Women Are Going To Die

Criminalizing abortion is already creating potentially deadly consequences for woman -- and major political problems for Republicans. Also Republicans and Guns: A Love Story.

I’m Michael A. Cohen, and this is Truth and Consequences: A no-holds-barred look at the absurdities, hypocrisies, and surreality of American politics. If you received this email - or you are a free subscriber - and you’d like to subscribe: you can sign up below.

The Crunchy Outer Shell Of A Fetus

It’s been more than three weeks since the Supreme Court overturned Roe. v Wade, which, in effect, made abortion illegal in broad swathes of the country. And already, the lives of American women (or, as anti-abortion activists consider them, the crunchy exterior of a fetus) are in danger.

Dr. Jessian Munoz, an OB-GYN in San Antonio, Texas, who treats high-risk pregnancies, said medical decisions used to be clear cut.

“It was like, the mom’s life is in danger, we must evacuate the uterus by whatever means that may be,” he said. “Whether it’s surgical or medical — that’s the treatment.”

Now, he said, doctors whose patients develop pregnancy complications are struggling to determine whether a woman is “sick enough” to justify an abortion.

With the fall of Roe v. Wade, “the art of medicine is lost and actually has been replaced by fear,” Munoz said.

Munoz said he faced an awful predicament with a recent patient who had started to miscarry and developed a dangerous womb infection. The fetus still had signs of a heartbeat, so an immediate abortion — the usual standard of care — would have been illegal under Texas law.

“We physically watched her get sicker and sicker and sicker” until the fetal heartbeat stopped the next day, “and then we could intervene,” he said. The patient developed complications, required surgery, lost multiple liters of blood and had to be put on a breathing machine “all because we were essentially 24 hours behind.’’

In Texas, abortion has been illegal for months — ever since Republicans passed a so-called vigilante law that places onerous legal restrictions on abortion clinics seeking to operate in the state. According to a study by the American Journal of Obstetrics and Gynecology, two Texas hospitals “cited the cases of 28 women less than 23 weeks pregnant who were treated for dangerous pregnancies. The doctors noted that all of the women had recommended abortions delayed by nine days because fetal heart activity was detected. Of those, nearly 60% developed severe complications — nearly double the number of complications experienced by patients in other states who had immediate therapeutic abortions.”

What’s happening in Texas is a preview of what will happen in states where abortion is now illegal. Women with dangerous pregnancies will be denied care — or receive delayed care — because medical professionals fear running afoul of the law and facing possible prosecution for trying to save their lives.

The criminalization of abortion procedures has put doctors in a nearly impossible position: if they provide women with life-saving care, they risk prosecution for conducting what is now an illegal medical procedure. The perverse irony is that if, in these situations, the mother dies, the doctors would likely face no criminal sanction. So there is potentially less legal risk to letting a woman die than there is to perform an abortion.

Anti-abortion activists will argue that doctors are misinterpreting anti-abortion laws like the one in Texas, which allows for abortions in cases where the mother’s life is in danger. But this means that doctors have to pinpoint the exact moment when a woman could be in danger of dying. If they act too soon and end a pregnancy, they could face possible prosecution. Since anti-abortion laws are often vaguely written, lack input from medical professionals, and are conditional on the prosecutorial decisions of local district attorneys, doctors are finding themselves in a medical gray area.

And uncertainty around the full scope of abortion laws is already having a broad and dangerous effect. In Virginia, a woman diagnosed with lupus, an autoimmune disease, can longer receive a pain-relieving medication called methotrexate because it can cause miscarriages and could potentially be used to induce an abortion. In Missouri, another woman had a miscarriage but couldn’t get a prescription for mifepristone, which prevents post-miscarriage infection but also can be utilized in medical abortions. In Texas, pharmacists are refusing to fill prescriptions for misoprostol, another medicine routinely given to women who have experienced a miscarriage but can also be used to induce an abortion. A woman with an ectopic pregnancy traveled to Michigan because a doctor in her home state wouldn’t treat her for fear that “the presence of a fetal heartbeat meant treating her might run afoul of new restrictions on abortion.” Keep in mind that in ectopic pregnancies, a fertilized egg begins growing outside a woman’s uterus and is, by its very nature, not viable. But because there is still a fetal heartbeat, the hands of doctors could potentially be tied.

In the uncertain post-Dobbs world, doctors and pharmacists are erring on the side of caution in conducting procedures or prescribing medication that could lead to criminal charges for them, imperiling women's lives in the process.

And there is every reason to believe that some Republican officials want things this way. Recently, at the state Republican Party’s annual convention in Idaho, a motion calling for an abortion exemption if a mother’s life is in “lethal danger” was rejected by a vote of 412-164.

State lawmakers could clarify the confusion around abortion laws since Roe was scrapped — but that would mean clearly delineating when abortion is allowed. Not surprisingly, anti-abortion politicians don’t want to be on the record for that, hence the reluctance of many to consider abortion bans in cases of rape or incest or even use the word abortion when 10-year-old rape victims are involved. To do so would risk raising the ire of anti-abortion activists. Instead, it’s easier to pass laws that provide, at best, stated exceptions for a woman’s health and let doctors figure out how to implement them. Or, in the case of some anti-abortion lawmakers, they are utterly clueless about how reproductive health works but certainly aren’t letting that stop them from writing anti-abortion laws.

This is the new reality of reproductive rights in America, and it looks very different from the pre-Roe world. Then the greatest threat to women’s health was a so-called back alley or coat hanger abortion. Today, with the ubiquity of abortion medication, we will likely see fewer similar situations. But what will happen now is a far broader and more insidious problem: women will be denied or delayed care, and the women affected will not just be those seeking abortions but also women who miscarry or have pregnancy complications. Women will die from infections or hemorrhaging. Life-saving and pain-relieving medications will be denied — and they will experience needless and debilitating trauma. And their deaths will have been 100 percent preventable.

Utterly Depraved

The story of a 10-year-old girl in Ohio forced to travel to Indiana to abort a pregnancy created a brief media firestorm. Still, as outrageous as her case might be, it’s a future that anti-abortion activists are seeking.