Abortion and Reproductive Care in the State of Georgia

As you surely know, if you have been reading my posts here on The Pulse, we have been exploring the patchwork of different situations regarding access to abortion in different US states. This is because This is because, back in June, the Supreme Court of the United States (SCOTUS) ruled on the Dobbs versus Jackson Womens Health Organization abortion case, involving Mississippi’s Gestational Age Act. Written to prohibit all abortions subsequent to 15 weeks gestation, with very few exceptions, the Mississippi was upheld in the highest court of the United States, but the ramifications have extended far beyond the borders of that one state. That’s because the majority opinion in Dobbs, representing the views of five of the nine SCOTUS justices, overturned the 1973 Roe v Wade decision. This means that SCOTUS no longer agrees that the US Constitution, by way of the Due Process Clause of the Fourteenth Amendment, protects privacy in a way that should prevent all states from prohibiting abortion.

In the aftermath of the Dobbs decision, numerous pro-choice states, including New York, Connecticut, Illinois, Oregon, and Washington have been extremely supportive of abortion rights, as they were prior to Dobbs, but also are welcoming abortion seekers from other US states. Some pro-choice states, such as Oregon, even have budgeted funding to support travel and lodging for women who arrive from anti-abortion states. Available care in states where abortion is legal includes medication abortion, which is possible up to a gestational age of 77 days (11 weeks), as well as procedure abortions, meaning that the provider works with instruments to terminate the pregnancy. One such procedure is called a D&C, which stands for dilatation and curettage. Curettage is a kind of scraping of the inner lining of the uterus. Extracting a pregnancy, either viable or not, is only one of several reasons for performing a D&C. D&Cs can be performed for diagnostic reasons, such as when there’s a suspicion of abnormal cell growth in the endometrium. Therapeutic D&Cs can be performed for removing products of conception, but also for removing overgrowth of the uterine lining. D&C by itself is adequate only early in pregnancy, so after a certain point the next option is dilatation and suction. This means that, after the cervix is dilated, the doctor suctions out the products of conception. Sometimes this can be done with a syringe, but often it requires power suction. A tube called a cannula is inserted through the opened cervix. Cannulae come in a range of sizes that are chosen based on how far along the pregnancy is, or was before it became inviable. In some cases, following suction, the doctor may then perform some curettage to extract any remaining products of conception.

Today our focus is the Peach State, Georgia, which has a long history of being hostile to abortion rights, dating back to the era prior to Roe V Wade. Back in the 1960s, The Peach State did not permit abortion, even in cases of incest. More recently, in the aftermath of the Dobbs decision overturning the Roe decision, a Georgia law went into effect prohibiting abortion beyond a gestational age of six weeks. The Georgia law allows exceptions in cases of rape and incest, although you must have a police report of the incident on file and know that you’re pregnant before that six week cutoff point. Exceptions are also allowed when the mother’s life is in danger, but it is expected that abortion providers will hesitate, fearing prosecution and potential loss of licensure, because most issues that threaten a pregnant woman’s life show up, not when she is about to die in that very moment, but earlier. While laws like the one in Georgia would leave little doubt, that a pregnant woman’s life is in danger when she is coding (her heart is not pumping blood adequately and she needs advanced cardiac life support), such laws create legal uncertainty for clinicians when the mother’s health is deteriorating in connection with pregnancy.

Now let’s talk about this six-week gestational age that Georgia and some other US states have chosen as their cut-off point for legal abortion. As we have discussed, we start counting the gestational age on the first day of bleeding of the last menstrual period, prior to pregnancy. The optimal time window for fertilization in women with the classic 28-29-day cycle is thus two weeks into the gestational age count, then implantation of an entity called a blastocyst (a kind of early embryo) into the endometrium (lining of the uterus) takes place 5-6 days after fertilization. This means that pregnancy begins near the end of week three, and it can begin even later in women with longer cycles, such as those with polycystic ovarian syndrome. It then takes several days before a home pregnancy test would be positive, and consequently many women do not learn that they are pregnant until well after six weeks gestation. States such as Georgia have chosen six weeks as milestone based on the idea that a ‘heartbeat’ can be (but isn’t always) detectable by this point on ultrasound. What that means so early in pregnancy is not the presence of a heart, but simply the coordinated beating of muscle tissue around blood vessels that are in the process of fusing into what will become a fish-like heart as development advances. It does not have any significance in terms of the early embryo being a person. It’s not a person. It’s a 6 millimeter, brainless entity at this point and what anti-choice activists and politicians are doing is trying to get women emotional about about the cyclic sound that the cyclic movement of blood through the embryonic pre-heart may produce at 6 weeks, when ultrasound is applied in what’s called Doppler mode. Often, it takes a few weeks longer than 6 weeks, but either way, there is nothing special about it. All that Doppler detects is blood moving fast, then not so fast, then fast again. But what that six-week cut-off point actually does is to prevent many women from having access to abortion at all.

So what do you do if you have an unwanted pregnancy in Georgia and you are beyond six weeks? The answer is that you need to travel out of state. As of the writing of this post in late

September, abortion is still legal in Florida up to 15 weeks. Usually, 15 weeks is enough time to know that you are pregnant and to decide to end the pregnancy and most abortions do occur before 15 weeks. However, there are cases when you may not find out until after 15 weeks about serious chromosomal anomalies, or other fetal abnormalities that may lead you to terminate pregnancy. In the opposite direction from Florida, there is North Carolina, which more supportive of abortion rights than Florida and is becoming a haven for abortion seekers from throughout the American southeast.

Also, keep the politics in mind. Georgia’s governor, Brian Kemp, is staunchly antichoice, but he is running for reelection this November against challenger Stacey Abrams, who is unequivocally pro-choice. Also, keep in mind which candidates are for or against a woman’s right to choose in the district where you vote. Mixed in with the politics is the fact that in states such as Georgia that are dominated by politicians who want embryos to be considered to be people, it’s not just abortion that’s at risk. It’s also various other aspects of reproductive care, including technologies, such as in vitro fertilization that help people to want to become parents. So make sure to get out and vote.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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