[Senate Hearing 118-111]
[From the U.S. Government Publishing Office]
S. Hrg. 118-111
THE ASSAULT ON REPRODUCTIVE RIGHTS
IN A POST-DOBBS AMERICA
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON THE JUDICIARY
UNITED STATES SENATE
ONE HUNDRED EIGHTEENTH CONGRESS
FIRST SESSION
__________
APRIL 26, 2023
__________
Serial No. J-118-13
__________
Printed for the use of the Committee on the Judiciary
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
www.judiciary.senate.gov
www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
53-538 PDF WASHINGTON : 2024
-----------------------------------------------------------------------------------
COMMITTEE ON THE JUDICIARY
RICHARD J. DURBIN, Illinois, Chair
DIANNE FEINSTEIN, California LINDSEY O. GRAHAM, South Carolina,
SHELDON WHITEHOUSE, Rhode Island Ranking Member
AMY KLOBUCHAR, Minnesota CHARLES E. GRASSLEY, Iowa
CHRISTOPHER A. COONS, Delaware JOHN CORNYN, Texas
RICHARD BLUMENTHAL, Connecticut MICHAEL S. LEE, Utah
MAZIE K. HIRONO, Hawaii TED CRUZ, Texas
CORY A. BOOKER, New Jersey JOSH HAWLEY, Missouri
ALEX PADILLA, California TOM COTTON, Arkansas
JON OSSOFF, Georgia JOHN KENNEDY, Louisiana
PETER WELCH, Vermont THOM TILLIS, North Carolina
MARSHA BLACKBURN, Tennessee
Joseph Zogby, Chief Counsel and Staff Director
Katherine Nikas, Republican Chief Counsel and Staff Director
C O N T E N T S
----------
OPENING STATEMENTS
Page
Durbin, Hon. Richard J........................................... 1
Graham, Hon. Lindsey O........................................... 3
WITNESSES
Goodwin, Michele................................................. 9
Prepared statement........................................... 50
Questions submitted with no response returned................ 63
Skop, Ingrid, M.D................................................ 7
Prepared statement........................................... 65
Verma, Nisha, M.D., MPH.......................................... 13
Prepared statement........................................... 92
Responses to written questions............................... 95
Wubbenhorst, Monique C., M.D., MPH............................... 11
Prepared statement........................................... 98
Zurawski, Amanda................................................. 6
Prepared statement........................................... 124
APPENDIX
Items submitted for the record................................... 49
THE ASSAULT ON REPRODUCTIVE RIGHTS
IN A POST-DOBBS AMERICA
----------
WEDNESDAY, APRIL 26, 2023
United States Senate,
Committee on the Judiciary,
Washington, DC.
The Committee met, pursuant to notice at 10:04 a.m., in
Room 216, Hart Senate Office Building, Hon. Richard J. Durbin,
Chair of the Committee, presiding.
Present: Senators Durbin [presiding], Whitehouse,
Klobuchar, Blumenthal, Hirono, Booker, Padilla, Ossoff, Welch,
Graham, Grassley, Cornyn, Lee, Cruz, Hawley, Kennedy, Tillis,
and Blackburn.
OPENING STATEMENT OF HON. RICHARD J. DURBIN,
A U.S. SENATOR FROM THE STATE OF ILLINOIS
Chair Durbin. Good morning. This hearing of the Senate
Judiciary Committee will come to order.
Over the past year, Americans have learned a painful lesson
on the dangers of judicial activism. Lives have been disrupted,
life-saving healthcare has been declared illegal, and women
have been denied their fundamental liberties. The chaos began
last June, June the 24th, when the Supreme Court issued its
decision in Dobbs v. Jackson Women's Health Organization.
With a single ruling, the right-wing majority overruled
five decades of legal precedent, revoking a constitutional
right for the first time ever in the history of this Nation.
In the years leading up to the Dobbs decision, we were
warned about the danger of overruling Roe v. Wade. Medical
experts warned us it would unleash an immediate healthcare
crisis across this Nation. Legal experts warned us it would
establish a dangerous precedent in which unelected judges can
deny fundamental freedoms.
And women across the country warned us that overturning Roe
v. Wade would insert politicians and judges into the most
personal decision imaginable, and ultimately force women into
continuing pregnancies that may not be viable or may endanger
their lives. Tragically, all of these warnings have proven to
be true. I'd like to turn to a video on the impact of the Dobbs
decision.
[Video is presented.]
Chair Durbin. With the Dobbs decision, Justice Alito and
the majority claimed that overruling Roe would finally settle
the so-called controversy over abortion by returning the issue
to the States and elected leaders. Well, months later, we've
learned the opposite is true. The Dobbs decision didn't resolve
anything. It merely replaced controversy with chaos, and it
paved the way for activist judges and Republican lawmakers to
try to impose their anti-choice agenda on everyone else.
Even in States that have protected the right to abortion,
their ultimate goal is clear: total ban on abortion nationwide.
So instead of ending the debate on abortion, Dobbs was
really the beginning of a different debate. How far will the
war on women's health go before we say enough is enough? From
the moment Roe was overruled, women and medical professionals
were thrust into a sea of confusion and fear. The laws
surrounding abortion and miscarriage management seem to be
changing by the week.
And doctors have no idea if the care they provided today
will be legal tomorrow. A few weeks ago, a judge in Amarillo,
Texas, issued a nationwide ruling, banning one of the safest
forms of reproductive care, mifepristone. It's a medication
approved more than 20 years ago by the Food and Drug
Administration. It is used in more than half of all abortions
in America, and it is used to help women suffering from
miscarriages. This medicine has a safety profile better than
penicillin, Tylenol, and Viagra.
Thankfully, the Supreme Court issued a temporary reprieve
by staying the decision last week. So for the moment,
mifepristone remains on the market as a case that's considered
on the merits.
But the district court's judge's initial ruling marked the
first time--first time ever that a judge has overruled the FDA
to ban a medication that they deemed safe and effective--
medical and scientific experts backing them up at our Federal
drug regulatory agency.
It begs the obvious question, what's next? Is it going to
be birth control pills? The morning after pill?
Do we want to live in a country where judges and
politicians replace doctors, medical experts, and scientists as
the arbiters of which drugs are safe? The number of horror
stories that have emerged over the past year is staggering.
Stories of rape victims as young as 10 years of age being
denied healthcare because of laws outlawing abortion. Stories
of women being forced to leave their home States and travel
hundreds of miles to access basic reproductive care services.
Stories of pregnant women suffering miscarriages, who've
been turned away by doctors who, through no fault of their own,
are afraid of breaking this law in this new Dobbs world. You'll
hear one of these stories this morning.
That's why Congress needs to step up and address this
chaos. We need to respect the rights of women to make their own
health care decisions.
And we can do it by passing the Women's Health Protection
Act, which would restore abortion access across America. Now
the question is, will our Republican colleagues stand with the
vast majority of Americans who support legal access to
abortion? With that, I turn to Ranking Member Graham for his
opening statement.
OPENING STATEMENT OF HON. LINDSEY O. GRAHAM,
A U.S. SENATOR FROM THE STATE OF SOUTH CAROLINA
Senator Graham. Thank you, Mr. Chairman. I appreciate it
very much.
Before we start, in 15 days, the Biden administration is
going to basically do away with the ability to deport people
under Title 42. There's going to be a gasoline thrown on an
illegal immigration fire. People on our side are going to write
the President, and we would like you to join us if you could,
to reverse this decision. Thousands of people are waiting for
this moment to pass, and it's just going to create chaos upon
chaos.
So, I request my Democratic colleagues, if you could, to
join us in urging President Biden to change his mind about
abandoning the Title 42 deportation. I think in a few weeks,
we'll see why I say this.
To the topic at hand, I appreciate very much the hearing.
And we'll try to do this in a very respectful way. After Dobbs,
our Democratic friends are basically declaring war on the
unborn.
[Poster is displayed.]
Senator Graham. This is an emotional decision. Two-thirds
of Americans believe abortion should be limited after the first
3 months.
[Poster is displayed.]
Senator Graham. And our friends on the other side have the
Women's Health Protection Act, which has really no limits on
abortion. There is a healthcare exception after viability that
is no exception at all. It puts America in the company of North
Korea and China that allow abortion on demand up to the moment
of birth. It takes all the State-level protections and
abolishes them. The bottom line, it doesn't codify Roe, Mr.
Chairman. It becomes one of the most extreme laws anywhere in
the world.
Colorado, New Jersey, New Mexico, Oregon, Vermont, are
passing laws with absolutely no restrictions. The Democratic
bill is of the same ilk with taxpayer funded. Let's take a look
and see how that would put us as a nation, regarding the rest
of the world.
[Poster is displayed.]
Senator Graham. As you see, behind me, 47 of 50 European
Union nations limit abortion at 15 weeks or below. France is at
14 weeks. China, North Korea, Iran, and a few other nations,
allow abortion on demand up to the moment of birth. And your
bill would put us in that category.
[Poster is displayed.]
Senator Graham. Fourteen-week limitations: France, Belgium,
Germany, Spain. Twelve weeks: Denmark, Norway. My proposal is
having a national minimum standard of 15 weeks for exceptions
for rape, incest, life of the mother pregnancies. Why do we do
this?
[Poster is displayed.]
Senator Graham. By 15 weeks, an unborn child has teeth,
fingers, and toes, may begin sucking their thumb or making a
fist. Each finger moves independently. Fingerprints have become
to develop, fully formed organs, and feel pain.
If you operate on a 15-week-old unborn child, the standard
practice is to provide anesthesia because the baby can feel
pain. That's why 47 of 50 European Union nations prohibit
abortion on demand after 15 weeks or below. Your proposal, Mr.
Chairman, puts America in a category I think most Americans
reject, abortion on demand up to the moment of birth, taxpayer
funded, which I believe is barbaric.
[Poster is displayed.]
Senator Graham. So, what do we do? We're going to debate
this topic. We're going to try to find consensus. But as for
me, I'm going to lend my voice to the idea that America post-
Dobbs should not be like North Korea and China, that America
post-Dobbs should draw a line. States can take their own path
up to a point. And the line I have drawn is 15 weeks.
[Poster is displayed.]
Senator Graham. A line that puts you in association with a
civilized world and rejects the barbaric practice of abortion
on demand up to the moment of birth with taxpayer funding. NPR
poll today said 66 percent of Americans support limiting
abortion after 12 weeks.
I don't know how long it will take, but I do believe over
time, in a post-Dobbs world, Americans are going to come to a
consensus on this issue. The numbers are pretty compelling for
early-stage abortions. Most Americans feel comfortable with a
woman making that decision, but the more we learn about the
unborn child, the more we understand how it develops, the more
we're going to have a consensus in this country that there
needs to be a point in time, Mr. Chairman, where we draw a
line.
Allowing abortion on demand up to the moment of birth with
taxpayer funding doesn't make America a better place. It makes
us an outlier in the civilized world. So, I welcome the debate.
It's going to be part of the 2024 election cycle and beyond.
And I will close with this. This is a moment for America to
have some self-reflection on a very difficult topic. Why does
most of the world, particularly Europe, limit abortion at 15
weeks or under? And why would we choose to be North Korea and
China on this topic? It'd be a debate worthy of a great Nation.
Thank you.
Chair Durbin. Thank you, Senator Graham. And I certainly
respect your point of view, but I want to respond to it because
you've made reference to a bill that I support.
Here are the facts: According to the Center for Disease
Control, abortions after 21 weeks make up less than 1 percent
of all abortions in the United States. When abortions later in
a woman's pregnancy happen, they can hardly be considered
elective.
There are three main reasons why women need access to an
abortion late in pregnancy: maternal health endangerment,
diagnosis of severe fetal abnormalities which did not show up
until late in the pregnancy, or restrictive State laws that
made it difficult for a woman to get an abortion earlier in
pregnancy.
The exceptionally rare cases that occur after 24 weeks are
often because a fetus has a condition that cannot be treated
and will never be able to survive, such as anencephaly, where
the fetus forms without a complete brain or skull, or Limb Body
Wall Complex, where the organs develop outside the body cavity.
I don't believe this is a nonchalant decision late in
pregnancy. I think it's a medical emergency in many cases. And
in this situation, I think the analogy to other countries and
their standards does not apply.
Today, we welcome five witnesses, and I thank them for
joining us. Before we swear the witnesses in, I'll briefly
introduce the Democratic witnesses, then turn to Senator Graham
to introduce his witnesses.
Our first witness is Amanda Zurawski. Ms. Zurawski has
joined us from Texas. She is here to speak to her personal
experience of being denied healthcare when she needed it. I'm
grateful for your traveling here, Ms. Zurawski.
Professor Michele Goodwin, a chancellor's professor of law
at the University of California, Irvine. She also serves as the
director of the Center for Biotechnology and Global Health
Policy at UCI Law. Welcome.
Dr. Nisha Verma is an OB-GYN in Georgia, where she provides
comprehensive reproductive healthcare. She also serves as a
fellow with Physicians for Reproductive Health. Thank you, Dr.
Verma.
Now, Senator Graham, your witnesses.
Senator Graham. Thank you, Mr. Chairman.
We have Dr. Ingrid Skop. Is that right? She's been a
practicing board-certified OB-GYN physician in San Antonio,
Texas, for 27 years. She received her bachelor of science in
physiology from Oklahoma State, and her medical doctorate from
Washington University School of Medicine. She completed her
residency at the University of Texas Health Science Center, San
Antonio.
She is a fellow of the American College of OB-GYN
physicians, a member of the American Association of Pro-Life
OB-GYN specialists. She currently practices with OB Hospital
Group and is also the vice president of medical affairs for
Charlotte Lozier Institute. She currently serves as a medical
director for Any Woman Can pregnancy resource center in San
Antonio, Texas, and on the medical advisory board of Save the
Storks.
Dr. Monique Wubbenhorst. Pretty good? Pretty close? Okay.
She's a board-certified OB-GYN specialist with over 20 years of
experience in patient care, teaching, research, health policy,
global health, and bioethics. She graduated from Mount Holyoke
College, and received her medical degree from Brown University.
She earned her master's degree in public health from Harvard.
She completed a residency at Yale New Haven Hospital and her
postdoctoral fellowship in health services research at Sheps
Center for Health Services Research at the University of North
Carolina, Chapel Hill. She's a faculty member at the Duke
University School of Medicine from 2003 to 2018. She
subsequently served as senior deputy assistant administrator in
the Bureau for Global Health at the United States Agency for
International Development.
She is a senior research associate at the Center for Ethics
and Culture at the University of Notre Dame. Her clinical
career is focused on caring for women in underserved and
disadvantaged populations, especially African Americans and
Native-American communities, with a focus on women with
medical, social, and psychiatric problems. Thank you.
Chair Durbin. Thank you, Senator Graham. Let me lay out the
mechanics of today's hearing. After we swear in the witnesses,
each witness will have 5 minutes for an opening statement. Then
Senators will have an opportunity to ask questions for up to 5
minutes. Can I ask the witnesses to please stand and raise
their right hand?
[Witnesses are sworn in.]
Chair Durbin. Let the record reflect that the witnesses
have all answered in the affirmative. And our first witness
will be Ms. Zurawski.
STATEMENT OF AMANDA ZURAWSKI, AUSTIN, TEXAS
Ms. Zurawski. Chairman Durbin, Ranking Member Graham, and
Members of the Senate Committee on the Judiciary, thank you for
the opportunity to testify before you today.
My name is Amanda Zurawski, and I'm here to tell you a
little bit about my experience with the Texas abortion bans.
