Roe v. Wade will be overturned and laws that further restrict abortion care and services in many states will become effective. We asked you questions about access to abortion in the U.S. after the Supreme Court draft opinion was leaked.
Many people wrote to us asking for information about the potential impact of this decision on hospitals, in vitro fertilation, and miscarriage care. Kristyn Brandi is an OB-GYN, a family planning doctor and the chairperson of Physicians for Reproductive Health. Selena Simmons Duffin, NPR’s health policy correspondent, was also available to answer these questions.
It’s already happening in Texas.
Many people mistakenly think that miscarriage is something that happens spontaneously and that someone has no control over. While that can be true, it is also possible for people to make decisions. The standard of care to treat a miscarriage will be the same as that for an abortion.
This can happen in two ways. If someone has a miscarriage, and they need medication to empty their uterus to prevent infection, the same medication can be used to perform medication abortion. There have been many instances where Texas pharmacists failed to fill miscarriage prescriptions.
These laws don’t say that a miscarriage must be proven. However, there have been reports from Texas about doctors asking patients questions about any medications they may have taken, or what might have caused it. Practically, it might be difficult to get the right treatment at the right time and without any barriers.
Selena Simmons-Duffin aEUR
It is not always easy to determine if someone will die due to pregnancy. Many restrictive abortion laws have exceptions for medical emergencies that may require treatment that could involve ending a pregnant woman’s life.
According to the Centers for Disease Control and Prevention, there are approximately 700 deaths in pregnancy each year in the United States. One third of these deaths result from stroke and heart disease. These new restrictions mean that if you have a condition such as preeclampsia, which can put you at risk of a stroke, the exemption won’t apply. The risks may mean that you have to continue with the pregnancy.
A person’s water breaking too soon can be a very serious medical emergency. Savita Halappanavar, a dentist from Ireland, was one of the victims. Her water broke at 17 weeks. She could still detect a heartbeat, and was denied abortion in Ireland. She died from complications. Ireland legalized abortion after her death in 2018.
Similar stories are already being reported in Texas, despite an emergency exemption.
Selena Simmons-Duffin aEUR
Or, to put it another way: could someone be forced to continue a pregnancy past term even though it is obvious that the foetus will not survive beyond the womb?
Brandi believes that the answer could be “yes”.
She says, “When I have a patient facing this outcome, I want them to talk with me about their options and make it clear that they can decide when and how to terminate that pregnancy.”
These abortion bans do not allow for abortion in cases of severe fetal anomalies. People who live in states that restrict abortion will likely have to continue their pregnancies until the end. They would give birth as they normally would, possibly by C-section or natural birth. The palliative care system would not be able support them in a way that would allow them to grieve the loss of the child.
Brandi said that this is a very important question. She also stated that she is concerned about the readiness of the health system to deal with the growing number of patients who will need to go to hospital for labor and delivery care.
She says that rural areas were already facing closures of many hospitals, particularly in labor and delivery wards, long before COVID. “People were already travelling long distances to receive all kinds of care and women’s health professionals were leaving those areas. Imagine if we can double or triple the amount of deliveries in these communities.
These laws could have an impact on in vitro fertilization (or IVF). Because the definitions of certain words in these laws are often not consistent with medical terms, it can be difficult to understand why.
Texas law states that pregnancy starts with fertilization aEUR, when a sperm meets an egg. However, in medicine, pregnancy means that the fertilized egg divides, grows, and implants in the uterus.
Many laws include a line that states “Unborn child” as a reference to a human embryo or fetus at any stage of pregnancy, from fertilization to birth. Unborn children are embryos that have not been used for IVF. Many people who undergo IVF end up with a lot of embryos that are discarded.
According to Liz Sepper (a law professor at The University of Texas at Austin), it is not clear if these laws will limit IVF. She said that the anti-abortion movement was, in part, a religious fundamentalist movement. It combines some Catholic theology with some of the evangelical Christian tradition, politics, and some of the Catholic theology. “Conservative Catholics oppose fertility treatments, such as IVF. However, that has not been an issue for evangelical Christians who support IVF to procreate.”
It is difficult to predict what the impact of Roe being overturned on IVF, as it appears that the anti-abortion rights movement has not come together on this issue.
Selena Simmons-Duffin aEUR
Yes, condoms are available and so is vasectomies. What about the latest advancements in male birthcontrol?
Brandi states, “I wish I could share better news about the new innovations for male birth control.” “Unfortunately, men have not been motivated to use birthcontrol as much as the current options are.
Brandi stated that although there are currently several clinical trials for pills, injections, and other procedures for men, it will likely be many years before these options become available. She said that condoms and vasectomies offer the best option for men looking to prevent pregnancy in their relationships.
