‘A matter of life and death’: maternal mortality rate will rise without Roe, experts warn | Roe v Wade

After the U.S. constitutional right to abortion is revoked, pregnancy-related deaths will almost certainly increase — especially among people of color, experts say. They called for urgent action to protect the reproductive rights and health of patients across the country.

“There will be more people who will be forced to carry pregnancies to term, which means there will be more people at risk,” said Rachel Hardeman, professor and researcher in reproductive health equity. at University. from the Minnesota School of Public Health. “More pregnancy means more chance of death.”

Existing state bans could result in 75,000 additional births per year for those without access to abortion, according to an estimate. The bans will disproportionately affect younger, poorer people of color and those who already have children.

But America is an incredibly tough place to get pregnant, with by far the highest maternal mortality rate of any developed country – and it’s rising sharply. For every 100,000 births, 23.8 people died from causes related to pregnancy or childbirth in 2020 – a total of 861 women – according to the US Centers for Disease Control and Prevention (CDC).

When Roe fell, states immediately moved to ban abortion, and more than half of US states would eventually have to do so. But some, like former Vice President Mike Pence, want lawmakers to go even further, calling for a national abortion ban.

A nationwide ban would lead to a 21% increase in pregnancy-related deaths across the country, but it would be even worse for people of color, with a 33% increase in deaths, according to research by Amanda Jean Stevenson, assistant professor. in sociology at the University of Colorado at Boulder.

“Pregnancy is really, really dangerous,” Stevenson said.

And it’s disproportionately more dangerous for people of color, including blacks, Indigenous peoples and Latinos.

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“The truth is, it’s already hitting people [of color] harder than others – that’s the reality,” said Monica McLemore, associate professor of family health care nursing at the University of California, San Francisco.

Black people in the US were already 3.5 times more likely than their white peers to die from pregnancy and childbirth, according to a study examining data from 2016-2017, and 2.9 times more likely according to a CDC analysis in 2020. They are also more likely to need abortion services.

“Because Black, Indigenous, and Latinx communities are going to be disproportionately impacted by the lack of access to abortion services, this will exacerbate the racial gap in maternal mortality that we’ve already seen in the United States,” he said. said Hardeman.

Pregnant women of color have long been marginalized and neglected in the medical system, often subject to racism and discrimination at all points of care.

“That translates into not getting the care they need, which can be a matter of life and death,” Hardeman said. And racism also has an immense physical impact, so “by the time that person becomes pregnant, they are in poorer health than their white counterparts who have not experienced racism in their lifetime.”

The cumulative and chronic effects of living in America as a person of color increase stress, which can also affect reproductive health. “We know the stress pathway is what leads to infant mortality, premature birth and other outcomes,” Hardeman said.

Even living in a community or neighborhood with disproportionate levels of police surveillance and contact with the police, for example, is associated with an increased risk of premature birth – which can be dangerous both for the person giving birth and for the child. the baby.

“We must view the Scotus decision and abortion bans in general as racist policy, because the burden will fall hardest on black pregnant women, it will fall hardest on Indigenous peoples and other people of color, people living in rural areas as well as people of lower socioeconomic status,” Hardeman said.

Friday’s Supreme Court decision and state-level abortion bans “disproportionately harm people of color and reinforce a system of inequity and, frankly, white supremacy,” Hardeman said.

States that have now banned or restricted abortion also have some of the highest mortality rates around pregnancy and childbirth, as well as the highest infant mortality rates. Mississippi, for example, where the supreme case that toppled Roe originated, has one of the highest maternal mortality rates – almost twice as high as the rest of the country – and the highest infant mortality rate. highest in the country.

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Some people seek abortions because they are at high risk of dying from pregnancy – due to a medical condition, an unsafe home environment, harassment based on their identity or another raison.

“If you think about why people have abortions, it’s often because it’s not safe for them to stay pregnant,” Stevenson said. “People who are currently having an abortion are very likely to actually have higher rates of pregnancy-related death and maternal mortality than people who are currently giving birth.”

Having an abortion is “much, much, much safer than staying pregnant,” Stevenson said. Researchers estimate that childbirth is 14 times more deadly than abortion.

But childbirth is only one of the risks of pregnancy. “That’s well, way over 14 times more deadly to stay pregnant – that’s a huge understatement,” Stevenson said.

While about half the country is on the verge of banning abortion, other states and cities have worked to expand access, including to out-of-state patients. But significant restrictions remain to access these sanctuaries.

“The question is, who is going to be able to access it?” Hardman asked. Many people of color who face systemic barriers to health care may not have the tools, resources, money, free time and childcare to travel to a sanctuary state or city to receive care, she said.

“We have to think about the fact that because we live in a society where access to resources is based on racism and race, there are people who will not be able to access the services that are available.”

For many reproductive rights researchers, the court’s decision came as no surprise. “It’s been happening for a long time,” McLemore said. “I get really grumpy when people just want me to regurgitate stats about how black people are going to die – we know that. What do we do?”

First, she said, “Congress could act now and render Scotus’ decision moot” by enshrining reproductive rights in national law. If this Congress doesn’t, she says, the six out of 10 Americans who support abortion rights should vote for a new Congress that will.

Members of the Black Maternal Health Caucus in Congress have advocated for laws that would protect the well-being of people giving birth, including the Momnibus Act of 2021.

Lawmakers could also expand the social safety net, including paid family leave and health insurance for low-income and postpartum patients, for the growing number of people giving birth.

All of these strategies would not only ensure that reproductive health continues to be available to those who need it — they will also prevent patients from dying, McLemore said.

“We need a holistic approach on deck here – with brilliance, not fear.”

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