About 8 months ago, I was thrilled to be cruising through the
second trimester of my first pregnancy. I was carrying our
daughter, Willow, who had finally blissfully been conceived
after 18 months of a grueling fertility treatment.
My husband, Josh, and I were beyond thrilled. Then on a
sunny August day, after I had just finished the invite list for
the baby shower my sister was planning for me, everything
changed.
Some unexpected symptoms arrived and I contacted my
obstetrician to be safe and was surprised when I was told to
come in as soon as possible. After a brief examination, my
husband and I received the harrowing news that I had dilated
prematurely due to a condition known as cervical insufficiency.
Soon after, my membranes ruptured and we were told by multiple
doctors that the loss of our daughter was inevitable.
It was clear that this was not a question of if we would
lose our baby. It was a question of when. I asked what could be
done to ensure the respectful passing of our baby and to
protect me, now that my body was unprotected and vulnerable. I
needed an abortion. My healthcare team was anguished, as they
explained there was nothing they could do because of Texas
anti-abortion laws, the latest of which had taken effect 2 days
after my water broke.
It meant that even though we would, with complete
certainty, lose Willow, my doctors didn't feel safe enough to
intervene as long as her heart was beating or until I was sick
enough for the ethics board at the hospital to consider my life
at risk.
I shouldn't have had to wait in anguish for days for the
inescapable ill fate that awaited. But this was August 2022 in
the State of Texas, where abortion is illegal unless the
pregnant person is facing a life-threatening physical condition
aggravated by, caused by, or arising from, a pregnancy.
People have asked why we didn't travel to a State where the
laws aren't so restrictive, but we live in the middle of Texas.
And the nearest sanctuary State is at least an 8-hour drive.
Developing sepsis, a condition that can kill in under an hour,
in a car in the middle of the West Texas desert, or on an
airplane, is a death sentence. And it's not a choice we should
have even had to consider in the first place.
So, all we could do was wait. I cannot adequately put into
words the trauma and despair that comes with waiting to either
lose your own life, your child's, or both. For days, I was
locked in this bizarre and avoidable hell. Would Willow's heart
stop? Or would I deteriorate to the brink of death?
The answer arrived three long days later. In a matter of
minutes, I went from being physically healthy to developing a
raging fever and dangerously low blood pressure.
My husband rushed me to the hospital, where we soon learned
I was in septic shock, made evident by my violent teeth
chattering and incapacity to even respond to questions. Several
hours later, after stabilizing just enough to deliver our
stillborn daughter, my vitals crashed again. In the middle of
the night, I was rapidly transferred to the ICU, where I would
stay for 3 days as medical professionals battled to save my
life. What I needed was an abortion, a standard medical
procedure.
An abortion would have prevented the unnecessary harm and
suffering that I endured, not only the psychological trauma
that came with 3 days of waiting, but the physical harm my body
suffered, the extent of which is still being determined.
Two things I know for sure: the preventable harm inflicted
on me has already made it harder for me to get pregnant again;
the barbaric restrictions that are being passed across the
country are having real-life implications on real people.
I may have been one of the first who was affected by the
overturning of Roe in Texas, but I'm certainly not the last.
More people have been, and will continue to be, harmed until we
do something about it.
You have the power to fix this. You owe it to me, and to
Willow, and to every other person who may become pregnant in
this country to protect our right to safe and accessible
healthcare--emergency or no emergency. No one should have to
worry about the life of their loved ones simply because they
are with child.
Your job is to protect the lives of the people who elected
you, not endanger them. Being pregnant is difficult and
complicated enough. We do not need you to make it even more
terrifying and, frankly, downright dangerous to create life in
this country. This has gone on long enough. And it's time now
for you to do your job, your duty, and protect us. Thank you.
[The prepared statement of Ms. Zurawski appears as a
submission for the record.]
Chair Durbin. Dr. Skop, please proceed.
STATEMENT OF INGRID SKOP, M.D., BOARD-CERTIFIED OBSTETRICIAN-
GYNECOLOGIST, AND VICE PRESIDENT AND DIRECTOR OF MEDICAL
AFFAIRS, CHARLOTTE LOZIER INSTITUTE, SAN ANTONIO, TEXAS
Dr. Skop. Thank you, Chairman Durbin, Ranking Member
Graham, and Members of the Committee.
As you've heard, I am Dr. Ingrid Skop, a board-certified
obstetrician-gynecologist practicing in Texas for over 30
years. Today, I advocate for both of my patients, a woman and
her unborn child. Every successful abortion ends the life of
one of my patients and often harms the other, as well.
In the coming legislative session, Senator Graham will
likely reintroduce Federal minimum protections limiting
elective abortion after 15 weeks gestation, with exceptions for
rape, incest, and the life and health of the mother.
Conversely, Senator Baldwin has reintroduced the Women's Health
Protection Act, which, ironically, does nothing to protect the
health of a pregnant woman from a dangerous abortion. The
unborn human life is never acknowledged. And abortion is
presented as procedurally and morally equivalent to a vasectomy
or a colonoscopy.
This proposed legislation insists that there can be no
commonsense safeguards to protect a woman. The words
``choice,'' ``voluntary,'' and ``consent'' are completely
missing, opening the door to others who will benefit from
abortion--sex traffickers, incestuous abusers, and unwilling
fathers. An abortion provider is not required to be a physician
or even medically licensed. Despite its euphemistic name, the
Women's Health Protection Act prioritizes the death of the
unborn human at the expense of the health, or even the desires,
of a pregnant woman.
A woman and her unborn child are not natural enemies. Most
pregnancies end in delivery of a healthy baby to a healthy
mother. Media sources have misinformed the public, alleging
that abortion limits will prevent an obstetrician from
providing necessary medical care, increasing maternal
mortality, but this is not true. Every legal restriction
protecting unborn life allows a physician to use his reasonable
medical judgment, that is, to follow the standard of care to
determine when to intervene in a medical emergency.
Let's compare how second-trimester limitations versus
unlimited abortion throughout pregnancy will actually impact
American women. Ninety percent of abortions in the second half
of pregnancy are obtained for the same reasons as early
abortions: social and financial concerns. Additionally, there
are other important factors: coercion and indecision. Nine
months is a long time for a woman who desires her child to say
no to a coercive partner.
Decisional uncertainty leaves a woman likely to regret
aborting a baby whose kicks she can feel and with whom she has
begun to bond. The physical risk of abortion increase as
pregnancy progresses. The risk of maternal death is 76 times
higher in the second half of pregnancy, compared to an early
abortion.
The dilation and evacuation procedure used for most later
abortions involves forcing open a strong muscular cervix and
blind insertion of sharp instruments to dismember and extract a
struggling fetus, and may cause hemorrhage, cervical damage,
retained tissue, and uterine perforation. Mental health
complications, including anxiety, depression, suicide, and
substance and alcohol abuse, are higher after abortion,
particularly after late or coerced abortions, or if there are
preexisting mental health issues.
European records linkage studies document a woman has six
times the risk of suicide in the year following an abortion,
compared to childbirth. Unfortunately, the U.S. Centers for
Disease Control does not even attempt to link mental health
deaths to abortion in its dramatically incomplete maternal
mortality data. Americans intuitively recognize these risks, as
three-quarters support a limitation at 15 weeks, and only 1 in
10 support abortion without gestational limits.
Extremely late abortions are sometimes performed by labor
induction because the fetus has grown too large to easily
dismember. European studies document over half of babies
survive induction abortion. And 69 percent of U.S. late-term
abortionists report they do not routinely kill the fetus first,
so it is likely that many babies survive late abortions and
then are passively or actively killed. Infanticide used to be a
red line, but no longer, as legislative protection for these
unfortunate children has repeatedly been rejected.
Fetal neurologic research documents that the pathways
required for pain perception are in place by 15 weeks
gestation. And during an abortion, the fetus displays all the
responses that we, too, would exhibit if we were torn limb from
limb. I have cared for many tiny babies, delivered at the edge
of viability, around 22 weeks. Their precious faces express
pain when their fragile bodies undergo therapeutic procedures.
Fetal surgery as early as 15 weeks can be performed to heal
some neurologic and vascular disorders before birth. Of course,
these babies are always offered pain relief. How can we justify
painful dismemberment of unborn babies at similar gestational
ages just because we cannot hear their cries? Thank you.
[The prepared statement of Dr. Skop appears as a submission
for the record.]
Chair Durbin. Professor Goodwin.
STATEMENT OF MICHELE GOODWIN, CHANCELLOR'S PROFESSOR OF LAW,
UNIVERSITY OF CALIFORNIA, IRVINE SCHOOL OF LAW, ABRAHAM
PINANSKI VISITING PROFESSOR OF LAW, HARVARD LAW SCHOOL,
CAMBRIDGE, MASSACHUSETTS
Professor Goodwin. Committee Chairman Durbin, Committee
Ranking Member Graham, and distinguished Members of the Senate
Judiciary Committee, my name is Michele Goodwin, and I am a
chancellor's professor at the University of California, Irvine,
and the Abraham Pinanski Visiting Professor at Harvard Law
School.
In its 2021-2022 term, the United States Supreme Court
decisively undercut stare decisis and the rule of law when it
overturned Roe v. Wade and Planned Parenthood v. Casey.
In doing so, the Supreme Court unleashed a torrent of
unnecessary uncertainty--fear about the future of protections
for women's health and their rights to life, liberty, and
safety. Justice Thomas' concurring opinion placed all privacy
rights on a high alert, save for interracial marriage, a status
enjoyed by the Justice himself. For all other privacy rights,
including marriage equality, access to contraception, freedom
from State-imposed sterilization, and more, his concurrence
remains a cause for serious alarm.
Despite the promised protections articulated by the
majority and Justice Kavanaugh, that freedom of travel would be
preserved and that its dismantling of Roe would return abortion
rights to the States, today, some legislatures are seeking to
dispossess citizens of access to the ballot, whether by
enacting provisions, making it more difficult to vote, or
engaging in efforts to rewrite States' laws related to ballot
initiatives and referenda, thereby introducing anti-democratic
principles into the democratic process itself.
The post-Dobbs era exposes not only a cruel disregard for
the lives of those most affected, but also a lack of regard for
constitutional law and foundational principles and values, such
as freedom of movement, freedom of speech, freedom of
association, privacy, and separation of church and state.
In the aftermath of Dobbs, women, girls, and people with
the capacity for pregnancy, are more at risk of State-level
criminal and civil surveillance than before, whether in the
effort to track their menstruation and travel.
The Bill of Rights, once proudly championed by our
Government because it protected speech, because it protected
bodily privacy, because it protected freedom from Government
overreach, including cruel and unusual punishment--it, too, now
is vulnerable.
Understandably, women and girls who do not wish to become
pregnant, are not prepared for motherhood, or whose health is
placed at risk by pregnancy and miscarriage, are horrified--
absolutely horrified--about credible present dangers and those
that lurk ahead.
The United States bears the worrying, worrying distinction
as, quote, ``the deadliest nation in the industrialized or
developed world to be pregnant.'' This is what barbarism looks
like. This is what cruelty looks like. Nationwide, as noted by
Justice Breyer, childbirth is 14 times more likely than
abortion to result in death. I'll repeat that. Childbirth is 14
times more likely to result in death than by abortion. As
reported by Nina Martin and Renee Montagne, more American women
are dying of pregnancy-related complications than any other
developed country.
In fact, only in the U.S. has the rate of women who die
during pregnancy risen. As research from the Texas Observer
shows, and my prior scholarship explains, this trend maps with
the destructive anti-abortion legislating and dismantling that
has gone on in our country exacerbated between 2010 and 2013,
and now in just rapid exhilaration. More recently, data show
that the U.S. maternal mortality crisis has worsened in the
period overlapping with COVID-19 and, as well, in the period
since Dobbs itself. Today, you'll hear more about these matters
from me.
Let me just say that, as I close, this period of time since
Dobbs has unleashed criminal actions against women and their
doctors. It has also unleashed civil surveillance, the type of
which includes, in Nebraska, a mother and her daughter being
criminally pursued. In Texas, doctors facing a $100,000 fine
and 99 years' incarceration, should they try to help a patient
terminate a pregnancy. In Louisiana, a woman being forced to
gestate a fetus that had no skull development. In Wisconsin, a
woman needing to bleed nearly to death before her doctors could
intervene.
And as you mentioned, Senator Durbin, right after Dobbs,
the case of a 10-year-old girl having to flee Ohio to get to
the State of Indiana in order to terminate a pregnancy due to
rape. Thank you so much.
[The prepared statement of Professor Goodwin appears as a
submission for the record.]
Chair Durbin. Dr. Wubbenhorst.
STATEMENT OF MONIQUE C. WUBBENHORST, M.D., MPH, SENIOR RESEARCH
ASSOCIATE, DE NICOLA CENTER FOR ETHICS AND CULTURE, UNIVERSITY
OF NOTRE DAME, SOUTH BEND, INDIANA
Dr. Wubbenhorst. Chair Durbin, Ranking Member Graham, and
Members of the Committee, thank you for your invitation and the
opportunity to testify at this hearing.
My name is Dr. Monique Wubbenhorst. I am a practicing
board-certified OB-GYN with more than 30 years' experience in
patient care, teaching, research, health policy, and global
health.
I'd like to begin by noting that the Dobbs decision
presents an opportunity to mitigate abortion's many harms to
women, unborn children, families, and community.
Abortion not only poses risks to the mother; it is also, by
definition, always lethal to an embryo or fetus, an unborn
child, who is a human being, a member of the human family, not
a clump of cells or a potential child, but a child assuming the
human form. Abortion's goal is to kill that human being. It
neither treats, palliates, or prevents any disease, and is
therefore not healthcare. This is reinforced by the fact that
the majority of OB-GYNs do not perform abortions.
Studies show that the percentage that do is declining and
has been for decades, from a high of 40 percent in 1985 to
between 7 and 24 percent at present. Given this, abortion
cannot be considered essential healthcare for women. And if
abortion is healthcare, my question is, what disease are you
treating? Clinicians caring for pregnant women have two
patients. Advancements in technology have allowed us to
recognize the fetus as the patient within the patient.
If the unborn child was not human, this investment in
research and clinical care would not have occurred, but that
view changes only if the same child is unwanted by his or her
mother. And the current emphasis on dilation and evacuation in
the second trimester really arises from a eugenic view of
abortion. It's a recognition of the--it's an admission that the
fetus is not truly a human being and ignores the fact that
fetuses do experience pain at earlier gestational ages.
Most abortions are elective. The bar for safety should be
very high. And there is evidence that the safety of both
medical and surgical abortion is overstated. As noted earlier
by my colleague, the risks of abortion increased dramatically.
Bartlett, et al., from 2004, found that the risk of a woman
dying from abortion, not experiencing complications but dying,
increased 38 percent for each week of gestational age.
Abortions performed past 21 weeks had a mortality rate 76 times
greater than abortions done in the first trimester.
Abortion does not prevent pregnancy complications or reduce
maternal mortality. A woman's individual risk for pregnancy
complications such as diabetes, even mortality, is estimated,
but cannot be predicted with certainty. There's no way to
predict whether an individual woman will suffer a pregnancy
complication, and any presumed effect of abortion on maternal
mortality is speculative and based on statistical sleight of
hand. It does not address causes of maternal mortality, in
particular, cardiovascular disease and infection.
The women in the United States who are at the highest risk
for adverse pregnancy outcomes, mostly African-American women,
are in fact, from the eugenic viewpoint, the unfit. The early
eugenicists made similar arguments, proposing contraception and
sterilization as solutions to medical and public health
problems. Therefore, we must consider that the effect of public
health measures and medical treatment, patient education that
are needed to improve maternal outcomes, are the real answer to
maternal mortality, not abortion.
