The GOP Wants To Manage Your Miscarriage – You Good With That?

Posted on | April 17, 2023 | 5 Comments

Mike Magee

Twenty years ago, I headed up a social science think-tank focused on defining the role of the patient-physician relationship in well-functioning democracies. In six countries (including the U.S., UK, South Africa, Germany, Japan, and Canada), our studies revealed a rapidly evolving relationship – one moving toward mutual decision making and team approaches to care.

Perhaps more significant was the revelation that the relationship was advancing the cause of democracy in three ways. First, it promoted trust and confidence across entire populations without prejudice. Second, it processed individual’s fear and worry which, if allowed to build and expand, could have a destabilizing effect on self-governance. And third, it encouraged forward facing optimism while reinforcing bonds between individuals, families and communities committed to joint problem solving.

In short, the patient-physician relationship showed the strength and willingness to individualize and confront complex, deeply personal, and intensely human dilemmas in real time and privately on a 24/7 basis. These very traits were the reason why the Supreme Court in 1973, in Roe v. Wade, entrusted the patient-physician relationship to navigate the wide range of issues involved in women’s autonomy over birth decisions.

Consider for example that 1 in 5 of the roughly 5 million U.S. pregnancies in 2020 ended in miscarriages. 80% of these were in the first trimester, with the remaining 20% almost exclusively in the second trimester.

Health professional management of a miscarriage is an exceedingly complex affair. It requires rapid, same-day, evaluation to assess the mother’s condition, the stage of development and viability (if any) of the fetus, the need for medical or surgical treatment to minimize blood loss or prevent infection, and the short and long term management of grief, depression, and (at times) feelings of guilt for the mother and family members.

Now consider that the cases above are being grouped together by Republican state governors with another  930,000 women in 2020, who for a wide range of reasons, took a different path and chose to terminate their pregnancies. That’s roughly 14 women for every 1,000 women age 15-44 in our nation, with Southern states having 4 times the number of abortions as northeastern states. 54% used the 2-pill regimen for medical abortion, and 46% underwent a surgical procedure. In either case, health professional management was once again time dependent, complex, and required both medical and psychological team support to achieve satisfactory outcomes.

The size and nature of managing the societal challenge of maternal-fetal health is exactly the reason why the Supreme Court in 1973, in Roe v. Wade, entrusted the patient-physician relationship to navigate with women patients the wide range of issues involved in women’s autonomy over birth decisions. The ruling left decision making largely in the hands of women and their doctors during the first two trimesters, and allowed a significant role for government in the third trimester.

At the time, most agreed that this reasoned compromise was both wise and sound, and leaders accepted that “perfect should never be the enemy of the good.” For example, in 1971, America’s leading conservative religious organization, the Southern Baptist Convention, went on record as encouraging its members “to work for legislation that would allow the possibility of abortion under such conditions as rape, incest, clear evidence of severe fetal deformity, and carefully ascertained evidence of the likelihood of damage to the emotional, mental, and physical health of the mother.”

Two years later, both the Southern Baptist Convention and the Christian Medical Society chose not to actively oppose Roe v. Wade, and reaffirmed that position in 1974 and 1976. The Southern Baptist Convention’s views on abortion were part of its long-standing support for the separation of church and state, and Baptist medical communities largely opposed the idea of churches and their pastors wading into delicate health care issues.

Yet thanks to the Dobbs decision by a Court stacked with ultra-conservative Justices, here we go again with male state politicians playing doctor to the detriment of women’s freedom, autonomy, and health.  It’s 2023, and the GOP wants to manage your miscarriage. Are you good with that?

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