Clarify Care: End the Confusion of 'Abortion' In Miscarriage and Ectopic Pregnancies

Medical terminology plays a crucial role in the accuracy of patient care and the emotional well-being of those affected. Miscarriage, also known as a spontaneous abortion, refers to the natural loss of a pregnancy, typically before the 20th week, often due to chromosomal abnormalities, maternal health issues, or environmental factors. An ectopic pregnancy occurs when the fertilized egg implants outside the uterus, usually in a fallopian tube, and can be fatal if not treated immediately.

While these conditions are sometimes categorized under the umbrella term "abortion" in medical records, referring to a miscarriage or ectopic pregnancy as an "abortion" can have profoundly negative emotional, psychological, and social consequences for patients. This terminology can cause unnecessary distress, confusion, and stigma, particularly for individuals who are grieving the loss of a pregnancy or who are facing life-threatening complications. The use of "abortion" in these contexts fails to acknowledge the nuanced nature of miscarriage and ectopic pregnancy, which are not voluntary actions but tragic, unintended medical events.

For many, the experience of miscarriage or an ectopic pregnancy is already fraught with physical and emotional pain. When the term "abortion" is used, it can deepen feelings of guilt, shame, and confusion, particularly for those who do not understand the medical distinction between voluntary abortion and involuntary pregnancy loss. This mislabeling perpetuates unnecessary stigma and alienates individuals who are already navigating an emotionally complex and often devastating experience. Moreover, the inappropriate use of this term can lead to a lack of support and understanding in social and healthcare settings, where individuals may be unfairly judged or misunderstood.

The financial implications of this miscommunication can be equally severe. In some cases, insurance policies treat voluntary abortion and medical abortion (due to miscarriage or ectopic pregnancy) very differently, often resulting in the denial of coverage for miscarriage or ectopic pregnancy treatments under the same terms. Patients who are misclassified as having had an "abortion" may face:

Increased medical costs: Insurance plans that cover "abortions" may not cover procedures related to miscarriage or ectopic pregnancy if they are mislabeled, leading to unexpected out-of-pocket expenses for patients.

Inaccurate billing: Incorrect medical terminology may lead to errors in billing, where patients may be charged for services or procedures under a category they were not expecting or do not qualify for, resulting in additional financial burdens and billing disputes.

Insurance denial: Some insurance policies include specific restrictions on coverage for "abortion", and using this term for miscarriage or ectopic pregnancy may inadvertently trigger a policy exclusion, leaving patients with significant unpaid medical bills for treatments related to their care.

Moreover, individuals who experience miscarriage or ectopic pregnancies may already face financial strain due to missed work, medical leave, or the emotional toll of dealing with the loss. The added financial burden resulting from insurance disputes and misclassification of their condition exacerbates their hardship, making a difficult situation even more overwhelming.

Iowa's healthcare system and its providers must be held to the highest standards of clarity and compassion. Iowa's medical professionals must use precise and sensitive language that acknowledges the reality of the experiences and ensures that the terminology aligns with the actual medical facts. By making this change, we will help reduce unnecessary distress, support patient rights, and promote a more compassionate and respectful healthcare environment in our state.

Iowa must lead the way in fostering an environment where language is used thoughtfully, and healthcare providers are held accountable for ensuring that all patients, regardless of their medical experiences, receive care and treatment that honors their dignity, rights, and emotional well-being.

The Committee on Health and Human Services which Iowa State Senator, David D. Rowley sits on passed SF 210 on February 6th, 2023(1) which references the term "brain health". As follows in the bill, "The general assembly finds that to reduce the stigma associated with brain health disease and brain illness and to assist Iowans in receiving brain health diagnosis and treatment, the terms 'brain health' or 'brain illness' may be used synonymous with the terms 'mental health', 'mental illness', and 'behavioral health' as to allow for more preventative and earlier treatments for those Iowans with brain health issues. The recognition of the term 'brain health' does not replace or alter the terms 'behavioral health', 'mental health', or 'mental illness' as those terms relate to medical billing, insurance regulation, or state professional licensure."(2)

According to an entry in the British Medical Journal in 1988, Dr. R A A R Lawrence writes: "Abortion was discussed during a recent phone in programme on BBC Radio Derby. A number of women listeners expressed their objection to the term 'abortion' when it referred to the spontaneous event. They were unanimous in their wish that the term 'miscarriage' should be used instead." Later in the entry, Dr. Lawrence states, "Our use of medical terminology should take account of the fact that what may be accurate medically could cause distress to the lay person because of ambiguous interpretation. (3)

(1) Legislative Services Agency. (n.d.). Iowa Legislature - BillBook. https://www.legis.iowa.gov/legislation/BillBook?ga=90&ba=SF%20210

(2) https://www.legis.iowa.gov/docs/publications/SJNL/20230206_SJNL.pdf#page=6

(3) Conlon, C. P. (1988). Points: Upper gastrointestinal Kaposi’s sarcoma in patients positive for HIV antibody. BMJ, 296(6624), 792. https://doi.org/10.1136/bmj.296.6624.792-h Iowa