On June 29, five days after the United States Supreme Court struck down federal protections for abortion rights, Emily Diament, who is pregnant with her second daughter, was due for her 20th week checkup. Everything was going so well during pregnancy that she couldn’t have asked for more. She will always remember it: it was Wednesday, at 2pm, when the doctor told her and her husband that the fetus’s heart had stopped beating. “It was terrible. Ram [her husband] and I had to think: Where does the Supreme Court ruling leave us now?” “This was all new,” says the 33-year-old public relations practitioner in an email: “A panorama full of unknowns and worries.”
The gynecologist explained the other options. The first, “induction,” was the least safe. It basically means giving birth to the stillborn child. The second, which was more reliable and less stressful for her, was to undergo a D&E operation, an acronym for “dilation and evacuation.” “The process is also faster,” explains Diament. The couple chose the latter.
The couple lives in New Orleans, “the best city in the world,” as Diament likes to define it. The Supreme Court’s ruling, which overturned half a century of precedent set by the Roe v. Wade in 1973, power to regulate women’s reproductive health returned to the states. Diament legislators in Louisiana, were anxiously awaiting the moment of the “stimulus law,” which has been ready to take effect since 2006. Three days after the ruling, a judge blocked the activation of that rule, one of the most restrictive in the country But that didn’t last long: on July 8 abortion was banned in Louisiana even because of rape and circumcision. After several proceedings and proceedings in the courts, the ban remains, pending new legal battles.
Among the restrictions proposed by the law is the veto of D&E if the mother‘s life is not in danger, or if the child has already died. Diament’s case fell into the approved categories, but her ordeal forced her to tell her story. “After going through that process and talking to several doctors about their concerns,” she explains, “I know this happened to me at this exact time for a reason.”
Bhavik Kumar is one of those nervous doctors, who are being pushed into legal limbo by the new rules. He is a consultant with the largest provider of abortion in the United States, Planned Parenthood, in Houston, Texas, another one of the centers of the restrictive tsunami that hits the United States. He explains that “induction” can last “from 1 to 12 or 24 hours,” has more risks (“the same as childbirth”) and creates more hospital costs, which creates serious debt among less affluent patients. Some, however, prefer it, because “the baby comes out safe, and they can bond with it,” says Kumar. With D&E, which uses forceps, mothers cannot see the dead body.
Conversation between doctor and patient
And that’s all Kumar asks: that the issue be resolved in a conversation between doctor and patient, “without political interference.” “Since the law went into effect [in Texas], the only cases where we are allowed to intervene after six weeks are if the person’s life is in danger, or if there is no doubt that the pregnancy is not viable,” he warns.
Kumar, like many of his peers, is skeptical of the “life at risk” idea. “It’s not exactly a scientific concept,” he clarifies. “Each doctor, each ER, each clinic and each hospital may have their own theory of what that means. This may interest you : The United States is looking for alternatives to Chinese cobalt. Now, instead of looking at the data and talking to patients to decide what is best, doctors, hospitals and clinics have to consult lawyers, ethics committees or administrators about what they can and cannot do. Meanwhile, they also remain in limbo.” It seems that the precautions are justified: Texas and Louisiana threaten prison sentences of between 10 and 15 years for those who perform abortions outside the approved limits.
So a gynecologist explained the new dilemmas of her practice during an interview with EL PAÍS held at a reproductive health center in Des Moines (Iowa): “It’s terrible,” lamented the doctor, who asked to speak anonymously. “They make us choose between the Hippocratic Oath [the famous “do no harm”] and the penal code.”
This week, Attorney General Merrick Garland decided to take matters into his own hands with a Justice Department lawsuit challenging a new Idaho law that, when it takes effect at the end of the month, will allow prosecutors to “indict, arrest and prosecute doctor. just to show that an abortion has taken place, regardless of the circumstances.” So the rule endorses the burden of proof on doctors (that is, to prove whether or not the woman’s life was in danger, for example, or whether there was mutilation or rape, in cases where those exceptions are involved the law). According to Garland, who warned that it is the first in a series of legal actions by the Biden administration to mitigate the effects of the new state laws, that provision conflicts with a federal regulation, the Emergency Medical Treatment and Labor Act (EMTALA). .
“A lot of physicians need training,” explains Diament. “With the new laws, it is likely that there will be doctors who prefer not to learn the technique to avoid the possible consequences. It’s not that we don’t have autonomy over our bodies, it’s because doctors can’t monitor our health either. This is not protecting life, quite the opposite. It’s completely surreal.”
“We must not forget that we are dealing with situations where pregnancy is really desired. First they have to accept terrible news, and then they are forced to go through a process that is extremely traumatic for many, and then, a few weeks later, they have to relive the experience when the bill arrives hospitals,” says Gabriela Benazar Acosta, spokeswoman for Planned Parenthood Latino, New York.
Kumar warns, for his part, that “medicine is a science with large gray areas, no matter how hard these legislators insist otherwise. No one knows better than doctors, in caring dialogue with patients and their families, in each particular case what is the best way to act.”
These days, stories like Diament’s are emerging in the United States (“they’ve always been there,” says Kumar, “but now they’re in the spotlight”). Stories of women sent home by hospitals with instructions to return when they get worse and are “really” bleeding” – “even when it’s clear there’s no turning back,” says the doctor. A patient in Texas whose water broke at week 18 was advised to stay in the hospital until week 24, which is when the fetus could be “viable” outside the womb. Maybe then the baby could survive (Alan Peaceman, a professor of maternal-fetal medicine at Northwestern University Feinberg School of Medicine in Chicago, told radio station NPR that the chances are “as close to zero as far as a cure “).
“All of this means that some people have to travel to other states because they don’t want to wait to be sick anymore,” says Kumar. Since the Supreme Court overruled Roe, class and race have become two factors that have come to the fore in the reproductive health debate in the United States. This regressive wave, which comes half a century after the Roe ruling, means that women have to travel to a state where abortion is allowed. This has created yet another gap between those who can afford to take days off, often without pay, from their jobs and pay for the trip and operation, and those who cannot. In the case of miscarriage, which is unavoidable in between 10% and 20% of pregnancies, the new regulations could have fatal consequences.
