We’re on a reproductive tour of the United States that takes us today to Louisiana, also known as the Bayou State. As you know by now, if you have been reading my posts here on The Pulse, we are doing this tour because of what the Supreme Court of the United States (SCOTUS) did last June, regarding the Dobbs versus Jackson Women’s Health Organization case on abortion. As a consequence, the US is now a patchwork of different situations, when it comes to the legality of abortion and access to abortion. In places where the right to choose abortion is not protected, there also are implications for pregnancy care overall. In some cases, fertility treatment is being threatened as well. The Dobbs versus Jackson Women’s Health case involved a Mississippi law prohibiting abortion after 15 weeks of pregnancy. This means 15 weeks counting from the first day of bleeding of the last menstrual period. Six of nine justices voted to uphold the Mississippi law, but five of those six also joined onto a majority opinion written by Associate Justice Samuel Alito overturning the 1973 Roe v Wade decision that protected the right to choose.
In the aftermath of Dobbs, states that are very supportive of abortion and reproductive rights include New York, Connecticut, Illinois, Oregon, New Mexico, Washington, and North Carolina, and various others. Of such pro-choice states, many protect the right to choose up to the point of fetal viability (24-26 weeks gestation) or close to that point. Some pro-choice states, such as New Jersey, Vermont, and Oregon do not even have any limit at viability, nor at any point during pregnancy, meaning that abortion is up to the mother throughout pregnancy. Meanwhile, there are states with strong majorities of anti-choice Republican politicians in the state legislatures and governors, because of the state constitution, or because of the court system. Such states include Kansas, Alaska, Montana, and Ohio. In Kansas, the people voted strongly on a ballot measure in favor of keeping a guarantee of the right to choose in the Kansas state Constitution. But there also are many states with laws extremely hostile to abortion, and with it reproductive health overall. Such states include Mississippi, Tennessee, Georgia, Alabama, Arizona, and Missouri, and sadly they also include Louisiana.
In Louisiana, you cannot have an abortion at any time, and not even in cases of rape or incest. Exceptions are allowed, only if the mother’s life is in danger, or if the fetus will not survive birth. The law has been very undescriptive about what constitutes saving the mother’s life and very restrictive about what conditions mean that the fetus will not survive birth. As an example, Louisiana did not permit abortion in a nationally-covered case of a woman whose ultrasonography revealed acrania, meaning that the fetus was developing without a complete skull, so it would not survive birth. The mother ended up traveling to New York, where she was provided abortion care. Meanwhile, the Louisiana Department of Health quietly recommended in September that the state abortion law be modified to include acrania among among medical conditions rendering a fetus inviable and thus eligible for abortion in Louisiana.
Prior to the Dobbs decision, Louisiana already was adding an increasing number of restrictions, designed to make abortion more inconvenient and difficult to obtain. Such measures included a pseudoscience-based requirement that physicians must “inform” patients that medication abortion could result in “reversal”. This “reversal” idea is not a real thing and the American College of Obstetricians and Gynecologists has stated clearly that it’s a myth, with no scientific basis, and that it does not fit with clinical standards. Just to elaborate on this, in medication abortion, you are given two different medications. The first medication that you take is a progesterone antagonist, meaning that it blocks the actions of the hormone progesterone. This causes the placenta to detach from the uterus. You later need the second drug to help get your uterus to expel the products, so that you don’t develop an infection in the uterus that can lead to sepsis (infection throughout the body), but once the placenta has detached, the fetus or embryo is no longer viable, and there is no possible way to reverse that. Sadly, this is not the only example of legislators in anti-abortion states that is not based on clinical or physiological reality. Other updates to Louisiana abortion rules in 2021 also made things more difficult for pregnant minors. Previously, Louisiana minors seeking abortion without consent from a parent were able to petition judges located anywhere in the state for a bypass of the parental requirement. With the modification, however, only judges within a minor’s own local jurisdiction would have such power. Since abortion clinics were located only in very limited locations, the change effectively denied the judicial bypass option to certain minors, based on their geographical location.
All of this makes the Bayou State among the most hostile US states on the matter of abortion. Consequently, if you find yourself with an unwanted pregnancy in Louisiana, it is extremely advisable for you to travel out-of-state. There are organizations equipped to help you with needed arrangements and finances. There also are a number of states that not only have legal abortion, but that also provide travel and lodging funding to out-of-state abortion seekers who cannot otherwise afford to travel.
As a last resort, there is a possibility to obtain a medication abortion by way of a telemedicine visit with an out-of-state abortion provider. This is possible, if you will not be more than 77 days (11 weeks) pregnant (counting the first day of bleeding of your last menstrual period as day 1) by the time that you begin the treatment that will be mailed to you. It is important that you do not reveal your medication abortion to anybody who works for Louisiana, nor to any healthcare provider who helps you with the aftermath, who might face legal consequences for helping you. In most cases, women who undergo medication abortion, guided by telemedicine providers, do not need any in-person care. Understanding of the medications and the abortion process is advanced enough that asking you about your symptoms, and asking followup questions, via phone or videoconference reveals enough to be sure that all of the products of conception have been expelled and that you are not in any danger. In a certain fraction of cases, however, there may be persistant symptoms, such as extensive bleeding and/or a fever, making an ultrasound exam necessary to make sure that the products of conception have indeed been entirely expelled. Some recipeints of medication abortion also may want to visit a healthcare facility for reassurance.
It is very importnat for you to know that, medically, the abortion that you would experience as a result of the medication would be indistinguishable from a spontaneous abortion (miscarriage). Doctors and nurses know this and most of them want to help you and don’t have any objection to you terminating your pregnancy. But in states like Louisiana, they don’t want you to reveal the reason for your abortion. They want to be able to document in the records that you received care for a spontaneous abortion. They are at risk of getting into trouble —getting prosecuted and/or losing their licenses— only if you declare that your abortion was self-induced. But they may or may not warn you about this, so just go in with the idea that you are miscarrying and leave it at that.
As mentioned earlier though, traveling out-of-state is the better option. Sadly, Louisiana, not only lacks legal abortion, but traveling by land to places with legal abortion involves extremely long drives. Florida has legal abortion up to 15 weeks, but the abortion services are concentrated deep into the eastern part of the state, the peninsula. This means that residing in Louisiana, with a limited budget, your best bet is seek out an abortion-assistance organization to guide you through the process of obtaining air travel, lodging, and other necessities.