Misha Pangasa: I worry about the toll pregnancy will take on women who are not ready to accept the risks and burdens

When abortion is prohibited, women will no longer have that choice.

(Leah Hogsten | The Salt Lake Tribune) State Street was filled with hundreds during the SLC Women's March for reproductive rights and access to safe abortions, Oct. 2, 2021. Saturday's march was held in conjunction with other marches across the country.

As an obstetrician-gynecologist, I’ve had unique opportunities to marvel at the wonders of human reproduction. Families have shared with me the joys of long-awaited positive pregnancy tests and first ultrasound views. I’ve become emotional, alongside families, at the miraculous moment their new child enters the world and lets out their first cry. These are some of the unparalleled joys of my work.

But alongside the thrills and delights, I’ve been witness to the often-underestimated burdens of pregnancy and motherhood. Sophia, a healthy black woman, shared with me at her first prenatal visit her overwhelming fear of dying from pregnancy. She and her husband desperately wanted a child, but they were terrified about the cost to her life.

As the United States leads the developed world in maternal mortality rates, with black women dying at three times the rate of white women, I struggled to find the right words to reassure her. We talked about complication and death rates, and I discussed all the ways we would prioritize her health.

But the reality is, that for those who choose to have a baby, it is often a complicated, nuanced balance between the health of the mother and the health of the child. While acutely dangerous stresses to a woman’s heart, lungs and other organ systems often drive recommendations for premature deliveries, the answers to the more insidious dangers of pregnancy are less clear.

For the many women who experience debilitating musculoskeletal pains and relentless nausea, who suffer lost wages because of employment without accommodations, who struggle to attend appointments while juggling childcare, who labor for days and push for hours, who suffer extensive vaginal lacerations or undergo open abdominal surgery, who receive blood transfusions and endure ICU stays, the only solace I’ve ever been able to give is: “It will all be worth it when you are home with your baby.”

As a young physician who trained in a country where abortion is legal, I have often taken for granted that having a baby is a deliberate decision. I’ve (naively) told myself that my patients had access to affordable, accessible, safe abortion care, but chose the path of pregnancy and delivery, thereby consenting to both the miraculous marvels of new life and to the innumerable risks to their lives and bodies.

My years of medical practice have also taught me that not all women have these options. The numerous geographic, logistical and financial obstacles to safe abortion care enacted by politicians have left many women without a decision to make, even when their positive pregnancy tests evoke only dread and fear.

I fear that in a few months, we will lose our freedom to make these decisions altogether. The anniversary of Roe v. Wade, the court case that established the right to an abortion in the United States, is January 22. This could be the last year we mark this date, as the Supreme Court has made it clear that the constitutional right to abortion is no longer guaranteed. If the Supreme Court relegates the decisions about abortion to state legislatures, current Utah law will go into effect, and nearly all abortions will be banned.

I recognize that, for some people, fetal life is all that matters in the discussion about abortion. But as a physician dedicated to safe, evidenced-based care, everything must matter. Without access to safe, legal abortion care, I worry about the toll pregnancy will take on many women in Utah who are not ready to accept the risks and burdens of pregnancy and motherhood, to whom I cannot simply say, “It will all be worth it.”

Misha Pangasa

Misha Pangasa, M.D., is an obstetrician and gynecologist in Salt Lake City.