THIS IS PART TWO OF A TWO-PART SERIES ON Abortion. FOR PART ONE, GO here.
The first part of this post detailed the horrific stories of two pregnant women, one in Ireland and one in Poland, who died because laws that restricted abortion prevented doctors from providing the necessary care to save them. Dr. Sabaratnam Arulkumaran, who examined what happened in the Irish case, warned that similar tragic and avoidable outcomes are coming to the U.S., as well.
Dr. Arulkumaran was interviewed recently by NBC News, shortly after the U.S. Supreme Court’s “extremist majority” overturned Roe v. Wade in Dobbs v. Jackson Women’s Health Organization. He offered: “I think maternal mortality will go up,” and added, “Those who are going to be affected are those from lower socioeconomic groups, adolescents, those who don’t have facilities to go for termination.”
Vice President Kamala Harris laid out the facts on how maternal mortality already disproportionately impacts vulnerable communities in her speech to the NAACP’s 113th National Convention: “Today, in America, Black women are three times as likely to die from pregnancy-related causes. Native American women are more than twice as likely to die. Rural women are more than one and a half times more likely to die.” To put it another way, as Shawnee Benton Gibson—whose daughter Shamony died from complications related to childbirth—chanted at a recent National Action Network rally: “Black lives matter because Black wombs matter!”
In the weeks since Roe fell, we don’t know of any deaths yet in our country along the lines suffered by the women in Ireland and Poland. Yet. But that doesn’t mean the curtailing of abortion rights hasn’t led to suffering and serious harm in America. We can see this in particular in Texas, where SB 8 all but eliminated abortions last fall.
The authors of an article in the New England Journal of Medicine spoke with 25 reproductive health care providers in Texas about SB 8’s impact on how they practice, along with 20 patients with “medically complex pregnancies” who got care either in the state or outside its borders after the law’s passage. Overall, the authors found that the law “has had a chilling effect on a broad range of health care professionals, adversely affecting patient care and endangering people’s lives.”
More specifically, in cases where the patient’s life could be at risk if care is delayed because doctors are afraid of violating the law, the authors found:
Patients with pregnancy complications or preexisting medical conditions that may be exacerbated by pregnancy are being forced to delay an abortion until their conditions become life-threatening and qualify as medical emergencies, or until fetal cardiac activity is no longer detectable. An MFM specialist reported that their hospital no longer offers treatment for ectopic pregnancies implanted in cesarean scars, despite strong recommendations from the Society for Maternal–Fetal Medicine that these life-threatening pregnancies be definitively managed with surgical or medical treatment.
Some clinicians believe that patients with rupture of membranes before fetal viability are eligible for a medical exemption under SB8, while others believe these patients cannot receive an abortion so long as there is fetal cardiac activity. In multiple cases, the treating clinicians—believing, on the basis of their own or their hospital’s interpretation of the law, that they could not provide early intervention—sent patients home, only to see them return with signs of sepsis. An obstetrician–gynecologist recalled only one patient who was able to obtain an abortion at their hospital under SB8’s maternal health exemption, because her severe cardiac condition had progressed to the point that she was admitted to the intensive care unit.
One physician who specializes in high-risk pregnancies told the authors that “people have to be on death’s door to qualify for maternal exemptions to SB 8.” Welcome to Texas.
Additionally, a new study just published in the American Journal of Obstetrics and Gynecology tracked pregnant patients in two Dallas-area hospitals who, after SB 8 went into effect, had severe complications prior to the point when a fetus was viable. The law’s effect looks to be profound and severe:
Out of 28 women who met the criteria for the study, more than half experienced “significant” medical problems, including infections and hemorrhaging, in the face of state-mandated limits on treatment, the study found. One woman required a hysterectomy. And the rate of maternal health problems was far higher than the rate in other states where patients were offered the option to end their pregnancies.
As Dr. Monica Saxena, an ER doc at Stanford, bluntly put it: “In this post-Roe world, women with miscarriages may die.”
One patient in Texas, Marlena Stell, went public to her 1.5 million YouTube followers with her story about being denied care after her fetus died in the womb when she was 9.5 weeks pregnant. She wanted the fetus removed—standard procedure for what’s commonly known as an “incomplete miscarriage”—but was told that because the procedure to do so (a dilation and curettage, or D&C) was the same one used in an abortion, the doctor could not perform it. If none of this makes a lick of sense to you, you’re not alone. Stell was told to “try to miscarry at home.” This increases the risk of infection—including lethal sepsis—thus putting the pregnant patient in danger.
