One Year after Dobbs . . .

When Women Became No Longer Human, Part 13: Women's Lives (and Deaths) One Year After Dobbs (24 June 2023)

As if maternal mortality rates in the United States weren't bad enough before Dobbs, a new study by the Kaiser Family Foundation (now KFF), "National Survey of OBGYNs’ Experiences After Dobbs," provides necessary data about the effect of the 2022 forced birth decision and its impact on medical professionals who specialize in women's healthcare.

You can access the full report by clicking here.

Meanwhile, here are the highlights (lowlights?):

Key Findings

ABORTION ACCESS AND CONSTRAINTS ON CARE SINCE DOBBS

• Since the Dobbs decision, half of OBGYNs practicing in states where abortion is banned say they have had patients in their practice who were unable to obtain an abortion they sought. This is the case for one in four (24%) office-based OBGYNs nationally.
• Nationally, one in five office-based OBGYNs (20%) report they have personally felt constraints on their ability to provide care for miscarriages and other pregnancy-related medical emergencies [emphasis added] since the Dobbs decision. In states where abortion is banned, this share rises to four in ten OBGYNs (40%).
• Four in ten OBGYNs nationally (44%), and six in ten practicing in states where abortion is banned or where there are gestational limits, say their decision-making autonomy has become worse since the Dobbs ruling. Over a third of OBGYNs nationally (36%), and half practicing in states where abortion is banned (55%) or where there are gestational limits (47%), say their ability to practice within the standard of care has become worse.
• Most OBGYNs (68%) say the ruling has worsened their ability to manage pregnancy-related emergencies [emphasis added]. Large shares also believe that the Dobbs decision has worsened pregnancy-related mortality (64%) [emphasis added], racial and ethnic inequities in maternal health (70%) and the ability to attract new OBGYNs to the field (55%).

ABORTION POLICIES AND CONCERN ABOUT LEGAL RISK

• Two-thirds of OBGYNs nationally (68%) say they understand the circumstances under which abortion is legal in the state they practice very well. However, among OBGYNs in states where abortion is restricted by gestational limits the share is lower (45%) compared to those practicing in states where abortion is available under most circumstances (79%) or banned (68%).
• Over four in ten (42%) OBGYNs report that they are very or somewhat concerned about their own legal risk when making decisions about patient care and the necessity of abortion. This rises to more than half of OBGYNs practicing in states with gestational limits (59%) and abortion bans (61%).
• Eight in ten OBGYNs approve of a recent policy change from the FDA that allows certified pharmacies to dispense medication abortion pills.

ABORTION SERVICES

• Nearly one in five (18%) officed-based OBGYNs nationally say that they are providing abortion services after the Dobbs About three in ten OBGYNs (29%) practicing in states where abortion is available under most circumstances offer abortion care, compared to just 10% in states with gestational restrictions. There were already large differences between states prior to the Supreme Court’s ruling. Many of the states that have abortion restrictions today had these or similar restrictions in place prior to the Dobbs decision.
• Nationally, 14% of OBGYNs say they provide in-person medication abortions, but only 5% say they provide telehealth medication abortions.
• In states where abortion is banned, essentially no OBGYNs offer abortions, except under very limited circumstances. Additionally, nearly half (48%) of OBGYNs in these states only offer information, such as online resources, to help patients seek out abortion services on their own, but 30% do not even offer their patients referrals to another clinician or any information about abortion.

CONTRACEPTION

• More than half (55%) of OBGYNs nationally say they have seen an increase in the share of patients seeking some form of contraception since the Dobbs ruling, particularly sterilization (43%) and IUDs and implants (47%).
• Nearly all OBGYNs offer their patients some form of contraceptive care, but only 29% make all methods of contraception available to their patients, including all three methods of emergency contraception (copper intrauterine device (IUD), ulipristal acetate/Ella, and levonorgestrel/Plan B).
• Only one-third of OBGYNs (34%) prescribe or provide all three methods of emergency contraception and one in seven (15%) do not provide any methods of emergency contraception to their patients. A quarter of OBGYNS (25%) only prescribe or provide Plan B, which is available over the counter.
• Availability of care via telehealth expanded greatly after the onset of the COVID-19 pandemic. Today, almost seven in ten OBGYNs (69%) nationally say they provide at least some care via telehealth.