For pregnancies where serious complications occur, early
delivery of the unborn child may be necessary, but such a
delivery is not an abortion because its goal is to save the
life of the mother and the life of the fetus if possible. This
is ethically permissible. As in law, in medicine, intent is
paramount. Premature delivery is not induced abortion,
according to the American Association for Pro-Life OB-GYNs.
And the Dublin Declaration upholds that there is a
fundamental difference between abortion and necessary medical
treatments that are carried out to save the life of the mother,
even if such treatments result in the loss of her unborn child.
Since Roe v. Wade, an estimated 17 million unborn African
Americans have been aborted in the United States, which is more
than the populations of the countries of Senegal and Cambodia,
respectively, and slightly less than the entire population of
the Netherlands.
This means the deaths of not only the 17 million Black
people who were aborted, but all their descendants, their
families, hopes, and dreams. Annually, approximately 300,000
Black women undergo abortion every year, while in 2021, there
are approximately 518,000 births to Black women, a number that
continues to decline.
We must ask ourselves, how is this destruction of innocent
life reproductive justice? How does one defend the deliberate
killing of the most vulnerable members of a minority group,
especially when births to that group have been, and continue to
be, in decline? Rather than Black women achieving bodily
autonomy and controlling their fertility, instead, their
fertility is being controlled.
There are substantial racial disparities in abortion rates,
abortion mortality, and non-abortion-related maternal mortality
between Black and white women. Thirty-eight percent of
abortions occur in Black women, a rate which is two to three
times higher than that of white women, even though we comprise
only 12 to 14 percent of the total U.S. population. An
estimated 684 Black children are aborted every day. African-
American women also have a two to three times higher mortality
from abortion, compared with white women. Therefore, Black
women have the highest rates of abortion and the highest rates
of maternal mortality. Both of these facts cannot be true if
abortion reduces maternal mortality.
In conclusion, the medical, public health, and social
landscape post-Dobbs offers many opportunities to help and
support women to carry their unborn children to term. These
include pregnancy resource centers, programs to improve
maternal health, interventions to treat unborn children with
disabilities, as well as perinatal hospice, and stronger civil
society engagement in the mission of strengthening families.
The pro-life message is one of profound hope and healing,
of love and encouragement, of walking with women and parents
and families through often difficult circumstances and helping
them to thrive. Thank you for your invitation to this hearing.
I look forward to your questions.
[The prepared statement of Dr. Wubbenhorst appears as a
submission for the record.]
Chair Durbin. Dr. Verma.
STATEMENT OF NISHA VERMA, M.D., MPH, BOARD-CERTIFIED
OBSTETRICIAN-GYNECOLOGIST, AND FELLOW, PHYSICIANS FOR
REPRODUCTIVE HEALTH, ATLANTA, GEORGIA
Dr. Verma. Good morning, Chairman Durbin, Ranking Member
Graham, and distinguished Members of the Senate Judiciary
Committee.
My name is Dr. Nisha Verma, and I am a board-certified,
fellowship-trained obstetrician and gynecologist providing
full-spectrum reproductive healthcare. That means I do
everything from cancer screenings to delivering babies to
supporting people as they decide to continue or end a
pregnancy.
I am a fellow with Physicians for Reproductive Health, and
I am also a proud Southerner. I was born and raised in North
Carolina. I currently provide care in Georgia. And I have lived
in the Southeast for most of my life. I decided to stay in
Georgia after the Supreme Court overturned the constitutional
right to abortion care. And Georgia enacted a law that bans
most abortions in our State last year.
I decided to stay, knowing Georgia's law threatened to make
me a criminal for providing life-saving care to my patients
because I made a commitment when I became a doctor to serve my
home and my community in the South. But every day, Georgia's
law forces me to grapple with impossible situations where State
laws directly violate the medical expertise I gained through
years of training and the oath I took to provide the best care
to my patients. Because of a law that is not based in medicine
or science, I am forced to turn away patients that I know how
to care for.
I've had adolescents with chronic medical conditions that
make their pregnancies very high risk, women with irregular
periods who don't realize they're pregnant until after 6 weeks,
and couples with highly desired pregnancies who receive a
terrible diagnosis of a fetal anomaly, cry when they learn that
they can't receive their abortion in our State and beg me to
help them.
Imagine looking someone in the eye and saying I have all
the skills and the tools to care for you, but our State's
politicians have told me I can't.
Imagine having to tell someone you are sick, but not sick
enough to receive care in our State, based on our law's very
narrow exceptions.
Abortion is extremely safe, and none of the arbitrary
barriers imposed by politicians make it any safer. In fact, the
National Academies of Sciences, Engineering, and Medicine
published a comprehensive study affirming the safety of
abortion and pointed out that the biggest threat to patients is
medically unnecessary restrictions.
One of my patients--I'll call her M--gave me permission to
share her story with you all today, and her experience brings
the findings of this study to life. She struggled with
infertility, and she and her husband were thrilled to see the
positive pregnancy test after they transferred their final
embryo. Then, at 17 weeks, when there was no chance of her baby
ever developing lungs that would allow it to live outside of
her, her water broke. She went to the hospital, but because her
baby still had a heartbeat, her doctors couldn't do anything to
help her.
Instead, she had to wait to get sick, to start bleeding
heavily, or develop an infection of her uterus that could
spread into her bloodstream. M shared with me that, ``to be
denied the basic medical care I needed, to be told that I must
first be at risk of dying, to be forced to relive the trauma of
losing my baby every day for 5 days because of Georgia's law,
the trauma of that, on top of my loss, is devastating.'' She
told me her baby's name was Ezekiel Charles, which means God's
strength, and that she would miss him at every major and minor
milestone he would have had in his life.
I stayed in Georgia to provide care for people in my
community, but my heart breaks every day for my patients like
M, as I bear witness to the pain they have to carry because of
these restrictions on abortion access.
We know from recent data that already thousands of people
have been forced to remain pregnant and have faced harm like
developing serious medical conditions as a result.
And we know that States with higher numbers of abortion
restrictions are the same States with worse maternal health
outcomes, with marginalized populations facing the largest
burden. Already the U.S. has the highest maternal mortality
rate of all high-income countries in the world, and data from
the CDC shows us that this crisis is only worsening.
I understand that abortion care can be a complicated issue
for many people, just like so many aspects of health care and
life can be. But I also know that abortion is necessary,
compassionate, essential healthcare, and that my patients are
capable of making complex, thoughtful decisions about their
health and lives. No law should prevent them from doing so. I
am unwavering in my commitment to support people in my home in
the South.
It shouldn't have to be this way. I urge you to listen to
the stories of people who provide and access abortion care. I
hope these stories help you understand that abortion care is
not an isolated political issue, and to see how profoundly
restrictions on abortion access harm all of our communities.
Thank you for having me today, and I look forward to your
questions.
[The prepared statement of Dr. Verma appears as a
submission for the record.]
Chair Durbin. Thank you, Dr. Verma. Thank you, to all of
the witnesses.
Ms. Zurawski, I can't remember a testimony as compelling or
as forceful as yours. I do this for a living. When I heard your
story, as you presented it, I thought for a moment, what would
I feel like if you were my daughter going through this?
The joy of a possible grandchild that's been erased, and
now you struggling to live, and an arbitrary political obstacle
to saving your life. At some point, you had to be so sick and
near death before they finally would agree to terminate the
pregnancy.
As you listen to the testimony from witnesses who share
your feelings and don't, what was your reaction?
Ms. Zurawski. It's a good question. It's very complicated.
As Dr. Verma said, everything about abortion is complicated. I
understand that. You know, it gives me a lot of hope to know
that there are people like you and like some of my fellow
witnesses who are fighting for safe and accessible healthcare.
But it's also infuriating to know that there are people who
think that what happened to me was okay and that it should have
happened and that it should continue to happen.
Chair Durbin. Once again, your answer is direct and has
great meaning for me, personally, I hope, for others.
I'd like to ask Dr. Skop a question. Based on your
profession and medical expertise, with a reasonable degree of
medical certainty, tell me when life begins.
Dr. Skop. Ninety-six percent of biologists agree, and I
agree--and this is scientifically proven--that life begins at
the time the sperm fertilize an egg to create a zygote, which
is the first stage in the process of human life.
Chair Durbin. So, the termination of a pregnancy is the
taking of life at any stage after the moment of conception?
Dr. Skop. The legal definition of abortion is an action
performed with the intent to end the unborn human life.
Chair Durbin. So, is the answer in the affirmative?
Dr. Skop. Yes, sir.
Chair Durbin. Do you support Senator Graham's bill?
Dr. Skop. I'm here today in the capacity as a clinician and
as a researcher. And as I've stated in my testimony, I think
there are many reasons to support Senator Graham's bill, based
on the effects that late-term abortions have on women, which I
have noted in my practice can be devastating----
Chair Durbin. But----
Dr. Skop [continuing]. Particularly the case that many of
these women are coerced into these abortions.
Chair Durbin. I'm not--I'm not at that level. I'm trying to
stick to the original question. But it's my understanding that
if you believe an abortion occurs when the pregnancy has ended,
after the moment of conception, then the notion of his bill,
limiting abortion to 15 weeks, suggests that would be the
taking of a human life for 15 weeks after conception. Is that
correct?
Dr. Skop. I understand what you're saying. And there is a
difference between what is politically feasible and what is
morally defensible. And I think our country does need to have a
conversation about the reasons that we are taking human life.
Chair Durbin. In my mind, this gets to the heart of the
issue and the debate. When does life begin? The debate has been
going on for a long period of time, maybe from the beginning of
civilization.
I'm not sure I have the right answer. I'm not sure Dr. Skop
has the right answer. We're trying to find a humane response.
When I listen to Ms. Zurawski, I understand if you start
from the moment of conception and say that she has to weather
what she did, literally at the brink of losing her life before
you could end that abortion, you have to ask yourself, what
about the life of the mother? Is that a critical element too? I
think it is.
Professor Goodwin, you've talked about what women are going
through now with data privacy and the possibility that they're
going to be tracked, as to whether they visit an abortion
clinic and penalized by their home State. Is that a
possibility?
Professor Goodwin. It is a possibility. And already in the
State of Idaho, there is legislation moving forward to track
whether people would leave the State and travel. What we see is
the dismantling, the vulnerability of constitutional principles
that date back centuries. And abortion is being used as a proxy
to dismantle fundamental constitutional principles, including
the right to travel.
Chair Durbin. Dr. Wubbenhorst makes a point about the
number of African-American women who are seeking abortions.
Would you like to respond to that?
Professor Goodwin. Yes, I would. Senator Durbin, in the
State of Mississippi, a Black woman is 118 times more likely to
die by carrying a pregnancy to term than by having an abortion.
The State of Mississippi has notoriously been a death sentence
for Black women, dating back to the time of slavery through Jim
Crow and to the present. And if we don't thread that needle
together, then there's a lot that we are missing.
There is a reason why Black women in Mississippi have
sought to be able to terminate pregnancies for their own bodily
autonomy, for their own safety, for their own health.
Mississippi is one of the deadliest places, not just in the
country, to be pregnant, but it's one of the deadliest places
in all of the industrialized world to be pregnant.
And right now, as there are anti-abortion measures being
spread through what was the U.S. Confederacy, what we see are
the people who are most harmed were the people most harmed
during American slavery and Jim Crow, too, and that happens to
be Black women.
Chair Durbin. Thank you, professor. Senator Graham.
Senator Graham. Thank you. A very interesting discussion,
and I think we need to put it in context of where the world's
at. Dr. Skop--is that right? Are you from Texas?
Dr. Skop. I am from Texas.
Senator Graham. Amanda's situation was terrible. How does--
what happened in Texas?
Dr. Skop. You know, Amanda, I want to say I am so sorry at
your loss of Willow, and I am so sorry that your doctors
misunderstood Texas law. I've reviewed Texas law, of course,
because I practice there, and I want to understand, as well as
all of the other laws in the States. Every single law allows an
exclusion for a doctor to use their reasonable medical judgment
to determine when to intervene in a medical emergency, which is
usually defined as a threat to the life of the mother or
permanent irreversible damage to an organ or an organ system.
None of the States have the terminology that the threat
must be immediate. Doctors know, we, and obstetricians have
always known, even prior to Dobbs, the Hyde Amendment has been
in place since the late 1970s. And the Hyde Amendment allowed
an exclusion for life of the mother. So doctors have been
practicing. And I have not changed my practice in any way since
the Dobbs decision.
The American College of Obstetrics and Gynecology--in
regards to the horrible situation that Amanda found herself in,
pre-viable, premature rupture of membranes, where the water bag
breaks, but labor does not ensue and the baby is a long way
from being able to live outside of the mother, the American
College acknowledges that the risk of infection is high, which
can become sepsis, which can threaten the mother's life. The
likelihood that the baby can make it to an age in which it can
live outside of the uterus is very low.
And they tell us--and obstetricians do follow ACOG's
recommendations for the standard of care. They tell us at the
time of diagnosis that we should offer immediate termination of
pregnancy, which they define as induction, or dilation and
evacuation abortion, or expectant management. So, in a woman
who is not currently infected and sick--I have had patients who
have wanted to stay pregnant, in hopes that they could get the
baby to a gestational age where it could live, but it has
always been the standard of care, and continues to be the
standard of care, to offer delivery at that time. Most of my
patients have opted for induction rather than D&E because they
wanted to have a baby to mourn, but either one could have been
offered, and should have been offered, to Amanda.
Senator Graham. Thank you. Fifteen weeks. Is it fair to say
that a baby has a heartbeat at 15 weeks? Does anybody on the
panel disagree with that? As a matter of fact, the baby has a
heartbeat about 2 months before 15 weeks. Is that right, Dr.
Skop?
Dr. Skop. Twenty-three days after conception, there's a
muscular chamber innervated by electrical impulses pumping
blood cells which are oxygenated throughout the baby's body.
Senator Graham. Does anybody disagree with what I said
about the European standard, that 47 of 50 European nations
limit elective abortion at 15 weeks or less? Does anybody
disagree with that? Good.
The bottom line is, 55,000 babies are aborted after 15
weeks in the United States. Is that right, Dr. Wubbenhorst?
Dr. Wubbenhorst. Yes, that's correct.
[Poster is displayed.]
Senator Graham. And most are elective, so this would
matter. So I'm for my bill. I'm not asking you to be, Dr. Skop,
but I'm for it. And let me tell you why I'm for it. I'd like
America, at some point in time, to say, 15 weeks being pretty
good to me, that a baby is well developed, can feel pain. You
can't operate on the baby medically without anesthesia because
the baby can feel pain in efforts to save its life, to draw a
line.
There's nothing unreasonable about trying to draw a line at
15 weeks when 47 of 50 European nations do that, with
exceptions for rape, incest, life of the mother. What's
unreasonable is allow abortion on demand up to the moment of
birth.
That's exactly what your bill does. That puts you in the
category of China and North Korea. I welcome this debate. We're
not going to back off. We're going to try to have America in
line with the civilized world, not North Korea and China.
Nothing good comes from wholesale abortion on demand at 15
weeks, when the baby can feel pain.
Chair Durbin. Senator Whitehouse.
Senator Whitehouse. Thank you, Chairman. Welcome, to the
witnesses. One of the things I noticed about the Dobbs decision
was that in order to get where the Justices in favor of that
decision wanted to go, they had to change the legal standard
from a balancing of interests to history and tradition.
In a balancing of interests, one of the interests is the
interest of the woman involved in the procedure.
In history and tradition, you go back to ancient history,
before women had rights, like the right to vote, like the right
to have credit without the permission of their husband.
