The Law of Unintended Consequences

(Written during the summer of the Dobbs decision)

      A physicist and a physician were sitting in a bar each nursing quietly their beers when the physicist   spoke up, “My friend, I challenge you to a contest. Each of us will describe the most powerful law in their respective discipline. Whoever comes in second pays for the drinks.” The physician nodded,  “You’re on.”

   The physicist opined that E=mc2 was so powerful that all other laws of nature were simply fighting for second place. His proofs were erudite, extensive, and seemingly irrefutable. When he concluded his monologue, he leaned back, placed his hands behind his head and with a smug, self-satisfied smile whispered, “Your turn.”

   The physician took a sip of beer, sighed and then began to slowly speak.

“The most powerful law in my discipline is the most powerful law in the universe-all who attempt to challenge it fail miserably. It is the Law of Unintended Consequences.”

   In the year 2022, the United States Supreme Court overturned a law called Roe vs Wade, a law that for the previous 50 years had given women the right to control their reproductive health and if necessary, obtain an abortion. The Court held that this law was inherently flawed for the Constitution had never expressed an opinion on this matter. Each State therefore, was empowered to enact whatever restrictions they so choose. Many of them did, some even to the point of prohibiting all abortions except those needed to prevent the imminent death of a woman.

And now the Law began to exert its will.

   Although abortion was prohibited, the number of unintended pregnancies did not significantly decrease. At that time approximately 50%  of all pregnancies were unplanned. Women, particularly those who had limited financial resources (predominantly women of color) and could not afford a journey to a state with less restrictions, sought abortions at sites  that were not sterile and at the hands of those untrained to perform the procedure or handle the complications that might arise.

   Consequently, these women experienced a significant increase in horrific complications

:exsanguination and sepsis. Even if they were fortunate enough to reach an emergency room, they had to undergo extensive surgery and long stays in the intensive care unit. Some died despite intervention; many lost their fertility or developed chronic pain. The monetary cost of this care, uncompensated as few of the women had health insurance, added to a struggling hospital's financial burdens they could not handle. A few rural hospitals folded leaving the small communities they served bereft of care.

   The women who died left behind distraught widowers and anguished children. Families crumbled. If the woman was a single mother, as so many of them were, their children were now orphans, for often the biological father was unknown or unwilling to accept the responsibilities of paternity. The men argued that even if the baby was his, the other children were not as he had never married the now deceased woman. And women who had been raped often never knew the man who assaulted her.

   Because these children were now orphans, they had to be placed in the homes of relatives. But far too often, these placements were impossible and the children were thrown into an already overburdened foster care system. These children, their lives shattered by the untimely and unnecessary death of their mothers grew up plagued with severe emotional problems. Many failed to develop into competent adults choosing to suppress their grief and anger by refuge in drugs and alcohol. The societal cost of caring for these damaged children and young adults has yet to be calculated.

   For those women who survived the ordeal, they brought into a household often struggling to survive on limited income, another mouth to feed and clothe. These children, along with their brothers and sisters, now grew up shackled by chains of poverty and few fared well.

   Older obstetricians-gynecologists working in restrictive states began to retire at increasing rates lest their careers end in a lawsuit or worse conviction of a felony offense. Unfortunately, their numbers could not be replaced as recent graduates, the vast majority of them women, did not want to work in a state where their license, their liberty, and sometimes, their life was continually threatened.

   As the numbers of practicing obstetricians-gynecologists declined, the ability of all girls and women in the state to access competent, timely, and affordable care was compromised. Conditions that required prompt intervention to minimize serious and long-lasting disability (sexually transmitted diseases, malignancies) were treated too late. Morbidity and mortality rates increased along with the overall   financial cost of care. (Treating stage 1 uterine cancer is far less expensive than treating metastatic cancer.)

   The overall quality of the state’s obstetrical care also declined. Many counties lacked obstetrical care within their borders forcing even women with adequate financial resources to travel long distances to distant cities. Obstetrical problems that could have been treated quickly and efficiently now progressed to severe degrees of danger. Some women died who need not have.

   But for those women who did not have adequate insurance pregnancies became even more perilous. Often their first prenatal visit took place in the emergency room as they were experiencing a complication or worse, when they were in active labor (and often premature). Their pregnancies, hampered with complications produced newborns with a host of medical and surgical problems. Neonatal intensive care units were overwhelmed.

