The Reality of Maternal Health in Post-Roe America

Posted on by BUJPH

By Simran Singh & Nina Faynshtayn

In the wake of the Supreme Court Dobbs v. Jackson Women’s Health Organization decision to overrule Roe v. Wade and Planned Parenthood v. Casey, there has been a significant shift in the landscape of abortion in the United States. At least 13 states implemented “trigger laws” to make abortion illegal or inaccessible once Roe was finally overturned.1 Six months later, this decision continues to have long-standing consequences for people, disproportionately impacting low-income, disabled BIPOC and LGBTQ+ communities.2,3 In a country that constantly lags behind its peers in maternal mortality, what does this decision mean for pregnant people and our fragile healthcare system?

Access to safe and quality abortion care is just as essential as any other basic maternal health service. As student leaders of Brown Students for Saving Mothers, we operate a chapter of an international nonprofit organization of physicians, midwives, community health workers, and other allied health professionals working with governments and local organizations toward eradicating preventable maternal deaths and birth-related complications in low-resource settings.4 Our student organization focuses heavily on understanding and improving maternal health outcomes, which is inextricably tied to improving reproductive health decisions concerning one’s body. Hence, we recognize the devastation of the Supreme Court’s decision on the U.S. maternal health crisis and, therefore, the importance of raising awareness of abortion and maternal health, particularly at an elite, privileged institution like Brown.

First and foremost, it is crucial to understand the impact of abortion bans on the physical and social conditions of pregnant people. Following the decision to overrule Roe, researchers predicted that maternal mortality would increase by 24% overall, with a 39% increase among non-Hispanic Black people.5 Black women are three to four times more likely to die from pregnancy complications than white women, and Indigenous women are more than two times more likely to die from pregnancy complications, such as eclampsia, than white women.6,7 In states with high abortion rates and maternal mortality rates, maternal deaths are projected to increase by 29%.5 These increases are likely due to increases in forced high-risk pregnancies, unsafe abortion, and intimate partner violence, not to mention a decrease in abortion providers due to fear of criminal liability.5 Further studies show that women who were denied abortion care and gave birth instead were more likely to have poor physical health (i.e., chronic migraines, joint pain, and gestational hypertension), suffer from elevated anxiety levels, and remain trapped in poverty.8 Carrying a pregnancy to term is markedly more dangerous–14 times riskier–than a wanted abortion.9 The verdict is clear: being pro-abortion is the only way to care for pregnant people.

Healthcare providers are also undoubtedly struggling with the effects of a post-Roe world. As of October 2022, about 100 days since Roe v. Wade was overturned, over 66 clinics across 15 states have stopped providing abortion care, and this number continues to rise.10 As some clinics are shutting down, others are overflowing. Before the overturning of Roe v. Wade, Dr. Katie McHugh, an OBGYN, saw 15 to 20 patients for abortions every day. After the Supreme Court decision, however, she had seen up to 50 patients before Indiana’s abortion ban was set to take effect.11 Abortion clinics are seeing an increase in out-of-state patients from states with abortion bans, causing increases in wait times and delaying care. Patients are forced to delay their abortion to later in their pregnancy when costs are higher and treatment is more complicated.12 To put it simply, abortion providers and clinic staff are overwhelmed.

While knowledgeable of the medical aspects of abortion and reproductive care, healthcare professionals are unsure how to interpret the corresponding laws. During a House subcommittee meeting on the overturning of Roe, Dr. Nisha Verma–an OB/GYN and a fellow of Physicians for Reproductive Health–discussed that she was unsure whether she would be able to provide abortions in the case of pregnant people with pulmonary hypertension, those with a 50% death risk if the pregnancy is pursued.13 Furthermore, when considering medications such as methotrexate that can treat ectopic pregnancies, it is crucial to recognize that this drug is also used in treating cancer and autoimmune diseases; the future of its usage is unclear.13 Some forensic nurses who perform rape kits and care for people who have experienced sexual assault have stopped providing emergency contraception, fearing it would be considered an abortion medication.14 With threats of felony charges now present, many doctors and healthcare professionals are unsure how to help their patients. Their anecdotes clearly demonstrate how abortion restrictions in the law have altered the medical landscape. In what cases can abortion truly be considered a right? Medical professionals must grapple with these questions, both in terms of abortion as a right and as an accessible procedure. At the core of the issue is the chasm between having the right to perform an abortion and having the means to perform one.

In the state of Rhode Island, the Reproductive Privacy Act of 2019 codified the right to abortion in state law.15 However, exercising the right to abortion in the state is a different story. Many harmful laws–even in states where abortion is still legal–restrict insurance coverage of abortion care. The Hyde Amendment passed in 1976 prohibits using federal funds for abortion; this ultimately prevents people on state employee insurance or Medicaid from using their insurance to cover the costs of abortion.16 In Rhode Island, nearly 1 in 3 residents are prevented from using their insurance to cover abortion.17 Low-income people of color with the fewest resources pay the steep price of abortion inaccessibility.

