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Abortion access questions, asked and answered


A few years ago, Erika Parr had an unexpected experience that she will never forget.

ERIKA PARR: I experienced a miscarriage when I was 27, a few months after I married my husband. And nobody expects to lose a pregnancy. And I consider myself fairly, like, educated and, like, body literate.

SHAPIRO: Parr is 30 years old now. She's more than halfway through another pregnancy. And when she heard about the leaked Supreme Court draft opinion that could overturn the right to an abortion in the U.S...

PARR: The news has brought up a lot of personal feelings for me.

SHAPIRO: Parr's religious beliefs as an Orthodox Christian weigh heavily on her feelings about abortion.

PARR: And our church definitely holds, like, strong sanctity-of-life values, and that is something that I personally align myself with.

SHAPIRO: But she lives in Tennessee, one of 13 states that would immediately ban abortion if the Supreme Court overturns Roe. In many cases, the procedures and medications that women need after a miscarriage are the same as those used for abortion. And Parr is thinking a lot about that.

PARR: There are actual, like, life-and-death moments where, like, a matter of hours makes a huge difference in situations in which - I don't know - legal considerations seem like they shouldn't be at the forefront of anyone's mind when they're making decisions about their own health care.

SHAPIRO: Her feelings are prompting questions. So she wrote to NPR, as did a lot of you who asked us about what will happen if the justices overturn Roe vs. Wade. You sent us so many good questions that we're going to answer them in a couple of segments. Today, we'll focus on health policy and medicine.

Our experts with the answers are NPR health policy correspondent Selena Simmons-Duffin and Dr. Kristyn Brandi, an OB-GYN and family planning doctor who's also the board chair for Physicians for Reproductive Health. Good to have you both here.


KRISTYN BRANDI: Glad to be here.

SHAPIRO: And before we start, I do want to let listeners know that we are going to have a frank discussion about some difficult topics that might not be appropriate for all listeners.

So to begin, if the Supreme Court lets states make decisions about abortion rights access, the rules are going to vary from one place to another. And some states have passed laws that prohibit abortion except in cases where the life of the mother is threatened. Keston Smith in Indiana wanted to know more about that standard. Here's his question.

KESTON SMITH: What medical conditions definitely threaten the life of the mother and medically would require a procedure that threatens the life of the mother or child?

SHAPIRO: It seems like that question of whether somebody will die from a pregnancy is rarely black and white. So, Selena, how will this be determined?

SIMMONS-DUFFIN: Yeah, you're right. I mean, the exemptions written into these laws often talk about medical emergencies, so not just a chance that, you know, if your condition that could turn into a life-threatening condition does so, you're going to be in trouble, but, like, there's something happening right now and you need emergency treatment. And that treatment might involve ending a pregnancy.

SHAPIRO: That seems like a much higher standard than you are likely to die from this.

SIMMONS-DUFFIN: Yeah, and I should say that CDC tracks pregnancy deaths, and there are about 700 a year. A third of them are from heart disease and stroke. But really what these laws, I think, are trying to carve out is the really most urgent medical emergency. And the physicians that I've talked to really talk about when water breaks way too early in pregnancy.

And there's actually a famous case of when this happened. Dr. Savita Halappanavar - she was a dentist in Ireland. Seventeen weeks into her pregnancy - this was 10 years ago - she ended up not being able to have an abortion even though her pregnancy was not going to continue. She got an infection and died. And that case spurred the country of Ireland to change their abortion laws. And I should say, NPR has reported of similar cases that are happening now in Texas, which has a six-week abortion restriction in place right now.

SHAPIRO: OK. Our next question comes from an obstetrician in Cleveland, Ohio. That's a state where lawmakers are considering several bills to restrict abortion, including a trigger law should Roe fall. Here's what Dr. Emily Hamburg-Shields wants to know.

EMILY HAMBURG-SHIELDS: In states that post-Roe do not allow for termination of pregnancy for lethal fetal anomalies, what are the implications for parents of fetuses and newborns who have issues that are not compatible with life?

SHAPIRO: Lethal fetal anomalies - so, Dr. Kristyn Brandi, to put this in very stark terms, under some of these state laws, could people be compelled to carry a pregnancy to term even if it is clear that the fetus will not survive outside of the womb?

BRANDI: Unfortunately, the answer to that could be yes. When I have a patient that is facing that outcome, I want to talk to them about their options and make sure that they can decide if and when and how to end that pregnancy. According to these abortion bans, there's not a lot of language that allows for abortion in the cases of lethal fetal anomalies. People that are in states where abortion is restricted likely will have to continue those pregnancies to term. And they would deliver how they normally would deliver, either by a natural birth, potentially even a C-section. And they likely wouldn't be able to have the palliative care system support them in an outcome that would help them, you know, grieve the potential loss of this child. So it's really depressing to think about how devastating that diagnosis is to patients and how they won't be able to choose what happens to that pregnancy afterward.

SHAPIRO: All right. Erika Parr, who we heard from at the beginning of this segment, had this question as well.

