Maybe the pharmacist at the Tucson, Arizona, Walgreens was acting out of religious conviction. Maybe they were afraid that they could get arrested. We may never know. What we do know is that on 26 September, two days after Arizona’s abortion ban went into effect, Emma Thompson, a 14-year-old girl with rheumatoid arthritis and osteoporosis, was denied her prescription for methotrexate.
Thompson had been on methotrexate for some time; this was a longstanding prescription that she was getting refilled. The drug, a potent anti-inflammatory drug, is used to treat a wide array of issues, from autoimmune disorders, like Thompson’s, to arthritis and cancer. It’s estimated that 60% of all rheumatoid arthritis patients are prescribed the drug, and for Thompson, it was working well. After a childhood spent in and out of hospitals, enduring years of debilitating pain, her doctors had finally found a medication and a dosage that seemed to be working for her. Her symptoms abated enough that she was able to attend school. “It’s her first year and she’s in high school and it feels like a dream,” said Thompson’s mother, Kaitlin Preble. “She’s not in a wheelchair, she has a social life and friends for the first time, and a life all young people should have.”
But in high doses, methotrexate can also terminate a pregnancy. The drug is not used in most abortions – when methotrexate is used as an abortion drug, it is often administered as an injection to treat an ectopic pregnancy, the kind of nonviable pregnancy that occurs when a fertilized egg implants outside the uterus, which can never result in a baby and frequently has fatal implications for pregnant women. It’s for this reason that several state abortion bans mention methotrexate by name. When the pharmacy wouldn’t fill Thompson’s prescription, this was why: they refused to give the drug to any female patient of “childbearing age”.
Thompson is not alone. Facing politically motivated refusals from rightwing or religious healthcare providers – and caution and confusion from others, who may refuse to prescribe or dispense necessary drugs for fear of being prosecuted or sued under abortion bans – American women living in anti-choice states have suddenly found themselves unable to access a wide array of medications. Drugs which can be used in abortions, or which can possibly cause fetal abnormalities, are used to treat everything from chronic pain to lupus to ulcers to acne. These were medications that these patients were prescribed, and medications that they could get with relative ease before Dobbs. They are medications that they could still get, if they were men.
In response, these women have had to change the course of their medical treatment, or gone through onerous procedures to find new prescribers, pharmacists or medicines. Many women and trans people have long had to take pregnancy tests before they are allowed to access certain medications, proving that there is no fetus to be harmed or risked before they are allowed the medicine that they need to get well. Others are now finding that scared or anti-choice doctors are demanding that they have themselves sterilized before they can continue the treatments that allow them to live normal, productive and relatively pain-free lives.
This is the new state of healthcare in America, where misogynist laws banning abortion have ushered in an era of sex-segregated medical care for all sorts of ailments and conditions. In states where abortion is banned, there are now de facto two standards of medical care: the one that men are entitled to, and the lesser one that women have to make do with.
Thompson was relatively lucky. She had a doctor and a mother who both advocated for her, and were alert to the injustice of her plight. Deborah Power, Thompson’s rheumatologist who prescribed the methotrexate, was so outraged when she heard that the prescription had been refused that she expressed her frustration on Twitter at what was being done to her patient.
“Welcome to AZ,” Dr Power wrote. “Today a pharmacist denied the MTX refill for my adolescent patient … MTX denied purely because she’s female, barely a teenager.” The post went viral. Meanwhile, Thompson’s mother, Preble, drove to the pharmacy “and made a big deal inside”. She eventually learned that the pharmacists who denied her daughter’s prescription had looked up the patient’s age and sex, but not her medical history.
“My entire life, I was in and out of the hospital,” Thompson told a local news station. “I was never able to stay in school until this past year, I was never able to ride a bike or get on the monkey bars like other kids could.” She continued: “It’s not right. They’re trying to make any girl who’s on this medication drop a pregnancy test when they get their medicine and I feel like it’s really unfair.” Eventually, Thompson was able to get her medication, and hopefully, she will be able to keep getting it – to keep her pain manageable, to stay in school, and to live the full life that she deserves.
Other patients haven’t been so lucky, and other doctors have not been such good advocates for their patients. In Tennessee, Becky Hubbard, a 46-year-old whose rheumatoid arthritis became so debilitating that she had to quit her job as a nurse, was told by her own longtime rheumatologist that she would either have to go on birth control or get sterilized if she wanted to continue taking her medication. If she refused, she wouldn’t get the prescription. “It’s frustrating as hell,” Hubbard told the Washington Post. “If you can’t get the medicine that gets you out of the flares, you just have to live with the pain.”
The logic of misogyny often dictates that women sacrifice their own needs and wellbeing for the comfort of others. Be it as doting wives, as ever-available mothers, as self-effacing workhorses or as ornamental sex objects, sexist culture frequently demands that women’s own ambitions, comforts, desires and, yes, health, be put aside to make them better suited to serve and support those around them. The anti-choice movement has always relied on this logic, extending women’s obligation to sacrifice themselves for other people into an obligation to sacrifice themselves for potential other people, or future other people, the embryo or the fetus whose interests seem to supplant any claims the pregnant person may have over her own future, ambitions or body. To deny women medication that could damage a pregnancy, even when there is no pregnancy, just takes this same logic even further. The nominal benefit to others is erased; there is not even a pretext of another person whose interests can justify the mandate to make women suffer. The only principle that remains is make women suffer. If Thompson’s case is any indication, that mandate also extends to girls.
