Tamara Kay and Susan L. Ostermann
In 2015, then Indiana Gov. Mike Pence and the GOP engineered one of the most grossly incompetent and unsuccessful policy debacles in the state’s history. Their ill-conceived and discriminatory Indiana Religious Freedom Restoration Act (RFRA) generated immediate outrage and backlash from the public and businesses, costing Indianapolis up to $60 million. Hoosiers’ disgust with RFRA forced Pence and Indiana state legislators to amend the bill after only 10 days, making it less harmful to the LGBTQ community.
This week history may repeat itself as legislation curtailing health care rights, specifically abortion care, was introduced in a special legislative session. If abortion restrictions pass, Indiana will become an anti-freedom, forced-birth state.
Abortion restrictions will be devastating for women’s health and well-being, as research shows. But they also threaten Indiana’s economy and business environment. Indiana already struggles to retain college-educated workers. Recruiting talent will be even more challenging in a state that undermines reproductive health and freedom.
Abortion restrictions negatively affect all pregnant people, as evidenced in states with trigger laws, including Texas and Ohio. Because it is nearly impossible to distinguish an abortion from a miscarriage, women are being denied the highest standards of care by physicians who fear prosecution for providing it. Intentionally vague legislation is forcing physicians to wait before delivering life-saving care while they contact lawyers, hospital administrators, even legislators, to determine how to comply. And what counts as life saving and when? Will a woman with cancer be allowed to terminate a pregnancy? How long will a woman with sepsis need to wait before being given a life-saving abortion? Pregnancy in Indiana is also going to be more dangerous because fewer physicians will be trained to perform life-saving abortions, particularly those later in pregnancy. Over 33 Indiana counties currently have no hospital or those that provide no OB-GYN services. Indiana’s maternal mortality rate is already the third highest in the US Adding abortion restrictions will make Indiana that much more dangerous for pregnant people.
Abortion restrictions will also affect people who are not pregnant. The drugs mifepristone and misoprostol that are used for medication abortions are also used to treat miscarriages. Misoprostol is used for stomach ulcers, and often administered to make it easier and less painful to insert an intrauterine device (IUD) for birth control. Methotrexate, which is used to end ectopic pregnancies, is also used in treatment for cancer, psoriasis, rheumatoid arthritis and lupus. In states with trigger laws, there is evidence pharmacies are refusing or making it difficult to dispense these drugs for fear of prosecution. Abortion restrictions will make it more difficult for all of us to access medicine we need to treat chronic and debilitating conditions.
Abortion restrictions will also increase our medical costs. Insurance companies cover all physicians who treat pregnant people (for example, oncologists, endocrinologists, etc.), not just obstetricians/gynecologists. Their risk of liability increases if they do not provide that care and a patient dies, becomes permanently disabled or loses their future reproductive capacity. These scenarios — that rise with abortion restrictions increase medical liability insurance premiums. And malpractice insurance doesn’t protect physicians from liability for illegal actions, which abortion may become. What physician will choose Indiana if the threat of prosecution looms over her for providing life-saving, emergency care that she took an oath to provide? This traumatizes physicians in addition to patients. With abortion restrictions in place, we will likely have fewer physicians and medical specialists, and health care costs will rise. If Indiana employers are prohibited from providing health insurance coverage for abortion, health care costs for families who must leave the state for care will be stunningly high — if they can even get it. All of this will add to the already high rate of medical debt and bankruptcy in Indiana.
If state legislators impose abortion restrictions, Indiana will become a forced birth, anti-freedom state with few physicians capable of performing life-saving care for pregnancy emergencies that require termination, particularly later in pregnancies. This will not only affect women’s lives, health and well-being, but also the state’s economy, its ability to nurture innovation and attract and retain talent. This affects all of us, whether we are capable of getting pregnant or not. Hoosiers should demand that Indiana remain a free state. Let’s be ethical and pragmatic and not repeat the RFRA failure.
Tamara Kay is a professor of global affairs and sociology at the University of Notre Dame. She is the co-author (with Nicola Beisel) of the multi-award-winning “Abortion, Race, and Gender in Nineteenth-Century America.”
Susan L. Ostermann is an assistant professor of global affairs and political science at the Keough School of Global Affairs, University of Notre Dame. She also holds a law degree from Stanford Law School.