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The Death of Savita Halappanavar: A Tragedy Leading to Long Overdue Change?

10:23 am in Uncategorized by RH Reality Check

About Ten Thousand People Attended A Rally In Dublin In Memory Of Savita Halappanavar

About Ten Thousand People Attended A Rally In Dublin In Memory Of Savita Halappanavar

Written by Carole Joffe for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

The tragic and unnecessary death of Savita Halappanavar — a 31-year old Indian woman who was denied a life-saving abortion in an Irish hospital — has sparked reactions across the globe. Thousands have marched in Dublin. Demonstrations have taken place in India and elsewhere. An international day of protest is called for November 21. Tense meetings between Indian and Irish government officials are taking place. The overriding question now is: what will be the legacy of this horrible event, beyond the unspeakable grief of Savita’s loved ones? After the demonstrations have stopped, will Irish hospitals — where abortion remains illegal but is permissible in life-threatening conditions — proceed differently in the future? Will the country finally move toward legalizing abortion?

This heartbreaking incident has led me to contemplate the long history of abortion struggles around the globe and under what circumstances, change takes place. It is not an exaggeration to say that throughout history millions of women have died and even more have been injured because of the lack of safe abortion. But only some of these tragedies capture the public’s attention and become catalysts for change.  And sometimes public attitudes are affected even when a woman’s death is not involved.

Consider the history of abortion in the United States. Two events that occurred in the 1960s were instrumental in moving much of the country toward an endorsement of legal abortion. The first, in 1962, involved Sherri Chessen Finkbine, a Phoenix woman pregnant with her fifth child, who learned that the Thalidomide pills she had been using as a sleep aid were strongly associated with severe birth defects. Her doctor was able to arrange a “therapeutic” (i.e. approved) abortion for her at a local hospital, but Finkbine, in an act of decency that would prove costly, went public with her story as she hoped to warn other women who were in her situation. Her interview with a journalist created a media sensation, and nervous hospital authorities cancelled her abortion. Ultimately Finkbine, unable to find an abortion anywhere in the United States, obtained one in Sweden, where she delivered a fetus with missing limbs. Doctors told her the fetus would have had no chance of survival. Finkbine’s story spread beyond Phoenix to become a national story, including a cover on Life magazine. This incident, particularly the unprecedented visibility of abortion on the cover of the leading news magazine of the 1960s, “had a galvanizing effect on public opinion,” in the words of the journalist Linda Greenhouse, a longtime observer of the trajectory of abortion rights in the United States.
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Death in Ireland is a Wake Up Call to Fight Bans on Later Abortions Here at Home

1:07 pm in Uncategorized by RH Reality Check

Written by Susan Yanow for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Recent press about the death of Savita Halappanavar, admitted to a hospital in Ireland with medical complications in a 17-week pregnancy, is a grim reminder about the impact of abortion restrictions on women’s lives.

In Ireland, abortion is legal only to save a woman’s life. In the last two years in the United States, nine states have passed laws banning abortion after 20 weeks (in Arizona abortion is banned after 18 weeks) except to save a woman’s life. But as the death of Ms. Halappanavar so poignantly illustrates, “risk to a woman’s life” in emergency situations is extremely difficult to assess.

Savita Halappanavar was 31 years old, and had a wanted pregnancy. She began suffering severe back pain, was admitted to the hospital and was told that she was miscarrying. As the pain increased and her health worsened, she and her husband requested that the pregnancy be terminated. Because the fetus still had a heartbeat, however, she was denied her right to a safe abortion. After three days in the hospital, Savita Halappanayar died. The doctors attending her did not determine that her life was sufficiently at risk to warrant performing an abortion.

Could this happen in the United States? In short, it certainly could. Let’s remember the 1988 case of Michelle Lee, a resident of Louisiana who had a serious heart condition and was waiting for a heart transplant. She became pregnant, and because of her medical condition could not be seen at an outpatient abortion clinic. She was sent to the only hospital in Louisiana with appropriate services, Louisiana State University. However, as reported at the time:

A committee of five LSU doctors concluded that Lee’s chance of dying was not greater than 50 percent. And under Louisiana law, a public hospital could not perform an abortion on Lee unless her life were endangered. They decided her case didn’t meet the test.*

What must the chance of dying be for a woman to “qualify” for a life-saving abortion? In Louisiana, a 50 percent chance of death was not enough. Who knows how the doctors in Ireland assessed the risk to Savita Halappanavar?

In the states that have passed limits on when an abortion can be performed, lawmakers are expecting physicians to juxtapose their assessment of medical risk to a given woman with the legal risk of prosecution if, after the fact, there are “second guesses” about whether the woman was at sufficient risk to trigger the legal exception the abortion ban.  This untenable intrusion of law makers into medicine puts physicians into an impossible situation. 

