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Patients May Not Receive Miscarriage Care in a Post-Roe America

The vagueness of the laws mean that medical professionals will have to decide whether to terminate a pregnancy—knowing that penalties for calling a case too soon or it not perfectly fitting the risk criteria could range from hefty fines to suspension of their medical license to life in prison. “When you have a broadly worded law, it can have a chilling effect,” says Manian. “This is why we generally don’t have politicians regulate medicine.”

How does a doctor determine the percentage risk of their patient dying to justify ending a pregnancy? Does the patient have to be at risk of dying within the next hour? And does dying have to be the qualifier? What if carrying the pregnancy didn’t meant the patient would die, but they would have severe disabilities as a result?

The future availability of the drugs needed to treat a miscarriage could also be in peril if Roe falls. The medication option—two drugs, misoprostol and mifepristone—is the best and most effective treatment for a miscarriage where the pregnancy hasn’t passed yet, says Harris. But both drugs are also used to induce an abortion. So will doctors give them to patients? Will pharmacies even stock them? “Or will they be too worried that someone will think that they’re doing something illegal?” says Harris. There are already reports of pharmacies in Texas refusing to fill prescriptions for them.

Back in October 2012, Savita Halappanavar, a 31-year-old dentist, died unnecessarily in Ireland because doctors refused to terminate her pregnancy. A decade later, the circumstances that led to her death are poised to become a new reality in the US. Seventeen weeks into her pregnancy, Savita was admitted to a hospital in Galway while experiencing a miscarriage. But as the fetus still had a detectable heartbeat, her doctors refused her a termination. “This is a Catholic country,” they told her. Under the Eighth Amendment of the Constitution of Ireland—which recognizes the equal right to life of a pregnant person and their unborn child—her doctors feared they could be accused of breaking the law. Savita died of septicemia a week later. Another woman, Valentina Milluzzo, died in Italy in 2016 while having a miscarriage after her doctor refused to intervene on religious grounds. We can likely expect to see more cases like Savita’s and Valentina’s in a post-Roe America.

Religious institutions readily provide a template for how miscarriages could be treated in states where abortion is illegal. The Catholic Church, for example, has a sizable influence on the US health care system: One in six acute-care hospital beds are in a Catholic hospital. Out of the 10 largest health systems in the US, four of them are Catholic-owned. Often people don’t even know when they’re in a Catholic hospital: A 2018 survey found that almost 40 percent of its female respondents were not aware their primary hospital had a religious affiliation. Research has also shown that pregnant women of color are more likely than their white counterparts to give birth at a Catholic hospital.

Catholic health care facilities are governed by the Ethical and Religious Directives, a set of rules that dictate that aborting a pregnancy only becomes permissible if fetal heart tones are not present or the pregnant person becomes ill—essentially, the watch-and-wait method. This has meant, as multiple cases brought forward by the American Civil Liberties Union have shown, that people are denied critical care they need at these institutions. “And that right there is really unethical and deeply problematic for medicine. But now what we’re seeing is, I think, part of the United States could follow their example,” says Lori Freedman, a medical sociologist at the University of California, San Francisco, who investigates the ways reproductive health care is shaped by our social structure and medical culture.

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