As the United States has grappled with the unfolding ramifications of the Supreme Court’s decision overriding Roe v. Wade, one question lurks between court rulings and news stories: why are the risks of pregnancy so rarely discussed anywhere, even though they are information is not only relevant for individual decisions, but also for abortion, pregnancy and health care policies for women?
With the wave of abortion bans taking place in states across America, those risks will be more in the spotlight — both in women’s decisions about risk of becoming pregnant and if they live in a state that has banned abortions, as the arguments that will happen in state legislative chambers about how much of a risk to a mother’s health must be present to allow an abortion under untested and rapidly changing state laws.
“We spend an awful lot of time talking about avoidance behavior because of the very small risks that can occur associated with the fetus. ‘Don’t eat bean sprouts’ or ‘don’t eat processed meats,'” Emily Oster, an economist at the United Nations, said. Brown University and author “Expecting Better,” a data-based book on pregnancy, told me “And then we never really talk to people about the risks of things that are almost certainly going to happen.”
For example, during a vaginal delivery: ‘Your vagina is going to tear. It’s going to tear a lot,” she said. “That’s not even a risk, it’s just realistic.” Those who give birth by cesarean section, major abdominal surgery, end up with a major wound that requires significant recovery time.
And more serious complications, while rare, are not That special. In a given maternal group, someone is likely to have survived hyperemesis 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 in 10 pregnancies). All of these conditions can be fatal.
Out of Opinion: The End of Roe v. Wade
Commentary from Times Opinion writers and columnists on the Supreme Court’s decision to end the constitutional right to abortion.
- Michelle Goldberg: “The end of Roe v. Wade was anticipated, but it still left painful and potentially tragic uncertainties across much of the country.”
- Spencer Bokat-Lindell† “What exactly does it mean for the Supreme Court to go through a crisis of legitimacy, and is it really in one?”
- Bonnie Kristian, journalist: “For many supporters of former President Donald Trump, Friday’s Supreme Court ruling was a long-awaited justification.” It could also mean the end of his political career.
- Erika Bachiochilawyer: “It is precisely the unborn child’s state of existential dependence on its mother, not its autonomy, that entitles it to special care, education and legal protection.”
In most situations, the standard for risk is informed consent: awareness of the potential for harm, and an opportunity to accept or decline it. If driving a car or taking a plane meant a near-guaranteed abdominal or genital injury and a 10 percent chance of a life-threatening accident, people would expect a warning and a chance to consider whether the trip was worth it.
But pregnancy is different.
Jonathan Lord, a practicing gynecologist and the English medical director of MSI Reproductive Choices, an organization that provides family planning and abortion services in countries around the world, said he suspects people often fail to talk about the dangers of pregnancy for women’s health because they see such conversations as a cause of unnecessary suffering. “It’s actually kind of ingrained in society. It’s not so much a medical issue, but people don’t talk about the risks and the unpleasant aspects, and I think that’s largely because people want to be nice,” he said.
Oster had a similar hypothesis about serious pregnancy complications. “We’re generally not interested in the risk of really bad things,” she said. “We would really like to pretend they are zero.”
And yet, if you look at the reports of risks to the fetus during pregnancy, rather than to the mother, the plot thickens.
Women are “bombarded” with messages about the risks they themselves may pose to their fetuses, said Rebecca Blaylock, the study leader of the British Pregnancy Advisory Service, a charity that provides abortion and other reproductive health services. Her organization’s research team, together with colleagues from Sheffield University, studied British media coverage of pregnancy. They found that media attention predominantly portrayed women as a vector of harm, not a population in need of protection. Fetuses were the sole focus of health outcomes.
Such assumptions even affected prenatal care. “We saw women suffering from hyperemesis gravidarum” – an extreme and potentially fatal form of morning sickness associated with near-constant vomiting – “who were not receiving appropriate treatment because their health care providers thought the medication was a risk to their pregnancy, and who really felt they had no choice at the time but to terminate an otherwise wanted pregnancy,” Blalock said.
The different attitudes to risk “really fit into a larger cultural climate in which women are blamed for all the ills that may or may not happen to their children, and a preoccupation with reproducing the next generation of healthy citizens,” Blaylock told me.
That study focused on the United Kingdom. But Kate Manne, a philosophy professor at Cornell University and author of two books on how sexism shapes society, said there’s a widespread assumption in the United States and elsewhere that having children is something that women naturally or even do. are morally predestined. to do. Accordingly, guiding them to do so – even if it means depriving them of the opportunity to give informed consent to the risks – is seen by some as in their best interest. (She noted that transgender men and non-binary people can also get pregnant, but said the norms and societal assumptions about pregnancy tend to assume that pregnant people are women.)
“We don’t tend to think of pregnancy as something that someone could very rationally decide not to do because it’s too much of a risk,” she said. “That kind of thought process is overcome by the sense that it’s natural and moral, and perhaps sacred, for women to do this.”
But such a reluctance to recognize risks can also make the dangers of pregnancy invisible to policymakers. As a result, abortion bans are written so bluntly that they don’t provide clear avenues for doctors to protect women’s lives and health. In Poland, where most abortions are not allowed, vague exceptions that allow them to continue have left doctors confused about potential liability, leading to the death of a pregnant woman last year. And now, similar confusion is unfolding in US states where abortion bans came into effect after last week’s Supreme Court ruling overturned Roe v. Wade.
For example, doctors in several US states have raised concerns about whether women can receive timely care for ectopic pregnancies, a condition in which a fertilized egg implants outside the uterus or in the wrong part of it. Such pregnancies are never viable: it is not possible for a fetus to reach full term unless it is implanted correctly. But those who implant in scar tissue in the uterus, said Dr. Lord, can continue to develop for several months before finally rupturing, at which point they are life-threatening to the mother, he said.
“You have to get there really early for it to grow that far,” he said. “It is inevitable that the fetus will die, but it will probably kill the mother with it.”
“I’m afraid in those states that have strict laws, that’s what will happen.”