Pregnancy is risky; adoption not replacement for abortion

The U.S. Supreme Court’s decision to reverse decades of legal precedent by overturning Roe v. Wade — the 1973 ruling asserting constitutional protections for a woman’s right to choose whether to have an abortion — triggered laws in multiple states either outright banning abortions altogether, or severely restricting the ability to access them. In most cases, these laws only allow abortions in cases where the procedure will prevent serious injury or death. Those exceptions aren’t nearly as reassuring as some may believe them to be.

The maternal mortality rate in the United States is abysmal, especially for Black women who die at nearly three times the rate during childbirth as White women, according to the Centers for Disease Control and Prevention. Among developed countries, the U.S. ranks among the worst in terms of maternal mortality, according to The Commonwealth Fund, a private foundation funding research and grants around health care issues and policy. Maternal deaths have been increasing here since 2000, with two-thirds of those deaths reported as preventable, and this is partly attributable to low numbers of midwives and obstetricians/gynecologists, access to postpartum care, an absence of guaranteed paid parental leave, and systemic racism.

Dr. Jenni Villavicencio, a boardcertified obstetrician/gynecologist who serves as the lead for equity transformation at the American College of Obstetricians and Gynecologists, leading their anti-racism, diversity, and equity and inclusion work, took some time to talk about what it looks like, from a medical perspective, to make a life-saving decision during pregnancy; whether adoption is a sufficient alternative to abortion; and the very real risks of patients being forced to carry pregnancies to term without the option of abortion as part of their overall care. (This interview has been edited for length and clarity. For a longer version of this conversation, visit sandiegouniontribune.com/ sdut-lisa-deaderick-staff.html.)

Q:

A number of the trigger laws that are going into effect will only allow abortions in the case that the life of the pregnant person is at risk, but what that means seems unclear. What’s your understanding of how this would work in practice? How do you determine when a pregnant person’s life is at risk to the extent that an abortion could be performed legally? What factors go into making that kind of decision? A:

I can tell you that many people are, in some ways, breathing a sigh of relief with these exceptions. “Oh, well, at least if someone’s life is at risk, the doctor can intervene.” Unfortunately, it’s not nearly as clear-cut as that because these laws are being written by non-scientists, and certainly not experts in medicine. They are not reflective of the way that medicine is actually practiced.

We know that “life-threatening” is certainly a term that is used, and when someone’s life is at risk, that can mean many, many different things along a spectrum. There’s no line that says, “OK, now is the moment that you are dying.” That’s not a clear moment in in time. It is a slow, sometimes fast, fall down a clinical hill. What we are seeing, and what we’re deeply concerned about, is instead of physicians being able to treat someone at the moment that they make a diagnosis and know what the right treatment is, we will have to wait for the person to get sicker and sicker — sick enough for the physician, as well as the hospital, to be willing to risk the consequences of the laws. Sometimes, that means that people will get so far down that road of becoming sick that you may not be able to come back. The reason why a principle in medicine is to “treat as quickly as possible” is because we don’t want people to get that sick. Unfortunately, these medical exceptions are not as clear as people would hope that they are. They really are putting the burden on the physician to be able to decide whether or not they’re willing to face civil, professional or even criminal penalties for doing the best things for our patients. That sort of interference in the patient-physician relationship is cruel and dangerous.

Q:

As many anti-abortion organizations celebrate this ruling, some of their representatives have talked about a focus on caring for pregnant people that highlights adoption as a response to an unintended or unwanted pregnancy. From your perspective, is adoption a sufficient alternative?

A:

Before I answer that, I want to mention that while the way that we’re hearing about this decision is that it’s being portrayed as there are winners who are happy about this and then losers who are not happy about this, what I can tell you is that the reality is that every single American in this country loses and is more at risk because of this decision. I do abortions for everybody: I do abortions for people who are against abortion, I do abortions for people who are pro-abortion, I do abortions for people who don’t know how they feel about abortion. The reason for that is that when a family knows that abortion is the right decision for them, the ideology and the politics go out the window. They know that this is the right medical decision for them to make, so this is not a win-or-lose situation for some people, it’s a lose situation for everyone.

We often hear adoption being offered up as a potential alternative to abortion. As someone who takes care of pregnant people — I deliver babies, I do prenatal care, and I also perform abortion care — what I understand is that adoption is not an alternative to abortion, it is an alternative to parenting. In order to place an infant or a newborn up for adoption, you have to go through what, for many people, is life-threatening pregnancy. It requires 10 months of ongoing and nearly weekly medical care, sometimes physical ailments that mean that you can’t work, and you may not be able to take care of your children as well as you have before. There are plenty of people in this country who are reading this who know exactly what I’m talking about. Pregnancy is not a walk in the park for most people, so adoption certainly may be an option for some who don’t want to parent, but it’s not an alternative for people who do not want to, or cannot, be pregnant.