Three ob-gyns and a lawyer on why Amendment 4 needs to pass

There was no way Chanae Jackson was pregnant.

Jackson was 45 years old. She had fibroids. Years ago, she’d had a uterine ablation — removal of the lining of the uterus — to stop heavy periods. Her tubes were tied. 

And yet like some great cosmic punch line, she “popped up pregnant,” she told a recent gathering at The IVF Center in Winter Park. “The universe and God have a funny sense of humor.”

The pregnancy was ectopic — stuck in one of her tied off fallopian tubes — and not viable. But meanwhile, her physician had spotted a polyp in her uterus on ultrasound and was concerned it could be cancerous. He wanted to biopsy it. The most effective way, her doctor told her, was with a D&C (dilation and curettage) — dilate the uterus, scrape the lining, send the polyp to the lab for testing.  

But Jackson’s pregnancy, even in a fallopian tube, along with a fibroid in her uterus inconveniently blocking the polyp, complicated things. “We had to try multiple different procedures” to try to biopsy the polyp first, she said in a followup email to VoxPopuli,

It took 26 days and three different — painful — procedures before Jackson finally received the D&C she said her physician told her she needed from the start. 

“He was clear in advance that the D&C and fibroid removal was the best course of action, but because of this law [the six-week abortion ban], he had to proceed very cautiously,” she said in her email. “I was only afforded these multiple opportunities because I have insurance and the means to cover my deductible.”

The polyp turned out to be benign. But the anxiety, fear, pain and $176,000 in medical procedures she had to endure before getting the D&C she needed, were not. 

“Those were the hardest 26 days of my life,” Jackson said during the roundtable. “Choice seems like this really abstract thing, but it's something that's so necessary in order to be able to take care of the citizens in our state. Abortion is absolutely health care. D&Cs quite often are done to save lives, not because someone just didn't want to have a baby.”

The impact on essential health care 

Jackson was among nine participants — including three ob-gyns and an attorney who specializes in assisted reproductive technology (ART) law — who gathered last week for a roundtable about the medical necessity of abortion access and the importance of passing Amendment 4. If passed, the amendment would guarantee a person’s right to make their own reproductive healthcare decisions — without government interference — in the Florida Constitution.  

The event was hosted by Democratic State Rep. Anna V. Eskamani of Orlando, who has been one of the drivers for getting Amendment 4 on the ballot this year. 

The amendment needs 60 percent of vote support to pass. A Florida Atlantic University poll, released Tuesday, shows that 58 percent of Florida voters support Amendment 4, with 32 percent opposed and 10 percent still undecided.

Prior to 2022, abortion was available through viability, generally considered 22 to 24 weeks of pregnancy, under the Florida Constitution’s privacy clause. Earlier this year, the Florida Supreme Court upheld a 2022 ban on abortion after 15 weeks, ruling that the right to privacy did not include abortion. That decision also allowed a six-week ban, passed in 2023, to go into effect on May 1. 

Critics argue that a six-week abortion ban is essentially a total ban because most women do not realize they are pregnant at that stage. In the cases of rape, incest and trafficking, abortion can be performed up to 15 weeks, but there are still many hoops to jump through to obtain the procedure, and physicians, wary of the law and afraid of losing their medical license, often won’t provide an abortion after six weeks regardless. 

“To be limited with the care that I can provide to my patients is not something that aligns with the American College of Obstetrics and Gynecology. It doesn’t align with the tenets of — I’m a DO — the tenets of osteopathy,” noted Allison Bradley-Amore, DO, an ob-gyn at Premier ObGyn with offices in Winter Park, Maitland, Oviedo and Lake Mary.

Even if they don't perform abortions themselves, Florida ob-gyns are scared to provide medical care to women who have recently had abortions. 

Orlando ob-gyn Matthew Wollenschlaeger, MD, recalled a phone conversation with a colleague in another state who terminated a pregnancy for a Florida woman. Six weeks later, the woman went to the hospital with a fever, worried she was having post-abortion complications. Once she was discharged, she went to see her regular ob-gyn. 

“Her ob-gyn in Orlando evaluated her and told her I will not do anything for you. I cannot do anything, and I don’t know anybody in the state of Florida who can do anything for you because we can be charged with aiding and abetting an abortion,” Wollenschlaeger said. 

