A 12-year-old girl, sexually assaulted by a family friend, comes to the Christus St. Vincent Regional Medical Center emergency room with abdominal pain and is found to be pregnant.

The Catholic Church's ethical and religious directives do not allow abortion, despite her age or the fact that she has been raped.

The hospital refuses to terminate the pregnancy, and the child must travel to Albuquerque for the procedure.

"The way it's been explained to me is that the [patient's] ability to live -- to breathe air -- has to be immediately threatened," said a local physician familiar with the hospital's protocol.

"If the fetus is normal and the mom is not going to die, she can't have it done. It doesn't matter how the fetus got there."

The emotional impact on a 12-year-old is not a factor, the doctor added.

Direct abortion is never permitted under the Catholic health care directives that guide decisions at Christus, Santa Fe's only general hospital.

The church does allow a woman to be treated for serious pathological conditions, even if the procedure might indirectly result in the death of the fetus. But "age, rape and incest are not indications in and of themselves to create a life-threatening situation that could result in an indirect abortion," said hospital spokesman Arturo Delgado in an email. "Therefore they are not considered as reasons for a medically-indicated abortion." No matter how compelling the circumstances.

In cases where the pregnancy is threatening the life of the mother, requests for therapeutic abortions are forwarded to the hospital's chief medical officer, who determines whether there is a way to save all the lives involved, Delgado said. The hospital's bioethics committee might be asked to assist all the parties involved.

No medically indicated abortions were performed at the hospital last year, Delgado said.

The same directives apply to the Christus-owned Physicians Medical Center.

In certain situations where a procedure is not allowed to be performed at the hospital, SVH SupportCo may be notified to assist with transportation to a location where the service can be provided, Delgado added.

The nonprofit was created to insulate the hospital from involvement in procedures that conflict with Catholic health directives. SVH SupportCo, according to its website, provides financial assistance for postpartum tubal ligations performed at the hospital, elective tubal sterilization and vasectomies ("incidental to another procedure") and therapeutic abortions under the following circumstances:

• Where the future health of the mother is endangered, although the determination "cannot rest purely on psychiatric grounds alone."

• Rape or incest.

• When the medical evidence is that the fetus will be born "in a state of health incompatible with normal existence."

Thirty-nine years after the U.S. Supreme Court legalized abortion in Roe v. Wade (Jan. 23, 1973), access to reproductive health services is shrinking throughout the country, and that includes Santa Fe.

With the retirement of physician Lucia Cies in December, there is no abortion provider in the state north of Albuquerque.

Threats of violence -- and actual violence, even murder -- "are keeping good, compassionate doctors from providing a safe and legal service," said Jorgia Decatona, who works for a Santa Fe OB/GYN.

Since 1995, states have enacted 711 measures limiting abortion rights, according to a NARAL Pro-Choice America report. Last year, 25 states passed 67 measures restricting access to abortion.

In a special message to the Legislature last week, Gov. Susana Martinez said she would allow legislation in the 2012 session requiring a minor seeking an abortion to notify a parent or guardian.

"The strategy of anti-abortion people is, you don't have to outlaw it. You just have to make it harder and harder," said a Santa Fe obstetrician.

Nationally, the Catholic Church is also cracking down on Catholic health care institutions that stray from the directives.

A hospital in Bend, Ore., lost the title Catholic for refusing to stop doing tubal ligations. Two hospitals in Texas were forced to cease doing what the church called "immoral sterilizations." And in 2010, a nun at a Catholic hospital in Phoenix was excommunicated for assenting to an abortion in the case of a mother of four suffering from pulmonary hypertension.

Since the merger between Christus Health and St. Vincent in 2008, tubal ligations are only available to hospital patients immediately after delivery (as required under federal law). But even then they are hard to schedule, according to one doctor connected to the hospital. In 2011, there were 82.

Although New Mexico scored an A-minus on NARAL Pro-Choice America Foundation's 2012 report card on women's reproductive rights, more and more women are having to travel to Albuquerque -- to places like Planned Parenthood, Southwestern Women's Options and The University of New Mexico Center for Reproductive Health -- for health care. (One abortion provider, Bruce Ferguson, retired last year.)

Dr. Lance Mikkelsen, who retired from the practice of obstetrics and gynecology a year ago, called access in the community "limited, limited to virtually nonexistent."

One doctor said she didn't even approach Christus about terminating a pregnancy involving twins, one with no head, one with no heart, because one of the fetuses had a beating heart. "Could I have fought that one? Maybe. Could I win? Maybe. But families need to be loved and taken care of," and in questionable circumstances, "I just call Albuquerque and send them there."

While clinical abortions are unavailable locally, women can obtain elective tubal ligations at Physicians Plaza, an ambulatory surgery center for procedures requiring no overnight stay. Some sterilization options (such as Essure, a permanent birth-control procedure) are also available at some doctors' offices.

Under state law, emergency contraception is available in the emergency room at Christus St. Vincent. And Planned Parenthood provides the abortion pill, a medicine that ends a pregnancy up to nine weeks -- one day a month.

Decatona said she's frustrated over the failure of the U.S. to learn from the experience of other developed countries -- nations such as England, France and Germany that we compare ourselves to -- if the goal is really to reduce unwanted pregnancy and abortion.

"They educate kids, give full and easy access to contraception and abortion, and that's that," she said. And "they report higher ages for first intercourse and fewer unintended pregnancies per capita. Our statistics are shameful."

Robert Benon, a nurse practitioner who works with teenagers, said he was worried about those who don't have transportation, "some of whom will not tell their parents they are pregnant and who really may have difficulty getting to Albuquerque and explaining their absence from school that day. I wouldn't be surprised if some have babies who might have opted otherwise for abortion."

Dana Middleton of Santa Fe NOW said the coalition of pro-choice organizations in the area has a fund to help women pay expenses connected to reproductive health services, such as bus fare, lunches and overnight accommodations.

"We have a serious reproductive health problem in this state, and we fear it is going to get more difficult," she said.

The New Mexico Coalition for Choice will be holding an event Monday at the Roundhouse to mark the 39th anniversary of Roe v. Wade, the Supreme Court decision legalizing abortion.

The news conference, which includes an invocation by Rabbi Marvin Schwab and various speakers, is set to begin at 2:30 p.m.

"Anti-choice groups are promising unprecedented efforts to diminish reproductive choices in our state," the news release says. "The Coalition for Choice is particularly concerned about the negative impact that parental involvement laws, which include both parental consent and notification, have on teens and young women. Parental involvement laws have only one goal: To chip away at protections granted by Roe v. Wade and make it difficult for teens to access reproductive health services."

Hearing about the governor's message, Middleton added, "We will be ready. We plan to be there."

She added, "Young women should not have to have parental consent, because sometimes it's the brother or the uncle" who is the father of an unborn child.

Contact Anne Constable at 986-3022 or aconstable@sfnewmexican.com.

IF YOU GO

What: News conference; celebration of 39th anniversary of Roe v. Wade
When: 2:30 p.m. Monday
Where: Roundhouse
Who: The New Mexico Coalition for Choice




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