If you miscarry in Republican America, your health is now at risk | Moira Donegan

JWorst-case scenarios are happening with alarming speed. In the weeks following the United States Supreme Court’s decision in Dobbs v. Jackson Women’s Health, the case that overturned Roe v. Wade and eliminated the constitutional right to abortion, American women faced a radical reorganization of their lives. A fundamental right to their dignity and self-determination has been taken away after nearly 50 years – and with it, the gains women have made in professional, political and social life are once again and seriously threatened. But in addition to this moral and civic crisis, the Supreme Court’s decision has also created a vast and acute new public health crisis, as abortion bans complicate once-standard care for pregnant women – and place health itself of those who are not pregnant at risk. new and arbitrary danger.

On the one hand, there are the miscarriages. Care for patients with spontaneous pregnancy loss has been significantly reshaped in Republican state hospitals. The treatment for a miscarriage is to evacuate the contents of the uterus, either with minimally invasive surgery or with drugs, and these procedures, it turns out, are identical to those used in voluntary abortions. But with ambiguous, yet uninterpreted but strongly worded laws currently in effect in anti-choice states, providers don’t know what they’re allowed to do for patients who miscarry. Many prohibitions include so-called “mother’s life” exemptions, but these are vaguely worded and carry heavy penalties for providers if they get it wrong. How sick must a patient be before a doctor can abort the pregnancy that is killing her? Does she need to die? How far must she be from death?

These are not assumptions: since the Dobbs decision, accounts of dangerously delayed miscarriages have been reported with alarming frequency. Providers postpone life-saving abortions, often until a fetus dies on its own and heart activity can no longer be detected – an emotionally charged and physically painful process that can take days or weeks. A woman in Texas told CNN she had to carry a dead fetus that her body wouldn’t expel for two weeks as she searched in vain for a provider who would take the legal risk of giving her a D&C.

Meanwhile, a woman who miscarries has a softened cervix, which puts her at increased risk of infection, and she is vulnerable to hemorrhage or even sepsis when the pregnancy tissue to inside of her begins to decay. Dr. Jessian Munoz, an obstetrician in San Antonio, told the AP about his attempts to treat a patient who developed a uterine infection while her fetus still showed signs of heart activity. Constrained by Texas laws, he couldn’t do much until it was almost too late. “We physically watched her get sicker and sicker and sicker,” Munoz said. The woman lost several liters of blood, required emergency surgery and had to be placed on a life support device, all because the law of her state considered the hypothetical life of her fetus to be more valuable than her own. So far, we have not seen any reports of women dying due to these delayed miscarriage treatments. But the dead are coming.

Then there are ectopic pregnancies. In about one in 50 pregnancies, a fertilized egg will implant somewhere other than the uterine wall – usually in the fallopian tube, but sometimes elsewhere in the abdominal cavity. In these cases, the pregnancy is never viable; it is always fatal for the pregnant patient. As with miscarriages, the treatment is abortion. But vendors in conservative states don’t know exactly what they’re allowed to do under the law, or what they can do without incurring penalties from zealous anti-choice colleagues or newly empowered vigilantes. bring ruinous lawsuits.

In Michigan, now an island of legal abortion in a Midwestern anti-choice deep sea, a woman presented to a hospital emergency room with an ectopic pregnancy that could have killed her; she had traveled there from another state, where the doctors had turned her away. Another woman was not so lucky: Her central Texas hospital advised her doctor not to intervene in her ectopic pregnancy until it ruptured, in which case her life was in danger. immediate.

The more intellectual denizens of the anti-choice movement insist that the deluge of draconian misogynistic laws that have been enforced by the Supreme Court shouldn’t really create these disastrous results, despite the starkly obvious fact that anti-choice laws choices have clearly created a rapidly more dangerous landscape for women’s health.

These voices claim that the vague wording and narrow circumstances allowed by the laws’ “mother’s life” exemptions are not the real problem, but rather that the real problem is how hospitals and their lawyers interpret the law. . “I’ve seen reports from confused doctors,” John Seago, president of Texas Right to Life, told The New York Times, “but this is a failure of our medical associations.” National Review expert Alexandra DeSanctis Marr wrote: “Abortion advocates are those who confuse abortion with miscarriage care and ectopic pregnancy care. Pro-lifers know the difference between necessary health care for women and intentionally killing a baby. It is the proponents of abortion who will not make the distinction.

If only these distinctions were as clear and obvious as Seago and DeSanctis believe. The truth is that while any moral movement for choice must wholeheartedly defend women’s right to control their own bodies, in these tragic medical crises the line between “optional” and “emergency” abortion is not not so easy to distinguish. The difference between abortion and “health care necessary for women” is ambivalent because medicine and the body do not conform to the strict moral lines in which the anti-choice movement tries to place them. When pressed, even Seago admits it. Shortly after declaring that the laws championed by his group pose no danger to women’s health, he acknowledged that following the law would indeed force providers to delay emergency care. “He recognized that such delays could lead to medical complications for women,” the Times said.

Not that Seago and DeSanctis are in touch with their movement anyway. The base of the anti-choice movement appears alarmingly comfortable with the waiver of the “mother’s life” exemptions, just as that same movement has largely dispensed with its stated support of the rape and incest exemptions. In Wisconsin, anti-choice groups have called for changes to the long-dormant 1849 abortion ban to grant fewer exemptions for maternal life and health. In Idaho, a recent Republican Party convention shifted its platform to support an abortion ban with no exceptions. When a proposal to include an ectopic pregnancy exemption was put forward, it failed by almost four to one.

In retrospect, it seems obvious that the anti-choice movement would insist on a false dichotomy between abortion and women’s health. This seems in line with the other false binaries the movement is so enamored with: like the one between women who have children and women who have abortions; or between those who deserve to control their lives and those who were born with a womb.

theguardian Gt

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