Women with unintended pregnancies will face higher risks of maternal mortality, increased poor pregnancy outcomes and greater divide in access to health care following recent Supreme Court reversal on Roe v. Wade, according to Northeast health experts.
The inability to obtain a safe and legal abortion will affect the health of pregnant women in several specific ways, whether they are still trying to have an abortion or continue the pregnancy, says Kathy Simmonds, women’s health nurse practitioner and researcher, who will be joining Northeastern’s Institut Roux this summer.
“People will have abortions, whether it’s legal or illegal,” Simmonds says. “If they can get it legally, they can access clinical providers who know how to perform the procedure, provide medication and education, and guide the patient through the process.”
Since July 1, abortions are completely forbidden in at least five states — Alabama, Arkansas, Missouri, Oklahoma and South Dakota — according to the Guttmacher Institute. Abortions are protected in 20 states and Washington DC, while in the remaining states access to abortion is restricted or uncertain.
In recent decades, clinical abortions have become safe procedure with less than 3% of people having complications, while serious complications occur in less than 1% of patients, Simmonds says. Without any contact with a standard medical system, trying to self-manage an abortion, or turning to illegal providers, pregnant women will be more likely to experience complications, even if they just take abortion drugs without the help of a qualified healthcare professional.
After Roe, Simmonds also anticipates an increase in subsequent abortions. Roe v. Wade allowed abortions up to the point of viability, which was determined to be at the 24 to 28 weeks. With advances in neonatal medicine, the viability of a fetus, when it can survive outside the womb, has increased to 22 weekswhile most abortions in the United States – nine out of 10 – occur during the first trimester of a pregnancy, before 13 weeks of gestation. Late-term abortions usually happen under duress, Simmonds says, when something quite catastrophic happens to a person with a wanted pregnancy — a health problem or the discovery of a genetic problem — or when a guardian, for example , discovers the pregnancy of a teenager as a result of sexual abuse.
With new abortion bans and laws restricting gestational age well beyond viability, pregnant women will need to get an appointment for a legal abortion in another state and gather resources to travel, Simmonds says. This will lead to more people being at risk of major abortion complications.
“The sooner you can have an abortion, the safer it is, the less complications you have,” says Simmonds.
There is more uncertainty now on a gray line between termination of pregnancy and carrying out a life-saving intervention in the event of an ectopic pregnancy, for example, or rupture of membranes, which exposes the mother to a risk of infection.
“If you’re having a miscarriage, you can no longer have the procedures that would help you end that pregnancy faster, which protects your health,” Simmonds says. “It’s a new sticky area.”
Between the money needed to travel and the fear of what will happen if you travel, in case states choose to enact legal consequences, there will be many people who will not be able to have an abortion and will have to continue a pregnancy. unwanted, says Simmonds. It will affect the poor, the young and the frightened; undocumented immigrants; women in rural areas, without a car or in an abusive relationship, who will be much more limited by their situation in their ability to travel to another state.
“In effect, you are creating a public health crisis rather than solving the problem. And we do this while being steeped in health inequalities at every level,” says Allison Bauer, an associate professor at the Bouvé College of Health Sciences in the North East, specializing in health policy and public health.
Health equity issues surrounding reproductive health care stem from financial, racial, religious, geographic and gender disparities, Bauer says.
“Nobody tells men…to go for a vasectomy,” she says. Carrying a pregnancy to term and giving birth is 12 to 14 times riskier than having a safe and legal abortion, says Simmonds, when the United States is already going through a maternal mortality crisis, which disproportionately affects black women. In 2020, 861 women are dead maternal causes across the country, up 14.2% from 2019, according to the Centers for Disease Control and Prevention. The maternal mortality rate for black women was 55.3 deaths per 100,000 live births, which is about three times higher than for white and Hispanic women.
The United States has the highest maternal mortality rate of any developed country in the world, says Bauer: In 2019, the U.S. maternity rate was 20.1 deaths per 100,000 live births, while it was 3.2 in Germany3.9 in Austria, 5.3 in the Netherlands and 7.5 in Canada.
A Duke University study estimated that a total ban on abortion in the United States would increase pregnancy-related deaths by 21% for white women and 33% for black women.
According to Simmonds, one of the factors causing poor pregnancy outcomes, high maternal morbidity and mortality among black women, regardless of income, is racism, which causes stress, high blood pressure and low levels. higher levels of cortisol, leading to other negative effects on the body. Poor pregnancy outcomes include premature birth, low infant weight, low blood pressure, and postpartum heart attacks.
If clinics that offered abortions close, there will be many more unwanted pregnancies and other health problems, Bauer says, because these clinics also provide prenatal and pregnancy care, sex education, contraception and testing. screening for sexually transmitted diseases. The closures will limit access to health care for some women and create a deeper divide across the country.
“If you’re from New York or California or Massachusetts, you’re going to have access to it. If you live in Alabama, Mississippi, or Texas, you won’t have access. Your health shouldn’t be determined by your ZIP code,” says Bauer.
Unplanned pregnancies are also associated with less prenatal care and, therefore, more complications and poor pregnancy outcomes, Bauer says.
The Rejection study, which followed 1,000 women after some of them were able to have an abortion, while others were denied an abortion, showed that women who have to pursue an unwanted pregnancy are much more locked in poverty, as they are more likely to fall behind in their education and career, remain in violent relationships or have more debt. Living in poverty has health consequences for both the adult and their child through poor nutrition, less likely breastfeeding, anxiety, low self-esteem, depression and other health effects.
Unwanted children are more likely to experience bad connection with their mother and undergo more psychiatric hospitalizations than their brothers and sisters or than other children of planned pregnancies.
It’s bad for both individuals and society as a whole, says Simmonds.
Unwanted pregnancies often occur in abusive relationships, putting women at significant risk of being a victim of homicide, Bauer says. A study based on National Center for Health Statistics Mortality Files from 2018 and 2019 found homicide to be a leading cause of death during pregnancy and the postpartum period for women in the United States. The study authors concluded that pregnancy carries a greater risk of homicide for Black women and girls and young women aged 10 to 24 across all racial and ethnic subgroups.
Simonds says abortion policy should focus on the most vulnerable people it will affect.
“The [Supreme Court’s] This decision further entrenches us in the issues of inequality and consistent lack of access that we already face in our country when it comes to health outcomes in general,” Bauer said. “The irony is that we are preserving life, but, in reality, we are putting a lot more life at risk.”
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