How abortion providers are adjusting to new realities in a post-Roe world

After the Supreme Court ruling on Roe, physicians in states with near-total abortion bans are having to navigate medically and ethically murky waters. In Texas, for example, a law set to go into effect makes all abortions illegal, including in cases of rape and incest. Dr. Ghazaleh Moayedi, an OB-GYN in Texas who had offered abortion care as part of her practice, joins Stephanie Sy to discuss.

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  • Judy Woodruff:

    It's been almost two weeks since the Supreme Court overturned the five-decade-old landmark abortion rights decision Roe v. Wade.

    In that short time, doctors and abortion providers have been left to navigate different state-by-state laws while still trying to provide care for their patients.

    Stephanie Sy has more.

  • Stephanie Sy:

    In this post-Roe world, physicians in states with near total abortion bans are having to wade through medically and ethically murky waters.

    In Texas, for example, a law set to go into effect makes all abortions illegal, including in cases of rape and incest. The only exception is to keep a woman from dying. But what does that mean in practice?

    To help us understand, I'm joined by Dr. Ghazaleh Moayedi, an OB-GYN in Texas who had offered abortion care as part of her practice.

    Dr. Moayedi, thank you so much for joining the "NewsHour."

    I want to jump right in here.

    In Texas, the law says if a doctor sees — quote — "substantial impairment of bodily function during a pregnancy," they can legally provide an abortion. But couldn't that mean something different to every doctor? And what are the ramifications of that?

  • Dr. Ghazaleh Moayedi, OB-GYN:

    Exactly, Stephanie.

    There isn't one type of medical complication where you say, OK, this is life-threatening, and this isn't. In practice, what that means is that every single person will be faced with different hospitals, different physicians, different nurses that will make different decisions depending on the day. And that is catastrophic to the health and well-being of pregnant people in our state.

  • Stephanie Sy:

    Dr. Moayedi, in the recent article you co-authored that was published in "The New England Journal of Medicine," you interviewed dozens of clinicians in Texas.

    And you wrote — quote — "Patients with pregnancy complications or preexisting medical conditions that may be exacerbated by pregnancy are being forced to delay an abortion until their conditions become life-threatening."

    Do you think that some doctors are already waiting until a woman's vital signs are in distress, where she is near dying, before they feel they are legally covered to provide an abortion?

  • Dr. Ghazaleh Moayedi:

    Yes, that's exactly what we saw in the research that we conducted and exactly what I have been hearing from my colleagues across the state, that people will come in the early second trimester with their bag of water broken.

    This is a pregnancy complication that, let's say, at 18 weeks, cannot be saved. But they are being told that they need to go home and wait until they have a fever, wait until they start hemorrhaging, or wait until they show signs of sepsis before they can return to have an abortion.

    And that is — we saw that through our study. And I'm hearing that from colleagues all across the state in that setting.

  • Stephanie Sy:

    Another complication that can happen in pregnancy and one of the most dangerous is an ectopic pregnancy, when a fertilized egg implants outside the uterus. This is, in theory, excluded from the abortion ban in Texas, but what are you hearing in practice is happening in that instance?

  • Dr. Ghazaleh Moayedi:

    Exactly.

    Even an ectopic pregnancy, which seemingly is excluded, falls into a gray area, which can be interpreted differently depending on where the person shows up. So, most commonly, an ectopic pregnancy might implant in the fallopian tubes or in the ovaries. But an ectopic pregnancy can also implant into a C-section scar or into a uterine scar from a prior surgery.

    That pregnancy will then grow through the uterine scar, potentially outside of the uterus, and into the bladder. Even before this ban went into effect, there were hospitals in Texas that would refuse to care for someone with an ectopic in the C-section scar, because they weren't sure if it was actually an ectopic or not.

    And so what we are seeing now is that more and more people are being denied care for these gray areas that are not as clear-cut, because that decision-making is very individualized. It can't be clearly defined in a law, this is a complication, and this is not a complication, this is near death, and this is not near death. That is very individual.

  • Stephanie Sy:

    In all the cases you have described so far, we're talking about the life of the mother. What about those mothers that are carrying fetuses with diagnosed fatal abnormalities, genetic abnormalities, where they know that, once they have the baby, that the baby's lifespan is limited?

  • Dr. Ghazaleh Moayedi:

    Yes, unfortunately, none of these laws in our state have any exceptions for lethal fetal diagnosis.

    And so what we have seen over the past 10 months is that people that are diagnosed with lethal fetal conditions, for example, like anencephaly, where the brain doesn't grow, or renal agenesis, where there are no kidneys, there is not a potential for life after birth, and yet pregnant people are forced to endure a complete pregnancy and the risks that come with that.

    And we have to remember Texas has one of the highest maternal mortality rates in the country, even more so for Black women in our state. And so this disproportionately puts Black people, people of color at risk of maternal death, without any benefit or potential chance for a live birth.

  • Stephanie Sy:

    And we know that the United States as a whole has a higher maternal mortality rate than other nations of equal affluence.

    If a doctor or a hospital does make a decision to not provide an and that leads to a woman's or a girl's death, what accountability do they have under the law?

  • Dr. Ghazaleh Moayedi:

    You know, that will remain to be seen.

    I strongly believe that our duty is to our community and to our patients. And we have to act through that moral compass, the ethical duty we have to care for people and to save their lives. But how this is going to turn out from a medical legal standpoint is going to be determined by the courts.

    And that is the even more terrifying part for all of us, as pregnant people, as pregnant-capable people, as moms, and as Americans.

  • Stephanie Sy:

    Dr. Ghazaleh Moayedi, an OB-GYN in Texas, thank you for joining the "NewsHour."

  • Dr. Ghazaleh Moayedi:

    Thank you for having me.

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