by Anne Marie Reidy, MD, JD
He stood in the doorway, threatening to call his lawyer. The man was irate that his wife had asked a friend to come to her ultrasound appointment with her “without his permission.” He said, “that’s my child,” as if he had total control over his wife’s body because she was carrying his unborn child. Understand, his wife was not attempting to keep him from attending the ultrasound. These parents-to-be were in the process of divorcing, and we knew the husband had been physically abusive. No wonder she wanted a sympathetic person present for her ultrasound and visit.
We stood our ground. “No sir, your wife is entitled to have someone else with her.” Not for the first time, we wondered if we needed to have security at our lovely, boutique practice. He called his lawyer. No surprise, he did not get the answer he wanted. The ultrasound proceeded as planned.
This scenario played out recently at Women4Women OBGYN, my practice in Huntsville, Alabama. Later that day, I reflected on what would be the logical consequences of giving an unborn child the same legal status as an actual child. Could a husband have control over his wife’s choices just because she is pregnant? What made him think he was entitled to dictate who could be present at her prenatal ultrasounds? Would he demand she follow a certain diet and think he had the right to enforce it? Would he curtail any dangerous activities, like driving on the highway? How far did he think his control reached?
The Dobbs Decision in 2022 reversed Roe v. Wade and gave the power to regulate abortion and other reproductive rights to the individual states. [https://constitutioncenter.org/the-constitution/supreme-court-case-library/dobbs-v-jackson-womens-health-organization] The results of that decision and the 2024 Alabama Supreme Court decision [https://publichealth.jhu.edu/2024/the-alabama-supreme-courts-ruling-on-frozen-embryos] designating frozen embryos as “children” have been dramatic and swift. The effects are still unfolding.
What are some of the real life consequences we are seeing here in Alabama? The example above is just one of the many areas where we see erosion of women’s rights to choose their own medical care for themselves for pregnancy, birth control, fertility treatment, pregnancy losses, and terminations.
When it comes to birth control, we have had a major uptick in young women (under age 30), coming in requesting surgical sterilization (having their fallopian tubes removed laparoscopically) because they are concerned they will lose that right down the road. They are rejecting options such as intra-uterine devices (which can be removed in case the patient changes her mind about future child-bearing) due to the uncertainty of whether insurance will cover such devices in the future. I am saddened that so many women feel that they have to make this decision so young, and not have the option of reversing it down the road. These are thoughtful, intelligent women who often say to me, “I don’t want to bring a child into this world.” They are referring to a whole host of issues, including the gender gap, the climate crisis, women’s rights, and the lack of support for working mothers.
As I delve deeper into a patient’s reasoning for her decision to have her tubes removed, I will often get the statement “I am terrified of getting pregnant.” It may actually rise to the level of a phobia in some patients. The possibility of an early pregnancy termination has been all but taken away from them, unless they have the resources and liberty to travel to another State. What woman wants to find herself in that predicament? Yet they know it is a risk, because there are unfortunately nonconsensual sexual encounters producing pregnancies happening all the time, and unless sterilized there could always be a failure of their chosen method of birth control, assuming they have one.
I also see married patients whose husbands have had vasectomies coming in for their own surgery. They are not planning a divorce, or having an affair, they are simply trying to prevent ever having to be in the position of having an unwanted, unplanned pregnancy in the future.
On the flip side of the coin, infertility is a growing problem all over, with Alabama having a high rate owing to our population’s obesity and other health issues. When it comes to assisted reproductive technology, our patients’ options are becoming limited. One of the two providers of this specialty in Huntsville moved to New York City to join a practice there. Patients can use the remaining specialist, or drive to Birmingham, about 90 minutes away for their care. Once they have embryos, the issues get thornier. How long to keep the embryos frozen? What to do if they have more embryos than they need? What if the couple divorces or disagrees?
I have a current patient who was informed by her fertility practice that unless she used her embryos in the next year, they were going to be shipped out of state. Her baby is not even a year old! She is feeling coerced into spacing her pregnancies closer together because of this. Another patient was faced with a similar dilemma and she opted to have her two remaining embryos transferred at the age of 45. They didn’t think the embryos would both take, but yes, she ended up with a very high risk pregnancy that threatened her own life and could have left her other children motherless.
Of course, we have all heard about patients not getting treatment for ectopic pregnancies or miscarriages by either not seeking treatment or by being turned away from emergency departments. Within our group, however, we have been fortunate not to have encountered those issues so far. The one instance I had where an early pregnancy was threatening a patient’s life by causing her to bleed out not once but twice was eventually taken care of under the exception in Alabama for terminations where the life of the mother is at risk. Fortunately, she underwent the life-saving procedure and has made a full recovery, in answer to both her and her husband’s prayers, and she can now concentrate on raising her two boys. I know not every state makes an exception for this, and I shudder to think of what would have happened to her if she happened to live in one of those states.
Tragically, lethal fetal anomalies (birth defects which are so severe that a baby won’t survive after birth even at full term) are something we find fairly often given the volume of patients we see. These are families who have all their hopes and dreams for their unborn child come crashing down when an ultrasound shows the baby is developing with a very malformed heart, or no brain, or multiple severe issues which prevent the development of the baby’s lungs, for example. Often, the patient is 20 weeks or more at the time of diagnosis. What is that patient to do? If the baby has a heartbeat, and the pregnancy is not threatening her life, there is nothing we can do in Alabama. She would simply have to wait until either the baby passes away in utero, or she gives birth. The out of state options for termination are few and far between.
As a business owner, I have found it difficult to recruit new physicians to come to Alabama due to its reputation for being “hostile” to women’s reproductive rights. A number of other local providers have retired recently and our city is having trouble keeping up with the growth of our population and the need for obstetric care. If Huntsville is seeing a shortage of OBGYNs, imagine how the rest of the state is faring. It has developed increasing “maternity deserts” where women have NO access to obstetric care and safe delivery. Those women too are coming to Huntsville for care even though it is costly and inconvenient to drive over an hour to each appointment.
I have practiced Obstetrics and Gynecology in Alabama since 2004. The limitation of women’s reproductive rights here began even before the Dobbs decision. For instance, all of our teachers from pre-K through college were insured under a Blue Cross and Blue Shield policy which DID NOT cover ANY birth control for them until Obama’s Affordable Care Act required it in 2010. These teachers, many of them young women in their prime reproductive years, were effectively denied the ability to space and limit their number of children through this omission.
The current climate here is one of fear. What’s next? Will my company give me maternity leave? Will my daughter grow up and move away to a place with better options for her? Will my controlling husband be emboldened to threaten my health care providers? The answer to that last question, is, unfortunately, yes.
Just one voice from the trenches, y’all,
Anne Marie Reidy, MD, JD