Where Pregnancy Risks Comply with Abortion and Healthcare Laws

As the United States grappled with the unfolding fallout from the Supreme Court decision overturning Roe v. Wade, one question lurks between the lines of opinion in courts and news reports: why is the risk of pregnancy so rarely discussed anywhere, even though this information is relevant not only to individual decisions, but also to policies regarding abortion, pregnancy, and maternity care. women?

With a wave of abortion bans sweeping through states across America, these risks will take center stage—both in women’s decisions about whether they should risk getting pregnant if they live in a state where abortion is illegal, and in arguments that will take place in state legislatures over how great a threat to a mother’s health must be in order to allow abortion under untested and rapidly changing state laws.

“We spend a lot of time talking about how to avoid behavior because of the very small risks associated with the fetus. “Don’t eat bean sprouts” or “don’t eat deli meats,” Emily Oster, a Brown University economist and author of the data-driven pregnancy book Expecting Better, told me. “And then we kind of never talk to people about the risks of things that are almost certain to happen.”

For example, in a vaginal birth: “Your vagina is going to tear. It will tear a lot,” she said. “It’s not even a risk, it’s just realistic.” Those who give birth by caesarean section, a major abdominal operation, end up with a large wound requiring a significant recovery period.

More serious complications, while rare, are not what rare. In any given group of mothers, someone is likely to have experienced hyperemesis gestationis (which can occur as early as one in 30 pregnancies), ectopic pregnancy (up to one in 50 pregnancies) or hypertensive disorder due to pregnancy (before one in 10 pregnancies). All of these conditions can be fatal.

In most situations, the standard of risk is informed consent: the awareness of the possibility of harm and the ability to accept or refuse it. If riding in a car or flying in an airplane meant almost guaranteed injury to the stomach or genitals and a 10 percent chance of a life-threatening accident, people would expect a warning and a chance to consider whether the trip was worth it.

But pregnancy is different.

Jonathan Lord, a practicing gynecologist and English medical director of MSI Reproductive Choices, an organization that provides family planning and abortion services in countries around the world, said he suspects that people often don’t talk about the dangers of pregnancy for women’s health because they see such talking as a cause of unnecessary anxiety. “It’s really ingrained in society. It’s not so much a medical thing as people don’t talk about the risks and the unpleasant aspects, and I think it’s largely because people want to be kind,” he said.

Auster had a similar hypothesis about severe pregnancy complications. “In general, we are not interested in countering the risk of really bad things,” she said. “We’d love to pretend they’re zero.”

And yet, if you look at reports of risks to the fetus during pregnancy and not to the mother, the story gets thicker.

Women are being bombarded with reports of the risks they themselves may pose to their fetus, says Rebecca Blaylock, research director for the British Pregnancy Advice Service, a charity that provides abortion and other reproductive health services. Her organization’s research team, along with colleagues from the University of Sheffield studied British media reports about pregnancy. They found that the media overwhelmingly portrayed women as carriers of harm rather than as a population in need of protection. Fruits were the only focus of health outcomes.

Such assumptions even influenced prenatal care. “We observed women suffering from hyperemesis gravidarum,” an extreme and potentially fatal form of morning sickness accompanied by near-constant vomiting, “who were not properly treated because their healthcare providers believed the medication was a risk to their pregnancy, and who actually felt that at that moment they had no choice but to terminate the desired pregnancy, ”said Blalock.

Differing attitudes to risk “really fit in with a broader cultural climate where women are blamed for all the bad things that may or may not happen to their children and the concern of reproducing the next generation of healthy citizens,” Blaylock told me.

This study focused on the United Kingdom. But Keith Mann, professor of philosophy at Cornell University and author of two books on how sexism is shaping society, says there is a widespread belief in the United States and elsewhere that having children is something women are naturally or even morally doomed. do. Accordingly, directing them to do so—even if it means denying them the opportunity to give informed consent to the risks—some feel is in their best interest. (She noted that transgender men and non-binary people can also get pregnant, but said that norms and social notions about pregnancy tend to assume women are pregnant.)

“We don’t tend to think of pregnancy as something that someone could very rationally decide not to do because it’s too big of a risk,” she said. “This kind of thought process is eliminated by the feeling that for women it is natural and moral, and perhaps also sacred.”

But this reluctance to acknowledge the risks could make the dangers of pregnancy invisible to politicians as well. One consequence of this is that abortion bans are written so bluntly that they don’t give doctors a clear path to protecting women’s lives and health. In Poland, where most abortions are not legal, the vague exceptions that would allow them have left doctors confused about potential liability, leading to death of a pregnant woman last year. And now similar confusion is set in US states where abortion bans went into effect following the Supreme Court’s decision last week to strike down Roe v. Wade.

For example, physicians in several US states caused concern about whether women can get timely help with an ectopic pregnancy, a condition in which a fertilized egg is implanted outside the uterus or in the wrong part of it. Such pregnancies are never viable: the fetus cannot grow to term if it does not take root correctly. But those that are implanted in the scar tissue in the uterus, dr. Lord said they could continue to develop for several months before eventually rupturing, at which point they would be life-threatening for the mother.

“You really need to get there early before it grows to this size,” he said. “It is inevitable that the fetus will die, but it will probably kill the mother along with it.”

“I’m afraid that in those states where there are strict laws, this will happen.”