox and her family. it is incredibly painful when a family first learns that their dreams for a healthy child are dashed. However, it doesn’t mean that their pain is diminished by access to abortion. And it doesn’t mean that their lives won’t be enriched by their child -even if their child’s life is abbreviated.

It is worth reviewing some of the more prominent media distortions pertaining to the Cox pregnancy/baby that prejudice the public’s response to this tragedy:

1) Trisomy 18 has a poor prognosis. It is true that there is a high probability for a fetus with Trisomy 18 to be stillborn. However, the prognosis is not as bad as portrayed in the media. According to a recent systematic review, a baby born with Trisomy 18 in 2020 has a 13% 10-year survival rate.

2) A Trisomy 18 baby may face challenges, but their lives can be a source of great strength and inspiration for a family. Senator Risk Santorum’s baby, Bella , is a case in point.

3) For those families who choose comfort care (perinatal palliative care and/or perinatal hospice ) for their baby with Trisomy 18, the experience is described by many families as deeply moving and life-affirming. These families don’t try to extinguish the memory of their child, but instead, celebrate their short life. A team of professionals walks with the family during the pregnancy, at birth, and post-partum. They provide support to the mother and baby and ensure that when the baby dies it is without discomfort and surrounded by loving family. This can contribute tremendously to healing for the grieving family. The healing is impeded for those families that choose abortion since they will never forget their complicity in their child’s violent death.

4) At 21 weeks, the D&E procedure that was recommended to the Cox family is associated with substantial risk to the mother. This is omitted from mainstream media stories. The risk of dying from an abortion increases by 38% for each week of gestation after 8 weeks. Even without factoring in her increased risk for uterine rupture by virtue of her previous C-sections, the risk for an induced abortion is substantially greater than the risk of natural childbirth based on evidence from national record linkage studies. If the Cox baby needs a C-section rather than vaginal delivery, the risks are higher, but C-section is not an inevitability. If Ms. Cox had two previous low-transverse cesarean deliveries, she would be a candidate for a trial of labor after C-section (TOLAC).

5) The recommended D&E abortion procedure is often performed without administering a feticide- a chemical/drug that kills the fetus prior to the surgical abortion. One review reported that only 52% of abortion providers inject a feticide before proceeding with a second trimester D&E abortion. The D&E entails the systematic dismemberment of the living fetus which is pain capable by the gestational age of the Cox baby. Imagine for a moment the excruciating suffering elicited in the living fetus as its limbs are literally torn off. Some abortion advocates mistakenly view this as the “compassionate” choice.

6) Even in those cases where an abortionist chooses to administer a feticide prior to the procedure, the fetus will endure incredible suffering. The most common feticide, digoxin, takes up to 4 hours to kill the fetus if it is injected directly into the fetus and up to 24 hours if it is injected into the amniotic fluid surrounding the fetus. Digoxin overdose is associated with intense nausea, vomiting, abdominal pain, and delirium before it slows the heart and induces death. This can aptly be described as fetal torture.

7) The media suggests that Kate Cox’s life is in jeopardy if she continues the pregnancy. However, there is nothing in the lawsuit that corroborates this assertion. Ms. Cox visited the Emergency Department for cramps and diarrhea, but this is not a concerning symptom for her health or life. During a second Emergency Department visit she was reported to have some unidentified fluid from her vagina – suggesting the possibility of leaking amniotic fluid. This would be a more significant concern, but the Emergency Department commonly visualizes the cervix to make this diagnosis. They can also perform ultrasounds and several forms of tests on the vaginal fluid to establish this diagnosis (including pH-based tests, a fern test, and placenta alpha-1 globulin protein). The fact that none of this was mentioned in the lawsuit leads one to believe that Ms. Cox was not manifesting Premature Rupture of Membranes (PROM) and leaking amniotic fluid. The lawsuit mentions an elevated prenatal blood sugar, but gestational diabetes can be managed with a very low risk of morbidity/mortality. Translation - there was nothing in the lawsuit suggesting her life was at risk.

8) The media uncritically reports that future fertility is at risk if she continues her pregnancy. In the lawsuit, Ms. Cox indicates that she would like to have another child. It is true that if she had a C-section to deliver her child with Trisomy 18, there would be increased risk from a 4th C-section with a future child. The risk of uterine dehiscence (which means the partial opening of the uterus at the previous C-section scar) goes from 6.6% with her third C-section to 10.3% with her fourth C-section. This is a concern, but the absolute risk remains low. Furthermore, she is at increased risk with a future child regardless of her abortion decision by virtue of her C-section history. As indicated previously, it is not certain that a repeat C-section would be required and if she has a vaginal delivery of her Trisomy 18 child, there is little additional risk incurred with her future pregnancy.

9) Surgical abortions in general, and late abortions in particular, are associated with premature birth in subsequent pregnancies. Induced abortions are associated with cervical damage . This means that if Kate Cox obtains a late abortion, she may be putting her own and her future baby’s life at risk. Preterm delivery is associated with long term mortality for the mother and is the biggest driver of infant mortality for the child.

10) If any of the facts reviewed above miss some of the salient clinical features omitted from the lawsuit or if Kate Cox’s condition deteriorates, the Texas Supreme Court has made it clear that abortion is an option if her bodily functions or life are at risk. Furthermore, the court explicitly stated that her life does not need to be in “imminent” danger to pursue abortion in those circumstances. Her attending physicians simply need to make that determination based on reasonable medical judgement and the Texas Supreme court says it does not need to be reviewed by the judiciary.

The Cox family have our sympathy and we all wish them well. However, their decision should be based on all the facts and not the selective narrative of abortion providers. It is unfortunate that families with life-threatening fetal anomalies are often given no hope and coerced into pursuing an abortion that they later regret.

Reflections from a Prolife Democrat on Abortion Electoral Politics

Thu, 09 Nov 2023 18:53:38 GMT

There are some things I have a hard time understanding.

Why do people who profess a Christian worldview support a presidential candidate who is crude, cruel, vindictive, misogynistic, narcissistic, and does not pretend to know, much less follow, basic Christian moral teachings? When the prenatal human rights movement becomes associated with such figures, we lose moral credibility and ultimately, electoral power.

And why do people who are otherwise loving and compassionate fail to demonstrate any love or compassion for the preborn human being before they are killed in elective abortions? Why is it either the mother or the preborn baby and not both? Why do people go out of the way to knock down perceived barriers to abortion access, but seem disinterested in eliminating the socioeconomic barriers to giving birth and parenting? Why do people feel the only way to achieve equity between the sexes is to deny the biological realities of the sexes? Why do we primarily deal with the asymmetric burdens of human reproduction by promoting abortion? Why can’t we honor a woman’s different role by making social and economic accommodations for women so that their education and careers are prioritized during their reproductive years? Why is it that many of the same people who characterize themselves as “anti-racist” fail to recognize the systemic issues and underlying racism that result in many more preborn babies of color being aborted than White preborn babies?

I don’t profess to have all the answers. But what I do know is why I am prolife.

I am a physician. In medical school, I studied embryology and marveled at the remarkable and seamless journey from zygote to human birth. My textbook unequivocally stated that “development begins at fertilization, when a sperm fuses with an ovum to form a zygote; this cell is the beginning of a new human being”. Any attempt to distinguish a human being from a human person is philosophically and scientifically arbitrary. As part of my educational training at medical school, I had the terrifying experience of viewing a recently aborted second trimester baby at the bottom of a surgical bucket. You can’t unsee that. As a medical student, I witnessed an OB/GYN attending physician flaunt her wealth by driving a Rolls Royce – only to learn her wealth was predicated on a very lucrative abortion clinic practice.

I know that during the most common second trimester abortion procedure, an abortionist literally dismembers the fetus without the benefit of any anesthesia. I know that during abortions after fetal viability (22 weeks), the fetus is commonly injected with a drug, digoxin, which I have witnessed causing nausea, retching, abdominal pain, and delirium at toxic levels in my adult patients. It can take up to 4 hours to kill a fetus if the drug is injected directly into the body and up to 24 hours if it is injected into the amniotic fluid surrounding the fetus. That is up to 24 hours of fetal torture/anguish.

Because I am a physician, I understand that there is no connection between abortion restrictions and the medical management of a miscarriage. Because I am a physician, I know that abortion restrictions never prevent a physician from responding to a medical emergency in a pregnant patient. I know that for rare medical complications during pregnancy, a physician must deliver a baby prematurely – even if delivering the baby will foreseeably result in the death of the baby. Because I am a physician, I know that the scare tactics employed by abortion advocates are just that – scare tactics. If a woman must go to another state for urgent/emergent complications of her pregnancy, it is because of malpractice, not because of abortion restrictions.

I have had men and women yell and swear at me because of my prolife position who ultimately break down in tears, and admit they were angry because they aborted their child and knew it was wrong. I have had an elderly woman come up to me outside an abortion clinic where I was offering help to abortion vulnerable women and thank me as she cried and said that if I had been there 50 years ago, she many have not made the worst decision of her life and had an abortion. I have had a woman stop her car in the middle of the street outside an abortion clinic and smile from ear to ear, explaining that because I was there two years ago, her little boy was now two years old.

I know that abortion hurts women and men alike. I know that many women feel coerced by their financial situation or partners, but there is help and we won't let them stand alone. I know that sanctioning violence in the wound leads to increasing violence in our culture. I know that when we start dividing human beings into those that are worthy of rights/protections and those that are unworthy of rights/protections we undermine our own human dignity/value.

So why is a majority of the electorate voting against abortion restrictions?

It is true that if the mainstream media would cover the issue objectively, more could discern the truth about the reality of abortion. I also believe that if more could see what I see, they would vote to protect innocent human life in the womb.

And I know that I will fight to protect the dignity and value of every human being until the day I take my last breath. I hope more of you join me.

Thomas J. Perille MD

Commending those defending free speech and free medical practice rights in Colorado - Denver Post 11/5/23

Mon, 06 Nov 2023 17:07:39 GMT

Preliminary Injunction issued against SB23-190 which mandated viewpoint discrimination and banned abortion pill reversal.

Krista Kafer nailed it. A small faction of abortion rights extremists strong-armed the Democratic caucus and pushed through SB23-190 which punitively targeted Pregnancy Resource Centers which are commonly affiliated with religious organizations. Not only did they blatantly challenge the first amendment rights of these centers, but they also didn’t hide their animus in hours of testimony at the state capitol.

The bill also sought to ban the use of progesterone to mitigate the abortifacient effects of mifepristone – the first pill in the two-drug medication abortion regimen. Eliminating this option has nothing to do with improving abortion access but rather is all about denying a woman’s agency and removing her choices. Opposition to abortion pill reversal was never about the science since there is low-level, but multifaceted and compelling evidence to support the practice. Instead, their true motivations were revealed in testimony from ACOG to the Medical Board – they didn’t want to acknowledge that women change their minds about abortion since it would contradict their preferred narrative and lead to “abortion stigma”. They cared little about the desperate woman in their exam room who believed she made a tragic mistake and wanted to save her baby.

I hope my fellow Democrats take the judge’s decision as a wake-up call. It is past time to look beyond a narrow proabortion focus and support all attempts to serve women who face a challenging pregnancy.

Thomas J. Perille MD

President, Democrats for Life of Colorado

Abortion pill reversal is based on science!

Wed, 18 Oct 2023 13:18:16 GMT

The court's need to stop the implementation of SB23-190 - a reckless and cruel law!

Excerpts from Democrats for Life of Colorado's President, Thomas Perille MD, to the Colorado Medical, Nursing and Pharmacy Boards which walks through the evidence in support of abortion pill reversal:

Members of the Colorado Medical Board, Board of Nursing and Board of Pharmacy,

With the signature of SB23-190 into law by Governor Polis, you have been asked to evaluate a specific medical intervention to determine if it is a “generally accepted standard of practice”. As someone who has reviewed several cases for the Medical Board to determine if a provider deviated from accepted community standards, I would like to provide my perspective based on a careful review of the evidence.

So called “abortion pill reversal” (APR) protocols were developed in response to the rare situation in which a woman pursuing a medication abortion regrets her choice after taking the first pill, mifepristone, but before taking the second drug, misoprostol, in the two-drug regimen. The purpose of APR is to mitigate the abortifacient effects of mifepristone and increase the odds of a continuing pregnancy.

It should be no surprise that some women harbor significant ambivalence about their abortion decision. The Turnaway Study (page 126) reported that within one week of being denied an abortion, 35% of women no longer wished to have an abortion. In 2022, 31 Colorado women (approximately 0.4% of medication abortion patients) sought to pursue APR through the most prominent organization dedicated to APR – Heartbeat International .

As a matter of principle, clinicians routinely honor a patient’s right to withdraw consent from any medical or surgical intervention. Therefore, addressing the needs of women who change their mind about their medication abortion should not be controversial.

Mifepristone was developed in the 1980s as a progesterone antagonist. It is one drug in a whole class of Selective Progesterone Receptor Modulators (SPRMs). The drug binds progesterone receptors twice as avidly as progesterone. In the early 1990s it was studied primarily as a means to terminate early pregnancy .

APR is based on the premise that mifepristone competition for the progesterone receptors is a dynamic process. By flooding the receptors with natural progesterone, one could theoretically overcome the binding of mifepristone to progesterone receptors and reduce its abortifacient effects.

Some abortion researchers have questioned the potential for high dose progesterone to significantly impact mifepristone’s binding to progesterone receptors. They cite the observation that women treated with mifepristone for abortion have high progesterone levels and therefore it would seem implausible that more progesterone would make any difference. They also point to a study of the very potent progestin contraceptive implant, etonogestrel. When it was administered immediately after the ingestion of mifepristone, it did not reduce the percentage of successful medication abortions.

There are animal and human data to counter these arguments. Early in the research on mifepristone it was recognized that its binding to the progesterone receptor could be reduced by increasing progesterone levels. In a study in pregnant rats, those that received mifepristone only had 33% of pups survive. In contrast, those that were given progesterone with mifepristone, 100% of pups survived. A second study in rats demonstrated a clear progesterone mediated reversal of mifepristone induced pregnancy termination in a rat model. As early as 1991, a medical review of mifepristone use in medication abortions recognized that the mifepristone binding to the progesterone receptor could be reversed by adding progesterone. Collectively, these provide proof of principle for APR.

The fact that progestin can interfere with the action of a SPRM in humans is a documented concern outside of mifepristone use for medication abortion. The FDA recommends that progesterone containing hormonal contraceptives not be administered within 5 days of taking the SPRM, ulipristal, so as not to reduce its effectiveness as a form of emergency contraception.

Compelling evidence that a progestin can specifically interfere with a mifepristone (and misoprostol) in a medication abortion was found during a large, randomized, multinational study of depot medroxyprogesterone acetate use as a post-abortive contraceptive. In this study, the administration of medroxyprogesterone in conjunction with the ingestion of mifepristone (Quickstart) was associated with a 400% increase in the odds of a continuing pregnancy compared to delaying the administration of medroxyprogesterone after a mifepristone/misoprostol abortion (Afterstart). While the absolute difference was small (0.9% to 3.6%), the results were statistically significant. Some researchers speculated that depot medroxyprogesterone acetate differs from other progestins, such as etonogestrel, because of its potency and rapid achievement of peak levels.

The first known use of high dose progesterone to mitigate the effects of mifepristone during the course of a medication abortion was in 2006 by Dr. Matthew Harrison. A desperate woman who immediately regretted her medication abortion decision sought his help. Based on the known mechanism of action and the record of safety using progesterone to treat miscarriages, he initiated a course of high dose parenteral progesterone. This resulted in the delivery of a healthy baby girl.

