The Real Victims of Stupak-Pitts
From Nancy Stanwood, MD, MPH:
My patient Carol was excited to give birth to her first child. Her husband was a Marine serving in Afghanistan. Sadly, in her second trimester, Carol learned that her baby had a lethal anomaly. She and her husband made the difficult decision to have an abortion.
That’s when they learned that the military health insurance they relied on wouldn’t cover the abortion unless Carol’s life was in danger.
Her husband was outraged. He had just flown back from Afghanistan to be with her, and he angrily asked me, “I’m over there defending my country, and they won’t even take care of my family?”
From Natalie Roche, MD:
Renee was 18 years old and in prenatal care for a pregnancy she wanted. Her physician found that she had an elevated white blood count. Renee was diagnosed with acute leukemia.
Her oncologist could not begin treatment. The chemotherapy Renee needed came with a risk of miscarriage that could cause fatal hemorrhaging or infection. She decided to have an abortion to save her life.
But Renee did not have insurance. It took time for her to find a doctor who could perform her abortion. The time she spent searching for a provider she could afford endangered her health. She developed anemia and dangerously low white blood cell and platelet counts. She also entered the second trimester of her pregnancy, making her abortion riskier.
I performed her abortion successfully, and Renee went on to have her treatment for leukemia. I do not know if it was too late.
From Willie Parker, MD, MPH:
A woman who was 16 weeks pregnant and had an alcohol problem came to me for an abortion. She knew that she was not ready to be a mother. But she had a condition with her placenta that made abortion risky, and I had to tell her that the procedure would require a hospital stay, making it much more expensive.
She didn’t have insurance or enough money to cover the termination. She had no choice but to continue the pregnancy. I got her into prenatal care. That was the best I could do.
From Pratima Gupta, MD, MPH:
I wasn’t able to help Anna. She became pregnant unexpectedly and decided to have an abortion. But when I started the paperwork for Anna’s procedure, her insurance coverage was denied. Anna works for the postal service, and as a government employee, she is not allowed to have health insurance coverage for abortion.
I had to tell Anna that I couldn’t provide her abortion, and I gave her the phone numbers of some clinics that could help. In the end, Anna had to borrow money from several friends to pay for her abortion. I will never forget how frightened and frantic she was to learn that her good government health insurance didn’t cover the care she needed.
From Renee E. Mestad, MD:
My patient Sherry is 24, pregnant, and the mother of a 7-month-old son. Although her pregnancy was not planned, Sherry and her husband were initially excited to have a little brother or sister for their boy. Then Sherry’s early ultrasound showed she had twins. She and her husband spent several weeks eagerly anticipating the growth of their family.
But the next ultrasound showed that the twins are conjoined, or Siamese. The babies are joined at the head, sharing a brain, and chest, sharing a heart. They have two spines, four arms, and four legs. It would be impossible to separate them. If they survive after birth, it would only be for a few minutes. One heart can’t keep two bodies alive. The risk of stillbirth is also very high.
Now 19 weeks into her pregnancy, Sherry tells me she is depressed. She wakes up every morning wondering if today will be the day her babies will die inside her. How would she deliver them? She knows that she would probably need a cesarean section because their combined size might make them too large for the birth canal. Sherry then imagines carrying the twins for another four and a half months. She sees herself delivering stillborns or watching her babies die minutes after their birth.
Sherry must decide whether to continue her pregnancy. An abortion might give her and her husband some emotional relief. And if the twins are small enough, she might not need surgery to remove them.
But because Sherry’s insurance will not pay for her abortion, she has to worry about money on top of her other fears. She is on Medicaid, which will cover the twins’ delivery, alive or dead, but not an abortion—fetal abnormality isn’t enough to get around the Hyde amendment. Although the abortion would be less expensive in a clinic, Sherry would have to go to a hospital since she could need surgery. She would be responsible for the entire bill of at least $10,000 to cover the operating room, anesthesia, medication, and other fees. This expense would destroy her family’s financial well-being.
Sherry can carry her babies to term who cannot and will not live, or she can have an abortion and possibly bankrupt her family.
Sherry’s pregnancy is medically rare, but her dilemma about money is all too familiar. When a woman doesn’t have insurance coverage for abortion, she and her family suffer.