Pregnancy Risk Case Meets Abortion and Health Care Law

As the United States grapples with the ongoing consequences of the Supreme Court’s decision to review Roe v. Wade, a question looms between the court’s currents of opinion and news stories. : Why pregnancy risks are rarely discussed anywhere, even though such information is relevant not only to individual decisions but also to abortion, pregnancy and care policies. health care for women?

With a wave of abortion bans underway in states across the US, those risks will get even more attention – envisioned in women’s decisions about whether to risk pregnancy if they live in a whether the state prohibits abortion, and arguments that would occur in state legislative chambers about the extent of threat to the mother’s health to permit abortion under state law have not been examined and changed. change quickly.

“We spend a lot of time talking about avoiding behaviors because of the very small possible risks associated with the fetus. Emily Oster, a Brown University economist and author of “Better Expectations,” a data-driven book on pregnancy, tells me, “Don’t eat bean sprouts.” “And then we never talked to people about the risks of things that were almost certain to happen.”

For example, in a vaginal birth, “Your vagina will tear. It will tear a lot,” she said. “It’s not even a risk, it’s just a fact.” People who give birth by cesarean section, a major surgery in the abdomen that ends with a major wound, requires a significant recovery period.

And more serious complications, while rare, are not that rare. In any given group of mothers, someone may have survived hypertension (which can occur in one out of every 30 pregnancies), ectopic pregnancy (up to one in 50 pregnancies). pregnancy) or hypertensive disorder of pregnancy (up to one in 10 pregnancies). All of those conditions can be deadly.

In most situations, the criterion for risk is informed consent: perception of the potential for harm and the chance of accepting or rejecting it. If sitting in a car or on an airplane makes an abdominal or genital injury almost guaranteed and a 10% chance of a life-threatening accident, people should expect a warning and a chance. to see if the journey is worth it.

But pregnancy is different.

Jonathan Lord, a practicing gynecologist and British medical director of MSI Reproductiontive Choices, an organization that provides family planning and abortion services in countries around the world, says he She suspects people often don’t talk about the dangers of pregnancy to women’s health because they see such conversations as causing unnecessary suffering. “It’s really ingrained in society. It’s not too much of a medical issue, but people don’t talk about the risks and the unpleasant aspects, and I think that’s largely because people want to be kind,” he said.

Oster had a similar hypothesis about serious pregnancy complications. “Generally speaking, we’re not interested in facing the risk of really bad things happening,” she said. “We’d love to pretend they’re zero.”

However, if you look at the messages surrounding the risks to the unborn baby during pregnancy, rather than the mother, the plot thickens.

Rebecca Blaylock, research lead for the UK Pregnancy Advisory Service, a charity that provides abortions and other reproductive health services, said: with colleagues from the University of Sheffield, studied British media messages around pregnancy. They found that media coverage of women was framed as a mediator of harm, rather than a population in need of protection. The fetus is the sole focus of health outcomes.

Such assumptions even affect prenatal care. “We have seen women with repeated morning sickness” – an extreme and potentially deadly form of morning sickness that involves persistent vomiting – “who did not receive appropriate treatment because their health care providers think the drug poses a risk to their pregnancy, and who really feel that they have no choice but to terminate a desired pregnancy wanted to be different at the time,” Blalock said.

The different attitudes towards risk “really fit into the larger cultural environment, where women are blamed for any and all possible evils with their children, and preoccupation with preoccupation. focused on regenerating the next generation of healthy citizens,” Blaylock told me.

That study focused on the UK. But Kate Manne, a professor of philosophy at Cornell University and the author of two books on the ways that sexism shapes society, says there is a common assumption in the United States and elsewhere that Having children is something that women are natural or even morally destined to do. do. Accordingly, educating them about it – even if it means denying them the opportunity to give informed consent at risk – is considered by some to be in the best interests of the public. surname. (She notes that transgender men and non-pure people can also get pregnant, but says society’s standards and assumptions about pregnancy tend to assume that pregnant women are women. female.)

“We don’t tend to think of pregnancy as something that someone might very reasonably decide not to do because it’s too risky,” she said. “That kind of thought process is obliterated by the feeling that it’s natural and moral, and perhaps also holy, for women to do this.”

But a reluctance to acknowledge such risks could render policymakers invisible to the risks of pregnancy. One consequence is that abortion bans are written so bluntly that they do not provide a clear direction for doctors to protect women’s lives and health. In Poland, where most abortions are not authorized, the vague exceptions that allow them to proceed have confused doctors about potential liability, leading to the death of the patient. a pregnant woman last year. And now, similar confusion is playing out in US states where abortion bans took effect after last week’s Supreme Court decision overturned Roe v. Wade.

For example, doctors in several U.S. states have raised concerns about whether women can receive prompt care for an ectopic pregnancy, a condition in which a fertilized egg implants outside. uterus or in the wrong part of it. Such pregnancies are never viable: It is impossible for the fetus to develop to full term unless it is implanted correctly. Dr Lord said those implants in the scar tissue in the uterus can continue to grow for several months before bursting, at which point they are life-threatening for the mother, he said.

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

“I fear that in states with strict laws, that will happen.”