Missouri women’s reproductive health care rights are still under threat | Opinion

One person.

Under the 19th century system of coverture, married women’s legal identities were absorbed under their husbands’ rights, and, legally, they counted as “one person.” While coverture ended over 100 years ago, Missourians are now facing a new threat: modern-day digital coverture. The women of Missouri have already begun to see these troubling trends. Randall Williams, former director of Missouri’s Department of Health and Senior Services, said that a spreadsheet was created to track “failed abortions” and other data, including a woman’s last menstrual cycle.

Laws are not always the only thing restricting reproductive access for women. Risk management and uncertainty surrounding new laws and regulations can restrict access to reproductive health care every bit as much as a new law. We have now entered a new era of digital coverture, where women’s reproductive rights are not always controlled by statute or by her husband, but by regulatory systems. These systems include smartphone apps, insurance regulations, databases and hospital administrative decisions designed to avoid legal consequences.

Reproductive data is currently everywhere, from apps that keep track of a woman’s cycle and ovulation, insurance claims that maintain details of a woman’s reproductive timelines, pharmacy records that keep track of medications prescribed and hospital reporting systems. The data itself is becoming a form of modern-day coverture, as it affects not only women’s rights and access to reproductive care, but might influence decisions when their reproductive histories are being tracked through a variety of databases. Often, women and health care providers find themselves managing risk rather than acting in the patient’s best interests, which ultimately alters outcomes.

While a woman’s identity is no longer absorbed into her husband’s, her reproductive rights are now being absorbed into a variety of systems. Limited access to reproductive health care is often limited not only by laws and regulations, but by insurance decisions and a lack of legal access to crucial medications. However, these systems ultimately determine outcomes every bit as much as statutes.

Risk management before physician judgment

Hospitals, pharmacies and reproductive health care centers now seem to be focused on risk management, even when that conflicts with the patient’s best interests in efforts to reduce liability and the ever-changing laws surrounding women’s reproductive health care. A physician’s judgment has become secondary to risk management and liability prevention.

Josseli Barnica was 17 weeks pregnant when she went to a Houston-area hospital for a miscarriage. Doctors determined that she was dilated 9 centimeters, which left her at high risk for infection. It was determined that a miscarriage was in progress and inevitable. Normally, a dilation and curettage or D&C would be performed. However, since the fetus still had a detectable heartbeat, under Texas law, it would have been a crime to administer any medications or perform any procedures that would have ended the pregnancy. Barnica was forced to endure 40 hours until the fetal heartbeat was no longer detected. Unfortunately, it was too late. After returning to the hospital several days later, Barnica died of sepsis, one of the complications from a delay in medical care following a miscarriage. (Jaramillo & Surana, 2024)

The hospital staff was aware of this common complication following a miscarriage. However, their medical expertise and knowledge were overshadowed by Texas law. Barnica did not need a husband to strip her of her rights; the system did it for her.

Reproductive rights are not only controversial, but rigid, and often overpower a medical provider’s expertise. However, softer restrictions such as administrative policies, insurance outcomes, and pharmacy regulations that are far less noticeable and less likely to become a splashy front-page headline can restrict women’s access to reproductive care.

Suffragists fought for decades for women to be granted legal personhood, without being absorbed into her husband’s legality.

We now have an evolving system in which legal risk outweighs medical judgment, which often becomes a crucial factor in determining her outcome.

These restrictions can hide in back-page stories about another woman dying from an incomplete miscarriage when the hospital staff determines that life-saving medication or surgery would be too risky. It can be obscured by the pharmacist who does not prescribe medication to reduce legal liability, or by the insurance provider who denies a claim not based on medical judgment but upon an aversion to legal risk.

Coverture has now entered the digital age, where women’s rights are governed not only by laws but also by systems, regulations, and less visible restrictions, even when these conflict with sound medical judgment. The quiet interpretation of the law can have just as much influence on a woman’s ultimate outcome as a headline-grabbing, front-page law that restricts reproductive health care access.

Karen Benedict is a retired office manager and paralegal living in San Diego, California. She is an eighth cousin of Susan B. Anthony. Jennifer Kady Stanton is a lecturer at California State University, San Marcos, and shares ancestry with Elizabeth Cady Stanton.