How Complete Abortion Bans Endanger Maternal Health – The Harvard Gazette

Pregnant patients in El Salvador who, under the country’s abortion ban, had no choice but to carry fetuses with severe malformations experienced high rates of maternal morbidity, according to new research by Harvard sociologist Jocelyn Viterna and two fellow Salvadoran physicians. according to research. The study, which examined 239 pregnancies with one of 18 malformations commonly considered fatal between 2013 and 2018, appears in the American Journal of Obstetrics and Gynecology Global Reports.

In explaining why they began their research, Viterna and co-authors Carolina Mena Ugarte and María Virginia Rodríguez Funes write that “a striking number of national and subnational governments that previously allowed legal abortion in cases of severe fetal anomaly passed legislation to eliminate the allowances, but little was known about the effects on maternal health.

Viterna, who has spent nearly 10 years researching reproductive justice in the small Central American country, says she sees some parallels between the issues raised by the research in El Salvador and those arising in the US as many states followed the Supreme Court Restrictions on abortion have been tightened. Overturned the landmark Roe v. Wade decision. He said that in both countries, doctors are forced to follow a course of care that increases the risk of health complications for pregnant patients in order to protect themselves from prosecution.

“The more time I spend working on cases in El Salvador, the more convinced I am that we cannot legislate abortion,” said Viterna, a sociology professor. “There is no way to legally define viability. There is no way to legally define the exact time when a woman’s life is at risk or not. Pregnancy itself is high-risk. Whenever If someone becomes pregnant, it poses a risk to the health and life of the pregnant woman.”

Sandra Carolina collects data at the Mena Ugarte National Women’s Hospital. Photo by Jocelyn Viterna

Like many Latin American countries, El Salvador banned abortion except in three scenarios: when the mother’s life was in danger, when the fetus was incompatible with life, or if the pregnancy was the result of rape. That changed in the 1990s, when the anti-abortion movement in the heavily Catholic nation began pressing for major changes. In 1998, abortion became illegal under all circumstances.

The study was triggered by a conversation Viterna had with Mena, who expressed frustration at the lack of research into the effects of lethal fetal malformations on maternal health.

“Their feeling was that pregnant women were facing significant health costs, both physical and psychological, of being required to carry a non-viable pregnancy,” said the sociologist. The research tested Mena’s hypothesis, and found high rates of negative health outcomes across the entire study population.

After examining six years of cases at the National Hospital for Women in the capital city of San Salvador, researchers found that 54.9 percent of cases had at least one serious pregnancy-related health complication that included severe fetal malformations. Additionally, 47.9 percent required physically invasive medical procedures to manage complications—including fetal head decompression, decompression amniocentesis, cesarean delivery, and hysterectomy.

Overwhelmingly, cases involved individuals who were low-income, less educated, and young. About 40 percent were first pregnancies, she said, and 75 percent were unplanned. Pregnant people in El Salvador with the financial resources generally do not seek health care at the public National Hospital for Women, instead choosing private providers.

The researchers also discovered multiple clinical treatments within the same institution, which suggests that physicians interpreted the abortion ban differently. Physicians flouted the law in 10 cases, and induced labor in those patients before the pregnancy reached 37 weeks (full term). In 21 cases, doctors did not induce early and went as far as to treat the fetus, even though it was diagnosed with a fatal malformation. In 21 cases, pregnant patients discontinued treatment after receiving a diagnosis of fatal fetal malformation.

“Forcing these women to have these pregnancies is not only psychologically harmful to the woman, but it is also tremendously harmful to the woman physically,” Viterna said. “There’s nothing about this that I find humane, especially considering the painful deaths these babies often suffer after birth.”

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