When pregnancy risks meet abortion and health care laws

As the United States grapples with the ongoing fallout from the Supreme Court’s decision overturning Roe v. Wade, a question lurks betw...


As the United States grapples with the ongoing fallout from the Supreme Court’s decision overturning Roe v. Wade, a question lurks between court opinions and news reports: why are pregnancy risks so rarely discussed anywhere, even though this information is relevant not only to individual decisions, but also to policies regarding abortion, pregnancy and health care for women?

With the wave of abortion bans unfolding across US states, these risks are going to come into greater focus – figuring both in women’s decisions to risk getting pregnant if they live in a state that has banned abortions, and arguments that will occur in state legislative chambers about the degree of threat to a mother’s health that must be present to permit an abortion under untested and rapidly changing state laws.

“We spend an awful lot of time talking about behaviors to avoid because of the very small risks that could arise that are associated with the fetus. “Don’t eat bean sprouts” or “don’t eat deli meats,” Emily Oster, a Brown University economist and author of “Expecting Better,” a book based on pregnancy data, told me. “And then we never talk to people about the risks of things that are almost certainly going to happen.”

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

And more serious complications, although rare, are not this rare. In any group of mothers, someone has probably survived hyperemesis gravidarum (which can occur up to one in 30 pregnancies), ectopic pregnancy (up to one in 50 pregnancies), or a pregnancy-induced hypertensive disorder (up to one in 10 pregnancies). All of these conditions can be fatal.

In most situations, the standard for risk is informed consent: awareness of the potential for harm and the ability to accept or refuse it. If traveling by car or flying meant near-guaranteed abdominal or genital injury and a 10% risk of fatality, people would expect a warning and the opportunity to question whether the journey 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 people often don’t talk about the dangers of pregnancy for women’s health because they see these conversations as a cause of unnecessary distress. “It’s kind of ingrained in society, really. It’s not so much a medical issue, but people don’t talk about the risks and the unpleasant aspects, and I think a lot of that is because people want to be nice,” he said.

Oster had a similar hypothesis about serious pregnancy complications. “We’re generally not interested in taking on the risk of really bad things,” she said. “We’d love to pretend they suck.”

And yet, if you look at the messages about the risks to the fetus during pregnancy, rather than the mother, the plot thickens.

Women are ‘bombarded’ with messages about the risks they themselves could pose to their fetuses, said Rebecca Blaylock, head of research at the British Pregnancy Advisory Service, a charity that provides abortions and other services reproductive health. His organization’s research team, along with colleagues from the University of Sheffield, studied British media messages around pregnancy. They found that media coverage overwhelmingly portrayed women as vectors of harm, not as a population in need of protection. The fetuses were the sole target of the health outcomes.

Such assumptions have even affected prenatal care. “We’ve seen women with hyperemesis gravidarum” – an extreme and life-threatening form of morning sickness that involves near-constant vomiting – “who weren’t receiving proper treatment because their health care providers thought the drug was causing a risk to their pregnancy, and who truly felt they had no choice but to terminate an otherwise desired pregnancy at that time,” Blalock said.

The different attitudes towards risk “are really part of a larger cultural climate where women are blamed for all the ills that may or may not befall their children, and a preoccupation with breeding the next generation of healthy citizens. health,” Blaylock told me.

This study focused on the United Kingdom. But Kate Manne, a philosophy professor at Cornell University and author of two books on how sexism shapes society, said there is a widespread assumption in the United States and elsewhere that having children is something that women are naturally or even morally destined to do. Therefore, guiding them towards this – even if it means denying them the chance to give informed consent to the risks – is considered by some to be in their best interest. (She noted that transgender men and non-binary people can also get pregnant, but said societal norms and assumptions about pregnancy tend to assume that pregnant women are women.)

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

But such a reluctance to recognize the risks can also make the dangers of pregnancy invisible to policy makers. One of the consequences is the ban on abortion which is drafted so bluntly that it does not provide doctors with clear avenues to protect women’s lives and health. In Poland, where most abortions are not permitted, vague exceptions that would allow them to take place have left doctors perplexed about their potential liability, leading to the death of a pregnant woman Last year. And now similar confusion takes place in US states whose abortion bans went into effect after last week’s Supreme Court ruling overruling Roe v. Wade.

Doctors in several US states, for example, have raised concerns whether women will be able to get timely care for ectopic pregnancies, a condition in which a fertilized egg implants outside the uterus or in the wrong part of it. Such pregnancies are never viable: it is not possible for a fetus to grow to term if it does not implant properly. But those that implant in the scar tissue of the womb, Dr Lord said, can continue to grow for several months before eventually rupturing, in which case they put the mother’s life at risk, he said. -he declares.

“You really have to get on it early before it grows to this big,” he said. “It’s inevitable that the fetus will die, but it will probably kill the mother along with it.”

“I’m concerned that in states that have strict laws, this will happen.”

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Newsrust - US Top News: When pregnancy risks meet abortion and health care laws
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