Abortion bans are poised to make ectopic pregnancy and miscarriage more dangerous and difficult in states across the country—and are already doing so in some states. It turns out, once you make it illegal to choose to terminate a pregnancy, suspicion falls on any pregnancy that ends early, and there are fewer resources to care for pregnancies that are ending or must end.
Go figure.
Ectopic pregnancies are one major area of concern. They occur when a fertilized egg implants somewhere other than the uterus, and though they occur in less than 2% of pregnancies, they account for 2.7% of pregnancy-related deaths. When an egg that has implanted somewhere without room to grow, grows, it can lead to rupture and hemorrhage, both of which can happen very quickly. An ectopic pregnancy is an emergency that demands immediate treatment—but abortion bans can put a pause on that treatment as doctors worry that it will be categorized as illegal. This is not hypothetical.
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A Texas woman with an ectopic pregnancy had to go to New Mexico, a more than 12-hour trip, for ectopic pregnancy care after both her own doctor and a local emergency room told her that her case did not meet the law’s narrow and vague “medical emergency” exemption, Caroline Kitchener reported at The Lily last fall.
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“If a patient shows up with signs of an ectopic pregnancy, the patient should be in the operating room in less than 12 hours,” a maternal fetal medicine professor at Northwestern University’s Feinberg School of Medicine told Kitchener. “You do not have time to send her to another hospital, much less out of state.”
Around the same time, a pharmacy in the Austin area told doctors it would no longer fill prescriptions for a drug used to treat ectopic pregnancy. Again, these are emergency situations.
A bill under consideration in Louisiana criminalizing abortion also has giant red flags for cases of ectopic pregnancy, expanding the definition of a “person” from a fertilized egg implanted in a uterus (already an outrageous and dangerous claim) to any fertilized egg, including, in other words, ones implanted outside a uterus. But it’s not just ectopic pregnancy that requires treatment that’s doctors may hesitate to provide in states with the harshest abortion bans.
As many as 20% of known pregnancies end in miscarriage, and while some miscarriages happen without requiring significant medical intervention, many require medical care. And the medical care for miscarriage is … abortion, basically. (In fact, the medical term for miscarriage is “spontaneous abortion.”) The reason for providing the medications or surgical procedures may be different—a choice to end a pregnancy versus treatment to ensure that a nonviable pregnancy comes to a safe conclusion—but the medications and surgical procedures are the same. And that means that abortion bans make miscarriage more dangerous.
A Sweetwater, Texas, doctor told NPR she no longer sends prescriptions for misoprostol to a local Walmart because a pharmacist there cites the Texas abortion ban and refuses to fill the prescriptions even if the doctor notes on the prescription that it is for miscarriage care. A doctor in the Austin area reported similar refusals from pharmacists: “The pharmacy has said, ‘We don't know whether or not you might be using this medication for the purposes of abortion.’”
Each one of those incidents involves someone who is dealing with a pregnancy ending completely outside of their control or intent, having to then deal with a hostile system that casts suspicion on them and throws up barriers to obtaining medical care at a difficult time.
The same goes for treating miscarriages with surgical procedures. A Minnesota doctor told Bloomberg that she had done a surgical procedure on a patient from a neighboring state who could not find a doctor willing to do it in their own state. Another doctor described being the only one willing to do a dilation and evacuation for a patient in an Oklahoma hospital.
“I did the procedure in 15 minutes,” he told Bloomberg. “I remember asking the provider, ‘What would you have done if I hadn’t been in the state?’ They would have probably removed her uterus.”
”I’ve had patients who were 15, 16, or 17 weeks pregnant when the fetus died and had to carry it around, and I’ve seen patients who had been told they can’t get care for miscarriages, even though these services are completely legal for miscarriage,” a Texas doctor told NBC News.
Clearly, these are not isolated cases. The legislative director of Texas Right to Life may tell the media that this is “an awful misunderstanding of the law,” but if it’s a misunderstanding held by multiple pharmacists and doctors, that translates to a lot of patients who don’t get the care they need—on an emergency basis, in the case of ectopic pregnancy.
Abortion should remain a legal choice, and should be an accessible form of medical care for everyone, not just those who can afford to travel out of state. But for anyone tempted to think that abortion bans won’t affect them, and won’t affect anyone whose life they approve of or value, consider that ectopic pregnancy, though rare, is a serious threat to life, and that miscarriage is extremely common.
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