Wisconsin’s criminal abortion law has been a major issue in the midterm elections, and some of the people most affected by it are physicians.
While some anti-choice politicians have tried to distance themselves from the prosecution aspect of the law, doctors and medical professionals who provide abortion care could be committing a felony. Although the law makes an exception for saving the life of the pregnant person, in practice, it can be difficult to know where the line is between what’s considered life-saving and what’s not.
Wisconsin is already facing a shortage of OBGYNs, and due to its abortion law, experts fear the state will have difficulty attracting new physicians and training those who come here for medical school. Dr. Laura Jacques, an assistant professor of obstetrics and gynecology at UW-Madison, talks about how abortion care is used for patients and how failing to provide this training could impact medical care in the state.
“The word abortion really just means the ending of a pregnancy,” says Jacques. “There’s a lot of gray area when it comes to what is an abortion, what the media or the general public understands as an abortion is sort of different than what is understood in medical literature.”
Jacques breaks down some types of abortion: spontaneous abortion, which covers miscarriage, ectopic pregnancy, inducted abortions to interrupt a pregnancy, and abortion as a result of rape. She explains that there are various health-related reasons that someone would want to end a pregnancy, like high blood pressure linked to kidney issues, higher risk of disease, fetal developmental anomalies, placenta planting, or any other case where the pregnancy causes health care risks to the patient.
This variety of needs for abortion and terminating pregnancy Jacques believes makes OBGYN abortion education training important and applicable to the field. She notes that one in five pregnancies result in miscarriage.
“There’s an incredible amount of overlap between pregnancy care for abortion and termination of pregnancy and also with early pregnancy loss and miscarriage,” says Jacques. “The way that we manage those two conditions medically are really similar, and so people who have more experience are going to feel more competent.”
Without this training, Jacques argues that the patients will be the ones to suffer. Oftentimes if a health care provider does not feel comfortable, they will have to be referred to outside of their community and their personal doctor. She says that some providers do not care for those dealing with second-trimester pregnancy loss during a 14-week gestational period.
“It's in a setting where they're already feeling oftentimes very vulnerable. They're grieving because they've just lost a pregnancy. And so then to have to travel to a city and a system that they're not familiar with, and not be able to be cared for by their doctor who they know," says Jacques." Who they have a relationship with, that they feel comfortable with, can be really difficult for them.”
Wisconsin has one of the strictest criminal abortion laws in the country. While it remains strict, it also proves to be vague and leads providers like Jacques and her colleagues to question the legality of their practices. Health care providers around Wisconsin have begun questioning when it is permissible to intervene in a failing pregnancy or when the diagnosis of ectopic pregnancy is certain enough to intervene.
“[Health care providers] think about this in the context of more rare but more risky second-trimester situations where the pregnancy is directly impacting the health of the pregnant person," says Jacques. "And when can they intervene and can they intervene to help that person or does that patient need to make the trip to Minnesota or Illinois.”
Jacques mentors all students in her department that are looking to match into obstetrics and gynecology. She has found that her students are already measuring their programs based on if they can provide abortion training.
“There's no question that this is on the minds of students. And that's because they recognize the importance of the training in their future ability to help their patients, even if they don't plan to provide elective abortion care induced abortion care,” says Jacques.
Students seeking a more rounded education elsewhere will significantly impact medical care in Wisconsin. One in five counties in Wisconsin qualifies as maternity care deserts, meaning they have limited or no access to obstetric services. Jacques fears the fewer people that come to train in Wisconsin because of these strict laws, the more the gap in care will worsen.
“So rural communities who are already struggling to provide adequate health care for their community members that's only going to worsen as we siphon off people who don't want to practice in an environment where their job could be criminalized,” says Jacques.
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