Indiana’s war on pregnant women

PURVI PATEL'S pregnancy was, in many ways, like those that half of American women face: unplanned. Like other women, Patel's pregnancy was also at times complicated by ambivalence, fear, denial, disconnection and feeling that it was unwanted and unwelcome. She shared her pregnancy with a close friend, but intended to shield it from her conservative Hindu family, who she didn't think would approve of either pregnancy out of marriage or abortion.

We don't know if Patel attempted to get a legal abortion at any point, or if she ever "illegally" purchased the medication misoprostol from overseas in order to abort, as prosecutors allege. But we do know that she was stuck in a difficult situation during that pregnancy in 2013, and some time in the second trimester, likely around 23 to 25 weeks, the pregnancy ended unexpectedly with labor and stillbirth.

When that pregnancy outcome left her with excessive vaginal bleeding, Patel did what most women would do. She went to the nearest emergency room--which happened to be at a Catholic hospital in Mishawaka, Indiana--for urgent medical attention.

Instead of receiving the best and most compassionate medical care, however, Patel became the subject of what one commentator described as a "junior CSI" investigation.

Whether it was because the obstetrician, Dr. Kelly Maguire, who was called to assess her was a known anti-abortion doctor, or because Patel didn't meet medical staff's cultural expectations of how a woman with a lost pregnancy should behave, or because she was a woman of color, this event cascaded into a legal nightmare, resulting in Patel's sentencing this week to 41 years in prison (of which she will serve 20, plus five years of probation)--for the confusingly contradictory "crimes" of feticide and neglect of a dependent.

As the National Advocates for Pregnant Women pointed out, this is the first case nationally to result in a woman being "charged, convicted and sentenced for the crime of feticide for having attempted to end her own pregnancy"--effectively demonstrating that the "feticide and other measures promoted by anti-abortion organizations are intended to punish, not protect women."

PATEL'S STORY oozes with injustice at every step of the way.

Let's start with fact that by the time Patel discovered her pregnancy, around 20 weeks, abortion was already illegal for her in Indiana. She would have had to come up with the money to miss work, travel to another state like Illinois or Ohio, and pay for lodging and several hundred dollars in fees for the procedure.

Whatever caused her to go into labor and deliver the fetus before viability, it's clear that Patel needed medical care--and going to the nearest hospital, she clearly didn't get care, but became the subject of a witch hunt. Everyone who should have been there for her--from the medical staff at the hospital to the "justice" system that saw a case against her--viewed Patel as a criminal, not as a person who needed care and support.

Illustrating this perfectly is the fact that prosecutors got away with calling on a forensic pathologist who used a 17th century "scientific" method to "prove" that Patel's fetus was born alive and viable, and therefore she "neglected" it after birth. The "lung float test" performed by this "expert" should have been put to rest after the war on witchcraft--it has been by most of the medical community, for about 100 years. But it is still dusted off when it suits the purposes of a political prosecution, as it did in this case.

Like a witch exposed by floating instead of sinking in water, fetal/neonatal lungs are presumed to have taken at least one breath if they float in this test. Unfortunately, the science doesn't hold up, in either detecting a witch or determining the viability of a baby. The medical "experts" in our legal system also failed to consider that even practitioners extremely skilled in neonatal resuscitation, under the best of circumstances, are not always able to resuscitate an extremely premature baby.

Many commentators have also noted the contradictory nature of the two "crimes" for which Patel was convicted--feticide and neglecting an infant. Some, such as Amanda Marcotte at Slate, claim Patel should have been charged with just one, but the fact is that justice would not have been served with a single conviction on either charge.

Abortion should be legal, safe and protected, whether induced (elective) or spontaneous (miscarriage). All abortion must be both understood as a normal part of women's reproductive lives and defended as integral to reproductive freedom and gender equity.

Patel's story likely unfolded in the way it did due to a complex intersection of oppressions related to race, immigration, abortion and other health care access, legalistic use of bad science, abortion stigma, religion, personal isolation, the strength of the anti-abortion movement, providers' ideology, and so forth. Each of those things alone might not have stood in the way of Patel getting humane medical care from the beginning of her pregnancy, but their interplay conspired to condemn her to a dangerous pregnancy outcome (unassisted labor and stillbirth/hemorrhage) and its draconian aftermath.

MANY WRITERS have wrung their hands about how little it makes sense, but this case can't be understood without placing it in the context of the steady erosion of reproductive rights nationally, and a rightward shift in Indiana in particular. Nationally, the last four years witnessed a massive uptick in state abortion restrictions--231 in that time period alone, with more certain to follow in 2015.

Indiana itself has passed so many abortion restrictions over the last 15 years that the Guttmacher Institute, which conducts rigorous research on family planning and abortion, considers it to be one of 18 states in the U.S. that is "extremely hostile" to abortion rights.

Anti-abortion restrictions on the books in Indiana include: forcing women to receive anti-abortion "counseling" and then undergo a mandatory 18-hour waiting period before receiving the procedure; requiring parental consent before providing abortion to a minor; mandating an ultrasound and offering the opportunity for the pregnant woman to view the image before the abortion; several restrictions on public and private insurance funding that may put pregnancy termination out of reach for poor women; and the post-20-week abortion ban mentioned previously.

As a result of all these restrictions, as of 2011, 93 percent of all counties in Indiana--where 61 percent of the state's women live--had no abortion provider.

And that's just the picture of abortion access in Indiana. From the anti-union "right-to-work" legislation that withstood a Supreme Court challenge last fall to the bigoted Religious Freedom Restoration Act (RFRA) enacted last week, the state's right wing is on a rampage, aiming to make the state's working-class and oppressed citizens even more vulnerable.

Indiana's public health infrastructure has also been gutted, which recently led to the closure of several HIV testing sites, resulting in an HIV epidemic in one small town. And while the loss of reproductive health services like those offered by Planned Parenthood clinics was a direct result of a particular kind of right-wing anti-abortion campaign, the state Medicaid program has been losing funding since at least 2010.

Each cut means fewer providers will accept the state insurance program, and thus, poor and low-income Indianans have less access to preventive and reproductive health care. All of this is about shifting the budget crisis onto the state's working-class and poor people.

It's not surprising, therefore, that some of the state's most vulnerable people, women of color, would be among those most impacted by this rightward turn--Patel being only the most recent example. A few years ago, a Chinese woman living in Indiana named Bei Bei Shuai was also convicted, though not sentenced, under the state's feticide laws--in this case, for attempting suicide during the third trimester, which allegedly resulted in fetal death.

The answer isn't to leave states where the conservatives are winning, nor to try to turn back the tide by electing more "pro-choice" Democrats to local or national office. The only way to win justice for Patel or to stop the myriad other attacks that our side faces is to work together to organize against every face of the right-wing assault in Indiana, and anywhere else similar attacks are happening.

As socialists, we stand against every case of oppression, because each attack makes it easier for the next to occur--until someone like Patel pays the price with decades of her life, not to mention a dangerous precedent set for future assaults on our rights and freedom. The struggle for justice for Purvi Patel also puts us in a better position to repeal the state's RFRA and overturn "right to work."

These interconnected struggles require building a broad, intersectional movement for reproductive justice that is independent of the two pro-capitalist parties. Indiana's right wing and ruling class are trying to turn back the clock on reproductive and workers' rights, and we have our work cut out for us, not only to defend services, but also to restore and advance our rights and power.