Health

Without Roe v. Wade, Maternal mortality could be worse


BILLIONHe USA is a surprise dangerous place to get pregnant. The Maternal mortality rate in the US—Early 24 deaths per 100,000 live births, by 2020 — is much higher than comparable developed countriesand from research it has gotten worse in recent years, not better. Maternal mortality rates among black women are particularly high, with 55 deaths per 100,000 births compared with 19 deaths per 100,000 births among white women.

Experts fear that these numbers will only get worse now Roe v. Wade was overturnedabolished the constitutional right to abortion and triggered a series of state bans that placed limits on reproductive health care.

Michelle Drew, a family nurse and midwife, executive director of Ubuntu Black Family Wellness Collective, a Delaware-based nonprofit, said: “Even pregnancy and birth carry risks also carries a higher risk to the mother than termination of the contract. When you consider “compulsory pregnancy and childbirth, with a pregnancy that may not be at the right time or desire or may be high-risk,” Drew says.

A 2021 study estimates that, if the United States bans abortion altogether, the total number of pregnancy-related deaths will increase by more than 20% in the following years, with a 33% increase in black women. That estimate doesn’t exactly apply today, because abortion is expected still available in about half of all US states even without Roe. But research clearly shows that as access to abortion increases, maternal mortality goes down — and vice versa.

That said, in the US, the effects vary considerably across demographics. After abortion was legalized in the US, culminating in the Supreme Court original Roe v. Wade decided in 1973, the maternal mortality rate among women of color in the United States fell by more than 30%, while white women had limited influence. a study published in preprint last year. Co-author Lauren Hoehn-Velasco, an assistant professor of economics at Georgia State University, says most of the drop is due to fewer abortion-related deaths in the US, more women of color. used unsafe methods to end an unwanted pregnancy.

“I don’t know that we can say exactly how things will play out in the future,” said Hoehn-Velasco, noting that advances like abortion pill can now help provide safe access even in states that restrict abortion.

Even with advancements like medical abortion there is still a link between access to abortion and maternal mortality in the U.S. As of 2017, states have restrictive policies on abortion, such as limiting gestational age or waiting time before having a procedure. continued, had an average maternal mortality rate of 28.5 deaths per 100,000 births. , compared with an average of 15.7 in states that protect access to abortion, according to a 2021 study published in a magazine Contraception. A separate study from the same year, published in American Journal of Public Health, found a similar trend: states with significant restrictions on abortion care recorded a 7% increase in total maternal deaths from 2015 to 2018.

There are several possible reasons for this motivation. Countries with strict abortion policies also tend to be those that have not expanded Medicaid and have lower numbers of practicing health professionals, both of which can make it difficult for people to access care. better health care. “Incidentally, they are also states that have a lot of families living in poverty and especially people of color who are on low wages,” Drew said.

Socioeconomic factors like these are strongly linked to risk factors, such as underlying health status and inadequate access to prenatal care, which increase the risk of complications. pregnancy. Report 2020 from health insurer Blue Cross Blue Shield found that pregnancy and childbirth complication rates among commercially insured women in the United States increased between 2014 and 2018, in part because more and more people pregnant with pre-existing health problems. The report also found that a third of women had less than 10 recommended prenatal appointments during pregnancy – and of those without, nearly a quarter suffered complications during delivery. .

Mark Hoofnagle, a trauma surgeon at Washington University School of Medicine in St. Louis and co-author of Contraception study, noted that abortion clinics often offer multiple forms of reproductive health care, so policies that make it harder for these facilities to survive could have a trickle-down impact. “Planned parenthood is more than just abortion,” says Hoofnagle. “When you attack clinics in general, you are exacerbating existing inequality.”

Most people who go through pregnancy do not experience life-threatening problems; there are 861 maternal deaths in the US in 2020 and about 3.6 million births. But especially for those entering pregnancy with existing health problems, “a full-term pregnancy is much riskier than abortion in this country,” said Dovile Vilda, assistant professor Maternal and Child Health Research at Tulane University. of Public Health and Tropical Medicine and co-author of American Journal of Public Health research. Not available Roeand with many people can’t go out of state to have an abortionmany individuals “will be forced to have an unwanted and high-risk pregnancy to term even when their health and life are in jeopardy,” she said.

The risk of that situation is not hypothetical. Because a 2015 study, researchers followed a group of about 850 women who sought abortions at U.S. facilities. Some are denied because they have exceeded the gestational age limit in their state, which ranges from 10 weeks to more than 20 weeks of pregnancy. About 6% of those denied abortion and childbirth went on to report a potentially life-threatening complication, such as bleeding or eclampsia, compared with about 1% of those who had an abortion near the age limit. pregnancy in their state and about 0.4 percent of those who have an abortion in the first trimester. A woman died after being turned away by an abortion and childbirth clinic.

At this point, Vilda says, the research makes it clear: getting abortions more difficult means more women and babies will get sick and die. “We have enough data and we have enough research and we have enough evidence,” she said. “What we really need now is political will.”

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Write letter for Jamie Ducharme at jamie.ducharme@time.com.



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