Pregnancy is a medical condition. Call it what you will—miracle, blessing, burden, number-one fear—it’s a health condition for which people seek medical and/or health care. But people, and our government, treat it like some special exception. People often say to me, “It’s not a disease, it’s a natural part of life.” Yes, well, so are bacteria, yet we call having an infection a “disease.” We cannot ignore that pregnancy alters one’s physiology and puts one’s health and life at risk due to these changes. We must accept this truth to be self evident, that pregnancy, while natural, is a condition that requires medical attention.
To say otherwise is to engage in reproductive coercion.
That’s right, I said it. Offering health insurance for prenatal care, but not for abortion or infertility care, is nothing short of coercion. Many state governments, including mine (Utah), are guilty of this reprehensible practice. To have policies in place that pay for (and thus “promote”) prenatal care, but then actually prohibit funding of other forms of pregnancy care, is financial coercion in reproductive health. If you are going to pay for me to continue a pregnancy, you should also pay for me to begin a pregnancy or to end a pregnancy. It's all part of the same health condition. If you need surgery, insurance doesn’t merely reimburse for the removal of the appendix (for example) and then forego reimbursement for the incision to open the body and the stitches to close it up. Who would stand for such an a la carte insurance plan? Everyone in this country would, apparently. We should vote intelligently, but we don’t.
Let’s say your sister, Rose, has high blood pressure and she needs treatment. We won’t get into the weeds of how Rose hasn’t taken very good care of herself, she has a poor diet, a sedentary lifestyle, and she does not exercise, but we know she needs treatment for high blood pressure.
Now, imagine that our legal system, health care system, and value system make it relatively easy and affordable to receive Treatment A, and makes Treatment B expensive and difficult—or impossible—to get. Rose’s health and life background are such that Treatment A carries much more risk to her wellbeing than Treatment B. The government has passed laws ensuring that taxpayer funds go toward paying for Treatment A, but it is against the law for virtually any to go toward Treatment B. (Never mind that Treatment B saves taxpayers a lot of money.) Rose wants to get Treatment B because she knows it’s safer for her and she wants to live a long, healthy life with her family, but she can’t afford it. She has no choice but to accept Treatment A given her financial situation.
Do you think your sister has been able to make a real choice regarding her health care options? Do you think it’s fair that she risk her health and life because of government policies that have no basis in public health improvement? Neither do I.
Yet this is how reproductive health care is conducted in our country. Treatment A is prenatal care vs Treatment B that is abortion care. Treatment A is abstinence-only sex education vs Treatment B that is comprehensive sex education. Treatment A is the crisis pregnancy center vs Treatment B that is Planned Parenthood. Etc, etc.
There is no choice for those who are pregnant and do not want to be, at least if they are someone who depends on having health insurance in order to obtain health care. You either continue your undesired pregnancy, which is all paid for, and risk your health and life, or you find your own way (hopefully) to access the abortion that fulfills your right to life, liberty, and the pursuit of happiness.
It seems crystal clear that this kind of reproductive coercion is unconstitutional.
Before anyone chimes in with “But what about the baby’s rights?” I will first direct you to a lovely article by Andrea Grimes regarding appropriate language (zygote/embryo/fetus/etc.) and why it matters. Then I will assert that a fetus is not equal to the person pregnant with it and never can be whilst it depends on the bodily functions of said person. To equate a fetus to its pregnant mother is factually incorrect, even though philosophically you may be able to argue it. Even still, a philosophical argument of their equality can be put forth until the cows come home. But once they do, the only philosophy that matters is that of the person who is pregnant. I have cared for a wide range of pregnant people and I can tell you this: While some would give their own life to save the pregnancy, others see the pregnancy as, yes, a clump of cells. Both views, and everything in between, are valid. And they are sufficient reason for a pregnant person to make their own decision about their own body. As long as my life and my health are affected by a pregnancy, I am the one calling the shots.
Carrying a pregnancy involves significant risks. It is my ethical medical duty, my personal moral obligation, and my humble honor to provide medical care to any and all pregnant people. And that includes helping those who cannot get pregnant to become pregnant, and helping those who are pregnant and don’t want to be.
Your Gynecolumnist regularly donates to Guttmacher.org.
Leah Torres, M.D., is a physician specializing in obstetrics and gynecology. Twitter: @LeahNTorres
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