- Olivia Kim
Treatment for miscarriages under Dobbs v. Jackson
After having no issues with her pregnancy before her third trimester, Marny Smith and her husband were excited to meet their son Heath in a matter of weeks.1 One evening, before falling asleep, her son wasn’t kicking like usual at that time of day. When the next morning came around, and there was still no movement, Smith knew her baby was gone. She and her husband called her physician, and they were told to go to the hospital immediately.
Smith had to endure the pain and wounds of childbirth, along with the pain of having a stillborn child. In the U.S., there are 21,000 stillbirths2 every year, and approximately 15-20%3 of all pregnancies will result in a miscarriage or stillbirth. If a pregnancy is determined to be a miscarriage,4 the treatment is the exact same as one for an abortion.
After the ruling of Dobbs v. Jackson Women’s Health Organization, physicians in many states are left wondering how to treat miscarriages. An abortion pill can be used earlier on in a pregnancy, but when the pregnancy has gone into its third trimester, dilation and curettage surgery is often necessary.4
Pharmacists have admitted reluctance to fill prescriptions for abortion medications in the case of miscarriages out of fear of being prosecuted,5 and that’s still only if the physician has even prescribed it. Not only are pharmacists and physicians at risk of prosecution for treatment for miscarriages; so are the mothers.
Even before Roe v. Wade was overturned, women who had miscarriages were prosecuted for engaging in risky behavior during pregnancy. One woman in California sat in jail for 15 months while facing murder charges because she took hard drugs during her pregnancy, following years of addiction. Legal analysts warn that women will be prosecuted even in cases of miscarriages and stillbirths.6 And in cases where treatment is received, clinicians are at legal risk, too.
Not only does the legality of treatment for miscarriages and stillbirths leave women and providers in a gray area, but postpartum mental health services for women have also not improved. Medicaid covers 4 in 10 births, but only eight states have explicit programs to provide maternal mental healthcare.7 Maternal mental health is often overlooked, but it is especially important for women who have suffered through a miscarriage or stillbirth to have access to assistance following the loss of a pregnancy.
Most women and physicians report believing that mental health services after losing a pregnancy are important, but most women don’t have access to them. Inability to receive counseling after such a traumatic event often results in women being too afraid to become pregnant again.8 Nearly 20% of women who had a miscarriage became symptomatic of anxiety and depression, and for most of these women, these symptoms lasted for years.8
Women should not lose clinical support when they become pregnant. Because more women are likely to face more arduous miscarriages than before in states with restrictive abortion treatment access, finding ways to assist these women better is essential. Women should not be blamed for miscarriages and prosecuted for it, and physicians should be able to perform routine clinical care for those instances.
Edited by: Elissa Gorman
Graphic Designed by: Alejandra Gonzalez-Acosta
Smith, M. (2022, January). After a death, bringing stillbirth prevention to the US. Health Affairs. Retrieved April 12, 2023, from https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.00745
Centers for Disease Control and Prevention. (2022, September 29). What is stillbirth? Centers for Disease Control and Prevention. Retrieved April 12, 2023, from https://www.cdc.gov/ncbddd/stillbirth/facts.html#:~:text=Stillbirth%20affects%20about%201%20in,stillborn%20in%20the%20United%20States.
Pregnancy loss - New York. Pregnancy Justice. (2022, December 22). Retrieved April 12, 2023, from https://www.pregnancyjusticeus.org/issues/pregnancy-loss/#:~:text=No%20matter%20what%20a%20pregnant,in%20a%20miscarriage%20or%20stillbirth.
Pradhan, R., & Knight, V. (2022, June 28). Five things to know now that the Supreme Court has overturned Roe v. Wade. KFF Health News. Retrieved April 12, 2023, from https://kffhealthnews.org/news/article/five-things-to-know-now-that-the-supreme-court-has-overturned-roe-v-wade/
Reingold, R. B., Gostin, L. O., & Bratcher Goodwin, M. (2022, November). Legal Risks and Ethical Dilemmas for Clinicians in the Aftermath of Dobbs. Jama Network. Retrieved April 12, 2023, from https://jamanetwork.com/journals/jama/fullarticle/2797863
Baldwin III, R. (2022, July 3). Losing a pregnancy could land you in jail in post-Roe America. NPR. Retrieved April 12, 2023, from https://www.npr.org/2022/07/03/1109015302/abortion-prosecuting-pregnancy-loss
Usha Ranji, I. G. (2022, May 19). Medicaid coverage of pregnancy-related services: Findings from a 2021 State Survey - Report. KFF. Retrieved April 12, 2023, from https://www.kff.org/report-section/medicaid-coverage-of-pregnancy-related-services-findings-from-a-2021-state-survey-report/
Nynas, J., Narang, P., Kolikonda, M. K., & Lippmann, S. (2015, January 29). Depression and anxiety following early pregnancy loss: Recommendations for Primary Care Providers. The primary care companion for CNS disorders. Retrieved April 12, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468887/