How Overturning Roe V. Wade Could Impact Maternal Health

Pregnancy

On May 2, 2022, the internet was set ablaze by a leaked draft Supreme Court majority opinion indicating that Roe v. Wade—the landmark 1973 Supreme Court decision that ruled that people in the Unite States have the consitutional right to obtain an abortion before fetal viability —may be overturned. Abortion rights are a politically fraught topic, to be sure, but the American College of Obstetrics and Gynecology (ACOG), the governing medical organization for board-certified ob-gyns in the United States, has a clear stance on the issue.

“Induced abortion is an essential component to women’s health care,” its policy reads. “Like all medical matters, decisions regarding abortion should be made by patients in consultation with their health care providers and without undue interference by outside parties. Like all patients, women obtaining abortion are entitled to privacy, dignity, respect and support.”

So if legal access to abortion is critical to women’s health, what are the health implications of potentially overturning Roe v. Wade? Here, three ob-gyns provide answers to pressing questions around unintended pregnancy, abortion safety and considerations, and how anti-abortion laws affect maternal health.

What are the biggest maternal health risks of overturning Roe v. Wade?

Experts point to a number of factors at play here. Firstly, the overturning of Roe v. Wade could potentially worsen the US maternal mortality rate, which is already the highest among developed countries. “Currently, there are about 700 pregnancy-related deaths a year, and 60 percent of these deaths are preventable,” says Sherry Ross, MD, a women’s sexual health expert and author of she-ology and the she-quel. “For now, it’s safe to get an abortion in the US. If the number of abortions go down as a result of Roe being overturned, the number of pregnancies [carried to term] will go up, and the death rate for women could rise.”

Doctors also worry that banning abortions will simply lead to a spike in illegally sought abortions outside of a medical setting, putting women’s health at risk. “People will seek abortion care regardless of whether it’s legal or not,” says Sara Twogood, MD, an ob-gyn at Ceders Sinai in Los Angeles. “Limiting access to care doesn’t decrease the number of abortions—it decreases the number of safe abortions.”

It’s a reality proven by past history. According to the Guttmacher Institute, in 1965 (before Roe v. Wade), illegal abortion accounted for 17 percent of all pregnancy-related deaths. Not only were illegal abortions unsafe, but they were widespread: The Guttmacher Institute estimates the number of illegal abortions in the 1960s ranged anywhere from 200,000 to 1.2 millon a year. “For women experiencing unplanned pregnancy, limited access to abortion can literally be a death sentance,” says Kameelah Phillips, MD, an ob-gyn and founder of Calla Women’s Health in New York City. “In a country with already appalling maternal health statistics, the US has no room for damning more women to maternal-related deaths.”

The health implications of denied access to abortion are far-reaching, including “the social, psychological and economic consequences of unplanned pregnancy,” Phillips says. “These include the limits on education and job opportunities that contribute to the ongoing cycle of poverty and pay inequality.” Not only that, but according to ACOG, more than 320,000 women are abused by their partners during pregnancy each year. “Unplanned pregnancy increases these risks,” Phillips adds. “Unplanned pregnancy presents a myriad of health risks for women.”

How might an unwanted pregnancy affect a mother’s health in the short and long term?

Carrying an unwanted pregnancy has been shown to have consequences for the mom’s physical and mental health. “An unwanted pregnancy can, in the short term, worsen or cause depression, anxiety or other mood disorders; and lead to less consistent prenatal care, poor maternal weight gain, more fetal and maternal complications during the pregnancy and an increased risk of postpartum depression,” Ross says. “The mother is also at risk of being physically abused, and her relationship with her partner (if she has one) is less likely to be successful.”

There have been numerous research studies on this issue. A 2017 study examined the mental health impacts of an unintended pregnancy on mothers and found that women who experienced an unplanned pregnancy were 1.73 times more likely to exhibit signs of postpartum depression nine months after birth as compared to women with planned pregnancies. There are long-term implications as well: A 2016 report published the findings of a 60-year ongoing survey of women who were pregnant before the legalization of abortion, and found that unwanted pregnancies that resulted in live births were strongly associated with poorer mental health outcomes later in life.

