Purvi Patel suffered a huge trauma – the end of a pregnancy. She then suffered another trauma when her reproductive narrative was criminalized in a medical setting. There have been many conclusions drawn from Patel’s case. But the one that isn’t being focused on is the greater implications of trauma that come with putting an immigrant woman of color in prison for the outcomes of her pregnancy.
From a public health perspective, the outcome of Patel’s case further complicates a medical system that is already hard to navigate if you are low-income, a non-English speaker, and/or an immigrant. For immigrants from countries like India, where medical corruption is rampant, there is a legacy of mistrust in the medical system. Now that same attitude is being harshly reinforced for South Asian immigrants in the US.
Physicians have previously criticized laws that can criminalize pregnant woman’s behaviors or their reproductive choices. In May 2012, the Prenatal Nondiscrimination Act (PRENDA) went before the House of Representatives to ban abortion based on sex. The bill failed. But had it become a law it would have meant that a health care provider who suspected that a patient was seeking a sex-selective abortion would be required to report that patient to the authorities. Doctors who performed the abortion could face heavy fines, lawsuits, and/or jail time. Previous versions of PRENDA even sought to ban abortions based on race.
And who would have been targeted? Women like Purvi Patel. Asian-American women, given the issue of sex selection in Asian countries, were the most at risk if PRENDA had passed. PRENDA was not created to protect women, but to limit reproductive choice for a certain group of people. In Indiana, it feels like we are seeing the same kind of mindset that led to PRENDA inform how Patel’s case was handled.
Indiana’s feticide laws, which allegedly are intended to protect women, seem to be harming them by sending the message: Don’t seek out reproductive health care unless you want to run the risk of criminalizing or legalizing your behaviors, choices, and happenstances. In this case, the state of Indiana exemplifies the use of biopower in its control of Patel’s body.
Biopower is a term used in bioethical discussions surrounding how manipulations of biotechnologies can help serve an authoritative entity. Basically, it means having power over bodies. Governments have historically and continue to use biopower to impose stigma on marginalized populations, including subjecting women’s pregnant bodies to violence. And this kind of biopsychosocial violence definitely leads to second traumas that are not being taken into account in Patel’s situation.
I have previously written about second traumas and how they affect women in Indian society. Women’s narratives of reproductive trauma are what drew me to exploring women’s health as a potential medical specialty. Understanding how physicians can practice healing with trauma informed care were specifically interesting because I have seen Indian women disproportionately report and experience more trauma as a result of socio-cultural factors. Looking at the Patel case, however, I realize my statement is too narrow. Second traumas affect women everywhere to a greater extent because their choices and agency are constantly under attack.
The second traumas caused by the Patel case reach further than just the woman in jail who went to a hospital seeking care. The second trauma is the one that is being inflicted on South Asian women and Asian-American women who are watching the news and reading the newspapers – realizing that their stories have to be iron-clad if they go to a hospital for pregnancy-related issues. That their pregnancies and health will face judge and jury. Their narratives will have to be framed in the context of a medical system that can function in a perverse type of mandated reporting not based on “safety and risk-reduction,” but on race and sex.
My biggest practical fear is that young brown girls and women (and other women of color) will not seek out the proper care they need. This goes double for brown women who identify as LGBTQ. Living in communities where sex is not openly discussed and pregnancy is reserved for after marriage, the trauma caused by the handling of Patel’s case will definitely impact women of color to a larger extent.
My second fear stems from thinking about my role in cases like this as a future medical professional. The patient-doctor relationship is commonly championed in the medical world. Had PRENDA passed, it would have forced physicians to racially profile their patients and to ask a series of intense questions about a woman’s decision to get an abortion. Physicians would also have been limited in the reproductive care they could provide under PRENDA.
In addition, physicians, nurses, clinical social workers, and patient advocates also face the added burden of mandated reporting. I have worked as a mandated report in a clinical setting. The kind of trust that patients would often put in me and the stories they would share about vulnerable, intimate moments in their lives only occurred because I was able to build rapport with them in a short amount of time. And because of that relationship, some of the most emotionally and mentally taxing parts of my role on the health care team were deciding when and how to report. But my ethics required me to only report a person based on two things: 1) If they were going to harm themselves; or 2) Harm someone else.
Both of these fears make me wonder just how much Patel’s case will change that patient-health care professional relationship. How will it affect how women seek out care? How will it affect how they tell their story? Will their narrative be shadowed with falsities and fear? Personally, I have seen healing and favorable outcomes occur when there is an honest, open-relationship in health care. I have also seen the consequences, several fatal, of when that relationship is exploited or filled with mistrust.
Regardless of how Patel miscarried, the important thing is that she did miscarry. The evidenced presented against Patel for feticide and/or for inducing an abortion is based in pseudo-science. And the toxicology reports speak for themselves.
But, I am not here to argue about whether or not abortion should be legal or if Patel induced an abortion. I’m asking you to look beyond that and think about the huge physical, mental, and emotional trauma Patel suffered losing her pregnancy. She was alone and bleeding out. The bottom line is that she needed help. And when seeking help, her decision to come to the hospital was criminalized.
Can you imagine coming out of a huge surgery, and being questioned by the police? There is no world in which that is reproductive justice. Providing mental health services to deal with the situation and to promote healing would have been reproductive justice. Allowing Patel to share her narrative and have it received in a proper manner would have been justice.
There are young women watching everywhere, including myself. We are not the ones most represented in the media. We are not the women whose faces you see tied in with buzzwords like pro-choice and reproductive health. We are people of color. We are immigrants. We are first-generation. We come from more culturally conservative backgrounds. We don’t come armed with sex-positive messaging. Our bodies are often not our own. We are young women who “look” Asian. We are trans women of color. We are queer and cis women of color. We may have had abortions. We may be vehemently against abortion. We might be pregnant now or trying to get pregnant. We may have been triggered by our own experiences. We might not identify at all with Patel’s experiences.
But we are not just a checkbox next to Asian/Pacific Islander on a form.
And the one thing we all collectively see is Patel’s face plastered all over the media. We see family members, neighbors, colleagues, and ourselves. And by proxy, we are watching our bodies and health decisions be criminalized.
When I heard the sentencing decision, the first thing I could think was: How must she feel? What kind of second trauma Patel must be going through to have her lived experience so unabashedly mishandled, vilified, and shamed publicly? How will she get the mental and emotional help she needs in prison?
And until we realize that the outcome of Patel’s case will create a change in health-seeking behaviors and strategies for marginalized individuals and communities, then we can’t claim to understand the complexities of reproductive justice. I fear that as a South Asian woman and a future physician, I may face this issue from both sides one day: as the patient and as the provider. And when protecting yourself from further trauma means not seeking out proper medical care, it’s clear to see what a dangerous pattern is being set by Patel’s sentencing.