July 6, 2022

Dear Representative,

We write as physicians who provide abortion care later in pregnancy to thank you for voting in favor of H.4954,
An Act expanding protections for reproductive rights. All the provisions are critical to our ability to provide
essential health care for our patients, whether they reside in the Commonwealth or travel to Massachusetts for
abortion care because of restrictions in their home states.

We are especially grateful for the provision to clarify the statutory framework for abortions after 24 weeks of
pregnancy by referencing “severe” fetal anomalies.

As doctors – many of whom advocated for passage of the ROE Act – we know from experience that this Act is
making a critical difference in Massachusetts. However, we believe strongly that we cannot realize the full
intention of the ROE Act without this clarification.

We are fortunate to have the ability to detect chromosomal abnormalities early in pregnancy, such as Trisomy 13,
18, and 21 (Patau Syndrome, Edward Syndrome, and Down Syndrome). These findings will ordinarily be
discovered between 10-20 weeks depending on the method of testing, allowing patients ample time to determine
the best reproductive decision for themselves and their families.

However, some patients present with pregnancies affected by serious fetal anomalies later in pregnancy and
require compassionate, high-quality and often complex care. Most of these patients have wanted pregnancies, and
they face the heartbreaking decision to either terminate the pregnancy or give birth to a child whose life will be
foreshortened, severely compromised, and possibly very painful. Pregnant patients who learn about a severe fetal
diagnosis rely on us as physicians to provide the information they need to consider their options and to support
them as they navigate these difficult decisions.

Our ability to meet the needs of our patients in these circumstances is hampered by the wording of the current
statute that draws the line for care at lethal fetal anomaly, because in the real-world practice of medicine, this is
difficult to implement and requires clarification. It is sometimes impossible to predict with absolute certainty
whether a fetal anomaly will have fatal consequences or other extremely grave and painful outcomes. The
outcome depends on many factors including the type of anomaly, the presence of other medical conditions,
whether the pregnancy is singleton or multiple, the likelihood of a premature delivery, and the birth weight and
sex of the fetus. For these reasons, each situation must be considered on a case-by-case basis. Clarifying
legislative language that allows physicians to use their best medical judgment to offer abortion care to patients
with serious fetal anomalies speaks to the realities of medical practice and allows us the latitude we need to
provide appropriate care for our patients.

Nothing is more distressing than having to tell patients in these difficult circumstances that they need to leave the
state to obtain abortion care, especially given the tremendous barriers to access that they face. We know from
experience that some will not make it and will be forced to carry extremely compromised pregnancies to term
against their wishes. The lives of our patients hang in the balance, and now more than ever, we need the
legislature to help us help them.

As physicians, we thank you for taking this step to advance more comprehensive and equitable care in our
communities, especially at this critical time in our nation’s history. Just over one week ago, the Supreme Court
stole away bodily autonomy from millions of people across the country. A dozen states currently are moving
forward with enforcing abortion bans. Twenty-six states are expected to ban or severely restrict abortion, and we
expect individuals from those states to come to Massachusetts for care.
We have already seen patients from Texas in the wake of the six-week ban that went into effect last September,
and people from other conservative states have recently shown up at our doors. If Massachusetts is to be a leader
in this moment of crisis, we cannot send our own residents out of state for abortion care. To do so is incongruous
with our Commonwealth’s obligation to promote true reproductive equity, and with our commitment, as providers,
to delivering exemplary health care.
Thank you for standing with patients and providers to make this change and realize the legislative intent of the
ROE Act.

Sincerely,

Robert Barbieri, MD Lynne Bartholomew Goltra, MD

Department of Obstetrics and Gynecology Vincent Obstetrics & Gynecology
Brigham and Women’s Hospital Massachusetts General Hospital

Tiffany Blake-Lamb, MD, MSc Kari Braatan, MD, MPH

Massachusetts General Hospital Brigham and Women’s Hospital

Rachel Cannon, MD, MSc Laurent Delli-Bovi, MD

Boston Medical Center Women’s Health Services

Megan L. Evans, MD, MPH Kathryn Fay, MD, MSCI

Tufts Medical Center Brigham and Women’s Hospital

Alisa Goldberg, MD, MPH Cheryl Hamlin, MD, MPH

Director, Division of Family Planning Mount Auburn Hospital
Brigham and Women’s Hospital

Luu Ireland, MD, MPH Thomas Kishkovich, MD

UMass Memorial Healthcare MGH, Brigham and Women’s Hospital

Tara Kumaraswami, MD, MPH Allison Mantha Bryant, MD, MPH

Obstetrics & Gynecology Residency Program Senior Medical Director for Health Equity
Director, UMass Memorial Healthcare Massachusetts General Hospital

Elizabeth Maxwell, MD, MPH Divyah Nagendra, MD, MSHP

MGH/Brigham and Women’s Hospital Cambridge Health Alliance

Boris Orkin, MD Maureen Paul, MD, MPH

Beth Israel Deaconess Medical Center Beth Israel Deaconess Medical Center

Katherine Pocius, MD, MPH Deanna Sverdlov, MD

Medical Director of Family Planning Tufts Medical Center
Massachusetts General Hospital

Kelly Treder, MD, MPH Samantha Truong, MD

Complex Family Planning Massachusetts General Hospital
Boston University School of Medicine

Chloe Zera, MD, MPH

Maternal Fetal Medicine, Beth Israel Deaconess
Medical Center