Invisible Women: a high stakes conflict of interest
The disingenuous politicking over abortion has to stop
Well, GFPs, so much for my “I probably won’t be writing as much in the coming months” post. But then again, stories keep coming up that upset me. Two weeks ago it was the horrifying court case in France about the husband who admitted drugging his wife and inviting scores of men over to rape her while he filmed it. This week it was the first confirmed reports of deaths of women who were, as a result of the 2022 Dobbs decision, unable to receive abortion care in America.
Back when the decision was first handed down, I wrote about it in this newsletter. I wrote angrily, because I was angry. I was angry that politics was interfering with female healthcare. And I was angry because I knew that women would die. As I wrote at the time:
What abortion bans do categorically result in are:
An increase in maternal mortality, both from desperate women -- and let's not forget, children -- who will seek unsafe abortions when there are no legal abortions available, and women who develop complications in their pregnancy but cannot access the healthcare they need because anti-abortion laws mean doctors won't treat them.
This is not alarmism. This is not scare-mongering. These are young women and girls who have died because we refused them treatment. And more will come.
Well, more have come. And never have I been less happy to have been proven right. On the contrary: I am devastated. And I am angrier than ever.
Over the two years since the Dobbs decision we have heard from a steady stream of American women who were denied the healthcare they needed because of this legal ruling. We’ve heard about rape victims having to carry their rapist’s child — including one rape victim who was only thirteen years old when she gave birth despite living in a state where there is theoretically an exception for rape. We’ve heard about women who were forced to carry babies that were never going to survive (a particularly cruel form of psychological torture, as anyone who has ever experienced a pregnancy-gone-wrong can surely understand), even when continuing with the pregnancy was threatening the mother’s own life or her future fertility. We’ve heard about women who were denied or had to delay their cancer treatment because the medication that would save her life would harm the foetus inside her. One woman had her liver transplant cancelled because it transpired she was in the very early stages of an unwanted pregnancy. And many, many more women were left bleeding for days, coming close to death because their miscarriage was incomplete and doctors were too scared to give them the treatment they needed. Many of them now have long-term health complications, as a result — including no longer being able to have children at all. That’s a high price to pay for ensuring no one has an abortion.
A higher price to pay is death, and that is what we now know happened to at least two women in 2022, shortly after Dobbs was passed (the committees that investigate maternal deaths “often operate with a two-year lag behind the cases they examine,” so, much as I hope there won’t be, there are likely still more to come). One of these women, Amber Nicole Thurman, was a 28 year-old medical assistant from Georgia. She is the first case that has been made public.
Thurman became pregnant with twins shortly after the Dobbs decision. She was a single mother and had only recently managed to establish some stability for herself and her six-year old son, moving “out of her family’s home and into a gated apartment complex with a pool.” She was planning to enroll in nursing school.
Unable to get an abortion in state, and her plans to have one out of state having fallen through, Thurman decided to take the abortion pill. Some commentators have blamed this pill for her death but in fact it has an excellent safety record: out of the millions of times these pills have been used in the US, there are only 32 deaths associated with them, most of them involving “intentional and accidental drug overdoses, suicide, homicide and ruptured ectopic pregnancies.”
But since these drugs are to all intents and purposes no different from the action of a miscarriage, sometimes things can go wrong, and the miscarriage can fail to complete — which is what happened to Thurman. After a week of bleeding, she vomited blood and passed out.
In this scenario, a routine procedure called a dilation and curettage is needed, to clear the uterus and prevent a potentially life-threatening infection. But like for so many of the miscarriage patients we’ve read about over the past two years, doctors delayed treating Thurman. By the time they did act it was too late; she died during surgery the day after she presented at hospital. The conclusion of the maternal mortality committee was that her death was preventable and that the delay had a “large” impact on the fatal outcome. In short, had doctors given Thurman the standard of care she would almost certainly still be alive, and her son would not have been left an orphan.
The doctors involved in Thurman’s case have so far declined to comment on their thinking in delaying the care she clearly needed. But it’s not exactly difficult to figure out what happened here: they had a high-stakes conflict of interest. Instead of being focused entirely on the life and health of the patient in front of them, they were also considering their own lives. Their livelihoods. Their freedom: a doctor found to have performed an illegal abortion in Georgia faces up to a decade in prison.
