How Forced Births Will Affect Women’s Healthcare

From Kate Riga of Talking Points Memo:

… The Supreme Court has not only let red states flip the calendar pages back to pre-1973 America. In many ways, it’s worse than that.

Abortion has become a foundational pillar to all kinds of health care procedures. Ripping it out [reduces their availability].

America now faces a reality that will be like returning to the early ‘70s, but with half a century of medical and technological advances that health care providers in certain states can no longer use. Since Roe, abortion care became drastically safer and more efficient, and the medical procedures involved in abortion have become indelibly embedded in the wider health care landscape. They’ve become a key aspect of all kinds of other health care, from miscarriage management to cancer treatment.

Now, in states from Texas to Ohio, we’re already seeing how abortion — or procedures that can be construed as abortion — are deeply intertwined with health care more broadly, and what it means for them to be taken away.

It’s easier, and convenient for the anti-abortion movement, to imagine abortion as a siloed-off procedure, under the auspices of Planned Parenthood and only relevant to young women seeking to end their unwanted pregnancies. But for decades, that hasn’t been the case.

After Roe, Abortion Becomes Safe

After the Supreme Court legalized abortion nationwide, researchers and physicians could finally learn how to get better at it.

“If the procedure is illegal, you can’t do clinical studies and you can’t develop new procedures because you’re doing it secretly,” Johanna Schoen, a professor of history at Rutgers University told TPM. “Most people providing abortions were not clinicians and not able to do it in a medical setting.”

“After Roe, clinicians made it not only the safest out-patient procedure in the country, but also much safer than pregnancy and delivering a baby,” she added. “All of that has to do both with the improvement of abortion procedures and development of new ones.”

In addition to the procedure improvements, after Roe, physicians started receiving more training in how to perform abortions and manage potential complications. Mortality rates associated with abortion started to plummet. And the number of women hospitalized for abortion-related complications dropped between 1970 and 1977, with a steep dip after 1973. By 1995, fewer than 0.3 percent of abortion patients were hospitalized with complications from the procedure.

Abortion Is Now Woven Throughout Today’s Medical Landscape 

While abortion care developed apace, other related medical technologies improved too. By the late 1970s, ultrasounds were being used widely in American hospitals, helping to advance detection of fetal abnormalities.

As the technology continued to improve over the next few decades, physicians became better able to identify abnormality markers. Under Roe, in states that hadn’t impinged on the abortion right with gestational bans (many diagnoses occur in the second trimester, though advances are pushing some earlier), women could opt for an abortion once abnormalities were detected rather than carrying the pregnancy to term.

Now, after Dobbsexperts are certain that women in states with draconian abortion bans will have to go through labor and give birth to babies that cannot survive.

The development of ultrasound technology has also enabled physicians to more accurately diagnose unruptured ectopic pregnancies in a way that was not possible pre-Roe. In these pregnancies, the fertilized egg implants outside of the uterus where it cannot survive but can pose a deadly threat to the woman if it’s allowed to grow.

The improvement in mortality rates associated with ectopic pregnancies followed: a more than 70 percent decrease in deaths-to-cases from 1970 to 1978.

Already, stories are emerging about the demise of Roe throwing ectopic pregnancy care into chaos. Doctors report feeling unsure about whether abortion bans — which are often written using broad political messaging language rather than medical — include ending ectopic pregnancies, which are not viable. Various lawmakers and anti-abortion activists have proven themselves to be particularly unlearned on the subject, some suggesting that terminating ectopic pregnancies is not medically necessary, while others have offered up a supposed solution — just moving the ectopic pregnancy inside of the uterus — technology for which does not currently exist.

Another medical success story already under threat is in-vitro fertilization, or IVF. The first IVF baby was born in 1978; since then, initial single-digit success rates have blossomed to nearly 50 percent for cases where the woman is under 35 years old. One to two percent of births in the United States annually result from IVF.

Fertility clinics have already been flooded with calls by people panicked about what abortion bans mean for their procedures. During IVF, clinicians usually implant one or two embryos in the uterus and store the rest for potential future use. It’s unclear whether bans would stop people from discarding the unneeded embryos, perhaps forcing them to pay to keep them frozen forever. Genetic testing of the embryos could become illegal. And if some embryos don’t survive the implantation process — or are nonviable and discarded — clinics could potentially be liable.