As Brown students who have an impact, we must better understand local politics and healthcare. In the new legislative session, the Equality in Abortion Coverage Act (EACA)–introduced by Senator Valverde and Representative Liana Cassar–will add abortion coverage to the state Medicaid program, if enacted by the State of Rhode Island General Assembly.18 Now is a better time than any to act. The cause for equitable abortion access is one that any student–from any background–can champion. For some, this may look like testifying in the upcoming legislative session or joining Brown-affiliated, and non-Brown-affiliated, organizations focused on reproductive and racial justice. Students with financial means can also focus their efforts on supporting local abortion funds. Abortion funds–independent, grassroots organizations–work tirelessly to fill in the gaps in abortion care, primarily by providing financial and logistical assistance, including the cost of abortion pills, travel, and lodging.19

Ultimately, we envision a world where cost and strict laws are not barriers to basic care, and we hope others will start to do so too. While Saving Mothers may appear to be confined within the realm of public health or medicine, it spans numerous sectors and fields that students actively pursue, including but not limited to politics, sociology, economics, and gender studies. Regardless of what field or career one decides to pursue, Brown students have the power to support pregnant individuals and abortion seekers in the country.

 

References

  1. Jiménez J. What is a trigger law? and which states have them? The New York Times. https://www.nytimes.com/2022/05/04/us/abortion-trigger-laws.html. Published May 4, 2022.
  2. Diamondstein M. The Disproportionate Harm of Abortion Bans: Spotlight on Dobbs v. Jackson Women’s Health. Center for Reproductive Rights. https://reproductiverights.org/supreme-court-case-mississippi-abortion-ban-disproportionate-harm/. Published November 29, 2021.
  3. Medley S. Gutting abortion rights would be devastating for LGBTQ+ people. Them. https://www.them.us/story/gutting-abortion-rights-devastating-lgbtq-people. Published September 17, 2021.
  4. Saving Mothers: Our Vision. Saving Mothers. https://savingmothers.org/our-vision/.  Published January 16, 2019.
  5. Stevenson AJ, Root L, Menken J. The Maternal Mortality Consequences of Losing Abortion Access. SocArXiv; 2022. doi:10.31235/osf.io/7g29k
  6. Marshall L, Plain C. Black women over three times more likely to die in pregnancy, postpartum than white women, new research finds. Population Reference Bureau. https://www.prb.org/resources/black-women-over-three-times-more-likely-to-die-in-pregnancy-postpartum-than-white-women-new-research-finds/. Published December 6, 2021.
  7. Petersen EE, Davis NL, Goodman D, et al. Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016. MMWR Morb Mortal Wkly Rep. 2019;68(35):762-765. doi:10.15585/mmwr.mm6835a3
  8. Foster DG, Biggs MA, Gould H, et al. The Turnaway Study. ANSIRH. https://www.ansirh.org/research/ongoing/turnaway-study. Published August 15, 2022.
  9. Raymond EG, Grimes DA. The Comparative Safety of Legal Induced Abortion and Childbirth in the United States: Obstetrics & Gynecology. 2012;119(2, Part 1):215-219. doi:10.1097/AOG.0b013e31823fe923
  10. Kirstein M, Dreweke J, Jones RK, Philbin J. 100 Days post-roe: At least 66 clinics across 15 US states have stopped offering abortion care. Guttmacher Institute. https://www.guttmacher.org/2022/10/100-days-post-roe-least-66-clinics-across-15-us-states-have-stopped-offering-abortion-care. Published October 6, 2022.
  11. Smith M. ‘We are drowning in despair’: How 3 doctors are navigating the chaos of a post-Roe America. CNBC. https://www.cnbc.com/2022/09/14/us-doctors-on-providing-abortion-care-post-roe-its-devastating.html. Published September 14, 2022.
  12. Cobler N, Gonzalez O. Influx of out-of-state patients causes abortion delays. Axios. https://www.axios.com/local/austin/2022/09/12/texans-out-of-state-patients-abortions-delays. Published September 12, 2022.
  13. Muoio D. Dobbs decision ‘opened the door for complete and utter chaos,’ physicians and legal experts tell Congress. Fierce Healthcare. https://www.fiercehealthcare.com/providers/dobbs-decision-opened-door-complete-and-utter-chaos-physicians-and-legal-experts-tell. Published July 20, 2022.
  14. Zernike K. Medical Impact of Roe Reversal Goes Well Beyond Abortion Clinics, Doctors Say. The New York Times. https://www.nytimes.com/2022/09/10/us/abortion-bans-medical-care-women.html. Published September 10, 2022.
  15. Reproductive Privacy Act.; 2019. http://webserver.rilin.state.ri.us/BillText19/HouseText19/H5125B.htm
  16. Herman J. Let’s get rid of abortion coverage restrictions once and for all. The Century Foundation. Published September 26, 2019. https://tcf.org/content/commentary/lets-get-rid-abortion-coverage-restrictions/
  17. Yergeau T. Fact sheet: Equality in abortion coverage act. Planned Parenthood Votes! Rhode Island. Published April 24, 2021. https://www.plannedparenthoodaction.org/planned-parenthood-votes-rhode-island/blog/fact-sheet-equality-in-abortion-coverage-act
  18. Equality in Abortion Coverage Act. http://webserver.rilin.state.ri.us/BillText/BillText22/SenateText22/S2549.pdf
  19. Limon G, Weiss-Wolf J. Abortion Funds Enable Access: The Time to Invest in Direct Aid Is Now. Brennan Center for Justice. Published November 9, 2021. https://www.brennancenter.org/our-work/analysis-opinion/abortion-funds-enable-access-time-invest-direct-aid-now
Nina Faynshtayn Simran Singh