By Susan E. R. Mitchell, Deborah Derrickson Kossmann, and Heather Tuckman
A woman you know has experienced a miscarriage. According to the Mayo Clinic, 20 percent of pregnancies end in this way.
The National Institutes of Health report that 80 percent of miscarriages happen during the first trimester, often before the pregnancy is recognized. Like many aspects of reproductive healthcare, this private, frequently painful episode is often shrouded in secrecy and silence.
Legislation sponsored by Rep. Frank Ryan, R-Lebanon (HB1890), currently before the state House Appropriations Committee, magnifies and intrudes into what is often an exceptionally difficult loss.
As three female psychologists with more than 70 years of clinical practice between us, we have helped many of our clients deal with the sequela of miscarriage. In addition, all three of us have personally endured miscarriages.
Because of our expertise and experience, we stand strongly against this proposal.
This poorly-worded and ambiguous piece of legislation is potentially emotionally harmful to the women of Pennsylvania, creating additional burdens and possible trauma.
Ryan’s legislation categorizes a miscarriage as a death, regardless of the length of the pregnancy, and, therefore, requires the health facility to file a death certificate, obtain a burial permit, and to provide ritual burial or cremation.
If a woman does not agree with these mandates, she will be responsible for potentially significant fees to opt out of this legal demand. By requiring a death certificate (under Article V of the Vital Statistics Law) for ALL miscarriages (not just those 16 weeks or later, as is now the case), family members could have immediate access to the record and it would also become part of the public record later on, thus compromising a woman’s privacy and safety.
Under current state law, miscarriages prior to 16 weeks are documented in a woman’s health record and are confidential under both federal and state laws. These records are never released without the woman’s permission. To be clear, in current law, there is also nothing that prevents a woman from having ritual burial for a miscarriage that is less than 16 weeks. Ryan’s bill seeks to make this a requirement.
Through these mandates, Ryan’s legislation, intrudes inappropriately into a woman’s experience of miscarriage, by compromising her privacy and dictating how she should make meaning of it, a process that is influenced by her health, religious beliefs/moral convictions, desire to have a baby or not, relationships and past experiences of loss.
In addition, especially with early miscarriage, the legislation raises questions about a woman’s ability to seek out relevant health information for herself through post miscarriage genetic testing so that she can better understand what happened in order to plan future treatment or make other decisions for herself and her family.
Miscarriage can be a relief or a tragedy or anything in between to the people who go through it. The three of us have born witness to the variety of meanings people make in order to understand this common event in their reproductive lives.
Ryan’s legislation should not determine how a woman and her partner/family cope with this loss. The Pennsylvania legislature needs to vote NO on this bill. It turns what is already a complicated and private event into one that is public and potentially psychologically damaging.
Susan E. R. Mitchell, Deborah Derrickson Kossmann, and Heather Tuckman are all licensed psychologists.