I would argue that even this early adoption of the APR concept met the criteria for a “generally accepted standard of practice” as defined by the Colorado Medical Board. The strategy was plausible based on the known mechanism of action of mifepristone – competitive inhibition of the progesterone receptor. Animal research supported the approach. The intervention was deemed safe in analogous OB indications (miscarriage prevention) at the time. And most importantly, the potential benefit - a life saved- justified an unproven intervention. The only alternative course of action was expectant management which would be anticipated to result in only a 20-40% chance of embryonic survival based on WHO data from 1997.

In 2012, the first case series utilizing progesterone to block the abortifacient effects of mifepristone was published. Four of six (66%) women who were administered parenteral progesterone after taking mifepristone carried their pregnancies to term. A second small case series in 2017 also demonstrated a 66% continuing pregnancy rate after administration of progesterone following mifepristone.

This compares to a historical rate of </= 25% for continuing pregnancy following the administration of mifepristone as a single agent abortifacient. This figure reflects a careful review of the literature in which documentation of ongoing pregnancy was required rather than the less specific term “incomplete abortion”. In other words, many early studies did not distinguish between residual pregnancy tissue which entailed the need for additional procedural intervention from a continuing pregnancy with a living embryo. More mifepristone abortions required surgical evacuation but many of these did not involve the persistence of a living embryo.

The largest case series was a retrospective compilation of patients treated with differing parenteral and oral high dose progesterone regimens within 72 hours of taking mifepristone. The study was reviewed and approved by an institutional review board. There were 547 women with analyzable outcomes and the overall rate of “reversal’ of mifepristone was 48%. Two regimens had the highest rate of reversal – those who received intramuscular progesterone (64%) and those that received the high dose oral regimen consisting of 400 mg bid for three days, followed by 400 mg qd for the first trimester (68%). The success of reversal was dependent on the gestational age – with the highest success rates at the longer gestational ages. The rate of birth defects in the women who received the APR regimen was 2.7% which was commensurate with the rate reported in the general birth population. The preterm delivery rate was only 2.7% which compares favorably with US average of 10%.

The series was criticized because all complications were not reported. This is a fair criticism but needs to be placed in perspective. The administration of progesterone to avert a threatened miscarriage had been employed for decades and found to be safe . For both women and babies, there is “no increase in risk of stillbirth, ectopic pregnancy, congenital abnormalities or adverse drug reactions” utilizing progesterone in a fashion analogous to APR. It has been proven effective in those women with threatened miscarriage and a history of one or more previous miscarriages.

During testimony on SB23-190 in the Colorado House on March 28 two experts in support of APR shared data relevant to the concerns regarding APR safety. Dr. George Delgado (recording at 5:46PM) reported that there were 150 women per month who contacted the Abortion Pill Rescue Network in 2022. All the reported complications were minor (dizziness, nausea, heartburn, injection site discomfort) and represented 0.5% of the 1800 patients. He also reported that there have been over 4000 live births to women who pursued the APR protocol. Dr. Brent Boles (recording at 9:45PM) who leads the Abortion Pill Reversal Services at Heartbeat International corroborated Dr. Delgado’s observations. He added that over 1000 physicians participate in the Abortion Pill Reversal Network including clinicians in Colorado.

One attempt was made to obtain randomized, placebo-controlled data regarding the efficacy of APR by Dr. Mitchell Creinin. The study randomized women seeking an abortion to mifepristone followed by progesterone vs. mifepristone followed by placebo. The study was terminated early because of severe hemorrhagic complications. Although the small sample size precluded drawing statistically significant conclusions, the results tracked with the previously reported case series. 80% of the women who received the progesterone had continuing pregnancies and only 40% of those who received placebo had ongoing pregnancies.

Abortion rights researchers have used the fact that the study was stopped early to cast aspersions on the safety of APR. However, a closer look at the results of the study might lead one to conclude the opposite – that for women changing their mind after taking mifepristone, utilizing progesterone per the APR protocol might be far safer than expectant management. Of the three women who had hemorrhage in the study, only the two women in the placebo group required surgical intervention and one of these also received a blood transfusion. One woman in the progesterone group was seen in the ED but did not require intervention for her completed abortion.

The fact that one woman who received progesterone per the APR protocol sought emergency department care should be unremarkable. Emergency Room utilization in the US following a medication abortion is significantly undercounted. Registry-based studies from other countries are more reliable sources for estimating the complication rates for medication abortion . A Finish study demonstrated a 15.6% hemorrhage rate following medication abortion. And a Canadian study revealed that 10.3% of women undergoing a medication abortion in the first trimester had an emergency department visit.

I recently attended a national meeting of the American College of Physicians in San Diego in which Dr. Eleanor Schwarz, Professor of Medicine and Chief, Division of General Internal Medicine at the University of San Francisco, stated that mifepristone is “safer than Tylenol”. This has been echoed by abortion rights researchers and mainstream media throughout the country. These same researchers implausibly claim that mifepristone followed by progesterone per APR is “dangerous”. There is no plausible scientific reason that mifepristone is safe, but when followed by progesterone, it becomes dangerous. The published and unpublished data coming from the Abortion Pill Reversal Network belies this characterization.

We are left with three observations:

1) There is moderate level (B) evidence that a progestin can mitigate the effects of mifepristone in humans.

2) There is low level (C), but multifaceted, evidence supporting the APR protocol to approximately double the odds of a continuing pregnancy following the administration of mifepristone.

3) There is moderate level (B) evidence that progesterone use is safe to use in a multitude of obstetric indications, including for threatened miscarriages.

Despite these observations, Dr. Mitchell Creinin (recording at 7:40PM), the principal medical expert who testified in favor of SB23-190 and against APR, called APR “medical fraud”. He ignored or dismissed the evidence which I have summarized for you. What he failed to disclose is that he is a paid consultant for Danco Laboratories, which is the distributor of mifepristone. Danco Laboratories has a vested interest in preserving the fiction that mifepristone is entirely irreversible.

Most of the others who testified in support of SB23-190 cited the fact that the AMA and ACOG oppose APR. However, neither the AMA nor ACOG are neutral arbiters of the evidence. Through AMA’s and ACOG’s position statements and the editorial content of the journals they sponsor, they make it clear that they are abortion rights advocates. ACOG’s “advocacy” statement regarding APR is outdated and incomplete. It more accurately reflects the abortion industry’s talking points and not the science behind APR.

What Dr. Creinin and other critics of APR also fail to acknowledge is that clinical recommendations and guidelines are often based on low level evidence. As much as we would like everything we do in medicine to based on double-blinded, placebo-controlled trials, the reality is that only a fraction of what is recommended, and what we do in practice reflects this level (A) of evidence. Cardiology is one of the most evidence-based specialties in medicine. Nonetheless, a recent analysis of their clinical guidelines demonstrated that 41.5% of their recommendations were based on low level (C) evidence.

Using a common recommendation/level of evidence framework , APR would be a Class 2a (Moderate) recommendation utilizing Level C-LD evidence. A 2a recommendation would be one that would support the wide adoption of the practice pending further trial data. There is virtually no other specialty area of medicine – not embroiled by abortion politics - in which a medical intervention, demonstrated to be safe, that resulted in a 50% or greater reduction in mortality based on low level evidence, would be outlawed by a legislative body.

The Handbook for BME Consultants (circa early 2000s) which I utilized to evaluate cases for the Medical Board indicated “the only question you will be asked to answer is whether the licensee’s action or lack of action was or was not below the prevailing standard of care. The standard of care is defined as “…that degree of care, skill, and diligence that is used by ordinarily careful physicians and surgeons in the same or similar circumstances in the community.” It goes on to say, you should “determine how a prudent practitioner might have treated the patient differently”.

I would argue that any clinician who is faced with a woman who has begun, but not completed, the two-drug medication abortion regimen and who regrets her decision and wants to save her baby, should be obliged to offer progesterone per the APR protocol. The potential benefit (a life saved) far outweighs the miniscule risk of administering progesterone (benefit>>>risk). The only alternative – expectant management – is associated with a much poorer outcomes and potentially worse safety - twice the embryo/fetus mortality and a possible greater risk of hemorrhage for the woman.

Thank you for your consideration.

Thomas J. Perille MD FACP FHM

President, Democrats for Life of Colorado

Promotion of Physician Assisted Suicide in the Media

Sat, 16 Jan 2021 08:31:34 GMT

Response to Merrily’s Choice - Denver Post January 5, 2021

Merrily’s Choice is a compelling story published in the Denver Post on Sunday, January 5 ( Under the Colorado End-of-Life Options Act, Merrily got to choose the day she'd die (denverpost.com) ) highlighting the perceived benefits of physician assisted suicide (PAS), commonly referred to by the euphemism, medical aid-in-dying (MAID). Merrily clearly had a loving family. It is easy to empathize with her family who thought that PAS was a good choice. However, the positive picture of PAS portrayed by Merrily’s granddaughter is both incomplete and misleading. It can have unintended consequences for those hearing her story.

Social libertarianism is highly regarded by many Coloradans. We dearly value personal liberty and frown on any attempts to limit those liberties. However, Coloradans have become so enthralled with the pursuit of personal liberty and independence that it seems we have forgotten our interdependence and the common good. Our laws are increasingly predicated on this notion of “rugged individualism”. They ignore the totality of our human nature which encompasses not only our individual self-expression but also our mutual dependence and vulnerability. They minimize the importance of human relationships and love. They reinforce the false notion that people with disabilities or sickness are less human and less valuable.

As Coloradans increasingly prioritize personal autonomy over other human values, we are turning our backs on the principle of solidarity. This has been highlighted recently by the refusal of some Coloradans to wear masks or follow social distancing guidelines in the face of the deadly coronavirus pandemic. PAS is another example. In the name of personal autonomy, PAS has become the ultimate abandonment of sick/elderly Coloradans by the physicians who have pledged to care for them and by the families who are called on to love and support them at the end of life. Beneath the veneer of “choice”, PAS often is the outcome of systematic dehumanization of the sick/disabled and inadvertent coercion.

Merrily was 98 years old and slowly losing her ability to perform activities of daily living. She had lost much of her independence and required assistance from home health aides to remain in her home. There is no mention of a terminal illness other than her advanced age. A Covid infection posed an immediate threat to her life and she was enrolled in a hospice program rather than pursue more aggressive medical interventions in a hospital or skilled nursing setting. None of this is controversial. Like most people her age, she was not afraid of the prospect of dying and, indeed, would welcome death. But Merrily did not die from Covid as she and her family expected. The family was “flummoxed” and Merrily “embarrassed”.

As a physician who has attended to hundreds of dying patients over the years, this is not an uncommon scenario. Families can be more disturbed that a loved one survives an anticipated lethal illness than dies during the illness. This is not lost on their sick family members. People who survive a lethal illness often feel embarrassed and believe that their survival poses an undue burden on their families. (They often don’t vocalize this fear.) Because dependency already carries such a stigma in Colorado, the sense of burden is further exacerbated. Studies in other states have demonstrated that the fear of being a burden on family is a primary reason for pursuing PAS. It appeared to be a significant factor in Merrily’s “choice”. Merrily did not have a typical terminal illness and her physicians likely felt that her “failure to thrive” was enough of an indication for PAS. Her children “had found a way” for her to die quickly. Advanced age was never cited as a reason for PAS during the Colorado debate over the End-of-Life Options Act and Merrily’s PAS illustrates how insidiously the “indications” for PAS evolve.

Caring for a family member who requires significant assistance certainly can be a burden, especially for those without time or financial resources. Thankfully, Colorado’s new family leave bill may reduce this burden. However, it is not enough. Colorado needs robust, free, out-patient/in-patient hospice programs. It needs to explore other models to care for the elderly and disabled. Paying family members to care for their loved ones in lieu of nursing home placement or “adult foster home care” are just two option being explored in other states. No Coloradan should be forced to make a “choice” for PAS because they feel a burden on their family or their community. How we take care of these most vulnerable members of our state will be how we are judged as a society – not how assiduously we can enshrine personal autonomy in our culture.

Merrily’s family had “quality” conversations in the two weeks between the prescription of the lethal cocktail and its ingestion. This is wonderful, but nothing unique to the PAS experience. I have attended to patients in hospice at the time of their deaths and personally witnessed incredibly moving conversations, reconciliations, and acts of love between my patients, their families, and friends. In fact, PAS may curtail this important time families have to spend with their love ones at the end of life.

My own father died at age 96 in 2018. He had a slow mental and physical functional decline over a period of years. Like Merrily, he was fiercely independent. He learned to accept help at home after a life-threatening fall and grew to love his home health aide. He did not dwell on his disability and the family did everything we could to make him feel honored and valued despite his limitations. My siblings and I rotated visits with him and relished “field trips”, remembering family events and reviewing old photographs. We will always cherish this time together. Also like Merrily, my father developed an acute respiratory illness superimposed on his advanced age. Per his wishes, he was enrolled in hospice rather than pursue aggressive in-patient care. My father remained comfortable and was able to say good-bye virtually to those who could not travel to be with him. He died painlessly and peacefully with his family at his side as a harpist (provided by the hospice program) played a beautiful musical piece. PAS was not wanted or necessary. He had a “good death”. You rarely hear these stories.

Because Merrily chose suicide rather than a natural death, others may be impacted. It is no secret that Colorado is plagued by teen suicide. Embracing PAS sends the message to vulnerable teens (and others) that suicide is a rational, sometimes preferable, way to address physical or emotional pain. Autonomy is all that is important, even if that autonomy is the instrument of your death. Glorifying suicide is known to increase suicide in a community. This is commonly referred to as the Werther effect. Merrily and others who pursue PAS have no desire to impact vulnerable teens, but, sadly, this may be part of their legacy.

People of Colorado have voted to have access to PAS. This right needs to be accompanied by responsibilities. Coloradans need to hear more stories about “good deaths” made possible by quality hospice programs and not just rosy PAS stories like Merrily’s in the Post. We need to know that disability or even dependence does not detract from a person’s inherent dignity and value. We need to hear that we are not burdens on family or communities, no matter our physical/mental disabilities. Our families need to know that the state of Colorado will be there to assist them with private/public programs at the end of life so that we can nurture our relationships and not focus on the burdens. Finally, we need to know that suicide is not the only answer to difficult or challenging physical, existential or emotional pain.

Why Coloradans Should Support Proposition 115

Wed, 09 Sep 2020 18:56:33 GMT

Vote Yes on 115 to restrict abortion after 22 weeks in Colorado

Introduction

Late abortions (after 22 weeks gestational age) are extreme by any national and international comparison. Just seven of the 50 States in the US permit abortion after 25 weeks.1 Most (38) prohibit abortion at 22 weeks or less. Internationally, only five of the 198 countries, independent states, and semi-autonomous regions with populations exceeding 1 million permit elective abortion after 24 weeks.2 Three of the five nations that permit late abortion are notorious human rights abusers: China, North Korea, and Vietnam. Colorado should not aspire to join the ranks of the few states and countries that dehumanize the developing fetus and permit the killing of these most vulnerable human beings. Colorado should also not jeopardize the health of Colorado women by allowing the unregulated out-patient practice of late abortion which is known to pose serious risks to the health and life of the woman.3

Late abortion is predicated on the notion that a woman’s right to bodily autonomy trumps the human fetus’ right to life. Both prolife and prochoice advocates would agree that a woman’s autonomy is an extremely important value; however, both sides differ on whether autonomy supersedes another human being’s fundamental right to life. These competing rights are why proponents of access to late abortion go to extreme lengths to minimize the humanity of the fetus. They refer to “terminating the pregnancy” as if the termination could occur without killing a vital, developing human being. A recent series on abortion rights by the Editorial Board of The New York Times refers to the developing human merely as a “cluster of cells” as if her brain, heart, circulatory system, appendages, hands/feet and nervous system were immaterial.4 Planned Parenthood of the Rocky Mountains characterizes the dismemberment of late second trimester fetus during a Dilation and Evacuation (D&E) abortion as removing “pregnancy tissue”.5 Orwellian language is utilized to refer to the crushed and dismembered human fetus as “products of conception” or simply “POC”. Even the preferred term “fetus” is an attempt to dehumanize the developing human. OB-GYN physicians commonly refer to the “baby” during a woman’s wanted pregnancy, but abortionists will rarely refer to the “fetus”, much less use the term “baby”, when counseling a woman on abortion.

