By Josephine Yurcaba. First published on Rewire.News
Ohio Rep. John Becker (R) drew widespread criticism last week for an anti-abortion bill that would allow insurance coverage for the “reimplantation” of an ectopic pregnancy into the uterus—a treatment that does not exist. Physicians and pro-choice advocates have called the line in the bill “science fiction,” but Becker told Rewire.News he does have sources to back up his claim: two articles—one more than 100 years old—with anecdotal stories from physicians who claim that “reimplanting” ectopic pregnancies into the uterus is possible.
HB 182, which Becker first introduced in April, seeks to ban almost all insurance coverage of abortions in cases where the pregnant person’s life is not endangered. It also bans coverage of what Becker called “abortifacients,” or “drugs or devices used to prevent the implantation of a fertilized ovum.” (This language seems based on a fundamental misunderstanding of pregnancy, medication abortion, and some forms of contraception.) Becker has saidthe intention of the bill is to “save lives” and cut costs for employers and insurers.
The bill received national attention when Dr. Daniel Grossman, an OB-GYN and director of Advancing New Standards in Reproductive Health (ANSIRH) at the University of California, San Francisco, described ectopic pregnancies in a viral Twitter thread criticizing the bill. Ectopic pregnancies occur when a pregnancy grows outside of the uterus, usually in the fallopian tube, though Grossman wrote that they can rarely develop in the cervix or the abdomen as well. According to the Mayo Clinic, “an ectopic pregnancy can’t proceed normally. The fertilized egg can’t survive, and the growing tissue may cause life-threatening bleeding, if left untreated.”
Ectopic pregnancies are the leading cause of maternal death in the first trimester.
There are two treatments for ectopic pregnancies: surgery or the use of a medication called methotrexate. “Reimplanting” an ectopic pregnancy is not a possible treatment, according to Grossman. “We just don’t have the technology,” he tweeted Becker. “So I would suggest removing this from your bill, since it’s pure science fiction.”
Becker responded to Grossman’s criticism in an email Grossman forwarded to Rewire.News, and the legislator attached two PDF articles that he said show the “procedure is twice documented as successful.” The first is a 1917 case report by C.J. Wallace published in the journal Surgery, Gynecology, and Obstetrics. Wallace begins the two-and-a-half page report with an intro about why he attempted the procedure, writing, “Why have we all these many years been so willing to deprive these little children of the right to live just because they were started wrong?” Wallace then describes a time he purportedly transplanted an ectopic pregnancy from a woman’s left fallopian tube to her uterus, and claims that the pregnancy “went on normally to full term.”
The second article that Becker sent to Grossman was a letter “To the Editors” by Dr. Landrum B. Shettles that appeared in a 1990 issue of the American Journal of Obstetrics and Gynecology. It describes a case in 1980 at the Gifford Memorial Hospital in Randolph, Vermont, in which Shettles says he witnessed a surgeon reimplant an ectopic pregnancy into a woman’s uterus.
Shettles is well known for helping to develop in-vitro fertilization, though he received criticism from his peers for his book How to Choose the Sex of Your Baby, in which he claimed that heterosexual couples could “choose” their baby’s sex by having intercourse during a certain time in a woman’s cycle and in specific sexual positions, according to the New York Times. He also was involved in a highly publicized lawsuit surrounding an IVF case; the lawsuit led to his resignation from Columbia Presbyterian Hospital, according to the Times.
Grossman told Rewire.News in a phone interview that the American College of Obstetrics and Gynecology (ACOG) does not include “reimplantation” as a treatment in its practice bulletin on the management of ectopic pregnancy, and that the articles Becker relies on are incredibly old and unreliable. “[The articles] are essentially just case reports, which is the lowest level of medical evidence in terms of the quality,” Grossman said. “So we would never base our medical practice on this.”
