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Northern New England: The State of Reproductive Care and Choice in the States of Maine, New Hampshire, and Vermont

Given the recent Supreme Court of the United States (SCOTUS) decision on the Dobbs versus Jackson Womens Health Organization abortion case, we are exploring some particular US states and regions with respect to reproductive care, including the issue of the right to choose whether to terminate a pregnancy. Just to remind you, the Dobbs case involved a Mississippi law prohibiting abortions after 15 weeks gestation. Along with upholding the Mississippi law with 6 justices for and 3 against, the Dobbs decision also overturned the Roe versus Wade decision of 1973, 5-4. Written by Associate Justice Samuel Alito, the Dobbs decision reverses Roe v Wade by taking issue with what is known as substantive due process, a mechanism through which Roe v Wade applied the 14th Amendment to protect abortion as a privacy right. Rather than representing a sudden loss of abortion rights, the Dobbs decision, overturning Roe, was the latest of almost a 50 year process of chipping away at abortion rights. Today, our focus will be the northern part of New England, namely the states of Vermont, New Hampshire, and Maine.

Known affectionately as the Pine Tree State Maine is a state, where the right to an abortion is protected. Since 1994, Maine has protected access to abortion through various laws. Under those laws, prior to the Dobbs decision, the only requirement for those seeking abortion fell on under the age girls who require the consent, either of a parent, or and older family member. Unlike even most pro-choice states, Maine requires insurance companies to cover telemedicine abortion. This means that, up to 77 days gestation, you can consult with an abortion provider in video conferencing and have a medication abortion, without going to a clinic in person. A medication abortion, also called a medical abortion, is an  abortion that is achieved with medicines alone, without the need for instruments to be inserted into the uterus. Usually, a medication abortion consists of mifepristone, followed 36 to 48 hours later by misoprostol.

For those beyond 77 days gestation, or who otherwise do not opt for a medication abortion, pregnancy can be terminated by way of a procedural abortion, also called a surgical abortion. The various procedure begin with dilation of the cervix, meaning that the cervix is encouraged to open. This can be done with an instrument that the OB/GYN pushes through the cervix, typically after medication has been applied hours earlier to help the cervix to relax. Alternatively, the OB/GYN can insert what’s called a laminaria stick. This is made of seaweed and it expands as it absorbs water. After a few to several hours, the cervix can be open enough  to allow a procedure. Following this step, there are a few options, depending on how advanced the pregnancy is. In one such procedure, called a D&C, which stands for dilatation and curettage, the inner lining of the uterus is scraped. D&Cs also are performed frequently for diagnostic reasons, such as when there’s a suspicion of abnormal cell growth in the endometrium. Therapeutic D&Cs can be performed for removing products of conception, but also for removing overgrowth of the uterine lining. D&C by itself is adequate only early in pregnancy, so after a certain point the next option is dilatation and suction. This means that, after the cervix is dilated, the doctor suctions out the products of conception. Sometimes this can be done with a syringe, but often it requires power suction. A tube called a cannula is inserted through the opened cervix. Cannulae come in a range of sizes that are chosen based on how far along the pregnancy is, or was before it became inviable. In some cases, following suction, the doctor may then perform some curettage to extract any remaining products of conception. At some point during pregnancy, generally around the midpoint, suction is not enough to extract either a viable or inviable fetus. In such cases, the OB/GYN must use instruments to grab onto the fetus, or parts of the fetus. Such a procedure is known as a D&E, which stands for dilatation and extraction. The extraction includes not only the fetus, but also the placenta, as well as the membranes.

After the SCOTUS decision on Dobbs v Jackson overturned Roe v Wade, Maine’s Governor, Janet Mills, signed an executive order. The order safeguards access to abortion and also protects abortion care providers and patients throughout the state.

New Hampshire, the Granite State, also is an abortion-safe state. In 1997, Governor Jeanne Shaheen ended a collection of outdated restrictions on reproductive rights known as the “zombie laws”. New Hampshire has four abortion providers within its borders, but it should be noted that, like Maine, New Hampshire requires parental notification in order for a minor to have an abortion. Practically speaking, most young women who seek an abortion have at least one, and often two, supportive parents, but there is an option in cases when parental consent is not possible. The process is called “judicial bypass”, which means that a judge must decide whether the young woman, or girl, is “mature” enough to terminate a pregnancy. Any judge who has some reason to think that such an individual is not mature enough to have an abortion, then has to rationalize why the same individual would be mature enough to become a mother. Given the absurdity of such a comparison, judicial bypass almost always leads to a decision allowing the abortion.

Moving on to the Green Mountain State, Vermont also is abortion safe. From the Roe decision onward, the state has protected reproductive rights, including the right to choose. Since the Dobbs v Jackson decision, Vermont has been moving forward to encode the right to choose into the state constitution. In fact, in the upcoming November 2022 election, Vermonters will vote directly on “Proposal 5” —the Right to Personal Reproductive Autonomy Amendment. Passage of this proposal would amend Vermont’s constitution to guarantee the right to reproductive liberty throughout the Green Mountain State.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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