There is little doubt that there is a bipartisan consensus that late abortions should be regulated. According to a 2018 Gallup poll, only 18% of Democrats, 13% of Independents, and 6% of Republicans believe that third trimester abortions should be legal.6 In 2020, the Marist Poll found that 70% of Americans felt that abortion should be restricted to the first 3 months of pregnancy or less.7 The Marist poll also revealed that 41% of self-identified prochoice voters were more inclined to vote for a candidate who supported abortion restrictions. The polling presumably reflects the public’s widespread recognition that late abortion kills a human being not materially different than a newborn infant and that late abortion represents a substantial medical risk to the pregnant woman.

Is the 22 week fetus a human being?

Human embryology has long established the fact that human life begins at fertilization and that human development is a seamless process that continues for years after birth. It should not be surprising that 96% of 5577 biology scientists who were recently surveyed agreed that human life begins at fertilization.8-9 No matter how hard abortion rights activists try to obfuscate, human zygotes, embryos and fetuses are biological human beings.

A primordial heart develops in the human embryo by the fifth week (post last menstrual period) and begins to pump blood by the sixth week.10 Rapid development of the brain occurs in the seventh week. By the 10th week, the embryo has distinctly human characteristics, developed the beginnings of all major organ systems, and demonstrates purposeful limb movements. During the 19th week, the mother can feel the fetal movements and by 22-weeks the fetus can respond to her mother’s touch. Fetal surgeries, in which the human fetus is operated on by specially trained fetal surgeons and anesthesiologists, have been pursued as early as the 19th- week gestation.11-12

Human fetuses have been born in the 21st-week gestation with excellent neurodevelopmental outcomes.13 Based on one national study performed on infants born at 22 weeks gestation between 2006 and 2011, 23% survived with active treatment.14 However, more recent data from the University of Iowa encompassing outcomes between 2006 and 2015, suggest a much more robust 70% survival.15 The majority had no or mild neurodevelopmental impairments.

While there is considerable debate concerning when the human fetus can experience pain, it is very likely that a 22-week-old human fetus can experience pain – likely, more intensely than an infant or adult.16 The experience of pain in humans is characterized by two neurological functions: nociception which involves the transmission of painful stimuli to the central nervous system and perception which entails the organization, identification, and interpretation of the painful sensory information. Nociception occurs early in fetal life, but perception occurs later. In a systematic multidisciplinary review published in 2005, researchers (who opposed abortion restrictions) argued that the processing of painful stimuli can only occur once the brain cortex is fully functional – not before the third trimester.17 However, the majority of contemporary fetal medicine specialists now consider the evidence that a 22-24 week fetus experiences pain compelling.16,18-22 Some believe a fetus as young as 13 weeks able to experience pain, albeit without the capacity for self-reflection.23 They cite the adequacy of nociceptive pathways, the presence of a working thalamus (which relays painful stimuli), the development of the subplate (which is an active, albeit transient, layer of the human brain cortex), documented periods of wakefulness/arousability, hormonal stress/pain responses, and fetal behavioral correlates of pain. This conclusion is reinforced by measurements of nociception-specific brain activity using near-infrared spectroscopy (NIRS), electroencephalography (EEG), and functional MRI.24-26 More sophisticated 4D ultrasound technology has also enhanced our ability to use facial expression to assess fetal pain.27-28 Because inhibitory descending pathways, which down-regulate pain perception, mature only after birth, the human fetus may be much more sensitive to pain than infants or adults.18,20-21 Clinicians have long observed that preterm infants at the lowest limit of viability have “profound, acute adverse reactions” to major painful stimuli.29 Physicians and nurses in neonatal intensive care units witness this every day and utilize multiple different pain assessment tools to help measure and mitigate the pain.19

Ultrasound using 4D technology has revealed a surprising diversity of fetal movements and added to our knowledge of the fetal central nervous system and neurobehavior.30-31 By the 11th week of gestation, the fetus demonstrates head flexion/rotation, isolated arm/leg movements, stretching, sucking, swallowing, hiccups, jaw opening and yawning.32 By the 22 weeks gestation the fetus can blink, repetitively open/close their mouth, extrude their tongue, smile, and grimace.33-34 Fetuses have been observed to cry in utero.30 These observations attest to the sophistication of the fetal brain at 22 weeks and suggest a nascent fetal emotional response.

The human fetus develops the ability to detect other sensory stimuli such as tastes and smells.35-36 Researchers have demonstrated that specific foods and flavors in the maternal diet during pregnancy can transfer to and flavor the amniotic fluid. These flavors are in turn tasted by the fetus and result in post-natal food preferences. This is how culture-specific flavor preferences are learned by the fetus and initiated early in life.

It has also long been recognized that the human fetus can respond to sound as early as 19 weeks.37-38 The human fetus specifically responds to her/his mother’s voice.39 At 25 weeks human fetuses have been observed to mimic their mother’s resuscitation of a nursery rhyme by opening and closing their mouths.40 Furthermore, a newborn human shows preference for her/his mother’s voice and for musical pieces to which she/he were previously exposed, which confirms a capacity for a fetus to learn in utero. Studies have shown that prenatally acquired acoustical memory can persist at least 6 weeks after birth.41

Late second trimester and third trimester human fetuses display a number of other advanced cortical functions. The human fetus’ sensorimotor behavior demonstrates the same characteristics later observed in the child’s behavior.40 They show curiosity or intrinsic motivation to explore their body and environment, perform repetitive actions to elicit sensations, react to sensory inputs, display intentionality, and demonstrate goal directed movements.

Human fetuses in utero with gestational ages of 22 weeks or greater are biologically indistinguishable from infants born at 22 weeks – they are vital human beings. They have developed all the essential organ systems, they can perceive pain, they can demonstrate sophisticated behaviors including nascent emotion, they can respond to and learn from familiar tastes and sounds, and they can undergo curative operative therapies as independent patients. The only difference is location. Location should not be the determinant of human value. A human’s inalienable right to life, proclaimed in our Constitution has not, and should not be, contingent on location.

Why do women choose late abortion, how common is the practice, and what are the alternatives?

There is very limited information available in the United States regarding who pursues very late abortions. Most studies suggest women have later abortions for similar reasons that they have early abortions with several caveats.42-44 Age and educational level were not associated with abortions after 16 weeks in one Guttmacher sponsored study.42 Black women were twice as likely to have late abortions. Another study which was based on the baseline Turnaway data concluded that “reasons for seeking abortion are not different whether women sought abortion early or late in pregnancy.”43 They did not find a statistically significant difference between early and late second trimester abortions based on finances, parity, timing of pregnancy, degree of interference with future opportunities, emotional/mental preparedness, health related reasons, prospects for the baby, level of independence/maturity, influences from family/friends or the inability to contemplate adoption. A second study based on the Turnaway data suggested statistically significant differences in the age of the woman (younger patients, later abortions OR 2.7) and time that pregnancy was recognized (before 8 weeks, earlier abortions OR 0.1).44 They also found that women who had late abortions faced more logistical delays (finding a provider, raising funds, and travel costs). Both Turnaway studies excluded abortions for fetal anomalies or life endangerment.

Many people are under the impression that most late abortions are necessitated by terrible fetal anomalies or life endangering conditions. Ron Fitzsimmons, the executive director of the National Coalition of Abortion providers, famously admitted that he lied to Congress and the public when he stated that late abortions are rare and performed primarily to save the lives of women and to prevent them the burden of bearing severely deformed babies.45-46 He stated that late abortion is performed much more commonly than acknowledged and generally on healthy women bearing healthy fetuses. He feared the truth would hurt the cause of abortion rights. This sentiment is echoed by Frances Kissling, president of the Center for Health, Ethics and Social Polity who admitted that “our talking point is, most of these procedures are on women who discover abnormalities late in the pregnancy” even though “we don’t know if that is true”.47 Late abortionists have admitted doing thousands of late abortion procedures annually and only a “minuscule amount” on abnormal fetuses.45 Hillary Clinton famously repeated the false spin that late abortions “are because of medical necessity” during a debate with candidate Donald Trump. This assertion was widely debunked by fact checkers.48 Diana Foster, Professor at the University of California San Francisco’s Bixby Center for Global Reproductive Health stated that “there aren’t good data on how often later abortions are for medical reasons”. Her opinion, based on the limited research and discussions with fellow researchers in the field, was that abortion for fetal anomalies “make up a small minority of later abortions”.48 There are other sources including investigations, blog posts, interviews and documentaries that suggest it is not hard to schedule a late abortion or uncommon to abort an entirely normal fetus after 24 weeks gestation.49-53 One of the few mandatory state databases that confidentially tracks late abortions in Arizona, reported that 80% of abortions after 21 weeks were performed on normal fetuses in 2018.54

There is no mandatory reporting for number of abortions, indications for abortions or complications from abortions in the United States. Consequently, it is difficult to independently assess the practices of late term abortionists and the patients they serve. It is also uncommon for an independent expert to review late abortionists’ practices. In a rare move that resulted in significant controversy/litigation, Kansas Attorney General Phil Kline had Dr. Paul McHugh, University Distinguished Service Professor of Psychiatry at Johns Hopkins School of Medicine, review redacted records of prominent third-trimester abortionist, George Tiller.55 Dr. McHugh reported that he found instances where abortions were obtained for “trivial reasons” (like a desire to play sports) and for psychiatric reasons (such as adjustment disorder, anxiety, and depression) that could have been more appropriately remedied without resorting to late abortion. He indicated that from his review of the records “anybody could have gotten an (third trimester) abortion if they wanted one”.

In Colorado, the Boulder Abortion Clinic advertises elective abortions, (for any reason) to 26 weeks and then to 36 weeks for “medically indicated terminations”.56 Few Colorado abortionists publicly admit performing late/third trimester abortions and Dr. Warren Hern from the Boulder Abortion Clinic is the exception. In a number of newspaper and magazine stories, the impression is given that he only performs late abortions for fatal fetal anomalies and life-endangering conditions of the mother.57-58 However, anecdotal reports and a scientific publication suggests that the Boulder Abortion Clinic is willing to consider later abortions for normal human fetuses.49, 52, 56, 59 Dr. Hern has admitted that 70% of his abortion practice is for normal human fetuses.59 In those 30% of abortions performed for fetal anomaly, he reports that Down Syndrome is his most common indication (24%). Potentially treatable structural anomalies are included in his series (such as spina bifida, aortic stenosis, abdominal wall abnormalities, urinary obstruction, extra digits, fused digits, deformed hands or feet, scoliosis, and cleft lip/palate).59

To obtain Colorado-specific abortion data is extremely difficult. The Colorado Department of Health (CDPHE) collects an (admittedly) incomplete survey of abortion providers (since it is anonymous, not mandated, and there is no enforcement mechanism). In their 2018 Report of Induced Terminations of Pregnancy, 323 abortions were performed after 21 weeks gestation in Colorado (which represents 3.6% of the total abortions performed).60 The corresponding figure for 2019 was 169 or 1.9%.61 The Guttmacher Institute pegs the abortion rate in Colorado approximately 40% higher (based on 2017 data)62 Assuming the CDPHE underestimation persists and is uniformly distributed amongst all gestational ages, this would translate into approximately 452 abortions after 21 weeks in 2018 and 237 in 2019.

There is reason to believe that late abortions are significantly under-reported In Colorado. The precipitous drop in late abortion in 2019 is not credible. Abortions dropped from 277 between 22-24 weeks gestation in 2018 to 123 in 2019.60-61 There is no plausible explanation for this drop other than a decrease in clinic(s) reporting late abortions. The notion of under-reporting is further reinforced by the observation that the Boulder Abortion Clinic can’t be reporting their figures. Dr. Hern’s own published research suggests that he was performing approximately 250 abortions per year with 70% after 22 weeks, and 40% after 26 weeks.59 The 2018 and 2019 CDPHE reports only indicate 12 and 13 abortions were performed after 25 weeks – instead of the estimated 100 abortions performed by Dr. Hern after 26 weeks alone.

How often is it medically necessary to abort a human fetus to preserve the life or health of the mother? Dr. Diane Foster from the University of California San Francisco states that the number is very hard to characterize.48 Although there is almost no literature on the subject, one Maternal-Fetal Medicine expert concludes that this is an exceedingly rare event, perhaps encompassing as few as 4 extremely uncommon conditions: pulmonary hypertension (primary or Eisenmenger’s syndrome), Marfan’s syndrome with aortic root involvement, complicated coarctation of the aorta, and peripartum cardiomyopathy with residual dysfunction.63 These would all likely be adjudicated long before 22 weeks gestation. Dr. Hern has said that he is unaware of a situation where abortion was necessary (as opposed to delivery) to save the life of a mother in the third trimester.64 When a mother has a true medical emergency after 22 weeks gestation, abortion is never the safest approach. Emergent delivery of the baby via cesarean section is considered the medically appropriate option. To pursue a multi-day abortion procedure would be widely perceived to be medical malpractice.

Some women may feel the need to abort their fetus if they discover chromosomal or structural abnormalities. Prenatal screening tests can confirm fetal abnormalities by 18-20 weeks using currently recommended national screening guidelines – first trimester screen or quadruple marker screen, or integrated stepwise sequential/contingent screening, or cell free DNA screening and mid-trimester ultrasound.65 These women who choose to abort these fetuses should not be impeded by a prohibition on abortion after 22 weeks gestation. Similarly, women who have fetuses conceived in rape and choose abortion need not be affected by late abortion restrictions.

There is no question that woman contemplating late abortion make heart-wrenching decisions. They often feel that abortion is their only choice because of lack of support from family/friends. They may be unaware of life-affirming alternatives. Women need to know that in Colorado there are many private and governmental organizations that can provide medical, financial, housing, educational, employment, adoption, emotional and spiritual support to them and their families. They should also be made aware of the many compassionate services that Perinatal hospice offers.

Perinatal loss is one of the most devastating events a family will ever experience. Tragically, many families are unaware that perinatal hospice offers a compassionate, loving, and life-affirming alternative to late abortion for fetuses with life-limiting genetic or congenital abnormalities. Perinatal hospice can improve the mother’s and family’s experience when confronted with a fatal fetal diagnosis.65-67 Perinatal hospice involves a multidisciplinary team that includes obstetricians, perinatologists, labor & delivery nurses, neonatologists, clergy, social workers, midwives and hospice professionals. Together they accompany the family through the pregnancy and birth allowing them to fully embrace and celebrate the abbreviated life of their baby. The baby receives palliative symptom management to ensure a natural and comfortable passing. The family is afforded precious time to hold, feed, bathe, and love their baby. Perinatal hospice provides ongoing bereavement services for a year or more. None of these services are typically provided with a late abortion – families are left on their own to navigate the emotionally wrenching reality of their babies illness and death – in which they were complicit.