“People need to understand how these laws affect all women, even cases like mine,” Stell said. “I feel like it’s very dangerous for government of any type to be intervening in a woman’s care because there’s multiple reasons of why she may need a procedure.”
Stell added: “I felt like a walking coffin. I get so angry that I was treated this way because of laws that were passed by men who have never been pregnant and never will be. I’m frustrated, I’m angry, and I feel like the women here deserve better than that. It doesn’t matter what side of the fence that you want to sit on, laws like this affect all women regardless of what situation you’re in, and it’s not right.”
Going forward, she explained that “our fear is that if I get pregnant and miscarry again that something will happen. We just do not feel confident at all that we’ll get the care that we need in Texas if something were to happen.”
Stell isn’t alone, as doctors are reporting a noticeable uptick in the number of both men and women who—motivated by a desire to have certain control over their reproductive futures—are seeking to be sterilized in the weeks since the Dobbs v. Jackson Women’s Health Organization ruling.
Putting it all together, Dr. Rakhi Dimino, in an interview with PBS, stated that in the past few months, she has seen more patients with hemorrhaging/heavy bleeding or sepsis “than I’ve ever seen before.” She added that, right now, women in Texas are losing faith and trust in the health care system completely, which increases the danger they face: “We could be losing valuable time, [and the patient could] lose her reproductive organs and her life.”
In response to these and other numerous reports, the Texas Medical Association (TMA) has filed a request with state regulators to “swiftly act to prevent any wrongful intrusion into the practice of medicine.” One of the cases the TMA cited was a patient with an ectopic pregnancy—when the fetus implants outside of the uterus, most commonly in the fallopian tube—whose doctor was told not to take the medically necessary step of removing the fetus until there was a rupture. The TMA document stated: “Delayed or prevented care in this scenario creates a substantial risk for the patient’s future reproductive ability and poses serious risk to the patient’s immediate physical wellbeing.” In other words: If not treated swiftly, an ectopic pregnancy quickly leads to serious risks, including maternal death.
When an ectopic pregnancy occurs, the fetus cannot develop fully, at the proper rate, or survive to a point at which it can live outside of the womb. It cannot be delivered or reimplanted int he proper location. The result will never be a viable pregnancy. This is true 100% of the time, without exception. No human being has ever been born from an ectopic pregnancy in the history of all humankind. If you thought observable facts would protect pregnant patients with life-threatening complications who live in places with an abortion ban that supposedly has an exception for the “life of the mother,” well, bless your heart.
There have been multiple other reported cases where patients with an ectopic pregnancy could not get appropriate care immediately, thus putting lives in danger. Dr. Pamela Parker, an OB-GYN, stated flat out that not providing immediate, evidence-based treatment was tantamount to medical malpractice.
Like miscarriages, etopic pregnancies are not uncommon. Our family has experienced this pain, too, which has only served to cement my own pro-choice views. In July 1973, just six months after Roe v. Wade was decided, a member of my family was only a few weeks pregnant and hadn’t even done a pregnancy test. As she tells it, she felt severe abdominal pain, which traveled to her shoulder. This led her doctor to suspect an ectopic pregnancy, so he asked her to come to the hospital. Her fallopian tube had burst, putting her life in serious danger.
Once she arrived at the hospital and was examined, she was immediately brought into surgery. The doctor wouldn’t even let the staff do the paperwork to formally admit her; as my relative recalls, he said, “We have to operate on her now, otherwise she’ll be in the morgue.” Thankfully, this doctor didn’t have to hesitate and figure out if the fetus was still alive, or weigh whether he was risking his license or his freedom by acting to save her life. The right to reproductive care was already protected by law when this took place, making this a family story with a happy ending rather than a tale of tragedy. Today, my relative tells me, “I wasn’t thinking about Roe v. Wade at the time. I was just thankful to be alive.”
Since the Supreme Court overturned Roe v. Wade, the Biden-Harris administration has taken steps that will, one would hope, provide enough clarity so that patients in these kinds of emergency situations get the care they need without having to be “on death’s door.” One part of the guidance makes clear that federal law will protect physicians who perform an abortion in any situation where it is medically necessary. Furthermore, the guidance informs hospitals that violations will bring significant penalties. "We are making enforcement a priority," a senior official at the Department of Health and Human Services (HHS) stated.