Some states are already contemplating granting personhood to the embryos, which could put IVF clinics out of business and leave the people who depend on them without options.

Far-Reaching Consequences

Even cancer treatment, a seemingly far cry from reproductive care, depends on abortion to afford its patients the right to treat their illnesses without worrying about the oftentimes toxic effect those treatments have on fetuses.

Cancer occurs in about one in every 1,000 pregnancies annually, leaving the women with few options even while Roe’s protections were the law of the land. Many treatments can cause miscarriages or birth defects in the developing fetuses, especially at the beginning of the pregnancy. The CEO of the American Cancer Society said that radiation therapy is never given to pregnant patients at all.

Ending their pregnancies, for these patients, can become a matter of literal life and death — the only way for women to receive the full gamut of treatment to cure their cancer. Now, in some states, women may have to choose: lifesaving treatment that will harm the developing fetus, or leaving their cancer untreated.

Some pharmacists are already restricting patients’ access to methotrexate, a therapy for certain kinds of cancer that can induce abortions. Methotrexate is also used in treating ectopic pregnancies and, since the 1980s, soothing chronic inflammation and pain, making it a mainstay in treating diseases like lupus, rheumatoid arthritis and psoriasis. The Arthritis Foundation has stood up a hotline amid reports of patients struggling to obtain the drug.

Two other pills — mifepristone and misoprostol, the collective “abortion pill” approved by the Food and Drug administration for combined used through 49 days of gestation in 2000, and for longer now — are already being acutely targeted by anti-abortion lawmakers. There’s a long history of animosity towards mifepristone in particular, with the FDA baselessly categorizing it as dangerous for years.

Those medications are indispensable in treating miscarriages, which at least one in four American women will have by age 45. Even before the Dobbs ruling, women have had to rely on abortion clinics for miscarriage treatment, often because of arbitrary limitations on who can distribute mifepristone. That problem has been compounded since the ruling by sparking confusion among some hospitals about whether other aspects of miscarriage care will be misconstrued by authorities as an elective abortion.

“Management of miscarriages and ectopic pregnancies are things that were not really possible when abortion was illegal,” Schoen said. “Women in the middle of miscarriages and ectopic pregnancies were up shit’s creek — and people died as a result of that.”

Abortion is a medical success story. Bringing the procedure out of the shadows allowed clinicians to make it safe and humane, and to weave it into other medical treatments. Procedures that are related to, or can be construed as abortion, are now integral parts of an astoundingly wide range of medical care. All of it is under threat.

The Supreme Court is not sending large swaths of the country back to the relative ignorance of pre-Roe America. It’s sending us back in time armed with prodigious knowledge and then-undreamed-of technology that lessen women’s suffering, and uncomplicate and alleviate illnesses where pregnancy is not an option — but forbidding health care workers to use that knowledge.

Women will suffer and they will die, even while doctors have 50 years of medical advancements at their backs….

I Suppose This Is a Hobby

I retired almost thirteen years ago and have rarely thought about getting a job, even a part-time job, since. But it appears I’ve settled on a hobby, without really intending to. This blog has been part of it for twelve years. Another part is a philosophical “book” about perspective (or points of view) I’ve been “working on” for almost ten years. The other part is lots and lots of comments I’ve spread around the internet.

Many of these comments have been deposited at an interesting site called Three Quarks Daily. It’s mainly an aggregator. They link to articles of intellectual interest at other sites. They also have a Monday Magazine, which features original content.

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The site is free, although a “one-time donation” or “small monthly payment” makes advertisements disappear. Most of us don’t need more to read on the internet or elsewhere, but I highly recommend 3 Quarks Daily.

What led me to writing this post is that I spent part of last night and most of this afternoon responding to four articles at 3 Quarks (which is more than average output for me).

The first was a response to a Guardian article called “The Federal Reserve Says Its Remedies For Inflation ‘Will Cause Pain’, But To Whom?”. At 3 Quarks, I merely quoted some of Sen. Elizabeth Warren’s recent dialogue with the Fed Chairman, Jerome Powell:

Warren asked Powell if Fed rate increases will lower gas prices, which have hit record highs this month. “I would not think so,” Powell said.

Warren asked if grocery prices will go down because of the Fed’s war on inflation. “I wouldn’t say so, no,” Powell said.

