A new study reveals how radical anti-abortion laws implemented by Republicans in “red” states such as Louisiana have critically degraded—and, in some cases, completely eliminated—established standards of normal and necessary medical care expected by women and others during pregnancy. Drawing upon extensive data collection, records reviews, and interviews with physicians in the wake of the Supreme Court’s decision to strike down Roe v. Wade, the study by Lift Louisiana shows how even routine, uncomplicated pregnancies are now a dangerous proposition for those living in states banning abortion. Should Republicans succeed in imposing a national ban on abortion—as has been proposed by Donald Trump—the same consequences would be inflicted on the entire nation.
The Lift Louisiana study, titled “Criminalized Care: How Louisiana’s Abortion Bans Endanger Patients and Clinicians,” is significant because it implicates medical care for all pregnancies, not just “high-risk” ones. What it shows is that the pervasive impact of these laws on the practice of medicine is no longer limited to fearful doctors and hospitals reluctant to treat pregnant patients whose fetuses may have life-threatening conditions. Nor are their impacts limited to the refusal by clinicians to adequately treat patients who themselves might die or suffer harm by continuing their pregnancies.
Those appalling outcomes have been amply documented in several states since the Supreme Court decided to allow individual state legislatures to act as experimental laboratories, imposing tighter and tighter restrictions on anyone who might want or need to terminate a pregnancy. What is unprecedented about the Lift Louisiana study is that it shows a stunning drop in standard care applicable to all pregnant patients, directly as a result of the state’s punitive anti-abortion law.
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Almost immediately after the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision was handed down, doctors treating high-risk or anomalous pregnancies suddenly found themselves at the mercy of draconian statutes limiting or prohibiting medical intervention altogether. That is, if such treatment might conflict with the overarching right-wing mandate requiring their patients to give birth. For example, as reported last month by Kavitha Surana, writing for ProPublica, doctors in Tennessee and other states now must submit their planned courses of treatment to an overseeing “abortion committee” tasked with evaluating compliance with the state’s strict anti-abortion laws before treating pregnant patients. As Surana notes, this added layer of bureaucratic intrusiveness has “warped doctors’ decision-making and forced them to violate the ethics of their profession, which require acting in the best interests of their patients.”
Under threat of prison time and professional ruin, they are finding their personal interests pitted against their patients’ and are overriding their expert training for factors that have nothing to do with medicine, like political perceptions and laws they aren’t qualified to interpret. As a result, some patients are forced to endure significant risks or must travel out of state if they want to end a pregnancy. Sometimes, their doctors aren’t even giving them adequate information about the dangers they face.
These consequences are certainly bad enough for women and others facing risky pregnancies. But the abandonment of normal, routine prenatal care as a consequence of these odious laws—whether intended or not—now poses serious, real risks for anyone who becomes pregnant in a Republican-controlled state.
As reported by Molly Jong-Fast for MSNBC:
[A] new report out of Louisiana reminds us once again that post-Roe America isn’t dangerous just for women who want to terminate pregnancies but also for women who welcome their pregnancies and are seeking prenatal care.
“We are seeing more cases where OB-GYNs are not acting and are making the woman wait until complications arise, waiting for signs of infection, and then it is more complicated and difficult,” the report from Lift Louisiana, a reproductive rights organization, says. The report says that “in general, we are seeing more pregnancies where the correct management is delayed.” In some cases, doctors are refusing to even see patients until after 12 weeks — that is, until after their first trimester, when miscarriages are less likely and they, therefore, can’t be accused of having done something or having given some advice that caused them.
As Jong-Fast observes, “It has become clear that pregnant women are getting a lower standard of care post-Roe because doctors who don’t want to lose their licenses, end up in jail or be fined hundreds of thousand dollars are afraid to treat them.”
In Louisiana, doctors face imprisonment of up to 15 years and fines of up to $200,000 if they perform an abortion that falls outside of the state’s intentionally vague “exceptions.” Texas’ “trigger law,” imposed immediately following the Supreme Court’s decision, imposes a penalty of life imprisonment. Other states have imposed criminal penalties on medical providers that vary in length and severity, intentionally creating a climate of fear surrounding any medical treatment of pregnancy that might conceivably result in an abortion.
The consequences of these laws for the medical treatment of “ordinary” pregnancy has been stark and undeniable. Rosemary Westwood, reporting for NPR, cites specific examples described in the Lift Louisiana report, including the performance of unnecessary and potentially dangerous C-sections, as one doctor reviewing the report puts it, “to preserve the appearance of not doing an abortion.”
