Photograph: Kathleen Flynn/Reuters
Louisiana is fighting to become a leader in the race to criminalize doctors who allegedly perform abortions, ever since the US Supreme Court struck down federal protections against abortion.
In doing so, the state may also become an example of how abortion bans could worsen maternal health in the United States, as criminal penalties in the US redefine where and how doctors are willing to practice.
Related: Colorado Governor Issues Executive Order to Protect Access to Abortion
In turn, that is likely to worsen a main reason some states are more dangerous places to give birth: a lack of hospitals, birthing centers and obstetricians.
“It should come as no surprise that in many of the states where there is a [trigger ban]there is a strong correlation [with maternity care deserts]said Stacey Stewart, president and CEO of the March of Dimes, an organization that advocates for maternal and child health and is strictly neutral on abortion.
Many of the same states that are hostile to abortion have also pursued intersecting policies that can worsen residents’ overall health, such as a refusal to expand a public health insurance program for the poor called Medicaid.
Now, the severe criminal penalties and extraordinary civil liability to which physicians are exposed under such anti-abortion statutes could become pivotal in determining how and where health care providers choose to practice.
“There has been an unprecedented invasion of the legal world in these medical decisions,” said Dr. Rebekah Gee, an obstetrician and gynecologist in New Orleans, CEO of family medicine practice Nest Health and a former secretary of the Louisiana department of health. Louisiana’s trigger law allows for fines of up to $250,000 and 15 years in prison for mistakenly inducing an abortion. “These are penalties that people have for rape and armed robbery,” Gee said.
Roughly half of US states are expected to attempt to ban abortion from conception or very early in pregnancy, the result of a cataclysmic Supreme Court decision that ended nearly 50 years of federal protection for abortion. right to abortion.
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“Forget fines – people are afraid of going to prison,” said Lisa M Wayne, executive director of the National Association of Criminal Defense Lawyers (NACDL). NACDL has received calls from reproductive rights groups, medical associations, and even other attorneys in recent days, trying to sort out the kind of legal exposure they may face from state to state.
“No one wants to sign up thinking their freedom will be interfered with,” Wayne said.
Louisiana provides an especially prominent example of how the geography of medicine could be affected. If the triggering bans in Louisiana and neighboring states go into effect, as expected, the closest state without an abortion ban would be hundreds of miles away in Illinois.
Louisiana’s would also be especially punitive, allowing prosecutors to seek lengthy prison sentences and felony charges. State law also does not provide any exemptions for victims of rape or incest.
Abortion bans will likely cause “even greater job challenges in certain areas, particularly if OB-GYNs are unable to live and work in states with restrictive abortion laws,” said Dr. Jen Villavicencio, equity transformation lead at the College. American Obstetricians and Gynecologists. .
For now, the state’s activation law has been blocked by a state court, but state officials like Republican Attorney General Jeff Landry have come out in favor of a ban. However, the court case to stop the law has created a record of how doctors say a climate of fear and confusion has settled in the state and is sure to affect care.
“Frankly, I’m concerned that I could go to prison just for handling a miscarriage like I’ve always done,” said Dr. Nina Breakstone, an emergency physician in Terrytown, Louisiana, in an affidavit opposing the state’s trigger ban. .
Frankly, I’m worried I could go to prison just for handling a miscarriage.
In another affidavit, an ER doctor said his colleagues were afraid to report miscarriages in patient charts because, medically, a miscarriage is described as a “miscarriage.”
“Providers like myself have absolutely no direction on how to resume their practice or what, if any, of their actions could subject them to prison time and huge fines,” said Dr. Rebecca Perret, an obstetrician and gynecologist at Orleans Parish, in another affidavit.
By the state’s own health department’s own admission, Louisiana has one of the worst maternal mortality rates in the nation, with black patients four times more likely to die than their white counterparts. The state is also struggling to attract doctors to care for pregnant patients. About a third of the counties, called parishes, lack an obstetrician, according to court documents.
In 2019, for every 100,000 births, 33 women died. That’s well above the US national average of 20 deaths per 100,000 live births. Louisiana’s rate is more than five times the rate of maternal mortality in the United Kingdom and, according to another report in the American Journal of Obstetrics and Gynecology, is on par with those of Kyrgyzstan.
“Where you live matters,” Dr. Juanita Chinn, a demographer and population health expert at the National Institute of Human and Child Health Development, told The Guardian. “A geographic barrier in the ability to access care will likely only increase the risk of experiencing an event of serious maternal morbidity or maternal mortality.”
Many parishes are “maternity care deserts,” or places where there is no hospital, birthing center or obstetrician, according to a 2020 March of Dimes report. That lack of doctors has already become a driving factor in the risks pregnant patients face in Louisiana, research shows.
In court documents, doctors said Louisiana’s decision to try to enact harsh penalties for alleged abortions has already deterred some from practicing in the state, with hospital administrators concerned about staffing shortages and medical school professors concerned about the future workforce.
Other doctors said in depositions that climate is likely to have huge knock-on effects for patients in Louisiana, as resident doctors choose other states to practice in and doctors look elsewhere for jobs.
“I worry that maternal mortality rates will only get worse if the triggering ban [goes] in force,” Dr. Jennifer Avegno, an emergency room physician and director of the New Orleans health department, said in a court filing. In part, she said, maternal mortality would worsen because patients, especially in rural areas, would have to travel farther for care.
“One of the main reasons women are more likely to die in Louisiana is because they are forced to travel long distances for care in many areas of the state due to a lack of health care providers,” Avegno said.
Dr. Clarissa Jo Beutler, a family medicine doctor, wrote to the court that she was concerned about the ripple effect in general medicine, with doctors often prescribing medications that can cause miscarriage or pregnancy complications from depression, migraines and autoimmune disorders.
Dr. Valerie Williams, an obstetrician and gynecologist at Orleans Parish and an assistant professor at the Louisiana State University Health Care Network, said in an affidavit that she was concerned that the triggering bans would affect the “number and quality” of obstetrics residents who choose to train in the state. thereby impacting the state’s future workforce. The ban has already dissuaded one vendor from coming to Louisiana.
“In helping to find a replacement for my previous position, an amazing candidate came forward who was highly motivated to practice in Louisiana,” said Williams. “However, once she heard that Louisiana has activation bans with stiff penalties for doctors, she backed off.”