"It made an awful situation even worse."
Why abortion access must be discussed during Pregnancy and Infant Loss Awareness Month
My first pregnancy ended with the sounds of suction.
Dilation and curettage — a D&C. Standard procedure for removing fetal tissue that will never become a baby but refuses to come out on its own.
Only weeks earlier, as beaming first time parents, my husband and I floated into my doctor’s office. I eagerly jumped up pantsless on the table and we waited to hear the tones of cardiac rhythm promised by multiple positive pregnancy tests.
But there were no tones. An image on the screen showed a sac that would never hold anything resembling a life. My body carried a stagnant clump of cells and fragments of attempted placental formation.
And that crushed me.
I had started down the road of testing my fertility only weeks earlier. After trying to get pregnant for “too long” without any success, it was time to consider the next steps in our journey towards parenthood. I waited for a menstrual period that would signal the time to schedule my Progesterone test, but that period never came. I was pregnant. Due date math indicated Mid-April. A spring baby! We patiently waited for my appointment to “meet” this new life that would upend ours.
Of course, that theoretical baby would not upend our lives. There was no life to upend our lives. Only stubborn fetal material that never passed and gave me false hope.
We scheduled my D&C for a couple weeks out in case I miscarried on my own. Really, though, I think I delayed the procedure because I held tightly to the idea that something would jumpstart. That they would listen again and say “oh, hey, there it is! Congratulations!”. I asked for another ultrasound before the procedure, but again, no tones, no sound, nothing.
“Hon, if it was so easy to cause your own miscarriage, we wouldn’t still be debating abortion.”
So we walked into another room, and I laid down on the papered table, mentally preparing as best I could. For anyone who hasn’t experienced a D&C, it is not pleasant. A vacuum, cleaning out your insides. A fresh start.
I had a different doctor doing the procedure. A woman who had been practicing for decades and was nearing retirement. She had a blunt demeanor that might have been off putting for many but hit exactly the emotional chord I needed in the moment. I started asking questions about what I had done wrong. Could it have been that long hike we went on? The hot bath I took? The doctor took my hands, looked me in the eyes and said: “Hon, if it was so easy to cause your own miscarriage, we wouldn’t still be debating abortion.”
After we went home, I popped the prescribed Percocet and sat on the couch for the rest of the day. My husband joined me. We both took off work. It was Yom Kippur, the Jewish Day of Atonement. A day of communal slate-wiping and reflective prayer. A day that marks a fresh start for the new year. Yes, I scheduled my D&C on Yom Kippur, the holiest of days in Judaism. Maybe I subconsciously wanted to situate this moment within that symbolism.
October is Miscarriage and Infant Loss Awareness Month but this is where I stop talking about my miscarriage.
From hereon, we’re talking about abortion.
This is about abortion access. And everything that comes with it.
I was absolutely in a “best case scenario” with my miscarriage. I was fully supported during my loss. It was 2012, in Berkeley, California, well before Dobbs and far from the influence of anti-abortionists. An educated white woman, in my early 30’s, married to a man who was fully present and supportive through all of it. I was able to take off work. I had all the care options available to me with little to no stigma attached to the procedures I needed. I had no issue talking to my doctor or setting up my D&C. I had full psychological support during every stage. And yet, the experience still affected me deeply1.
Imagine a world where every element of my “best case scenario” flipped: where I didn't have the options, where I didn't have the support system, where I didn't have a supportive partner, a supportive family, supportive friends, supportive workplace, where I lived in a place that blamed me, where I experienced institutional racism or bias at any step of the journey, where I had a doctor who implied that my loss was my fault.
That is the post-Roe/post-Dobbs world, a world without abortion access. A world where criminalization and unscientific language around “life” adds gray space in a medical setting and risks impacting the health of every birthing person and pretty much anyone with a uterus who needs health care at any point in their life.
Abortion access is a deeply connected stressor:
Abortion is key, life-saving health care for anyone who needs any element of the procedure at any point. In addition, the way this country is currently limiting abortion access (and discussing the unscientific reasons behind bans) elevates the risk of every birthing person’s health by tacking on unnecessary stress at a time of life when stress exposure should be as limited as possible.
The relative severity of abortion bans as a stressor likely relates to control over one’s health, fear, stigma, racism, lack of support, and everything in between.
This stress relates to wanted and unwanted pregnancies, planned and unplanned, and, sometimes, it is completely unrelated to pregnancy.
Abortion access is both impacted by other stressors and has impacts on other stressors (they are often the same ones).
The connections put together in the map run especially deep when considering the the effects of limiting abortion access in cases of an unexpected, unwanted, or unhealthy pregnancies, and for pregnancies that cannot (and should not) be carried to term due to a mother’s safety and health. I examine the wanted abortion side of the stressor map and the health repercussions of abortion bans in a follow up piece with a close look at the incredible Turnaway study:
For now, let’s focus in on pregnancy loss…
The effects of abortion access on wanted pregnancies.
