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

Tworst-case scenarios arrived at an alarming rate. In the weeks since the US 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 are facing a radical change in their lives. A right essential to their dignity and self-determination has been stripped away after almost 50 years – and with it the gains women have made in professional, political and social life are newly and seriously threatened. But in addition to this moral and civil crisis, the Supreme Court’s decision also created a huge and acute new public health crisis, as abortion bans complicate what was once standard care for pregnant women—and put the health of even those who are not pregnant into new and random hazard.

On the one hand, there are miscarriages. Care for patients who have suffered spontaneous pregnancy loss has been dramatically reshaped in hospitals in Republican states. The treatment for miscarriage is to evacuate the contents of the uterus, either with minimally invasive surgery or medication, and these interventions, as it happens, are identical to those used in voluntary abortions. But with ambiguous, as-yet-uninterpreted but strongly worded laws now in place in anti-choice states, providers don’t know what they’re allowed to do for abortion patients. Many bans have so-called “mother’s life” exceptions, but these are vaguely worded and carry serious penalties for providers if they get it wrong. How sick does a patient have to be before a doctor terminates a pregnancy that is killing her? Should she die? How close to death does she have to be?

These are not hypotheticals: since the Dobbs decision, reports of dangerously delayed miscarriage care have been reported with alarming frequency. Providers delay life-saving abortions, often until the fetus dies on its own and a heartbeat can no longer be detected—an emotionally taxing 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, putting her at increased risk of infection and vulnerable to hemorrhage or even sepsis as the pregnancy tissue inside her begins to break down. Dr. Jessian Munoz, a San Antonio obstetrician, told the AP about trying to treat a patient who developed a uterine infection while her fetus still had signs of a heartbeat. Restricted by Texas law, he could do almost nothing until it was too late. “We physically watched her get sicker and sicker and sicker,” Munoz said. The woman lost several liters of blood, needed emergency surgery and had to be put on a ventilator – all because her state’s law deemed the hypothetical life of her fetus more valuable than her own. So far, we have not seen any reports of female deaths from these delayed miscarriage treatments. But the deaths keep coming.

Then there is an ectopic pregnancy. In about one in 50 pregnancies, the fertilized egg will implant somewhere outside 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 life-threatening for the pregnant patient. As with miscarriages, the treatment is abortion. But providers in conservative states aren’t sure what they’re allowed to do under the law, or what they can do without being punished by zealous anti-choice colleagues or vigilantes recently empowered to file devastating lawsuits.

In Michigan, for now an island of legal abortion in a deeply anti-choice Midwestern sea, a woman came to a hospital emergency room with an ectopic pregnancy that could have killed her; she had traveled there from another state where doctors had refused her. Another woman wasn’t so lucky: Her central Texas hospital advised her doctor not to intervene in her ectopic pregnancy until it ruptured, at which point her life was in imminent danger.

The higher-minded denizens of the anti-choice movement insist that the flood of draconian, misogynistic laws enacted by the Supreme Court need not really create these disastrous results, despite the brutally obvious fact that anti-choice laws have clearly created a rapidly more dangerous landscape for women’s health.

These voices argue that the vague wording and narrow circumstances allowed by the exemption of “maternal life” laws are not the real problem, but rather that the real problem is how hospitals and their lawyers read the law. “I’ve seen reports of doctors who are confused,” 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: “Supporters of abortions are those that associate abortion with miscarriage care and ectopic pregnancy care. Pro-lifers know the difference between a woman’s necessary health care and the intentional killing of a baby. Abortionists don’t discriminate.”

Hopefully these distinctions were as clear and obvious as Seago and DeSanctis believe they are. The truth is that while any moral pro-choice movement should defend women’s rights to control their own bodies unreservedly, in these tragic medical crises, the line between “planned” and “emergency” abortion is not so easy to draw. The distinction between abortion and “necessary women’s health care” is ambivalent because medicine and the body do not conform to the strict moral lines that the anti-choice movement tries to place them within. When pressed, even Seago admits this. Soon after declaring that the laws his group is championing do not pose a danger to women’s health, he acknowledged that compliance with the law would indeed require providers to delay emergency care. “He acknowledged that such delays could cause medical complications for women,” the Times reported.

Not that people like Seago and DeSanctis are in touch with their movement anyway. The core of the anti-choice movement seems alarmingly comfortable with the “mother’s life” exemption, just as the same movement has largely abandoned their stated support for exemption from rape and incest. In Wisconsin, anti-choice groups called for an amendment to the state’s long-dormant 1849 abortion ban to provide fewer exceptions for the life and health of the mother. In Idaho, a recent GOP convention changed its platform to support a ban on abortion with no exceptions. When a motion was brought to include an ectopic pregnancy exemption, it failed by nearly 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 care. It seems consistent with the other false binaries the movement is so enamored of: like that between women who have children and women who have abortions; or between those who deserve to be in control of their lives and those born with a womb.

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