Being an abortion provider in Texas is not for me. This is also my home. I have a lot of support from my community. I work in a variety of clinics here and in Oklahoma – individually, mostly. I went to medical school with the clear intention of having an abortion in my own state.
We had previously been closed in Texas when Covid hit the state in March last year and Governor Greg Abbott issued an executive order “requiring all surgeries and procedures that are not immediately medically necessary.” At first, we weren’t sure how that would be interpreted. I spent that Monday as much as possible calling all the patients, telling them to come for an ultrasound immediately so that I would be able to give them pills at least the next day. We weren’t sure if the shutdown would only affect procedures or deliver pills. So I just ran all day, trying to take care of people, just to come back to my desk and see the attorney general’s statement, which made it clear to me that the order applies to all abortion care.
After we closed I became licensed to practice medicine in Oklahoma. Although abortion care in Texas was suspended for only a month, I continued to travel to Oklahoma periodically and would like to continue.
With the new law, the passage of Senate Bill 8, there is a lot that we do not know. By law, anyone who helps or persuades someone to have an abortion after the cardiac activity has been detected তথ the so-called heartbeat যা which may occur as early as the sixth week of pregnancy, or anyone who provides abortion care দ may be liable for one of the lawsuits. I don’t know if I was allowed to suggest traveling outside. It doesn’t seem illegal, but we’re starting to see some clashes from opponents against anyone referring patients for out-of-state abortion care. My lawyers are concerned that I will be seen to be helpful and persuasive in helping me get out of the state.
In other words, those restrictions leave us with questions. We don’t know: Can Texas come after people who help someone leave the state? Does this mean that if you live in Texas and you are diagnosed with pregnancy six weeks later, it is illegal for you to have an abortion somewhere? Opponents of abortion are worried about how this law can be used, but I am an obstetrician-gynecologist, and it is my moral responsibility to take care of people. My moral responsibility is to refer those patients elsewhere when I am prevented from taking care of them where they are. When I am in a place where I can take care of them, if possible, I am going to advise them to travel to me. This is also my moral responsibility.
It’s not just abortion care I’m worried about. All pregnancies in Texas have now become even more dangerous. There are several reasons for this. For one, we know that death from childbirth is much higher than induced abortion. And childbirth is especially dangerous in states like Texas, where our maternal mortality rate is very low. This does not mean that we should be afraid of pregnancy. But since pregnancy can be dangerous, you should have the consent to continue the pregnancy, right? And people have to do it with a whole heart and understanding.
Another factor that makes pregnancy more dangerous is having less to do with abortion or desire: Pregnancies that face complications are now at greater risk. Under this new law, abortion exceptions are allowed only for medical emergencies. This can mean if a woman loses an organ immediately or dies without intervention. But how we judge this risk will make each clinic work individually with each hospital policy.
I can’t think of any other area of health care where we would wait for someone’s death to almost deteriorate before proposing intervention. It’s just unrealistic.
In my practice many years ago, I cared for a pregnant person who had heart failure. Her heart function should be 20 percent or less. But the hospital decided that it was not bad enough that we could offer her an abortion. We know that the heart is incredibly stressed during pregnancy. We expand the amount of blood we have in our body to prepare for the loss of blood during delivery, but this expansion of the amount of blood puts a huge burden on the heart and it does a lot more work. So anyone who has heart function by the end of the first or second trimester and has 15 to 20 percent will only see those numbers get worse with the progress of the pregnancy. She is then at serious risk of having a heart attack.
What worries me the most is that the decision to intervene in such a case will depend entirely on how the personal physician of the day understands and interprets the law. And threatening physicians with financial ruin is a great way to intimidate them and influence their decision making.
I am also concerned about the young people I care for, especially those who cannot involve their parents in their abortion decisions.
In Texas, minors have to show parental consent or get a judicial bypass, allowing young people to make decisions for themselves. But court orders can take time – which under this law, young people probably won’t have.
Most of the people who see me for abortion care are already parenting. But I also take care of the kids. I saw 11 year old girls. And how to open our hearts to compassion. As a mother – and I’m a mother too – it’s really hard to take care of young children who have survived sexual abuse and to know how much our society or community has failed them. Politicians are far from these children in their lives. They never have to hold their hand.
In that case, fortunately, a little and far away.
My practice is full of people who look like me, who share my life experiences – immigrants, children of immigrants, unauthorized immigrants and people of color. And it also focuses on why I went into this job and why I started abortion care right after college.
In Texas, we know how to take care of our people. We have a very strong community working for abortion care and abortion. And I’m hopeful that even after the initial media frenzy subsides, people will still be directed to the right place in our state that can help them get an abortion here if possible, or travel outside the state for care. Media attention can be strong. But don’t forget about us.
We are working. We are all tired. And we all need a minute to rest, recover, and then re-imagine what we need.
Dr. Ghaz Ghazaleh Moayedi is an obstetrician-gynecologist in Texas.