Late abortions are performed for the same reasons that early abortions are performed. There may be more abortions for fetal anomalies late in pregnancy, but this is still likely a small proportion overall. Late abortions occur commonly in Colorado, but figures are inaccurate and lack some demographic and medical detail. Late abortions to preserve the life of the mother are a very rarely, if ever, indicated. Perinatal hospice offers a compassionate, life-affirming alternative to late abortion for families struggling with a fatal fetal diagnosis. Late abortion restrictions need not affect the choices for women with chromosomally or structurally abnormal fetuses and those suffering from rape.

How are late abortions performed and are they “humane”?

There are many different abortion techniques and remarkable procedure variability among physicians performing late second trimester and third trimester abortions. This reflects the lack of consensus in the abortion community.

Generally, beginning at 16 weeks gestation, Dilation and Evacuation (D&E) replaces sharp curettage and suction curettage as the surgical abortion procedure of choice.69 During D&E, cervical dilation is achieved over one or more days by osmotic dilators (+/- adjuvant misoprostol) to facilitate the subsequent mechanical destruction and dismemberment of the fetus. Parts of the human fetus grasped/torn from her/his torso are then easily removed through the dilated cervix. A large-bore vacuum curette is used to remove the placenta and remaining tissue. Administration of a pre-procedure feticide such as intraamniotic/intra-fetal digoxin, intracardiac potassium chloride or transection of the umbilical cord sometimes proceeds the D&E.

Dilation and Extraction (D&X) or Intact D&E is similar to the D&E procedure except that a suction cannula is utilized to evacuate the brain after delivery of the fetal human body/legs through the dilated cervix.69 The ensuing collapse of the head facilitates its passage through the cervical canal. In the popular vernacular this procedure is sometimes referred to as “Partial-Birth Abortion”. In order to comply with the Partial-Birth Abortion Ban Act of 2003, fetal demise must be ensured prior to the procedure. This is accomplished using a pre-procedure feticide or by transection of the umbilical cord.

During an Induction Abortion, labor is induced using mechanical means and/or by chemical means after several days of osmotic dilators.69 The human fetus is usually delivered intact. To remain within the framework of the law, fetal demise is achieved prior to delivery using a feticide. This is the method used in third trimester abortions.

Abortion proponents make the claim that fetal death during abortion is more compassionate and painless than natural fetal/infant death in instances where the fetus has a terminal diagnosis. However, there are no published studies comparing the pain/suffering induced during abortion vs. natural fetal/infant death. During D&E, only 30-50% of human fetuses are routinely killed prior to the dismemberment procedure in second trimester abortions.70-71 It is hard to imagine that dismemberment would be less painful than natural death in conjunction with advanced perinatal hospice/palliative care services.

Even for those human fetuses who are killed before they are dismembered or delivered in second and third trimester abortions, there may be substantial suffering. A recent post-mortem MRI study of fetuses who have been administered a feticide indicate secondary pneumothorax – collapsed lung (23%), hemothorax – hemorrhage in lung (42%), pneumopericardium – air around the heart (31%), and hemopericardium – hemorrhage around the heart (35%).72 These fetuses also had higher intraabdominal injuries. This suggests that just the process of injecting the feticide may inflict substantial pain. Furthermore, a highly concentrated potassium infusion can cause intense intravascular burning in normal patients.73 Even though an intracardiac infusion of potassium can kill a fetus within 2 minutes, It’s impossible to ascertain whether the human fetus experiences intense pain prior to its demise.74 Intraamniotic or intra-fetal digoxin is the more commonly used poison to achieve fetal demise.75 A digoxin overdose in older humans causes intense nausea, vomiting, abdominal pain, visual disturbances and delirium.76-78 Digoxin kills by causing severe bradycardia (slow heart rate) culminating in asystole (heart stopping), but it does not kill quickly. It can take up to 4 hours for intra-fetal and up to 24 hours for intraamniotic digoxin to achieve asystole.79-80 Women are routinely told to anticipate “kicks” for hours after the feticide is administered.81 The visual, gastrointestinal, neurological and cardiac manifestations of digoxin toxicity could arguably represent fetal human cruelty. Indeed, if this same methodology was utilized in a death penalty case, it would be considered “cruel and unusual punishment”.

In more candid moments, even abortion advocates sometimes characterize late abortion procedures on human fetuses as “morally abhorrent”.82 It is a form of intimate human violence which is unparalleled in medicine. The only reason that it persists is that the violence is hidden within the confines of the uterus. When the mother (and the broader public) are shielded from the reality of the carnage that is being inflicted on the human fetus, it is easier to rationalize its utility. Since there are no studies on the pain associated with late fetal abortion, to regard this as a painless, humane procedure is either wishful thinking or horribly misguided.

What is the risk to the woman undergoing a late abortion?

Late abortion is associated with significant morbidity and mortality. The precise magnitude of the risk associated with abortion can’t be reliably gleaned from the CDC or state databases because reporting abortion numbers and related complications is not consistently state mandated and never federally mandated. Furthermore, abortion procedures in the US are not linked to other sources of health data such as birth or death certificates making meaningful estimates of mortality rates nearly impossible. Since the system is voluntary and physicians are reluctant to disclose serious complications (including death), under-reporting is also a major problem.83 There have been multiple instances documented where abortion related morbidity and mortality were not captured by the official state/federal databases. Since Colorado does not have require any oversight of abortion clinics (other than low-bar licensing requirements for their nursing/physician employees), there is substantial risk that maiming and death of affected women may go unreported. The Gosnell grand jury report in Pennsylvania should serve as a sober reminder that assuming major injuries and deaths from abortion are reported to and acted upon by civil authorities or medical boards is extremely naïve.84

Even using the admittedly inadequate medical claims/surveillance data, late abortion poses a substantial risk compared to early abortion in both relative and absolute terms. Using California Medicaid billing data, Emergency Department visits and complications were 2.5 times more likely following a second trimester abortion compared to a first trimester abortion.85 Data from the national Abortion Surveillance System indicate that while the overall risk of death from abortion was 0.7/100000 induced abortions, the risk of death increased exponentially (by 38%) for each additional week of gestation.86 CDC researchers found that gestational age was the strongest predictor of abortion-related-mortality.3 In absolute terms, the risk goes from 0.1 deaths/100000 for surgical abortions < 9 weeks to 8.9 deaths/100000 at > 20 weeks.86-87 To put this in perspective, the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) compiled a 5 1/2 year database of over 1 million out-patient surgeries performed in ambulatory surgery centers.88 The death rate was 2/100000 for patients that were, on average, significantly older than patients undergoing late abortion. This is only 22% of the mortality rate seen in late abortion. The Canadian counterpart, the Canadian Association for Accreditation of Ambulatory Surgical Centers (CAAASF), conducted a survey that pointed to a death rate of approximately 1/100000 which represents only 11% of the risk of late abortion.89 The risk must be viewed in the context of strict oversight of ambulatory surgical centers in Colorado and the absence of oversight or regulations pertaining to abortion facilities in Colorado.90 Media Trackers reported that “while standard healthcare and out-patient surgical clinics in the state fall under the authority of the Health Facilities division of the Colorado Department of Health and Environment for regular licensing and regulation, Planned Parenthood (and other abortion providers) are not held to the same standard”. Not only does late abortion represent a significant mortality risk to women but the lack of health/safety oversight potentially compounds that risk.

Mortality studies that are based on countries with linked birth, pregnancy, abortion and death registries give an even more stark view of the risk from abortion. In Denmark, the 180-day mortality associated with late abortion (>12 weeks) was 55/100000.91 This is far worse than US surveillance data would suggest and places it in a league with neurosurgery (lumbar discectomy 60/100000), and abdominal surgery (laparoscopic appendectomy, inguinal herniorrhaphy 20/100000, laparoscopic cholecystectomy 200/100000).92-95 While this study is not adjusted for socioeconomic factors, marital status or psychological history, they suggest that mortality risk for women undergoing late abortion might be substantially underestimated in the US.

Some have tried to claim that a legal induced abortion is much safer than childbirth.96 However, others have pointed out that these studies are inherently biased and plagued with differences in ascertainment of deaths, duration of susceptibility to mortality, lack of accounting for gestational age and inappropriate comparators.83 The relative risk of pregnancy associated death between delivery and abortion may be better assessed by looking at countries with linked birth/medical/death databases. A systematic review and meta-analysis suggested that based on 11 studies from three such countries, termination of pregnancy is a marker for reduced life expectancy.97 They found that within a year of their pregnancy outcomes, women experiencing pregnancy loss (from either abortion or natural loss) were twice as likely to die compared to women giving birth. In Denmark, this adverse mortality rate persisted for 10 years.91 While there could be confounding variables complicating this analysis, the notion that abortion leads to better health outcomes is unlikely (and certainly speculative without more rigorous research).

The morbidity associated with abortion also increases with gestational age. A large retrospective study from the University of California San Francisco suggested that the complication rate for second trimester abortions was 9.8% (including cervical laceration, hemorrhage, uterine atony, anesthesia complications, uterine perforation, disseminated intravascular coagulation, and retained products of conception). Major life-threatening complications (complications requiring hospitalization, transfusion, or further surgical intervention) occurred in 1.7% of patients.98 Any of these complications increased with each additional week of gestation beyond 20 weeks. Another study observed that for each one-week increase in gestational age, there was a 7.1% increase in estimated blood loss.99 Unfortunately, there are no published studies specifically addressing the likely extremely high morbidity/mortality associated with third trimester abortions.

Long-Term health effects of abortion are controversial.3 Retrospective studies suggested a correlation of abortion with breast cancer. Better, case control studies suggested no correlation. There appears to be an association of abortion with postpartum hemorrhage in later pregnancies, but the mechanism is undefined. Late abortions may result in an increased risk for premature birth in subsequent pregnancies (aOR= 1.13, 99% CI 0.91-1.4). This trend becomes statistically significant for women who have had multiple abortions.3 Researchers have found a dose-response relationship between the number of prior abortions and the risk for extreme premature birth. The correlation between late abortion and/or multiple abortions with extremely premature birth and very low birth weight was more recently corroborated by a large Finnish national registry study.100 Since black women have, on average, more late abortions and more multiple abortions, one might speculate that the scourge of increased infant mortality (tied largely to premature birth and low birth weight infants) in the black community could be partially caused by abortion.

A balanced synthesis of the literature suggests several consensus opinions regarding the nexus between abortion and mental health:

“1) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion,

2) the abortion experience directly contributes to mental health problems for at least some women,

3) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion.”107

The risk of affective disorder and suicide ideation may be even more pronounced after the abortion of a wanted pregnancy – such as for fetal anomaly or maternal indications.108 Adverse mental health associations or effects may be tied with increased mortality in women having induced abortion.91, 97, 109

Conclusions:

Late abortion is extreme by any measure and should be prohibited. Passing Proposition 115(formerly Initiative 120) is not only medically/morally correct, it is consistent with the views of a majority of Coloradans. Very few countries in the world permit abortion after 20 weeks. Most Americans, regardless of their political affiliation, feel that abortion should be illegal late in pregnancy. A 22-week fetus in biologically indistinguishable from a baby born at 22 weeks. There is scientific evidence that a 22-week human fetus demonstrates all the fundamental characteristics of more developed humans, including the ability to perceive pain and perform sophisticated behaviors. The reasons women choose late abortion are similar to the reasons that women choose early abortion. Most late abortions are performed on normal human fetuses. For those tragic situations where a human fetus has a life-limiting prognosis because of a genetic or congenital fetal abnormality, perinatal hospice offers a compassionate, life-affirming alternative to late abortion. Late abortions are violent procedures that commonly involve the crushing and dismemberment of the human fetus. Late abortions pose a substantial morbidity and mortality risk to the pregnant woman, which is further exacerbated by the lack of regulatory oversight. Long term sequelae of abortion include the risk for future premature birth and adverse future pregnancy outcomes. There may be an increased risk of early mortality in women who have abortion compared to women who deliver babies. This may be related to antecedent poor mental health in women who choose abortion and possibly adverse long-term mental health outcomes from abortion.

Thomas J. Perille MD

Head, Medical Advisory Team, Coalition for Women and Children

Democrats for Life of Colorado

Revised June 2020

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Finn, M. (2017, February 7). I had a Late-Term Abortion. President Trump and Pro-lifers have no Right to call me a Murderer. Slate. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/019904s014lbl.pdf . Retrieved February 7, 2019.

Douthat, R, Goldberg, M, and Leonhardt D. (2019, February 7) The New York Times - The Argument: The Abortion Debate [Audio Podcast]. Retrieved from https://www.nytimes.com/2019/02/07/opinion/the-argument-abortion-medicare-for-all.html?emc=edit_ty_20190207&nl=opinion-today&nlid=6448792420190207&te=1 . Retrieved February 7, 2019.

Thorp, JM. Public Health Impact of Legal Termination of Pregnancy in the US: 40 Years Later. Scientifica 2012; Article ID 980812.

Williams RS, Report of the Grand Jury in Re: Misc. No. 0009901-2008 County Investigating Grand Jury XXIII. Retrieved on January 8, 2020 from https://cdn.cnsnews.com/documents/Gosnell,%20Grand%20Jury%20Report.pdf .

Upadhyay, UD et.al., Incidence of Emergency Department Visits and Complications after abortion. Obstetrics & Gynecology 2015; 125(1): 175-183.

Bartlett, LA, et.al., Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol 2004; 103(4): 729-737.

World Health Organization, Safe Abortion: technical and policy guidance for health systems. 2012.

Keyes, GR et.al., Mortality in Outpatient Surgery. Plast Reconstr Surg 2008; 122: 245-250.

Ahmad, J. et.al., Assessing patient safety in Canadian ambulatory surgery facilities: A national survey. Plast Surg 2014; 22(1): 34-38.

Media Trackers Colorado. Planned Parenthood Clinics Not Regulated by Colorado Health and Medical Standards. March 18, 2013. Retrieved from https://www.redstate.com/diary/pwatson/2013/03/18/colorado-planned-parenthood-clinics-not-regulated-by-standard-state-health-and-medical-guidelines/ . Retrieved on February 16, 2019.

Reardon, DC and Coleman, PK. Short and long term mortality rates associated with first pregnancy outcome: Population register based study for Denmark 1980-2004. Med Sci Monit 2012; 18(9): PH71-76.

Pugely, AJ, et.al., Outpatient Surgery reduces Short-Term Complications in Lumbar Discectomy. Spine 2013; 38(3): 264-271.

Frazee, RC et.al., Outpatient Laparoscopic Appendectomy: Is it Time to End the Discussion? J Am Coll Surg 2016; 1-5.

Saleh, F et.al., Safety of laparoscopic and open approaches for repair of the unilateral primary inguinal hernia: an analysis of short term outcomes. The American Journal of Surgery 2014; 208: 195-201.

Rao, A, et.al., Safety of Outpatient Laparoscopic Cholecystectomy in the Elderly: Analysis of 15,248 Patients Using the NSQUIP Database. J Am Coll Surg 2013; 217: 1038-1043.

Raymond, EG and Grimes, DA. The Comparative Safety of Legal Induced Abortion and Childbirth in the United States. Obstetrics and Gynecology 2012; 119(2): 215-219.

