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 1. The National Academies of Sciences, Engineering, and Medicine, The Safety and Quality of Abortion Care in the United States 2018; pages 45-93. The National Academies Press, Washington DC. 2. Bartlett LA, et.al., Risk factors for legal induced abortion-related mortality in the United States. Obstetrics & Gynecology 2004; 103(4): 729-737. 3. 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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.

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.

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

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

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.

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

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.

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

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.