“It’s just really unimaginable to be in a position of having to think: How close to death am I before somebody is going to take action and help me…To them my life was not in danger enough,” Elizabeth Weller said while describing what she went through when her desired pregnancy became a medical nightmare. When I read this story over the summer, I could not imagine that in just four months I would be listening to a similar one, but this time my sister Catharine would tell it.
The post-Roe v. Wade world can be equally dangerous for pregnant people with wanted and unwanted pregnancies. We were very excited when Catharine revealed her long-awaited and carefully planned pregnancy. This joy quickly faded when Catharine’s water suddenly broke at 18 weeks of pregnancy, and we faced the hostile entanglement of emergency pregnancy termination. The Emergency Medical Treatment and Labor Act (EMTALA) mandates health care provisions in the event of a “medical emergency.”
However, even after a clarification that Centers for Medicare & Medicaid Services issued in July specifically regarding pregnant patients, the EMTALA does not clearly define when an “emergency” is urgent enough for clinicians to terminate a pregnancy without fear of prosecution. This often results in expectant management treatment (EMT) or, in other words, watchful waiting for the case to become critical.
In Catharine’s case, the available “treatment” was to wait for the complications to worsen to the point where her own life was in danger, such as sepsis. This strategy leads to a range of mental and physical health consequences for people like Elizabeth Weller and my sister. It is time for the federal government to reform the EMTALA to provide a comprehensive definition and specific criteria for medical emergencies involving pregnant patients.
According to a recent study, the risk of serious complications in pregnant people who had an abortion through EMT was almost twice as high compared to those who were able to immediately terminate the pregnancy; 57% vs. 33% experienced complications. Hemorrhages, chorioamnionitis, unplanned hysterectomies and intensive care unit admissions were largely more prevalent in the EMT group. Stress and fear caused by physical complications trigger subsequent mental health issues.
For Catharine, it was the pain and fear from anticipating either the death of the fetus in the womb or her own health in a critical state. The evidence clearly shows such traumatic experiences double the risk of anxiety disorders and increase the incidence of depression and post-traumatic stress disorder.
People who received EMT abortions face higher stigma and shame from fighting for the termination of the wanted pregnancy. Furthermore, states that ban abortions also limit access to after-abortion counseling, making people in need of mental health support hesitant to reach out for it. Texas, for example, allows suing anyone who assists a patient in receiving abortion care, whether it be driving a pregnant person to a clinic or providing health services.
The pro-life movement asserts elevated risks of mental illness associated with abortions. Such arguments break down when considering long-term effects and pre-existing risk factors. On the other hand, unmanaged depression and post-traumatic stress disorder following the delayed abortion show significant negative effects on family climate and the ability to parent other children, not to mention the reluctance of getting pregnant again. Unfortunately, I see evidence of these effects not only in the scientific literature but also in my own family.
In addition to the fallacy of the pro-life side’s argument that banning abortions should improve the mental health of the population, the harms caused by this ill-informed position are compounded by the disregard for pregnant people whose lives are at risk after a desired pregnancy. With the Supreme Court no longer guaranteeing the right to abortion, it’s time for the federal government to step up and ensure that pregnant patients at risk are provided with the standard of care they deserve and that clinicians who follow appropriate medical practices are fully protected from prosecution.
Anna Shchetinina is a 2021 University of Minnesota alumnus and is currently working on her PhD in public health at Harvard University.