Reardon, DC and Thorp, JM. Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: A systematic review with a narrative synthesis and meta-analysis. Sage Open Medicine 2017; 5: 1-17.

Ledeerie, L et.al., Obesity as a Risk Factor for Complications after Second Trimester Abortion by Dilation and Evacuation. Obstet Gynecol 2015; 126(3): 585-592.

Bridges KH et.al., Maternal and procedural factors associated with estimated blood loss in second trimester surgical uterine evacuation: A restrospective cohort analysis. Int J Obstetst Anesth 2020; 6: S0959-289X(20)30032-7

Situ KC et.al., The duration of gestation at previous induced abortion and its impacts on subsequent births: A nationwide registry-based study. Acta Obstet Gynecol Scand 2020: 99: 651-659.

Steinberg JR et. al., Examining the Association of Antidepressant Prescriptions with First Abortion and First Childbirth. JAMA Psychiatry 2018; 75(8): 828-834

Steinberg JR et. al., The association between first abortion and first-time non-fatal suicide attempt: a longitudinal cohort study of Danish population registries. Lancet Psychiatry 2019; 6: 1031-1038.

Sullins DP, Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States. SAGE Open Medicine 2016; 4: 1-11.

Weng S-C et. al., Do stillbirth, miscarriage, and termination of pregnancy increase risks of attempted suicide within a year? A population-based nested case-control study. BJOG 2018; 125: 983-990.

Luo M et. al., Association between induced abortion and suicidal ideation among unmarried female migrant workers in three metropolitan cities in China: a cross-sectional study. BMC Public Health 2018; 18: 625.

Wie JH et. al., The association between abortion experience and postmenopausal suicidal ideation and mental health: Results from the 5th Korean National Health and Nutrition Examination Survey (KNHANES V). Taiwan J Obstet Gynecol 2019; 58(1): 153-158.

Reardon, DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. AAGE Open Medicine 2018; 6: 1-38.

Sullins DP, Affective and Substance Abuse Disorders following Abortion by Pregnancy Intention in the United States: A longitudinal cohort study. Medicina 2019; 55: 741.

Jalanko, E. et.al., Increased risk of premature death following teenage abortion and childbirth – a longitudinal study. Eur J Public Health 2017; 27(5): 845-849.

The 22 Week Abortion Ban in Colorado

Tue, 03 Mar 2020 06:48:29 GMT

Our Experience at the House Committee Hearing for HB20-1098

On February 11, 2020, the Colorado House, State, Veterans and Military Affairs Committee “killed” HB 20-1098 – which would have prohibited abortion after 22 weeks gestation except to save the life of the mother. However, this was not an exercise in futility. The committee hearing extended for several hours and shed light on an issue that is rarely openly debated in Colorado. The defeat of the bill has already motivated people across the state to redouble their efforts to place Initiative 120 on the ballot. Democrats for Life of Colorado played a key role throughout, from the development of the bill through the testimony phase.

The proponents of the bill established several facts that were not contested by the opponents of the bill. These included the reality that a 22-week fetus in utero is not biologically different from a baby born at 22 weeks gestation. The former currently has no legal rights or protections and the latter enjoys all the rights established in the US constitution and Colorado law. The second uncontested fact was that late abortion poses a substantial risk to the health and life of the mother. For each additional week of gestation, the CDC reports that the women’s risk of dying from an abortion increases 38%. Late in the second and third trimester, these procedures are more dangerous than other out-patient procedures and yet they are performed in Colorado abortion clinics which are unregulated. The third uncontested fact was that a 22-week fetus is now considered “viable” – can survive outside the womb with standard neonatal intensive care. The 22-week fetus demonstrates the ability to respond to voice and touch as well as more sophisticated behaviors seen later in fetal development and infancy. She can undergo fetal surgery as an independent patient to cure congenital anomalies. The fourth uncontested fact is that a 22-week fetus can experience pain, perhaps more intensely than an infant or adult. This is because the ability to perceive pain develops by 22-weeks but the brain’s ability to suppress the perception of pain develops much later. The fifth uncontested fact is that late abortion is a violent procedure that inflicts untold pain on the fetus. A D&E procedure late in the second trimester involves the systematic disarticulation and dismemberment of the fetus without anesthesia. An induction abortion in the third trimester requires the administration of a feticide – usually digoxin – which is known to induce severe nausea, retching, abdominal pain, and delirium. It kills slowly over a period of hours – amounting to fetal torture. The last uncontested fact was that Perinatal Hospice offers a loving, compassionate alternative to late abortion for families confronting a life-limiting fetal diagnosis.

The opponents of the bill argued that late abortion is often necessary to save the life of the mother. However, the opponents provided insurmountable evidence that expedited delivery is far safer than abortion in urgent/emergency situations.

Most of the opposition to restrictions on late abortion voiced in the hearing pertained to the rare scenario in which a family is told that their fetus had life-limiting or fatal fetal anomalies. Several families, testifying for the opposition, relayed their anguish dealing with these situations and felt that late abortion was their only compassionate choice. What became clear over the course of the hearing was that these families likely had not been offered Perinatal Hospice services and, consequently, their choice wasn’t fully informed. Furthermore, they were invariably told that their fetus would suffer a horrible death if they were born rather than aborted. By choosing language that was exaggerated/sensational, counseling physicians hoped that families would choose their preferred approach – which was abortion. The physicians claimed their babies would “drown in their own saliva” or “suffocate” to death. It is easy to see why families might choose to abort. This unprofessional and manipulative language did not accurately describe death by respiratory failure accompanied by a multi-disciplinary Perinatal Hospice team. This reflects a gross abdication of their counseling physician’s role to inform families rather than steer families. In the process, these physicians also demonstrated their ignorance of the violence inflicted in late abortion procedures.

In written and oral testimony, several women who, when informed that they had fetuses with limited prognoses, chose not to abort. These women described in agonizing detail how their physicians described the poor quality of life their babies would have if born – which they later learned did not accurately reflect reality. Their physicians clearly equated living with a disability with living a life of suffering – revealing their extreme ableism bias. Their physicians were relentless in suggesting abortion and seemed aggravated when these women chose life. As in so many other aspects of the abortion decision, coercion, rather than choice, frequently plays a larger role than many acknowledge.

It became clear that families with fatal fetal anomalies were being used in the hearing to justify all late abortion. Representatives from Cobalt (formerly NARAL Colorado) and Planned Parenthood tried to claim all late abortions were performed for medical diagnoses. However, when asked whether they would support the bill if exceptions for fetal anomaly were included, they all indicated they would not. Even the women who had fetuses with fatal fetal anomalies and indicated late abortion was necessary for their families, refused to concede that a bill with exceptions for fetal anomalies would be acceptable – betraying their ideological bent.

Proponents of the bill presented several forms of evidence pointing to the fact that these fetuses represented a small minority of late abortions. Most late abortions are in fact performed on healthy women with fetuses without genetic or congenital abnormalities. The most shocking illustration of this fact came in testimony from a woman who wanted to establish just how easy it would be to schedule a third trimester abortion for no medical indication at the Boulder Abortion Clinic. She called the clinic and posed as a woman with a 28-week gestation who did not want to carry the baby because of its mixed race. The screening receptionist did not hesitate to have her come in for an abortion, even with this blatantly racist intent.

Late abortion is a violent procedure that takes the life of a precious human being. Recognizing that a fetus has disabilities should not be a justification for late abortion. Ableism is just as pernicious prenatally as it is for children and adults. The tragic instances in which a family is faced with a fatal fetal diagnosis should not be used as a ploy to justify abortion up till birth. Rather, it should be a clarion call to redouble our support for these families with free Perinatal Hospice support services. There is significant evidence that Perinatal hospice provides better psychological health to the mother/family than abortion in these tragic circumstances. Finally, it is clear that abortion rights extremists will stop at nothing to foist their agenda – tax payer funded abortion, anytime, for any reason, without regulations, till birth – unless Coloradans stand-up and say ENOUGH! The time to act is now!

Hear Our Members Testify on this bill:

Tom Perille, MD: link , time segment: 5:23:42 to 5:35:50

Kathy Houston: link , time segment: 3:56:42 to 3:59:26

Roger Morin: link , time segment: 6:24:26 to 6:28:06

FAMLI and Senator Faith Winter

Wed, 27 Nov 2019 21:16:00 GMT

Paid Family and Medical Leave in Colorado

Democrats for Life of Colorado was privileged to host a meeting with Colorado Senator Faith Winter, from District 24, to learn about a bill she is sponsoring: the Family Medical Leave Insurance Program , or FAMLI.

Senator Winter is currently the Chair of the Transportation and Energy Committee, as well as a member of the Health and Human Services Committee. In 2016, she sponsored HB 1438: Employer Accommodations Related to Pregnancy, which supports the implementation of reasonable accommodations by employers for people with conditions related to pregnancy.

Paid family and medical leave is an issue important to us not only as Democrats, but as pro-life activists. This bill would allow new mothers and fathers needed time off to care for newborn children, newly fostered or adopted children, without having to forego a paycheck. It allows for time to care for sick or dying family members, thus hopefully decreasing the financial pressures that contribute to the desire for assisted suicide. The bill also covers time off needed for self medical care.

“Many advanced-economy countries entitle workers to some form of paid family leave. Whereas some provide leave to employees engaged in family caregiving (e.g., of parents, spouses, and other family members), many emphasize leave for new parents, mothers in particular. The United States is the only Organization for Economic Co-operation and Development (OECD) member to not offer paid leave to new mothers.”

- CRS Report on Paid Family Leave in the United States

The Need for Paid Leave

A r ecent article from the Denver Post discussed the push for Paid Leave in Colorado. 9to5, a group that fights for the economic security of women, is one of the groups supporting this bill.

“We don’t believe any workers should be carved out,” said 9 to 5’s Judith Márquez. “You shouldn’t have to hit the employer lottery, to be working at the right company at the right time, to get paid family leave.”

Almost 9 out of 10 Colorado workers have no access to paid family and medical leave and only 7% of low income workers in our state have access to paid leave.

This has concrete effects on lives in Colorado. A quarter of mothers go back to work just 2 weeks after giving birth. There are stories of people with cancer skipping life-saving treatments because they can’t afford to take time off work. People have to decide between keeping their job and being present as their parent dies.

Paid Medical Leave in the U.S.

“According to a national survey of employers conducted by the Bureau of Labor Statistics, 16% of private-industry employees had access to PFL through their employers in March 2018.” - from the CRS Report on Paid Family Leave in the United States

Currently, eight other states, plus Washington D.C., have passed laws ensuring paid medical leave for workers, including Washington, Oregon, Massachusetts, California, New Jersey, New York, Rhode Island, and Connecticut. Studies have shown that 70% of medical leave has been used for self medical care, with an average of 7.1 weeks taken per year.

See the chart from A Better Balance for the current status of Paid Family Leave across the country.

FAMLI

This year Governor Polis approved the creation of a task force for the study of implementation of a paid family and medical leave program in the state. This task force includes business leaders, domestic violence advocates, policy makers, and others. Learn more about this task force here .

An actuarial study for a program will be coming out by the end of 2019. The task force’s final recommendation for a paid family and medical leave program will be coming out at the beginning of January 2020 . Senator Winter, and other supporters of a program, are still open to privatization of a paid leave program. The studies coming out will detail the solvency of both public and privately run programs.

Current details of the bill are as follows:

Both employees and employers pay into a state fund
60/40 Employee/employer contribution
For the average salary in Colorado the employee pays $45 per year and the employer $38 per year per employee
Minimum wage workers get 95% of normal pay, higher earners 60%
1099 workers can opt in, with a minimum of 3 years
Expands definition of family beyond spouse, children, and parents to include siblings, grandparents; blood relations or shared financial responsibility
12 weeks of paid leave; possibly 8 weeks to begin the program in CO, then expanding as the program becomes more established
Employers don’t pay employee when the employee is on paid leave, salary comes from the shared pool
Requires medically qualified reason
Includes leave for victims of domestic abuse
Not required to take leave from every job, if working multiple jobs

Details in Progress:

Required length of time of paying into the system before qualifying for benefits
Which companies are exempt from the mandate and for which employees; ex. Company offers comparable or better paid leave
Possibility of including seasonal workers

Why Support Paid Family and Medical Leave?

This program would allow small businesses to offer competitive benefits, as they would not be paying the salary while the employee is on leave. Small businesses support paid leave because it allows them to compete with bigger companies that can afford to offer better leave. Studies of paid leave programs in other states have shown it to either be good and not harmful to businesses.

A study done at the University of Denver states:

“The growing body of research on the impacts of caregiving on employment and earnings has contributed significantly to the shift in thinking about paid leave. In fact, the U.S. Department of Labor (DOL) released a report on paid family leave in 2015 entitled, The Cost of Doing Nothing, in which the DOL argued that the country lost an estimated $500 billion in economic activity each year as a result of our lack of a national paid leave policy. The Federal Reserve Board of San Francisco found recently that a lack of paid leave access among new mothers contributes significantly to low workforce attachment among women.”

A Paid Leave policy is pro-family and good for children. The American Academy of Pediatrics has supported paid family leave at the federal level. From their statement in 2017:

"When parents cannot afford to take time off from work to care for their children, it's the children who suffer the most," said AAP President Fernando Stein, MD, FAAP. "All parents should be able to bond with and care for their young children during the critical first months of life and if their children fall ill.”

A Paid Leave policy would benefit workers with severe illnesses and expensive medical bills. A Better Balance has put together an “At a Glance” case for Paid Family Leave.

“About 1 in 3 people in healthcare debt have had to take a cut in pay or hours as a result of a serious illness and struggle to pay medical bills due to income loss. Paid leave can ease this burden by helping make up for lost income when workers must miss work for treatment or recovery.”

More Resources

Action Network: https://actionnetwork.org/letters/tell-your-legislator-to-support-the-co-famli-act/
Colorado FAMLI Coalition: www.cofamli.org
A Better Balance: https://www.abetterbalance.org/resources/paid-family-leave/

We encourage you to contact your local representatives. Get to know them and learn their preferred method of communication. We have learned the effective means of communication is different for each legislator. Let them know your thoughts by calling, emailing, messaging on social media, or going to a local meeting.

Learn more about Senator Faith Winter:

https://www.faithwinter.com/

https://www.facebook.com/FaithWinterCO

https://twitter.com/FaithWinterCO

Are Reproductive Rights Activists Pro-Choice or Pro-Abortion?

Sat, 26 Oct 2019 00:11:30 GMT

The Case of "Abortion Pill Reversal"

There is increasing evidence that many in the elite of the “reproductive rights” movement are pro-abortion rather than pro-choice. These elite advocates attempt to influence public opinion and public policy through the mouthpiece of organizations such as Planned Parenthood and NARAL. However, they are also embedded in, ostensibly, apolitical medical organizations such as the American College of Obstetrics and Gynecology (ACOG), the American Medical Association (AMA), and the New England Journal of Medicine (NEJM).

Perhaps the best illustration of this unfolding reality is the attempt to scuttle any progress on medication abortion “reversal” bills in state legislatures across the country. If Planned Parenthood, NARAL, ACOG, and the AMA were truly interested in providing women with choice, they would do everything to support women who choose to parent/adopt, as well as though who chose abortion. They would not preference one choice over another. However, in the instance when a woman has a wrenching change of heart during the two day medication abortion process, they are decidedly against choice. They are unwilling to contemplate any therapy to reduce the chance of a completed abortion. This is consistent with a pro-abortion rather than a pro-choice orientation.

