Her repeated requests for an abortion were ignored due to the presence of a fetal heartbeat, according to her husband. He died of septicemia – or bacterial blood poisoning – 2 ½ days later. Halappanavar’s death is regarded as a pivotal moment in the abortion debate in Ireland, leading the country to overturn its constitutional ban on abortion in a referendum six years later. Pregnancy and the birth process can be traumatic and have inherent risks – from excessive bleeding to vaginal and other forms of tearing, cardiovascular problems and death. The maternal mortality rate is eight per 100,000 in Canada, compared to 24 per 100,000 in the United States — a much higher mortality risk than that of a legal abortion procedure. Doctors in the US are now pointing to Halappanavar’s death as an example of the thorny legal and ethical challenges they face — as well as the potentially deadly consequences — after Roe v. Wade. According to Dr. Louise King, a bioethics expert at Harvard Medical School, in many states, doctors will have the impossible task of trying to determine exactly when an intervention should be deemed medically necessary, as was the case with Halappanavar. Messages are left at a memorial for Savita Halappanavar, a day after the abortion referendum voted to allow abortion in Ireland in 2018. (Clodagh Kilcoyne/Reuters) But if they act too quickly, he said, they could face the prospect of prosecution or fines under new or pending legislation, such as about half of US states is expected to outlaw or severely restrict abortion. “It’s absolute nonsense, because he’s leaving [physicians] in these situations where they have no real choice,” said King, who is also an obstetrician and gynecologist at Brigham and Women’s Hospital in Boston. “Broadly speaking, it removes an important choice … from all people who are pregnant in the United States, in states where abortion is restricted.”

When is an emergency an emergency?

In Missouri, for example, there is an exception for a “medical emergency,” while in Michigan, a law already in place allows only abortions “necessary to preserve the life” of a pregnant woman. (This law is on hold pending a court order.)
Doctors say the specifics of these exemptions remain unclear. Dr. Lisa Harris, obstetrics and gynecology associate chair at the University of Michigan, expressed her concerns in an essay widely circulated was published in the New England Journal of Medicine earlier this year. He then referred to the Supreme Court’s dissenting opinion in Dobbs v. Jackson Women’s Health, the case that overturned Roe v. Wade. “What must be the danger of death and how imminent must it be?” she wrote A security officer walks past the Jackson Women’s Health Organization clinic in Jackson, Miss., on July 3. The state’s only abortion clinic is trying to stay open and has filed a lawsuit trying to block a state law that would ban most abortions. (Rogelio V. Solis/The Associated Press) Doctors have identified “countless” scenarios where these questions apply, Harris said, from patients diagnosed with cancer during pregnancy to those with pulmonary hypertension, “for whom we report a 30 to 50 percent chance of dying with ongoing pregnancy”. One of the most commonly reported examples is an ectopic pregnancy, when a fertilized egg implants outside the uterus. Ectopic pregnancies are not viable and can be potentially fatal if the tissue where the egg is growing grows to the point of rupture. However, some US lawmakers have argued that they should not be exempt from abortion bans. Research shows that maternal mortality in the US, already on the rise, will rise further now that Roe is overturned. A study which was published last year He estimated that a nationwide ban on abortion in the US would lead to a 21 percent increase in maternal deaths and a 33 percent increase in deaths among blacks in particular. The study did not include a possible increase in deaths from unsafe abortions. Dr. Stephanie Mischell, a family physician in Dallas, Texas, said that before Roe v. Wade, was already forced to turn away many patients due to her state’s restrictive laws. The decision will make matters worse, he said. “The risk of mortality during the prenatal period, labor, delivery and the postpartum period is extremely high compared to people who are not pregnant,” said Michel, also a fellow at the advocacy group Physicians for Reproductive Health. “Especially for pregnant black women, we have a huge disparity there that’s really exacerbated in states where there are abortion bans. “Over and over and over again, we see that places where abortion is more limited, maternal mortality is much higher.”

Access is still a problem in Canada, says expert

Dr. Lacey Harding, an obstetrician in Toronto specializing in non-viable pregnancies and late-term abortions, sympathizes with her American colleagues. In her experience, there are situations where a pregnancy can be “very dangerous and could quickly get out of control.” Harding cited the example of a woman who broke her water at 14 weeks pregnant. “Unfortunately, there is almost no way it will end up being a healthy baby, even in a premature setting. So I sometimes advise patients to terminate the pregnancy now, because sepsis is a very dangerous condition.” WATCHES | This registered nurse says Canada needs to expand access to abortion:

Roe v. Wade decision sparks greater access to abortion in Canada

The U.S. Supreme Court’s decision to strike down abortion rights in the United States is prompting calls to protect and strengthen abortion care in Canada. Registered nurse Martha Painter says the federal government needs to expand access. Harding also said problems with access to abortion remain in Canada, even though it is decriminalized and treated as a medical procedure. She said she regularly sees patients several hours away by car, particularly those who need a late-term abortion for medical reasons. More clinics and better training would help, he said. “As the pregnancy goes on, things get a little more complicated,” Harding said. “Hospitals and other settings are just not willing or set up to provide that kind of care. So it can definitely be a minefield to navigate, definitely, definitely in terms of medically necessary care later in pregnancy, in some hospitals. “