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Reproductive Rights and Abortion in Alaska and Hawaii

We have been touring around the United States regarding reproductive care and abortion rights. That’s because of the recent Supreme Court of the United States (SCOTUS) decision on the Dobbs versus Jackson Womens Health Organization abortion case this past June. The Dobbs versus Jackson Women’s Health case involved a Mississippi law prohibiting abortions after 15 weeks gestation. Not only did six of the nine SCOTUS justices vote to uphold the Mississippi law, but five of those six also voted to overturn the Roe versus Wade decision of 1973. Written by Associate Justice Samuel Alito, the Dobbs decision reverses Roe v Wade by taking issue with substantive due process, a mechanism through which Roe v Wade applied the 14th Amendment to protect abortion as a privacy right. But this followed almost a 50 year process of chipping away at abortion rights, since the time of Roe. During that half century, several US states with state legislatures and governors opposing abortion passed abortion trigger laws, laws that would go into effect in the event of Roe v Wade being overturned. This, plus the passage of new laws, has begun to restrict abortion access further in such states, but there are others states that are going all out to protect abortion rights and in some cases. Today, we’ll look at the abortion situation in Alaska and Hawaii.

Alaska is called The Last Frontier and you might assume that it’s very unfriendly to abortion rights, given that it’s a very Republican state. Indeed, the Alaska governor strongly opposes abortion and the state legislature has made several attempts to block abortion access, but it hasn’t worked. Polling data show that Alaskans overall believe that women should decide for themselves what to do with their bodies. Moreover, Alaska’s judiciary branch —its court system— has made various decisions that have upheld the right to choose and also because the state’s constitution provides good protection of privacy, which the courts have protected. That being said, there are very few abortion providers in Alaska. Planned Parenthood handles most of the abortions, plus there are a few independent providers scattered about the state, but it’s an enormous state and difficult to get around. Consequently, if you live in Alaska and need an abortion, you may face some challenges traveling to an aboriton location, but you will not need to leave the state.

Meanwhile, the Aloha State, Hawaii is extremely protective of reproductive rights, including the right to an abortion. The Aloha state was one a handful of states where abortion was legal prior to the Roe v Wade decision. Abortions in Hawaii are performed by Planned Parenthood and the by the University of Hawaii medical center, with extremely qualified. Hawaii is so abortion friendly that some women from anti-abortion states might choose to travel there, although only women who have the means to afford such travel. It’s a heavy price, so Hawaii will not be an option for most abortion seekers in mainland states with abortion restrictions. But it is becoming a destination for medical tourism, including abortion care, for women who have the means and simply inhabit an anti-choice states.

Both of these western state offer both procedural abortions and medication abortion. The latter you can have up to the gestational day 77, meaning  through the end of the 11th week of pregnancy. 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.

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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