During a medication abortion, a woman takes the first abortion pill, mifepristone, on day 1, and then the second abortion pill, misoprostol, 24-48 hours later. Many women have changed their mind about abortion after taking the first pill, but before taking the second. Reproductive rights activists refuse to believe these women exist, much less explore the possibility of mitigating the effects of the first of two abortion pills. Fortunately, prolife researchers in several countries have tried to address the plight of these women by devising protocols to inhibit the effects of mifepristone and increase the likelihood that a pregnancy will continue.

In 2019, North Dakota passed an “abortion reversal bill” (HB 1336) that is similar to bills introduced in other state legislatures (including Colorado’s).(1) The bill asks physicians, as part of the informed consent process, to let patients know “that it may be possible to reverse the effects of an abortion-inducing drug, if she changes her mind, but time is of the essence”. At the behest of the American Medical Association (and others), a federal district court has recently issued a preliminary injunction to block enforcement of the law.(2) AMA President Patricia Harris stated that “with this ruling, physicians in North Dakota will not be forced by law to provide patients with false, misleading, nonmedical information about reproductive health that contradicts reality and science.” Planned Parenthood, NARAL, and ACOG, along with numerous media outlets denounced the law as propaganda that had no scientific basis. They have testified in legislatures across the country against abortion informed consent legislation. NEJM previously had published an editorial “Abortion ‘Reversal’ – Legislating without Evidence” deploring the efforts by state legislatures across the country to facilitate a dialogue on mitigating the effect of abortion drugs in informed consent legislation.(3)

So how strong is the evidence that medication abortion could be “reversed”? Are the protocols used to moderate the impact of mifepristone “quackery” as critics suggest? To answer those questions we need to wade into the scientific process and how physicians weigh evidence when providing advice to patients.

The fact is that most of what physicians recommend to patients reflects expert opinion which is the lowest level of clinical evidence. The highest level of evidence is derived from “randomized, double-blind, placebo-controlled trials”. Unfortunately, only a small fraction of any physician’s practice is governed by this level of evidence. The remainder of a physician’s practice is informed by lesser degrees of clinical evidence including from a contemporary series of cases compared to historical controls or lesser quality clinical trials. The evidence for abortion “reversal” falls into this latter category.

Every good science-based medical therapy starts with a plausible scientific justification. Progesterone is the hormone that stimulates the lining of the uterus to grow and support the developing pregnancy. Mifepristone avidly attaches to progesterone receptors in the lining of the uterus and thereby interferes with the action of progesterone to maintain the pregnancy.(4) The abortion “reversal” process involves flooding the body with additional progesterone to dislodge mifepristone from progesterone receptors and allow progesterone to exert its beneficial effects on the uterus.5 The “reversal” protocols administer abundant progesterone in either an oral or injectable form.

Ideally, before pursuing a trial of a new therapy in humans, it is best to look at animal models to find evidence to support the approach. In 1989, a Japanese researcher demonstrated that giving progesterone to pregnant rats treated with mifepristone allowed 100% of the fetal rats to survive compared to only 33% survival in rats given mifepristone alone.(6) This would suggest that at least in one animal model, progesterone can antagonize the effect of mifepristone.

There has also been at least one study published in the contraceptive literature which may have some bearing on the effects of supplemental progesterone administration to interfere with the efficacy of medication abortions in humans. In a multinational randomized trial, women who received depot progesterone (as a long term contraceptive) at the time of mifepristone administration during a medication abortion were 4 times more likely to have a continued pregnancy compared to the women who did not.(7)

The use of progesterone in early pregnancy has a long and safe history. It has been used for decades early in pregnancy in women with a history of recurrent miscarriage.8 Only recently was it determined that progesterone is largely ineffective to prevent miscarriages, except in women with a history of multiple miscarriages.(9-10) Nonetheless, the use of progesterone for threatened abortion is not a new concept in humans.

Based on the scientific plausibility and known safety of progesterone administration in early pregnancy, Dr. George Delgado began offering women, who had changed their mind after taking mifepristone, high dose progesterone. In 2018, Dr. Delgado published his case series which included 547 women.(5) He found that 64-68% of women who took high dose oral/injectable progesterone had a continued pregnancy. This was much higher than historical controls of approximately 25%. Others have published small case reports supporting the conclusion that high dose progesterone might be an effective therapy to preserve a pregnancy after the administration of mifepristone.(11)

Critics have pounced on this data in efforts to discredit its conclusions. They point out that the efficacy of mifepristone as a single agent abortifacient drug depends on the gestational age of the embryo/fetus. Dr. Delgado’s protocol clearly was less successful very early in pregnancy and more successful later. Therefore, giving progesterone may be no better than placebo. However, when you adjust Dr. Delgado’s experience for gestational age, a continued pregnancy is still nearly twice as likely after progesterone.(3) The kicker - because of the small sample size of the historical controls used by critics –is that the results are not “statistically significant”. By low balling (5,12) the success of mifepristone historically, critics attempt to completely dismiss any potential therapeutic value of progesterone administration.

The bottom line is that there is a scientifically plausible rationale to administer progesterone to “reverse” the effects of mifepristone. There is animal data supporting this approach. There is data in the contraceptive literature demonstrating that progesterone interferes with medication abortions. And now there is a large case series suggesting that progesterone administration after mifepristone leads to a higher percentage of continued pregnancies compared to historic controls. While this is not high level evidence, clearly, this is not “no evidence” as NARAL, Planned Parenthood, ACOG, AMA, and NEJM would have you believe. To say otherwise betrays an intellectual dishonesty that is unbecoming these professional organizations.

The next step is to gather randomized trial data to lend further support to the use of progesterone to “reverse” the effects of mifepristone in a medical abortion. Dr. Mitchell Creinin from the University of California, Davis, is an abortion rights advocate. He has begun a trial in which 40 women will be randomized to be given oral progesterone or placebo after mifepristone administration to assess the efficacy of the “reversal” protocol.(13) Typically, you would design the study protocol to maximize the chance to demonstrate efficacy of progesterone as a mifepristone antagonist. Unfortunately, the trial protocol begins the progesterone the day after mifepristone which might diminish its effectiveness and lead to inconclusive results. Furthermore, the small sample size will make it hard to demonstrate the statistical significance of any benefit. Nonetheless, he should be applauded for at least attempting to address the clinical question.

Having demonstrated that there is indeed low to moderate level evidence to support giving progesterone to antagonize the effects of mifepristone, it is perfectly reasonable that states include this tentative information in their abortion informed consent laws – otherwise abortion providers would likely ignore it. When making policy that can potentially save the life of another human being, the medical community and legislators should not require high level evidence before they act. During testimony on Colorado’s “Abortion Pill Reversal Information Act” in 2017, three women tearfully recalled their own change of heart midway through their medication abortions. They were extremely grateful that all three delivered healthy babies after utilizing the progesterone “reversal” protocol. They passionately made the case that this information should be available to other women contemplating medical abortions so that they indeed can make informed choices.

The reproductive rights elite including NARAL, Planned Parenthood, ACOG, AMA, and NEJM show little interest, much less compassion, for women who choose life during a medical abortion. It is time the American public recognizes that they are nominally pro-choice, but in practice, firmly pro-abortion.

References:

1) “North Dakota House Bill 1336”. 2019. Retrieved 9/17/2019 from https://www.legis.nd.gov/…/66-2…/documents/19-0517-03000.pdf .
2) “Court blocks law that would force physicians to mislead patients”. September 10, 2019. Retrieved September 17, 2019 from https://www.ama-assn.org/…/court-blocks-law-would-force-phy… .
3) Grossman D, and White K, Abortion “Reversal” – Legislating without Evidence”. New England Journal of Medicine 2018; 379(16): 1491-1493.
4) Soon JA, et.al., Medications used in evidence-based regimens for medical abortion: An Overview. J Obset Gynaecol Can 2016: 38(7): 636-645.
5) Delgado G, et.al., A case series detailing the successful reversal of the effects of mifepristone using progesterone. Issues in Law & Medicine 33(1): 21-31.
6) Yamabe S, et.al., The effect of RU486 and progesterone on luteal function during pregnancy. Nihon Naibunpi Gakkai Zasshi 1989; 65(5): 497-511.
7) Raymond EG et.al., Effects of depot medroxyprogesterone acetate injection timing on medical abortion efficacy and repeat pregnancy. Obstetrics & Gynecology 128(4): 739-745.
8) Hass DM et.al., Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiology. Cochrane Database Syst Rev 2018; Oct 8;10CDC003511.doi: 10.1002/14651858.CD003511.pub4.
9) Coomarasamy A, et.al., A randomized trial of progesterone in women with recurrent miscarriages. NEJM 2015; 373(22): 2141-2148.
10) Coomarasamy A.J., et.al., A randomized trial of progesterone in women with bleeding early in pregnancy. NEJM 380(19): 1815-1824.
11) Garratt D and Turner JV, Progesterone for preventing pregnancy termination after initiation of abortion with mifepristone. European Journal of Contraception and Reproductive Health Care 2017; 22(6): 472-475.
12) Van Look PFA and Bygdeman M, Medical approaches to termination of early pregnancy. Bulletin of the World Health Organization 1989; 67(5): 567-575.
13) “SFP Research Grant Awards”. 2018. Retrieved September 17, 2019 from https://www.societyfp.org/research-and-grants/grants-funded .

Colorado End-of-Life Options Act 2018 Observations

Sun, 09 Jun 2019 22:51:22 GMT

Is Aid-in-Dying Medication Really a Compassionate Option?

In 2016, Proposition 106, also known as “Access to Medical Aid In Dying” passed in Colorado, allowing doctors to prescribe life ending medications to patients, in specific circumstances, upon request.

Before discussing the numbers, I want to clarify that I am aware this is a very personal and difficult issue to address. I respect that the specific details of each case should not be shared with the public unless the patient wishes to share. There are real people with real pain behind these statistics. I can’t begin to understand what it is like to receive a terminal diagnosis or know every person’s experience watching a loved one die. There is a lot of pain and suffering involved in these situations, despite our great advancements in medicine, and we are not ignoring this fact. I have seen people live with and eventually die from some of these diseases, including breast cancer, dementia, and ALS. It is understandable to want to avoid the pain, both mental and physical, that diseases like these bring. I am also aware that palliative care is not easy or simple, though we have wonderful people who work in that field. The administering of pain medication to a dying patient requires delicate balance by hospice and medical staff. However, palliative care is a separate, but related, issue to be addressed another time.

Our motivation behind opposing these “aid in dying” medications is to prevent abuse of those in vulnerable circumstances and to uphold the dignity and value of every human life.

The Disability Rights Education & Defense Fund describes why they opposed assisted suicide:

“Most people [choose assisted suicide] because they fear burdening their families or becoming disabled or dependent. But anyone dying in discomfort that is not otherwise relievable, may legally today, in all 50 states, receive palliative sedation, wherein the patient is sedated to the point where the discomfort is relieved while the dying process takes place. Thus, today there is a legal solution to any remaining painful and uncomfortable deaths; one that does not raise the very serious difficulties of legalizing assisted suicide.” [ https://dredf.org/public-policy/assisted-suicide/key-objections-to-the-legalization-of-assisted-suicide/ ]

Review of the 2018 Data Summary, from the Colorado Department of Public Health and Environment site, found here, [ https://www.colorado.gov/pacific/cdphe/medical-aid-dying ] shows the following:

"The Colorado End-of-Life Options Act does not authorize or require the Colorado Department of Public Health and Environment to follow up with physicians who prescribe aid-in-dying medication, patients, or their families to obtain information about use of aid-dying medication. Additionally, the Colorado End-of-Life Options Act requires that the cause of death assigned on a patient’s death certificate be the underlying terminal illness." (from the CDPHE report)

125 patients received prescriptions for aid-in-dying medications which represents a 74% increase from 2017.
68.6% were prescribed DDMP (diazepam, digoxin, morphine, propranolol) and 31.4% were prescribed secobarbitol.
The youngest recipient of these aid-in-dying prescriptions was in their mid-30s and the oldest in their upper 90s, with a median patient age of 69
48.1% of the recipients were female and 54.9% male. 94.2% were white (compared with 87% of all Coloradans), 4.8% Hispanic, and 1% other ethnicities
51% of recipients were married (compared with 55.7% nationally), 52.9% had college and/or advanced degrees (compared to ⅓ in the overall population)
84.6% of the recipients were enrolled in hospice
60% of the recipients had a malignant neoplasm (cancerous tumor), 20.8% had a progressive neurological disease, 5.6% had pulmonary disease, and 4.8% had cardiac disease. There were 8.8% who had “other illnesses”, including chronic kidney disease, stroke and other unspecified diseases
The median time from date of prescription to time of death was 12 days, with a range from 0 days to 8 months
There is no way to determine which patients prescribed the lethal overdose of medication actually took the medication . 104 patients died from either the overdose, the underlying terminal disease, or another cause
66 unique Colorado physicians provided aid-in-dying medications, but it is not known how many of these physicians also served as consulting physicians, meaning the doctor who confirms the terminal diagnosis. There is something called “doctor shopping”, where the patient will search until they find a physician willing to prescribe the life-ending prescription (example with reference provided below).
13% of attending physicians did not submit an attending physician prescribing form documenting compliance with the requirements of the End-Of-Life Options Acts
For 28% of the recipients, no documentation of the patient’s written request for medical aid-in-dying medication was received, also a requirement [see C.R.S. 25-48-104]
There were no confirmations of mental capacity from a licensed mental health professional.
32.8% of the consulting physician’s reports were missing.

Not Dead Yet is is a national, grassroots disability rights group that opposes legalization of assisted suicide and euthanasia as deadly forms of discrimination against old, ill and disabled people. On the site for Not Dead Yet Colorado they state:
“Although intractable pain has been emphasized as the primary reason for enacting assisted suicide laws, the top five reasons Oregon doctors actually report for issuing lethal prescriptions are the “loss of autonomy” (89.9%), “less able to engage in activities” (87.4%), “loss of dignity” (83.8%), “loss of control of bodily functions” (58.7%) and “feelings of being a burden” (38.3%).” (Death With Dignity Act Annual Reports) [ http://www.notdeadyetcolorado.org/ ]
Note: the Death with Dignity Act was approved by voters in Oregon in 1994 by only a 51% majority, but did not go into effect until 1997.

