The Choice To Be A Mom

Illustration of a woman in a hospital bed. A recent report found that women living in a state that b...

How Women In States That Ban Abortion Are Re-Thinking Their Baby Plans

“What if something goes wrong?”

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I never planned on wanting another baby. I didn’t anticipate that one early June morning, as I watched my two young children digging in the sandbox, I’d suddenly imagine a third entering the frame — a mental addition that began to happen all the time. I didn’t foresee the early fall morning I rocked my friend’s newborn in my arms and ached for another of my own. I especially didn’t imagine that I would get pregnant again but it would end in a miscarriage that just made me want another baby even more.

But I’m not going to have that baby. At least, not right now, not in Tennessee.

For me, it’s not worth the increased anxiety of being pregnant in a post-Dobbs world, especially in a state with one of the strictest abortion bans in the country. A year ago, on June 24, 2022, the Supreme Court decided the Dobbs v. Jackson Women's Health Organization case, overturning Roe v. Wade and our constitutional right to an abortion. When Tenneese’s trigger law went into effect that August, I knew that I wasn’t willing to take on the risk of pregnancy in my home state. At the time, the law had no exceptions for incest, rape, or the life of a woman, though, on paper, it gave physicians who could be prosecuted for performing abortions the ability to claim an “affirmative defense,” meaning they could argue that they performed the abortion to save the woman’s life or “prevent serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman.”

My family and medical history taught me how dangerous any pregnancy can be — even ones that seem perfectly healthy. In second grade, I watched my mom endure the trauma of carrying a fetus with severe genetic abnormalities that threatened her health. At 20 weeks pregnant, she had to travel from Tennessee to Boston to get the life-saving abortion she needed. During my first pregnancy, I had postpartum preeclampsia, which puts me at greater risk for the same condition during subsequent pregnancies. I’ve already witnessed and experienced some of the (many) potentially deadly complications of pregnancy, and I’m afraid of dying of a treatable complication because doctors can’t or won’t treat me. I’m afraid of how close to death I’d have to be to get life-saving help in Tennessee.

The University of Washington’s Department Obstetrics and Gynecology has issued a travel warning for patients who may leave the state during their pregnancy.

In the year since Roe was overturned, this fear has only grown. A year’s worth of data and horrifying news stories have proven that abortion bans are creating a healthcare crisis in this country, making pregnancy more dangerous. I know I’m not overreacting or alone in my fears. I spoke to women like me who live in states with abortion bans and want to become mothers or expand their families. Here’s what it feels like to be one of us: to want a baby in post-Roe world.

“What do I do if something goes wrong?”

Laurel, a 31-year-old woman in Missouri, got married last year and is ready to start a family, but she’s nervous. “I always thought my biggest worry would be what if I can’t get pregnant?, not what if I can and what do I do if something goes wrong?

Before starting to try, she and her husband sat down and worked out a plan outlining what they’ll do if she needs emergency care during her pregnancy. If there’s time, they’ll cross state lines and drive into Illinois, which is less than an hour away. But Laurel knows in a true emergency, that may not be an option. And she’s scared.

Laurel’s fears are legitimate. A recent report by the Gender Equity Policy Institute (GEPI) found that women living in a state that banned abortion after Dobbs were up to three times more likely to die during pregnancy, childbirth, or soon after giving birth. This statistic is especially alarming given that the United States already has one of the highest maternal mortality rates in the developed world — a rate that almost tripled over the last 30 years and increased dramatically during the pandemic (it was 89% higher in 2021 than it was in 2018). The statistics are even more dire for women of color, especially Black women who are almost three times as likely as white women to die in pregnancy. Risks are also higher for Hispanic and Indigenous women.

“Pregnancy is not a net-neutral event in this country,” says Dr. Stephanie Gustin, M.D., the medical director for the Heartland Center for Reproductive Medicine in Nebraska.

Consider that 44 million women and girls now live in states with abortion bans, where pregnancy has become even more dangerous. “[T]here are many reports emerging of doctors feeling like they can’t give the care patients need and deserve without breaking the law,” a GEPI spokesperson tells Romper.