“Even though the abortion happened six weeks previous and this was likely not a complication to that, physicians in Florida are scared because if my license, my livelihood, my life is on the line along with the patient, it puts us into a spot where I have to decide if I can retire tomorrow of if I still need to provide for my family,” he said. 

Wollenschlaeger said Florida’s six-week abortion ban forces him to factor in considerations that should never go into decisions about medical care. 

“It makes me make a choice between my family and my life and trying to get patients the care they need. That's not a choice you should have to make. It should just be what's in the best interest of that patient,” he said.

Cori Baill, MD, a professor of obstetrics and gynecology at University of Central Florida (UCF), noted that abortion bans are driving up rates of maternal mortality and infant mortality, particularly among low income women and women of color who already have higher mortality rates than white women. 

“These restrictions do not save lives, they do not decrease the number of abortions, and they impair women, and especially low income women,” Baill said via Zoom during the roundtable. “Brown and Black women already face, nationally, a three times increase in the mortality rate associated with pregnancy, and in Florida that's four times, that of white women,” she said. 

A 2020 study in American Journal of Preventive Medicine showed that maternal mortality increased 38 percent in states that imposed gestational limits on abortion. The association is likely related to a decline in maternity care providers, a common situation parts of Florida. Approximately 20 of Florida’s 67 counties, primarily in the Big Bend and Panhandle regions, have few to no maternity care providers at all, according to a new study done by the March of Dimes. 

The impact on ART

Attorney Robert Terenzio, who specializes in assisted reproductive technology law, describes ART as the “other side of the abortion question.” He said the right to abortion “also implies the ability to choose help from a medical professional to expand your family.” 

In 2021, 2.3 percent of all babies born in the U.S. were conceived using ART, which includes donor sperm and donor eggs, in vitro fertilization (IVF) and gestational carriers, according to the U.S. Department of Health and Human Services. Florida ranks among the top 10 states for ART-conceived infants.  

Terenzio said he was disturbed by recent developments in Italy where a new law punishes would-be parents who seek gestational carriers (or surrogates) outside of the country. 

“This is a path the United States is going down,” Terenzio said, noting that the Supreme Court justices stated in the Dobbs decision that access to IVF should be examined in the future. “We need this constitutional amendment to stop that or at least inhibit it to some extent.”

He also nodded to the expense of IVF, which typically costs $20,000 per cycle to produce viable embryos for implantation. 

“If the government does not allow excess embryos, sperm or ova to be frozen, patients will have one chance of getting pregnant and then will have to start over agin with an extra $20,000. This is just unbelievable to me.” 

The impact on physician education

Baill, the UCF professor, worries reproductive health care services will suffer in Florida if Amendment 4 doesn’t pass simply because top-quality students will go elsewhere for medical training.

Physicians tend to stay and practice in the state where they do their residencies — about 54 percent, according to the Association of American Medical Colleges (AAAMC). In a survey of physicians who completed residency between 2008 and 2017, nearly 62 percent of physicians stayed in Florida after their residencies.  

Baill fears that number will drop because of Florida’s political climate. She ticked off the state’s Covid response, Don’t Say Gay, book bans, removing AP Psychology from the high school curriculum, banning gender-affirming care, and of course, the abortion ban. She said it all adds up to motivate medical students and residency candidates to seek training elsewhere. 

A 2022 Journal of Medical Ethics survey, done after the Dobbs decision, suggests that abortion care is on medical students’ minds as they ponder which programs to apply to for residency. Of the 494 third- and fourth-year medical students surveyed, 77 percent were factoring in changes to abortion access to their residency program choices.

“I don’t think people want to come here, and if they are here, they’re not matching [for residencies] in ob-gyn,” Baill said. “People are fed up, and they’re thinking they’ll train someplace else.”

Baill noted that an ongoing ban’s effects will ripple out beyond the ob-gyn specialty to affect surgery, internal medicine, family medicine, emergency medicine, pediatrics, even nursing and pharmacy. This will only exacerbate a critical physician shortage that the state is already anticipating because of growth and doctor supply. According to the Florida Medical Association, within 10 years, the state will be short nearly 18,000 physicians, including about 500 ob-gyns.  

“We’ve lost physicians because the government decided it’s their purview to be in the exam room with the doctor and the patient,” she said.