I also encourage you to learn about Colorado lawyer and disability rights advocate Carrie Ann Lucas , who passed away in February of this year. This remarkable women was the adoptive mother of 4 children with multiple disabilities and the founder of Disabled Parents Rights. She worked with Not Dead Yet Colorado and in 2016 wrote a legal analysis on the End of Life Options Act, which you can find here: http://www.notdeadyetcolorado.org/wp-content/uploads/2016/02/PAS-bill-analysis-updated-1.pdf
Read more about her here:
https://www.coloradoindependent.com/2019/02/28/remembering-disability-rights-carrie-ann-lucas/

National Suicide Prevention Lifeline (1-800-273-8255)

Specific cases
Doctor Shopping
“Kate Cheney, 85, died by assisted suicide under Oregon’s law even though she had early
dementia. Her physician had declined to provide the lethal prescription. Her managed care
provider then found another physician to prescribe the lethal dose. The second physician
ordered a psychiatric evaluation, which found that Cheney lacked “the very high level of
capacity required to weigh options about assisted suicide.” Cheney’s request was denied, and
her daughter “became angry.” Another evaluation took place, this time with a psychologist who
insisted on meeting Cheney alone. Disturbingly, the psychologist deemed Cheney competent
while still noting that her “choices may be influenced by her family’s wishes and her daughter,
Erika, may be somewhat coercive.” Cheney soon took the drugs and died, but only after
spending a week in a nursing home.” The referenced document includes other cases, including the next one.
https://dredf.org/wp-content/uploads/2012/08/revised-OR-WA-abuses.pdf

Insurance Prefers to Pay for Physician-Assisted Suicide
“Barbara Wagner & Randy Stroup: What happened to these patients underscores the danger
of legalizing assisted suicide in the context of our broken U.S. health care system. Wagner, a
64-year-old great-grandmother, had recurring lung cancer. Her physician prescribed Tarceva to
extend her life. Studies show the drug provides a 30 percent increased survival rate for patients
with advanced lung cancer, and patients’ one-year survival rate increased by more than 45
percent. But the Oregon Health Plan sent Wagner a letter saying the Plan would not cover the
beneficial chemotherapy treatment “but … it would cover … [among other things,] physician assisted suicide.”
Stroup was prescribed Mitoxantrone as chemotherapy for his prostate
cancer. His oncologist said the medication’s benefit has been shown to be “not huge, but
measurable”; while the drug may not extend a patient’s life by very long, it helps make those last
months more bearable by decreasing pain. Yet Stroup also received a letter saying that the
state would not cover his treatment, but would pay for the cost of, among other things, his
physician-assisted suicide”.

Late Term Abortion

Thu, 07 Mar 2019 05:47:56 GMT

Why Prohibit Late Term Abortions

Introduction

Late abortions (after 24 weeks gestational age) are extreme by any national and international comparison. Just seven of the 50 States in the US permit unrestricted abortion after 24 weeks.1 Internationally, only five of the 198 countries, independent states, and semi-autonomous regions with populations exceeding 1 million permit abortion after 24 weeks.2 Three of the five nations that permit late abortion are notorious human rights abusers: China, North Korea, and Vietnam. Colorado should not aspire to join the ranks of the few states and countries that dehumanize the late term fetus and permit the killing of these most vulnerable human beings. Colorado should also not jeopardize the health of Colorado women by allowing the unregulated out-patient practice of late abortion which is known to pose serious risks to the health and life of the woman.3

Late abortion is predicated on the notion that a woman’s right to bodily autonomy trumps the fetus’ right to life. Both prolife and prochoice advocates would agree that a woman’s autonomy is an extremely important value; however, both sides differ on whether autonomy supersedes another human being’s fundamental right to life. These competing rights are why proponents of access to late abortion go to extreme lengths to minimize the humanity of the fetus. They refer to “terminating the pregnancy” as if the termination could occur without killing a vital, developing human being. Orwellian language is utilized to refer to the crushed and dismembered fetus as “products of conception” or simply “POC”. A recent series on abortion rights by the Editorial Board of The New York Times refers to the developing human merely as a “cluster of cells” as if her brain, heart, circulatory system, appendages, hands/feet and nervous system were immaterial.3 Even the preferred term “fetus” is an attempt to dehumanize the developing human. OB-GYN physicians commonly refer to the “baby” during a woman’s wanted pregnancy, but abortionists will rarely refer to the “fetus”, much less use the term “baby”, when counseling a woman on abortion.

Is the 24 week fetus a human being?

Human embryology has long attested to the fact that human life begins at fertilization and that human development is a seamless, continuous process that continues for years past birth. A primordial heart develops in the human embryo by the third week (post fertilization) and begins to pump blood by the fourth week.6 Rapid development of the brain occurs in the fifth week. By the eighth week, the embryo has distinctly human characteristics, developed the beginnings of all major organ systems, and demonstrates purposeful limb movements. During the 17th week, the mother can feel the fetal movements.

Fetal surgeries, in which the fetus is operated on by specially trained fetal surgeons and anesthesiologists, have been pursued as early as the 19th- week gestation (post last menstrual period).7-8 Fetuses have been born in the 21st-week gestation with excellent neurodevelopmental outcomes.9 Based on studies performed on infants born at 24 weeks gestation between 2004 and 2011, 58-77% survive with active treatment.10-11

While there is considerable debate concerning when the fetus can experience pain, it is very likely that a 24-week-old fetus can experience pain – perhaps more intensely than an infant or adult. Some researchers argue that a functional mesodiencephalon is all that is required and that a fetus as young as 15 weeks gestation can perceive pain.12 Because inhibitory descending serotonin pathways in the nociceptive system mature only after birth, the fetus might be even more sensitive to pain than infants or adults. Other researchers insist that functional thalamocortical circuitry is required for conscious perception of pain.13 However, even for these latter researchers, there is good evidence that the thalamic pain fibers reach the cortex on or near the 24th week. Thalamic projections reach the visual subplate at 20-22 weeks, the visual cortex at 23-27 weeks, and the auditory cortical plate at 24-28 weeks.13-14 Given these findings, it should be assumed that the 24-week-old fetus could feel pain.

Besides neuroanatomy, there are other observations that support the notion that a fetus can experience pain. As early as 18 weeks gestation the fetus exhibits pituitary-adrenal, sympathoadrenal, and circulatory stress responses to noxious stimuli.14 Even more provocative is the observation from 4-D ultrasounds that fetuses as young as 24 weeks exhibit facial expressions consistent with pain or distress.15-16 Furthermore, preterm infants at the lowest limit of viability have “profound, acute adverse reactions” to major painful stimuli.17

Late second trimester and third trimester fetuses display a number of other advanced cortical functions. The fetus’ sensorimotor behavior demonstrates the same characteristics later observed in the child’s behavior.18 They show curiosity or intrinsic motivation to explore their body and environment, perform repetitive actions to elicit sensations, react to sensory inputs, display intentionality, and demonstrate goal directed movements.18 It has also long been recognized that the fetus can respond to sound as early as 19 weeks.19 The fetus specifically responds to her/his mother’s voice. At 25 weeks fetuses have been observed to mimic their mother’s resuscitation of a nursery rhyme by opening and closing their mouths.18 Furthermore, a newborn human shows preference for her/his mother’s voice and for musical pieces to which she/he were previously exposed, which confirms a capacity for a fetus to learn in utero.20 Studies have shown that prenatally acquired acoustical memory can persist at least as long as 6 weeks.21

Fetuses in utero with gestational ages of 24 weeks or greater are biologically indistinguishable from infants born at 24 weeks. They have developed all the essential organ systems, they can perceive pain, they can demonstrate sophisticated behaviors, they can respond to and learn from familiar sounds, and they can undergo curative operative therapies as independent patients. The only difference is location. Location should not be the determinant of human value. A human’s inalienable right to life, proclaimed in our Declaration of Independence, has not, and should not be, contingent on location.

Who chooses late abortion and how common is the practice?

There is very limited information available in the United States regarding who pursues very late abortions. Most studies suggest women have late abortions for similar reasons that they have early abortions with several caveats.22-24 Age and educational level were not associated with abortions after 16 weeks but black women and women with higher incomes were more likely to have late abortions in one Guttmacher sponsored study.22 Another study which was based on the baseline Turnaway data concluded that “among women without fetal anomalies, reasons for seeking abortion are not different whether women sought abortion early or late in pregnancy.”23 They did not find a statistically significant difference between early and late second trimester abortions based on finances, parity, timing of pregnancy, degree of interference with future opportunities, emotional/mental preparedness, health related reasons, prospects for the baby, level of independence/maturity, influences from family/friends or the inability to contemplate adoption. A second study based on the Turnaway data suggested statistically significant differences in the age of the woman (younger patients, later abortions OR 2.7) and time that pregnancy was recognized (before 8 weeks, earlier abortions OR 0.1).24 They also found that women who had late abortions faced more logistical delays (finding a provider, raising funds, and travel costs). Both Turnaway studies excluded abortions for fetal anomalies or life endangerment.

Many people are under the impression that most late term abortions are necessitated by terrible fetal anomalies or life endangering conditions. Hillary Clinton famously made this assertion during a debate with candidate Donald Trump. This assertion was widely debunked by fact checkers.24-25 Diana Foster, Professor at the University of California San Francisco’s Bixby Center for Global Reproductive Health stated that “there aren’t good data on how often later abortions are for medical reasons”. Her opinion, based on the limited research and discussions with fellow researchers in the field, was that abortion for fetal anomalies “make up a small minority of later abortions”.25 There are other sources including investigations, blog posts, interviews and documentaries that suggest it is not hard to schedule a late abortion or uncommon to abort an entirely normal fetus after 24 weeks gestation.26-29 In Colorado, the Boulder Abortion Clinic advertises elective abortions (for any reason) to 26 weeks and then to 36 weeks for “medically indicated terminations”.30 (Anecdotal evidence suggests that the Boulder Abortion Clinic is willing to consider later abortions for normal fetuses).26,29,31 For those women who do have fetuses with likely life-limiting genetic or congenital abnormalities, perinatal hospice offers a holistic, humane, and compassionate alternative to late abortion.32

There is no mandatory reporting for abortion numbers, indications or complications in the United States. Consequently, it is difficult to objectively assess the practices of late term abortionists and the patients they serve. It is also uncommon for an independent expert to review late abortionists’ practices. In a rare move that resulted in significant controversy/litigation, Kansas Attorney General Phil Kline had Dr. Paul McHugh, University Distinguished Service Professor of Psychiatry at Johns Hopkins School of Medicine, review redacted records of prominent third-trimester abortionist, George Tiller. Dr. McHugh reported that he found instances where abortions were obtained for “trivial reasons” (like a desire to play sports) and for psychiatric reasons (such as adjustment disorder, anxiety, and depression) that could have been more appropriately remedied without resorting to late abortion.33

To obtain Colorado-specific abortion data is extremely difficult. The Colorado Department of Health collects an (admittedly) incomplete survey of abortion providers (since it is not mandatory and there is no enforcement mechanism). In their 2017 Report of Induced Terminations of Pregnancy, 285 abortions were performed after 21 weeks gestation in Colorado.34 The Guttmacher Institute pegs the rate approximately 24% higher (based on previous data).35 Assuming the CDPHE underestimation is uniformly distributed amongst all gestational ages, this would translate into approximately 353 abortions after 21 weeks in the last reporting year.

Few Colorado abortionists admit performing late/third trimester abortions. The exception is Dr. Warren Hern from the Boulder Abortion Clinic. In a number of newspaper and magazine stories, the impression is given that he only performs late abortions for fatal fetal anomalies and life-endangering conditions of the mother.36-37 However, Dr. Hern has admitted that 70% of his abortion practice is for normal fetuses.38 In those 30% of abortions performed for fetal anomaly, he reports that Down Syndrome is his most common indication (24%). Potentially treatable structural anomalies are included in his series (such as spina bifida, aortic stenosis, abdominal wall abnormalities, urinary obstruction, extra digits, fused digits, deformed hands or feet, scoliosis, and cleft lip/palate).38

How often is it medically necessary to abort a fetus to preserve the life or health of the mother? Dr. Diane Foster from the University of California San Francisco states that the number is very hard to characterize.25 Although there is almost no literature on the subject, one Maternal-Fetal Medicine expert concludes that this is an exceedingly rare event, perhaps encompassing as few as 4 extremely uncommon conditions: pulmonary hypertension (primary or Eisenmenger’s syndrome), Marfan’s syndrome with aortic root involvement, complicated coarctation of the aorta, and peripartum cardiomyopathy with residual dysfunction.39 These would all likely be adjudicated long before 24 weeks gestation. Dr. Hern has said that he is unaware of a situation where abortion was necessary (as opposed to delivery) to save the life of a mother in the third trimester.40

Late abortions are performed for the same reasons that early abortions are performed. There may be more abortions for fetal anomalies late in pregnancy, but this is still likely a small proportion overall. Late abortions occur commonly in Colorado, but figures are inaccurate and lack some demographic and medical detail. Abortions to preserve the life of the mother are a very rarely, if ever, indicated in late abortion. Perinatal hospice offers an alternative to late abortion for families confronting a fetus with a likely terminal diagnosis.32

How are late abortions performed?

Generally, beginning at 16 weeks gestation, Dilation and Evacuation (D&E) replaces sharp curettage and suction curettage as the surgical abortion procedure of choice.41 During D&E, cervical dilation is achieved over one or more days by osmotic dilators and misoprostol to facilitate the subsequent mechanical destruction and dismemberment of the fetus. Parts of the fetus grasped/torn from her/his torso are then easily removed through the dilated cervix. A large-bore vacuum curette is used to remove the placenta and remaining tissue. Administration of a pre-procedure feticide such as intraamniotic/intrafetal digoxin, intracardiac potassium chloride or transection of the umbilical cord sometimes proceeds the D&E.

Dilation and Extraction (D&X) is similar to the D&E procedure except that a suction cannula is utilized to evacuate the brain after delivery of the fetal body/legs through the dilated cervix.40 The ensuing collapse of the head facilitates its passage through the cervical canal. In the popular vernacular this procedure is referred to as “Partial-Birth Abortion”. In order to comply with the Partial-Birth Abortion Ban Act of 2003, fetal demise must be ensured prior to the procedure. This is accomplished using a pre-procedure feticide or by transection of the umbilical cord.

During an Induction Abortion, labor is induced using mechanical means and/or by chemical means .40 The fetus is then delivered intact. To remain within the framework of the law, fetal demise is achieved prior to delivery using a feticide.

During D&E, there are estimates that only one half of fetuses are killed prior to the dismemberment procedure.42-43 It is hard to imagine that dismemberment would be less painful than natural death in conjunction with advanced perinatal hospice/palliative care services.

Even for those fetuses who are killed before they are dismembered or delivered, there could be substantial suffering. A highly concentrated potassium infusion can cause intense intravascular burning in normal patients.44 Even though an intracardiac infusion of potassium can kill a fetus within 2 minutes, It’s impossible to ascertain whether the fetus experiences intense pain prior to its demise.45 Intraamniotic or intrafetal digoxin is the more commonly used poison to achieve fetal demise.46 A digoxin overdose in older humans causes intense nausea, vomiting, abdominal pain, visual disturbances and delirium.47-49 Digoxin kills by causing severe bradycardia culminating in asystole, but it does not kill quickly. It can take up to 4 hours for intrafetal and up to 24 hours for intraamniotic digoxin to achieve asystole.50-51 Women are routinely told to anticipate “kicks” for hours after the feticide is administered.52 The visual, gastrointestinal, neurological and cardiac manifestations of digoxin toxicity could arguably represent fetal cruelty. Indeed, if this same methodology was utilized in a death penalty case, it would be considered “cruel and unusual punishment”.

In more candid moments, even abortion advocates sometimes characterize late abortion procedures on fetuses as “morally abhorrent”.53 It is a form of intimate human violence which is unparalleled in medicine. The only reason that it persists is that the violence is hidden within the confines of the uterus. When the mother (and the broader public) are shielded from the reality of the carnage that is being inflicted on the fetus, it is easier to rationalize its utility. Since there are no studies on the pain associated with late fetal abortion, to regard this as a painless, humane procedure is either wishful thinking or horribly misguided.

What is the risk to the woman undergoing a late abortion?