Nationally, 1 in 5 office-based OB-GYNs (20%) say they have felt constraints on their ability to provide care for miscarriages and other pregnancy-related medical emergencies since the Dobbs decision, nonpartisan health research and news organization KFF discovered when it surveyed hundreds of OB-GYNs around the country this spring. The survey, released this week, found that in states where abortion is banned, this share rises to 4 in 10 OB-GYNs (40%). More than two-thirds of OB-GYNs nationwide say that the ruling has “exacerbated pregnancy-related mortality.”

There are now “two Americas” for women, girls, and gender diverse people who can become pregnant, says GEPI’s spokesperson. In the America that bans or restricts abortion (20 states as of today), a Texas woman lays in a hospital bed carrying a fetus that isn’t viable, waiting for her health to decline to the point where an abortion can be deemed medically necessary. That same woman survives sepsis only to be told that her uterus is now so scarred from the infection that she may never be able to carry another child. In this America, a woman is forced to drive 18 hours to receive treatment for an ectopic pregnancy. An Ohio woman must cross state lines in order for a doctor to remove the nonviable fetus endangering her life — because her own doctor can’t help her without breaking the law. Over the past year, there have been too many stories like these.

It is critically important for people to be aware that reproductive care is an umbrella. For people that are not in support of abortion but are in support of fertility care, these bills compromise all of that care.

“Abortion bans create a chilling effect on standard medical treatments. Doctors are afraid to offer the level of safety for obstetric complications that they used to, for fear of being accused of doing something illegal,” says Lori Freedman, Ph.D., an associate professor at the University of California, San Francisco, who works with the research group Advancing New Studies in Reproductive Health (ANSIRH) in the Department of Obstetrics, Gynecology & Reproductive Sciences.

For this reason, the University of Washington’s Department of Obstetrics and Gynecology has issued a travel warning for patients who may leave the state during their pregnancy: “In the states that are now limiting abortions, it is unclear to what extent necessary medical treatment for pregnancy-related emergencies will be permitted. You should not assume that a state’s limitations on abortion services will contain an exception for your particular circumstances.”

Abortion bans are also affecting care for women who experience pregnancy complications in states with less strict bans. For example, in a state like Nebraska that currently has a 12-week abortion ban (just signed into law May 22), women are being refused medications to manage their miscarriages. Gustin says that when her patients experience ectopic pregnancies, they can no longer pick up methotrexate — the medication they need — from the pharmacy because it’s become “too political” to fill it. Instead, her patients must go to an infusion center — a place where people usually receive chemotherapy— or to the ER.

“I do think it’s important for people to realize [abortion bans] will affect all people of reproductive age,” says Gustin.

The impact is so great that, in April of this year, 196 organizations and experts, including Global Justice Center, Amnesty International, and Human Rights Watch, sent a letter to the United Nations calling for intervention, claiming the United States is in violation of its obligations under international human rights law. The letter explains the consequences of Dobbs “are even worse than feared. Women and girls in need of reproductive health care are being met with systematic refusals, huge financial burdens, stigma, fear of violence, and threats of criminalization.”

“Do I have to sit there and bleed enough?”

Elizabeth, a 33-year-old attorney in Nashville, is at least a year away from trying to conceive, but she has already bookmarked the closest out-of-state clinics on her phone, places she could go in an emergency. She knows she will need a backup plan and is grateful she is in a financial position to travel out of state if necessary. But she doesn’t want to have to. “Do I have to sit there and bleed enough [to receive care] and what is that line? Will you truly be sitting in a hospital room or sent home [to bleed] in your bathroom, waiting until you can say, ‘Hey husband, I think it’s time. My life is threatened. Take me back.’”

There are countless stories already of women experiencing scenarios like this, women who are filling diapers with blood, bleeding for days. The potential risks and lack of control terrifies Elizabeth. She believes this dangerous waiting game is just to “appease lawmakers” who have no regard for the lives of women. Fifteen women who experienced life-threatening complications in Texas agree and are currently suing the state because of the harm they suffered under the abortion ban.

Elizabeth is also worried that women’s healthcare in Tennessee will continue to decline as doctors leave the state. “I’ve talked to a lot of doctors here, and they are having a hard time getting qualified doctors [to move] here because they don’t want to come. Morale is low and people are trying to relocate.”

