If America Really Cared About Mothers, Reproductive Health Care Would Be Available to All

(AP Photo/South Bend Tribune, Robert Franklin)

Purvi Patel is taken into custody after being sentenced to 20 years in prison for feticide and neglect of a dependent on Monday, March 30, 2015, at the St. Joseph County Courthouse in South Bend, Indiana. Yet she may simply have had a miscarriage.

This essay is published by The American Prospect in partnership with The OpEd Project's Public Voices Fellowship. It is part of a package of commentary pieces centered on Mother's Day 2015.

OMarch 30 Purvi Patel, a 33-year old Indian immigrant from South Bend, Indiana, was charged with feticide and child neglect. While many of us wonder how she can be charged with feticide, which requires a dead fetus and the simultaneous neglect of a dependent child, which requires a live birth, state prosecutor Ken Cotter said Patel deliberately attempted to terminate her second-trimester pregnancy with illegal pharmaceutical abortifacients procured online. Instead, she delivered a living fetus, which was “allowed” to die.Thus, she is guilty of feticide and child neglect, of causing death to the same body not once—but twice.

Patel’s case has occasioned the circulation of the expected anti-abortion and pro-choice debates with predictably heated rubric on the moral decrepitude of one versus other. Instead, by invoking this exceptionally horrific story a few days before Mother’s Day, I ask: What does Purvi Patel’s case tell us about what might it take to be truly for life, and fully celebrate mothers and their children? 

Patel believed she was two months into her pregnancy. In phone texts to her friend obtained in court Patel says she ordered abortifacients online that arrived a month later. She took the pills on July 10, 2013, and aborted on July 13, 2013. She texted her friend: “Just lost the baby. I’m gonna clean up the bathroom and then go to Moe’s [the family-run restaurant].” She then wrapped the fetus in paper towels, placed him in bags and eventually in the dumpster behind the restaurant. But she continued to bleed, and took herself to nearby Catholic-run St. Joseph Regional Medical Center’s emergency room. No traces of the drugs were found in her body, but the phone texts were pivotal in conviction. 

It turned out Patel was 24-25 weeks pregnant, not in her first trimester. The forensic pathologist, Dr. Joseph Prahlow, used the widely discredited “lung float” to testify the baby took a breath before dying, endorsing the view that Patel willfully neglected a dependent child. But air in the lungs, ostensibly present only if a baby has taken a breath, could very well be because of tissue decay. Or, air in the lungs could have resulted because of attempts at resuscitation, which Patel reported to the E.R. doctors she had tried in vain. Assistant prosecuting attorney Aimee Herring went on to present Patel as a selfish person who sought care for herself while the baby lay dying. Incriminating testimony from E.R. doctors didn’t help either because they said she was emotionally flat, disengaged and on her cellphone the entire time. 

Yet, how are we to interpret her emotional affect? Just as much as a flat affect might reveal the soul of a psychopath, might it also reflect someone who is in deep shock, unable to comprehend or fully accept the situation she finds herself in and what is happening to her body, including profuse blood loss? Moreover, Patel was alone in the E.R. without friends or family, and being questioned about her actions that she knows are illegal. 

Still others argue she could have had an abortion because first trimester abortions are currently still legal in the U.S. But abortion is not easily accessible in Indiana; as of 2011, there were just 12 providers. Health plans under the Affordable Care Act and public funding cover abortions only if the woman’s life is endangered, or she is a victim of rape or incest. Moreover, women seeking abortions must receive state-directed, in-person counseling including an ultrasound, and the health-care provider must the option of viewing the images. And, they must wait 18 hours before any procedures can be initiated.

But how might Purvi Patel have accessed abortion without the support of family and friends? Raised in a conservative Hindu family in the predominantly Irish Catholic town of South Bend, she had been considered an upstanding member of the Indian immigrant community. As an unmarried daughter, she lived with her parents and helped build the family’s restaurant business by working throughout the week, and returning home to take care of her aging grandparents who lived with them. Patel’s parents disapproved of premarital sex much like the sex education promulgated in the state’s schools. They preferred their daughter marry within the faith. They did not know their daughter had a secret lover who was a married man. And neither did they know of her pregnancy or that she had delivered pre-term until her arrest.

Patel is the second woman in Indiana to be convicted of feticide, the first being Bei Bei Shuai in 2011, who had attempted suicide when she was eight months pregnant. She survived, but her daughter did not. The feticide charge in Shuai’s case was ultimately dropped after she accepted a plea bargain of criminal recklessness. Various commentators have noted it is perhaps not surprising both cases of feticide are against immigrant Asian women, from India and China, no less. These countries are marked as having little respect for sacred life because of the prevalence of sex selective abortions in India, and China’s long-standing single child policy. Widespread misogyny no doubt exists in these countries, but pervasive American beliefs about the moral failures of those nations are imputed to individual immigrant women from those countries, which ironically leads to the application of the American brand of misogyny, and condemnation of women as “baby-killers,” circulating at the very center of America’s heartland, Indiana.

Patel’s case is horrific, but how might the outcome have been different if she had access to easily available, affordable reproductive care, which I understand as far more comprehensive than simply abortion provision? What if women and children had the right to broad sex education including contraception and not just abstinence; deeper understanding about pregnancies; comprehensive, easily accessible and high quality prenatal care; equally excellent and accessible post-natal care; and, emotional support for mother and child? 

Infant mortality rates, defined as the number of deaths of children less than one year of age per 1,000 live births, are high in the U.S. A 2014 Centers for Disease Control and Prevention report says despite the fact healthcare spending is significantly higher than any other country in the world, a baby born here is less likely to see its first birthday than one born in Hungary, Poland, Slovakia, and Belarus. Infant mortality rates are an important indicator of a nation’s health because it is associated with maternal health, quality and access to medical care, and public health practices. Infant mortality rates are higher in Indiana than the national average, with far worse outcomes for black infants than others.

Maternal death is greater in the U.S. than in 40 other countries, including almost all other industrialized nations; and unsurprisingly, black women are four times more likely to die from pregnancy-related conditions when compared to white women. Admittedly Indiana is not as bad as Texas, Mississippi, or Louisiana in overall child well being, but more has to be done to support mothers in their mothering activities. 

What does it mean to punish women for what their individual perceived moral failures, while remaining silent on the systemic failures that result in lack of support for women in their pregnancies, and after childbirth? And, given the abysmal ways by which Patel has been treated in Indiana, are we to believe her perhaps dead-at-birth son would have been treated any better if he had lived out his life as the brown child of an unmarried, immigrant woman? 

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