Even using the admittedly inadequate medical claims/surveillance data, late abortion poses a substantial risk compared to early abortion in both relative and absolute terms. Using California Medicaid billing data, Emergency Department visits and complications were 2.5 times more likely following a second trimester abortion compared to a first trimester abortion.55 Data from the national Abortion Surveillance System indicate that while the overall risk of death from abortion was 0.7/100000 induced abortions, the risk of death increased exponentially (by 38%) for each additional week of gestation.56 CDC researchers found that gestational age was the strongest predictor of abortion-related-mortality.3 In absolute terms, the risk goes from 0.1 deaths/100000 for surgical abortions < 9 weeks to 8.9 deaths/100000 at > 20 weeks.57 To put this in perspective, the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) compiled a 5/12 year database of over 1 million out-patient surgeries performed in ambulatory surgery centers.58 The death rate was 2/100000 for patients that were, on average, significantly older than patients undergoing late abortion. This is only 22% of the mortality rate seen in late abortion. The Canadian counterpart, the Canadian Association for Accreditation of Ambulatory Surgical Centers (CAAASF), conducted a survey that pointed to a death rate of approximately 1/100000 which represents only 11% of the risk of late abortion.59 The risk must be viewed in the context of strict oversight of ambulatory surgical centers in Colorado and the absence of oversight or regulations pertaining to abortion facilities in Colorado.60 Media Trackers reported that “while standard healthcare and out-patient surgical clinics in the state fall under the authority of the Health Facilities division of the Colorado Department of Health and Environment for regular licensing and regulation, Planned Parenthood (and other abortion providers) are not held to the same standard”. Not only does late abortion represent a significant mortality risk to women but the lack of health/safety oversight potentially compounds that risk.

Mortality studies that are based on countries with linked birth, pregnancy, abortion and death registries give an even more stark view of the risk from abortion. In Denmark, the 180-day mortality associated with late abortion (>12 weeks) was 55/100000.61 This is far worse than US surveillance data would suggest and places it in a league with neurosurgery (lumbar discectomy 60/100000), and abdominal surgery (laparoscopic appendectomy, inguinal herniorrhaphy 20/100000, laparoscopic cholecystectomy 200/100000).62-65 While this study is not adjusted for socioeconomic factors, marital status or psychological history, they suggest that mortality risk for women undergoing late abortion might be substantially underestimated in the US.

Some have tried to claim that a legal induced abortion is much safer than childbirth.66 However, others have pointed out that these studies are inherently biased and plagued with differences in ascertainment of deaths, duration of susceptibility to mortality, lack of accounting for gestational age and inappropriate comparators.54 The relative risk of pregnancy associated death between delivery and abortion may be better assessed by looking at countries with linked birth/medical/death databases. A systematic review and meta-analysis suggested that based on 11 studies from three such countries, termination of pregnancy is a marker for reduced life expectancy.67 They found that within a year of their pregnancy outcomes, women experiencing pregnancy loss (from either abortion or natural loss) were twice as likely to die compared to women giving birth. In Denmark this adverse mortality rate persisted for 10 years.61 While there could be confounding variables complicating this analysis, the notion that abortion leads to better health outcomes is unlikely (and certainly speculative without more rigorous research).

The morbidity associated with abortion also increases with gestational age.68 A large retrospective study from the University of California San Francisco suggested that the complication rate for second trimester abortions was 9.8% (including cervical laceration, hemorrhage, uterine atony, anesthesia complications, uterine perforation, disseminated intravascular coagulation, and retained products of conception). Major life-threatening complications (complications requiring hospitalization, transfusion, or further surgical intervention) occurred in 1.7% of patients. Any of these complications increased with each additional week of gestation beyond 20 weeks. Unfortunately, there are no published studies specifically addressing the likely extremely high morbidity/mortality associated with third trimester abortions.

Long-Term health effects of abortion are controversial.3 Retrospective studies suggested a correlation of abortion with breast cancer. Better, case control studies suggested no correlation. There appears to be an association of abortion with postpartum hemorrhage in later pregnancies, but the mechanism is undefined. Late abortions may result in an increased risk for premature birth in subsequent pregnancies (aOR= 1.13, 99% CI 0.91-1.4). This trend becomes statistically significant for women who have had multiple abortions. Researchers have found a dose-response relationship between the number of prior abortions and the risk for extreme premature birth. Since black women have, on average, more late abortions and more multiple abortions, one might speculate that the scourge of increased infant mortality (tied largely to premature birth and low birth weight infants) in the black community could be partially caused by abortion.

The adverse effects of abortion on mental health is particularly controversial. Recent reviews cited by abortion proponents rely heavily on the methodologically flawed Turnaway study to conclude that abortion is not associated with new mental health disorders.3 However, a more balanced review of the literature suggests several consensus opinions regarding the nexus between abortion and mental health: “1) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion, 2) the abortion experience directly contributes to mental health problems for at least some women, 3) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion.”69 The reason that this is a particularly urgent issue is that studies suggesting high long-term mortality outcomes from abortion point to markedly increased rates of suicide, accidents, and homicide. 61 ,67, 70

Conclusions:

Late abortion is extreme by any measure and should be prohibited. Very few countries in the world permit abortion after 24 weeks. Most Americans, regardless of their political affiliation, feel that abortion should be illegal in the third trimester. There is irrefutable scientific evidence that a 24-week fetus demonstrates all the fundamental characteristics of more developed humans, including the ability to perceive pain and perform sophisticated sensorimotor behaviors. The reasons women choose late abortions are similar to the reasons that women choose early abortion. Most late abortions are probably performed on normal fetuses. For those tragic situations where a fetus has a life-limiting prognosis because of genetic or congenital fetal abnormality, perinatal hospice offers a compassionate, life-affirming alternative to abortion. Late abortions are violent procedures that commonly involve the crushing and dismemberment of the fetus. Late abortions pose a substantial morbidity and mortality risk to the pregnant woman, which is further exacerbated by the lack of regulatory oversight. Long term sequelae of abortion include the risk for future premature birth and adverse future pregnancy outcomes. There appears to be a substantially increased risk of early mortality in women who have abortion compared to women who deliver babies. This may be related to worse long-term mental health outcomes for women who choose abortion.

References:

1. State Policies on Later Abortions. (2019, January 1). Retrieved from https://www.guttmacher.org/state-policy/explore/state-policies-later-abortions . January 10, 2019

2. Lee, M. Y. H. (2017, October 9). Is the United States one of seven countries that ‘allow elective abortions after 20 weeks of pregnancy?’. The Washington Post.

3. Committee on Reproductive Health Services. The Safety and Quality of Abortion Care in the United States. Washington DC: The National Academy Press, 2018.

4. The Editorial Board of the New York Times. (2018, December 28). A Woman’s Rights. The New York Times. Retrieved from https://www.nytimes.com/interactive/2018/12/28/opinion/abortion-murder-charge.html . January 10, 2019.

5. Trimesters Still Key to Abortion Views. (2018, June 13). Retrieved from https://news.gallup.com/poll/235469/trimesters-key-abortion-views.aspx . January 10, 2019.

6. Moore, KL, Persaud, TVN, and M Torchia. The Developing Human: Clinically Oriented Embryology. 2013. Elsevier Saunders. Print.

7. Moldenhauer JS and Adzick NS. Fetal Surgery for myelomeningocele: After the Management of Myelomeningocele Study (MOMS). Seminars in Fetal & Neonatal Medicine 2017; 22: 360-366.

8. Graves CE, Harrison MR, and Padilla BE. Minimally Invasive Fetal Surgery. Clin Perinatol 2017; 44: 729-751.

9. Ahmad KA, Frey CS, Fierro MA, Kenton AB, and Placencia FX. Two-Year Neurodevelopmental Outcome of an Infant Born at 21 Weeks’ 4 Days’ Gestation. Pediatrics 2017; 140(6): e20170103.

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17. McPherson C, Inder T. Perinatal and neonatal use of sedation and analgesia. Seminars in Fetal and Neonatal Medicine 2017; 22: 314-320.

18. Fagard J, et.al. Fetal Origin of Sensorimotor Behavior. Frontiers in Neruorobotics 2018; 12:23.doi:10.3389/fnbot.2018.00023.

19. Hepper PG, Shahidullah BS. Development of Hearing. Archives of Disease in Childhood 1994; 71: F81-F87.

20. Gerhardt KJ, Abrams RM. Fetal exposures to sound and vibroacoustic stimulation. J Perinatol 2000; 20 (8 Pt2): S21-30.

21. Granier-Deferre C, et.al. A Melodic Contour Repeatedly Experienced by Human Near-Term Fetuses Elicits a Profound Cardiac Reaction One Month after Birth. PLoS one 2011; 6(2)L e17304. doi:10.1371/journal.pone.0017304.

22. Biggs MA, Gould H, and Foster DG. Understanding why women seek abortions in the US. BMC Women’s Health 2013; 13: 29.

23. Pappas S. (2011, December 16). Study Reveals Who Gets Late-Term Abortions. Live Science. Retrieved from https://www.livescience.com/17529-trimester-abortions.html , on January 10, 2019.

24. Foster DG and Kimport K. Who Seeks Abortions at or After 20 weeks. Perspectives on Sexual and Reproductive Health 2013; 45(4): 210-218.

25. Llevitan D. (2015, September 29). Clinton Off on Late-Term Abortions. Fact Check.Org. Retrieved from https://www.factcheck.org/2015/09/clinton-off-on-late-term-abortions/ . On January 10. 2019.

26. Pavone, F. (2019, February 4). LISTEN: Undercover Call Catches Abortion Clinic Offering to Kill Baby at 32 Weeks. Retrieved from https://www.lifenews.com/2019/02/04/listen-undercover-call-catches-abortion-clinic-offering-to-kill-baby-at-32-weeks/ . Retrieved February 4, 2019.

27. Vial, B. (2019, February 8). What It Was Like to Get a Later Abortion. Retrieved from https://www.teenvogue.com/story/what-it-was-like-to-get-a-later-abortion . Retrieved February 8, 2019.

28. Tolentino, J. (2013, September 20). Interview with Dr. Retrieved from https://www.thehairpin.com/2013/09/interview-with-dr/ . Retrieved February 10, 2019.

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Abortion and Infant Mortality

Sun, 11 Nov 2018 04:15:20 GMT

Disproportionate Effects on the Black Community

Infant mortality is 2.2 times greater for black infants than white infants. Medical researchers have been perplexed because the difference is not explained by the recognized (health, socio-economic) risk factors. We know that Planned Parenthood and other abortion providers disproportionately target black neighborhoods with clinic location and advertising.

There is growing evidence that abortion leads to preterm births in subsequent pregnancie s, particularly in women who have late abortions or multiple abortions. Black women account for 25% of all abortions. They have a disproportionate number of multiple abortions and abortions later in gestation. Preterm birth and low birth weight infants have been demonstrated to be the principle drivers of higher death rates in black infants. This could help explain the tragic increase in infant mortality in the black community.

People in the whole life community should call on the federal government to research the connection between abortion and infant mortality. In the mean time, we should publicize the potential link between abortion and infant mortality, especially in the black community.

"Gosnell" Movie and Its Relevance to Colorado

Sun, 11 Nov 2018 03:38:50 GMT

Everyone should see Gosnell: The Trial of America's Biggest Serial Killer

Everyone should see the "Gosnell movie" (the full title is: Gosnell: The Trial of America's Biggest Serial Killer ) which was released in October of this year. The movie is not a pro-life screed. Rather it is a methodical re-enactment of the investigation and prosecution of abortionist Kermit Gosnell based on Grand Jury testimony and trial transcripts. The screen play and acting are exceptional. Gosnell weaves a story of abortion politics and jurisprudence gone horribly wrong.

Although the movie is much more restrained than the actual Grand Jury report, we are presented with the horrific facts that Kermit Gosnell ran an uninspected abortion clinic with untrained staff that commonly used dangerous sedatives/narcotics indiscriminately and without adequate monitoring during abortion procedures. He performed abortions in a strikingly dirty clinic littered with biohazard waste and cat feces, and used single-use instruments multiple times with inadequate sterilization resulting in the transmission of STDs to multiple patients. Gosnell routinely performed abortions past the legal limit of 24 weeks in Pennsylvania. (Colorado has no gestational limit for abortion). His protocol led to the delivery of living, viable fetuses which he subsequently killed by severing their spinal cords. His practices not only led to the death of perhaps hundreds of babies but also contributed to the maiming of multiple women and the death of at least two.

Pennsylvania health authorities chose not to investigate the Gosnell clinic despite multiple complaints and at the bequest of their pro-choice governor. Despite the existing law in Pennsylvania, they viewed inspection of abortion clinics as an undue burden on reproductive rights. Furthermore, University hospital officials did not report the maiming of multiple women during abortion procedures to public health authorities. The failure of oversight at multiple levels by medical and governmental officials is breathtaking. To their credit, public health officials were held accountable and the Pennsylvania legislature subsequently passed legislation strengthening abortion clinic licensing, oversight and regulations. By mandating that abortion clinics follow the regulations instituted for ambulatory surgical centers, they were able to uncover two other unsafe abortion clinics that used unsterilized equipment, lacked resuscitative equipment, and routinely used outdated medications.

Why is this story so important for Coloradoans to hear? Colorado has absolutely no regulations of abortion clinics – aside from the global requirements that physicians and nursing staff be licensed. When legislators have attempted to improve abortion clinic oversight, we are told by Planned Parenthood and NARAL representatives that this is unnecessary and a nefarious plot by prolife advocates to restrict access to abortion. They claim that “Colorado is different” despite the knowledge that Gosnell-like activities and serious abortion clinic safety violations have been documented in several states including Maryland, New York, New Jersey, Virginia, Delaware, Michigan, Illinois, Ohio, Indiana, and Alabama. Prochoice politicians routinely claim that they are motivated by concerns for women’s reproductive health, but their refusal to impose even modest oversight of 2nd and 3rd trimester abortion clinics would suggest they care more about abortion than women’s lives.

Not only should you, your family and your friends see the Gosnell movie, but I would encourage you to email your state representative and senator to ask them to see the movie as well. Prolife Democrats who truly care for the health and well-being of both women and the preborn should lead the way on improving Colorado abortion clinic oversight/legislation.

Sidewalk Counseling in Denver

Sun, 11 Nov 2018 03:38:50 GMT

A member's experience of spending a Saturday morning outside one of the largest Planned Parenthood facilities

A couple of weekends ago I spent a few hours Saturday morning outside the Stapleton Planned Parenthood in Northeast Denver. I was encouraged to see a large group praying quietly across the street. This was in contrast to some horrific signs from another pro-life group. I will not share all the photos here, but some of them were of aborted babies. They also had torn apart baby dolls scattered across the driveway entrance. It was very disturbing. This same group shouts at people as they go in and out of the clinic, telling them they are murderers and will go to hell. Then expect people will stop and listen to their offers of help, but understandably people ignore them. This is unfortunate because we have had conversations with these fellow pro-lifers and they have passion for this cause and seem to genuinely want to help women.

I want to be very clear that we do NOT condone the use of yelling and publicly displayed graphic images. Attempts have been made to explain to them that their approach in harmful, but this was not received well. Their approach just doesn't work, it does more harm than good. This is supported by research done by the Vitae Foundation over many years. Read more about their findings at https://vitaefoundation.org/abortion-a-failure-to-communicate .
There was actually a pro-choice counter-protest that morning, and I had a conversation with the organizers.
I agreed with them that yelling at the women going in to PP is hurtful and helps no one.

Our approach when outside an abortion facility is one of compassion, we wave and calmly ask if they would like information about pregnancy centers in the area. We point them to Marisol Health ( https://marisolhealth.com ), which has an office around the corner from the Stapleton PP (also Alternatives Pregnancy Center is a great resource in the Denver metro area https://youhavealternatives.org , both organizations offer all their services for free).

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