Abortion in Louisiana: The Real Criminals Are the Ones Enforcing the Bans

It must be terrifying to be pregnant in Louisiana right now. The state broadly banned abortion, thanks to a 2006 trigger law that went into effect after the savages on the Supreme Court overturned Roe v. Wade in the 2022 Dobbs decision and handed control of women's bodies to the states, subject to the whims of insane Christian nationalists and terrible leaders. It's awful in many states, and Louisiana is one of the worst. The only exceptions to the abortion bans in Louisiana are if the mother's life is in imminent danger and if the fetus is considered "medically futile," a term not recognized by, you know the medical community, and wouldn't survive. No exceptions for rape or incest.

A study came out last week from Physicians for Human Rights, the Center for Reproductive Rights, Lift Louisiana, and Reproductive Health Impact, and it chronicles the bleak terrain that Louisiana's pregnant people and medical personnel must negotiate in the scorched post-Dobbs reproductive health landscape.  Its conclusion couldn't be more stark: "The findings contained in this report are alarming: the research shows how Louisiana’s abortion bans violate federal law meant to protect patients, disregard evidence-based public health guidance, degrade long-standing medical ethical standards, and, worst of all, deny basic human rights to Louisianans seeking reproductive health care in their state." The report is filled with the words of doctors, nurses, and others who live constantly with the fear that they will lose their careers or their freedom if they are accused of violating the statute. It's also got the words of women, who fear they will lose their ability to have children or their lives if they don't receive the care they need.  It's beyond a confusing mess. It's a catastrophe in slow, but quickening, motion. 

For instance, "most recent iteration of the emergency rule contains 25 'medically futile' conditions and allows abortion care for a fatal fetal condition that is not explicitly named on the list only if it can be certified by two physicians licensed in Louisiana." So your doctor is willing to take the risk in trying to get you the medical help you need, but, sorry, you gotta get another doctor to sign on. And the rules on this are vague as hell. In 2022, "because the Department of Health’s declaration did not resolve clinicians’ lack of clarity, they requested greater insight into what kinds of conditions would qualify a pregnant person to receive legal abortion care. In response, the Department refused to provide clarity and instead referred clinicians to the state’s Attorney General." That Attorney General, by the way, was Jeff Landry, who is now the governor, and he is gonna make damn sure that anyone who violates the law can face its punishments: up to 15 years in prison and up to $200,000 in fines. 

It's just nightmare scenario after nightmare scenario: "clinicians described how the bans have adversely affected their ability to provide evidence-based pregnancy care in circumstances including the management of miscarriages, preterm premature rupture of membranes (PPROM), ectopic pregnancies, medical emergencies that may not be perceived as immediately life-threatening, but which may well threaten a pregnant patient’s life, and lethal fetal conditions not included in the state’s 'medically futile' emergency rule."

How do they try to do something for their patients but not go to jail? "Clinicians described how the bans have increased the use of medical procedures and treatments that do not meet the standard of care—heightening risk to patients—and which could have been avoided if they had been able to provide abortion care." In other words, they're giving cesarean sections instead of abortion procedures because somehow that's a way around the bans. That's major surgery instead of a simple outpatient visit. But it's how afraid doctors are. This is not to mention that "to avoid the risk of criminal penalties under the bans, nearly every clinician relayed an account in which they and/or their colleagues delayed abortion care until complications worsened to the point where the patient’s life was irrefutably at risk." Some OB/GYNs won't see pregnant patients until after 12 weeks because the risk of miscarriage is much lower then. 

It gets even worse. If doctors screw up on the paperwork, they can face legal ramifications: "An OB-GYN shared how the bans’ lack of clarity and the risk of professional and legal consequences is causing stress for clinicians as they cautiously document and seek to clearly demonstrate that their medical decisions adhered to the law. One OB-GYN noted: 'I can go to jail for documenting something the wrong way. Even if it was the medically necessary thing to do.'" Clinicians are worried about giving information on out-of-state care for patients who need abortion, even though the laws don't prohibit it. Some have been told not to do it because their hospital's lawyers believe they could possibly be prosecuted for doing so. 

Another conclusion: "Clinicians in Louisiana are facing an impossible choice: to comply with the law or to violate their medical, ethical, and human rights obligations, all the while harming pregnant patients by delaying or denying care or information. The difficulties with this coerced choice are only exacerbated by the harsh civil, criminal, and professional penalties a clinician may face for violating the bans." One definite response to this is that some doctors stop practicing in the state or medical students go elsewhere to do their residency. "In 2023, one year after the bans took effect, there was a decline in numbers of applicants to Louisiana’s OB-GYN residencies."

Louisiana is number one in the United States for percentage of households in poverty, with 1 in 5 people living below the poverty line. Maternal mortality is incredibly high in the state, especially for Black women. The health care system is broken, especially for rural hospitals, where they simply can't handle medical emergencies in pregnancy due to a lack of doctors and lawyers not wanting the hospitals to deal with it. The women are sent to urban hospitals, which are overwhelmed with patients. 

And the thing is that this ban, like all the wide abortion bans, violates federal law, especially the Emergency Medical Treatment and Labor Act, although the savages on the Supreme Court have put a hold on enforcement of that. It also violates several international treaties on human rights that the United States is a party to. You could make a case that the federal government should arrest anyone enforcing the laws. 

Two kickers here: many of the most severe aspects of the law, including the banning of abortion pills, were signed into law by the state's previous governor, a Democrat, John Bel Edwards, who was pretty liberal on many other things, but the only way to get elected statewide as a Democrat now is to be anti-choice. Yet a majority of people in the state oppose the abortion bans. 53% are against the new law, with 41% in support and 6% too stupid to decide. 

That's fine and all, but the state is in for a hell of a time on abortion for the next few years, at least. Harming women and sending doctors elsewhere, which harms everyone.