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Purvi Patel was suffering from heavy vaginal bleeding when she walked into the St. Joseph Regional Medical Center in Mishawaka, Indiana. She insisted that the bleeding was not the result of pregnancy. After the doctors persisted, however, she admitted that she’d had a miscarriage, and, not knowing what to do, had placed the remains in a dumpster.

What came next is a cautionary tale about what can happen to Black and brown women when they face bias and betrayal by health-care workers who are supposed to help them, and the ways in which hospitals, which are supposed to be places of healing, can become carceral.

Patel likely believed she would get medical treatment and then be able go home to her family. But overzealous law enforcement and prosecutors—and a betrayal of trust by the medical staff who were supposed to treat her—left Patel facing 41 years in prison for an illegal self-induced abortion.

How could this have happened? How did a woman who sought medical treatment for a pregnancy loss end up languishing in jail?

The answer to that question lies with the shifting tactics of abortion foes.

Historically, anti-abortion campaigners have focused their ire on doctors. Attacking actual pregnant people didn’t align with their goal of casting pregnant women as victims who know not what they do; blame lay with the doctors who were coercing innocent young women to ignore their maternal instincts and end the growing life inside them.

But as more people are choosing self-managed abortion—including taking abortion pills either on their own or under the supervision of a medical professional—the lie that pregnant people don’t know what they are doing when it comes to choosing abortion has been laid bare.

The truth is that pregnant people have managed their own abortions for centuries. Historically, women used herbs to terminate unwanted pregnancies. Enslaved women in particular tried desperately to control their reproduction through DIY methods, and when those failed, enslaved women often resorted to killing their newborns. It sounds unconscionable, but for these women—whose newborns were ripped from their arms and often shipped off to far-flung plantations never to be heard from again—consigning their newborns to a life of slavery was barbaric.

All this is to say that self-managed abortion is not new. It is, however, growing in popularity. More and more pregnant people are choosing to manage their own abortions. For those who do so without medical supervision—particularly if they buy abortion pills online—punitive prosecutors use laws intended to protect pregnant people to punish them, leading to pregnancy being put on trial.

Purvi Patel is a perfect example.

The nightmare that Patel lived through is a testament to the lengths that prosecutors and judges will go to punish women for bad pregnancy outcomes.

The harsh treatment of Purvi Patel

In 2015, Purvi Patel was sentenced to 41 years in prison for feticide and neglect of a dependent. With a sentence that extreme, one might think that Patel had gone on a serial baby-killing spree.

Not so.

She simply suffered a pregnancy loss, sought treatment at a hospital, and was betrayed by the health-care workers she expected to help her. That it was the people to whom she turned for medical assistance who ultimately turned her over to the police highlights dangerous biases in the health-care system.

In July 2013, Patel, an Indian American woman who lived at home in a conservative Hindu household, entered an emergency room outside South Bend, Indiana, while suffering heavy vaginal bleeding. She eventually admitted to her doctors that she had been pregnant and had miscarried; she told them the fetus was stillborn and that she had disposed of the remains. Medical staff at the hospital alerted the police, who went looking for the fetal remains and found them in a bag in a dumpster at a nearby Target.

The police proceeded to interrogate Patel without a lawyer present while she was still in the hospital. Police also searched her cellphone, which led them to a series of text messages in which Patel told a friend that she had ordered mifepristone and misoprostol, the two drugs used in a medication abortion, online from a pharmacy in Hong Kong. Patel, who was living at home with her parents, wanted to keep the pregnancy a secret. Prosecutors claimed that the text messages made the case for Patel’s illegal abortion and felony charges.

Prosecutors would eventually charge her with both feticide and felony neglect of a dependent, based on the theory that Patel had tried to self-induce an abortion and delivered a live infant, which then almost immediately died post-delivery. She was convicted of both counts in February 2015. (A judge would ultimately overturn her conviction, stating that she had already served enough time.)

What is striking about Patel’s case is that the two charges—feticide and felony neglect of a dependent—are contradictory. A charge of feticide requires a dead fetus, while a charge of neglect of a dependent requires a live birth. That she was convicted of both counts indicates how eager prosecutors in Indiana were to put her pregnancy on trial.

