Now that Roe v Wade has been overturned many of the states in the USA are likely to enact abortion bans. These laws may be so draconian that women are not offered appropriate care for pregnancy problems such as miscarriage and ectopic pregnancy and their lives may be put at risk. There have been recent cases of women dying or being put at risk in Poland and Malta.
People think the abortion debate is all about terminating an unwanted pregnancy but the scope of laws banning abortion impacts the practice of safe obstetric and gynaecology care that could be needed by any pregnant woman, including those who may be vehemently opposed to abortion themselves. It also means that practitioners who want to be able to offer women an up to date, fully evidenced service encompassing the full range of treatments that may be needed are likely to choose not to practice in states with draconian abortion laws. This further impacts women by reducing availability of qualified practitioners and treatment choices.
The fact is that women who travel to these countries could find themselves in a dangerous situation where they will not be given the appropriate treatment they could expect in the U.K.
It is really important that all women of childbearing age understand this. If you could be pregnant, or your daughter or friend is pregnant and they travel to one of these countries and develop early pregnancy problems or miscarry they could actually die.
So I have written to Liz Truss to ask that all foreign office travel advice is updated to include advice regarding those countries and states in the USA that ban abortion.
Here is my letter. Perhaps not one of my best but I've added some references and please copy and paste or improve it and also write to Liz Truss and anyone else you feel appropriate.
The Right Hon Elizabeth Truss MP
Secretary of State for Foreign, Commonwealth and Development Affairs and
Minister for Women and Equalities
House of Commons
London
SW1A 0AA
26 June 2022
Dear Ms Truss
On Friday the Supreme Court in USA struck down Roe v Wade, overturning the constitutional right to an abortion for millions of women in USA. Thirteen states had “trigger” laws ready to ban abortion within 30 days of the ruling and others will follow.
For women in the United Kingdom who have grown up with the knowledge that safe access to abortion is legal and free, it is hard to understand the extent of the implications of this ruling. Many of the laws that ban abortion, both in USA and in other countries which ban abortion such as Poland and Malta, are so restrictive that safe and appropriate management of common pregnancy related problems such as ectopic pregnancy and miscarriage is hampered by abortion laws.
I did not understand this myself until the 2012 case of Savita Halappanavar, who died of sepsis after she contracted infection during a miscarriage. The pregnancy could not be terminated as there was still a foetal heartbeat and in Ireland she was denied appropriate treatment that would have been given if she had been living in the UK.
I work in the NHS and am a qualified midwife albeit not working in maternity currently. I can remember much of the lecture on abortion that we received as students from one of the hospital consultants. Miscarriage and ectopic pregnancy were not mentioned during this lecture, they were topics for another day. This is perhaps one of the reasons why I, and many other women and health professionals do not understand that treatment for these conditions can be impacted by strict abortion laws. Previously the terms used for miscarriage included the word “abortion”, such as “threatened abortion”, “septic abortion” or “incomplete abortion”. These days, out of respect for mothers who are likely to be upset at the loss of a pregnancy, language has been updated so that the word “miscarriage” is used instead of “abortion”, eg “threatened miscarriage” or “inevitable miscarriage”. It is easy to fail to understand that treatment of these events may fall within the remit of laws that ban abortion.
People think the abortion debate is all about terminating an unwanted pregnancy but the scope of laws banning abortion impacts the practice of safe obstetric and gynaecology care that could be needed by any pregnant woman, including those who may be vehemently opposed to abortion themselves. It also means that practitioners who want to be able to offer women an up to date, fully evidenced service encompassing the full range of treatments that may be needed are likely to choose not to practice in states with draconian abortion laws. This further impacts women by reducing availability of qualified practitioners and treatment choices.
More recent cases that have occurred in other countries include that of Isabel Sajbor who died last September in Poland, after her waters broke at 22 weeks gestation, but doctors would not induce delivery of the foetus despite the pregnancy not being viable so long as the foetus still had a heartbeat. When they were able to treat her surgically it was too late and infection and sepsis were advanced such that she died soon after.
Meanwhile just last week in Malta, Andrea Prudente an American tourist who was miscarrying at 16 weeks was also denied appropriate treatment as the foetus still had a heartbeat. Terrified she might succumb to infection she had to battle with doctors to share her medical records with her insurance company so that she could be transferred to another country for treatment. Thankfully she has been medically evacuated to Spain and I believe has now had appropriate treatment.
I have checked RCOG guidelines for treatment for these sorts of cases in the UK and there is no reference to abortion law. All treatment is guided by medical need on an individual basis. However, if British women, who are pregnant (they could be in very early pregnancy and quite unaware) travel to any of these countries or states in USA with abortion bans, their lives could be put at risk if they develop an ectopic pregnancy or if they miscarry.
For this reason I am writing to you to ask, as Secretary of State for Foreign, Commonwealth and Development Affairs and Minister for Women and Equalities, that you require the Foreign, Commonwealth and Development Office to update all Foreign Travel Advice to include advice regarding abortion and women’s health so that British women of childbearing age can make an informed choice when travelling to these countries, and consider avoiding travel to them if they are pregnant or there is a possibility that they may be.
I would also ask you to raise this issue with Travel Insurance providers, so that they can give customers appropriate advice and ensure that medical evacuation or repatriation is covered and can quickly be arranged if women need it.
I hope you will recognise the importance of this demands whilst deploring the treatment of women in these countries.
Yours sincerely
References:
https://elearning.rcog.org.uk/sites/default/files/Early%20pregnancy%20loss%20-%20management/sagilitogg_2007.pdf
https://www.bbc.co.uk/news/uk-northern-ireland-203217411_
https://www.ekathimerini.com/nytimes/1186635/poland-shows-the-risks-for-women-when-abortion-is-banned/
https://www.theguardian.com/global-development/2022/jun/22/us-woman-left-traumatised-after-malta-hospital-refuses-life-saving-abortionn_