'Ripple effect' after Roe: Obstacles to miscarriage, ectopic pregnancy care

WASHINGTON, June 29 (UPI) -- As legal experts ponder what may happen next after the U.S. Supreme Court's decision to overturn the Roe vs. Wade abortion ruling, health experts worry that pregnancy care in the United States will be compromised.

The nation's high court on Friday overturned the 1973 landmark case affirming the federal constitutional right to an abortion, leaving it up to each state to decide the issue.


From some health policy experts' view, this legal reversal could have "enormous" ripple effects, including greater maternal and infant mortality in the United States.

"Women and girls will die," as they did before the Roe vs. Wade ruling and in places where abortion is restricted or banned, Amita Vyas, director of George Washington University's Maternal and Child Health Center in Washington told UPI.


"It's the maternal deaths, it's the long-term mental health and economic consequences," for girls, women and their family members, she said.

Black women in the United States are three times more likely to die during childbirth than White women, and 75% of women seeking abortions live below the poverty line and are Black, Indigenous or other people of color, she said.

"It's truly a public health crisis," said Vyas, a behavioral scientist and associate professor at the GW Milken Institute School of Public Health. "We're going to exacerbate an already very dismal situation."

Others on the front lines worry that it will disrupt their ability to provide safe and effective care for their patients, such as people experiencing miscarriage or atypical pregnancies that require immediate medical intervention.

"The problem is that pregnancy care is complicated and it is difficult and often impossible to draw a line between people having abortions over here and everyone else needing pregnancy care over there," Dr. Kate White, a Boston-based obstetrician-gynecologist in practice for 20 years, told UPI.

"So when legislation is written to try to outlaw abortion, there are 'ripple effects' on all kinds of pregnancy care," said White, associate professor of obstetrics and gynecology at Boston University School of Medicine.


White noted that she practices medicine in Massachusetts, a progressive state, "which means we'll see people coming to us" for pregnancy care.

She also predicts that people with specific conditions will face challenges from the court's ruling and states' subsequent legislative actions.

"When it comes to miscarriage and pregnancy loss in the first trimester, the most common time, I fear abortion bans will affect [patients] in two ways," she said.

First, the medications used for pregnancy care and miscarriage are the same medications used for abortion, White said, "and there are already stories about pharmacists not filling prescriptions."

Second, she said, "the procedure used to treat miscarriage -- a suction aspiration or D&C [dilation and curettage] or dilation and evacuation -- is also the same procedure as used to a surgical abortion."

Since the medications and procedures are the same for miscarriage and abortion, "more women are going to be forced to expectantly manage their pregnancy loss -- a fancy term for waiting it out -- because 80% of the time, the pregnancy will spontaneously leave the body within eight weeks" after the fetus stops growing, White said.

"While some people want that option, not everybody wants to wait," she said. "So I fear this is taking away choices for people facing pregnancy loss at a time that is already filled with much grief."


White said it is challenging to offer advice to pregnant women amid the disruptions.

Patients and their doctors are going to have to work hard to find pharmacists who will dispense the medication or physicians who have the medicine in their office to dispense directly to their patients, she said.

Doctors also may decide to assist their patients who are having a miscarriage by performing the procedure in the office, "which is totally safe and effective, but not many doctors do it," she said.

All things considered, White said, "the onus is on the healthcare community to maintain access to the full range of options for miscarriage care. There's not a lot patients can do for themselves."

Another area of worry centers around ectopic pregnancies, in which the fetus develops outside the uterus.

"The concern about ectopic pregnancy comes from the imprecise way that a lot of these [abortion banning] laws are written," White said.

The law may define abortion as any disruption of a pregnancy after fertilization, without specifying where the fertilized egg is implanted, she said, and if it implants outside the uterine cavity, the pregnancy is unviable and can't proceed to full term.

Ectopic pregnancies, in fact, "are defined as medical emergencies that have to be treated urgently to save the life of the pregnant person," White said.


"But we already have heard stories from Texas of people with ectopic pregnancies being turned away for care because the doctors were afraid of violating the abortion ban," she said.

Given that healthcare providers may face penalties for treating pregnant women, White said doctors in states passing abortion bans must advocate with state legislators to have "exceptions or carve-outs" for ectopic pregnancy patients.

White said some of her patients are calling her office, "making sure they have a fresh IUD in" as the legal landscape begins to change. But she said many seem either unaware of the latest news "or don't realize how these bans will affect them."

Demonstrators gather at Supreme Court after Roe vs. Wade overturned

Abortion opponents celebrate after the U.S. Supreme Court overturns Roe vs. Wade, ending federal abortion protection in Washington on Friday. Photo by Jemal Countess/UPI | License Photo

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