The 2016 edition of "A Women's Right to Know," a booklet provided to patients prior to seeking an abortion, has drawn controversies from several medical groups for what they claim is flawed, biased, and outright incorrect information.
In particular, they've taken issue with statements that seemingly connect abortion with depression, breast cancer and fetal pain.
"There is medically incorrect information," explained Dr. Kimberly Carter, who's the President of the Texas Association of Obstetricians and Gynecologists (TAOG).
While Carter added that the 2016 edition is a big improvement over previous iterations due to a softening of language, she highlighted several issues still exist.
"Most importantly - the fetal pain is still medically inaccurate. And to bring up a link between breast cancer and elective terminations is still medically inaccurate," explained Dr. Carter.
Another point of contention - linking depression with abortion. Dr. Carter said the language used to describe emotional responses following an abortion were overly negative, and not inclusive of all available data.
Her statements - backed by the American Cancer Society and American Psychological Associations. Both organizations have stated no link between abortion and cancer or depression, respectively.
Sarah Wheat, a spokesperson with Planned Parenthood, believed the pamphlets are motivated by politics rather than medicine.
"That's always been incredibly challenging for our professional medical staff and for patients who don't understand why they're receiving information that's not based on medical science from a medical professional," explained Wheat.
State law requires women seeking the procedure to receive the packet from their physician and wait at least 24 hours before returning. Wheat said she believes the pamphlet did little to discourage women seeking the procedure.
Through the reviewal process, Carrie Williams, a spokesperson with the state Health and Human Services Commission, said they received 13,000 public comments.
Some of the most prominent criticism came from the American Congress of Obstetricians and Gynecologists (ACOG) and Texas Association of Obstetricians and Gynecologists.
In a six-page letter, they pointed out over twenty issues, many surrounding biased language, a lack of legitimate sourcing, cherry-picked statistics, or outdated and incorrect information.
The Texas Medical Association (TMA) also stated their objection to much of the language used in the pamphlets, echoing previous criticism they have shared in past years.
For example, ACOG and TAOG objected over the use of the term "baby" instead of the medically-accepted term for "fetus." Other language issues - using "womb" instead of "uterus."
On top of page two of the pamphlet, in italicized red lettering, it states “We know that babies develop the ability to feel pain while in the womb. In consideration of the potential for fetal pain, Texas law currently limits abortion to under 20 weeks.”
However, ACOG and TAOG's letter noted, "There is no credible, current medical evidence that fetuses are sufficiently neurologically developed to perceive pain before 24 weeks; indeed, there is significant evidence to the contrary. [Lee; RCOG] The language is unnecessarily inflammatory, putting forth an ideological rather than scientific perspective and should be removed."
It goes on to note that the article sourced for this finding has not been peer-reviewed and "not considered to be the authoritative study on fetal pain."
In a letter written this summer by Dr. Shanna Combs, the Chair on the Committee on Reproductive, Women's and Perinatal Health for the Texas Medical Association, she expressed her overall displeasure with much of the content.
In part, she wrote "We continue to be concerned with the biased terms and inferences throughout the pamphlet, on almost every page."
In a 2013 review, the American College of Pediatricians looked into many of the sources cited in the pamphlets, and agreed with their respective findings.
"We're pleased with the evidence that we've found so far regarding the link. Certainly more (research) needs to be done," explained Dr. Patricia Lee June, who is part of the organization. Dr. June noted they had not conducted any studies, but had reviewed other studies on the issue.
While Dr. June acknowledges the American College of Pediatricians morally objects to abortion, she asserted their findings were based on science.
We reached out to the Health and Human Services Commission for an interview. They declined our request, but provided a statement which read in part:
"We very carefully reviewed the booklet for accuracy and took to heart the feedback we received over the summer.... Our focus was on making sure the booklet is helpful, user friendly and medically accurate, and we carefully studied the medical and scientific research available to us along the way. In the end, it's about making sure pregnant women have the information they need to make decisions that are right for them."
The pamphlets are currently being printed to be given to women's health facilities. In total, the 20-page pamphlet cites 31 different sources.