Patients are guaranteed access to emergency care thanks to the Emergency Medical Treatment and Active Labor Act (EMTALA), which “protects providers' clinical judgment and the actions they take to provide stabilizing treatment to pregnant patients who are under emergency medical conditions, regardless of restrictions in any given state.” Here’s HHS Secretary Xavier Becerra:
Under the law, no matter where you live, women have the right to emergency care — including abortion care. Today, in no uncertain terms, we are reinforcing that we expect providers to continue offering these services, and that federal law preempts state abortion bans when needed for emergency care. Protecting both patients and providers is a top priority, particularly in this moment. Health care must be between a patient and their doctor, not a politician. We will continue to leverage all available resources at HHS to make sure women can access the life-saving care they need.
In what qualifies as the least surprising bit of news in this entire conversation, Texas sued Biden over this guidance. State Attorney General Ken Paxton argued that … you know what, who cares what lies that motherforker told? White House Press Secretary Karine Jean-Pierre responded by calling it “unthinkable” that an elected official would “sue to block women from receiving life-saving care in emergency rooms, a right protected under U.S. law.” There are some other adjectives that apply as well. As of now, the guidance has been blocked by a Texas judge who, absurdly, agreed with Paxton because reasons.
What the White House did here (along with other actions they’ve taken and undoubtedly will continue to take) is vitally important. Just to focus on ectopic pregnancies, they occur 2% of the time and, if left untreated, most could end up being life-threatening. Furthermore, as we’ve seen, there are multiple other complications that require abortions or treatment that might be considered (or imagined) to resemble abortion in some way. Thus, serious harm or death resulting from not getting appropriate care during pregnancy is a realistic possibility for anyone in an anti-choice state, despite the lies being spewed by foes of reproductive rights like Florida Gov. Ron DeSantis.
Unfortunately, it’s impossible to truly protect abortion rights without legislation or constitutional amendments at either the state or federal level. In Georgia, Democratic gubernatorial nominee Stacey Abrams is putting abortion rights front and center (interestingly, her position on this issue has evolved over time, as she was not always pro-choice) in her campaign to defeat incumbent Brian Kemp.
“Georgia is part of a nation that faces economic vicissitudes — things go up, things go down,” she said. “But this law is permanent.” She added that she would ask the state’s scores of moderate Republican and independent voters, who may be disillusioned with Democratic leadership in Washington, to “balance whether your immediate concerns about money outweigh your concerns about your constitutional protected rights.”
The Abrams campaign released survey data indicating that a majority of Georgia voters do not want any new restrictions on the previously existing law, which had protected the right to an abortion up to 20 weeks after fertilization (which means 22 weeks after the last menstrual period). Over 60% of independents opposed making it harder to get an abortion. And this is Georgia we’re talking about, not exactly a solid blue state. Abortion rights have wide support among Americans.
What can each of us do? We can fight like hell so that Stacey Abrams—and as many pro-choice Democrats as possible—can win. Abortion rights are directly on the ballot in a number of states this fall. The first vote in Kansas on Aug. 2 defied expectations, as voters came out in force to protect the right to an abortion mandated by that state’s constitution, thus turning back the attempt to remove it from the document. As Daily Kos’s Laura Clawson, in wonderfully understated fashion, put it the next morning: “A lot of pundits have some rethinking to do.”
Additionally, abortion rights were a primary issue in a swing congressional district that saw the staunchly pro-choice Democrat win in an open-seat race. It appears that the Dobbs decision has made a real impact on Democrats’ chances this fall. Even so, the forced-birther side is only getting more extreme in terms of what they are pushing for next.
Victories like Kansas that maintain or enshrine abortion rights into state laws will help countless women and others who become pregnant. And maybe, just maybe, enough victories will convince wavering politicians in other states that they’ll have to choose between trying to control women’s and pregnant people’s bodies and saving their own political careers.
Ian Reifowitz is the author of The Tribalization of Politics: How Rush Limbaugh's Race-Baiting Rhetoric on the Obama Presidency Paved the Way for Trump (Foreword by Markos Moulitsas)