Last week was Black Maternal Health Week, which reproductive justice activists started in 2018 to raise awareness of the grim fact that maternal mortality rates for Black women are up to three times higher than they are for white women. For the first time ever, the White House also joined in, with President Joe Biden issuing a proclamation noting that "America's maternal mortality rates are among the highest in the developed world" and calling on "all Americans to recognize the importance of addressing the crisis of Black maternal mortality and morbidity in this country."
The reasons for this crisis are multifaceted. As Vice President Kamala Harris explained in an interview with STAT, "systemic disparities and implicit bias" in health care are major contributors. She also explained that the White House is committed to "investing in social determinants that we know influence maternal health, such as housing, transportation, and nutrition." A new study published in the medical journal Contraception points to another factor that is often overlooked as a likely contributor to lack of health care access that is making maternal mortality outcomes worse: Abortion restrictions.
As Amy Roeder explained in a 2019 piece for Harvard Public Health, "Following decades of decline, maternal deaths began to rise in the United States around 1990—a significant departure from the world's other affluent countries." Black women in the U.S. are so dispropotionately affected that their odds of "surviving childbirth are comparable to those of women in countries such as Mexico and Uzbekistan, where significant proportions of the population live in poverty."
Dr. Mark Hoofnagle, assistant professor of surgery at Washington University School of Medicine in St. Louis, told Salon that he had a hunch that there was a reason that this rise started to happen around the same time as an infamous 1992 Supreme Court case, Planned Parenthood v. Casey. That case opened the door to a crush of abortion restrictions that slowly, over the decades, decimated abortion access, especially in red states. So he and a group of other doctors started comparing states based on their abortion restrictions and found a strong correlation to their maternal mortality rates.
"States that restrict abortion have higher maternal mortality than states that either protect or are neutral towards abortion," the eventual paper in Contraception bluntly concluded.
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This is something that many people working in the field of reproductive health care have long suspected. As OB-GYN Dr. Jamila Perritt wrote last week at Rewire News Group, the failures of the nation's maternal health care system are "intimately tied to Black women's lack of access to comprehensive reproductive health care, including access to abortion care."
The authors of the Contraception paper stressed to Salon that it's not as simple as women dying because they wanted an abortion and couldn't get one, though there is strong evidence that women in this situation suffer worse health outcomes than women who are able to abort unwanted pregnancies. It's also likely that, as the paper explains, "states that restrict abortion may have broader hostility towards women's health."
Dr. Amy Addante, an OB-GYN and co-author of the paper, explained to Salon that "they are not prioritizing things that have been demonstrated to lower maternal mortality." Instead of "improving access to care, not just, obstetrics care, but contraceptive care," Addante noted, the legislatures are "really prioritizing passing anti-abortion legislation."
Indeed, the same legislatures that are keen on gutting abortion access are also happy to make birth control harder to get, even though, as Addante noted, "unplanned pregnancies are at increased risk of adverse outcomes." In Texas, for instance, the anti-abortion legislature has also spent years slashing family planning programs, and even redirected funds that used to go to birth control services to shady anti-contraception groups. Texas also happens to be one of the states that has rising maternal mortality rates.
As Dr. Hoofnagle pointed out, restrictions on abortion close down clinics that were part of the larger "safety net" offering affordable services like birth control and other reproductive health care. For instance, the Donald Trump administration cut funding to 900 reproductive health care clinics, using the fact that those clinics acknowledge that abortion is legitimate health care as an excuse. Similar assaults on abortion access have shuttered Planned Parenthood and other low-cost clinics across the country.
Of course "the women that rely on the safety net are going to be most affected," Hoofnagle told Salon.
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Dr. Jennifer Leonard, another surgeon at Washington University School of Medicine and co-author of the paper, emphasized that the maternal health care problem affects doctors from all walks of life. For instance, treating gunshot victims has highlighted for her the high rate of severe domestic violence pregnant women experience. Indeed, pregnant women are at heightened risk of both homicide and suicide, which contributes to the maternal mortality problem in the U.S.
Dr. Addante emphasized that women themselves understand these dangers and "a lot of women who are seeking an abortion are doing so because they feel like it's the best way to protect the family that they already have." Being denied the ability to prevent or terminate an unwanted pregnancy can make it much harder for women to leave abusive partners, increasing the risk of death.
Unfortuantely, Trump's ability to pack the federal courts and especially the Supreme Court with anti-choice hardliners has invited Republican-controlled state governments to double down on abortion restrictions. They've also become bolder about moving towards laws that would allow states to target women of color for direct discrimination. As NYU law professor Melissa Murray in the Washington Post wrote about on Monday, a "federal appeals court last week allowed an Ohio law to take effect that bars doctors from performing abortions on women" based on the presumed reason for the abortion.
While that law was specific to Down syndrome cases, Murray warned, it could lead to many similar laws that single out Black women and deny them wanted abortions based on right-wing conspiracy theories accusing Black women who get abortions of committing "eugenics" against their own families. It is true that Black women have higher abortion rates than white women, but that is due to higher unwanted pregnancy rates that stem from lack of health care. But of course, conservatives project their own racism onto Black women themselves, pretending that Black women who get abortions are the "real" racists and thus must be stopped.
But, as this research shows, abortion access cannot be meaningfully separated from other health care access, and taking it away has ramifications throughout the health care system that lead to poorer overall health outcomes. For all the bad faith claims by conservatives to want to restrict abortion access to protect Black people, the reality is that such restrictions are linked to poorer health outcomes that are hurting Black women especially. Much needs to be done to improve maternal health care, but one good place to start is by empowering women to choose for themselves when and if they give birth.
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