Mike Wolanin | The Republic People leave Columbus City Hall to march around the downtown area during a Bans off Our Bodies rally in Columbus, Ind., Saturday, May 14, 2022.
DOCTORS and researchers are expressing concern that restricting access to abortion in Indiana and elsewhere could lead to more pregnancy-related deaths, particularly among the most vulnerable who can’t travel out of state to end their pregnancies.
The concerns come as America confronts an uncertain and quickly shifting reality in the wake of the U.S. Supreme Court’s decision to strike down the constitutional right to an abortion, leaving it up to states to decide the extent to which the medical procedures are allowed.
The high court’s decision is expected to lead to a patchwork of abortion laws across the country, with about half of states expected to enact restrictions or outright bans in the coming weeks, including Indiana.
Though abortion is still legal in Indiana up to 20 weeks after fertilization (22 weeks after the last menstrual period), state lawmakers have called a multi-week special session starting July 25 to, among other things, “take action to protect life,” referring to possibly passing legislation that would restrict or ban abortions.
Currently, it’s not clear what kind of restrictions will be discussed in the General Assembly, but the Republican lawmakers who represent Columbus — Rep. Ryan Lauer and Sen. Greg Walker — have said they would be open to considering a total ban on abortions — without exceptions in cases of rape, incest or when the mother is at risk of dying.
Whatever lawmakers decide could dramatically reshape the landscape of reproductive health care in Indiana, including for tens of thousands of people in Bartholomew County.
In 2021, 76 Bartholomew County residents got abortions in Indiana, according to an annual report compiled by the Indiana Department of Health. Over the past decade on record, 834 abortions were performed on Bartholomew County residents.
A total of 8,414 abortions were performed in Indiana last year, up from 7,756 in 2020.
But as lawmakers prepare to consider further restrictions, medical groups and doctors are worried that banning or severely restricting abortions could exacerbate longstanding health inequities in Indiana, lead more women to resort to unsafe abortion procedures and increase pregnancy-related deaths.
The United States already has the highest maternal mortality rate among 11 of the most developed countries, according to data recently released by the Commonwealth Fund, a nonpartisan research group.
“We know that anywhere where abortion is severely restricted, limited or banned altogether, maternal mortality increases,” said Dr. Caitlin Bernard, an obstetrician and gynecologist and assistant professor at the Indiana University School of Medicine. “…We know, particularly in Indiana, we do not have the best health determinants. We have high rates of chronic medical conditions, substance use. Many people have pregnancy conditions that have occurred in other pregnancies that would make a future pregnancy risky.”
“All of these people are going to be at significant risk for health and life-threatening conditions if they were to be forced to continue a pregnancy,” Bernard added.
Similar concerns have been by raised doctors’ groups and medical journals, including the American Medical Association and American Association of Obstetricians and Gynecologists, which considers abortion to be a “safe, essential part of comprehensive health care.”
Two dozen medical groups filed an amicus brief to the Supreme Court in Dobbs v. Jackson Women’s Health Organization, the case that led to the high court striking down the constitutional right to an abortion.
In the brief, the 24 medical groups argue that banning abortion after 15 weeks “is fundamentally at odds with the provision of safe and essential health care, scientific evidence and medical ethics.”
“Reproductive health care is essential to women’s overall health. Access to abortion is an important component of reproductive health care,” the groups state in the brief.
Not all doctors’ groups share these concerns, however. The American Association of Pro-Life Obstetricians and Gynecologists wrote its own amicus brief to the Supreme Court outlining the risks of abortion.
According to the Centers for Disease Control and Prevention, there were 0.41 deaths per 100,000 legal abortions from 2013 to 2018. By comparison, the U.S. maternal mortality rate was 23.8 deaths per 100,000 live births in 2020.
‘Chilling effect’
Medical professionals also worry that potential grey areas and the vague wording of some of the new abortion laws could create confusion among physicians, potentially putting patients’ lives in jeopardy.
“The language about, you can perform an abortion, but only to save the life of the mother — well, how close to death do they have to be?” Bernard said.
“What about treatment of an ectopic pregnancy? What about what we call an inevitable abortion, where somebody is coming with an early-stage miscarriage?” Bernard added. “They’re bleeding. They may have an infection, but there’s still cardiac activity of the fetus on the ultrasound. What am I supposed to do at that point? How far does (the patient) have to get (to death) for me to be able to, within the legal limits, perform an abortion?”
Researchers say abortion bans may have a “chilling effect” on health care providers, as they try to navigate the new landscape and not run afoul of restrictions and face potential criminal prosecution, civil penalties or other sanctions.
A recent study by the Texas Policy Evaluation Project suggests that a Texas law that went into effect in September that bans abortion after cardiac activity is detected in the fetus — usually around six weeks — has led physicians to delay care out of fear of potential legal consequences.
The law authorizes lawsuits against clinics, doctors and anyone who “aids or abets” an abortion that is not permitted by law, but allows for some exceptions in the case of “medical emergencies,” though the law doesn’t define the term, The New York Times reported.