Indeed, nurses and doctors are leaving states with abortion bans, many of them quitting the profession all together. In a country where 36% of counties nationwide are already “maternity care deserts,” this exodus is dire. A March of Dimes 2022 report found that 6.9 million women of childbearing age — concentrated in the Midwest and South — have no obstetric hospitals or birth centers and no obstetric providers. As physicians leave states with strict abortion bans, these deserts will only expand.

In Idaho, the state with arguably the strictest abortion ban in the country, this is already happening. Two hospitals recently ended their delivery services. One of those hospitals, Bonner General Health, cited abortion bans as a major contributing factor in that decision. “Highly respected, talented physicians are leaving,” states the hospital’s news release. “Recruiting replacements will be extraordinarily difficult. In addition, the Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care. Consequences for Idaho physicians providing the standard of care may include civil litigation and criminal prosecution, leading to jail time or fines.”

Under these conditions, the nationwide shortage of OB-GYNs is expected to worsen as medical students choose not to pursue that specialty or avoid practicing in places with abortion bans.

“I don’t want to be a guinea pig under these new rules and procedures.”

As a Black woman, Amy, 30, was already concerned about the quality of health care she’d receive in Nashville. Care disparities coupled with the new law mean pregnancy is an even scarier risk to take on, and she and her husband are debating if it’s worth moving to a state without abortion bans before starting a family. Amy is not only afraid for her life; she’s concerned about the financial security of her husband and future child if she dies during childbirth — she earns the bulk of the household income.

These fears have delayed their timeline. “I didn’t want to be a guinea pig under these new rules and procedures, so I’m waiting and watching,” she says.

“It feels really cruel because I’ve had to fight so hard to have another kid.”

Shannon Perri, a 34-year-old mom in Austin, Texas, easily got pregnant with her son, now 3 years old, but then struggled with secondary infertility. Last summer, she wrote about why Texas’ new abortion ban made the choice to do another round of IVF difficult. Then, this winter, she decided to try again because she really wanted her son to have a sibling and feared that in the future, abortion laws may imperil her access to IVF or that doctors might not be willing to perform the procedure. “It feels really cruel because I’ve had to fight so hard to have another kid, but I’m also terrified to be pregnant.”

The potential impact of abortion laws on fertility treatments like IVF is murky, but the biggest issue arises from the fact that most abortion bans define life as beginning at fertilization. Eventually, this could affect everything from the number of eggs women are allowed to fertilize during a cycle to what can legally happen to any unused embryos. There are also potential legal risks to doctors or lab technicians who oversee failed incubations, say, or who discard nonviable or unused embryos. Recently, three states (Kansas, Arkansas, and West Virginia) introduced bills that criminalize the destruction of a fertilized embryo.

Despite this, Gustin feels it’s important to not “fearmonger” right now. “While I know people are worried about the ability to utilize IVF, there isn’t a single state where it is compromising fertility care at the moment,” she says. However, she adds, “it is critically important for people to be aware that reproductive care is an umbrella. For people that are not in support of abortion but are in support of fertility care, these bills compromise all of that care.”

“Where do I have to travel? Will that doctor know my history?”

Kim, a 28-year-old mom in Memphis, gave birth to her first child in September and is feeling overwhelmed at the thought of a future pregnancy, even though she very much wants another baby. Since the birth of her son, she has struggled with both perinatal depression and perinatal anxiety. Kim has been seeing a therapist since she first found out she was pregnant and is worried about the added emotional stress that the abortion ban is creating. She doesn’t want to be forced to carry a nonviable fetus or have to travel out of state to abort it.

She imagines how stressful it would be to hear her doctor give her a recommendation but say that they can’t help her medically. “Where do I have to travel? Will that doctor know my history? Will that doctor have empathy?”

There is a common misconception that having an abortion negatively impacts a woman’s mental health, says Dr. Stephanie Collier, M.D., MPH, an instructor in psychiatry at Harvard Medical School. But studies show that it’s women who are denied an abortion who have higher levels of distress and more anxiety in the months that follow than women who are not denied access to health care.

“What happens if a condom breaks?”

