Reproductive Care and Abortion in the US Virgin Islands

We are approaching the end of our reproductive tour of the United States, headed today for a US territory, the US Virgin Islands. Here on The Pulse, we have been going state by state, region by region, looking at reproductive law, especially as it relates to abortion, because of the Supreme Court of the United States (SCOTUS) decision last June. Designated as the Dobbs versus Jackson Women’s Health Organization case, this was an abortion case concerning a Mississippi law prohibiting abortion after 15 weeks of pregnancy. This means 15 weeks counting from the first day of bleeding of the last menstrual period. Six of nine SCOTUS justices voted to uphold the Mississippi law, but the law did not go into effect. That’s because five of those six justices also joined onto a majority opinion written by Associate Justice Samuel Alito overturning the 1973 Roe v Wade decision that protected the right to choose. Being one of the most hostile US states against the right to choose, Mississippi soon replaced its 15-week ban with a complete ban on abortion and various other states have done the same. Along with Mississippi, abortion hostile states include Tennessee, Georgia, Alabama, Arizona, Texas, Louisiana, and Missouri. In such states, there also are implications for pregnancy care overall and in some cases fertility treatment is being threatened as well. Even with strong majorities of anti-choice Republican politicians and anti-choice governors, some states have upheld abortion rights, because of the state constitution, or because of the court system. Such states include Kansas, Alaska, Montana, and Ohio. Meanwhile, legal systems supporting abortion and reproductive rights for abortion seekers from inside and outside the state are in place on numerous states, including New York, Connecticut, Illinois, Oregon, New Mexico, Washington, and North Carolina. Pro-choice systems are also present in US territories, such as Puerto Rico and practically speaking also in the highlighted US territory for today, the Virgin Islands.

Although abortion in the US Virgin Islands technically is not protected legally as a right, as of the writing of this post in early November, abortion is permitted up to 24 weeks. It is not considered to be a crime of any sort and it is available as part of health care. This puts the US Virgin Islands in the realm fetal viability for the cutoff point, although there are some restrictions. Outside of hospitals, abortions are permitted only up to 12 weeks. Beyond 12 weeks, up to 24 weeks, they must be performed in hospital. As with other regions of the US that permit abortion, you can have a medication abortion up to 77 days (11 weeks) gestation. Otherwise, it must be a procedural abortion, also known as surgical abortion.

One type of procedural abortion that can be used for an abortion 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.

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. All the products of conception must be removed and accounted for, because products that remain inside the uterus can become infected. In discussing these techniques, notice how we have switched back and forth between mentioning elective and non-elective procedures. That’s because performing any of these procedures requires the same set of skills regardless of whether it’s a medical necessity, such as removal of retained products after a missed abortion, or it’s an unwanted pregnancy.

In contrast with the US Virgin Islands, the British Virgin Islands actually prohibit abortion. Consequently, the US Virgin Islands are a destination for British Virgin Islands abortion seekers.

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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