REVERSAL OF ROE CREATES TRAVEL QUANDARY
Some pregnant women, fearing inadequate care, rethink visiting red states
Kristina had been looking forward to her business trip. She was planning to hold a leadership development workshop for a client, a highlight of her work.
But a couple of weeks before the scheduled meeting, the 33-year-old Brookline resident canceled, because she was 19 weeks pregnant — and the event was in Dallas. She feared that abortion restrictions in Texas would prevent her from getting the care she needed should an emergency occur.
“If I travel there and I require lifesaving medical intervention, I don’t know if I can receive that,” said Kristina, who asked to withhold her last name because she doesn’t want her clients to know she’s pregnant.
Massachusetts provides some of the strongest protections for abortion rights of any state — but that shield falls when people venture beyond the state’s borders. As other states introduce ever-stricter abortion bans, pregnant residents in Massachusetts have reason to fear health consequences if they travel and have a miscarriage in a restrictive state. Suddenly, planning a trip within one’s own country requires research into local law. For some, like Kristina, it seems safest to stay home.
Since the Supreme Court last year toppled the constitutional right to abortion, 13 states have banned abortion altogether, with very limited exceptions, and 15 other states have restricted access to medication abortion, with measures such as requiring a physician to prescribe it and requiring in-person visits.
The same drugs and procedures used in abortion are also often used to care for miscarriages, which occur in 10 percent to 20 percent of known pregnancies. As a result,
physicians in states with strict abortion limits fear prosecution for providing miscarriage care. Several cases have been reported about doctors in red states letting women endure potentially dangerous complications rather than taking steps to end a pregnancy that is no longer viable.
Stephanie Donohue-Ganesh, a 38-year-old library director who lives in Auburndale, realized she needed to research the laws in her destination before a trip in March when she was in the early stages of pregnancy. “It was a truly surreal experience,” Donohue-Ganesh said.
It turns out the place she was thinking of visiting, Puerto Rico, allows abortion up to 22 weeks gestation. Still, she ended up staying home after she started experiencing a miscarriage a couple of days before her planned departure.
Donohue-Ganesh said she enjoyed “humane options” in Massachusetts, but knows “in other places people in the exact same circumstances had no options.”
“It’s very sad,” she added. “It was really hard to see everything going on in the country and to know I had what felt like a privilege, and it shouldn’t feel like that.”
Alexis Bernstein, a 40-yearold Needham resident, found out what could go wrong when she visited her in-laws in Houston in December while nine weeks pregnant. She started bleeding when she arrived, a sign of a possible miscarriage. A visit to a local obstetrician brought news so devastating that the medical team had to leave the couple alone for a while to process it: There was no heartbeat. After discussing the options with the doctor, Bernstein chose medication to expel the fetus.
But not until she returned from the pharmacy did Bernstein realize she wasn’t getting the best treatment available.
The prescription from the doctor in Texas included only one drug, misoprostol. Patients are supposed to take mifepristone first, followed by misoprostol, but Texas law bans prescribing mifepristone to women more than seven weeks pregnant.
Misoprostol alone is not as effective as the combination, and for Bernstein it didn’t work. She ended up bleeding for weeks before she underwent a surgical procedure after her return to Massachusetts. The experience compounded her trauma, reminding her daily of the loss of her baby. “What had been so easy — just a plane flight — meant me going from having access to the full spectrum of reproductive care to having limited options,” she wrote in a recent essay for the Globe.
Dr. Luu D. Ireland, an obstetrician-gynecologist at UMass Memorial Medical Center, said she’s cautioned her pregnant patients about travel to certain states, although none so far has changed plans.
“When I am counseling patients about the risk of travel … I counsel on the usual things — how to prevent a blood clot, how to protect yourself from COVID,” Ireland said. “Now there are new items on the agenda — what states they’re going to.”
Since the Supreme Court overturned the constitutional protection for abortion rights, leaving the decision to states, “the biggest thing that has changed is the number of times patients bring up the political climate,” said Dr. Erika Werner, chair of obstetrics and gynecology at Tufts Medical Center, “and talk about how appreciative they are to live where they live and be offered the services that we offer.”
In 15 years of practice, in which she discussed with patients whether to continue or end a pregnancy, she never, until recently, had patients thank her for that conversation. “Patients go out of their way to say, ‘I’m so grateful you are able to talk me through my choices,’” she said.
Lindsay Bouton, a 36-yearold West Roxbury resident, was thrilled when a test showed she was pregnant in March. That happened the day before flying to Austin, Texas, to visit relatives. She didn’t cancel her trip, knowing that the likelihood was low that something dire would happen during a four-day stay.
But her visit, she said, was shadowed by “a nagging concern in the back of my mind.”
“It’s easy to be complacent living in a place like Massachusetts, where we can feel a little more confident in our health care system and our abortion rights,” Bouton said. “But it’s easy to forget that we go to other places, and people we love live in other places. …These restrictions do hit close to home.”