Women in Peril: Arkansas in the Post-Roe World

The news is full of danger signals for women in Arkansas thanks to Arkansas’ punitive abortion ban, one of the nation’s most ruthless on problematic pregnancies.

From across the country and Arkansas, come warnings or real cases of harm to women from the US Supreme Court’s decision to end abortion rights and the resulting campaign for state laws to punish women and those who seek to help them.

In Arizona, an ex-husband is suing an abortion clinic for “wrongful death” in his ex-wife’s abortion. A judge has allowed the man to open an estate for the embryo and the woman remains mired in a lawsuit four years after the abortion. As Pro Publica notes in an article on the case:

Experts said the rare tactic could become more common as anti-abortion groups signaled their desire to further limit reproductive rights in the wake of the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization. , which overruled Roe against Wade. The lawsuit in Arizona and others that may follow could also be an attempt to discourage and intimidate suppliers and harass plaintiffs’ former love partners, experts have said.

And more problems:

This article reports that support groups for low-income women seeking abortions are pulling out for fear of legal harm. Such groups exist in Arkansas. You can be sure that the religious crusaders in the Arkansas legislature are willing to attempt to criminalize these support groups; criminalize women who seek treatment in states where abortion remains legal, and criminalize those who provide women with assistance, whether in money, transportation, or even simple counselling.

In Texas, hospitals refuse medical care for women with high-risk pregnancies for fear of breaking anti-abortion law (which is slightly less strict in Texas than in Arkansas for women with difficult medical conditions). Arkansas allows treatment ONLY to save a mother’s life. Mere damage to health is not enough.

Even ectopic pregnancies are scrutinized. These are fetuses not implanted in the uterus. Without an abortion, the woman dies. Arkansas law provides for an abortion for ectopic pregnancies. But doctors fear aborting such a pregnancy while a fetal heartbeat can still be detected (another prohibition in Arkansas law). The treatment of incomplete miscarriages is also a dilemma for doctors under Arkansas law.

The Arkansas lawmakers who blithely claim that the ectopic pregnancy exception is sound are NOT doctors. Consider this from the Post article.

Many state laws with new abortion restrictions make exceptions for ectopics, but uncertainties can arise if a fetus implants on cesarean section scar tissue on the wall of the uterus or cannot not be located.

Patricia Nahn, another obstetrician-gynecologist at Zeal, said she recently had a patient with signs of an ectopic pregnancy, including abdominal pain. But because this was not a specific case in which an ultrasound showed that the fetus was developing outside the womb, Nahn risked terminating a fetus that was in the womb and violating Wisconsin’s abortion ban.

Pregnancy is a complicated business. Dangerous even. Science and medicine should take precedence over a legislator’s religion or beliefs, just as with cattle deworming. The Arkansas legislature should not practice medicine. And it is malpractice and dishonesty on the part of Attorney General Leslie Rutledge to claim that Arkansas’ cruel law is about protecting women.

In a state with a sky-high maternal mortality rate, the number of deaths in Arkansas will rise. And complications are much more than ectopic pregnancies, but also complicated pregnancies with serious, but not necessarily fatal, health risks.

The Legislature should read the column in today’s Democrat-Gazette by Jill Wieber Lens, a law professor at the University of Arkansas. She writes about how Arkansas’ total abortion ban (barring the wave and I think not a fully protective exception for ectopic pregnancies) will hurt care for ALL pregnant women.

Specifically, the Arkansas Trigger Law limits treatment options for pregnancy loss – at the same time pregnancy losses in Arkansas are likely to increase, also due to the Trigger Law.

…An example is a missed miscarriage, when the baby stops growing but the fetus’ heart is still beating. Medical interventions for these miscarriages are the same medications and procedures used for abortion. These procedures, however, are no longer legal in Arkansas until the fetal heartbeat stops on its own. This can take weeks or even longer. Pregnant Arkansans who experience a missed miscarriage are left with no choice but to wait, which increases physical and emotional trauma.