One hospital in Texas has stopped offering treatments for ectopic pregnancies in certain situations, the researchers said. An ectopic pregnancy is when the fertilized egg implants outside the main cavity of the uterus, according to the Mayo Clinic.
In other cases, Texas hospitals had different interpretations of the law and when pregnancy-ending treatments were permitted.
“In multiple cases, the treating clinicians — believing, on the basis of their own or their hospital’s interpretation of the law, that they could not provide early intervention — sent patients home, only to see them return with signs of sepsis,” the authors wrote in the New England Journal of Medicine.
“People have to be on death’s door to qualify for maternal exemptions,” one maternal and fetal medicine specialist told the researchers, referring to a patient in Texas who was not deemed eligible for an abortion until she had been admitted to an intensive care unit.
“When these laws are written, they’re often not consulted with physicians, and the language is such that it makes it quite difficult for doctors to know what is within and what is outside of the law, even when they’re practicing what we would consider to be evidence-based, appropriate, ethical care,” Bernard said.
“I can tell you, right now, all of the OBGYNs in Indiana are reaching out and asking, ‘What does this mean for me? What could I face? How am I supposed to practice in this environment, even for normal, non-abortion care?’” Bernard added.
Local abortion services
Currently, the closest providers to Bartholomew County that performed abortions last year were in Bloomington and Indianapolis, according to the Indiana Department of Health’s annual report.
Columbus Regional Health, for its part, does not perform procedures that officials described as an “elective termination of pregnancy,” meaning there is no emergency medical need to end the pregnancy.
“No CRH physician or midwife or any other clinical support we work with through CRH provides … elective termination of pregnancy,” said CRH spokeswoman Kelsey DeClue.
CRH, however, refers cases of newly diagnosed fetal anomalies to Planned Parenthood or other hospitals in the state, unless there is a medical emergency that puts the mother or fetus at risk, DeClue said.
If state lawmakers were to ban abortions, the closest abortion provider to Bartholomew County would be in Champagne, Illinois — about a 167-mile drive from Columbus.
Currently, abortion is unlikely to be restricted in Democrat-controlled Illinois.
Following the Supreme Court’s decision, Illinois Gov. JB Pritzker called a special legislative session to take “swift action to further enshrine our commitment to reproductive health care rights and protections,” according to a statement from the governor’s office.
However, abortion providers in Illinois are bracing for a surge in demand for abortions from residents of nearby states that have already banned the procedures or are expected to do so in the coming weeks.
A total of 1,878 Indiana residents got abortions in Illinois in 2020, down slightly from 1,949 in 2019 but up from 1,279 in 2015, according to data from the Illinois Department of Public Health.
Past is prologue?
Before the Supreme Court’s 1973 Roe v. Wade decision, which established the constitutional right to an abortion, the procedures were illegal across much of the country, including in Indiana.
Yet illegal abortions were common in the United States — ranging from 200,000 to 1.2 million per year in the 1950s and 1960s — as women still tried to end their pregnancies on their own or look for back-alley procedures that were less safe and sometimes proved fatal, according to the Guttmacher Institute, a research group that supports abortion rights.
In many communities, people were charged with crimes for helping women get abortions — and Bartholomew County was no exception.
In 1961, a 26-year-old Columbus woman died at Bartholomew County Hospital from an infection and hemorrhaging following what authorities believed was an attempted abortion, according to a front-page story in the Sept. 22, 1961, edition of The Republic.
It was 12 years before the Roe v. Wade decision, and abortion was illegal in Indiana. “Criminal abortion” carried a jail sentence of three to 14 years, according to The Republic’s news coverage at the time.
Following the woman’s death, Columbus police interviewed witnesses and authorities charged a 22-year-old Bartholomew County woman with criminal abortion, accusing her performing the abortion that they believed led to the other woman’s death.
Prosecutors also charged the woman with “soliciting an instrument for abortion” for allegedly purchasing a catheter from a local drug store to perform the procedure. That charge carried a possible sentence of 30 days to one year in jail.
The woman appeared in Bartholomew County Circuit Court and pleaded not guilty.
As she awaited trial, the court of public opinion issued its judgment. A local restaurant refused to serve her, and she “received numerous anonymous telephone calls of a threatening nature,” the woman said in court before requesting a change in venue.
The case was moved to Decatur County, but both charges were ultimately dismissed due to “insufficient evidence.”
But as state lawmakers prepare to potentially enact restrictions on abortion that have not been place in nearly 50 years, medical professionals are encouraging people to talk about their experiences with abortion and get involved in the political process.
“The most important thing is to be able to talk to people in your community about abortion, why it may have been personally important in your life, or why it may have been important in someone that you love’s life,” Bernard said. “…This is not a political issue. This is not a religious issue. This is a health issue. Abortion care is health care.”
“Legislating health care, legislating the decisions that you can make about your own personal health, legislating the decisions that are made between a physician and their patient is incredibly dangerous,” she said.
