About a year ago, I was working with a friend and colleague on a vague idea for a piece along the lines of "abortion is health care... and health care sucks!" I gave a guest lecture on some of the themes we were exploring, we both got busy, the piece (God do I hate the word "piece") never developed further. Well, now here we are, sitting with the "puzzling" result that ballot measures protecting abortion at the state level did well while Kamala Harris bit the fucking dust in the presidential race. What could explain this? I don't expect the Democrats to do any reflection on this, but here on Closed Form we can say and do whatever we want.
A few years ago I wrote a profile of Leana Wen (she's baaaaaaaack!). I didn't have much as much space as I would have ideally liked to go into a detailed critique of her tenure as president of Planned Parenthood, but I came to take major issue with her "abortion is health care" campaign. Here's what I wrote then:
In 2018, Wen left Baltimore to accept a new job as the sixth president of Planned Parenthood — the first Asian-American woman and the second doctor to ever hold the role. Less than a year later, Wen was dismissed from the position, with a flurry of news reports describing differences in vision and strategy for the organization. The most insurmountable differences derived, in part, from her center-aisle approach to business; Wen’s vision, in her telling, was to depoliticize abortion by rebranding Planned Parenthood as a general health-care provider. In Lifelines [Wen’s memoir], this is framed as a concession to sensible moderates, based on her previous interactions with some Title X grant recipients who were leery of attending meetings where Planned Parenthood would be present. “If Planned Parenthood was seen as too controversial,” Wen writes, “then reproductive health was at risk of becoming even more cut off from the rest of health care.”
Wen’s goal was to resituate abortion within the spectrum of “regular” health care, but she confused cause and consequence: abortion is siloed off from other health care precisely because it is so politicized, and it is politicized because of fundamental values conflict over reproductive autonomy. Thus, with longstanding political conflicts increasingly placing reproductive rights at jeopardy, the head of the single largest provider of reproductive health services in the nation was busy placating a phantom constituency of moderates.
Abortion is, literally, health care -- sure. I have said as much in public fora before. It’s part of a wide, wide spectrum of obstetric care that covers much more than elective terminations. But what are the implications of depoliticizing abortion by medicalizing it like this?
The Democrats’ messaging highlighted the ways that abortion is embedded in this broader suite of care techniques. The ads that I saw featured partnered white women who really wanted to be moms, who needed an abortion procedure regrettably and through no fault of their own — like after a spontaneous miscarriage (if any “products of conception” remain in the uterus after a termination, whether induced or spontaneous, they can, for lack of a better word, rot; this can lead rapidly to septic infection and death if an abortion procedure is not performed) or in the case of an ectopic pregnancy (a life-threatening emergency where a fertilized embryo implants outside the uterus, usually in the fallopian tube; these pregnancies have no chance of survival and the patient will with 100% certainty die if the pregnancy is not terminated, contrary to the belief of 23 year old TikTok-brained MAGA dipshits that “we have the technology” to recoup the fertilized embryo and implant it in the uterus). Many focused on the torturous cruelty of forcing a person to carry a high-risk pregnancy with a fatal fetal anomaly through to term. These ads focused on the grievous injustice of being denied health care, of having to endure grueling hours of travel and significant expense to go out of state for routine procedures that take about fifteen minutes.
The stories featured were the stories of women who lived to tell the tale. Not everyone is so lucky. Josseli Barnica, age 28, died in Texas in 2021 after doctors at HCA Houston Healthcare Northwest made her wait more than 40 hours to receive routine care — a dilation and curettage, or D&C — after a spontaneous miscarriage that left products of conception in her uterus. Here’s what the ProPublica reporting on her case found:
On Sept. 2, 2021, at 17 weeks and four days pregnant, she went to the hospital with cramps, according to her records. The next day, when the bleeding worsened, she returned. Within two hours of her arrival on Sept. 3, an ultrasound confirmed “bulging membranes in the vagina with the fetal head in the open cervix,” dilated at 8.9 cm, and that she had low amniotic fluid. The miscarriage was “in progress,” the radiologist wrote.
When Barnica’s husband arrived, she told him doctors couldn’t intervene until there was no heartbeat.
The next day, Dr. Shirley Lima, an OB on duty, diagnosed an “inevitable” miscarriage.
In Barnica’s chart, she noted that the fetal heartbeat was detected and wrote that she was providing Barnica with pain medication and “emotional support.”
In a state that hadn’t banned abortion, Barnica could have immediately been offered the options that major medical organizations, including international ones, say is the standard of evidence-based care: speeding up labor with medication or a dilation and evacuation procedure to empty the uterus.
By the time no “fetal heartbeat” was detected and doctors treated Barnica to complete the miscarriage, it was too late. She returned to the hospital septic two days later and died there. The hospital doesn’t give a single shit:
Even three years after Barnica’s death, HCA Healthcare, the hospital chain that treated Barnica, will not disclose whether it has a policy on how to treat miscarriages.