But Indiana’s feticide law, like many states’ feticide laws, was not intended to ensnare pregnant people; at the time they were enacted, anti-choice campaigners were still operating under the pretense that pregnant women are vulnerable and susceptible to coercion by unscrupulous abortion doctors. But over the last 15 years, abortion foes have changed tactics: Instead of casting pregnant women as victims of overzealous doctors, they are castigating pregnant women as participants in murder.

And the way they’re going about it is craven.

Feticide laws were meant to help not punish

Feticide laws are intended to provide a remedy to pregnant people who experience pregnancy loss as the result of a third party. Indiana’s law, for example, was upgraded to a Class B felony in the wake of a 2008 shooting; a woman named Katherin Shuffield was shot in the stomach during a bank robbery. She survived. Her twin fetuses did not.

Some seven years later, Patel became the first pregnant person to be convicted under the law. Unfortunately, Indiana’s law does not expressly exempt pregnant people from prosecution, which permitted prosecutors to wield a law intended to protect people like Purvi Patel against her.

Patel isn’t the only person to be prosecuted for self-managing an abortion. According to a report by If/When/How, since 1973, at least 21 people have been arrested for self-induced abortions in 20 states. They include Jennie Linn McCormack and Jennifer Whalen, who bought or were suspected of buying abortion pills online. McCormack’s case was dismissed, and Whalen served time in prison. (More recently, Ursula Wing was indicted for smuggling and selling misbranded prescription drugs that she had purchased in India. After self-managing her own abortion, she began selling abortion pills from her apartment to women who wanted to self-manage their abortion but didn’t know how to go about it.)

Patel’s case, however, is by far the most egregious.

Would Patel have been subjected to these farcical criminal proceedings if she were not South Asian? Certainly white women do get caught up in the criminal justice system—frequently when they are poor. But inherent biases exist when it comes to Black and brown people. As a South Asian woman, Patel may have faced anti-Asian stereotypes about son preference; there’s a pernicious stereotype that Asian people prefer boys and will terminate pregnancies if they know it’s a girl. (This stereotype forms the basis of sex-selective abortion bans that bar doctors from providing abortions if those abortions are being sought on the basis of sex.)

As a result of this stereotype, it’s possible that the doctors at the hospital viewed Patel more critically than they would have a white woman who presented with the same symptoms. And if you’re a brown or Black woman, it’s possible that doctors may view you with suspicion as well.

If medical personnel suspect that you used abortion pills to end your pregnancy, their biases may kick in, and they may call the police. They may even, as was the case with Patel, get involved directly in the investigation of your pregnancy loss as opposed to focusing on your medical care.

And once the police get involved, then the decision to prosecute under a state’s feticide law is left to the discretion of the prosecutor, particularly if the law doesn’t provide an explicit exemption for pregnant people. And whether to allow the prosecutor to charge a pregnant person under laws intended to protect, not criminalize, them becomes a matter of the judge’s discretion.

In Patel’s case, that discretion did not work in her favor.

Buying abortion pills online can be illegal, but that hasn’t stopped people from doing it. For those who have access to a clinic, medication abortion under the supervision of a physician remains an option. But dozens of states don’t permit medication abortion care to be conducted remotely, even though they permit telemedicine generally. And with the pandemic making it dangerous for people to leave their homes to seek in-person medical care, buying pills online and managing their abortions at home without medical supervision has become a favored method of terminating one’s pregnancy.

That prosecutors have trained their fire on pregnant people is not a coincidence. These prosecutors are urged on by anti-choice campaigners, who are trying to eradicate abortion and will use any tools at their disposal to do it. They’ve managed to squeeze clinic access to such an extent that it’s virtually impossible for a pregnant person to get abortion care in a clinic. Medication abortion allows a pregnant person to safely end a pregnancy on their own terms without going to a clinic. It is safe. It is effective. And that’s why it is under attack both at the point of access (buying pills online) and the point of termination. It’s illegal to buy pills online, and if you show up at a hospital and medical personnel suspect that you’ve induced your own abortion, that may lead to law enforcement and state prosecutors getting involved.

Whether or not a pregnant person becomes the focal point of a criminal investigation depends on factors outside their control. But it is clear that if you are a person of color, there’s a chance that systemic racism and bias in health care result in carceral medical care rather than compassionate medical care. And that means people of color who experience pregnancy loss—whether by choice or by accident—must take on the added burden of determining whether it is safe to be entirely honest with health-care workers. You simply never know if an offhand statement made during a traumatic experience can trigger a police investigation.

Such was the case of Purvi Patel.