“Rate hikes won’t make Putin turn his tanks around and leave Ukraine,” Warren said, adding that they won’t break up corporate monopolies or stop Covid-19.

“Inflation is like an illness and the medicine needs to be tailored to the specific problem, otherwise you could make things a lot worse,” Warren said. ” … the Fed can slow demand by getting a lot of people fired and making families poorer.”

The Massachusetts Democrat urged Powell to proceed cautiously with further rate hikes.: “You know what’s worse than high inflation and low unemployment? It’s high inflation with a recession and millions of people out of work”.

Next was a response to an article at Aeon called “Armchair science: Thought experiments played a crucial role in the history of science. But do they tell us anything about the real world?”

I disagreed with one of the philosophers quoted in the article, James Robert Brown of the University of Toronto. He said he was extremely impressed with Galileo’s thoughts regarding falling objects. 

Suppose we connect the two objects [a musket-ball and a heavier cannonball] with a short, stiff rod. One could argue that the lighter musket-ball acts as a brake on the heavier cannonball, slowing its fall. Then again, one could also argue that the composite body, whose weight is equal to the sum of the two original bodies, must fall faster than either body alone. This is obviously a contradiction. The only solution, Galileo says, is that all bodies fall at the same rate, independent of their weight.

“I fell out of my chair when I heard it,” Brown said. ‘”It was the most wonderful intellectual experience perhaps of my entire life.” Brown went on to become a leading authority on thought experiments.

At Three Quarks Daily, I expressed skepticism, concluding that Galileo’s thought experiments didn’t prove anything except that it was worth getting empirical evidence on the question (trying it out) before reaching a conclusion.

Number 3 concerned an original article at Three Quarks written by Thomas R. Wells, a “British academic philosopher living in the Netherlands”. He called his article “We Should Fix Climate Change, But We Should Not Regret It”.

Mr. Wells argues that the climate crisis began with the Industrial Revolution, but we shouldn’t regret the Industrial Revolution because of what it’s led to. I’m not sure any sane environmentalists actually regret the Industrial Revolution. I left the fifth comment:

We can agree the Industrial Revolution was a good thing, while also noting that climate change [is] the result of regrettable choices we made along the way, not by starting the Industrial Revolution, but by ignoring our effect on the climate, even though scientists discovered that effect decades ago.

We could have made this a “vastly better world for most people” without making it a vastly worse world for so many other living things. Not exactly coining a phrase, but other living things matter.

Finally, another Three Quarks contributor, Mike Bendzela, who I believe teaches in the English department at the University of South Maine, published an article today called “Abort All Thought That Life Begins”. He argues that there is no such thing as the “beginning of life”. Life has always developed as a gradual process without any particular beginning (its ending isn’t always clear either).

As you might expect, this article has elicited a variety of comments (they’re still landing). I responded to another reader this way:

Justice Blackmun, who wrote the Roe v Wade opinion, shared an internal memo with the other justices before the majority decision was published. He wrote “You will observe that I have concluded that the end of the first trimester is critical. This is arbitrary, but perhaps any other selected point, such as quickening or viability, is equally arbitrary.” [https://en.wikipedia.org/wi…]

… I believe the author … is making the point that any decision regarding a moment when there is “conversion from not human to human” is somewhat (or totally) arbitrary. I’d say the transition from “not human enough” to “human enough” is a matter of convention.

That’s how the five Republicans and two Democrats on the Court ruled in 1973 — they came to a nuanced agreement based on trimesters and viability. It was a reasonable compromise that worked well enough for 50 years, until the Court was corruptly (after Senatorial hypocrisy and lies told to the Judiciary committee) taken over by ideologues.

I see that the person I responded to has now responded to me. Once more unto the breach…

I’ve never read all of Roe v. Wade or the dissents, and I know some lawyers and scholars who oppose forced births (women who get pregnant being compelled by the state to eventually give birth) disagree with the Roe majority’s legal reasoning.

However, as others have pointed out, the 9th Amendment to the Constitution says: “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people”. Even though the Constitution doesn’t mention a right to privacy, or pregnancy or abortion for that matter, I agree with Tim Quick above that we all have certain fundamental rights, including the ones he mentioned that justify women and their doctors sometimes ending a pregnancy without interference from the government.

If topics like these interest you, I recommend Three Quarks Daily. You don’t have to read the comments.