Understanding Pregnancy Loss Was Supposed to Improve Health Outcomes—Not Lead to Punishment

On Dec. 13, Brittany Watts, a 33-year-old Black woman from Warren, Ohio, appeared before a grand jury in Trumbull County to face charges of felony corpse abuse after suffering a pregnancy loss at home. Prosecutors charged Watts after police found an unviable fetus in a toilet of her home on Sept. 22. A local forensic pathologist, Dr. George Sterbenz, testified that the fetus was already “non-viable” due to “premature ruptured membranes” when Watts’s water broke and the pregnancy ended at only 22 weeks gestation.

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The case soon made national news, and although some media coverage used careful, medical language like Sterbenz’s description, other outlets like the New York Post inflamed tensions by writing that “prosecutors have accused her of abusing her baby’s corpse by trying to plunge it down a toilet.”

Watts’ prosecution stands in sharp contrast to past efforts to prevent pregnancy loss in American society. Historically, the desire to reduce miscarriages, stillbirths, and maternal deaths motivated those who investigated pregnancy losses. Rather than charging women for these common occurrences, the medical profession, local governments, and federal agencies once were far more concerned with proper classification categories and ways to minimize pregnancy loss.

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In the first half of the 20th century, state and federal governments, along with the medical organizations, classified a pregnancy that ended prior to birth as either a miscarriage, an abortion, or a stillbirth. Miscarriages were understood to be the earliest end to a pregnancy in the first weeks or months. Abortions were pregnancies that ended at four, five, and six months. And most defined stillbirths as pregnancies that ended without a living child from the 28th week through a full-term pregnancy (37-40 weeks). These definitions and the data remained vague, however, and were often complicated by the fact that women did not know how long they had been pregnant.

Despite the efforts of medical officials to establish clear terminology, defining a stillbirth remained a challenge. In a 1917 article on how to best implement a national stillbirth registry, for example, Dr. Lee Thomas explained that the medical profession entertained “a wide diversity of opinions as to what constitutes a stillbirth, as practically no two answers were the same.” This is evident in the federal census, which captured the varied state definitions of stillbirths. In a 1931 federal census stillborn report, for instance, a table noted that Idaho, Montana, Ohio, and Pennsylvania required state involvement with pregnancies of four months or more. Most states, however, fell in the range of requiring documentation when the pregnancy ended at five, six, or seven months. Indiana’s law required that the state receive notification for stillbirths seven months and over.

Aligning the definition of a stillbirth with the timing of potential fetal viability reflected and affirmed those in Howard County, Ind., who, in the first half of the 20th century, publicly mourned losses in front page newspaper stories and with gravestones. Some historians imagined that the Catholic Church’s position that a stillborn infant who had never taken a breath could not be baptized and therefore could not be buried in the church graveyard left past losses unseen. In Kokomo, Ind., however, the largely Protestant population publicly grieved some stillbirths with burial in community cemeteries, and increasingly in the first few decades of the century, by bestowing names upon them. Community newspapers covered stillborn losses borne by everyone from a poor, overworked woman trying to “keep the wolf from the door” to the president’s namesake son, Franklin D. Roosevelt Jr., and his wife, Ethel DuPont Roosevelt.

Read More: The Politicization of Fetal Viability

Nationally, pregnancy loss in the second half of the century continued to be complicated to define. Starting in the 1950s, medical language narrowed to delineate losses as either miscarriages or stillbirths. Most states continued to report losses in the first six months (24 weeks) as miscarriages, defining losses in the last trimester as stillbirths. In the 1960s, the Centers for Disease Control captured any “spontaneous intrauterine death of a fetus at any time during pregnancy” as a fetal death in their reporting, but newspaper accounts continued to describe a pregnancy that ended before 20 weeks as a miscarriage or spontaneous abortion, with later losses defined as a stillbirth. In 2003, the Centers for Disease Control began to redefine pregnancy losses at 20 weeks or greater as fetal demise, but parents still preferred the terms miscarriage and stillbirth. Twenty years later, Americans continue to embrace the use of the term miscarriage for a pregnancy loss in the first or second trimester, and some states such as California do not mark a fetal demise until 23 weeks or later. All of this was (and still is) extraordinarily confusing, especially as fetal viability is unlikely before six months.

This preoccupation with categorization historically was paired with a far greater interest in trying to understand why the loss occurred, so that these circumstances might be prevented. But these answers were often hard to come by. Even today, the demand for answers far exceeds what the medical field can provide, with one doctor estimating in 2023 that between 25 and 60% of fetal demise is still unexplained. For the one in three pregnancies that end in a miscarriage, or the estimated 1 in 175 people who have stillbirths, the inability to know what caused the spontaneous abortion has meant private anguish for those who hoped to have a baby—as well as for the medical professionals who supported them. The urgency for these answers is particularly felt by Black women, who suffer a much greater rate of pregnancy loss, as well as devastating rates of infant and maternal mortality.

Generally, doctors do not admit women who seek medical care for a pregnancy loss—they are sent home to miscarry a fetus. As one woman reflected in Glamour UK, pregnancy loss is most likely to occur in a bathroom and on a toilet—and it is both natural and understandable to flush. American society has long understood pregnancy loss to be a quiet, private experience, but those who oppose abortion access have sought to criminalize miscarriage. Chrissy Teigen and John Legend shared with the world their 2020 pregnancy loss. Teigen later acknowledged to herself and then publicly that the hospital performed an abortion to save her life. Her critics questioned why she had characterized the loss as a miscarriage, with defenders who had experienced loss noting the important difference between medical chart terminology and patient care.

The demonization of Brittany Watts by assistant prosecutor Lewis Guarnieri, who asserted that she cavalierly “went on her day” after suffering a miscarriage, and by the judge Terry Ivanchak who sent her felony case to a grand jury and forced her to come up with $5,000 bail money, is a harbinger of the cruelty wrought by anti-abortion extremism.

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Shifting definitions and classifications of pregnancies are increasingly weaponized in devastating ways. Across the past few years, police and prosecutors have terrorized women whose pregnancies ended, particularly poor women and women of color. The prosecution of Brittany Watts, like other legal cases against women seeking abortions from Shirley Wheeler in 1971 to Kate Cox in 2023, is the consequence of a cultural war waged by anti-abortion extremists intent on depriving women of health care. Redefining medical procedures and processes in political and legal language leaves people unable to secure life-saving treatments and the medical field is forced to betray its oath, unable to provide needed care. Religious activists, shaping public opinion and in their roles as legislators, judges, police, and prosecutors, are asserting their right to govern medical care and people’s control of their own bodies. If this trend continues, instead of compassion and scientific efforts to improve medical care, the Supreme Court may disallow access to medical abortions and medical personnel will be forced to report all miscarriages and deny needed medication and procedures.

Katherine Parkin, Ph.D. is professor of history and Jules Plangere Jr. Endowed Chair in American Social History at Monmouth University. She is the author of “Joy Turned to Sorrow”: Stillborns in Howard County, Indiana, 1890–1940” (Journal of Family History) and the forthcoming book, Buying and Selling Abortion Before Roe (University of Pennsylvania Press, 2024). Made by History takes readers beyond the headlines with articles written and edited by professional historians. Learn more about Made by History at TIME here.