Wednesday, October 23, 2024

Abortion -- Secondary and Tertiary Effects

One of the points we have been hammering for a long time now is that much, possibly even most of the impact of the Dobbs ruling will come from its secondary and tertiary effects. For the moment, we are keeping the discussion very narrow and leaving out issues like rape and incest or the larger impact on reproductive rights, not because they are unimportant (very much the opposite), but because they are too big to work in here.

Some of this is arbitrary, but this is how we are defining our terms.

The primary effect is that women lose the right to terminate a pregnancy.

Secondary effects include treatments for pregnant women, particularly with respect to miscarriages and other complications. They generally involve healthcare providers refusing to perform necessary procedures out of the fear that these will be incorrectly classified as abortions.

Tertiary effects include the direct and indirect impact on the healthcare and rights of all women including those who are not and in some cases may not be capable of becoming pregnant. If a woman loses access to a drug because that drug can also be used as an abortifacient, that is a tertiary effect. If a woman's Dr. moves out of a state or if new doctors choose not to locate in a state due to antiabortion laws, that is a tertiary effect. If women lose their right to privacy due to things like menstrual tracking, that is a tertiary effect.

The negative impact on postnatal treatment is a tertiary effect, which brings us to Louisiana, which even more than Texas has become Ground Zero for this story.

From NPR's All Things Considered:

A new Louisiana law will re-classify misoprostol as a dangerous controlled substance

Rosemary Westwood | September 27, 2024

 Louisiana already bans nearly all abortions. But starting in October, there will be additional restrictions on mifepristone and misoprostol. These drugs are used in medication abortions but also have other uses in pregnancy care. Under a new law in Louisiana, they will be reclassified as controlled, dangerous substances. WWNO’s Rosemary Westwood in New Orleans explains why doctors there are worried.

If women start bleeding out after giving birth, one of the key drugs doctors can reach for is misoprostol. It’s effective, safe and cheap. And hospitals often keep it immediately available on special hemorrhage carts in labor and delivery rooms.

JENNIFER AVEGNO: You have it either right there in the room, in an easy-to-access cart, or you’ve got nurses who walk around with it in their pocket, going from room to room.

WESTWOOD: That’s Dr. Jennifer Avegno, the director of the New Orleans Health Department. Over the summer, she started hearing that hospitals were pulling misoprostol off the carts and out of the rooms. They’re moving the drug to locked cabinets because that’s what’s required for controlled, dangerous substances.

Most controlled drugs have the potential of being abused, like Ambien and Xanax. Misoprostol doesn’t. But in some hospitals, doctors or nurses will have to go farther to reach it and unlock the cabinet. Avegno says some are even running drills to see how much longer it will take. New Orleans OB-GYN Nicole Freehill says any delay is dangerous.

NICOLE FREEHILL: Somebody’s just bleeding profusely. And at that point, if it takes even two minutes to access that medicine versus 20 seconds that it used to take when it was on the hemorrhage cart in the room, those seconds matter.


Under the category of secondary effects, which have produced dozens of horrifying and heartbreaking stories, Louisiana was also the state where Kaitlyn Joshua suffered her traumatic experience.



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