Denied Coverage: One Federal Employee's Story

by Jane L.
December 2003

My son had just turned two when I found out I was pregnant again. My husband and I were delighted; it took awhile for us to conceive, and at 42, I felt a certain urgency about having a second child. We wanted our son to have a sibling, and we knew that the chances of this happening decrease with each passing year.

The first trimester of this pregnancy was uneventful: some tiredness, some nausea, but nothing out of the ordinary. As the weeks passed, I started imagining life with a new baby, thinking about how much our son would enjoy being a big brother and looking forward to having a newborn in the house again.

Because of my age, 16 weeks into the pregnancy, I had an amniocentesis. We were told that the results of the tests would be available in about two weeks. I did not anticipate trouble.

Soon after the amnio, however, I began to experience bleeding and clotting. My doctor ordered a sonogram. During this exam, we discovered there was something seriously wrong. The radiologist could see multiple problems with the baby, including a heart malformation, a misshapen brain, and evidence of an open neural tube, among other devastating abnormalities. The results of the amnio soon confirmed what the radiologist saw.

Our baby boy had Trisomy 18, a chromosomal disorder that causes profound anomalies, and an open neural tube. My doctor explained that if I chose to carry the pregnancy to term, I would require more and more medical attention. Even with the best medical care, I had a 75 percent chance of having a miscarriage or stillbirth. Even if our baby were born alive, there was a 100 percent probability he would die within a year. His short life would be painful and increasingly difficult, requiring extensive medical intervention.

The bleeding and clotting continued; I grew weaker every day. None of my doctors could determine why I was bleeding, or predict with certainty how it would affect my health or the pregnancy. They labeled my condition a "threatened abortion" and explained I could miscarry at any time. If I chose to continue the pregnancy, and the baby eventually died in utero, my surgeon told me I would increase the risk to my health.

On my doctors' advice, my husband and I decided I should have an abortion while the risks were still manageable, and I could preserve my health.

Our heartbreaking ordeal did not stop there, however. As we mourned the loss of this pregnancy, we discovered that my health insurance would not pay for the abortion regardless of the risks to my health that the pregnancy posed and the dire condition of the baby. As an employee of the federal government, my health care is covered through the Federal Employee Health Benefits (FEHB) Program. By federal law, this program only pays for abortions if the pregnancy is the result of rape, incest, or threatens the life of the pregnant woman. It does not cover abortions if the pregnancy endangers a woman's health or if the fetus has severe problems.

As my experience illustrates, denying coverage for medically necessary abortions is not only heartless, it endangers women's health, as it did mine. Was I to ignore my doctors' advice and continue a pregnancy that would increasingly threaten my health, so I could either miscarry, give birth to a stillborn, or watch my infant suffer a short but very painful existence? What if my husband and I could not afford the more than $4000 needed to cover the costs of the procedure? Would I have been forced against my doctors' advice to carry the pregnancy to term? Federal employees should not have to put their health on the line and ignore their doctors' best medical judgment simply because Congress finds it politically expedient to deny certain reproductive health care benefits.