July 31, 2022 Liz Borkowski, MPH 0Comment

Five weeks after the Supreme Court’s Dobbs v. Jackson Women’s Health Organization stripped much of the population of reproductive autonomy, several states have banned abortion and several others have passed six-week bans that make abortions feasible for a very small proportion of those who want them.

Small entities are stepping up to assist in this public health crisis, while several states fail to make the kinds of changes that might reduce its toll. Abortion funds and clinics in states where abortion is still legal are overwhelmed, as residents of abortion-banning states seek care elsewhere, and Aid Access – a service that provides virtual consultations and ships medication abortion drugs to those for whom they’re appropriate – reported that they now get 1,000 emails a day from the U.S., compared to the 400 that was typical before the decision. And the states that force people to continue pregnancies against their will remain the least supportive of pregnant people, parents, and young children, a recipe for increased poverty and trauma as people are forced to give birth to children they know they don’t have the resources to parent. That indifference to the lives of pregnant people will soon be visible in more maternal deaths, which will disproportionately take Black and Indigenous women from their families.

Congress considered the Women’s Health Protection Act, which would have enshrined the right to abortion in federal law, but without Republican support it died in the Senate. The Biden administration has released guidance that could help in certain circumstances; the Department of Health and Human Services has reminded pharmacists that civil rights law prohibits them from refusing to fill orders for contraception or abortion medication or discriminate based on a person’s pregnancy status, and instructed hospitals that under the Emergency Medical Treatment and Active Labor Act, they must provide abortions to pregnant people who need them as treatment for emergency medical conditions.

Such federal guidance has proved necessary because the abortion bans that have taken effect over the past five weeks have resulted not only in people being unable to exercise the human right to decide whether to bear children, but in people being denied care when a wanted pregnancy goes wrong. Doctors who used to routinely provide abortions for ectopic pregnancies – which occur outside the uterus, never result in live births, and represent a clear threat to the pregnant person’s life – now face the threat of lawsuits and, in some cases, jail time if someone without a medical degree disagrees with the care they provided. Texas resident Elizabeth Weller suffered a premature rupture of membranes at 18 weeks and was told that, rather than receiving a medically indicated abortion to protect her from infection, she had to wait until fetal cardiac activity ceased or her symptoms indicated that she was already suffering from potentially fatal complications. Also in Texas, Marlena Stell miscarried at around two months, but had to endure two weeks of physical and emotional pain – not to mention the risk of severe infection or death – before she could receive a D&C procedure.

It’s no accident that we already know about horrific cases like these in Texas, because abortions after six weeks have been effectively illegal there since its SB 8 law took effect in September 2021 and the Supreme Court declined to block it. Whitney Arey and colleagues reported in the New England Journal of Medicine, “SB8 has had a chilling effect on a broad range of health care professionals, adversely affecting patient care and endangering people’s lives.” Anjali Nambiar and co-authors examined cases of premature rupture of membranes and other similar circumstances at two Texas hospitals after SB 8, and they found that when patients had to wait for the care that patients in other states can receive promptly, more of them suffered severe outcomes such as clinical chorioamnionitis and hemorrhage.

Doctors can’t give the care they’re trained to provide and must weigh their duty to their patients against hospital policies and the fear of legal action. Although they’re generally able to offer care that ends a pregnancy once the person’s life is obviously in danger, there’s no clear place to draw that line. “A woman comes in with sepsis (infection in her blood) in pregnancy. At what point does a clinician feel comfortable intervening to disrupt a pregnancy that could lead to multi-organ failure?” asked gynecologist Rebekah Gee in an affidavit about Louisiana’s law. “To satisfy these laws–does it have to be her heart that fails, what about her lungs, her kidneys, and so on, what organs would this law decide are necessary to protect her life?” Or, as Slate writer Mark Joseph Stern asked, “[W]hen is a patient sufficiently close to death to justify termination? When her pregnancy has a 10 percent chance of killing her? 50 percent? 90? That, increasingly, is a question for the hospital ethics committee.”

The damage isn’t limited to those who are already pregnant. People with uteruses who rely on drugs like methotrexate to manage conditions such as rheumatoid arthritis – including an 8-year-old girl in Texas – have been denied their prescriptions because the drug could disrupt a pregnancy. Those who rely on drugs with high risks of fetal harm (like the seizure medication Depakote) worry that in the case of an unintended pregnancy they won’t have the option for abortion, in a demonstration of how bans have a disproportionate impact on disabled people.

States that ban abortion could offer broad latitude for physicians and patients to decide on the best course of action when faced with medical difficulties, but they seem content to let these anguishing situations continue. In fact, I have yet to see compelling evidence that the architects of these bans care about their impacts on actual existing people. The complete abortion bans in Alabama, Arkansas, Mississippi, Missouri, South Dakota don’t even contain exceptions for rape or incest, something that has suggested a shred of empathy in earlier proposals. Mississippi House Speaker Philip Gunn says abortion should be illegal even for a 12-year-old raped by her father. When a 10-year-old had to travel from Ohio to Indiana for an abortion, abortion opponents claimed the rape case was invented (it wasn’t), and Indiana’s attorney general triggered a wave of harassment against the doctor who provided the abortion when he announced that he was investigating her (she had filed all the necessary paperwork, and is considering suing him for defamation).

This kind of cruelty and injustice will continue until we elect public officials at both the state and local level who respect the rights of pregnant people to decide whether and when to bear children and how to proceed when pregnancies go awry.

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.