For the past 50 years, many, if not most, conversations about abortion have revolved around ideas about “choice” and “individual rights.”
A new conversation is starting to emerge, however, one that revolves around understanding that abortion is health care. At its core, it’s about the reality that, for many pregnant folks, carrying a fetus to term can be fatal.
Pregnancy may not be as dangerous as it was in the 1800s, when nearly one per cent of mothers died either while pregnant, during delivery or in early postpartum days, but maternal mortality rates in Canada still hover around eight deaths in 100,000 — higher than most European countries.
South of the border, maternal mortality rates are already about twice as high as Canada’s. They’ve been on the rise over the past few years and that’s a trend that’s likely to continue, now that the United States Supreme Court has overturned Roe v. Wade, taking away constitutional protections for people seeking abortions. In response, several states have already criminalized abortion.
“Like every other country that’s criminalized abortion, we expect to see an increase in maternal mortality in the United States, which is heartbreaking since it’s preventable,” said Dr. Dustin Costescu, associate professor at McMaster University and an obstetrician-gynecologist at Hamilton Health Sciences. “Most of us have never lived in a time where we’ve ever experienced what maternal mortality looks like when abortion is not available.”
Costescu, a Romanian-Canadian, notes that when his family’s home country criminalized abortion in 1966, maternal mortality rates rose to triple the European average. Romania, it should be pointed out, at least made exceptions in the case of rape and incest, whereas legislation (as currently written) in at least 10 American states make no such exceptions.
And while exceptions for life-threatening conditions have been carved out, how that actually plays out in real life remains to be seen. Saving a patient with, say, an ectopic pregnancy (an urgent, potentially fatal, condition in which the fertilized egg is implanted outside the uterus, often in a Fallopian tube) by performing a medical abortion would require a doctor to act quickly and be certain that their decision it was a medical emergency wouldn’t be disputed.
Ectopic pregnancies are likely the most straightforward. In general, though, there’s the potential for a lot of grey area, given that even though most pregnancies have good outcomes, all pregnancies involve a certain amount of risk — more risk than abortions.
“Despite what anti-abortion groups claim about how it leads to depression or suicide or anxiety or substance abuse or any of those things, there’s no evidence to support that,” explained Dr. Gail Erlick Robinson, professor in psychiatry, obstetrics and gynecology at the Temerty Faculty of Medicine and a physician at Sunnybrook Hospital. “There is ample evidence that there are more risks involved in carrying a pregnancy than in having a safe and legal abortion.”
Compared with most mammals, human pregnancy is very risky. Blame evolution. When we started walking on two legs the birth canal narrowed and when our brains got bigger so did our heads. And those heads have to travel down the birth canal.
As such, humans have more than their fair share of “fetal-maternal conflict,” a.k.a. when the interests of the fetus and maternal health are in conflict. Pre-eclampsia, a fairly common complication that can be fatal if it progresses to the eclampsia stage, is a common example of a potentially life-threatening conflict, but there are many others, including immunological diseases and scenarios involving cancer treatments.
“There are situations where, if a woman takes the cancer drug, that might kill the fetus, which is deemed an abortion,” said Robinson. “So I guess she’s supposed to delay treatment and cross her fingers.”
And then there are miscarriages, which, she points out, are how 18 to 20 per cent of pregnancies end. Now, given criminalization, women will be afraid to go for help since they might be suspected of having obtained an illegal abortion.
“So these are the kind of things that people don’t think about,” said Robinson, who is also a member of the Order of Canada, having been recognized for work on women’s mental health and a co-founder of Canada’s first rape crisis centre. “And if we’re talking about mental health, I think we’re going to see a higher rate of depression and increased risk of suicide in states where, even in the case of rape or incest, the woman is not allowed to abort.”
On the topic of family violence, a 2021 study found that, in the United States, homicide, often by a domestic partner, is one of the leading factors in rising maternal mortality rates. Since some women are killed because their partner doesn’t want a child, removing safe and legal access to abortion is likely to exacerbate this problem.
So what lesson should we as Canadians take from all of this?
“I think Canadians should never take their rights for granted,” said Costescu. “And, as somebody who works closely with patients who are struggling to make these decisions, I can tell you that they are never easy.
“Often patients have had a complication in a previous pregnancy and actually have a child. And, overwhelmingly, these women will tell us that they would like to be alive for the kid that they do have.”
He added, “I don’t think it’s an unreasonable request for someone to want to stay alive.”
Not unreasonable at all. One might even expect it to be an unalienable right. Now, though, that seems to depend on where you live.
And, of course, how people vote.
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