Roe reversal has many unintended consequences for women and children

“Please refer me.”

Marie was a 35-year-old woman in her first pregnancy. Though it was unexpected, she was thrilled to find out about the pregnancy. Due to her age, she was given early genetic testing and had several early scans, which showed a normally progressing pregnancy.

Unfortunately, her anatomy ultrasound revealed the terrible truth. Her baby had a malformation of the brain (Arnold Chiari malformation) that could be incompatible with life. If the baby survived, he might need specialized care throughout life.

After many counseling sessions, hours of weeping and soul-searching, Marie reached her decision: she asked for a referral to the university system to terminate the pregnancy in the second trimester.

It’s hard to believe that today, five decades after Roe v. Wade changed abortion access, Marie’s choice could be so fraught with danger. It’s hard to fathom that the trauma of making a decision to terminate the pregnancy of a longed-for baby would be compounded by fear of incrimination and penalty by lawmakers.

But of course, this is the situation many women find themselves in on after the Supreme Court decision made its legal ripples felt throughout the country. The decision has endangered women’s health and independence in ways we may not yet have considered.

The diagnosis of Arnold Chiari malformation can lead to either a neonatal or intrauterine death (IUFD). In certain states IUFD in the late second and third trimester can be criminally investigated. The consequences — interrogation, review of private documents and health records, the need for representation — could lead to financial, physical and emotional trauma in women who also have to deal with the death of their baby.

This was the case in 2021 when an Oklahoma woman was charged with manslaughter after she suffered an IUFD due to drug addiction. According to a Kaiser Family Foundation brief, “miscarriages are often conflated with induced abortion in the news and in law, and under fetal harm legislation, women have been charged with crimes related to pregnancy loss in situations such as physical trauma.”

Even if she did not undergo criminal charges, Marie would likely be unable to access medications used to induce labor before spontaneous miscarriage begins. These medications, while also used in elective abortions, are used to avoid infection and hemorrhage that result from a retained IUFD.

We need to destigmatize these medications and lobby for legislation that allows use of these medications in states that would criminalize their use.

Had Marie been given the diagnosis in a state such as Texas she would have been left to raise a disabled child with very few resources. Texas — like many states with stringent pro-life legislation — has minimal early childhood funding, and the foster care system is unsafe and has been under litigation for 11 years. The state of Texas also does not offer maternity benefits.

If Marie’s company does not offer FMLA, she will not be paid to stay home immediately after delivery to care for a newborn with challenging health concerns. It is imperative in a post-Roe world that we improve our foster system and child-care resources, and expand maternity benefits.

The repercussions of the Supreme Court decision can be further extrapolated. As Justice Clarence Thomas wrote, the decision may set a precedent that could be used to outlaw contraception. Already, in Idaho, hearings to ban emergency birth control are under consideration.

Uterine hemorrhage risk

Since its advent, contraception has been synonymous with freedom and independence for women everywhere. Setting aside the concept that we are knowingly endangering the life of a child that cannot be adequately cared for, there is the consideration that uterine hemorrhage — the no. 1 cause of death in new mothers — is linearly related to multiparity, or having other children.

The lives of both mother and child are at risk when an unwanted pregnancy is conceived and brought to term. A woman’s freedom to work and her contributions outside the home — all of this will also be held hostage by her fertility.

In the past, a post-Roe world was the stuff of apocalyptic fantasy, but frighteningly, it has become our new reality. We must check the repercussions of the court’s decision as quickly as we can.

We can do this by destigmatizing lifesaving medications from their association as abortion medications; we must expand maternity benefits; we have to strengthen child care funding; and we must absolutely lobby against the use of this ruling as precedent to affect other issues like access to contraception.

The safety, quality of life, and the freedom of women are ultimately at stake.

An OBGYN for 14 years, Dr. Maya Nambisan of Manteca has practiced there and in Modesto.