Abortion restrictions jeopardize the health of women

“Advocating for women before, during and after pregnancy by promoting their reproductive choices.” This is the answer many OBGYN physicians give when asked why they chose OBGYN as their medical specialty. Unfortunately, the priorities of the governor and Republicans in the Iowa Legislature are at odds with the values that physicians practice every day. We strive to care for and advocate for the women of Iowa to maintain autonomy over decisions about their health.

In residency training we learned that most pregnant women have healthy pregnancies with a good outcome. We also learned that not every pregnancy is planned, normal or turns out well. We were taught to recognize maternal warning signs and intervene early to prioritize the mother’s health. Women may have complex heart, lung or kidney disease that makes a pregnancy more complicated or, in severe situations, not recommended at all. Complications can arise in pregnancy, even in the healthiest women, which can threaten their life and health. Examples include “breaking their water” or premature rupture of membranes prior to viability and developing an infection in the uterus or hemorrhage from placenta complications. Abortion is recommended in these scenarios and others to prevent the women from developing complications that could result in organ failure and death if not treated early. Any of the medical or pregnancy scenarios where abortion is recommended are rare, but they happen to women in Iowa every day.

These discussions are difficult for the patient, her support people and the medical team caring for her. Each scenario is unique and nuanced, requiring skill, empathy, and advocacy. Some women will choose to continue complicated pregnancies even though it may threaten their health and life. Other women will choose abortion based on their personal values about their life and health. There is no room for politicians or the government in any of these discussions.

Republicans in Iowa are striving to deny women the right to bodily autonomy in health care decisions, under the guise of compromise and exceptions. Abortion restrictions jeopardize the health of women. After extreme abortion laws were passed in Texas, women at two Texas hospitals who were less than 22 weeks gestation with a medically complicated pregnancy had worse outcomes. Delay of definitive care was associated with a higher risk of developing intrauterine infection, hemorrhage, a need intensive care unit admission, and dilation and curettage procedures.

In Ireland in 2012, a 31- year-old dentist, Dr. Savita Halappanavar, pregnant at 17 weeks, came to the hospital because she was miscarrying with her bag of water coming through her dilated cervix. Since the fetus had cardiac activity, she was told an abortion could not be performed because it was illegal in Ireland. Over the next three days, she developed sepsis and labor, delivering the fetus who had died. She died after delivering her fetus due to multiple organ failure from sepsis because of intrauterine infection. Dr. Halappanavar’s death resulted in the abolishment of restrictive abortion laws in Ireland.

It is not hyperbole to say these terrible maternal outcomes could happen in Iowa if more restrictive abortion legislation becomes law. We should not have to wait until a woman dies to reverse the course in Iowa. Yes, the Republicans will say that legislation will have some exceptions but those will not account for all the scenarios we see beyond six weeks of gestation and will have language meant to intimidate

1 Nambiar A, Patel S. American Journal of Obstetrics & Gynecology, Oct 2022.

https://doi.org/10.1016/j.ajog.

2022.06.060

2 https://www.hse.ie/eng/services/news/nimtreport50278.pdf

3 https://www.nytimes.com/2018/05/27/world/europe/savita-halappanavar-ireland-abortion.html

patients and health care providers. We ask the citizens of Iowa to make their opinions known about abortion availability for the women in our state by contacting their senators and representatives. We want every woman to have a healthy pregnancy and maintain her health in the long term. As physicians we want to be provide every woman with every option so that she can make the best decision for herself, her health, and her pregnancy.

Iowans for Health Liberty: Emily Boevers MD, Andrea Greiner MD, Jami Maxson MD, Jill Meadows MD, Francesca Turner MD.