It looked like the rights of women were being deliberately
removed from the equation by the Justices of the Supreme Court.
And in that context, Ms. Zurawski, how did it feel to you? How
did you feel that your rights, your interests, were being
considered as you went through the experience that you had to?
Ms. Zurawski. I felt I had absolutely no right to make a
decision for my own body, for my own health, for the health of
my child. You know, I thought about when my grandfather was in
the hospital, similarly also had sepsis, and my dad and his
siblings were making the decision on how he should receive
healthcare and what kind of treatment he should receive.
And what I couldn't understand in those 3 days, where I had
to sit and wait to get healthcare, is how is it that my dad was
able to make health care decisions for his dad, but I couldn't
make my own health care decisions for myself and for the child
that was inside me? I had no right, I had no opportunity, and
neither did my healthcare team.
Senator Whitehouse. In addition to changing the legal
standard to get the result they wanted, the other thing that
stuck out for me, in that decision, was Justice Alito's
language, that Roe v. Wade--and I'll quote him here, ``was
egregiously wrong from the start.'' So presumably, that means
``the start,'' back in 1973.
Well after that start, while Roe was egregiously wrong,
Alito came before this Committee and he had the chance to tell
us that he thought Roe was egregiously wrong, make that
observation about that case, and instead, he hid that
sentiment.
He said, instead, ``Roe v. Wade is an important precedent
of the Supreme Court. It was decided in 1973. So it has been on
the books for a long time. It is a precedent that has been on
the books for several decades. It has been challenged. It has
been reaffirmed.'' No egregiously wrong, everything designed to
reassure us that he was not going to overturn that decision.
So looking back, he looks a lot like a sleeper agent
predetermined to attack Roe, who wouldn't disclose what he was
up to until he had the majority that he needed to change the
legal standard and destroy the legal precedent. I think it's a
very unfortunate episode in the Supreme Court's history.
Dr. Verma, one of the groups I've heard the most from about
this, in Rhode Island, has been OB-GYN doctors, who express
real horror at what this means for their practice, particularly
in circumstances where a pregnancy has begun to go wrong, where
there are very difficult decisions that have to be made, that
balance the life of one fetus against perhaps another, if it's
twins, against risk to the mother.
And in that context, they view these laws as forcing
decisions, and disabling them from making decisions that are
customary medical practice. Could you comment on that and what
some of the circumstances are that you consider to be most
dangerous with regard to these laws?
Dr. Verma. Absolutely. Thank you for that question. I can
tell you, as the OB-GYN on this panel who provides full-
spectrum care, including labor and delivery and abortion care,
that these laws are creating huge amounts of confusion on the
ground, and preventing people from accessing the healthcare
that they need. We train for years and years to be able to look
at the person in front of us and to make the best health care
decisions with them and their families.
And we're seeing that many people with high-risk
pregnancies are not able to get the abortion care that they
need. You've heard a couple of examples of people that break
their water before the baby's able to survive outside of them.
I also take care of people with medical conditions like really
high blood pressure, where continuing the pregnancy puts them
at risk for things like stroke and preeclampsia. We see people
with peripartum cardiomyopathy, where the pregnancy causes
their heart to enlarge and weaken. And the risk of having that
happen again in another pregnancy is quite high.
For all of these people, we're having to ask ourselves, how
sick do they have to get to be able to intervene? Instead of
just being able to provide the best medical care for the person
in front of us, we're having to figure out, can I do this under
the law? And that's creating huge amounts of confusion and
absolutely preventing people from getting the care that they
need.
Senator Whitehouse. Thanks, Mr. Chairman. I'd like to ask
unanimous consent to let statements from some of Rhode Island's
OB-GYN doctors be admitted into the record.
Chair Durbin. Without objection.
[The information appears as a submission for the record.]
Chair Durbin. Senator Cornyn.
Senator Cornyn. Dr. Skop, if I understood you correctly,
you said that in your medical opinion that the way Amanda's
doctor handled her pregnancy was a deviation of the standard of
care in similar cases. Did I understand you correctly?
Dr. Skop. Yes, sir. ACOG tells us on when it's appropriate
to offer delivery.
Senator Cornyn. Well back, many years ago, I used to handle
medical malpractice cases. And usually, when a medical expert
says that what a doctor did violated the standard of care, that
gave rise to a cause of action for medical malpractice. I was
just curious about that. So, this is an emotional and divisive
issue. There's no doubt about it. That's a statement of the
obvious.
I appreciate, Dr. Skop, your pointing to the difference
between what is moral, which is an individual decision people
make about the appropriate conduct, and then what is possible,
when it comes to building consensus, either among the American
people or the people in a given State, or in the legislative
branch. But I can pretty much guarantee that post-Roe v. Wade,
now that that issue is back in the hands of the State
legislatures, there is--it's highly unlikely there will be a
Federal abortion standard. It requires 60 votes in the United
States Senate, and as you can see, this is a very divisive
issue.
But I want to ask you again, Dr. Skop--I'm just going
through the Women's Health Protection Act. This is what's been
offered by Senator Baldwin and her Democratic colleagues, as an
alternative to States determining what the abortion laws should
be. First of all, can you tell us who Kermit Gosnell was?
Dr. Skop. Yes. Kermit Gosnell was an obstetrician in inner
city Philadelphia, who, for 17 years, his clinic was never
inspected by the Pennsylvania State Department of Health. He
was allowed to perform very unsupervised late-term abortions on
unfortunate, poor, minority women and when--it was actually, I
think, I believe a pill mill through which the State started
investigating him. But it was determined that there were women
who had died under his care, that his clinic was very squalid
conditions.
There was evidence that babies had been born alive, and
then he committed infanticide. And he is currently serving time
in prison. He's an example of what happens if we allow politics
to keep us from supervising abortion providers, to make sure
they're performing adequate care. And unfortunately, under this
legislation, we may see more providers like that.
Senator Cornyn. Well, there's a cottage industry here in
Washington, DC, naming legislation in ways that are the
opposite of how they actually function. I'm thinking of the
Inflation Reduction Act, which didn't actually reduce
inflation, for example, but this legislation that Senator
Durbin and others are proposing is so-called the Women's Health
Protection Act. If it were more accurately named, it seems to
me it might be the Kermit Gosnell tribute act, because it would
eliminate all restrictions, at the State or Federal level, on
access to abortion.
The bill text says, ``It supersedes and applies to all
Federal and State laws and that no law in conflict with this
shall be enforced.'' It allows the access to abortion through
all 9 months of pregnancy, including late-term abortions. It
doesn't speak to infanticide, but we can imagine what would
come next.
The Hyde Amendment, which you alluded to, which has
provided for many years now, since the 1970s, that no tax
funds, no taxpayer funds should be used--could be used to fund
abortion, would be overruled.
All parental consent and parental notification laws--if
your child became--adolescent child became pregnant, you would
have no right to know of their seeking access to abortion, or,
certainly, no right to consent. If someone wanted to get an
abortion because they had a female baby, and they wanted a male
child, this law would--this proposed law would overrule that
restriction and allow sex-selection abortion. I could go on and
on and on, but I don't believe that the proposal that Senator
Durbin and his Democratic colleagues have made represents the
consensus in this country.
We all have a right to our own moral judgments, but when it
comes to the laws of the land, no one has a right to impose
their personal views on everyone else, which is what Roe v.
Wade did. The Supreme Court took that out of the discussion
among the American people, or the halls of Congress, or the
State legislators, and said that you could not pass a law
regardless of where the consensus was, effectively allowing
abortion on demand through--till the time of delivery.
So we need to solve this problem, but we're not going to
solve it in Congress. This is going to--this is now being
debated, should be debated and be resolved in the State
legislatures around the country. Thank you, Mr. Chairman.
Chair Durbin. Since Senator from Texas mentioned my name
several times, I'd like to make a point for the record.
In 2013, Dr. Kermit Gosnell, a physician in Pennsylvania,
was found guilty on three charges of infanticide, murdering
babies born alive in his clinic after botched late-term
abortions. Gosnell was also found guilty of involuntary
manslaughter and the death of a woman who was undergoing an
abortion in his care.
He was sentenced to life in prison, without the possibility
of parole. I might remind the Senator this happened while Roe
v. Wade was the law of the land. To suggest that it somehow
would absolve that kind of conduct is just plain wrong.
Senator Cornyn. Thank you, Mr. Chairman. You don't need to
remind me.
Chair Durbin. Senator Klobuchar.
Senator Klobuchar. Ms. Zurawski, thank you for sharing your
difficult story with all of us today. As you know, nearly half
the States in the country have now enacted restrictions, or are
moving toward bans. Twelve States are enforcing near-total bans
on abortion.
In your testimony, you say that traveling to another State
for care was not an option for you because you would have had
to drive 8 hours and risk, what you called, the death sentence
of developing sepsis, which can kill quickly in the middle of
the West Texas desert or 30,000 feet above the ground. What do
you want people to know about the risk that bans, and
restrictions placed on women experiencing miscarriages?
Ms. Zurawski. Thank you for that question. So first, I'd
like to revisit something that Senator Cornyn brought up in Dr.
Skop's response because I'd like to make it clear that Dr. Skop
is not my physician. She has never been my physician. She has
never treated me. She has not seen my medical records.
Quite frankly, my physician and my team of healthcare
professionals that I saw over the course of 3 days, while I was
repeatedly turned away from healthcare access, made the
decision to not provide an abortion because that's what they
felt they had to do under Texas law. And that will continue to
happen. And it is continuing to happen. And it's not a result
of misinterpretation. It's a result of confusion.
And the confusion is because the way the law is written,
the language in the law is incredibly vague. And it leaves
doctors grappling with what they can and cannot do, what
healthcare they can and cannot provide. And if they make the
wrong decision, they face up to 99 years in prison and/or
losing their license.
And in my opinion, that was intentional because after the
Dobbs decision, the administration put out guidance for when an
abortion can and cannot be, or should or should not be
provided. And the State attorney general in Texas, Ken Paxton,
hated that so much that he sued the Government to overturn
those guidelines. And so, what happened to me is exactly what
he wanted to happen.
Senator Klobuchar. And your point is that right now we have
a patchwork of laws across this country. And if we would enact
some Federal standards here and codify Roe v. Wade into law,
which was a law of land before this, this wouldn't have
happened to you?
Ms. Zurawski. That's right.
Senator Klobuchar. Okay. Thank you. Dr. Verma, how do the
medical consequences of delaying care impact women?
Dr. Verma. They impact women significantly. We are seeing--
I am practicing in Georgia, where we have a 6-week ban in
place. And we're having to turn away patients for all kinds of
reasons: people that have irregular periods that don't realize
they're pregnant until after 6 weeks; people that are
diagnosed--their babies are diagnosed with terrible fetal
anomalies on their 20-week ultrasound; people that develop
worsening medical conditions during their pregnancies.
And because they can't access their care in our State, even
though their doctors are trained to provide that care, they're
having to figure out if they can go out of State, get the
resources together, take time off work, figure out childcare.
Senator Klobuchar. What impact would a national ban on
mifepristone have on your ability to care for your patients?
Dr. Verma. It would have a devastating impact on our
ability to care for our patients. We know, based on decades of
evidence, that mifepristone is incredibly safe and effective
and can be used in combination with misoprostol for both
medication abortion and management of miscarriages. It's an
incredibly important treatment for our patients to have
available to them.
Senator Klobuchar. You know, since Dobbs, States like
Minnesota and Illinois have become islands of care in the
middle of the country. We are the States that are the islands
of care. In 2022, Whole Woman's Health of Minnesota and
Bloomington saw the percentage of out-of-state patients that
they treated increase to more than double the numbers in 2019.
Since Dobbs, have you seen influxes in patients going between
States to access care?
Dr. Verma. Absolutely. We're seeing patients trying to get
out of State to get the care that they need, although we also
know that many people are not able to do that and are being
forced to continue pregnancies that put their health at risk,
that are being forced to deliver because they don't have the
resources to get out of State.
Senator Klobuchar. Okay. Thank you. I'm going to ask one
question, in my remaining time of you, Professor Goodwin. One
judge in Amarillo and two on the Fifth Circuit would have
entered an injunction, setting limits, saying you cannot
receive mifepristone by mail. You can't get it over the counter
in the pharmacy, that they're going to have it be available,
not in up to 10 weeks, but 7 weeks instead.
And as you know, that's currently on hold. And one of the
things the Justice Department argued was that the doctors who
brought this case--unlike the American Medical Association,
that's made it very clear that this drug is safe, and it's been
used in 60 countries, over 23 years in America. The Department
of Justice--those few doctors that brought this case argued
that the Department of Justice said they should not be able to
sue because they hadn't been impacted by the approval of
mifepristone, and they were not going to be impacted in the
future, unlike someone, say, that we've just heard from, Ms.
Zurawski.
So, I thought this was interesting because, as you know,
Justice Scalia has made similar comments to this, where he
rejected a lawsuit, saying it would make a mockery of our prior
cases. That basically, you wouldn't have the standing to bring
a case when you haven't had harm or expect to have harm.
Quickly, do you want to comment on that and what----
Professor Goodwin. Well----
Senator Klobuchar [continuing]. Standing really means and
why this case should fall on the standing of those that brought
it?
Professor Goodwin. The case itself was absurdist. What the
petitioners claimed was that the FDA had rushed to judgment
with approving this drug. That drug spent over 54 months of
review--2000 it came into the marketplace. Other drugs that
were approved, in that same period, had spent 15 months of
review. What we know is that it's safe. It's a drug that had
already been used in Europe. And in 23 years, since it was
approved in the United States, we know that the safety of
mifepristone is--that it's far safer than penicillin, Tylenol,
even Viagra.
The claims that somehow these petitioners, including a
dentist, will somehow be overwhelmed with patients who have
used mifepristone but who will seek their care, is truly
absurdist. Because in 23 years, that has not happened. That has
not been the experience of the petitioners at all. And it is
worth noting that this was a form of forum shopping, looking
for a very specific judge who had already articulated anti-
abortion views and placing a petition before that specific
judge.
Senator Klobuchar. Thank you.
Chair Durbin. Thank you. Senator Grassley.
Senator Grassley. Dr. Wubbenhorst, could you explain how
women can still receive compassionate and necessary medical
treatment from pregnancy complications without their provider
performing an abortion?
Dr. Wubbenhorst. Yes, sir. Thank you for the question. I
think that, as I said earlier in my testimony, when women
experience complications--and in my career, I have had
literally hundreds of women, both here and in other countries,
have complications requiring delivery. When you are performing
a procedure to save the life of the mother, it is not morally
considered an abortion, and therefore, it is ethically
permissible. Compassionate care means that you consider the
circumstances carefully, you act in the best interest of both
patients.
If the death of the unborn child is a result of your
intervention, that is a tragic outcome, but nonetheless, our
priority is to save the life of the mother and preserve her
functioning. And that can be accomplished without performing an
abortion.
Senator Grassley. Dr. Skop, there's been discussion of
long-term health impacts of complications from pregnancy. Data
suggests that both chemical and surgical abortions can cause
adverse and life-threatening health impacts. Can you briefly
explain and discuss the possible complications and impact on
health of women that can arise from abortions, including
surgical abortions, or the use of the abortion pill?
Dr. Skop. Yes, sir. Thank you for that question. So, in my
30 years practicing caring for women, I've cared for many women
who have been harmed by abortion. I've cared for a woman who
died of a second-trimester abortion from sepsis. I have--in my
practice, another young girl died from sepsis after a first-
trimester surgical abortion in which her uterus had been
perforated. I've cared for many, many women who have explained
to me that their anxiety and depression is due to their
unresolved guilt over an abortion.