Additionally, OB-GYN Dr. Jenn Conti said neither of the physicians proved that the healthy pregnancies were the result of their procedure. “We know that after a termination, for example, someone can ovulate as soon as ten days after,” Conti told Rewire.News. “So, theoretically in both of these situations, you could end the pregnancy via the removal of the ectopic, the person could ovulate in 10 days, and then theoretically you could give birth to a preterm baby from a different [pregnancy].”
Grossman said that even including the nonexistent treatment in the bill is problematic because it could create obstacles to someone receiving coverage for approved treatment of an ectopic pregnancy, which the doctor and public health researcher said causes around 4 percent of maternal deaths. “Given that we’re in the middle of the maternal mortality crisis in this country, it’s just crazy to think about putting a barrier between women and the treatment that they need to save their lives,” Grossman said.
Becker, who said a lobbyist for the state’s Right to Life group gave him the documents, pushed back on this logic in a call with Rewire.News, saying that the bill allows coverage for the approved treatments of ectopic pregnancy. He said the inclusion of a treatment that’s not yet possible is “wishful thinking for future treatment.” “If one of the research hospitals wanted to do some type of research on that and … attempt to move an ectopic into the uterus, this bill will allow insurance coverage for that—doesn’t require it,” Becker said. “It doesn’t mandate anything. It just allows for it.”
But the use of an article that’s more than 100 years old to create policy is troubling to Conti, who said the 1917 article appears to be based on one physician’s opinion. “We never make medical decisions based on one person’s opinion or based on one case report, or certainly not based on medicine from 1917,” she said.
Nonetheless, Becker said he doesn’t plan on making any amendments to the bill as the result of criticism from physicians and advocates. He did say he might make an amendment to the portion of the bill that bans “drugs or devices used to prevent the implantation of a fertilized ovum.” When asked what kinds of devices he thought that would include, he said, “Well there’s a reason I didn’t specifically list them, because I don’t know what they are.” He at first said he would’ve included IUDs on a list of banned devices, but “it’s just coming to my attention there’s IUDs that don’t” prevent implantation.
According to the ACOG, all IUDs prevent fertilization, which occurs prior to implantation. Becker said the amendment he is considering adding would ban drugs and devices based on their intended use. “If it’s intended for the purposes of preventing fertilization … that would be OK,” he said.
ACOG notes that even the hormones in emergency contraceptives like Plan B, Plan B One-Step, and ella “do not affect implantation of a fertilized egg or harm or end an established pregnancy.”
But, even if most medications and devices could technically be covered under the bill, Conti said the bill’s use of vague language regarding what is and isn’t banned is harmful to physicians trying to provide the best care to patients. “I think it’s harmful to include that language because there are, as [Becker] has proven, numerous people in power who don’t even understand how contraception works,” she said. “And so if you don’t specify what it is that you mean, if you don’t even know what it is that you mean, then you are inherently hurting women and their opportunities and their abilities to obtain effective, safe contraception.”
On Thursday, ACOG, the American College of Physicians, the American Academy of Pediatrics, the American Academy of Family Physicians, the American Osteopathic Organization, and the American Psychiatric Association released a joint statement opposing “efforts in state legislatures across the United States that inappropriately interfere with the patient-physician relationship, unnecessarily regulate the evidence-based practice of medicine, and, in some cases, even criminalize physicians who deliver safe, legal, and necessary medical care,” in a reference to a number of laws seeking to limit and even criminalize abortion. “Physicians must be able to practice medicine that is informed by their years of medical education, training, experience, and the available evidence, freely and without threat of criminal punishment,” the statement read.
Grossman expressed a similar frustration about the Ohio law and laws nationwide that could affect a physician providing the best care to their patient, especially in dangerous cases such as ectopic pregnancies. Doctors, who could face up to 99 years in prison, would “want to be 100 percent sure that this patient is going to die before they intervene,” he said, referring to Alabama’s recent total ban on abortions. “And in the process, sometimes patients can get very sick and just die before there’s the possibility of intervening. Our whole approach in medicine is … detecting disease early and intervene early, and the wording of these kinds of laws kind of have a chilling effect that prevents physicians from intervening early and definitely can lead to worse health outcomes for pregnant people.”