I thank Rep. Pam Marsh for her vote in support of House Bill 3391B, the Reproductive Health Equity Act and for her courage in providing an articulate rationale (guest opinion, July 5). As she clearly points out, the ability of women to control their reproductive lives contributes to keeping families healthy and out of poverty.

If opposition to HB 3391B, which initially had bipartisan support, is based on reluctance to include the abortion provision, it must be recognized that denying access to other reproductive services, particularly contraception, will only increase the abortion rate. More unintended and unwanted pregnancies will occur, and women will in desperation resort to any means available to interrupt them.

Abortion services are only a small fraction of reproductive health options to be made available and paid for by insurance funds, including the Oregon Health Plan. Almost everyone wants that fraction to remain small, but delaying action on HB 3391B will be counterproductive, injurious to women and families, expensive, and in my opinion morally indefensible.

I began my medical training in 1965 in California. Contraceptives were available and I learned how to prescribe them. I began clinical bedside training in an urban county hospital in 1967-'68. One of my first rotations was on an OB-GYN ward, serving mostly poor women. Abortion was still illegal, but widely done by clandestine providers, or even worse, by self-administered traumatic methods. Severe life-threatening infections often followed. I attended several such cases, alongside experienced resident physicians. None of these women died, but deaths were known to occur. Fortunately, aggressive antibiotic therapy was effective in most cases, but occasionally emergency surgery was required. For some of these women, future child bearing would not be possible. These were not only naive young girls, but often mature women struggling to provide for children they already had.

My residency training was in internal medicine. However, I elected a rotating internship that included basic training in OB-GYN and surgery. Before 1973, abortion was legal only if a hospital committee determined that a pregnancy threatened a woman’s life and approved a “therapeutic” abortion.

Laboratory diagnosis of early pregnancy was not as accurate as it is now, and ultrasound not yet available. The resulting delays caused by the committee’s deliberations meant that abortions took place at a later gestational age, with greater risk. Methods then in use were not as simple and safe as they are now. General anesthesia and an operating suite were required. Women injured by the handiwork of unqualified and predatory practitioners still appeared at hospital doors. Nationwide, there was a significant death rate from illegal and primitive abortion procedures.

Abortion with medications is now safe and effective during the early weeks of pregnancy. When surgical methods are needed, most can be done in an outpatient clinic. The medications are legally available by prescription, but if barriers to legal and safe sources are imposed, they can be obtained on the internet for home use.

To minimize risks, medical abortions should be supervised by qualified providers in a clinic setting with accurate diagnostic facilities. But alternative sources cannot be effectively suppressed. Without safe and legal abortion, hospitals will likely once again be caring for desperately ill women suffering complications of amateurish and self-administered procedures.

— Bill Southworth, M.D., lives in Ashland.