The tragic death of a 30-year-old woman in Poland has sparked protests and calls for a review of the country’s strict abortion laws, which were tightened earlier this year.
The woman, Izabela, died of septic shock after complications involving her pregnancy, which opponents of the laws claim could have been avoided if she had undergone an abortion earlier in the pregnancy.
Under the latest abortion restrictions in Poland, there are only two circumstances in which an abortion is permitted, as an ABC News article reports:
“Before the new restriction, women in Poland could have abortions only in three cases: if the pregnancy resulted from a crime like rape, if the woman's life was at risk, or in the case of irreparable defects of the fetus.
The last possibility was closed by the tribunal's verdict.”
At 22 weeks pregnant, previous scans of Izabela’s unborn child had shown severe health issues, including not having enough amniotic fluid to survive.
Poland’s governing party, which passed the latest restrictions, says that the laws were not the problem, that the tragedy was the result of doctor error.
Prime Minister Mateusz Morawiecki said of the case "When it comes to the life and health of the mother … if it is in danger, then terminating the pregnancy is possible and the ruling does not change anything."
The deaths of Izabela and her unborn child are tragedies. The hospital has suspended the two doctors who were on duty at the time of their deaths, and there are important questions to be asked about the standard of care that Izabela received, given that her life was clearly at risk and an abortion would have arguably fallen within the nation’s strict laws in any case.
However, and in the absence of more details about the circumstances of Izabela’s case, questions must also be asked about whether an abortion would have been the best option for her in this case, or whether other measures, and earlier interventions, would have been safer for her and more likely to protect her life and that of her unborn baby.
The Dublin Declaration on Maternal Healthcare, issued on 8 September 2012, signed by thousands of obstetricians, gynecologists and health care professionals, asserts that abortion is never necessary to save the life of a mother:
“As experienced practitioners and researchers in obstetrics and gynecology, we affirm that direct abortion – the purposeful destruction of the unborn child – is not medically necessary to save the life of a woman. We uphold that there is a fundamental difference between abortion, and necessary medical treatments that are carried out to save the life of the mother, even if such treatment results in the loss of life of her unborn child. We confirm that the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women.”
Indeed, US obstetrician/gynaecologist Dr Anthony Levatino – who has cared for hundreds of women with severe pregnancy complications including cancers, heart disease, intractable diabetes, out of control toxemia – explains that late term abortions are inappropriate in emergency cases. This is because it can take 24 to 72 hours to prepare the cervix for the abortion, which is too long for women facing dire medical emergencies.
Dr Levatino’s practice, in high risk situations, is to deliver the baby, either by induction or cesarean section delivery. Where a pregnancy is endangering the life of the mother, the priority is to separate the mother and the baby, and to do everything within the physician’s power to save the lives of both patients. Such an approach, which prioritises the health and safety of both the mother and the baby, is critical to improving women’s health in such high risk maternal health care settings.
It is a tragedy that Izabela and her baby were not provided with the care that they needed, which may have saved either or both of their lives. But claims that abortion is the only answer “is based on faulty assumptions about the options available to women who face life-threatening pregancy complications”.
Activists, in Poland, around the world, and right here in Australia, will use this as an opportunity to demand less or un-restricted access to abortions. However, it is clear that Izabela’s case raises more questions than it answers. The way forward must be an approach based in best medical practice, not politics.