The current discussion and debate2 tends to revolve around “unwanted”, ”unplanned” pregnancies and the choices that women should and should not have available in those situations. Anti-abortionists lean into their distorted view on “life” and whose life to value (hint: not the mothers) and have even tried to masquerade their stance as a feminist issue. But their pro-”baby” logic stops short of acknowledging the damage they are doing to real, live, healthy babies, and the kids they will become.
They completely ignore that abortion bans inevitably increase the stress load during *wanted* pregnancies.
Especially in the context of pregnancy loss.
“The clinical nuances of miscarriage often place patients experiencing miscarriage at the crosshairs of ambiguous abortion restriction legislation, impacting both routine and emergent care of miscarriage.” – Roberti, 2023
Once research has the time to catch up to the full ramifications of the post-Dobbs world, I expect that we will start to see real, psychological consequences of anti-abortion laws in cases of wanted, expected, hopeful, planned pregnancies – pregnancies that are healthy and result in a live birth and pregnancies that do not or cannot go in the direction of a live, healthy birth. Critically, we need to understand how exposure to the additional stressor of limited healthcare options aligns with the dramatic physiological changes of pregnancy that make the body and the brain more at risk for illness.
Again, it does not matter if abortion care is needed or not. The psychological stressor relates to how we process external information against what we hold in our brains — the fear of not having access to healthcare if needed.
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Healthcare access vs. fear
The experience of pregnancy loss is stressful.
“The loss of the pregnancy is a physically, mentally, and emotionally taxing experience.“ — Ranji, Salganikoff, Sobel, 2024
Pregnancy loss can have profound effects on mental health. Studies report that up to 55% of women have depressive symptoms and over 18% report moderate anxiety following a loss. Black women have double the risk for major depression following pregnancy loss.
Satisfaction with healthcare provided during a pregnancy loss can have protective effects to counter the stress.
Fear does the opposite. Fear exacerbates the risk when care options become limited.
The scales are now tipping towards fear and away from healthcare satisfaction as more clinicians feel like their “hands are tied” and the key medicines and procedures used for both miscarriage and abortion become over-regulated or outright banned.
“Almost all of the clinical interventions used to manage miscarriages and stillbirths are identical to those used in abortions because they result in emptying the pregnant person’s uterus.” – Ranji, Salganikoff, Sobel, 2024
According to the American College of Obstetricians and Gynecologists, expectant management for early pregnancy loss (miscarriage) is not considered “safe” after 8 weeks gestation.
Expectant management (as the only option in cases when it should not be) is how women bleed out on their floor. It’s how women die or nearly die from ectopic pregnancies. It’s how women become septic.
For late term pregnancy loss, the remaining “option” under abortion restrictions – labor induction – is just inhumane:
“It is so cruel to force a woman to give birth to her dead baby – to be awake and present, to endure in the most traumatic way possible the loss of her baby and hope and motherhood. It made an awful, senseless situation even worse.” – as told to NPR Health Shots
Overall, the stress around pregnancy and infant loss is compounded when abortion access restrictions secondarily impact who can provide healthcare, what types of healthcare they can provide, and how limited access to critical tools affect the protective effects of compassionate care.
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The commonality of loss vs. the stress of stigma + loneliness
Pregnancy loss is common. A quarter of all pregnancies end in loss. One study suggests that nearly HALF of all humans, who get pregnant at any point in their life, experience at least one pregnancy loss.
About 50% of those lost pregnancies relate to chromosomal abnormalities. Turns out, it's pretty darn tricky for cells to divide their genetic material and then divide and divide some more without messing it up at some point. The likelihood of starting off with fetal material that will never develop normally should be viewed as a normal hiccup in the “miracle of life”. And yet, despite the fact that it is so incredibly common, pregnancy loss is lonely and carries a weight of shame exacerbated by stigma.
The stigma becomes further stigmatizing as the abortion debates bring the national conversation around “life” to insane standards (6 weeks?!), and blurs the legal lines for personal views on “right” and “wrong”:
“These laws are stigmatizing too. Some people may look to a law to decide whether or not something is morally acceptable. And if they internalize that, it could absolutely impact their mental health in the form of shame.”– Dr. Antonia Biggs, Associate Professor and social psychologist at UCSF, researcher on Turnaway study
While Dr. Biggs explained this to me in the context of abortion, it made me think – how many people will internalize the stigma, the shame, the fear of loss after constant bombardment by the language of “fetal personhood” and what constitutes “life” under the misguided direction of the state-by-state laws?
Then the laws add weight to the stigma+shame and make the loss even lonelier by cutting off social support.
Social support is a known stress buffer, and can improve mental health outcomes in cases of miscarriage. The opposite – isolation and loneliness – already negatively impacts those experiencing pregnancy loss. In the more extreme case, consider the elevated effects of stigma+isolation+loneliness for those living in a state that allows for anyone to sue someone who helps any action resembling abortion (with little protection or clarity for the gray space around healthcare for pregnancy loss).