I trust those women to tell me what the cause of their
concerns are. I've seen women who self-harm. I've seen women
who turn to substance and alcohol use and abuse due to this
guilt that they have regarding chemical abortion.
And I would like to state that, so that everyone is aware,
the United States does not have any Federal mandates to report
any data about abortion. We do not know how many abortions
occur. We do not know the complications. And we certainly don't
know the deaths because, as I reported, it's well known that
mental health deaths can follow abortion. And our CDC does not
try to make that linkage at all. Countries that have made this
linkage have documented far higher mental health deaths in the
year following abortion, compared to childbirth, including six
times as many suicidesy.
But regarding chemical abortion, the industry tells us it's
safer than Tylenol. They're comparing Tylenol-overdose deaths
to the undercounted deaths from chemical abortion. There's no
comparison. Women assume they mean normal Tylenol use. They
don't realize that they're comparing it to deaths that happen
from overdoses. The abortion industry tells us about the
complications they know about, but my experience has been,
because the women have been assured it is so safe, when they
have a complication, they do not return to the abortion
provider. They come to me, as their gynecologist, or they come
to the emergency room in distress.
And so, when we look at good quality records, linkage
studies that detect all chemical abortions and all subsequent
events, we find 5 to 6 percent of these women present to an
emergency room within a month. Approximately the same number
will require surgery because their bodies cannot evacuate all
of the dead tissue.
And I am still hearing--for these complications in Texas,
even though we've had abortion limitations for quite some time,
because these drugs are circulating in the State to try to
circumvent our State laws and provide abortions to these
unfortunate women.
Senator Grassley. Dr. Wubbenhorst, in your opinion, how can
we approach reducing mortality rates from pregnant women? And
you might also touch on the fact that, why is unrestricted
abortion not a solution to this issue?
Dr. Wubbenhorst. Thank you for the question. The solution
to maternal mortality--and I've been working in this area
globally and in the United States for many years--is to improve
health care, health education, and to increase support to
pregnant women. Abortion does nothing to address any of those
issues. The main causes of maternal mortality have been for
years, and in the most recent CDC data from 2021, are deaths
from cardiovascular causes, infection, embolism, and so on and
so forth. Abortion will not reduce those deaths.
There is no argument and no paper anywhere that shows that
abortion reduces maternal mortality. There are studies that
purport to do so, but when you look at the essence of the
studies, what they're saying is that, well, if you reduce the
number of women at risk by performing abortions in them, that
somehow reduces the number of mortalities.
In point of fact, we cannot predict exactly who will have a
poor outcome. We cannot predict who will have an adverse
maternity outcome. And so, that asks the question, what percent
of high-risk pregnancies should we abort? Twenty percent?
Thirty percent? Forty percent? I think the other issue really
relates to community and civil society engagement in terms of
helping women to have better outcomes for their pregnancies.
Senator Grassley. Thank you, Mr. Chairman.
Chair Durbin. Senator Blumenthal.
Senator Blumenthal. Thanks, Mr. Chairman. Thank you, all,
for being here today. And I want to begin by thanking Ms.
Zurawski, particularly, for your courage and sharing your story
today, but also, Dr. Verma, to you and all the OB-GYNs, all the
healthcare providers, the nurses, the escorts who are at
clinics around the country, providing protection and care in
the face of the danger--real, physical, as well as emotional
jeopardy inflicted on them, I think you are a profile in
courage, as well.
In Connecticut, we now have laws, thanks to our State
legislature, that help to protect women in other States because
we guarantee these rights in Connecticut. But in other States,
they come to Connecticut to exercise reproductive rights
because of those dangers that you face every day in Georgia.
When I first introduced the Women's Health Protection Act
10 years ago, the idea that Roe v. Wade would be overruled, in
fact, was unthinkable because it was well-established
precedent. It was long accepted under the principle of stare
decisis.
And three nominees came to this room to be confirmed before
our Committee and agreed that it was long-established
precedent. And under that doctrine of stare decisis, they could
not see how it would be overruled. They didn't refer to that
case. They made no promises, but they led us to believe that
they believed that the integrity of Supreme Court precedent
should be respected. I think the best way to refer to their
testimony here--and I'm talking about Justices Gorsuch, Coney
Barrett, and Kavanaugh--is that it was disingenuous.
And I think a number of my colleagues would agree. Senator
Whitehouse referred earlier to testimony from another Justice,
who perhaps had in mind the same result, despite Supreme Court
precedent, that is Justice Scalia. And their concluding, as
they did in Dobbs, that Roe v. Wade was wrong--with barely a
few years after they established their respect for it--I think
has helped to undermine the integrity and credibility of the
Court.
I would like to ask you about, not the legal issues here,
Dr. Verma, but, in hearing some of what has been said about the
medicine, about the healthcare issues, whether you would like
to correct some of what has been said here, and just give you
the opportunity to respond. Because I trust women to make these
decisions, not politicians or judges or Senators. And I want to
know what women should know from you in the face of what I
think has been some disinformation here, medically.
Dr. Verma. Absolutely. And thank you, Senator, for that
opportunity. So I want to start by saying that the American
College of OB-GYNs, which represents over 60,000 OB-GYNs across
the country, along with over 75 other major science-based
medical societies, have identified abortion care as incredibly
safe, essential healthcare.
This is not one profession. This is not one society. This
includes the American Medical Association, the American Academy
of Family Physicians, of Pediatrics, of Surgery, of Anesthesia.
This is--the science on this is settled. Abortion care is
incredibly safe, essential healthcare. This is the consensus of
the science-based, evidence-based medical community.
In addition, the American Board of OB-GYNs, which is the
board that certifies all of us OB-GYNs at this table, has
identified abortion care as incredibly safe, essential
healthcare, with risk of serious, major complications of less
than 1 percent and has actually said that misinformation about
abortion--spreading misinformation about abortion is medical
unprofessionalism.
In addition, we heard some people bring up Kermit Gosnell.
What he did was terrible. To say that that represents the
reality of abortion care in this country does a disservice to
me, my colleagues, and my patients. I see my patients accessing
abortion care from a place of compassion every day, compassion
for themselves, their existing families, their children.
When we see a patient, we give them all of their options,
that includes talking to them about adoption, continuing the
pregnancy, and abortion, and confirm that they are completely
sure before moving forward. And we provide them with abortion
care in a safe, compassionate way. If someone chooses to
continue a pregnancy, I'm also very happy to support them in
that and deliver their baby.
I do all of OB-GYN. I think that focusing on people have
experiencing regret does a disservice to our patients, who are
making these informed decisions about their health care and
lives, and are experts on their own lives. We also have
excellent data from the Turnaway Study, which followed 1,000
women for over 5 years----
[Gavel is tapped.]
Dr. Verma [continuing]. And showed that the most common
emotion after an abortion was relief.
Senator Blumenthal. Thank you, very much. Thank you, Mr.
Chairman.
Chair Durbin. Thanks, Senator Blumenthal. Next is Senator
Lee.
Senator Lee. From time to time, the Supreme Court corrects
prior errors. It happened with Plessy v. Ferguson, which was a
bad decision. We've all acknowledged that that, along with Dred
Scott, along with Korematsu, are bad decisions. I like it when
the Supreme Court is able to correct prior errors. That is what
occurred with Dobbs. Dobbs corrected a prior error.
It's difficult to endure hearing people say that they're
worried about the credibility of the Court when sometimes those
words are uttered by people who are themselves actively,
willfully, deliberately attacking the credibility of the Court,
sometimes as officers of the Court. We're seeing this through
unfair attacks on Justice Thomas and other members of the U.S.
Supreme Court, and it's got to stop. Look, Dobbs was right.
As a matter of constitutional law, this is a matter, not
for this Court's to decide, but for elected lawmakers,
typically in State legislatures, not our national legislature.
So, if you don't like the policy outcome, go to your State
legislature, but this is not an issue in which the Federal
judiciary is somehow empowered. There is no reproductive rights
clause of the U.S. Constitution. So let's not pretend that
we're worried about the credibility of the Court if we are
simultaneously attacking the credibility of the Court and its
ability to do its job.
Now, a lot of these issues relate to this legislation
that's been introduced in the wake of the Dobbs decision, which
is itself way more radical, even than Roe v. Wade was, and way
more radical than where Americans are comfortable going. You
know, 69 percent of Americans are uncomfortable with abortion
after the first trimester, 69 percent. But you'd never guess
that from the way Democrats in the United States Senate vote on
these issues, where essentially, all of them support, or appear
to be comfortable with, second- and third-trimester abortions.
In fact, all but, I think, two Members of the Democratic
caucus in the United States Senate voted against the Born-Alive
Abortion Survivors Act. And so, this legislation Democrats are
now pushing would prohibit any State law from regulating
abortion within a State's borders, essentially ever, not to
protect girls, not to protect women, not to protect health,
safety, and welfare, not to protect the rights of a baby born
alive.
Now, putting aside for a moment the life of the child, when
considering the health impact of abortion on women, I think
there are important considerations to make.
Dr. Ingrid, I'd like--Dr. Skop, I'd like to start with you.
What concerns do you have for the physical and mental well-
being of women who have late-term abortions?
Dr. Skop. It's well established that women who have late-
term abortions are at much higher risk for mental health
complications, as we mentioned, anxiety, depression, substance
use and abuse, and suicidal ideation and self-harm.
Senator Lee. Let's talk about suicide for a minute. Those
who have second- or third-trimester abortions, late-term
abortions, do they have--what do their higher suicides look
like?
Dr. Skop. In the United States, we do not have data on this
because, as I mentioned, it's--backing up to maternal
mortality, this is--data is collected until a full year after
the end of the pregnancy. And it is virtually impossible
because the CDC mostly looks at death certificates. It's
virtually impossible to link, say, a coerced abortion----
Senator Lee. To the causation.
Dr. Skop [continuing]. And a suicide 6 months later----
Senator Lee. Right, right.
Dr. Skop [continuing]. And I don't think that there are
many efforts to do this.
Senator Lee. By the way, how many, how many abortions are
medically indicated, medically necessary?
Dr. Skop. Using the definition that the intent is to kill
the baby, I would say none. As we discussed earlier,
occasionally, there is the need to do a separation of the
mother and the baby. The intent in that case is to save the
mother, and that sometimes the baby regrettably dies, but even
if you use that death, or if you said that, well, that counts
as an abortion, it's still far less than 1 percent of the
abortions in our country.
Senator Lee. Very good to know. Now if, as you have noted,
women are four times more likely to experience serious medical
complications from a chemical abortion as a surgical abortion,
why is the abortion industry pushing chemical abortion? Does it
have more to do with the fact that it's an industry that makes
a lot of money off of that?
Or does it have more to do with the fact that that
dispenses with a lot of inconvenient things, like the fact that
we've got Planned Parenthood clinics that have been caught on
tape telling girls not to tell the age of the person having the
abortion because then they would have a duty to report it? What
is that? What's causing that?
Dr. Skop. I think there are definitely advantages for the
abortion industry to promote chemical abortions. They don't
have to hire a surgeon, pay for sterilization of instruments,
and the costs that go along with that. And the reality I would
like to acknowledge is that, again, about 90 percent of
obstetricians do not perform abortions.
And even obstetricians who claim to be pro-choice, many of
them will not perform surgical abortions. So I think there was
a staffing issue that began the promotion toward chemical
abortion. There may be some advantages in terms of funding, but
now that we see----
Senator Lee. Is there a profit motive perhaps? Could that--
--
Dr. Skop. There was a time that the cost of a surgical
abortion and a chemical abortion were approximately the same,
an average of about $575, but I think we also see, in light of
States beginning to have pro-life restrictions, that this is a
way to get around those restrictions and provide abortions in
States that are trying to protect unborn life.
Senator Lee. Thank you. Thank you, Mr. Chairman. I see my
time has expired.
Chair Durbin. Senator Hirono.
Senator Hirono. Thank you, Mr. Chairman. Dr. Skop says that
Ms. Zurawski's doctors misinterpreted Texas law which
criminalizes abortion. So, her doctors were acting under advice
of the hospital's ethics committee, which includes lawyers. So
to suggest that doctors should ignore the advice and the
cautions of their own ethics committee is not realistic.
So, Professor Goodwin and Dr. Verma, wouldn't you agree
that the Dobbs decision led to this kind of chaos, as to
appropriate care to be provided in that----
Professor Goodwin. Absolutely----
Senator Hirono [continuing]. Situation?
Professor Goodwin [continuing]. Right, Senator. The Dobbs
decision did unleash a torrent of uncertainty throughout the
United States, where doctors fear losing their medical license
to practice if they intervene before the law says that they
should, these laws. They also fear criminal punishment and
civil fines. As I mentioned, in the State of Texas, there can
be criminal punishments up to 99 years----
Senator Hirono. Mm-hmm.
Professor Goodwin [continuing]. Incarceration fines up to
$100,000. These are some of the considerations that doctors
struggle with, including then, losing their medical license to
practice.
Dr. Verma. Absolutely.
Senator Hirono. Dr. Verma.
Dr. Verma. Every individual, person, pregnancy, and family
is different. And the reason we train for so long as doctors is
to be able to look at the unique person and medical situation
in front of us and make decisions with them about the best
course of action.
When we have to think about what the law says, and if a
patient is sick enough for us to be able to legally provide
them care without risking criminal prosecution or losing our
livelihood, that delays care. It prevents people from getting
the care that they need then.
Senator Hirono. I think to expect that doctors and hospital
personnel will risk losing their license or being held
criminally liable, that is something that--that is a risk that
I would say a lot of doctors and others wouldn't want to take.
Professor Goodwin, we've heard today that women are coerced
to have abortions. Is that the data, that women are coerced,
not that women freely choose to have abortions? Can you
enlighten us?
Professor Goodwin. Sure. Thank you so much for that
question. The coercion is the coercion to be pregnant, to
remain pregnant, States enacting coercive laws that force
women, girls to endure pregnancies that they do not want,
pregnancies that may be the result of rape and incest,
pregnancies that may threaten their health. This is what is
actually taking shape by these laws. And it's worth noting the
historical arc of this. We cannot forget that forced pregnancy
was also a feature of American slavery.
And we must remember that the effort to ratify the
Thirteenth Amendment, which abolished slavery and involuntary
servitude, specifically related to the forced pregnancies that
were placed upon Black women and girls, that they had to
endure. These forced pregnancies were so normalized that
advertisements in the 1700s and the 1800s tell us quite clearly
what it was that they endured. And if you will, let me just
read a couple of them to you, just so that we know exactly what
the Senators were trying to get rid of in American slavery.
They included advertisements such as the following:
``Runaways. The following Negroes ran away or absconded from me
on Friday last, a Negro woman named Lena, about 18 years of
age, and her child named Mary, about 2 years old. Mary is a
bright mulatto child.'' That's from the Republican Star, 1811,
Eastern Maryland.
``$5 reward. Ran away on Tuesday the 13th. The subscribers'
Negro girl named Maria, with her female mulatto child, about 9
months old. Maria was lately the property of Dr. Thomas
McCall,'' March 22nd, 1810, Charleston, South Carolina.
``For sale or exchange, a young, healthy Negro wench and
child. 'Tis not convenient to have a breeding wench in the
family,'' Virginia Chronicle, March 9th, 1793.
These kinds of advertisements were what Senators read as
they drank their morning coffee and orange juice.
So deeply troubling that baked into the story of American
slavery and abolition is the story of sexual terrorism
inflicted on Black girls and women. So troublingly normalized
that the descriptors ``breeding wench'' and ``mulatto child''
simultaneously read as mundane daily affairs and horrors.
