Women Die -- And That's 'Pro-Life'?

Strict abortion laws killed Izabella in Poland and Savita in Ireland...So what's in store in America?

The Supreme Court majority framed its evisceration of Roe v. Wade with the contrast dialed up, deploying a palette of black and white to conjure women who go to a clinic to terminate the pregnancy.

But the real world is messy, and medicine is limned in grays. Sure, many cases do involve women who simply seek an abortion. But one lesson from other countries that have adopted rigid anti-abortion laws is that these have a chilling effect that leads doctors to hesitate – so sometimes women die unnecessarily.

In Poland, a 30-year-old hairdresser named Izabela Sajbor was delighted to learn that she was pregnant. She already had a nine-year-old daughter and wanted the girl to have a sibling.

But the fetus turned out to be malformed and her water broke at 22 weeks. The fetus was not going to survive, but doctors were fearful of removing it until the heartbeat stopped.

Poland allows abortion when the health or life of a woman is at risk, but doctors don’t always know how to interpret this. Izabela was kept waiting in the hospital, knowing that her life was in danger; she texted angrily that because of the law “a woman is like an incubator.”

Izabela vomited, convulsed and developed a fever, but the hospital was concerned about prosecution if it intervened, according to an excellent account in The New York Times. By the time the fetal heartbeat stopped and the doctors rushed her into the operating room, it was too late. Izabela died.

The authorities called it a tragedy and exceptional – which it was – and suggested that the hospital was at fault. Yes it was, but bad law and bad medical care converged. The doctors certainly didn’t want Izabela to die, but concern about a bad law led them to offer substandard care that in this case proved lethal.

In Poland, another case has been reported in which a woman lost one twin she was carrying, in January, and doctors were reluctant to remove it for fear of harming the surviving twin. In the end, the woman herself died.

The United States has one of the highest rates of maternal mortality in the advanced world. The maternal mortality rate in the United Kingdom is 7 deaths per 100,000 live births, and in Canada it’s 8. In the United States, it’s three times as high, almost 24.

We have been willing to tolerate a level of risk to women’s lives that other countries find unacceptable. For similar reasons we accept that a woman dies every two hours from cervical cancer in the United States, instead of following Australia in adopting a major campaign against cervical cancer to save those lives. And now, in about half the states with strict abortion laws, we’ll have one more risk factor that in some cases will claim women’s lives.

Imagine you’re a doctor in the E.R. in Mississippi or Louisiana when a woman arrives with pelvic pain, cramping and vaginal bleeding. She tests positive for pregnancy, but repeat bHCG hormone tests indicate that the embryo is not developing properly and an ultrasound can’t locate an embryo in the uterus. You suspect an ectopic pregnancy, which could be life-threatening.

Almost 2 percent of pregnancies are ectopic, meaning that the embryo is implanted not in the uterus but somewhere else, most commonly in a fallopian tube. Ectopic pregnancies are the leading cause of maternal mortality in the first trimester and account for 10 percent to 15 percent of all maternal deaths in the United States.

In this situation, you might give the woman a drug called methotrexate, which will lead the embryo to be flushed out. That would not normally be considered an abortion, because an ectopic pregnancy is not viable. But what if your Mississippi county has a zealous “pro-life” prosecutor who thinks that an ectopic pregnancy is a life like any other?

Much of the anti-abortion lobby believes that an embryo should be protected from fertilization, which would seem to protect an ectopic embryo. An Ohio bill would even have required doctors to “reimplant an ectopic pregnancy into the woman’s uterus” — which is impossible. Treating the end of an ectopic pregnancy as an abortion feels crazy, but craziness is contagious these days. At least one hospital in Missouri is now reportedly monitoring ectopic pregnancies but not intervening until there is a documented fall in hemoglobin levels or other crisis in vital signs.

Or what happens when a woman arrives in your Mississippi hospital suffering a prolonged miscarriage, still with a fetal heartbeat. What do you do? That’s what killed Izabela in Poland.

What happens if a pregnant woman has breast cancer (which is sometimes treated with methotrexate)? How does the doctor manage the risk to her and simultaneously to the embryo? There are difficult tradeoffs that a woman and her doctor may weigh, but should the specter of a possible prosecution hang over them?

Or what if a woman engages in behaviors that endanger a fetus? A growing number of states have already been prosecuting women who abuse alcohol or drugs while pregnant, with a single prosecutor in Mississippi charging 20 women with such offenses. A woman in California, 26-year-old Chelsea Becker, was charged with murder in 2019 after she used meth and gave birth to a stillborn baby (a judge dismissed the charges two years later). What if a woman simply smokes, given that smoking increases the risk of miscarriage? Might a zealous prosecutor go after her?

Another famous case in which anti-abortion laws killed a woman rocked Ireland in 2012. A 31-year-old dentist, Savita Halappanavar, suffered a miscarriage at 17 weeks but was refused an abortion to clean her uterus.

An abortion rights protest in Ireland after the death of Savita Halappanavar. Creative commons license of photo by William Murphy

Doctors knew that the fetus would not survive but refused to perform the procedure as long as there was a fetal heartbeat. By the time the heartbeat stopped and she was able to get an intervention, it was too late: She had suffered sepsis and died the next day.

Inevitably, there will be cases like Izabela’s and Savita’s in the United States, and I hope these unnecessary deaths will galvanize voters. But by then, of course, it will be too late for some women.

There are perhaps 8,000 miscarriages in the United States every day (many of them so early they are undetected). There may be about half that many ectopic pregnancies. What will these mean in states where prosecutors are now effectively in the room with doctors and patients — remembering as well that some medicine is sub-optimal?

This Twitter thread offers a glimpse. A Texas woman named Marlena Stell suffered a miscarriage and needed a D&C abortion. She says her doctor was nervous about performing the procedure because of the Texas abortion law, so she carried the remains inside her for two weeks while at risk of sepsis. In her words:

Marlena Stell @MarlenaStell

I wanted my baby. My husband and I have tried for years. I got pregnant in august 2021 and then miscarried. My body doesn’t naturally expel so I needed a D&C. I was denied one because my doctor was worried about the laws here in Texas. I waited for 2 WEEKS carrying my loss while

Marlena Stell @MarlenaStell

Hoping I didn’t go septic. My pain got worse and I was scared. I begged to get a D&C and was still told no. Because politicians who have no right to butt into my healthcare needs decided their say so was more important than MINE.

Marlena Stell @MarlenaStell

Instead of allowing me to grieve my loss, I had to fight for 2 weeks to get care which I eventually got at an abortion clinic and not a hospital. The clinic gave me the care I was denied by doctors. And while

Marlena Stell @MarlenaStell

Entering the clinic, I was yelled at and told I was a “baby killer” from total strangers who didn’t even know why I was there or what I was going through. Because these strangers thought their opinions mattered more than my own health and well being.

Marlena Stell @MarlenaStell

Oh and here’s my 2 year old baby girl who has her mom still alive because I FOUGHT to get the care I needed. I will NOT let a government decide whether I can get care I need to stay healthy and ALIVE.

There are other arguments to make for abortion rights, of course. But a starting point is that judges and legislators sometimes perceive moral and medical lines that are more clear-cut than they are. I fear the upshot is still that women will die unnecessarily as Izabela and Savita already have – and how can that be pro-life?