New state abortion restrictions are creating health care problems for women

In the wake of the Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization which overturned the constitutional right to abortion, there has been a flurry of reports of abortion restrictions going into effect in a number of states that are compromising essential health care for women — ranging from post-miscarriage care to surgery for life-threatening ectopic pregnancies to access to anti-inflammatory medications that can double as abortifacients (abortion-inducing drugs).

Many Republicans have charged that these are scare stories with little or no foundation, intended to drum up support for abortion rights and frighten women. But as more facts emerge, it's becoming clear that the problem is real.

Take reports that female patients with chronic illnesses such as arthritis and lupus were suddenly having difficulty refilling prescriptions for methotrexate, an autoimmune medication seen as the best treatment for these conditions. Many people, myself included, were initially skeptical of what seemed to be anecdotal social media claims of refill denial — perhaps based on accidental glitches, or even made up.

But the story checks out. The New Republic reports that a CVS corporate memo — shared by a pharmacist in Alabama, then confirmed by a CVS spokesman — has instructed pharmacists in states with abortion restrictions not to refill prescriptions for methotrexate and another potentially abortifacient drug, misoprostol, unless the prescriber uses a diagnosis code and confirms that the medication is not being used for an abortion.

This problem, at least, should be relatively easy to solve once pharmacies and doctors have adjusted to the new policies. Treatment for miscarriages and high-risk pregnancies gone wrong may pose a much more difficult dilemma.

Virtually all anti-abortion legislation allows exemptions when the woman’s life is in danger; the laws also exempt ectopic pregnancies (in which the embryo has implanted outside the uterus) and removal of fetal tissue after miscarriage. But it turns out that these situations are not always clear-cut, especially since the typical “reasonable medical judgment” standard in these laws is anything but clear.

An ectopic pregnancy, for instance, may not always show on a scan; a doctor may feel pressured to perform extra procedures to confirm it to avoid being charged with an illegal abortion. A doctor managing a miscarriage in progress may hesitate to remove the fetus if it still has a heartbeat. The resulting delays can be dangerous.

An article in press in the American Journal of Obstetrics and Gynecology, recently made available online, describes 28 cases at two hospitals in Texas in which miscarriage care was compromised by delays based on fears of legal action. A Texas law passed last year, enforceable by private lawsuits, severely restricted abortions after fetal heartbeat detection.

Conservatives dismiss these reports as scaremongering by pro-choice doctors; some have even insinuated that physicians are deliberately compromising patient care to discredit anti-abortion laws. Yet anti-abortion lawmakers have deliberately rejected broad health exemptions for fear they may be used to justify nonmedical abortions. And many right-to-life activists openly admit that without imminent danger to the woman’s life, they want doctors to try to save the fetus.

I don’t think, as many pro-choice feminists hyperbolically claim, that pro-lifers hate women and want to see them dead. More likely, many of them never thought through the consequences of anti-abortion laws, including the second-guessing of doctors’ judgments about care for patients with perilous pregnancies.

Obviously, unverified horror stories should not be published. But anti-abortion politicians should also be forced to answer for the very real dangerous situations they have created.

Opinions expressed by Cathy Young, a senior fellow at the Cato Institute, are her own.

By Cathy Young

Cathy Young is a writer for The Bulwark.