New England Journal of Medicine: abortion ban is a health catastrophe

The prestigious magazine raises the alarm: it will be mainly poor and black women who will pay the price of the Supreme Court ruling, driven back into abortion with serious health risks. Even the morning-after pill and even the IUD could be banned and prosecuted as abortifacient means
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The decision of the US Supreme Court in Dobbs v. Jackson Women's Health Organisation represents an extraordinary reversal (...) Yet it was not unexpected. In the long and painful prelude to the decision, many states severely restricted access to reproductive healthcare. The fig leaf covering these restrictions was that induced abortion was a dangerous procedure that required stricter regulation to protect the health of women who sought such assistance. Facts disprove this false rhetoric. 

The latest data available in the United States from the Centers for Disease Control and Prevention and from the National Centre for Health Statistics indicate that the maternal mortality due to legal abortion is 0.41 per 100,000 procedures, compared to the overall maternal mortality rate of 23.8 per 100,000 live births

Experience around the world has shown that limiting access to legal abortion care does not substantially reduce the number of procedures, but it does drastically reduce the number of procedures safe resulting in increased morbidity and mortality. It is likely that millions of women in states without abortion protection also access to drug-induced abortions is also denied. It may be difficult for many Americans in 2022 to fully understand how complicated, stressful and expensive, if not unattainable, their most private and intimate decisions will become now that Roe was hit. 

A recent article in the New York Times recounted the experiences of women, now in their 60s and 70s, who have sought abortions before Roe . They describe humiliating circumstances, dangerous procedures performed literally in back alleys and the deep shame and stigma they suffered. The common complications of illegal procedures included injuries to the reproductive tract requiring surgery, induction of infections resulting in infertility, systemic infections, iorgan failure and death. Now we seem destined to relearn those lessons at the cost of human lives.

Without federal protection, recent state laws restricting or eliminating the right to abortion will deny Americans' reproductive autonomy and create an Orwellian dystopia. Examples are the Oklahoma law enacted on 25 May 2022, which declares that life begins at fertilisation, and the Texas bill, effective 1 September 2021, which authorises third parties to file civil lawsuits and collect damages against persons who aid or abet abortions. Defendants in such lawsuits will bear their own legal costs, while plaintiffs are indemnified against countersuits for filing baseless actions. 

The use of postcoital contraception, hormonal contraceptives or the placement of an intrauterine device (IUD) could be equated with abortion and prosecuted; some jurisdictions (e.g. Mississippi) are already considering such actions. After conception, about 14 days elapse before chorionic gonadotropin reaches detectable levels in the maternal blood. Approximately 30% of recognised pregnancies result in miscarriages. Therefore, in some jurisdictions women may be prosecuted for terminating a pregnancy using postcoital contraception, despite a 98% probability that their actions did not cause an abortion, but there is no way to prove or disprove that they were pregnant (...)

For almost 50 years, Americans have lived under the protection of Roe v. Wade, free to determine their own reproductive destiny. At a time when dozens of other countries around the world are codifying reproductive decision-making protections for their citizens, we are turning back the clock to take these rights away from our citizens. As has been pointed out by others, the most privileged members of US society will always be able to circumvent restrictive laws and find abortion assistance in jurisdictions that allow it. The changes currently proposed in the laws will be more burdensome and unfair for low-income people and people of colour who are less able to overcome the obstacles placed in their paths. These changes inevitably will exacerbate the already vast inequalities in wealth and health.

Abolishing long-standing legal protections, the annulment of Roe v. Wade by the US Supreme Court hurts American families, putting their health, safety, finances and future at risk. In light of these foreseeable consequences, the editors of the New England Journal of Medicine strongly condemn the decision of the US Supreme Court.

translation by Marina Terragni (the full article here).

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