   Many women, without access to competent obstetrical care, continued their misuse of drugs and alcohol. These women experienced complex and problematic deliveries and produced babies saddled with an overwhelming number of issues. The neonatal intensive care units buckled as the cost of care for these damaged children was astronomical.

  The children born in such circumstances, if they survived their prolonged stay in the NICU (any many did not), were  forever impaired by cognitive and emotional problems. The societal cost of  caring for these impaired children has yet to be calculated.

   It had long been recognized that the incidence of domestic violence spikes during pregnancy, particularly if it was unplanned. Cases of domestic violence surged and women were brought to the emergency rooms battered and sometimes dead. Those unfortunate deaths also lead to the death of the fetus.

   The legal system experienced unprecedented challenges. Courts had to decide if physicians in unrestricted states could legally treat women from restricted states. The same question arose for all of the individuals assisting the woman in her pursuit of an abortion. Vigilantes took the law into their own hands and assaulted physicians and all those engaged in the care of women seeking abortions. Hundreds of cases seeking millions of dollars of damages clogged the dockets. Other cases, having nothing to do with reproductive health, could not addressed within a reasonable time period. The maxim- justice delayed is justice denied- was never so true.

   Often women who had a spontaneous abortion were investigated as were those who cared for them. The tragedy of their loss was now compounded by the stress of legal jeopardy. Neighbors turned against neighbors as the promise of bounty awards spurred people to notify investigators about possible abortion seeking behavior.

   Physicians, faced with a pregnant woman struggling to handle a serious complication of their condition and for which abortion was necessary, now hesitated to act fearing being charged with a felony. This delay, at times, led to unnecessary complications resulting in infertility and/or chronic pain. In some cases, delay led to her death. Physicians were now charged  and convicted of malpractice.

   Malpractice rates soared and the additional cost of doing business was passed onto the consumer (i.e. patient) raising the cost of care for all women and thus reducing access further to those who did have financial resources to pay for care. Deductibles and premiums and co-pays rose.

   Medical schools and residencies in restrictive states faced a raft of logistical and legal problems for accreditation requirements required graduates to be proficient in certain surgical procedures. Students who wished to pursue a career in obstetrics-gynecology often avoided applying to the schools in restrictive states further compounding the increasing shortage of women’s health care professionals.

   Since life was defined as beginning at the moment of conception in restrictive states, the legal status of infertility clinics was jeopardized. Many such clinics, rather than face legal challenges or assaults from vigilantes, left these states. Thousands of couples desiring children lost access to these services.

   Many young women  involved in professional training unexpectedly got pregnant either because they carelessly failed to use contraception, the contraception they employed failed, or they were raped. Unable to obtain an abortion, they had to drop out of school to work so they could raise their infant. Many never returned to the class. The economic cost of this scenario has yet to be calculated but many believe it will be substantial.

   Often young women chose not to apply to institutions of higher learning in restrictive states as they correctly surmised that the state was hostile to those who demand reproductive health autonomy. Many women professionals also refused jobs in these states or insisted that their spouses reject job offers in these states. Again, the economic cost to the state for a shrinking talent pool was considerable and calculations will show these states were not only economically less vigorous but also had higher rates of poverty to contend with.

  In their zeal to “protect the unborn,” the draconian restrictions in abortion led to

1.     increased number of pregnant women dying either from domestic violence, complications of abortion done in unsafe environments, and from complications of pregnancies.

2.     increased number of women experiencing post abortion complications of infertility and/or chronic pain.

3.     increased number of non-pregnant women experiencing increasing rates of morbidity and mortality from delayed treatment of gynecological problems.

4.     increased number of neonatal deaths

5.     increased number of infants born with intractable and long term psychological and cognitive and medical problems.

6.     increased total cost of health care for both women and men

7.     increased number of children placed in foster care with its attendant problems

8.     decreased number of women’s health care professionals in the state

9.     decreased number of talented female students and professionals entering the state

10.  increased number of families forever and irrevocably destroyed by the untimely and unnecessary death of the pregnant mother

11.  a decrease in the number of women who successfully obtain services at an infertility clinic.

12.  a legal system that loses its effectiveness as it buckles under the onslaught of

hundreds  of abortion related cases

The physician now paused and took a sip of beer. Just then, the waitress appeared. “Gentlemen, the bar is about to close. Please pay your bill.”

The physicist reached into his wallet, pulled out a credit card. “The tab is mine.”