HYANNIS — Relying on a June 28 statement from Cape Cod Healthcare (CCHC), the Independent reported two weeks ago that abortion services are not available anywhere on Cape Cod. That, it turns out, is not the whole story.
In response to requests from the Independent for additional information, CCHC, which owns the Cape’s two hospitals and most of its other medical facilities and practices, provided a new statement the next day confirming that it does, in fact, provide abortions in cases “where underlying medical issues and out of concern for the wellbeing of the mother, a higher level of care is required than could be achieved in a freestanding outpatient center.”
The nearest clinic to the Outer Cape that provides comprehensive abortion care is in Attleboro, 110 miles from Provincetown. Others are in Boston, at least 114 miles away.
Efforts by reporters and editors to get more information about the kinds of underlying medical issues that would qualify a patient for an abortion at Cape Cod Hospital were unsuccessful. Similarly, hospital sources would not explain how they arrive at those decisions.
In a July 6 email to the Independent, CCHC Senior Vice President Patrick Kane wrote, “That’s a clinical decision based on many factors — age, health condition, family history, term of pregnancy and dozens of other factors — and our docs are not going to comment on hypotheticals.”
Kane did not respond to a question asking whether Cape Cod Hospital has an ethics committee. Such committees often make decisions at hospitals on whether procedures are medically necessary.
Kane and Marketing Communications Manager Lisa Connors also did not respond to questions about whether CCHC doctors would prescribe the abortion medications mifepristone and misoprostol, which are effective in the first 10 weeks of pregnancy. Kane told a reporter to stop trying to contact CCHC doctors directly because, he said, “our corporate policy requires that all employees direct media calls to our office.”
A Letter to Baker
Meanwhile, in a reaction to the Supreme Court’s reversal of Roe v. Wade on June 24, the Eastham Select Board has spoken out forcefully in favor of abortion rights and, at its meeting on July 11, signed a letter to Gov. Charlie Baker supporting his commitment to protect reproductive rights in Massachusetts.
“The Eastham Select Board is proud of Massachusetts and its leaders for taking fast action and a critical stand during this trying time,” the letter read. “We, the Eastham Select Board, endorse the swift actions of Governor Baker and the State of Massachusetts and will stand by the Executive Order to protect access to reproductive health care services.”
Eastham Select Board member Aimee Eckman said the lack of abortion access on the Cape is a serious problem, especially for those on the Outer Cape.
“I’m shocked that hospitals don’t provide it,” Eckman said. “I don’t really understand why that is, especially when there are no services locally. The hospital is far enough from Provincetown as it is. [Abortion care] is health care, for god’s sake.”
Fellow board member Suzanne Bryan agreed. “Even in a state that is liberal, it’s still not easy to access,” she said. “It’s just one piece of the larger puzzle of not having robust health services on the Outer Cape for younger people.”
Access to Medication
There are two different methods of getting an abortion, according to Planned Parenthood: the abortion pill or an in-clinic or in-hospital abortion. Ninety-five percent of all abortions in 2017 took place in clinics, according to the Guttmacher Institute. In recent years, medication abortions, available from pharmacies by prescription, have become much more common early in pregnancy.
The abortion pill consists of two different drugs, mifepristone and misoprostol, which can be taken at home, and can cause side effects that resemble a heavy menstrual period. The process, according to Planned Parenthood, is similar to an early miscarriage. The medications can be taken up to 10 weeks into a pregnancy.
The Independent has not been able to confirm whether medication abortion is available from Cape Cod’s doctors.
Spokesman Gerry Desautels at Outer Cape Health Services said that its physicians do not prescribe abortion pills because OCHS is a federally qualified health center and therefore is prohibited from providing abortion services by the Hyde Amendment — legislation that bars the use of federal funds to pay for almost all abortions.
The Independent contacted 17 providers of obstetrical and gynecological care on Cape Cod who are not associated with OCHS. Those who were reached declined to say whether they will prescribe abortion medication, while others did not respond to messages.
The Washington Post reported in 2016 that doctors often face challenges from hospitals for speaking out about abortion services they provide. The Post noted that “hospitals comprise more than one third of the nation’s abortion providers” but that “most do this work quietly, compared to the more visible standalone clinics such as Planned Parenthood.”
Massachusetts law places no restriction on abortions up to 24 weeks into a pregnancy, and abortion services are not restricted to obstetricians and gynecologists: physicians, physician assistants, nurse practitioners, and nurse midwives all may perform abortions.
After 10 weeks of pregnancy, women can get an in-clinic abortion procedure. After 24 weeks, the law says that abortions may be performed only “to preserve the life of a patient,” “to preserve the patient’s physical or mental health,” or if there is “a lethal fetal anomaly or the fetus is incompatible with sustained life outside the uterus.”
On July 6, Mass General Brigham, one of the largest hospital organizations in the state, issued a statement affirming its commitment to providing comprehensive abortion services.
“The Supreme Court ruling does not change the right to an abortion for patients receiving care in Massachusetts,” the statement read. “Mass General Brigham will continue to provide high-quality care to all patients who come to us for care. We will do this no matter what state or country they come from. We respect the very personal, and sometimes very difficult, decisions that patients make together with their care teams.”