Where the risk of pregnancy meets abortion laws and healthcare

As the United States jumps to conclusions about the Supreme Court’s decision to overturn Rowe v. Wade, a question is similarly hidden in court opinions and news stories: why pregnancy risks are rarely discussed anywhere, even though that information is not just relevant to personal decisions. But relevant to abortion, pregnancy and healthcare policies for women?

With the wave of abortion bans taking place across states across the United States, those risks are becoming more and more in the spotlight – allowing women to make abortions under untested and rapidly changing state laws to decide whether or not there is a risk of getting pregnant while living in a state where abortion is prohibited. The state legislature will decide how many threats to a mother’s health must be present.

“Because of the very small risks that can happen to the fetus, we spend a lot of time talking about avoiding behaviors. ‘Don’t eat bean sprouts,’ or ‘Don’t eat daily meats,’ ”Emily Oster, a Brown University economist and author of“ Expecting Better, ”a pregnancy information-driven book, told me. I don’t talk to people about it. “

For example, when a vagina is born, “your vagina is tearing. It’s tearing a lot,” she said. “It’s not even a risk, it’s just realistic.” Wounds are what require a significant recovery time.

And more serious complications, though rare, are not That In the group of rarely given mothers, one has probably survived hypermesis gravidarum (which can occur in up to one in 30 pregnancies), an ectopic pregnancy (up to one in 50 pregnancies), or a pregnancy-induced hypertensive disorder (up to one). 10 pregnancies). All of these conditions can be fatal.

In most cases, the value of risk is informed consent: awareness of the potential for harm, and the opportunity to accept or reject it. If getting in a car or going on a plane means an almost guaranteed stomach or genital injury and a 10 percent chance of a life-threatening accident, people will expect a precaution and an opportunity to consider whether the trip is worth it.

But pregnancy is different.

Jonathan Lord, a practicing gynecologist and English medical director at MSI Reproductive Choices, which provides family planning and abortion services in many countries around the world, says he suspects people often don’t talk about the dangers of pregnancy to women’s health because they find such conversations unnecessary. Sees as a cause of suffering. “It simply came to our notice then. It’s not so much a medical issue, but people don’t talk about the risks and unpleasant aspects and I think it’s mainly because people want to be kind, ”he said.

Oyster had similar assumptions about the complications of a serious pregnancy. “In general, we’re not really interested in dealing with the risk of bad things,” he said. “We very much want to pretend that they are zero.”

And yet if you see messages about the risk of the fetus in pregnancy, instead of the mother, the plot is dense.

Rebecca Blalock, head of research at the British Pregnancy Advisory Service, a charity that provides abortion and other reproductive health services, says women are “bombarded” with messages about the risks they can create for their fetuses on their own. Her organization’s research team, along with colleagues at the University of Sheffield, studied British media messaging around pregnancy. They have seen that media coverage has created women as carriers of harm, not the population in need of protection. The fetus was the only focal point of the health outcome.

Such assumptions affect even prenatal care. “We were seeing women suffering from hyperemesis gravidarum” – an extreme and potentially fatal form of morning sickness that causes almost constant vomiting – “who were not receiving appropriate treatment because their healthcare providers thought the drug posed a risk to their pregnancy, and who really felt That they have no choice but to abort the otherwise desired pregnancy at that time, ”Black said.

A different approach to risk “really fits into a larger cultural climate where women are blamed for any and all illnesses that their children may or may not have, and a preoccupation with the reproduction of the next generation of healthy citizens,” Blalock told me.

This study focuses on the United Kingdom. But Kate Mann, a professor of philosophy at Cornell University and author of two books on how sexism shapes society, says there is a widespread assumption in the United States and elsewhere that having children is something that women are naturally or even morally fortunate to have. To do so, to lead them in that direction – even if it means denying them the opportunity to give informed consent to risk – is seen by some as their best interest. (She noted that transgender men and non-binary people can also get pregnant, but said that rules and social assumptions about pregnancy make pregnant people look like women.)

“We don’t think of pregnancy as something that someone might decide not to do very rationally because it’s too risky,” she said. “This kind of thought process is clarified by the feeling that it is natural and moral and perhaps even sacred, to do it for women.”

But such reluctance to accept risks can make the dangers of pregnancy invisible to policymakers as well. One result is the prohibition of abortion which is so clearly written that they fail to provide a clear path for doctors to protect women’s lives and health. In Poland, where most abortions are not allowed, vague exceptions that would allow them to proceed have confused doctors about the potential liability that resulted in the death of a pregnant woman last year. And now similar confusion is unfolding in the U.S. states whose abortion bans have been in effect since last week’s Supreme Court ruling overturning Rowe v. Wade.

For example, doctors in several states in the United States have expressed concern about whether women will be able to receive timely care for an ectopic pregnancy, a condition where a fertilized egg is implanted outside the uterus or in the wrong part of it. This type of pregnancy is never effective: a fetus cannot prolong its life if it is not implanted properly. But those that implant in scar tissue in the uterus, Dr. Lord said, may continue to develop for months before finally rupturing, at which point they pose a threat to the mother, he said.

“You have to get there really early before it gets that big,” he said. “It’s an inevitability that the fetus will die, but it will probably kill the mother with it.”

“I’m afraid it will happen in states that have strict laws.”

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