Abortion vs. Miscarriage: Decoding Reproductive Health Care Terminology Post-Roe

In 1973, after years of fighting, people in the U.S. who could get pregnant received the news they'd been waiting to hear: Thanks to one crucial Supreme Court case, Roe v. Wade, they'd be allowed access to safe, legal abortions. Nearly 50 years later, the Supreme Court has stripped that right away. In fact, it took seemingly very little deliberation for the men and women who make up America's highest court to take away bodily autonomy. And if you think the overturning of Roe v. Wade will only affect people seeking voluntary termination of pregnancies, you're gravely mistaken — safe care during pregnancy loss and miscarriages is now also in danger thanks to the 2022 Supreme Court ruling.

How? Unsurprisingly, it all comes down to medical terminology, i.e. abortion vs. miscarriage, and the fact that many politicians (read: cisgender males) have no clue how the reproductive anatomy of people who can become pregnant works. Terms for pregnancy loss include "spontaneous abortions," "incomplete abortions," or even "inevitable abortions," which makes it all the more tricky to define what is an involuntary, medically necessary abortion for miscarriage care and what is considered an elective abortion.

With the overturning of Roe v. Wade, something as simple as a doctor choosing the wrong medical billing code could theoretically result in a criminal charge. Confused? Same. To help clarify at least some of the terminology surrounding this complex conversation, keep reading to learn more about abortion vs. miscarriage.

Abortion: A Common Definition

When most people think of the term "abortion," they aren't thinking about pregnancy loss. They're thinking of a voluntary decision to abort a pregnancy. In medical terms, that's often referred to as an "induced abortion" or "therapeutic abortion."

Of course, no one gets an abortion for fun. Extreme detractors love to vilify all people who choose abortion as sex maniacs and murderers, among so many other claims — which couldn’t be farther from the truth. You've seen the memes and probably already know your friends' abortion stories. Women voluntarily abort pregnancies for numerous reasons, all of which are valid. Just because it's voluntary doesn't make it easy.

Pregnancy Loss: Miscarriages and Stillbirths

Pregnancy loss comes in various forms and is tragically common. It's estimated that some 30% of all pregnancies end in miscarriage. Merriam-Webster defines a miscarriage as the "spontaneous expulsion of a human fetus before it is viable and especially between the 12th and 28th weeks of gestation." They can sometimes happen so early that a person may not even know they were pregnant. They most commonly occur in the first 13 weeks, which is why many doctors advise pregnant people to wait to share their news until they're out of the first trimester.

Another name for a miscarriage is "spontaneous abortion” — not because a pregnant person is choosing to abort their pregnancy, but because the body is aborting it. At 20 weeks gestational age and beyond, pregnancy loss is referred to as stillbirth, fetal death, and intrauterine fetal demise.

Ectopic Pregnancy

During a typical pregnancy, the fertilized egg latches to the lining of the uterus, but for someone experiencing an ectopic pregnancy, the fertilized egg grows outside of the uterus. This usually happens in the fallopian tube but can also occur in the ovaries and cervix. During this kind of pregnancy, the fertilized egg cannot survive and, if left untreated, can become deadly.

Chemical Abortion

This kind of abortion procedure uses medicine to end a pregnancy. It's one of the safest procedures a person can use during their first trimester. It can be done at the doctor's office or at home and doesn't require surgery or anesthesia. People usually take oral mifepristone (Mifeprex) and oral misoprostol (Cytotec) for the procedure, which should be taken within the first seven weeks of the first day of a person's last period.

Stillbirths/Miscarriage Management vs. Therapeutic Abortions

In many cases of a miscarriage, the pregnant or formerly pregnant person will call their doctor or seek care at a health care facility, often for cramping or excessive bleeding. How far along in the pregnancy a patient is will determine how managing the miscarriage is handled. Early in the pregnancy (usually around 12 weeks gestational age), doctors may wait for the unviable tissue to pass on its own. They may prescribe medicine to help the tissue pass (known as a medication abortion). Or they may use aspiration and suction, dilation and evacuation, or dilation and extraction (known as a procedural or aspiration abortion) to remove the unviable pregnancy.

These options get performed the same way whether the abortion is voluntary or not. Even when a doctor performs a D and C (dilation and curettage), they're not "killing" anything but simply removing dead tissue so that the person does not get an infection. However, the process is almost identical to and labeled similarly to voluntary or therapeutic abortion. See the problem yet?

How State Laws Put People Who Miscarry in Further Danger

Miscarriages and stillbirths are spontaneous and involuntary, not elective. However, both medical and political terms come into play in abortion restrictions and fetal harm laws. Many medical terms used to describe miscarriages and stillbirths use the word "abortion." Lawmakers took things a step further by using terms like "induced miscarriage" or "procuring a miscarriage" when writing abortion laws. With so many overlapping terms, it's very easy for both the formerly pregnant person and their doctors to find themselves under scrutiny, even when just attempting to receive and give care to a person suffering spontaneous, involuntary pregnancy loss.

Currently, 22 states have laws in place prohibiting certain procedures often necessary during pregnancy loss. Laws that ban D&X (dilation and extraction) or D&E (dilation and evacuation) usually contain language like "living unborn child" or "living fetus." Essentially, that means if the being in your body is dying, but fetal cardiac activity is still detected, a doctor or hospital can deny your care. In denying or waiting until all cardiac activity has ceased, they're also putting the pregnant person's life at risk. Additionally, it could mean that people receiving or giving care during documented fetal cardiac activity could later deal with legal ramifications.

So, is miscarriage a crime now? Not yet, at least not technically. But in addition to the problematic language in abortion restriction and fetal harm laws, several states have already proposed legislation that would require miscarriages and stillbirths to be reported. The state of Virginia went so far as to attempt to mandate that any pregnancy loss — including the mother’s name and the location of pregnancy remains — be reported to law enforcement.

Recent criminalization cases highlight just how dangerous this legislation can be for people who miscarry. In 2020, a 19-year-old in Oklahoma named Brittney Poolaw sought medical care after suffering a miscarriage. After telling the hospital staff that she’d recently used marijuana and methamphetamine, she was arrested for manslaughter and sentenced to four years in prison. In 2019, a woman named Marshae Jones was arrested and charged with manslaughter in Alabama when she miscarried after being shot in the abdomen (law enforcement claimed she started the fight, therefore was to blame for the miscarriage).

Getting the Care You Need Post-Roe v. Wade

Know your state's laws and the laws of the states near you. The overturning of Roe v. Wade doesn't mean that abortions are illegal. It means that abortion legislation is in the state lawmaker's hands. What might be illegal in your state could be perfectly legal in a neighboring state. You can still seek abortions, and that right is likely to remain protected in the following states:

• Alaska
• California
• Colorado
• Connecticut
• Delaware
• D.C.
• Hawaii
• Illinois
• Maine
• Maryland
• Massachusetts
• Minnesota
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• Oregon
• Rhode Island
• Vermont
• Washington

In the long run, abortion rights are still in your hands. Vote for lawmakers who will protect your autonomy.