Senator Hirono. Thank you, very much, Professor, for
reminding us there was a time when women did not own their own
bodies. And that is exactly where we are today, as far as I'm
concerned, that women in this country, persons are not able to
make free choices about their bodies, and what--what, to be
forced to have a child is probably the most freedom-taking
thing that we can impose upon anyone in this country.
And thank you for that reminder. Professor, you also
mentioned about judge shopping or forum shopping. I think this
is an issue that we need to face in this country, also. It was
very clear that in Texas, which has 27 divisions, 20 of which
has only one judge--it was so clear that there was judge
shopping going on with that judge. And would you--would you say
that we should do something to prevent judge shopping?
Professor Goodwin. The forum shopping that took place was
quite clear in this case----
[Gavel is tapped.]
Professor Goodwin [continuing]. As Judge Kacsmaryk had in
fact expressed anti-abortion views and activism. And most
recently, it's been disclosed that he removed his name from a
law review article that was going to be published at the
University of Texas, that also further explained his anti-
abortion views. And that name was removed before he came before
the Chambers for confirmation. So something does need to be
done.
Senator Hirono. Okay. Thank you for that.
Chair Durbin. Thank you, Senator Hirono.
Senator Hirono. Thank you.
Chair Durbin. Thank you, very much. Senator Cruz.
Senator Cruz. Thank you, Mr. Chairman. There's probably no
issue in modern American politics that engenders sharper
disagreement than the question of abortion. I think everyone
here agrees on that. It's a deeply moral issue that reflects
our values, who we are as a country. It's an emotional issue.
It's a personal issue on which people feel very strongly. I
believe the American people should decide abortion policy. I
believe that's what our Constitution designs. Unfortunately, my
Democrat colleagues on this Committee disagree.
They do not believe in democracy when it comes to the issue
of abortion. They want unelected judges to set one standard for
the entire country. And if the voters disagree, the voters have
no choice. And look, the reason the Democrats want this issue
to be out of the hands of the voters is quite obvious, because
the modern Democrat Party is wildly out of step with the
American people on the question of abortion.
The current position of virtually every Democrat Senator in
this body is that abortion should be absolutely unlimited,
available up until the moment of birth and even, shockingly, in
some instances, after birth, that partial-birth abortion should
be fully legal, that there should be no parental notification
and no parental consent, no matter how young the girl is, who
may be seeking an abortion, and that all of it should be funded
by taxpayer money. Now, that is an extreme and radical view.
How extreme and radical?
Well, according to a Harvard-Harris poll from last year, 10
percent of Americans, only 10 percent, support abortion on
demand up until the point of birth. That's the position. If you
want to be a Democrat in the Senate, that's the position you
have to embrace because that's where the money is. That's where
the activists are. That's where the angry voices are, that fuel
a Democrat campaign. But 90 percent of Americans look at that
position and say, we disagree.
And so, you understand now why my Democrat colleagues don't
want this decision decided by the voters. Because if 90 percent
of the voters disagree with the extreme policy decision they've
embraced, their position will not prevail at the ballot box.
And by the way, it's not just the voters in the United States
who disagree with Senate Democrats on this. It is virtually
every voter on planet Earth.
The United States is such an extreme outlier. Out of the
entire country, there are only seven countries on Earth--out of
the entire planet--that allow abortion after 20 weeks. And yet
every one of my Democrat colleagues wants to do so. Europe,
virtually all of Europe, including the left-wing socialists,
the Greens there, they think the Democrats in this body are
loons on this issue. Sweden has an 18-week limit on seeking an
abortion. None of my Democrat colleagues would vote for
Sweden's law. France has a 14-week limit, France. None of my
colleagues would vote for France's law. Germany and Luxembourg
have 12-week limits. And the position of Democrats is 40 weeks
up until the very moment of birth. No limits at all. That's a
horrifying position.
I suppose my Democrat colleagues can comfort themselves
with the company they're in. Communist China, Iran, and North
Korea, and the National Democrat Party, they all have the same
view, those tyrannies, at least, are explicit, which is life
has no value. And so, they don't embrace any limits.
And by the way, look, there's so much rhetoric on this
issue that a skeptical listener would be justified doubting
what any of us are saying, but if you don't believe what I'm
saying, look to the votes.
In the wake of the Supreme Court overturning Roe and
sending this decision back to the voters so the voters could
decide, what did my colleagues in the Senate do? Promptly voted
on a bill that would strike down just about every reasonable
restriction in the country, that the voters have decided--to
legalize partial-birth abortion, to provide no protection for
unborn children. Those are extreme positions.
And Dr. Skop, I'd like to ask you, what is unlimited--what
are the consequences of unlimited abortion on demand? What does
a 40-week or a 36-week unborn child who is enduring a partial-
birth abortion, what does that child experience if that
procedure is allowed to happen?
Dr. Skop. A partial-birth abortion delivers the baby
intact. So the very first thing that would happen is that the
woman's cervix must be aggressively dilated to a large dilation
that is very likely to damage her cervix. And several high-
quality systematic reviews have documented increased risk of
preterm birth in a subsequent pregnancy after a procedure like
that. So not only is it hurting her this time, it will lead to
further complications, such as cervical incompetence. The baby,
generally, is not killed first.
As I reported, 70 percent of late-term abortion providers
say they do not routinely do this. These babies are highly
likely to continue to live throughout the process of labor.
They're delivered as a breech, and their head is crushed. So
that would be the point when they would die, is when their head
is crushed.
Other late-term abortion, I mean these--they're blind
procedures in many cases. So the instruments could damage the
uterus. They could puncture the uterus. There are a number of
horrible consequences documented, where adjacent bowel has been
disrupted, urinary tract injuries, hemorrhage. There is really
no reason that an abortion needs to be done that late, ever.
Senator Cruz. Thank you.
[Gavel is tapped.]
Chair Durbin. Senator Booker.
Senator Booker. Thank you, Mr. Chairman. I want to thank
all the witnesses for being here today.
Ms. Goodwin, I'm appreciative of your scholarship. And I
want to ask you to maybe go a little bit deeper with me when it
comes to protecting women. The testimony by Ms. Zurawski and
Dr. Verma were really compelling to me, but the data is really
stunning. U.S. women are more likely to die during or after
pregnancy than anywhere else in the world--in the developed
world, excuse me. And public health experts are predicting that
this will get a lot worse.
Right now, the United States is only 1 of 13 countries in
the entire planet where maternal mortality rates, deaths of
women from pregnancy until 1 year postpartum, as worse today--
worse today than it was 25 years ago. We know that a 2022
University of Colorado study projected that in the first year
following a nationwide abortion ban, the number of maternal
deaths would increase 13 percent. And in subsequent years,
maternal deaths could increase 24 percent.
And the Commonwealth Fund found that States with heavily
restrictive abortion access in 2020 had maternal mortality
deaths that were 62 percent higher than they were in States
where abortion access was easily more accessible. I mean these
are stunning numbers when we're talking about the health and
well-being of women in this country, but you went one step
further. And I'd like for, maybe, this to be the second layer
of your response about the stunning realities for Black women.
Professor Goodwin. That's right. And thank you so much,
Senator Booker, for your question and also your commitment on
these issues. For Black women, it's devastating; nationally,
three-and-a-half times more likely than their white
counterparts to die during, or shortly after, pregnancy, but
that's nationally. When we go to certain counties and cities,
then it can be 5 times, 10 times, 15 times more likely, their
deaths, than their white counterparts.
I'd also like to correct the record here because there's
been much said about the history of eugenics being one that was
portrayed on Black women. To clarify, in 1927, the case Buck v.
Bell, which is a horrific case that introduced eugenics into
the United States, was a case that explicitly involved a poor
white woman. And this is important because it's a commentary
that Justice Thomas has made, and we've heard today, that early
eugenics was about Black women.
It was a horrific campaign that was targeted at poor white
people like Carrie Buck, in the State of Virginia. And it was a
law then, the eugenics law, that spread throughout the United
States, but that history is important because of inaccurate
conflations. It is true that later on, during Jim Crow, when
Black women demanded more, such as voting rights, such as
equality, that the Mississippi appendectomy, which was coercive
sterilization, was introduced.
And it's worth threading the needle because the person who
helped us learn about that was Fannie Lou Hamer, as she
threaded together the lack of bodily autonomy, the lack of
voting rights. And especially, as there are those that say,
take this to the democratic process, what does that mean in
States where Black people have historically been
disenfranchised from voting, including Mississippi, Georgia,
and other States with abortion banned?
Senator Booker. Thank you. Dr. Verma, I've been working on
maternal mortality issues since I came to the Senate and since
I discovered how stunning the numbers are in our Nation,
relative to other countries, how many women are dying in
childbirth. And the fact that Black women are three-and-a-half
times more likely is stunning, and I'm wondering--the data that
I'm looking at from, you know, non-partisan, I should say
independent, science-based research really are predicting that
these rates that are already horrific in our country are going
to rise.
And we heard the testimony of Dr.--excuse me, of Ms.
Zurawski. Could you just give us, from your professional
standpoint, an understanding that, again, this hearing, often,
they're set out to be about something, and then they get spun
off, but this hearing really is about the consequences for the
health and well-being after the Dobbs decision. These
staggering numbers, some of which I read--what is your
experience? And how do you see the next months, if not years
ahead.
Dr. Verma. Yes, absolutely. Thank you for that question. So
we've seen in the data that there is a link between places with
abortion restrictions--stricter abortion restrictions and
higher rates of maternal mortality in the United States.
Georgia has one of the highest maternal mortality rates in the
country and has very strict restrictions on abortion. And we've
seen, based on data out of places like Texas, that even when
these laws have exceptions for things like medical emergency,
we've heard about the confusion on the ground.
And we've seen in the data that people with high-risk
pregnancies still have a harder time----
[Gavel is tapped.]
Dr. Verma [continuing]. Getting the care that they need,
and often are denied that care. And so, we absolutely expect to
see more people getting hurt because of these laws. I also want
to just correct--so abortion care, again, is incredibly safe.
We've read a couple of mentions of it being a blind procedure.
As the one OB-GYN on this panel that does do full-spectrum
reproductive healthcare, including abortion care, we do this
procedure incredibly safely with ultrasound guidance.
I also want to address that, again, what Chairman Durbin
said earlier, that in this country, 90 percent of abortions
occur in the first trimester. Less than 1 percent occur after
20 weeks. And when abortions do occur later in pregnancy, it is
usually because something has gone terribly wrong with the
patient or the pregnancy. Abortions up until the moment of
birth simply do not happen. That does not reflect the reality
of abortion care in this country.
In addition, what the Democrats are trying to do here is to
allow people to make these important decisions----
[Gavel is tapped.]
Dr. Verma [continuing]. Without legislative interference. I
perform abortions for grandmothers, for adolescents, for
doctors, for people of faith, for people who never thought that
they would need an abortion. What each of my patients needs the
ability to do is to make these important decisions themselves,
about their health care and their lives.
Senator Booker. Thank you, Dr. Verma. Thank you, Mr.
Chairman.
Chair Durbin. Thank you, Senator Booker. Senator Tillis.
Senator Tillis. Thank you, Mr. Chair. Thanks to all the
witnesses for being here today. Special thanks to Dr.
Wubbenhorst, from my home State, for being here.
Dr. Wubbenhorst, just one point. I've had somebody ask me
what legislative measure I was most proud of when I was speaker
of the house. And I told them that it was compensation for
eugenics victims in North Carolina, first State to ever do it.
And Professor Goodwin, I would say I studied the issue a
lot to get support. And it's very clear it was
disproportionately racially motivated, beginning with the late
1950s, on into the early 1970s, when I've met a victim of the
Mississippi appendectomy, who's about my age, who found out
when she was trying to have a child that she had been
sterilized.
Dr. Wubbenhorst, I've noticed you during the--I was here
for all the testimony--I noticed you take a lot of notes. So
the first question I have--I hate to put you on the spot--are
there any points that have been made here that, in the
questions asked at this point, to this stage, that you would
like to either clarify or take a counter position from some of
the other witnesses' testimony?
Dr. Wubbenhorst. Sure. Thank you, very much, for the chance
to do that. I think that a couple of times, people have
mentioned the issue of maternal mortality being higher in
States with restrictive abortion laws. I'm very familiar with
that literature. There are about seven papers. Every single one
of those studies does not--has a methodological flaw. The most
important flaw is that none of those studies take into account
issues like health workforce, like the distribution of health
workers, the lack of care in rural areas, and economics.
So, I feel that that literature is very flawed. It is not,
by any means, definitive and cannot be stated to demonstrate
that abortion restrictions lead to increased maternal
mortality. On the contrary, there's a study that was done in
Mexico, indicating that--looking at all of these factors and
showing that the most powerful influence on maternal mortality,
was the availability of skilled help at birth and the
environmental situation. For example, did the household have
running water and sewage and so on and so forth?
Senator Tillis. I see some of your colleagues taking notes.
So I'll invite a member on the other side of the aisle to ask
them if they want to yield time for rebuttal. But I do think if
we're going to be instructed--if we're going to make good
policy here, we have to be fully informed.
And I believe that the factors that are leading to those
mortality rates are not as simple as either one, either extreme
of the arguments presenting here. So that's not putting us in a
good position to come up with reasonable policy.
Doctor, I'm going to call you Ingrid before I ask this
question. I've heard you referred to as Skop and Scope. Which
do you prefer?
Dr. Skop. It's Skop, but Ingrid is fine.
Senator Tillis. Okay. Dr. Skop, you were--and Mr. Chair,
I'd like to seek consent to put an article from Detroit
Catholic, where Dr. Skop is quoted, into the record.
Chair Durbin. Without objection.
[The information appears as a submission for the record.]
Senator Tillis. I've got the specific section of the Texas
law. I'm not an attorney, but my attorney suggests that Ms.
Zurawski's--did I pronounce that right, ma'am?--situation, that
perhaps the doctor was given bad legal advice. It appears in a
section under Section 170A.002, that they could have had--
knowing that the condition that Ms. Zurawski had was likely,
was an inviable fetus and going to threaten the health of the
mother. And within a few days, she did experience sepsis. It
seems like to me maybe the doctor wasn't guilty of malpractice,
but a legal advisor was guilty of malpractice. Would you agree
with that?
Dr. Skop. I think what's going on, on the ground in Texas--
and I will agree with Dr. Verma and Ms. Zurawski. There is
confusion----
Senator Tillis. Yes.
Dr. Skop [continuing]. Normally, doctors, of course, are
not legally trained. And normally, they depend on advice from
their professional societies to help them understand new laws.
What has been noticeably absent in Texas is any statement
from the Texas Medical Association, any statement from the
Texas Board of Medicine, Board of Pharmacy, Board of Nursing,
Hospital Association. So, all of these organizations--you can
figure out why they might be silent, you know, make your own
conclusions, but they have been silent----
Senator Tillis. Yes----
Dr. Skop [continuing]. And that is the reason for the
confusion.
Senator Tillis [continuing]. In my read of it, I honestly--
Ms. Zurawski, I'm blessed with a granddaughter named Willow,
2\1/2\ years old--my daughter, and, I hate--I'm not even going
to talk about it because I don't think I could get through it.
But this is a legal--legal professional who's guilty of
malpractice. And the legal advisors of the medical centers in
the State of Texas should be honest, set their political
agendas aside, and give good legal advice so doctors can
provide care that I think, in Ms. Zurawski's case, she was
entitled to. And instead, they let her get very sick. Thank
you, Mr. Chair.
Chair Durbin. Senator Tillis, I'm going to give Ms.
