Screening
for fatal congenital conditions will be limited as a result of Roe's decision
Jennifer
was aware that her 37-year-old pregnancy was loaded with dangers, so she was
all the more thrilled to be expecting twin boys. However, thorough ultrasound
scans taken around 12 weeks revealed serious difficulties. Both foetuses lacked
limbs, and fluid had built up in their brain chambers. Three weeks later, an
additional ultrasound and a more invasive test involving a tissue sample from
the mother's amniotic fluid confirmed the diagnosis of trisomy 18 (a condition
in which someone possesses an extra copy of chromosome 18).
One
of the boys died in the womb while the tests were being conducted, and the
prospects of the second embryo surviving appeared to be dwindling. "They
observed that his heart was beating, but it was missing a chamber,"
Jennifer explains, explaining that she was now confronted with a number of
difficult options. Jennifer could have a stillbirth, or she could haemorrhage,
as she had four years before when her daughter was born. Even if the foetus was
carried to term, he would most certainly die shortly after birth due to his
condition.
Jennifer
and her husband were able to reach an agreement with their doctor and terminate
the pregnancy at 17 weeks. But that was in 2018, and they wouldn't be able to
do so now. In April, new legislation went into force in the US state of
Oklahoma, where they lived at the time, prohibiting abortions beyond the sixth
week, well before congenital abnormalities like trisomy 18 are identified. Only
in a "medical emergency" can the law be broken to save a pregnant
woman's life. A civil lawsuit can be filed against anyone who performs an
abortion after the sixth week of pregnancy.
Such
restrictions may become far more common across the United States in the near
future. According to a leaked Supreme Court decision, Roe v. Wade—the 1973 case
that established the constitutional right to abortion in the United
States—could be overturned this summer, allowing each state to make and enforce
its own abortion regulations. If Roe is overturned, 26 states are certain to
tighten or outright ban abortions, depriving families like Jennifer's of the
ability to make medical decisions about their own and their unborn children's
health.
According
to the Guttmacher Institute, an abortion-rights advocacy and research
organisation, nine states have approved six-week restrictions similar to
Oklahoma's but have yet to enforce them, with state courts finding the laws to
be in violation of Roe v. Wade on an individual basis. (A six-week prohibition
is also in effect in Texas.) Thirteen states have stringent anti-abortion
legislation that will be "triggered" to take effect immediately if
Roe is overturned. Existing stalled prohibitions and new trigger legislation
are on the horizon in some states.
The
specifics of the upcoming trigger laws differ in each state. Most states
outright prohibit medical or surgical abortions, with a few exceptions for
situations of rape or incest, or to prevent the patient's death or significant
injury. Only a few states want to make exceptions for foetuses with
life-threatening congenital abnormalities, while six states currently restrict
abortions based on genetic conditions.
Although
it is optional, genetic screening is a frequent element of prenatal care and is
commonly done in conjunction with an ultrasound check between the 10th and 13th
week of pregnancy. Doctors check for foetal DNA floating in the mother's blood,
which can be used to diagnose brain and spinal issues, as well as chromosomal
disorders. If a blood test is positive, doctors will extract a small sample of
amniotic fluid or placenta from the uterus with a needle to confirm the
diagnosis. Aborting foetuses with a non-fatal illness like Down syndrome
creates moral and ethical issues, but doctors also test for conditions like
trisomy 18 and trisomy 13, both of which cause miscarriages, stillbirths, or
the baby dying soon after delivery.
Trisomy
18, also known as Edwards syndrome, affects roughly 1 in every 5,000 babies,
while trisomy 13, generally known as Patau syndrome, affects about 1 in every
16,000. The majority of these neonates die within the first few days or weeks
due to cardiac issues and other life-threatening diseases. Only about 5% to 10%
of people make it through the first year.
Jennifer
says of her unborn son with trisomy 18, "If I could have just given birth
and he died naturally, it might have been a decision for us." However, she
claims that knowing that doctors would have fought to keep the kid alive
despite his condition influenced her decision. There is no cure for the extra
chromosome that causes Edwards syndrome; treatment focuses solely on the
symptoms that babies experience, which might range from blood pressure medicine
to ventilators to feeding tubes.
Recent
events have highlighted the potential consequences of decreasing abortion time
limitations. In September 2021, a Texas law went into effect prohibiting
abortions at the point where an embryo's heart activity can be identified by
ultrasound for the first time, which can be as early as six weeks when many
women are unaware they are pregnant. The ban's consequences have spread across
state lines, with individuals who can afford to travel seeking abortions in
other states. According to University of Texas researchers, an average of 1,391
women per month sought an out-of-state abortion between September and December
2021. The majority fled to neighbouring Oklahoma, but due to a new restrictive
regulation in that state, this is no longer an option.
"Because
of the impact of the Texas and Oklahoma restrictions, people in neighbouring
states are experiencing delays in care," says Beverly Gray, an
obstetrician and gynaecologist at Duke University School of Medicine in North
Carolina. They travel to other states, and we're witnessing a tidal flow of
people seeking treatment. If Roe v. Wade is overturned and those trigger laws
are implemented, the influx of individuals might become considerably higher
very quickly. In June, the Supreme Court is anticipated to rule on Roe v. Wade.
Most
pregnant women choose to terminate their pregnancy after getting a fatal
diagnosis for their foetus, but many may soon lose that option if the Supreme
Court rules against them. For some women seeking abortions, it is an act of
parenting. "They don't want their child to live a life of misery,"
Gray explains. Individuals select whether or not to get abortions based on
their circumstances and the consequences for their families, she claims. I
don't think you truly grasp what they're going through, what their families are
going through, or what they're facing with a fatal diagnosis until you've
walked a mile in their shoes.