Some HCA shareholders have asked the company to prepare a report on the risks to the company related to the bans in states that restrict abortion, so patients would understand what services they could expect and doctors would know under what circumstances they would be protected. But the board of directors opposed the proposal, partly because it would create an “unnecessary expense and burdens with limited benefits to our stockholders.” The proposal was supported by 8% of shareholders who voted.
Amber Nicole Thurman, also 28, died in Georgia after being denied care for an induced abortion. She had tried to get a surgical abortion in North Carolina, couldn’t, and instead self-managed an abortion with misoprostol and mifepristone. Very similarly to spontaneous miscarriage, medication abortions carry a small but meaningful risk that some products of conception will remain in the uterus. This is what happened to Thurman. Another ProPublica report describes the final hours of Thurman’s life after entering Piedmont Henry Hospital in Stockbridge, GA:
Within Thurman’s first hours at the hospital, which says it is staffed at all hours with an OB who specializes in hospital care, it should have been clear that she was in danger, medical experts told ProPublica.
Her lower abdomen was tender, according to the summary. Her white blood cell count was critically high and her blood pressure perilously low — at one point, as Thurman got up to go to the bathroom, she fainted again and hit her head. Doctors noted a foul odor during a pelvic exam, and an ultrasound showed possible tissue in her uterus.
The standard treatment of sepsis is to start antibiotics and immediately seek and remove the source of the infection. For a septic abortion, that would include removing any remaining tissue from the uterus. One of the hospital network’s own practices describes a D&C as a “fairly common, minor surgical procedure” to be used after a miscarriage to remove fetal tissue.
After assessing her at 9:38 p.m., doctors started Thurman on antibiotics and an IV drip, the summary said. The OB-GYN noted the possibility of doing a D&C the next day.
But that didn’t happen the following morning, even when an OB diagnosed “acute severe sepsis.” By 5:14 a.m., Thurman was breathing rapidly and at risk of bleeding out, according to her vital signs. Even five liters of IV fluid had not moved her blood pressure out of the danger zone. Doctors escalated the antibiotics.
Instead of performing the newly criminalized procedure, they continued to gather information and dispense medicine, the summary shows.
Doctors had Thurman tested for sexually transmitted diseases and pneumonia.
They placed her on Levophed, a powerful blood pressure support that could do nothing to treat the infection and posed a new threat: The medication can constrict blood flow so much that patients could need an amputation once stabilized.
At 6:45 a.m., Thurman’s blood pressure continued to dip, and she was taken to the intensive care unit.
At 7:14 a.m., doctors discussed initiating a D&C. But it still didn’t happen. Two hours later, lab work indicated her organs were failing, according to experts who read her vital signs.
At 12:05 p.m., more than 17 hours after Thurman had arrived, a doctor who specializes in intensive care notified the OB-GYN that her condition was deteriorating.
Thurman was finally taken to an operating room at 2 p.m.
By then, the situation was so dire that doctors started with open abdominal surgery. They found that her bowel needed to be removed, but it was too risky to operate because not enough blood was flowing to the area — a possible complication from the blood pressure medication, an expert explained to ProPublica. The OB performed the D&C but immediately continued with a hysterectomy.
During surgery, Thurman’s heart stopped.
In the heavily Catholic countries of Argentina, Ireland, and Poland, deaths from clanedstine abortion or due to delayed care for complications of abortion and miscarriage have been treated as a moral outrage and have catalyzed social action: with street protests in Poland, with a huge and successful campaign to repeal an amendment banning abortion in Ireland, with legalization of abortion behind the “green kerchief” movement in Argentina. But not here. In fact, the ProPublica article on Josseli Barnica’s death notes this:
Many noted a striking similarity to the case of Savita Halappavanar, a 31-year-old woman who died of septic shock in 2012 after providers in Ireland refused to empty her uterus while she was miscarrying at 17 weeks. When she begged for care, a midwife told her, “This is a Catholic country.” The resulting investigation and public outcry galvanized the country to change its strict ban on abortion.
But in the wake of deaths related to abortion access in the United States, leaders who support restricting the right have not called for any reforms.
Why is this? The reasons are complex and far-ranging. But I think that this is related in some way to the move to “depoliticize” abortion as health care. Of course, neither abortion nor health care are depoliticized. But in the US, it’s extremely commonplace for people to die because they are refused medical care. That’s a common feature of the health care system and the provision of care on a for-profit basis. If your right to abortion is your right to health care, then it’s the right to die capriciously and arbitrarily because of financial and legal architecture that has nothing to do with saving your life. The Democrats, ever-averse to even lukewarm feminist talking points and extremely averse to challenging the labyrinthine and inhumane logic of health care rationing, have essentially conceded that women and uterus-havers deserve rights as health care consumers, not as people, which leaves a lot of room for people to keep dying unnecessarily. The obvious answer is not to depoliticize but to re-politicize not only abortion, but health and health care in general. The equally obvious prediction is that this will not be forthcoming. The Dems are in the deep strangling thrall of big corporate donors, including in health care, and of a murderous model of politics where the repeal of Roe and the acceleration of these deaths is something they can campaign and, most importantly, fundraise on in perpetuity.