If you have a miscarriage in Republican America, your health is now at risk | Moira Donegan

The supreme court's decision to overturn Roe has created a vast new public health crisis, as abortion bans complicate once-standard care for pregnant women

The worst-case scenarios arrived with alarming speed. In the weeks since the US supreme court's decision in Dobbs v Jackson Women's Health, the case that overturned Roe v Wade and eliminated the constitutional right to an abortion, American women have faced a radical reordering of their lives. A right essential to their dignity and self-determination has been stripped away after nearly 50 years - and with it, the gains women have made in professional, political and social life are newly and gravely endangered. But in addition to this moral and civic crisis, the supreme court's decision has also created a vast and acute new public health crisis, as abortion bans complicate once-standard care for pregnant women - and place the health of even those who are not pregnant into new and arbitrary danger.

For one thing, there are the miscarriages. Care for patients experiencing spontaneous pregnancy loss has been dramatically reshaped in hospitals across Republican states. The treatment for a miscarriage is to evacuate the contents of the uterus, either with a minimally invasive surgery or with medication, and these interventions, as it happens, are identical to those used in voluntary abortions. But with ambiguous, as-yet-uninterpreted but strongly worded laws now in effect in anti-choice states, providers don't know what they are permitted to do for miscarrying patients. Many bans have so-called life of the mother" exemptions, but these are vaguely worded, and carry strong penalties for providers if they get it wrong. How sick does a patient need to be before a doctor can abort the pregnancy that is killing her? Does she need to be dying? How close does she need to be to death?

Moira Donegan is a Guardian US columnist