From "A National Survey of OBGYNs' Experiences
after Dobbs" (p. 15)

This is our brave new world.

Update, 29 June 2023: Here's a great link to Grace Haley's "A Year Without Roe: In the Data," posted at Jessica Valenti's Abortion, Every Day.

The data and research that's come out over these last few weeks paint a stark picture of our first year without Roe. We wanted to share with you what people’s lives have looked like by pulling out a few statistics to pay particular attention to. There are three main themes encapsulated by these reports: documenting the harm done by abortion bans, the shifting public view on abortion, and accounting for what the future will look like in the post-Roe world.

Update, 12 September 2023: For ways to address the problem of maternal mortality, see Mara Gay's NYT opinion piece, "America Already Knows How to Make Childbirth Safer" (click here).

Gwenllian of Wales, Captive Princess

 Gwenllian, Captive Princess of Wales (born 12? June 1282)

Born on 12 June 1282 (perhaps), Gwenllian of Wales had a glittering royal heritage.* She was the only child of Llywelyn ap Gruffudd, prince of Wales, whose grandfather was Llywelyn ab Iorwerth, "Llewelyn the Great," who fought to consolidate power for decades until he could claim the title of prince of Wales.

Detail from a memorial to 
Gwenllian, princess of Wales,
noting her date of birth

Gwenllian's mother was Eleanor de Montfort (click here and scroll down), who was the daughter of Eleanor of England, countess of Leicester (and of the powerful Simon de Montfort, earl of Leicester). Eleanor de Montfort was the granddaughter of King John of England, making her daughter, Gwenllian, the great great granddaughter of the formidable Eleanor of Aquitaine, queen of England. 

(Through her paternal line, Gwenllian was also related to the English monarchy. Her great grandfather, Llywelyn ab Iorwerth, had married a daughter of King John of England, Joan, whose mother is unknown.)

But, despite Gwenllian’s royal heritage, her life was to be no fairytale. Instead, her life began and ended in blood, death, and deprivation. 

Gwenllian's mother died on 19 June 1282, just having given birth to her only child. By the end of the year, Gwenllian's father was dead as well, killed in battle on 11 December 1282. 

Dafydd ap Gruffydd assumed the title of prince of Wales after his brother's death, and with it he became the guardian of his niece, Gwenllian. But within ten months, he too was dead. On 22 June 1283, he was captured by Edward I of England's forces. The wounded Dafydd ap Gruffydd was transferred to Shrewsbury along with other members of his family--his wife, Elizabeth de Ferrers, their daughter, Gwladys ferch Dafydd, their sons, Davydd's six illegitimate daughters, and his niece, Gwenllian, then just about a year old. 

On 30 September, Dafydd ap Gruffyd was hanged, drawn, and quartered. His sons were sent to Bristol Castle, where they were imprisoned until their deaths (the elder died in 1287, the younger about 1325). Gwladys was sent to Priory of St. Mary's at Sixhills, a convent in Lincolnshire, where she died about 1336. The fate of Davydd ap Gryffyd's illegitimate daughters is unknown, though in his entry in the Dictionary of Welsh National Biography, Thomas Jones Pierce suggests they too may have ended their days in convents: "There are no records of David's marital associations before his alliance with Elizabeth Ferrers; but he had a large number of daughters who appear to have ended their days in various nunneries." Equally unknown is the fate of Davydd's wife, Elizabeth de Ferrers.

As for Gwenllian--after her uncle's capture, she was sent to the Priory of Sempringham in Lincolnshire. According to the English chronicler Robert Mannyng, emphasizing the little girl's tender age, she was delivered to the priory "in her cradle." 