We have a sobering lesson to learn from Ireland – when doctor’s medical judgement is compromised by restrictive abortion laws, it is women’s health and women’s lives that suffer.

*Activists mobilized and raised $8,000 to help Michelle Lee get a life-saving abortion in Texas. Today, Texas is one of several states considering a ban on abortions after 20 weeks in the next legislative session.

Photo by ge’shmally under Creative Commons license.

Doctor to Ohio Senate: I Do Not Want To Tell My Patients I Cannot Help Them

3:15 pm in Uncategorized by RH Reality Check

Written by Dr. Lisa Perriera for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Lisa Perriera, MD, MPH, gave this testimony live before an Ohio Senate committee yesterday afternoon at a hearing of the so-called “heartbeat” bill, H.B. 125.

Good afternoon. My name is Lisa Perriera and I am a board certified ob/gyn working at an academic medical center in Cleveland.  I come today representing myself and my patients.

I strongly urge the Ohio Senate to oppose “the hearbeat bill.” Lawmakers do not belong in the consultation room with me and my patients.  As an OB/GYN, I offer the full spectrum of care for women.  I deliver their babies, I screen them for cervical and breast cancer, and sometimes I perform their abortions.  Abortion is a safe and legal medical procedure that women deserve to be able to access here in Ohio. This bill is effectively a ban on abortion, since the heartbeat is usually detected between the 5th and 6th week after the last menstrual period, often before a woman even realizes that she is pregnant. Banning abortion has never stopped abortion from happening; it has only made abortion unsafe or more difficult to obtain. Worldwide 48 percent of abortions are unsafe. As a physician do not want to go back in time and see unsafe abortion in Ohio.

I also don’t want to tell any of my patients that I cannot help them. I am particularly concerned about my patients with fetal anomalies, as these are the patients that will be most adversely affected by this law. I have countless stories I can tell, but I’ll just share a couple.  Kristen and Steve were expecting their first child. Kristen had had two miscarriages, so she and Steve were so excited when they made it to 20 weeks in this pregnancy. They were eagerly anticipating the anatomy ultrasound, when they would find out their baby‘s gender. It was a girl! But then the terrible news: her heart was malformed. Kristen and Steve were referred immediately to a pediatric heart surgeon who told them that their daughter would need several surgeries to have a chance of surviving her heart defect, and that each operation posed a high risk of death. Even if the surgeries were successful, there was a substantial chance that she would be severely disabled. Kristen and Steve decided with great anguish that they could not put their little girl through so much pain and suffering without a reasonable chance that she would have a normal childhood. They chose to end the pregnancy.

Another is the story of Jamie and David.  They already had one son Luke, and were so thrilled to be pregnant again.  Jamie decided to have screening tests performed to determine if her baby was at risk for any chromosomal malformations.  She thought that since she was less than 35 there was a low chance the screening test would be positive. Unfortunately she was wrong.  The test showed that she was at risk for trisomy 18, a chromosomal abnormality that is not compatible with life.  This diagnosis was confirmed with an amniocentesis.  Jamie and David had to decide if they would continue the pregnancy knowing that their baby girl would die before birth or soon after, or if they would terminate this very desired pregnancy.  After much soul searching they decided to terminate the pregnancy.  They didn’t want to put Jamie through the risks associated with delivery when there was no hope of a healthy baby. Many people do not realize that abortion is actually safer than a full-term delivery. The risk of death from a first trimester abortion is 1 in a million, while the risk of death from childbirth is 6.6/100,000 live births.

They also didn’t want to go through the emotional agony of watching their little girl die. While they wish they didn’t need to have an abortion, they felt like they did what was best for themselves and their baby girl Grace.  They were referred to me and I did their procedure.  The bond we formed while I cared for them during that pregnancy led them to switch care to me when they conceived their next pregnancy.  They felt abandoned by their first OB/Gyn, and Jamie also didn’t want to have to explain everything she had been through; I was there with her and knew it all.  I was privileged to deliver Elise about a year after Grace died. 

The heartbeat bill would have forced Jamie and Kristen to continue their pregnancies or required them to go to another state to have an abortion.  It may seem easy to you to pass a law that bans abortion once a heartbeat is detected, but I’m the one that has to explain to my patients why I can’t provide the care that they need and deserve.  I urge you to please let me go on practicing medicine as I see fit.  Don’t bring this bill to a vote. Let me continue to care for patients and provide a safe and constitutionally legal medical procedure.  Thank you for your time.