There may also be health implications for the child. “Babies [may be] smaller at birth and more likely to die in the first year of life,” Ross says. As for long-term issues, “they are more likely to be abused, neglected and not receive proper medical care for a healthy development during childhood,” she adds. A 2019 study published in the Journal of Pediatrics found that children of women who were denied abortions had lower child development scores and were more likely to live below the federal poverty level than the existing children of women who successfully obtained an abortion.

What are the potential health risks and key considerations associated with terminating a pregnancy?

“When termination is done under the care of trained professionals and in a timely fashion, it is a safe procedure,” Phillips says. “Procedures that are performed earlier in the pregnancy are typically shorter and safer.” How far along a woman is in her pregnancy will impact potential health risks associated with an abortion, as well as the way a pregnancy is terminated and the experience of the physician who is performing the termination, according to Ross.

There are two types of abortion: surgical abortion and mediation abortion, which involves taking oral pills; one type may be recommended or specifically not recommended for an individual patient, according to Twogood, so the termination method should always be discussed with a physician. “Bleeding, infection and retained products of conception are all risks of both types of termination,” she says.

How does the safety of a legally sanctioned abortion compare to an illegal abortion?

“Legal abortion is a safe medical procedure—full stop,” Phillips says. “It is likely one of the safest procedures that can be performed. Termination does not lead to infertility, mental illness or any other chronic issue.” Rather, legal abortions provide safe medication monitoring, sterile instruments if needed and follow-up care, Twogood explains.

On the flip side, illegal abortions increases the risk of complications. “We know from our history that illegal abortion is unsafe,” Phillips says. “When termination is driven underground or performed by unskilled, non-medical individuals, then it [poses] a risk of serious bleeding, damage to internal organs, loss of fertility and death.”

Phillips remembers an encounter with an older woman who had had an illegal abortion in the 1950s. “She recalled the dark basement, the other scared women sitting around, the pain and blood. It was literally out of a movie scene. As I sat there in silence, I realized everything that I had read about ‘back-alley abortions’ was in fact true,” Phillips says. “As a result of this illegal procedure, she sustained multiple intestinal and uterine injuries. She lost half her blood and had major surgery to correct the holes in her intestines. She lost her uterus and fertility because of an anti-abortion climate that drove her to these lengths. This illegal procedure changed her life forever, both mentally and physically. This should never happen to another woman.”

What are the health implications of removing women from the decision-making process around reproduction?

As Ross points out, 51 percent of pregnancies are unplanned, and the decision to have a child has “life-changing implications” for a mother and her partner (if she has one). All of the doctors we spoke with underscored the importance of women retaining complete control over their personal health care and reproductive rights.

“Women uniquely know what is best for them, and (attempting) to remove them from this conversation represents an effort to undermine a woman’s autonomy over her body and uphold this country’s long-held inequalities,” Phillips says. “Anti-abortion laws serve to uphold the patriarchy, reinforce poverty and keep education out of reach, and are an assault on the female body. These laws punish women for their biology and abdicate men from their responsibility in this matter.” Furthermore, “in a country that does not provide pay equality, universal health care, paid family leave and other such rights, only the individual is aware of what they need to do to create the life they want and desire.”

For more information about abortion and maternal health, visit the ACOG website.

About the experts:

Kameelah Phillips, MD, is a board-certified ob-gyn in New York City and founder of Calla Women’s Health, her private practice. She received her medical degree from the University of Southern California Keck School of Medicine in Los Angeles. She is also a member of the International Board of Lactation Consultants and is especially interested in the areas of prenatal care, lactation, sexual health and menopause.

Sherry A. Ross, MD, is a board-certified ob-gyn and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California, and author of two books on women’s intimate health, she-ology and she-ology, the she-quel: let’s continue the conversation. She earned her medical degree from New York Medical College.

Sara Twogood, MD, FACOG, is a board-certified ob-gyn at Cedars Sinai Medical Center in Los Angeles. She’s also the author of Ladypartsblog.com, which covers topics relating to fertility and pregnancy, and the founder of FemEd, a program designed to empower females through health education.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

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