So they wait. They delay. They monitor the patient until her health has deteriorated so precipitously that no one could possibly accuse them of carrying out anything other than a life-saving abortion. And sometimes, they wait too long.
All of this was distressingly predictable. Indeed, it was predicted by experts, doctors and politicians (including, by the way, one prominent anti-abortion Republican politician), who all warned lawmakers that their exceptions were unworkable and women would die.
Anticipating how a woman will respond to a miscarriage gone wrong is not an exact science. Some women are fine; some women are not fine, but their bodies survive the delay (more or less); others, like Thurman, die. We currently simply cannot predict who these women will be. And so the delay represents nothing more than an appalling gamble on a woman’s life; a high-risk bet to which she has not consented and for which, if things go wrong, she will pay the highest price.
And yet despite the very clear and obvious and predictable reasons this happened and will continue to happen unless something changes, the response to this story has been, as
has written in her excellent Atlantic piece on the subject (gift link), as distressingly predictable as the tragedy itself:First comes denial: Before the law in Georgia passed, state lawyers referred to the idea that it would cause deaths as “hyperbolic fear-mongering.” Despite the state commission’s ruling that Thurman’s death was preventable, the Trump campaign has already argued that nothing in Georgia’s law stopped the D&C from happening earlier. “President Trump has always supported exceptions for rape, incest, and the life of the mother, which Georgia’s law provides,” a spokesperson said. “With those exceptions in place, it’s unclear why doctors did not swiftly act to protect Amber Thurman’s life.”
This is as heartless as it is disingenuous. We know very well why doctors no longer “swiftly act” when faced with pregnancy-related health issues, even if they won’t come out and say it. And these lawmakers know very well how to stop this from happening.
They have to trust doctors to know what treatment their patient needs and to stop politically interfering with their medical judgment. They have to stop pretending that the threat of litigation and prison will not cloud that medical judgment, when doctors very clearly tell us that it does. They have to stop putting ideology over women’s lives.
Good faith people can disagree over the rights and wrongs of abortion. I personally believe in abortion on demand because I trust women to make the right decisions for themselves and their family. I trust that women know when having a baby will make it impossible to leave an abusive partner. I trust that women will know when having a baby will risk their own health or when their family simply cannot afford another child; when having another child will harm their already existing children.
But I accept that other people, people I love and respect, feel differently. They believe that life is a gift and should always be protected; they would point to options like adoption in many of the scenarios that I have raised. Given everything we know about the demands even the most straightforward pregnancies and childbirths make on a woman’s body, I don’t believe it’s reasonable to force them on anyone to preserve the life of a baby that does not yet exist (I guess my loyalties lie with the already living rather than the potentially living) — but I accept that there can be good faith differences of opinion here. This is called living in a democracy.
Good faith people cannot, however, disagree on cases like this. And indeed, the evidence suggests that they do not: a growing number of men in red states, including those who have previously been staunchly anti-abortion for religious reasons, have changed their minds once faced with the reality of what these laws mean for women. These are men who, when faced with facts that do not fit their beliefs, do not try to change the facts to suit. These are men of good faith.
But there is no good faith in being warned repeatedly about unworkable laws and choosing to enact them anyway. There is no good faith in then feigning ignorance when those predictable consequences indeed come to pass, nor in wringing your hands in confusion over why yet another doctor waited too long when with your perfect hindsight it is now obvious that this particular abortion was legally defensible.
The price of pregnancy should never be death and it is simply not reasonable to demand that a woman should assume this risk. But this is precisely what these extreme and punitive anti-abortion laws do demand. And the politicians behind them can no longer claim that they didn’t know.
What can I say - it is beyond anger - I am in the UK - so I am spared - but whenever or wherever this assault on women is happening it needs action? What to do on this side of the Atlantic - keep going and keep protesting - and Just hope Trump and Vance are stopped.
Hey Caroline, have you seen the article in The Atlantic about women affected by X-linked disorders like MS and hemophilia?