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Do Legislators Really Care About Women’s Health, or is There More to the Story?

Imagine walking into your doctor’s office to a group of people shouting at you about what they think you should do in there. Would you be shocked?
In essence, this is what’s happening in legislatures all over the country—people are lobbying (some quite loudly) about your health care. They are sending emails, making phone calls and visiting lawmakers to pressure them into introducing bills about health care.

With the large number of bills related to health introduced in the past few years in Virginia, it may seem that you and your doctor aren’t alone in the exam room. There may be a procedure they have to do–even if they don’t need to, a warning paragraph to read to you or a procedure you want but they can’t do in your state. With all this interest in the how, what and when certain types of health care are delivered, we have to ask, “Why?”

Women’s Health as a Political Weapon

Legislators face intense pressure from organizations aiming to limit certain medical procedures, especially related to reproductive health.

“Abortion and reproductive rights are far and away more on people’s minds than other health issues,” Senator John Miller (D-1) says.

Anti-abortion groups do not consider abortions to be health care but acknowledge they must work with in the current system. Virginia-based Family Foundation seeks “to enhance the value of human life through increased restrictions on elective abortion…” Foundation president Victoria Cobb says, “…As long as abortion is legal in Virginia at all stages of pregnancy we will also work to ensure that women who face an unplanned pregnancy have the resources they need to make a better choice for life.”

These groups make their voices heard through advocacy days at the Capitol, visiting legislators and donating through political action committees like the Virginia Society for Human Life. The Concerned Women for America, Virginia Chapter, delivers cookies and prayer notes to legislators. “We will continue to identify voters who align with our values, educate and mobilize them to both vote according to those values and then hold their elected officials accountable,” says Cobb.

Christopher Newport University Political Science professor Quentin Kidd notes an irony in the politics of reproductive health: “On this matter, it’s actually the Left that is conservative, and the Right is not. One wants change and the other doesn’t. There’s no movement to further protect or expand access, it’s just reactive.” He says that the anti-abortion groups have consistent energy on this topic, and often go back to their base on fundraising appeals to help change the current status.

Prescription for Controversy

Because most legislators are not trained medical professionals, it falls to the few who are to explain the impact of laws on medical decisions. One is Delegate Chris Stolle (R-83), an obstetrician and gynecologist, who cites the influence of politics on health care as a reason he ran for office.
“Health care workers and doctors need to be more engaged in politics. They often say ‘I’m not political, I’ll stay away.’ But our ability to practice is now dependent on external pressure. So we have to be engaged,” Stolle says.

Stolle is concerned that the patient care environment is stifling [for health care workers and doctors] and continues to constrict.

“People want to do good things but those ‘things’ could eat up all of a doctor’s time. I often remind people, ‘That’s a wonderful idea, but we shouldn’t be directing how to practice medicine,’” he says.

Emotion Often Carries the Day

Emotional testimony presents a challenge for physicians who know the likely effects of a law. In particular, Stolle mentions a 2013 bill about Lyme disease testing requiring a doctor to provide two paragraphs written by the General Assembly, in discussing results with a patient.

“Doctors spoke up against it and the impact on [the] patient. It passed on emotion. Our job is to consider how it’s written, but also the intent and the repercussions,” Stolle says. If the Lyme disease test changes, will the written notice be irrelevant?

Lieutenant Governor Ralph Northam, a pediatric neurologist, says that he got involved in politics because of the outside influences on how he was practicing medicine.

Northam says, “Medicine is a science. The practice of medicine is an art.” So what does that make the legislation of the practice of medicine?

Stolle and former Senator Northam were called to explain to their peers in 2012 that the phrase “standard medical practice in the community” related to House Bill 462 was actually a transvaginal ultrasound, and not the abdominal or “jelly on the belly” ultrasound. Many legislators, including the sponsor of the bill, did not realize the standard practice for the first trimester of pregnancy uses a probe inserted into the vagina for ultrasounds. The controversial bill required any woman considering an abortion to have this procedure, prompting criticism for the physically invasive procedure and the interference between doctor and patient. The requirement for an ultrasound and its notation in the patient’s medical record passed into law in 2013 with the type of procedure changed to a transabdominal ultrasound.

Privacy and Personhood

Numerous bills about “personhood” have been introduced around the country in past years, including Virginia in 2012, defining personhood as beginning at conception, or the fertilization of the egg by the sperm. One of the largest opponents to these bills is the National Infertility Association, known as Resolve. The organization protests all “personhood” bills because of the common practice to fertilize multiple eggs to increase the chances of conception. Often embryos are frozen for future attempts. Resolve has concerns about criminal liability for unsuccessful embryo transfers, legal responsibility, privacy intrusions and the status of frozen embryos.