In one of the most extreme examples of how pregnancy care has changed, doctors described cases of women who experienced preterm premature rupture of membranes (when the “water breaks” early in pregnancy, before the fetus is viable). Some of these women were forced to undergo Cesarean section surgeries to empty their uterus and avoid infection, instead of receiving an abortion procedure or medication.
“Which is ludicrous, absolutely ludicrous,” said Freehill. “The least safe thing that we do, no matter if it’s early in pregnancy or full-term at your due date, is a C-section.”
As Westwood observes, the report also documents doctors deliberately waiting until the second trimester to treat their patients at all, fearing accusations of causing a miscarriage:
In what doctors described as another serious deviation from standard medical practice, OB-GYNs in Louisiana are now delaying routine prenatal care until patients reach 12 weeks of pregnancy — the point at which the risk of miscarriage drops significantly.
One patient interviewed in the report said several different doctors’ offices wouldn’t see her before 12 weeks. One office told her the abortion ban was “something that’s new” and that doctors wanted “to eliminate some of the spontaneous abortions, or miscarriages, that may happen up until that 12-week mark,” the patient recounted.
As Westwood notes, this delay of care until the second trimester can have serious, even life-threatening consequences for patients with blood clots or potentially ectopic pregnancies. The report notes that some rural hospitals in the state are deliberately transferring patients to larger urban hospitals so they don’t have to decide on a course of treatment that could subject them to criminal liability. But those urban hospitals are subject to the same criminal penalties, and they are acting accordingly.
The report documents numerous instances of women with severe medical conditions forced to endure a regimen of unnecessary medical treatments before the doctors would even consider terminating their pregnancies, just so those doctors can show due diligence should they be accused of violating the state’s laws. Some doctors are recorded as feverishly consulting with their colleagues to determine when and if a woman was “on the brink of death” that would justify aborting the fetus.
Physicians are also delaying treatment of miscarriage and ectopic pregnancy out of fear of breaking the law, the report found — as previously reported in news stories from states operating under abortion bans. Ectopic pregnancies — when the embryo implants outside of the uterus — are never viable, and they can even be deadly.
As the report notes, “In some cases, clinicians described treating severely ill patients whose other physicians had been afraid to even document their assessment of the patient’s medical issues before the patient was transferred for care.”
The malpractice now routinely occurring in Louisiana is simply a taste of what would occur throughout the entire nation should a national abortion ban be instituted. As Cecile Richards, formerly the head of Planned Parenthood, explains in Jong-Fast’s MSNBC article:
“The report from Louisiana makes it clear that getting pregnant in the state — or in any state that has banned or severely restricted abortion — is a dangerous proposition. Politicians are now interfering with the medical judgment of providers as well as preventing pregnant people from getting prenatal care and other care they need to preserve their future fertility or even their life. It’s a state of emergency in Louisiana, and depending on the November elections, we could have a national abortion ban, eliminating healthcare rights in every state.”
The “15-week” abortion ban sought by Trump would foster these practices on a nationwide basis. That proposal has been hawked by Republicans as a “compromise” standard, but that characterization is grossly misleading because it ignores the plain fact that the forced-birth lobby will never, ever agree to a national law that would supplant any of the current, stricter bans they’ve already achieved through Republican state legislatures. The effect of such a “15-week” ban, in other words, would simply impose the same restrictions on Democratically governed “blue” states, while allowing to stand the even harsher “red-state” bans already in place. In fact, a 15-week ban would almost certainly assure that those restrictions in pro-forced birth states would be tightened, leaving routine pregnancy medical care essentially under varying degrees of threat throughout the entire nation.
That is because there is no reason to believe that what is happening now in Louisiana, for example, is particularly unique or specific to that state. As Surana’s ProPublica article notes, the fear of potential criminal liability by doctors, clinicians, and hospital staffs has already warped the standard practice of prenatal care in other states, such as Texas. Louisiana’s health care system may not be comparable to the systems in other, wealthier states, but it is not the quality of the medical system that drives this refusal to properly care for pregnant patients. Rather, it is raw fear, and that same fear will exist in any state in which abortion is banned, whether altogether or subject to an arbitrary, 15-week limitation. In any circumstance, pregnancy care will be under constant scrutiny and second-guessing, and pregnant women and others will be forced to suffer the drastic consequences.
All women and those who may become pregnant need to understand exactly what the Republican party has done by tying itself to this forced-birth fanaticism. The stakes are no longer limited to the “debate” about abortion itself, but now to implicate the health care of anyone, anywhere, experiencing any type of pregnancy. That is the legacy that the right-wing majority on the Supreme Court left in the wake of its decision to overturn Roe v. Wade. It’s the legacy that a vote for Trump will perpetuate, as he has made perfectly clear. There is only one way to reverse it: voting Democratic in November.
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