In addition, when you bring in legal ramifications – from lawsuits to criminalization – like most aspects of the justice system, all of this is exacerbated by race. As in the case of Brittany Watts, a scared Black mother who received confusing and subpar care, miscarried in her toilet, and was subsequently prosecuted for “abusing a corpse”.
“The criminalization of miscarriage is not anything new. We need to be clear about that. But when miscarriage started being equated to abortion, it's almost all been people of color." – Michelle Colon, as told to NPR.
In a country with a growing maternal health crisis that disproportionately affects the Black community, the stress-related impacts of limiting abortion access needs to factor into the added weight of the risk.
Stress in cases of a healthy live birth AND stress completely unrelated to birth:
Limiting abortion access deepens the psychological wound that is pregnancy loss AND extends its tentacles far beyond pregnancy and birth.
A few quick takes:
IVF and the narrative of “life”
This piece on how abortion abolitionists are focusing their attention on IVF clinics had flames coming out of my head.
I already expressed my rage on this topic and I feel like if you’ve read this far, I don’t need to go further into explaining how cruel it is to make the stressful process of fertility more stressful by feeding in more shame and stigma and guilt and blame.
Child safety
If you are a parent to a reproductive aged child, abortion access connects to the child safety stressor.
After all — how can you keep your child safe in a state (country?!!!) where they could die from being denied life saving care?
Canceling out an anti-stress buffer: limited options during pregnancy = joy suck.
Joy can buffer the impacts of stress.
What happens when you take the joy out of pregnancy and replace it with fear?
“It honestly terrifies me to think about becoming pregnant. When I was talking about it with my mother-in-law, she said to me ‘You better have a will,’ and I almost fell to my knees.” – as told to NPR Health Shots
Even if you never need any interventions at all, you can be psychologically affected by the fear of anything going wrong at any stage of the journey for any and all of the above reasons.
Access to women’s health professionals:
Maternity care deserts are expanding for multiple reasons. The reasons include the availability of doctors trained and training in women's health as more clinicians choose to avoid or leave the state due to restrictions on the care they can provide. If doctors dedicated to the practice of women’s health abandon a state, what does that mean for accessing healthcare at any point in the reproductive lifespan, including care for perimenopause and later in life?
Women already often fight the uphill battle of medical gaslighting, a stressor in and of itself.
How can you get diagnosed for something overly perceived as “all in your head” if procedures, like endometrial sampling and D&C (also used to diagnose the cause of uterine bleeds before or after menopause), are limited or inaccessible in states with abortion access restrictions?
Is abortion itself a stressor?
Ok, I had to end with a little provocation. There has been a “pro-woman” framing recently, crafted by those trying to paint an anti-abortion stance as a feminist issue.
Call me biased, but I would strongly argue that their argument is full of shit. This framing seems to revolve around cherry picked data and lying through their teeth.
Looking at the stressor map, I see abortion, itself, as a stressor, only if “we” make it a stressor — if this country CHOOSES to make it a stressor — if the community, if society, if the government add in the elements of stigma and shame and criminalization and fear.
Yes, I know the opposition, for the most part, doesn’t follow logic (or actually care about women’s health), but I will continue beating this drum – the psychological benefits of having access to this life-saving care far outweighs any ‘potential’ risk.
Since the stressor map is still only theoretical, I do have some data to back up the physical and psychological repercussions of not having a wanted abortion – the beautifully designed, 10-year, longitudinal study that I alluded to above. A study designed to closely examine the repercussions of getting (or not getting) an abortion .
More on the incredible Turnaway Study here:
Keep fighting
If you are looking for ways to keep the issue moving forward when facing an opposition who would never be swayed by my argument above, go get yourself a copy of
‘s new book Abortion: Our Bodies, Their Lies, and the Truths We Use to Win. .You can also catch more of her writing by subscribing to her amazing Substack: Abortion, Every Day…
Or check out her interview with
…
Or cruise
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I’m a big fan of
, obviously.Ok, I know I said I would stop talking about my miscarriage but this is the last tie back to it.
On the map of stressors, the challenges experienced during the fertility journey connect broadly. Miscarriage is embedded in that stressor node, feeding into the stress related to the perinatal care journey and everything after. Talking with those who have struggled far more than me with multiple pregnancy losses or a long and convoluted path with fertility treatment, there is a heaviness that sets a new baseline for the parenting journey from that point on. A level of preciousness that adds more pressure to “doing it all right” as a parent (especially for mothers) from breastfeeding to child care to safety to everything in between.
My loss still followed me like a ghost through all of my other pregnancies. It chipped away at the joy. I was nervous, never excited, for every ultrasound, for every fetal heart beat check. I held back a bit of hope until I held a live baby in my arms.
Honestly, I’m not even sure its worth using the term “debate” anymore because so much of the opposition relies on a narrative that defies logic and, therefore, cannot actually be debated.
Thank you so much for writing, expressing and helping millions!
Just be sure that, whatever the psychological consequences of anti-abortion laws are, they won't kill you. Abortion kills an innocent human. All your eloquent writing won't change that.