Screening for fatal congenital conditions will be limited as a result of Roe's decision.


Screening for fatal congenital conditions will be limited as a result of Roe's decision

Jennifer was aware that her 37-year-old pregnancy was loaded with dangers, so she was all the more thrilled to be expecting twin boys. However, thorough ultrasound scans taken around 12 weeks revealed serious difficulties. Both foetuses lacked limbs, and fluid had built up in their brain chambers. Three weeks later, an additional ultrasound and a more invasive test involving a tissue sample from the mother's amniotic fluid confirmed the diagnosis of trisomy 18 (a condition in which someone possesses an extra copy of chromosome 18).

One of the boys died in the womb while the tests were being conducted, and the prospects of the second embryo surviving appeared to be dwindling. "They observed that his heart was beating, but it was missing a chamber," Jennifer explains, explaining that she was now confronted with a number of difficult options. Jennifer could have a stillbirth, or she could haemorrhage, as she had four years before when her daughter was born. Even if the foetus was carried to term, he would most certainly die shortly after birth due to his condition.

Jennifer and her husband were able to reach an agreement with their doctor and terminate the pregnancy at 17 weeks. But that was in 2018, and they wouldn't be able to do so now. In April, new legislation went into force in the US state of Oklahoma, where they lived at the time, prohibiting abortions beyond the sixth week, well before congenital abnormalities like trisomy 18 are identified. Only in a "medical emergency" can the law be broken to save a pregnant woman's life. A civil lawsuit can be filed against anyone who performs an abortion after the sixth week of pregnancy.

Such restrictions may become far more common across the United States in the near future. According to a leaked Supreme Court decision, Roe v. Wade—the 1973 case that established the constitutional right to abortion in the United States—could be overturned this summer, allowing each state to make and enforce its own abortion regulations. If Roe is overturned, 26 states are certain to tighten or outright ban abortions, depriving families like Jennifer's of the ability to make medical decisions about their own and their unborn children's health.

According to the Guttmacher Institute, an abortion-rights advocacy and research organisation, nine states have approved six-week restrictions similar to Oklahoma's but have yet to enforce them, with state courts finding the laws to be in violation of Roe v. Wade on an individual basis. (A six-week prohibition is also in effect in Texas.) Thirteen states have stringent anti-abortion legislation that will be "triggered" to take effect immediately if Roe is overturned. Existing stalled prohibitions and new trigger legislation are on the horizon in some states.

The specifics of the upcoming trigger laws differ in each state. Most states outright prohibit medical or surgical abortions, with a few exceptions for situations of rape or incest, or to prevent the patient's death or significant injury. Only a few states want to make exceptions for foetuses with life-threatening congenital abnormalities, while six states currently restrict abortions based on genetic conditions.

Although it is optional, genetic screening is a frequent element of prenatal care and is commonly done in conjunction with an ultrasound check between the 10th and 13th week of pregnancy. Doctors check for foetal DNA floating in the mother's blood, which can be used to diagnose brain and spinal issues, as well as chromosomal disorders. If a blood test is positive, doctors will extract a small sample of amniotic fluid or placenta from the uterus with a needle to confirm the diagnosis. Aborting foetuses with a non-fatal illness like Down syndrome creates moral and ethical issues, but doctors also test for conditions like trisomy 18 and trisomy 13, both of which cause miscarriages, stillbirths, or the baby dying soon after delivery.

Trisomy 18, also known as Edwards syndrome, affects roughly 1 in every 5,000 babies, while trisomy 13, generally known as Patau syndrome, affects about 1 in every 16,000. The majority of these neonates die within the first few days or weeks due to cardiac issues and other life-threatening diseases. Only about 5% to 10% of people make it through the first year.

Jennifer says of her unborn son with trisomy 18, "If I could have just given birth and he died naturally, it might have been a decision for us." However, she claims that knowing that doctors would have fought to keep the kid alive despite his condition influenced her decision. There is no cure for the extra chromosome that causes Edwards syndrome; treatment focuses solely on the symptoms that babies experience, which might range from blood pressure medicine to ventilators to feeding tubes.

Recent events have highlighted the potential consequences of decreasing abortion time limitations. In September 2021, a Texas law went into effect prohibiting abortions at the point where an embryo's heart activity can be identified by ultrasound for the first time, which can be as early as six weeks when many women are unaware they are pregnant. The ban's consequences have spread across state lines, with individuals who can afford to travel seeking abortions in other states. According to University of Texas researchers, an average of 1,391 women per month sought an out-of-state abortion between September and December 2021. The majority fled to neighbouring Oklahoma, but due to a new restrictive regulation in that state, this is no longer an option.

"Because of the impact of the Texas and Oklahoma restrictions, people in neighbouring states are experiencing delays in care," says Beverly Gray, an obstetrician and gynaecologist at Duke University School of Medicine in North Carolina. They travel to other states, and we're witnessing a tidal flow of people seeking treatment. If Roe v. Wade is overturned and those trigger laws are implemented, the influx of individuals might become considerably higher very quickly. In June, the Supreme Court is anticipated to rule on Roe v. Wade.

Most pregnant women choose to terminate their pregnancy after getting a fatal diagnosis for their foetus, but many may soon lose that option if the Supreme Court rules against them. For some women seeking abortions, it is an act of parenting. "They don't want their child to live a life of misery," Gray explains. Individuals select whether or not to get abortions based on their circumstances and the consequences for their families, she claims. I don't think you truly grasp what they're going through, what their families are going through, or what they're facing with a fatal diagnosis until you've walked a mile in their shoes.

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