In other words, the Court can tear up the Roe v. Wade, half a century old (and the Planned Parenthood v. Casey decision that reinforced it), but everyone else will have to pick up the pieces. The political impact, especially for the midterm elections, is difficult to predict, but one consequence is entirely foreseeable: the decision to allow the abortion ban will widen the health inequalities that are already stark in the US.
Eliminating access to abortion will have health consequences for women in two broad categories: among those with unwanted pregnancies who later give birth, and among women who seek abortions despite inevitable new laws restricting them.
If the result of a ruling is reduced access to abortion, then there is an even more urgent need to address the country’s appalling levels of maternal mortality, which are the highest among developed countries. Women are 14 times more likely to die during childbirth than from a legally induced abortion. Maternal mortality in Mississippi, the state whose policies are at the center of the Supreme Court case, is even worse than the national average. Black women are three times more likely to die from pregnancy-related causes than white women.
Reducing maternal mortality is not rocket science. While the US has many obstetricians and gynecologists, it has an insufficient number of midwives and other key providers of maternity care recommended by the World Health Organization.
Another solution would be postpartum health visits. In the UK, the National Health Service sends a health care visitor to homes after childbirth to check on mothers and their babies, provide support with breastfeeding, and offer advice on sleep and vaccinations. The United States, where more than half of pregnancy-related deaths occur after childbirth, and where one in five deaths occurs between one and six weeks after childbirth, is the only major country that does not offer universal provider home visits of medical care.
The lack of guaranteed paid maternity leave also puts stress on many new mothers, compounding postpartum pressures, and this falls disproportionately on the most vulnerable. While maternity leave varies around the world, the US is the only country advanced in its stinginess. Norway offers 91 weeks of paid vacation, France gives women 42 weeks, Canada 51 and Australia 18.
The Affordable Care Act passed under President Barack Obama improved maternity care coverage, but women can still face high out-of-pocket costs, depending on their insurance and where they live. Nearly half of all women in the US report problems paying their medical bills and a third skip care due to cost, compared to just 5% in the UK.
Women seeking abortions are disproportionately likely to be young (most are in their 20s), live below the poverty line, and have at least one child to care for. Poorer women who have children are more likely to experience health care-related financial stress with repercussions on maternal and child health and also on future outcomes, whether in terms of financial earnings or educational attainment.
Unwanted pregnancies are associated with increased health risks for both mothers and babies in poor and rich countries. Women with unplanned pregnancies tend to delay access to prenatal care, leading to missed warning signs, nutrient deficiencies, and other risks. They are more likely to suffer from depression, and their babies are at higher risk of complications and impairments from maternal alcohol and tobacco use.
And it’s not clear that restricting abortion will stop it. In countries where it is restricted, the percentage of unwanted pregnancies that end in abortion has steadily increased. Globally, abortion rates remain remarkably constant, even where it is prohibited.
The annulment of Roe v. Wade would pose risks for women who are determined to have an abortion. Some will do it in unregulated underground clinics or by buying drugs online. There will be ample opportunities for exploitation and abuse.
“We will certainly see an increase in deaths from unsafe abortions, unsafe and unwanted pregnancies, and abused children in foster care,” Columbia University professor Terry McGovern wrote in the British Medical Journal at February, anticipating the possibility of a reversal. by the Supreme Court. The greatest risks are in states with the worst maternal and child health records, for the most disadvantaged communities, and for black women in particular.
Since that landmark ruling in 1973, the abortion debate has focused myopically on the issue of where the rights lie, whether primarily with the fetus or with the mother. That has allowed the US to ignore the many ways in which both women and babies are neglected. If Alito’s trial stands, his denial of responsibility will ring hollow given the high stakes and the long precedent. The health of the most vulnerable will suffer unless radical steps are taken to improve access to health care and maternity support.
More from Bloomberg’s opinion:
• Online privacy becomes critical if Roe v. Wade: Parmy Olson
• No abortion means poor states will get poorer: Allison Schrager
• Leakage of an abortion case shows that the Supreme Court is broken: Noah Feldman
This column does not necessarily reflect the opinion of the editorial board or of Bloomberg LP and its owners.
Therese Raphael is a columnist for Bloomberg Opinion. She was an editorial page editor for the Wall Street Journal Europe.
More stories like this are available at bloomberg.com/opinion