“With Personhood legislation…anything that puts an embryo at risk could be a criminal violation, even if its goal is the undeniable social good of helping someone have a baby,” states Resolve’s policy on personhood legislation.

Norfolk-based doctors Howard and Georgeanna Jones piloted the first successful IVF procedure in America and Dr. Howard Jones lobbied against the personhood bill in an editorial in 2012.

“I am concerned that poorly written personhood legislation in Virginia and other states does not reflect our understanding of the ‘facts of life’ and may criminalize the appropriate management of life-threatening conditions, as well as interfere with the routine practice of in vitro fertilization,” Jones wrote. The bill passed the House but ultimately failed.

I Didn’t Vote For That…or Did I?

It’s unclear if legislators understand how popular forms of birth control work. Many legislators voting affirmatively for the personhood bill were surprised to find themselves accused of “voting to ban birth control.” The ambiguous consequences have been debated wherever personhood legislation has been introduced.

The personhood legislation was strongly opposed by the American College of Obstetricians and Gynecologists based partly on systemic birth control methods that may affect implantation. IUDs and oral contraceptives use multiple ways of preventing pregnancy, including suppressing ovulation, preventing fertilization and preventing implantation.

“These ‘personhood’ proposals, as acknowledged by proponents, would make condoms, natural family planning and spermicides the only legally allowed forms of birth control. Thus, some of the most effective and reliable forms of contraception, such as oral contraceptives, intrauterine devices (IUDs), and other forms of FDA-approved hormonal contraceptives could be banned in states that adopt “personhood” measures,” says ACOG’s statement.

Election Pressure

Debates about reproductive health often galvanize the supporters of pro-abortion rights, driving them to the polls on Election Day. The 2013 Virginia gubernatorial race showed a large gender gap, and pundits attributed this to Republican Ken Cuccinelli’s strongly conservative views on abortion which hurt him with female voters. Exit polls noted Democrat Terry McAuliffe won votes of 59 percent of people who said abortion was the most important issue to them.

Nationally, a 2012 Gallup poll suggests that abortion is the most important issue for one in six voters, split equally between pro-abortion rights supporters and those who are anti-abortion, with 45 percent of people citing it as a one of many important factors. In the 2012 presidential election, debates about Planned Parenthood funding, birth control coverage by health insurance and Medicaid services rose to the top, even with candidates claiming the economy was the top priority.

Besides getting out the vote, fundraising may be a major part of the reason these issues remain topical. Millions of dollars are raised and donated by pro-abortion advocates, such as Planned Parenthood, and anti-abortion groups like National Right to Life. According to the Center for Responsive Politics, more than $8.7 million was contributed nationally in the 2012 election on the single issue of abortion policy. Health issues in general elicited more than $300 million in contributions during the past two election cycles.

Campaign Contention

With so much attention focused on health care, it should be no surprise that campaigning for one of Virginia’s General Assembly races was affected by this issue.

In the 93rd District House race last fall, incumbent Mike Watson faced challenger Monty Mason. Mailers from the Mason campaign said “Mike Watson: Taking steps to ban ALL abortions and restrict access to birth control,” specifically citing affirmative votes on HB 1 and HB 462 in 2012. Watson shot back with a website called “MasonLies.com,” calling the claims false.

“It couldn’t be any more disingenuous. I feel it was egregious on this issue,” says Watson.

Watson ran on workforce development and transportation, so how did he get caught in a swirl of controversy about bills he didn’t sponsor?

Watson gave numerous examples of his philosophy to “vote on the writing of the bill, not the propaganda” and may have fallen into political quicksand related to the intention of the bills.

“I often heard ‘I like you on jobs. Why do you vote against women?’” Watson says. In a close race where Mason won by a thousand votes, it may have made the difference.

“I think that race was unique. Mason chose to focus on those sets of issues. He was disciplined and stayed focused on them, as a result, was able to take a competitive seat,” CNU professor Quentin Kidd says.

Strange Bedfellows

Health care and politics seem destined to remain intertwined. Debates about health care appeal to passionate advocates and make headlines. Reproductive rights are hotly partisan issues that bring in campaign contributions and votes.

Whether they ran on health care or abortion rights issues or if they got pulled into the fray with their votes, why do politicians care about health care?

In some cases, they care because they promised voters they would, and in others, they have to or their opponent will use it against them. Whether they do it for funding, publicity, personal interest or party pressure, the end result is that your discussions with your doctor about your health care have been and likely will be influenced by them. So beware, that smiling face on the campaign postcard may be making health care decisions for you in the General Assembly.

About the author

Natalie Miller Moore

Natalie runs Moore than Words, a health communications consulting firm in Williamsburg. She loves to learn and write about health, particularly relating to patient experience and research.