How Total Abortion Bans Put Mother’s Health at Risk – Harvard Gazette

Pregnant patients in El Salvador, who under the national abortion ban had no choice but to carry fetuses with severe malformations to term, had high rates of maternal morbidity, according to new research by Harvard sociologist Jocelyn Viterna and two Salvadoran physician partners . 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.

Explaining why they undertook their study, Viterna and co-authors Carolina Mena Ugarte and María Virginia Rodríguez Funes write that “a striking number of national and subnational governments that previously permitted legal abortion in cases of severe fetal abnormality” have passed laws to abolish of 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 nation, says she sees some parallels between the issues raised by the El Salvador study and those emerging in the U.S., as several states tightened restrictions on abortion after The Supreme Court overturned the landmark decision in Roe v. Wade. In both countries, doctors are forced to follow a course of treatment that increases the risk of health complications for pregnant patients in order to protect themselves from prosecution, she said.

“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 determine the exact moment when a woman’s life is in danger or not. Pregnancy itself is high risk. Whenever someone is pregnant, it carries risks to the health and life of the pregnant person.

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

Like many Latin American nations, El Salvador prohibits abortion except in three scenarios: when the mother’s life is at risk, when the fetus has an abnormality incompatible with life, or if the pregnancy is the result of rape. That changed in the 1990s, when the anti-abortion movement in the heavily Catholic nation began pushing for major changes. Abortion became illegal under all circumstances in 1998.

The study was prompted by Viterna’s conversations with Mena, who expressed frustration with the lack of research on the effects of fatal fetal malformations on maternal health.

“Her sense was that pregnant women incur significant health costs, both physical and psychological, by being required to carry non-viable pregnancies to term,” the sociologist said. The study tested Mena’s hypothesis and found high rates of negative health outcomes in the entire study population.

After examining six years of cases at the National Women’s Hospital in the capital San Salvador, the researchers found that there was at least one serious pregnancy-related health complication in 54.9% of cases involving severe fetal malformations. Additionally, 47.9 percent required physically invasive medical procedures — including fetal head decompressions, decompressive amniocenteses, cesarean delivery, and hysterectomy — to manage complications.

For the most part, cases involve people with low incomes, low education and young people. Nearly 40 percent were first pregnancies and 75 percent were unplanned, she said. Pregnant people with financial resources in El Salvador generally do not seek health care at the public National Women’s Hospital, choosing private providers instead.

The researchers also found a range of clinical treatments at the same institution, suggesting that doctors interpreted the abortion ban differently. Doctors defied the law in 10 cases and induced labor in these patients before the pregnancy reached 37 weeks (full term). In 21 cases, doctors did not induce early and went so far as to treat the fetus as viable, even though it was diagnosed with a fatal malformation. Pregnant patients in 21 cases discontinued treatment after receiving the diagnosis of fatal fetal malformation.

“Forcing these women to carry these pregnancies to term is not only extremely psychologically damaging to the woman, it’s also extremely physically damaging to the woman,” Viterna added. “There’s nothing about that that seems humane to me, especially considering the painful deaths these babies often suffer after birth.”

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