The situation with respect to abortion rights, and reproductive care overall is different throughout the United States, on account of the recent Supreme Court of the United States (SCOTUS) decision on the Dobbs versus Jackson Women’s Health Organization abortion case this past June. That’s why we are touring the US states here on The Pulse, touring the states with respect to reproductive care. To remind you, the Dobbs versus Jackson Women’s Health case involved a Mississippi law prohibiting abortions after 15 weeks gestation. Not only did six of the nine SCOTUS justices vote to uphold the Mississippi law, but five of those six also voted to overturn the Roe versus Wade decision of 1973. Written by Associate Justice Samuel Alito, the Dobbs decision reverses Roe v Wade by taking issue with substantive due process, a mechanism through which Roe v Wade applied the 14th Amendment to protect abortion as a privacy right. But the Dobbs decision did not come out of a void. It followed almost a 50 year process of chipping away at abortion rights. During that half century, several US states with state legislatures and governors opposing abortion passed abortion trigger laws, laws that would go into effect in the event of Roe v Wade being overturned. This, plus the passage of new laws, has begun to restrict abortion access further in such states, but there are others states that are going all out to protect abortion rights and in some cases, such as in Kansas, abortion rights have been preserved despite dominance by antiabortion politicians. Meanwhile, pro-choice states, such as New York, are becoming destinations for abortion seekers from elsewhere in the United States.
Today, let’s begin with Illinois, the Prairie State, the Land of Lincoln. This is a haven for abortion rights in the Great Lakes region and throughout the the midwestern United States, so Illinois is poised to become a destination for many women from anti-abortion states. Illinois, especially in the Chicago area, harbors a very large number of abortion providers, including for travelers from out-of-state. One challenging issue, however is that such high influx of out-of-state abortion seekers is expected that it may take some time for the Illinois infrastructure to catch up with the rising abortion demand. The electorate and the government of the Land of Lincoln is generally pro-choice. The state Governor, Jay Robert “JB” Pritzker, is working to strengthen the already progressive pro-choice legal framework of the state.
Meanwhile, the the northwest of Illinois, the North Star State, Minnesota has been friendly to abortion rights for many years. Like Illinois, Minnesota is becoming a haven for women from surrounding states who wish to terminate unwanted pregnancies. Judge Thomas A. Gilligan, Jr. of the Ramsey County District has blocked restrictions that state legislators have placed against abortion. Such antiabortion politicians have been motivated by the Dobbs v Jackson SCOTUS decision, but historically Minnesota has has been abortion safe and is likely to remain that way.
In both of these pro-choice states, you have access to medication abortion, which you can have up to the gestational day 77, meaning through the end of the 11th week of pregnancy. A medication abortion, also called a medical abortion, is an abortion that is achieved with medicines alone, without the need for instruments to be inserted into the uterus. Usually, a medication abortion consists of mifepristone, followed 36 to 48 hours later by misoprostol.
For those beyond 77 days gestation, or who otherwise do not opt for a medication abortion, pregnancy can be terminated by way of a procedural abortion, also called a surgical abortion. The various procedure begin with dilation of the cervix, meaning that the cervix is encouraged to open. This can be done with an instrument that the OB/GYN pushes through the cervix, typically after medication has been applied hours earlier to help the cervix to relax. Alternatively, the OB/GYN can insert what’s called a laminaria stick. This is made of seaweed and it expands as it absorbs water. After a few to several hours, the cervix can be open enough to allow a procedure. Following this step, there are a few options, depending on how advanced the pregnancy is. In one such procedure, called a D&C, which stands for dilatation and curettage, the inner lining of the uterus is scraped. D&Cs also are performed frequently 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. At some point during pregnancy, generally around the midpoint, suction is not enough to extract either a viable or inviable fetus. In such cases, the OB/GYN must use instruments to grab onto the fetus, or parts of the fetus. Such a procedure is known as a D&E, which stands for dilatation and extraction. The extraction includes not only the fetus, but also the placenta, as well as the membranes.
