Tuesday, May 10, 2022

The Great Unraveling

“When you say ‘social safety net’ in Texas, it sounds like a joke,” said D’Andra Willis of the Afiya Center, a North Texas reproductive justice group. “Everything they could have set up or increased to protect people if they really cared, they’re not doing it here.”

Pregnant women in Texas are more likely to be uninsured and less likely to seek early prenatal care than the rest of the country. They’ll give birth in one of the worst states for maternal mortality and morbidity. And low-income new parents will be kicked off of Medicaid sooner than in many other states.

So let's make it worse and criminalize healthcare while not really providing any, anyway.

This would make many Texans want to avoid pregnancy altogether. But learning about, let alone accessing, contraception can be a challenge in a state that does not require sex education and has narrowed family planning options in recent years.

Damned if you do, damned if you don't; and we like it that way!

The rate of severe maternal morbidity for Black women in Texas is nearly double that of white women, according to a study from the University of Texas.

“This is the worst place and the most dangerous place to have a baby,” said Willis. “It’s safer to get an abortion in Texas than it is to have a baby in Texas.”

Well, it's black people, amirite?  No racism here!  Nosireebob!  Oh, and we're cheap AND stupid!

One of the causes of Texas’ maternal mortality numbers, according to experts and advocates, is the state’s staggering rate of uninsured residents. Texas is one of just 12 states that has not expanded Medicaid and has one of the lowest eligibility standards in the country: A single parent with three children would have to earn less than $400 a month to qualify for Medicaid.

As a result, in 2019, nearly 1 in 5 Texans had no health insurance, double the national average. And the stats are worse for women of childbearing age — in 2017, more than a quarter had no health insurance, the highest rate in the nation.

Texas also has the lowest rate of women accessing prenatal care in the first trimester, according to an investigation from ProPublica and Vox. Babies are five times more likely to die if their mothers did not access prenatal care, according to the U.S. Office on Women’s Health.

Pregnant Texans can qualify for Medicaid at a much higher income level — up to $4,579 a month for a single parent of three. As a result, half of all births in the state are financed by Medicaid, among the highest rates in the nation.

It's not about births, it's not about babies.  It's about abortion and that's about who gets to be in charge:  us (the state) or the woman.  But by God we're against sex!

Texas has among the highest rates of teen pregnancy in the country, and the highest rate of repeat teen births — teens having multiple children before their 18th birthday. Texas does not require high school students to take sex education to graduate.

“We can’t get birth control. We can’t get adequate health care. We’re not given comprehensive sex education, so we’re not being educated on birth control or naturally preventing pregnancy, and now you can’t get an abortion,” said Willis. “You take away all of this … and you don’t have any plan in place.”
Suffering is the plan.  Suffering is the feature, not the bug.

It turns out that repealing Roe would be bad for law, because the "right to privacy" is a key concept in so many court rulings the public has come to rely on (contraception to marriage choices to sex between consenting adults, to name a few), and also bad for healthcare:
Here, let's just look at the highlights:

Between the lines: One immediate issue is the way state laws define "unborn human beings," and the way some definitions potentially make bans apply to embryos created through the IVF process and some forms of birth control.

Some states' trigger laws define life as beginning at fertilization, or when a sperm penetrates an egg.
Louisiana's trigger law, for example, specifies that "'unborn human being' means an individual living member of the species, homo sapiens, throughout the entire embryonic and fetal stages of the unborn child from fertilization to full gestation and childbirth."

The IVF process works by fertilizing eggs with sperm in a lab and then transferring that fertilized egg — or embryo — to a uterus. But it's common for surplus embryos to be created that wind up going unused.

Some state laws may confer legal protections to those unused embryos, experts say.

"There are going to be a lot of ancillary effects, and this could be quite catastrophic on the fertility industry," said Traci Keen, CEO of Mate Fertility. If a fertilized egg is declared life by law, then discarding that embryo "would be considered an abortion."

So, if you go to another state for IVF treatment, are you liable in your home state for the criminal act of abortion?  Again, you want to be the person who tests that case up to the Supreme Court?  This Supreme Court?

Some forms of birth control may also prevent a fertilized egg from implanting in a uterus and are considered forms of abortion by some conservatives.
And so we come back to the question of contraception without even touching on Griswold.  Except now we'd have to, and again, do you trust this Supreme Court to be Solomonic about that particular problem?

The other side: Some other state laws contain language that experts say make them less likely to apply to IVF or contraception.

In Missouri's trigger law, for example, abortion is defined as terminating "the life of an embryo or fetus in his or her mother's womb," which may exclude embryos outside of the womb.

Utah defines abortion as the termination of a pregnancy "after implantation of a fertilized ovum," suggesting protection only applies to embryos that have already implanted into the uterus.

Arkansas, Kentucky and Louisiana laws specify that their abortion bans don't apply to contraception that's administered before a pregnancy can be detected through medical testing.
People move much more freely between states than once they did.  And states in general enact as many "Uniform" legal standards as they can, for the convenience of all concerned.  Not just uniform commerical laws, but there is, for example, a widely adopted "Uniform Family Code", making child custody laws pretty much the same in all states that have adopted it.  It's not precisely universal, but it makes it more convenient for companies to move employees across state lines, because the employees know what to expect from the laws most likely to affect them.  Now let's start screwing with abortion and contraception and just see how anxious companies are to re-locate or build a large new facility in a state their employees don't want to move to.

And then there's the matter of medical care/technology:

The ruling could also have unintended consequences for managing miscarriages, which often uses the same methods as abortions.

"There's concerns about whether clinicians who are going to be working in states that will effectively ban abortion are going to be concerned about using a medication that is considered an abortifacient to manage the miscarriage," Salganicoff said.

State laws factor a provider's intent. That means providers may have to take additional steps to show they gave care after a fetus was already nonviable, to distinguish from providing the same care with the aim of terminating a pregnancy.

"I suspect in states where abortion is banned medical providers will develop appropriate techniques to determine compliance with the law. So I think it'll change the standard of care," said Naomi Cahn, co-director of UVA Law's Family Law Center. "I would imagine that they would want to be very careful in documenting this."
In Texas this would practically mean healthcare providers in the large urban areas won't face any intense scrutiny.  Those areas are dominated by Democrats and the DA's have announced they won't be prosecuting abortion cases.  But in the rural areas?  In other words, a sharp increase in the divide between the haves and the have-nots, between urban and rural.  That law of unintended consequences is a bitch!

Experts say women may also be forced to carry pregnancies in which the baby won't survive after birth.

Which is a very humane thing to do to a pregnant woman, isn't it?

State laws generally allow abortions when the life of the mother is at risk, and some contain clauses saying that abortion is permissible to remove a "dead fetus" or a "dead, unborn child." That generally means the same procedure used for an abortion can be used for the removal of a dead fetus in the event of miscarriage or stillbirth.

But some women whose lives aren't at imminent risk could be imperiled as the pregnancy continues. 

Abortion may not be an option for them, nor for some women with nonviable pregnancies.

Texas' six-week abortion ban makes no exceptions for these scenarios, the New York Times reported last year.
Again, Texas is the second most populous state in the union.  Again, prosecutions for such "abortions" probably won't occur in large urban areas.  Again, a woman in south Texas was prosecuted, briefly, for a miscarriage the DA wanted to treat as an illegal abortion.  This is not a nightmare scenario.  It's simple reality.

But the mother was poor and brown and lives in a small town, so that's okay?

Are these all "nightmare scenarios"? No.  But be careful what you wish for; you might just get it.
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