Removing safeguards to women’s health doesn’t advance their freedom — it puts them at risk.
Removing safeguards to women’s health doesn’t advance their freedom -- it puts them at risk.
W hile most of the country enjoys a welcome reprieve from political ads and major elections this November, Virginia voters face consequential choices. In addition to several statewide races, the people we elect this fall for the Virginia House of Delegates will determine whether HJ1, an amendment to our state constitution, will go on next year’s ballot. Underneath the election year slogans lies the truth: The “reproductive freedom” HJ1 promises includes unrestricted, unregulated abortion through birth — for any “pregnant person,” regardless of age — and once adopted, cannot be changed the same way ordinary laws can.
My nearly three decades of psychiatric practice confirm that abortion often compounds, rather than resolves, the struggles women face. In many cases, it is the conception and the birth of a child — not the ending of one — that brings the stability, hope, and healing they thought abortion would provide.
I’ve treated children born into difficult circumstances, and none of them regretted their existence. I’ve seen children conceived in the context of substance use and major mental illness, and time and time again, I’ve seen healthy outcomes when they receive support and treatment. I’ve also seen women’s mental health improve during pregnancy. By contrast, I have not seen healthy, happy outcomes after abortion — only patterns of depression, substance use, regret, complicated subsequent pregnancies, and infertility.
This reality is entirely absent from the conversation around our elections and HJ1, which would deregulate abortion through birth, without any of the protections included in other states’ amendments that have been adopted since the U.S. Supreme Court’s Dobbs decision repealed Roe. HJ1’s mere 500 words — shorter than this op-ed — would set the health of women and families back for generations; protecting the destruction of life behind a wall of legal “strict scrutiny” would make meaningful safety protections for women and children nearly impossible to implement.
Virginia abortion policy has regional significance as it could become an “abortion destination.” Seemingly in anticipation of HJ1’s expansion of abortion in Virginia, the Richmond City Council gifted the property of a former school, easily accessible to I-95 and valued at more than $1 million, to Planned Parenthood for $10. Combined with the provisions of HJ1, Virginia is poised to become the leading abortion provider to surrounding states attempting to protect women.
While some argue that abortion through medication is “as safe as Tylenol,” my clinical experience and the FDA’s data say otherwise. Mifepristone blocks the hormone progesterone, breaking down the lining of the mother’s uterus, to which the baby is attached, cutting off its food, water, and oxygen. Unlike Tylenol, mifepristone is marketed under the dark cloud of two of the FDA’s most strident warnings: a “black box warning” and a REMS (risk evaluation and mitigation strategy) requirement. Out of the thousands of medications approved by the FDA, only a few hundred have such designations.
Mifepristone requires both because of the risks of deadly bleeding and infection, including infections that even doctors, using lab tests and physical examinations, might struggle to diagnose in time to save a woman’s life. These drugs are already being dispensed in Virginia after an on-screen “visit” — no examination, no labs, and questionable follow-up — but HJ1 promises further expansion without any safety measures.
Removing existing safeguards on mifepristone, as HJ1 would do, cannot be about rights, freedom, or health. I prescribe medications with “black box warnings” and REMS requirements, but only when my patients’ conditions won’t respond to anything else. Further, I see those patients in person and order lab tests to monitor their safe use. I cannot imagine doing differently. Reckless prescribing doesn’t further anyone’s rights or freedoms — not my patients’, nor Planned Parenthood’s.
Virginia doesn’t need HJ1 to protect the health or lives of mothers who have rare, life-threatening complications of pregnancy. No state in the union prevents women from obtaining the procedures they need to save their lives when a pregnancy complication endangers them. Separating the fetus from its mother to save the mother’s life isn’t abortion and is always lawful. The American Association of Pro-Life Obstetricians and Gynecologists has made this clear.
This November, Virginia voters have their last opportunity to elect candidates to the General Assembly’s House of Delegates before HJ1 goes to its second and final vote in the Assembly. Removing safeguards to women’s health doesn’t advance their freedom — it puts them at risk. We need to protect their lives, not endanger them.