(Source: MIRS.news, Published 06/27/2022) As Michigan's 1931 abortion ban lingers in a temporary hold, some members of the OB-GYN community warn that it's exemption to preserve the life of a mother "is actually very unclear."
"Does a woman need to be 100% (certain) to die in order to end her pregnancy?" asked Dr. Lisa Harris. "We see people with a range of medical conditions in whom we might cite a 30% or 50% chance of death if they continued the pregnancy, and it's unclear if that is enough to allow a woman to decide to end her pregnancy."
Monday, the Committee to Protect Health Care – a nationwide assembly of medical professionals and "pro-patient" advocates – hosted a press conference on the potential impacts that the U.S. Supreme Court's overturning of Roe v. Wade could have on patients and care providers.
Harris, an obstetrics and gynecology professor at the University of Michigan (U of M), explained when abortion is illegal in a state – like it would be in Michigan under its 1931 ban – a patient is left with three alternatives: "traveling for care, self-managing abortion or giving birth."
She said while there are safe ways to conduct a self-managed abortion – which Harris said some people will "undoubtedly" attempt – there are life-threatening methods, like ingesting a toxin or poison, or a woman inserting outside objects into herself to disrupt a pregnancy.
"...Or intentional trauma like falling down stairs or asking someone to hit or strike them. These are all things that people have done and cause complications that we haven't really seen since before Roe," Harris said. "Legal abortion is really a public health intervention and giving birth raises maternal mortality."
Maternal mortality will expand as much as 21% under an abortion ban, Harris said, with Black women feeling the burden more than white women because maternal mortality among them is two to three times higher.
"More Black women enter pregnancy with underlying illnesses or chronic illnesses that haven't had adequate medical care before a pregnancy – leading to complications after pregnancy," she said.
For Harris, who's been a doctor for nearly 30 years, she is concerned doctors and their teams will hesitate to act when a patient comes to them with a complication requiring a pregnancy termination "because they're worried about the legal repercussions to themselves."
Melissa Bayne – a West Michigan OB-GYN – said the abortion pills, mifepristone and misoprostol, are utilized when membranes are ruptured during a patient's second trimester of pregnancy or when a blood vessel breaks and they're experiencing hemorrhaging.
The pills are also used to manage a miscarriage.
"What medical (indications) are those medications allowed? Because that is not defined within the law," Bayne said about the 1931 ban. "This will be a new landscape of having to actually define risks and benefits and medical ethics of autonomy and justice for a patient – versus claiming those things for myself and my family."
Bayne additionally asked what will happen to the women who come to her in an absolute mental health crisis, adding there are patient cases where carrying on a pregnancy will be "life threatening to their mental and physical health – and how do you define that within this law?"
Currently, Attorney General Dana Nessel has reiterated to residents that abortion providers in Michigan cannot be prosecuted due to the preliminary injunction issued by the state's Court of Claims in May.
However, as abortion appointments continue to have a greenlight in Michigan, individuals residing in states where pre-Roe abortion bans have been fully revoked could be on their way to the Great Lakes State.
"Certainly, the infrastructure for care as it existed may not be enough for every patient," said Harris, explaining Ohio residents could be journeying over now that their law prohibiting abortions after six weeks has been reinstalled.
Harris said she's talking to colleagues about who can take extra shifts, and that the sad reality is that Michigan may not be able to help everyone seeking an abortion right now.
"That part is going to be very hard – to know that we have the skills and the willingness to help people, but that we just may not have the clinical care space or the operating room capacity and we will have to turn people away," she said. "And that will be heartbreaking for all involved."
Over the weekend, Beaumont-Spectrum Health (BHBS) – Michigan's largest health system – announced it would be following the legal guidance of the 1931 law. However, the system later clarified abortions will still be provided when "medically necessary" within two days of its initial statement around complying to the old law.
"At present, the current legal landscape regarding abortion in our state is unclear and uncertain. We are aware of the 1931 Michigan law," the newest statement reads. "However, given the uncertainties and confusion surrounding its enforcement, until there is clarity, we will continue our practice of providing abortions when medically necessary."
According to the BHBS system, it provided approximately 60 "therapeutic, medically necessary abortions that required hospital level care" in 2021. On top of urging the state's courts to deliver clarity as soon as possible, the system shared it does not and will not perform elective abortions.