Zurawski an opportunity to respond, although she was in extreme
situation in the ICU when this happened. I know that her
husband is with her today. And I'm sure they've both discussed
some of the issues that have been raised about your care,
whether there was medical malpractice or legal negligence of
some sort. I want to give you a chance to respond, if you can.
Ms. Zurawski. Thank you for the opportunity. So, I'm not a
legal expert. I'm not a doctor. I think that my doctors and my
healthcare team were doing the best that they could with the
information that they had and the guidance that they were being
given by the ethics board at the hospital. I know that they
also consulted with colleagues at the hospital that I was at,
as well as outside of that hospital in Texas.
And they asked several times, to several physicians, at
several facilities whether I could be transferred, if there was
different healthcare that could be provided somewhere else, if
I could have received an abortion somewhere else. And across
the board, no matter who they asked, they were told time and
time again that no, they wouldn't have been able to provide an
abortion. So it wasn't just my healthcare team. It was everyone
else that they consulted during the whole 3-day ordeal, as well
as afterwards.
Senator Tillis. Mr. Chair, just to be clear on my position,
I don't believe doctors should be lawyers unless they've got a
legal degree. And I don't think lawyers should be doctors
unless they have a medical degree. My point was not about the
doctor. They were in a difficult situation. They were trying to
care for you.
My question is what the motivation was, to not read the
plain text of the statute that a non-attorney can read and
understand that that should have been a legal basis for saying
that they could have proceeded with the procedure that resulted
in devastating consequences for a prospective family. Thank
you, Mr. Chair.
Chair Durbin. Well, I'm going to conclude, if I might, as
Chair, and just say the reason we are at this moment in history
is because the Dobbs decision decided we were going to
redefine, State by State, the access to abortion and define the
legal and medical circumstances. This is tricky territory. It's
dangerous territory, as we've been told here. And that's why I
think we've had this hearing this morning. Senator Padilla.
Senator Padilla. Thank you, Mr. Chair. I want to start just
by thanking you for holding this important hearing and thanking
all the witnesses for joining us today as we discuss the
efforts we've undertaken to ensure a woman's right to abortion
care. It's not lost on me that this fight is actually larger
than abortion care alone.
As we work to address the unprecedented actions taken by
the far-right wing of the Supreme Court, it's not lost on us
that as they're working to strip away basic rights, they're
also failing to hold themselves accountable for some common-
sense ethical standards. So there's a lot going on here. I look
forward to working with the Chair to explore those greater
issues, as well to make sure that we can restore some public
confidence into a co-equal--they claim to be completely
independent, but is a co-equal branch of Government, as we work
to protect the rights and protections that so many Americans
hold dear.
Now, my first question deals with sort of the separation of
powers and role of the courts question. You know, it's clear
that one troubling aspect of the recent Fifth Circuit decision,
which many scholars and even fellow judges found legally
unsound, was its attempt to intrude on a decades-old, public-
safety-driven decision by the FDA.
Now, the FDA, we all know who the FDA is and what the FDA
does, but the FDA is the agency that Congress has entrusted
with making scientific decisions relating to our health and
safety. So, when the FDA tests and approves a medication for
use, people rely on that. They have trust in the testing and
approval process.
And so, when activist judges take it upon themselves to
overstep the separation of powers and intrude on the FDA's
decision-making authority, the authority entrusted in it by
Congress, it leaves science no longer to just the scientists.
And Senator Tillis is talking about, I don't want doctors
to practice law unless they have a law degree. He doesn't want
lawyers to practice medicine unless they have the medical
degree. I don't want Justices making scientific decisions
unless they have that education expertise.
Dr. Verma, simply a yes-or-no question, is regulated
medical abortion in the United States safe?
Dr. Verma. Yes, absolutely.
Senator Padilla. So can you describe then the risks to
patients when judges, rather than scientists, are making
decisions about medicines that Americans rely on?
Dr. Verma. Absolutely. Thank you for that question. So we
know, based on decades of data, that medication abortion is
incredibly safe and effective. By regulating a medication, or
taking a medication off the market, that we know is safe and
effective, we limit patients' ability to get the care that they
need. That includes care for people that need abortions and for
miscarriage management.
Mifepristone is used very safely and effectively for
management of miscarriages and shortens the amount of time it
takes someone to pass a pregnancy. A lot of people experiencing
miscarriages are already going through a traumatic event. And
so, to be able to offer them the most effective treatment
option is incredibly important.
Senator Padilla. Thank you. Now, despite the lack of
attention that it gets in the press coverage, we know that
abortions are sometimes necessary to stabilize a woman's
condition. Right?
When a woman's health or life is in danger, that becomes
part of the conver--it should be more of the conversation than
it is in our national discourse. Yet, it seems like so many
States post-Dobbs are passing laws that are creating, either
unintentionally or sometimes very intentionally, conflicting
laws, leading to confusion and impossible decisions, for
decisions to make on a moment's notice. And Exhibit A is your
testimony, Ms. Zurawski. So first of all, let me thank you for
being here. Thank you, for your courage and your bravery to
share your experience.
Some people in the legal world say, well, there's a
conflict between State and Federal law. Well, there's a process
for hashing that out through the courts. That takes a long
time. In the meantime, we have women showing up in hospitals
and emergency rooms, that can't afford to wait. And you've
described your experience from the medical perspective.
Just wondering if you could take a minute to share what
kind of mental anguish that experience was like in--while you
were in the ICU, and since then, and if you have a specific
message for women living in States that are denied abortion
care or access to the care that they need, but live in a State
that's clamping down on access and options for them.
Ms. Zurawski. Absolutely. And thank you for the
opportunity. We've heard a lot today about the mental trauma
and the negative, harmful effects on a person's psychological
well-being after they have an abortion, supposedly. And I'm
curious why that's not relevant for me, as well, because I
wasn't permitted to have an abortion. And the trauma and the
PTSD and the depression that I have dealt with in the 8 months
since this happened to me is paralyzing.
On top of that, I am still struggling to have children. And
I wanted to address my Senators, Cruz and Cornyn, who neither
of whom, regrettably, are in the room right now, but I would
like for them to know that what happened to me--I think most
people in this room would agree was horrific--but it's a direct
result of the policies that they support. I nearly died on
their watch. And furthermore, as a result of what happened to
me, I may have been robbed of the opportunity to have children
in the future, and it's because of the policies that they
support.
What happened to me was horrible, but I am one of many. And
quite frankly, I'm lucky. I'm lucky that I have a husband that
could take me to the hospital. I don't have other children that
I had to worry about finding healthcare for. I have a job that
was understanding, that allowed me to grieve for 3 days as I
waited to almost die. What about all of the women that don't
have those same opportunities, that don't have access to
healthcare, that don't have health insurance, that don't have a
partner? What about them?
Senator Padilla. Thank you. Thank you, Chair.
Chair Durbin. Senator Kennedy.
Senator Kennedy. Thank you, Mr. Chairman. Thank you, all,
for being here today.
Professor Goodwin, help me understand your point of view. I
think this is a yes-or-no question. Do you support it being
legal to abort an unborn child up to the moment of birth?
Professor Goodwin. Senator Kennedy, it is not a yes-or-no
question. I support women like Ms. Zurawski. Women across
this----
Senator Kennedy. No, ma'am, no, ma'am, I don't--I think it
is a yes-or-no question.
Professor Goodwin. No. Well, let me answer.
Senator Kennedy. If, if there were a law that's--I'm just
trying to understand your perspective. And I'm not accusing you
of this----
Professor Goodwin. Of course, not.
Senator Kennedy [continuing]. But, you know, people sort of
talk around this issue. If there were a bill that said that a
woman has an unfettered right to abort an unborn baby for any
reason up to the moment of birth, would you vote yes or would
you vote no?
Professor Goodwin. Senator Kennedy, I refuse to be shackled
by your question----
Senator Kennedy. You're----
Professor Goodwin [continuing]. What I have answered, is
that there are conditions----
Senator Kennedy. You--you----
Professor Goodwin [continuing]. That occur----
Senator Kennedy [continuing]. You don't know----
Professor Goodwin [continuing]. During pregnancy.
Senator Kennedy [continuing]. Whether you would vote yes or
no?
Professor Goodwin. There are conditions during pregnancy
that mean, after 10 weeks----
Senator Kennedy. No, I've said----
Professor Goodwin [continuing]. Fourteen weeks----
Senator Kennedy [continuing]. I've said----
Professor Goodwin [continuing]. Twenty weeks----
Senator Kennedy [continuing]. Unfettered discretion.
Professor Goodwin [continuing]. Twenty-four weeks----
Senator Kennedy. You would----
Professor Goodwin [continuing]. Conditions such as----
Senator Kennedy [continuing]. You would support----
Professor Goodwin [continuing]. Ms. Zurawski's, and----
Senator Kennedy. You're here advocating----
Professor Goodwin [continuing]. I would support--I would
support her life----
Senator Kennedy. You--I understand, I would, too----
Professor Goodwin [continuing]. I would support her
personhood.
Senator Kennedy. But, you're advocating a law----
Professor Goodwin. I support her person----
Senator Kennedy [continuing]. You're advocating a law that
says that an unborn baby can be aborted up to the moment of
birth for any reason. Are you not?
Professor Goodwin. Let me clarify what the Fourteenth
Amendment says in the first sentence, that ``Citizens of this
United States are individuals that are born.'' That is what our
Constitution says. Do you----
Senator Kennedy. But why won't you answer my question--
Professor Goodwin [continuing]. Support our Constitution?
Senator Kennedy [continuing]. Professor? I'm not trying to
argue. I just want to understand what your position is. And I
think you're afraid to say that you do support that. If you do
support it, I think you--for just, for the purpose of an
intellectual discussion, you ought to just say so.
Professor Goodwin. For purposes of an intellectual
discussion, I'm happy to have that with you, but that's----
Senator Kennedy. Could you answer----
Professor Goodwin [continuing]. Not the tone----
Senator Kennedy [continuing]. Could you answer my question?
Do you support--please? I mean, you teach. Okay? I'm sure
you've had students ask this question. Do you support--do you
support making it legal to abort an unborn baby for any reason,
any reason, up to the moment before birth?
Professor Goodwin. Senator, let's have that intellectual
discussion that you want.
Senator Kennedy. Okay. We could start if you'd answer my
question.
Professor Goodwin. And----
Senator Kennedy. I can't go to my next----
Professor Goodwin. Well----
Senator Kennedy [continuing]. Question until you answer
that question.
Professor Goodwin. I want you to be able to go to your
second----
Senator Kennedy. Good.
Professor Goodwin [continuing]. And your third questions--
--
Senator Kennedy. Answer it for me.
Professor Goodwin [continuing]. I do, but as I have
explained, there are many different conditions----
Senator Kennedy. No, I said unfettered----
Professor Goodwin [continuing]. During a pregnancy.
Senator Kennedy [continuing]. Discretion. No conditions.
I'm making it easy for you.
Professor Goodwin. Well, I have already shared with you----
Senator Kennedy. Okay.
Professor Goodwin [continuing]. Senator, that I support----
Senator Kennedy. I get it.
Professor Goodwin [continuing]. Women's person----
Senator Kennedy. I don't want to use all my time. You're
not going to answer.
Professor Goodwin. And I support Ms. Zurawski's----
Senator Kennedy. And that is your right.
Professor Goodwin [continuing]. Personhood----
Senator Kennedy. But I would, I would respect you more if
you'd just say, here's my answer.
Professor Goodwin. I'm sorry that you don't respect me----
Senator Kennedy. I do----
Professor Goodwin [continuing]. Very much.
Senator Kennedy [continuing]. Respect you, but I said I'd
respect you more if you'd just answer my question.
Dr., tell me how to say your last name.
Dr. Wubbenhorst. Wubbenhorst.
Senator Kennedy. Dr. Wubbenhorst, do you support a law that
will allow, for any reason, unfettered discretion, the abortion
of an unborn child up until the moment of birth?
Dr. Wubbenhorst. No.
Senator Kennedy. You don't. Dr. Verma.
Dr. Verma. Senator Kennedy, so, I'm the one person and one
doctor in this room that does provide abortion care. And I can
tell you that does not reflect the reality of abortion----
Senator Kennedy. No, I'm----
Dr. Verma [continuing]. Care.
Senator Kennedy. I understand. I'm just asking----
Dr. Verma. It doesn't----
Senator Kennedy [continuing]. A question.
Dr. Verma. It simply doesn't----
Senator Kennedy. But do you----
Dr. Verma [continuing]. Happen.
Senator Kennedy [continuing]. Support it? There are--there
are bills before Congress that will allow that to happen.
Dr. Verma. That's----
Senator Kennedy. You don't support it? Or are you going to
be a----
Dr. Verma. Again----
Senator Kennedy. You're not answering my question.
Dr. Verma. As the doctor in this room who does provide
abortion care, that is not how abortion care in this country
works. It's a hypothetical that does a disservice to our----
Senator Kennedy. But if a patient----
Dr. Verma [continuing]. Patients.
Senator Kennedy [continuing]. Came to you and said, I'm
going to probably have a baby this week, and I've changed my
mind. And I would like you, doctor, to abort the child, would
you do it?
Dr. Verma. That is not how abortion care in this country--
--
Senator Kennedy. But if----
Dr. Verma [continuing]. Works.
Senator Kennedy. But if a patient did, would you do it?
Dr. Verma. My job as a doctor is to look at each----
Senator Kennedy. Okay.
Dr. Verma [continuing]. Individual situation----
Senator Kennedy. I mean--I'm sorry.
Dr. Verma. I have never----
Senator Kennedy. I don't mean to be rude, but I can tell
neither you nor the professor will answer my question.
Dr. Verma. I have never----
Senator Kennedy. And I think you both have an opinion, and
I don't understand why you won't share it----
Dr. Verma. I have----
Senator Kennedy [continuing]. If we're going to solve this
problem.
Dr. Verma [continuing]. Provided----
Senator Kennedy. Doctor----
Dr. Verma [continuing]. I've provided care for a few
years----
Senator Kennedy [continuing]. How about you?
Dr. Verma [continuing]. And I've never seen that situation.
Senator Kennedy. How about you, Doc? Would you?
Dr. Skop. I do not support unfettered abortion, and I would
like to point out that if a woman did have a life-threatening
condition in pregnancy past approximately 22 weeks, that baby
can be delivered alive by induction or C-section. And we can
try to save that baby. The intent of abortion is a dead baby,
and that is not necessary in that situation.
Senator Kennedy. I mean, I want you to all understand where
I'm coming from. This is a tough issue, and it's a tough issue
because there's some tough questions we've got to answer. And
when you won't answer the questions--when you're invited by my
Democratic friends, the Majority, and you won't answer the most
fundamental question--we've got a bill in front of us that will
basically say----
[Gavel is tapped.]
Senator Kennedy [continuing]. A woman has the unfettered
right to abort at any time, for any reason, up to the moment of
birth. And that's a gut-check issue. And I would expect you, as
experts, to answer that truthfully, how you do it. Thank you
for your indulgence, Mr. Chairman.
Chair Durbin. Senator Ossoff.
Senator Ossoff. Thank you, Mr. Chairman. And thank you to
all of the witnesses for joining us and sharing your
experiences and perspective. It's been tremendously impactful
to hear from you.
Mr. Chairman, I do want to note and acknowledge that we
have a Georgia physician with us, and Dr. Verma, thank you for
your work providing healthcare for Georgia women at a time when
the provision of healthcare for Georgia women is under attack
by elected officials in Georgia. As you noted in your opening
remarks, where one of the most extreme laws in the country has
been enacted--a 6-week ban on abortion, which takes effect
before many women even know that they are pregnant--in the
midst of a maternal health crisis in our State.
