Considering the source, a state government that has at stake a large part of both its reputation and budget on preventing and restricting access to abortion, there is very little in the state of Texas' Department of State Health Services' new "A Woman's Right to Know" pamphlet that comes as a surprise.
The pamphlet, which became state required reading for any woman seeking an abortion in 2011 for any woman in the state who seeks an abortion, is full of the imagery and talking points of anti-abortion activists along with medical information that's contrary to what many doctors actually say.
The pamphlet begins its introduction by urging any woman who feels she is being coerced into getting an abortion to immediately ask for a phone and dial 911. Then there are the illustrations of fetuses in various stages of development, a section on the potential for fetuses to feel pain and a couple of paragraphs highlighting a potential causal link between a woman getting an abortion and being at a higher risk for breast cancer later in life. Throughout the pamphlet, too, are stock photos of distressed looking women talking to equally distressed looking doctors and infant feet.
Coerced abortion and fetal pain, specifically, are new to the 2016 version of the pamphlet. Both issues, along with the information linking abortion to breast cancer were pushed for inclusion in the state's required literature for women seeking abortions despite research and statements from doctors that challenge or refute the statements made in "A Woman's Right to Know."
According to a 2005 study from the Guttmacher Institute about the reasons women seek abortion, less than one percent of women cite pressure from a partner or others as their primary reasons for getting an abortion. More than half of the women who participated in the survey did say that they were concerned about the future of their relationship for a variety of reasons like abuse, infidelity or immaturity on the part of their partner before seeking an abortion.
A fetus' potential ability to feel pain is cited in the pamphlet as the reason women in Texas cannot seek an abortion if they are more than 20 weeks into their pregnancy. Some of the most recent comprehensive research on fetal pain, a report published by the UK Royal College of Obstetricians and Gynaecologists in 2010, says that the earliest fetal pain might be felt is 24 weeks, but that data is nowhere in the state's materials.
Most distressing to abortion providers in Texas is the state's insistence that there is a link between having an abortion and an increased risk for breast cancer. "Your pregnancy history affects your chances of getting breast cancer. If you give birth to your baby, you are less likely to develop breast cancer in the future," the pamphlet reads.
The American College of Obstetricians and Gynecologists says that just isn't true. “Early studies of the relationship between prior induced abortion and breast cancer risk were methodologically flawed. More rigorous recent studies demonstrate no causal relationship between induced abortion and a subsequent increase in breast cancer risk,” the college's Committee on Gynecologic Practice said after an extensive literature review in 2009.
According to the Centers for Disease Control and Prevention, the idea that there might be a link between spontaneous or induced abortion and breast cancer dates back to the first extensive research on the topic in the 1950s. Some of those early studies found no link between breast cancer and abortion, while some others found a correlation. According to the CDC, however, many of the studies that did find a correlation were "flawed in a number of ways that can lead to unreliable results." Sample sizes were often too small, or women were only surveyed about previous abortions after they developed breast cancer.
"Since then, better-designed studies have been conducted. These newer studies examined large numbers of women, collected data before breast cancer was found, and gathered medical history information from medical records rather than simply from self-reports, thereby generating more reliable findings. The newer studies consistently showed no association between induced and spontaneous abortions and breast cancer risk," the CDC says.
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Including claims about breast cancer risk in the pamphlet puts doctors who perform abortions in a difficult spot, Bhavik Kumar, a provider for Whole Woman's Health's Texas clinics told the Observer earlier this year.
"[When you read patients the pamphlet], you’re reading something that the state requires you to read but you’re then saying that it’s not true and you don’t believe it," Kumar said. "It creates a sort of confusion where you’re supposed to be the medical expert and you’re sitting in front of the patient with 'medical facts' and you’re reading stuff that you think is false from the state. I think for some patients that creates a confusing picture and I think that’s partly what [the pamphlet is] designed to do."
In a press release, Texas Right to Life celebrated the new pamphlet as a triumph over misinformation.
"Texas Right to Life thanks DSHS for resisting the ideologically motivated demands of the pro-abortion lobby. Prudently, health officials rejected multiple deceptive and malicious recommended changes to the booklet that would have undermined informed consent of Texas women," the group says.