The Washington PostDemocracy Dies in Darkness

How the abortion debate has skewed Americans’ understanding of pregnancy

What led a Walgreeens pharmacist to deny a woman her prescription.

A Walgreens retail store. (Charles Krupa/AP)
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Last week, Nicole Arteaga lost her very-much-wanted pregnancy. As often happens in early miscarriages — Arteaga was only nine weeks along — her body had not yet expelled the remains. Her doctor prescribed misoprostol to help her body complete the process.

Yet when she went to fill her prescription, she was turned away. The Walgreens pharmacist who denied her prescription cited his “ethical beliefs.” (Misoprostol is also used to induce abortion.)

His refusal highlights how fundamentally abortion politics have limited our understanding of pregnancy, and how a failure of understanding can translate into a heartbreaking failure of compassion.

The abortion debates of the past half-century have obscured a central reality of early pregnancy: It is a tenuous state of being. Arteaga’s situation is far from uncommon. About 20 percent of confirmed pregnancies miscarry, mostly in the early months. In fact, about the same proportion of pregnancies miscarry spontaneously as end in induced abortion.

A large portion of those spontaneous miscarriages are safely and effectively treated with the same drugs that are used to induce abortion. Without medical treatment, a woman must be monitored for infection for days or weeks, enduring the emotional distress of knowing that her pregnancy has ended without the closure of an empty womb, or she must submit to a more invasive surgical procedure to clear her uterus.

While battles over contraception have been a recurring part of public life since the 1850s, and 19th-century newspapers covered the occasional raid of Madame Restell’s scandalous yet well-attended New York abortion clinic, pregnancy was not a regular topic of public debate until the rise of 20th-century abortion politics. Before the late 1960s, pregnancy was only occasionally in the news, and ethical questions surrounding pregnancy were rarely subject to public scrutiny. The public thrilled to Lucy and Desi’s parallel real-life and television pregnancy on “I Love Lucy” in the 1950s and mourned Jackie and John Kennedy’s losses in the 1960s. They took note of the medical crises surrounding the birth anomalies caused by thalidomide and German measles in the 1950s and 1960s.

But the idea that everyone, young and old, should argue over the moral and ontological status of pregnancy? That was an innovation of the abortion debates. Sparked by the movement to decriminalize abortion in the United States, physicians’ organizations, feminists, medical ethicists, religious leaders and many others joined a noisy and contentious public discussion that only grew louder after the 1973 Roe v. Wade decision legalizing abortion across the country.

Since the late 1960s, philosophical arguments about the developmental status of embryos and the rights of women have appeared frequently in newspapers, magazines and books. Everyone is expected to have an informed opinion, whether they have ever been pregnant or plan to have children in the future. That gives a unique power to activists, whether abortion rights activists arguing that a woman should have the right to control her body, including ending a pregnancy, or antiabortion activists arguing that an embryo should have the full rights of a person beginning at conception. They are, in fact, so powerful that most of us learn to think about pregnancy in the context of the abortion debate long before we embark on our own childbearing.

That has real consequences for how we understand pregnancy. In our abortion debates, we tend to argue about pregnancy in the abstract, rather than deal with the messy and unpredictable nature of real-life pregnancies. We speak as if pregnancies always end in one of two ways: with a child, or with an abortion. Our public discussions have all too often failed to acknowledge that a fifth of pregnancies will end spontaneously even after they have been confirmed with a pregnancy test.

This shared blind spot has consequences for women who miscarry. Women who think that they have been promised the right to choose, and have chosen pregnancy, may feel blindsided by pregnancy loss. Women who have heard argument after argument for the rights of embryos as full people may be shocked to discover that the lives of those embryos are so much more precarious than those of already-born children. And even some medical professionals, such as the pharmacist who refused to fill Arteaga’s prescription, may fail to acknowledge the common medical needs of miscarrying women in their antiabortion zeal.

It seems unlikely that our abortion debates will be resolved anytime soon. But in the meantime, we need to make sure that the well-being of miscarrying women does not become collateral damage in the war on abortion.

Arteaga found herself begging for medication she had been prescribed. She stood in front of her 7-year-old child and the rest of the customers in line, describing to the Walgreens pharmacist how her doctor confirmed on the ultrasound that there was no heartbeat, and she needed the medication to help her body finish miscarrying. And yet she still left without her prescription, her heartbreaking loss now compounded by humiliation and rejection, and spent another day getting it from a different location.

No one who miscarries should be treated that way. The pharmacist may not have a legal obligation to fill a prescription for misoprostol, but he showed remarkably poor judgment: both in his medical judgment in withholding standard miscarriage treatment and in his ethical judgment in adding to a miscarrying woman’s suffering.

The abortion debates, as they have evolved and hardened over the past five decades, have generated a vast amount of discussion about pregnancy. Yet they have obscured the most basic understanding of the tenuousness and uncertainty of early pregnancy — even, apparently, on the part of some medical professionals. If we want to support women in their childbearing experiences, no matter our abortion politics, we need to acknowledge the reality of early pregnancy loss and treat miscarrying women with proper medical care, compassion and respect.