Tonia, a 30-year-old woman in Texas, knows that she wants to have children one day, but not now. She is currently single, and it has always been her plan to get married before she has a child. Tonia knows, however, that pregnancy isn’t always a choice. “What happens if a condom breaks or a crazy man attacks me or does something to me that I’m not ready to do?” She’s afraid that, especially as a woman of color, she won’t be able to access an abortion even if she is able to travel out of state.

Even though Tonia doesn’t want to have a baby now, it’s something she feels that she’s already preparing for. “I’m always thinking about exercising or stretching or eating good food because if I do get pregnant, I don’t want to have a bad birth experience.”

This knowledge creates both short and long-term anxieties — the immediate fear of needing an abortion and being unable to access one and the future fear of dying during a wanted pregnancy. Tonia often turns to her friends for emotional support because most of them are women of color and share these same feelings. “I don’t know when I will [get pregnant], but I just have to be really smart now about getting there.”

“I would be terrified to have my daughters try to carry a pregnancy here.”

In April, Lauren Necochea, a state representative in Idaho and mom of two girls, gave an impassioned floor speech in opposition of Idaho’s most recent abortion legislation, a law that makes it a felony to help a minor obtain a surgical or medication abortion without their parents’ consent. “I can’t encourage my two daughters to settle in Idaho with the laws we have on the books,” Necochea said on the floor. “I would be terrified to have my daughters try to carry a pregnancy here. This is not a safe place to be pregnant. I think this statute is tearing families apart and is pushing out OB-GYNs out of state. And this bill does nothing to change that.”

Necochea’s speech struck a nerve with women in her districts. “Since I made those remarks on the House floor, I’ve heard from women who are facing those same decisions in their families because they have a young daughter who is at childbearing age and are worried about the safety of staying in Idaho,” Necochea tells Romper.

Despite her pleas, Republican legislators passed the “abortion trafficking” bill and the Idaho governor signed it into law on April 23.

“Delaying the decision to have a baby would be legislators controlling my body in a different way.”

Blair, another Tennessee resident, is about to turn 32. She wants to have kids before she turns 35, and feels like she can’t delay trying to conceive — she doesn’t have the option of letting the abortion bans impact her family planning timeline. Blair worries delaying pregnancy may be riskier than being pregnant under the new abortion bans. Ultimately, she believes if she decided not to have a family because of the abortion laws, that would be lawmakers controlling her body in a different way. But she still wishes that she could plan for a baby without the added anxiety. “There’s already a lot of scary things that go along with pregnancy, and I’d like to not have to worry about dying.”

Most Americans don’t think we should have to live like this. A February Gallup poll shows that 69% of Americans are dissatisfied with abortion laws and 46% want fewer abortion restrictions. Last week, another Gallup poll found continued support for abortion rights post-Dobbs, with 69% of Americans — a record-high — now saying that abortion should generally be legal in the first trimester. Women are increasingly more likely to identify as pro-choice than men.

In April, Tennessee passed narrow exemptions that allow for the termination of molar and ectopic pregnancies, but there still aren’t exceptions for rape or incest. Instead of an “affirmative defense,” a doctor can now act with “reasonable medical” judgment. However, many argue that these exemptions are not enough. Bills like this one — which legislate between (some) medically indicated procedures and criminalized acts — imply that abortion is healthcare without doing enough to ensure that women and doctors are protected.

The debate surrounding Tennessee’s new bill highlights the growing divide between reproductive advocates. Some are fighting for legislative reforms they believe will save women’s lives now and others are unwilling to support such legislation because abortion exemptions rarely work in practice and create a “false hierarchy” of who is deserving of care.

The reality is that because of the Dobbs decision — and Republican-controlled state legislatures on a mission to enact the most draconian laws possible — it is increasingly dangerous to be pregnant in our country.

Personally, I can’t rationalize my desire to have another baby with my commitment to being alive and healthy to support my two children as they grow up. So, instead of going to my OB’s office for a visit to discuss getting pregnant again, I went to get an IUD inserted. I’m choosing to let the image of a third baby fade out of the frame.

Experts:

Dr. Stephanie Gustin, M.D., the medical director for the Heartland Center for Reproductive Medicine in Nebraska

Lori Freedman, Ph.D., an associate professor at the University of California, San Francisco

Dr. Stephanie Collier, M.D., MPH, an instructor in psychiatry at Harvard Medical School

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