How treatment of miscarriages is upending the abortion debate

FILE - Amanda Zurawski, one of five plaintiffs, speaks in front of the state Capitol in Austin, Texas, March 7, 2023, as the Center for Reproductive Rights and the plaintiffs announced their lawsuit, which asks for clarity in Texas law as to when abortions can be provided under the "medical emergency" exception. All five women were denied medical care while experiencing pregnancy complications that threatened their health and lives. The women are headed to court Wednesday, July 19, as legal challenges to abortion bans across the U.S. continue a year after the fall of Roe v. Wade. (Sara Diggins/Austin American-Statesman via AP, File)
Amanda Zurawski, a woman featured in a Biden campaign ad about her experience losing her fetus and then being unable to access prompt medical care, is shown speaking in front of the Texas Capitol in Austin in 2023. (Sara Diggins / Austin American-Statesman via AP)

For decades, the abortion wars have centered on whether a woman should be able to decide when and whether she has a child. But with increasingly strict restrictions on reproductive rights being enacted across the United States, these debates are charting new, unfamiliar territory — medical care for women who have had miscarriages.

Up to 1 in 4 women who know they are pregnant will miscarry, according to the National Library of Medicine. Although most miscarriages resolve naturally, some require medical intervention that is similar to an elective abortion.

Democrats, who believe abortion led to strong outings in the 2020 and 2022 elections, are now showcasing the dangers of miscarriages as another reason to support abortion rights — and Democrats.

Read more: Arizona's ban on abortion sets up the swing state for an election 2024 showdown

A seven-figure April ad buy in battleground states by President Biden’s reelection campaign highlights the story of a happily married pregnant Texas woman named Amanda Zurawski.

“At 18 weeks, Amanda’s water broke and she had a miscarriage,” the ad reads, with white lettering against a black background. “Because Donald Trump killed Roe v Wade, Amanda was denied standard medical care to prevent an infection, an abortion.”

The 60-second ad concludes “Donald Trump did this,” after showing Zurawski and her husband, Josh, looking through a box of items that they had bought in anticipation of the birth of their first child, including a baby book and the outfit they planned to dress her in to bring her home from the hospital.

The Biden campaign launched this ad a day before the Arizona Supreme Court upheld a near-total abortion ban dating back to 1864, a ruling that former President Trump, the presumptive 2024 GOP presidential nominee, Arizona Senate hopeful Kari Lake and other Republicans have struggled to explain as they simultaneously celebrate the U.S. Supreme Court overturning a federal right to abortion.

Read more: Inside an Arizona abortion clinic: Uncertainty looms and optimism reigns

But the ad also reflects a reframing of how abortion is discussed as a moral issue. Democrat Bill Clinton famously said the procedure should be “safe, legal and rare” during his successful 1992 presidential bid.

But now even liberals say the emphasis on “rare” failed to recognize the medical necessity of some abortions, such as those performed after a miscarriage. Clinton’s framing also carried a connotation of shame for a woman seeking an abortion, whatever the reason.

“That framework was harmful and perpetuates stigma,” said Kelly Baden, vice president for public policy at the Guttmacher Institute, a nonprofit research organization that supports abortion access. “Every situation is complex and every situation is unique. People would rather err on the side of having government stay out of it altogether rather than have politicians practice medicine.

“Everyone knows someone who has been pregnant or loves a pregnant person,” she added. “To think that somebody’s health might not be protected even in a wanted pregnancy really cuts through some of the stigma abortion has had to face in the last 50 years.”

Read more: NEWS ANALYSIS : Parties Seek Abortion Issue's Middle Ground : Campaign: Bush and Clinton want to avoid charges of waffling, but neither wants to appear an extremist.

Evangelical leader Ralph Reed, the founder of the Faith and Freedom Coalition, counters that focusing on potential restrictions on miscarriage care — or fertility treatments in the aftermath of an Alabama Supreme Court ruling earlier this year — are red herrings put forth by liberals.

“This is a strategy to try and change the subject and shift the narrative,” Reed said.

“I know the Democrats want to develop it as a talking point,” he added, “but I can’t imagine that pro-life laws are going to lead women to not be able to get treated for a miscarriage. I think that’s the talking point they are trying to develop because they don’t want to talk about their own position on abortion. And frankly, I don’t blame them.”

About 80% of miscarriages among women who know they are pregnant resolve on their own within eight weeks, with the fetus passing through the woman’s body without medical intervention, according to a 2018 paper by the American College of Obstetricians and Gynecologists and a 2019 report by KFF, an independent health policy organization.

But if the fetus or some of the tissue doesn’t pass, it needs to be removed to avoid potentially fatal medical complications for the woman, such as a sepsis infection, through drug-induced or surgical treatment.

Reproductive rights have been a political tinderbox for decades. But in addition to core ideological disagreements, both parties are hyper-focused on this issue this electoral cycle because of the Supreme Court’s 2022 decision to overturn Roe vs. Wade, the landmark 1973 ruling that granted federal protection of abortion rights. Since then, several states have severely restricted abortion access, and others have enshrined such access in state constitutions.

The Supreme Court on Wednesday heard arguments in a case about whether the federal government can make hospitals that receive Medicare funding perform emergency abortions. Several justices appeared skeptical of an Idaho law that would make it illegal for physicians to perform such a procedure for a woman whose health was seriously jeopardized but life not at risk.

Read more: Supreme Court sounds wary of Idaho's ban on emergency abortions for women whose health is in danger

Restrictions on reproductive rights are expected to be a pivotal issue among suburban, college-educated women, a key voter bloc in places like Orange County, as well as the suburbs of Philadelphia and Atlanta, critical regions that could determine control of Congress, and in some states, the presidency.

“Politically speaking, this is a big problem for Republicans,” said Barrett Marson, an Arizona-based GOP strategist. Still, Marson called on Republicans to support the 1864 antiabortion law, even if it meant losing some elections.

“I have actually just started to say Republicans should embrace this law and go down with the ship,” he said. “Republicans should stand their moral ground. They have wanted to overturn Roe vs. Wade for generations. They finally have, and in Arizona, abortions are so limited, they literally only have one exception — the life of the mother. They should celebrate. That is horrendous campaign advice, but at least stick to your principles.”

The Arizona Supreme Court ruled recently that the pre-statehood law, which banned all abortions except to save the life of the woman and carried a two- to five-year prison sentence for abortion providers, could be enforced.

The Arizona House voted to repeal the law Wednesday and the state Senate is expected to do likewise next week.

But even if repealed, the law would still go into effect for a period of time because repeals do not take effect until 90 days after the end of the legislative session. Then the state would revert to its prior restrictions on abortions after 15 weeks except for medical emergencies. (There is no exception for rape or incest.)

The uncertainty over legal restrictions on abortion is prompting women to seek out states where the procedure is still available.

Planned Parenthood Los Angeles, one of the nation’s largest abortion providers, has already seen women from Arizona and elsewhere seeking medical treatment because they miscarried and couldn’t receive care in their home states.

Read more: California saw a surge in abortions after Dobbs. Providers are bracing for more

“The impact of abortion bans extends far beyond what many people think of when they hear the word ‘abortion,’” said Sue Dunlap, president and CEO of Planned Parenthood Los Angeles.

“We have seen multiple patients travel from out of state for miscarriage care,” Dunlap said. “In at least one example, a patient flew to Los Angeles because she was unsure of the status of her pregnancy and felt unable to access the care she needed in her local community.

“Ultimately, patients are traveling hundreds of miles for care that theoretically should be permissible in their home state but that, in practice, becomes impossible to access due to fear and legal confusion.”

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This story originally appeared in Los Angeles Times.