Mr. Chairman, I don't know if you've heard these
statistics, but more than half of Georgia counties have no OB-
GYN at all. No OB-GYN in more than half of the counties in our
State. We have one of the worst maternal mortality rates in the
United States--even worse, much worse for Black women in
Georgia, and a shortage of qualified providers of OB-GYN care.
And so, Dr. Verma, what I want to discuss with you, as we
consider the impact on human health of Georgia's extreme 6-week
abortion ban, is how this risks worsening our shortage of
qualified physicians.
I'm looking at data here from the Association of American
Medical Colleges, that new OB-GYNs are much less likely to
apply into residency programs with extreme abortion bans like
the 6-week ban in Georgia. And I think we all recognize this,
but Dr. Verma, these physicians provide the full spectrum of
perinatal care. So, what does the State's OB-GYN shortage mean
for Georgia women, please, Dr. Verma, based upon your
professional experience?
Dr. Verma. Thank you, Senator Ossoff. And thank you for
everything that you do for healthcare providers and patients in
Georgia. So, I am very concerned that the law in Georgia, our
6-week ban, is going to make the healthcare shortage worse, and
affect providers wanting to go into OB-GYN and provide in
Georgia.
I have talked to multiple medical students and residents
who say they aren't going to stay in Georgia because they don't
want to be in an environment where they can't practice
evidence-based medicine and have to worry about whether they
are going to be criminally prosecuted, have their license
removed, have their livelihood threatened.
The same procedures that we use for abortion care are also
used for miscarriage management, the same medications, the same
procedures. And so, I've talked to trainees who worry that if
they stay in Georgia, they won't get the training that they
need to take care of someone who comes in at 14 weeks, bleeding
heavily, that they won't be able to provide them with the
emergency care that they need.
We know, based on survey data, that 90 percent of OB-GYNs
have said that they've had a patient in the last year that
needed abortion care. And the vast majority have gotten that
patient connected with the care that they need, even if they
personally feel conflicted with abortion, even if they don't
provide the care themselves.
So this is something that OB-GYNs support. They want
patients to get the care that they need, and they're worried
that they won't be able to practice evidence-based medicine in
Georgia and are leaving.
Senator Ossoff. And just to be clear--because I think it's
vitally important that Georgians understand this and that the
Senate understand this: a 6-week abortion ban in Georgia,
backed by threats of criminal prosecution and imprisonment for
physicians. And we see in the data that these laws are
deterring OB-GYNs from pursuing residencies in States with laws
like this.
Dr. Verma. Absolutely. And you're absolutely right, that
that then affects not just--again, like, I'm an OB-GYN that
does abortion care, but I also deliver babies. I do GYN
surgery. I do cancer screenings. I do full-spectrum OB-GYN, as
many OB-GYNs do. So this is not just going to affect access to
abortion care.
It's going to affect access to all care, all reproductive
healthcare in our State. We've--I practice in Atlanta, where
we've already experienced the closure of a major medical system
that's having devastating effects on access to care in our
city. You're absolutely right, that half of counties in Georgia
have no OB-GYN. I expect this is just going to get worse.
Senator Ossoff. Thank you, Dr. Verma. Thank you, Mr.
Chairman.
Chair Durbin. Senator Blackburn.
Senator Blackburn. Thank you, Mr. Chairman.
Dr. Verma, I've just--I just want to ask you very quickly,
you talk about evidence-based medicine. Do you consider a
heartbeat evidence-based? Would you consider----
Dr. Verma. Could you clarify that?
Senator Blackburn [continuing]. That a living--would you
consider that a living being if there's a heartbeat detected?
Would that be evidence enough that there is life?
Dr. Verma. So based on evidence-based medicine--and I think
what you're trying----
Senator Blackburn. No----
Dr. Verma [continuing]. To get at is that----
Senator Blackburn. No, I know what I'm trying to get at.
Dr. Verma. Could you clarify for me what you're trying to
get at?
Senator Blackburn. No. Let me just say, you talk about
evidence-based medicine. A beating heart is a sign of life.
And Dr. Skop, earlier, you said a heartbeat can be detected
at 28 days. Am I accurate? Did I understand that? I was
watching in my office.
Dr. Skop. It's present at about 23 days after
fertilization. Usually, it's about a week later before we can
detect it via ultrasound technology.
Senator Blackburn. Okay, so at 23 days. Thank you, very--I
think that's evidence of life. I want to talk for just a
moment, Dr. Wubbenhorst and Dr. Skop, late-term abortions. When
I'm talking to women in Tennessee, what I find is most people,
regardless of party affiliation, they are opposed to late-term
abortions. And the--from the work that I've done in the House
and in the Senate, what I have found is that there seems to be
dismemberment of the baby involved in these late-term
abortions. And many times, there is an injection to stop that
heart from beating. Is that accurate? Am I correct? You all are
nodding yes.
Okay, and then there are occasions during late-term
abortions when the baby survives that process. And then the
baby is delivered alive. And I've talked to so many women who
were so highly offended with Governor Northam of Virginia's
remarks around that. I'm just going to read these for the
Committee so that it's accurate. He said, ``If a mother is in
labor, I can tell you exactly what would happen.'' And of
course, he's referring to a mother in for an abortion, and she
has gone into labor. He continues, ``The infant would be
delivered. The infant would be kept comfortable. The infant
would be resuscitated if that's what the mother and the family
desired. And then a discussion would ensue between the
physicians and the mother.''
So, Dr. Wubbenhorst, you have delivered a lot of babies. As
someone who has done this and who has personally cared for
women who suffered physically and emotionally from the
complications of abortion, then tell me how--is there any way,
any reason, anyone would think that statement from Governor
Northam was a compassionate, caring statement?
Dr. Wubbenhorst. Yes. I think it's very clear that it's not
a compassionate statement because if you allow a child--and in
fact, I think the legal framework in this country is that if a
child is neglected and allowed to die or killed, that's
infanticide, and that's something that could be prosecuted.
I think that's the same situation--it's the same situation
if a woman undergoes a late abortion. We know that past 22, 23
weeks, we are able to resuscitate those children, and they'll
live. So I think that it is morally inconsistent to--and this
happens, has happened in hospitals where I've worked. In one
room you're fighting for the life of a child who's 22, 23, 24
weeks. And in another room, you're aborting a child that's 28,
32 weeks.
Senator Blackburn. Yes, and, you know, visiting our NICUs
and having friends and family that have had babies in the
NICU--and you pray over these babies for the continuation of
their life and their health and their recovery. And then when
you hear about the practice of late-term abortion, it's just
hard to square that up. I find it very difficult.
Dr. Skop, I want to talk to you for just a minute. And I
had talked with DOJ about the attacks on pregnancy centers,
which there has not been a push forward to address these. But
there have been many cases, and we've had some in Tennessee,
where they've gone after people that were across the street
from the center and were going through, protesting. And I see
my time has run out, but I do want to get this question in, and
you can answer it for me. We'll do this, Mr. Chairman, I'll
take it from her in writing.
I would like to know if you think DOJ and the Biden
administration is doing enough to protect the pregnancy
centers. They're protecting abortion centers but, and you can
give me this in writing. I would like to get your read on what
they are doing that protects the pregnancy centers and the
healthcare that you're providing for expectant moms. Thank you,
Mr. Chairman.
Chair Durbin. Senator Welch.
Senator Welch. Thank you, very much. I thank the witnesses.
Mr. Chairman, this hearing is extremely important, but I also
think it's in the context of the conclusion that I'm coming to,
and that is, that we have a crisis on the Supreme Court.
The United States Supreme Court has a duty--it is to
strengthen our democracy and strengthen respect for the rule of
law, yet the United States Supreme Court, in many recent
decisions, has, in my view, become a threat to democracy. And
it has profoundly eroded respect for the rule of law.
It's not just polls of American people that show a record-
low respect for the Court, confidence in the Court. It's not a
popularity contest, of course, but the Court has been making
decisions with outcomes that are very contrary to the public
interest. That's a point of view, but I think one that can be
backed up with evidence. But it's also been using intellectual
manipulation in reaching its decisions. And I think the public
gets that. It's not on the level.
Let me give three examples.
We have a corrupt campaign finance system, yet the Supreme
Court, in Citizens United, made an assertion of facts--that
I'll talk about in a minute--to justify unleashing unlimited
money, unaccountable money, undisclosed money to pollute our
political process.
In the Bruen decision, the United States Supreme Court came
up with a framework of analysis, so-called ``historical
analysis,'' which essentially made up a history of the way
back, to disregard the reality of today.
And in the Dobbs decision, the Supreme Court disregarded
precedent and stare decisis in order to achieve an outcome that
we're now living with.
The Supreme Court itself has added flames to the fire when
some of those Justices were before this Committee, in this
room, Mr. Chairman. On this question of precedent, one Justice
told the Committee in 2020, ``I will obey all the rules of
stare decisis,'' and agreed that Roe was super precedent.
In 2018, another Justice told the Committee that Roe is an
important precedent in the Supreme Court, which has been
reaffirmed many times.
In 2017, still another Justice told this Committee of Roe,
quote, ``A good judge will consider precedent of the U.S.
Supreme Court as worthy of treatment like any other.''
And, of course, we've also had recently the report of
ProPublica, about the ethical issues in the Supreme Court.
So, I have two concerns. I don't know if I'll have time,
but one is, for Professor Goodwin, about what I would regard as
the departure from the doctrine of judicial restraint to a
doctrine of judicial flexibility to achieve outcomes of the
Court.
And the second is for Ms. Zurawski, who, thank you for
being here. You've spoken about your own experience, but
there's moms who've lost kids because we are not allowed to
pass gun safety legislation that meets the Supreme Court
muster. There are citizens who are in agony about their
democracy being ruled by folks who can give multimillion-dollar
contributions. And there's women like you who are suffering
because they've lost access to the healthcare that they need.
So I'll start with you, Professor Goodwin.
Professor Goodwin. Thank you very much, Senator Welch, for
your question. As you mentioned, the outcome determinative
nature of the Dobbs decision--and you're absolutely right. One
day before, in the Bruen decision written by Justice Thomas,
Justice Thomas said that a prologue was necessary to understand
the history of men and their bodily autonomy, specifically
Black men.
He spent five paragraphs in the Bruen decision describing
Black men historically, discrimination against them during
slavery and Jim Crow, and how their bodily autonomy mattered,
and how gun safety, or having guns, was important to that.
You will not find a prologue mentioning anything about
women in the Dobbs decision. Two words that you will not find
in the Dobbs decision, ``Black woman,'' or ``Black women,''
together.
You will not find five paragraphs that speak to the forced,
involuntary nature of reproduction of Black women during
slavery being forced into pregnancies. You will not read
anything about Black maternal mortality in the Dobbs decision.
So one day before, five paragraphs devoted to it. In the Dobbs
decision, absolutely nothing.
And as we look at this kind of turn to history, as you've
mentioned, it's selective. It's opportunistic. It cherry picks
through history.
Let me just say this: Roe v. Wade was a 7-to-2 decision.
Five of those seven Justices were Republican appointed.
Prescott Bush, the father of George H. W. Bush, was the
treasurer of Planned Parenthood. In the Roe v. Wade decision,
what Justice Blackmun mentioned, and is absolutely right,
abortion had not been criminalized in the United States. The
Pilgrims had performed abortion, so had Indigenous People.
When abortion becomes criminalized in this country, it was
leading to, and around the time of, the Civil War. And we see
some of the same rhetoric today used then----
Senator Welch. Thank you.
Professor Goodwin [continuing]. The concern about the
browning of the United States. And that was the impetus for
early abortion laws during the time of the Civil War. And we
see the same kind of rhetoric today.
Senator Welch. Thank you. My time is up, but I don't know
if we can allow Ms. Zurawski just to speak briefly on behalf
of, essentially, the collateral damage of these decisions.
Ms. Zurawski. Thank you. And thank you for the opportunity.
I'd like to address this repeated attempt by the Republicans at
a vulgar mischaracterization of what someone who needs an
abortion looks like. Frankly, it's stigmatizing, it's
offensive, and it's unrealistic. And it doesn't reflect who
needs an abortion or who wants an abortion in this country. And
quite frankly, healthcare should not be a meritocracy. You
shouldn't have to deserve healthcare in order to access it in
this country. And what's going on is not an accident.
As I mentioned before, when Dobbs first came down, the
Biden administration put out guidance on who should and could
receive an abortion. And in Texas, in my home State, Attorney
General Ken Paxton sued over that guidance. And so, that
guidance was revoked. And so, again, as I said before, what
happened to me was intentional.
Senator Welch. Thank you, thank you. Thank you, Mr.
Chairman.
Chair Durbin. Thanks, Senator Welch. And thank you to our
witnesses.
There are a few points I'd like to make for the record as
we close, one is on clinic violence. I want to make it clear--I
think we have made it clear. It bears repeating. There is no
excuse--underline ``no''--for violence on either side of this
issue, none. And to harass physicians, or those who have an
opposite point of view, is unacceptable from my point of view.
And I hope the Department of Justice will treat offenders
on both sides of that issue the same way with force to stop--
protect those who have a point of view on this issue.
Second thing I want to say is the argument that this is
about States rights. What happened in Amarillo? Was that about
States rights? Here was an effort to eliminate the use of a
drug which is used for chemical abortions nationwide--
nationwide. And that's what this Amarillo judge set out to do.
So this is about more than States rights. I think it's about a
point of view that goes much further.
And finally, let me say I'm going to add into the record--I
think it may have been here already, but a statement by the
American College of Obstetricians and Gynecologists, that is
part of this hearing today.
[The information appears as a submission for the record.]
Chair Durbin. They went through specific examples of some
of the most outrageous cases you can imagine, already under
Dobbs.
One I'll read to you. ``An OB-GYN who was contacted by a
social worker about an 11-year-old sex trafficking victim who
was pregnant. Not only was the physician unable to perform an
abortion under State law''--11 years old--``unable to perform
an abortion under State law, but the social workers were unable
to help the child obtain it in another State without risking
prosecution themselves.''
The 10-year-old in Ohio we've already made reference to.
Come on. We're better than that as a Nation than to let
this disintegrate into this reality.
The reality is that the shameful situation needs to be
resolved, and I don't know if it can be, politically, but I
hope this hearing moves us closer to that day. The relentless
assault on reproductive rights has to come to an end soon. I'm
going to pledge to continue my efforts in this Committee to
make sure that the light is being shone on these issues and
work with my colleagues to enshrine protections for
reproductive freedom. The Committee stands adjourned.
[Whereupon, at 12:44 p.m., the hearing was adjourned.]
[Additional material submitted for the record follows.]
A P P E N D I X
Submitted by Chair Durbin:
American College of Obstetricians and Gynecologists (ACOG)....... 126
Catholics for Choice, Washington, DC............................. 129
``M,'' a patient from Cobb County, Georgia....................... 133
NARAL Pro-Choice America......................................... 136
National Council of Jewish Women (NCJW).......................... 140
Submitted by Ranking Member Graham:
George, Robert P., et al......................................... 142
Wsj.com.......................................................... 144
Submitted by Senator Whitehouse:
American College of Obstetricians and Gynecologists (ACOG), Rhode
Island Section................................................ 146
Brown, Benjamin P., M.D.......................................... 148
Ezike, Ogechukwu F., M.D., and Takeda, Caitlin................... 150
Rhode Island Medical Society (RIMS).............................. 152
Submitted by Senator Tillis:
Detroitcatholic.com.............................................. 154
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
[all]