PARR: How will treatment for miscarriage be impacted? What conversations should I be having now with my OB? And will women have to prove that their miscarriages are accidents?

SHAPIRO: Selena, do you know the answer to that question?

SIMMONS-DUFFIN: Yeah, I think that the answer is definitely miscarriage care is going to be impacted. It already is happening in Texas. And the reason is that a lot of times people think about miscarriage as something that's spontaneous, that somebody has no control over. And that can be true, but it can also be something that people have to make decisions about. And the standard of care for treating a miscarriage is the same as the standard of care for providing an abortion. And the way that that can play out is if somebody has a miscarriage and they need to take medication to empty the uterus so that, you know, they're not at risk of infection, that same medication is what's used for medication abortion. And we're hearing a lot of reports of pharmacists in Texas not filling those prescriptions for people who are suffering miscarriages.

And, you know, so I think that the other question that she had about having to prove it, no; in the laws, there's nothing that says if there's a miscarriage, somebody has to prove it. But there are reports that a woman wrote a thread on Twitter about how she had a miscarriage recently in Texas and was grilled by her doctor about what medications she might have taken or how she might have caused that miscarriage to happen.

SHAPIRO: We got a question from a listener who asked us not to use his name because he works for a large hospital system in the South, and he is in one of the states with a trigger law that would outlaw most abortions after a Supreme Court ruling that overturned Roe. So he wants to know, are hospitals ready for this change? Many rural areas in Southern states that did not expand Medicaid lost hospitals. Are there enough beds for labor and delivery, NICU beds? Will we see rising medical care and insurance costs because of the rise of charity care for maternity services? Dr. Brandi, what impact will this have on hospitals?

BRANDI: I think that's a really important question. I honestly am concerned about whether the health care system is ready to face the increasing number of patients that will be coming to our doors, that we're going to need labor and delivery care because they weren't able to access abortion care. Rural areas, even before COVID, were facing lots of closures of hospitals and particularly labor and delivery wards. People are already travelling long distances to get all types of care. And women's health providers were leaving those areas. Imagine now when we double or triple the number of deliveries that are happening in those communities.

SHAPIRO: OK. Elaine Foe from Greeley, Colo., has this question about in-vitro fertilization, or IVF.

ELAINE FOE: How will IVF be affected if abortion is banned? Will IVF be banned?

SHAPIRO: Selena, what impact could laws banning abortion have on IVF?

SIMMONS-DUFFIN: Well, there is the question of definitions. So some of the laws that are passing now have definitions of words that are different from how these things are understood in medicine. So as an example, the Texas abortion ban declares that pregnancy begins with fertilization - so when a sperm and egg meet. In medicine, pregnancy is defined as beginning after that fertilized egg divides and grows and implants into the uterus. So that's one definition that kind of raises some questions for IVF.

Another thing is that in a lot of laws, there's this line, quote, "an unborn child means a human fetus or embryo in any stage of gestation from fertilization until birth." So by that definition, if you have unused embryos that were created for IVF, that's an unborn child. But how this is going to play out is kind of up in the air, according to Liz Sepper, who is a professor of law at the University of Texas in Austin.

LIZ SEPPER: It's a fundamentalist movement that takes some of Catholic theology and combines it with some of the evangelical Christian tradition and politics. And conservative Catholics are opposed to fertility treatments, to IVF. But that has not been a target for evangelical Christians who are supportive of IVF in order to procreate.

SIMMONS-DUFFIN: She said that it's hard to predict the consequences because it seems like the anti-abortion movement itself isn't united on this point.

SHAPIRO: OK, one more question. This one is from Meagen Voss of Carrboro, N.C. Carolina.

MEAGEN VOSS: You know, we talk a lot about women's birth control, but what about the men? What birth control options are there for men, and how can they help us?

SHAPIRO: Dr. Brandi, she says surely there have been innovations. Have there been?

BRANDI: I really wish that I had better news to share about the new innovations in male birth control. Unfortunately, there hasn't been a lot of drive for men to use birth control. As far as current things that are in the works, there are several clinical trials investigating different types of birth control for men, things like pills to injections to other types of procedures. Unfortunately, it's going to take a while for those options to be available on the market, probably several years. And so right now, vasectomy and condoms are the options that are available to men that want to help prevent pregnancy in their couple.

SHAPIRO: Dr. Kristyn Brandi is board chair for Physicians for Reproductive Health and NPR health policy correspondent Selena Simmons-Duffin. Thank you both for helping us talk through these listener questions.


BRANDI: Thanks for having us. Transcript provided by NPR, Copyright NPR.

Selena Simmons-Duffin reports on health policy for NPR.
Jonaki Mehta is a producer for All Things Considered. Before ATC, she worked at Neon Hum Media where she produced a documentary series and talk show. Prior to that, Mehta was a producer at Member station KPCC and director/associate producer at Marketplace Morning Report, where she helped shape the morning's business news.
Ashley Brown is a senior editor for All Things Considered.