Similarly, medical treatment will not be available if a woman goes into preterm labor before she is viable (i.e. before the baby is likely to survive outside the womb, usually around 24 weeks of age). pregnancy). If a woman’s waters break at 18 weeks and doctors can’t stop preterm labor, doctors can’t legally do anything as long as the fetal heartbeat continues. Again, pregnant Arkansans will be forced to wait, increasing physical and emotional trauma.

In neither situation can a doctor legally perform an abortion. Abortions are legal in Arkansas only if necessary to “save the life of a pregnant woman in the event of a medical emergency.” Medical emergency is defined as “a condition in which the life of a pregnant woman is endangered by a physical disorder, physical illness or physical injury”.

But how in danger must his life be? Twenty percent chance of dying? Fifty-one percent chance of dying? Ninety-nine percent chance of dying? Should his life be immediately endangered, or is subsequent known endangerment enough?

Arkansas law does not answer these questions; the courts will eventually have to answer them. Hospital lawyers will now be intimately involved in medical treatment decisions.

Lens also notes the absence of an allowance in the law for fetal anomalies. Indeed, a 2019 Arkansas law encourages women in such cases to carry a pregnancy to term, with palliative and other care to prepare families for the death of a child before or after birth. The legislature, of course, has not provided any resources to provide such care to poor families.

And then there are stillbirths, which occur late in pregnancy. Some 25% of them are preventable, Lens writes. But, again, we are in Darkansas:

Based on 2019 data, the most recent national data available, Arkansas already has the third highest stillbirth rate in the nation. In the short time between 2017 and 2019, Arkansas’ stillbirth rate increased by nearly 28%. Black women in Arkansas are 85% more likely to give birth to a stillborn baby than white women. Studies also show that poor women have a double risk of stillbirth compared to women with economic means.

The effects of Arkansas’ abortion ban are not limited only to those who wish to terminate their pregnancies. The ban will also likely increase pregnancy losses while making the experience of pregnancy loss more difficult.

To quote again Leslie Rutledge on President Biden’s orders to protect access to abortion:

The order flatters President Biden’s base by perpetuating the false narrative that women’s lives are in danger.

And also from Rutledge:

In Arkansas we will always be protect life!

Whose life? Not that of a grown woman. More here on the “blurred line” on what it means to save a life.

The new abortion bans oversimplify the reality of obstetric care, doctors say, placing a binary on what is a continuous spectrum of increasing risk. Pregnancy places enormous stress on a patient’s body, sometimes exacerbating existing health problems such as diabetes or hypertension until they put their lives in danger.

“With a heart patient, when in her pregnancy will she die?” said David Hackney, a specialist in high-risk pregnancies in Ohio. “You don’t want to reach that point, where things are so clear.”

PS: Lens of the UA also wrote a scholarly paper that says efforts to support those experiencing pregnancy loss need not cede the right to abortion. From the summary:

More importantly, this article proposes that acknowledging pregnancy loss in abortion narratives will better position the abortion rights movement in a post-Roe world in which abortion and pregnancy loss are inexorably linked. Without legal access to abortion, women will turn to self-management. But because the complications of self-managed abortion are indistinguishable from miscarriage, the investigation and criminalization of pregnancy loss will increase dramatically as a mechanism for the enforcement of abortion laws. Furthermore, restrictions on abortion also create indirect consequences that undermine the treatment of pregnancy loss. Understanding how these two experiences are related will help normalize and de-stigmatize all pregnancy terminations that do not result in a live birth – abortion, stillbirth, and miscarriage. Finally, we argue that an abortion rights discourse that recognizes the subjective value of the fetus is less alienating and reflects nuanced views on the meaning of pregnancy.

The Arkansas legislature, as a rule, does not discriminate.

PS: None of these piling up horror stories mentions another – the potential loss of drugs useful in the treatment of various diseases – cancer, for example – as they can cause miscarriages. Women across the country are already experiencing this. Or the denial of the sale of contraceptives by those who claim a religious objection (protected by Arkansas law).

Comments are closed.