Like Sixhills, where her cousin Gwladys had been sent, this foundation had also been established by Ghilbert of Sempringham. About the selection of these two convents in Lincolnshire, historian J. Beverly Smith notes, "The choice of nunneries is not readily explained, but the houses were far enough from Wales, and Sempringham was a major house with accommodation for as many as 200 nuns." The accommodations were not luxurious: "the convent was at no time wealthy; though the standard of life seems always to have been simple[,] the revenues were small for the number of inmates."

Whatever the reason for his decision, it was a useful place for inconvenient women and girls. In his history of religious houses in Lincolnshire, William Page notes, "Probably by reason of its position as the head house of a purely English order, Sempringham was in high favour with the three Edwards, who sent thither wives and daughters of their chief enemies." 

On 11 November 1283, just months after he had executed Gwenllian's uncle, Edward I dictated a letter to Sempringham, noting that he had spared the child: "pitying . . . her sex and her age," the king had not condemned "the innocent" to "atone for the iniquity and ill-doing of the wicked." Charging the priory with her maintenance, the king "allowed the acquisition of certain lands" to be held in perpetuity as compensation.

The Princess Gwenllian daffodil,

"created for Mallt Anderson, 

the founder of the Princess Gwenllian Society"

In 1289, the king arranged for Thomas de Normanville, a Lincolnshire justice, to check on both Gwenllian and her cousin: "he was summoned to a council at Westminster to be held on 13 Oct[ober], and on 2 Sept[ember]. In the following year he was directed to report on the condition of the daughters [sic] of Llywelyn ab Gruffydd." In his mandate, Edward referred to both girls as having "taken the veil." Gwenllian would have been just seven. (Although she would spend her life among the nuns at Sempringham, she does not seem to have taken vows, nor did her cousin Gwladys.)

In 1327, Edward III granted £20 a year for Gwenllian, to be paid to the priory for her maintenance. Gwenllian would have been about forty-five years old. This pension was granted in response to a petition from Gwenllian: "Wentliane [Gwenllian], daughter of Lewelyn [Llywelyn] formerly the Prince of Wales prays the king of his grace to remember and aid her since the king . . . promised her when she was put in the house of Sempringham. . . ."

Gwenllian, princess of Wales, died at the Priory of Sempringham on 7 June 1337, just days before her fifty-fifth birthday. The date is noted by the chronicler Mannyng, who referred to her as Lleywelyn's "dear daughter," and as a "daughter of Wales" who had "remained" in England. According to Mannyng, Gwenllian (whom he calls "Wencilian") was "full courteous" (courtly, in the sense of having the manner, bearing, and conduct of a noblewoman), her death was "much lamented" by all.

As a further note about women held captive in convents: After the defeat of Robert the Bruce at the battle of Methven in 1306, his sister and his elder daughter were both imprisoned in Ghilbertine convents, Christian (Christina) Bruce at Sixhills, where Gwladys was confined, and Marjorie Bruce at Watton, in Yorkshire. The two women were freed in 1314 after Bruce's victory at Bannockburn. 

Among the other aristocratic women sent to Sempringham were Margaret de Clare, countess of Cornwall, who was detained there by Hugh Despenser from 1322 to 1326 during the reign of Edward II; Joan Mortimer, the daughter of Roger Mortimer, sent there in 1324, also during the reign of Edward II; and two of Hugh Despenser's daughters were dispatched to Sempringham--they were still there in 1337. 

For a longer list of royal and aristocratic women who were imprisoned for a variety of political motivations, click here.

*Although many sources indicate that the exact date of Gwenllian's birth in June is unknown, the birthdate of 12 June 1282 is inscribed on the memorial to her at Sempringham. Some who weigh in about the date of Gwenllian's birth argue that she was more likely born on 19 June, the day her mother died. Although the date is thus remains uncertain, I've used the date on her memorial as the occasion for today's post.