Yesterday in El Salvador, Beatriz (a pseudonym) had an abortion. The Catholic Church and the international anti-choice movement are desperate to deny this reality, so the anti-choice spin machine is in high gear, engaging in linguistic gymnastics to suggest otherwise.
And much of the media is taking the bait.
Beatriz had a hysterotomy, a form of abortion carried out through c-section, and a procedure of such high risk compared to other forms of abortion, and of such last resort, according to medical experts, it is practically never performed in the United States. What is known beyond a doubt is that having forced Beatriz into a situation of having a late abortion, the government of El Salvador, Catholic Bishops, and anti-choice groups in the country (and those supporting them from the outside) unquestionably privileged a non-viable fetus over the life and long-term health of the primary patient, a woman who wanted to—in fact begged to—live.
Sex. Abortion. Parenthood. Power.
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In parroting what anti-choicers and the government of El Salvador are saying, many media outlets are glossing over and ignoring what actually happened in El Salvador. As a result, otherwise highly regarded media sources such as the New York Times, Salon, the Associated Press, The Guardian, and Reuters are helping to perpetuate lies that defy both medical evidence and public health data and that support dangerous policies under women all over the world continue to lose their lives.
The New York Times, for instance stated that the “ill Salvadoran woman … delivered her 27-week-old fetus” and quoted El Salvador’s Minister of Health, María Isabel Rodríguez as saying, “At this point, the interruption of the pregnancy is no longer an abortion. It is an induced birth.” Rodríguez elaborated that it could be “either an abdominal or vaginal birth.” Meanwhile, Reuters uncritically reported that the c-section permitted El Salvador to avoid having to allow Beatriz an abortion.
Actually, the only thing El Salvador—and apparently the media—avoids by denying that a hysterotomy is an abortion is reality.
Beatriz is a 22-year-old woman from a poor, rural area of El Salvador who has the misfortune of suffering systemic lupus erythematosus (lupus), an autoimmune disease. Pregnancy often exacerbates lupus, with adverse effects on kidney function, potentially leading to accelerated progression to end-stage renal disease. In addition, pregnancies in women with lupus are at high risk for spontaneous abortion and premature delivery, intrauterine growth retardation, and a maternal complication called superimposed pre-eclampsia.
Beatriz’s doctors knew ten weeks into her pregnancy that she needed an abortion to save her life, and even in El Salvador, a country in which doctors go to jail for performing abortions, her physicians began petitioning the government for an exception to the law. Doctors also knew something else: Beatriz was carrying a fetus with no brain, and therefore it could not survive outside the womb under any circumstance. They also knew that the longer the delay in providing Beatriz with an abortion, the much higher the risks to Beatriz’s life and health.
While the Ministry of Health agreed the abortion was warranted (again, a profoundly unusual circumstance in El Salvador), the Catholic Bishops, anti-choice groups, and the attorney general would not budge, threatening to put both doctors and patient in jail. At one point, colleagues in El Salvador contended that the country’s bishops were quite willing to just let her die and put it down to “god’s will” so as to hold the hard line on their contention that “abortion is never necessary,” even to save a woman’s life.
The turning point came when an international campaign was launched, and every relevant court and human rights body was petitioned. Yet despite pressure from human rights bodies in the region and internationally, El Salvador’s Supreme Court refused to budge, and Beatriz was denied an uncomplicated early abortion and subsequently also a less complicated second trimester procedure. She was therefore pushed into the third trimester, with her health failing to “save” a fetus that could not be saved. Finally, in the face of mounting international opprobrium, she was given a hysterotomy, which anti-choicers are spinning as though it were a normal c-section.
Thankfully, Beatriz has survived the late abortion and is doing well, though according to colleagues in El Salvador, she lost substantial amounts of blood and as yet faces unknown health consequences from lack of an early abortion that complicated her lupus, compromised her kidneys, and racked up unnecessary medical bills. The key difference is that, at death’s door, Beatriz was an international cause célèbre. As a poor, rural woman who may now face lifelong health and medical complications gravely exacerbated by the delay in her treatment, she will almost certainly become a forgotten statistic, a woman who may need ongoing medical care she will almost certainly not be able to afford.
In what seems to be at best an afterthought of the media these days, I asked actual medical professionals about Beatriz’s condition. Dr. Faundes, as noted above, wrote about her condition extensively. But what about the decision to provide a “c-section”? Here is what doctors told me. In response to Beatriz’s case, Dr. Valencia Stephens, an OB-GYN and clinical consultant on safe abortion care, said that when she heard about the decision to give Beatriz a c-section, she was aghast. As she wrote via email:
A Cesarean section involves much more [risk] for even a healthy woman. The only reasons I would do a section for a 26 week pregnancy would be to prevent head entrapment if the fetus is breech (NOT an issue in her case since the fetus has anencephaly), if the fetus is transverse and cannot be verted, or if she had a prior section and was not a candidate for VBAC [vaginal birth after c-section] because of the MATERNAL risks involved.
Another OB-GYN, who asked that their name be withheld, wrote the following:
At 26 weeks gestation, the usual options for terminating a pregnancy are:
1. Dilation and Evacuation (D&E)
2. Induction of Labor (IOL)
In situations where neither of these can be done (and the reasons for this are usually because the cervix will not – or cannot – dilate adequately and one needs to get the uterus evacuated urgently) then a cesarian section is entertained. (Actually, we use the word, “hysterotomy” in these situations in an attempt to differentiate it from a delivery of a viable fetus). It is generally a last resort, and to give you some perspective on how uncommon it is, they are many a practitioner who have done both IOLs and D&Es for decades and have not ever had to do an hysterotomy.
What we do know for quite some time now, and this has been corroborated by recent data, is that abdominal surgery (in this case, c-section) carries a greater risk to the patient than a vaginal delivery (such as IOL) or D&E. In fact, these risks are not insignificant and may be as much as 10 to 100 fold times greater. So to answer your question, yes, they are opting for the more dangerous route.
“It may be more palatable in the public eye that Beatriz undergoes a c-section,” the doctor continued. “However this is certainly not the preferred method [in the case of a] fetus that is anencephalic (absence of higher-function brain tissue) and therefore incompatible with life. It is not the preferred method because doing so unjustifiably increases the patient’s risk (especially in someone like Beatriz who has an underlying medical issue like lupus and what you want most for her is to minimize any risks!).” (Emphasis added.)
What happened here is unethical and immoral, and the media is responsible for perpetuating conditions under which this scenario is almost certainly going to play out again and again. A woman was brought to death’s door for the sake of ideology made only somewhat more grotesque by the fact that the fetus she was carrying could never have survived in the first place. Abortion is part of health care. Sometimes it is required to save a woman’s life or health. Women’s lives are real, and we deserve medical care, not the fanatical ideology of a small group of men. It is time for the media to start doing its job in reporting on these issues, and stop providing the anti-choice movement with an uncritical platform for its misogyny.