After the revocation of the constitutional right to abortion in the United States, pregnancy-related deaths will almost certainly increase – especially among people of color, experts say. They called for urgent action to protect reproductive rights and the health of patients around the country.
“There are going to be more people who are forced to carry a pregnancy to term, which means that there’s going to be a greater number of people who are at risk,” said Rachel Hardeman, a reproductive health equity professor and researcher at the University of Minnesota School of Public Health. “More pregnancy means more likelihood of deaths.”
Existing state bans could lead to an additional 75,000 births a year for those who can’t access abortions, according to one estimate. The bans will disproportionately affect younger, poorer people of color and those who already have children.
But America is an incredibly difficult place to be pregnant, with the highest maternal mortality rate by far of any developed country – and it’s rising sharply. For every 100,000 births, 23.8 people died from pregnancy or childbirth-related causes in 2020 – a total of 861 women – according to the US Centers for Disease Control and Prevention (CDC).
As Roe fell, states immediately moved to ban abortion, with more than half of US states expected to ultimately do so. But some, like former Vice-President Mike Pence, want lawmakers to go even further, calling for a nationwide ban on abortion.
A nationwide ban would result in a 21% increase in pregnancy-related mortality across the country, but it would be even worse for people of color, with a 33% rise in deaths, according to a study by Amanda Jean Stevenson, an assistant professor of sociology at the University of Colorado Boulder.
“Pregnancy is really quite dangerous,” Stevenson said.
And it’s disproportionately more dangerous for people of color, including Black, Indigenous and Latino people.
“The truth of the matter is, it’s already hitting people [of color] harder than others – that’s been the reality,” said Monica McLemore, an associate professor of family healthcare nursing at University of California, San Francisco.
Black people in the US were already 3.5 times more likely than white peers to die because of pregnancy and childbirth, according to one study looking at 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 lack of access to abortion services, it’s going to exacerbate the maternal mortality racial gap that we’ve already seen in the United States,” Hardeman said.
Pregnant people of color have long been marginalized and neglected in the medical system, frequently experiencing racism and discrimination at all points of care.
“It’s translating into not getting the care they need, which can be a matter of life and death,” Hardeman said. And racism also takes an immense physical toll, so “by the time that person becomes pregnant, they are at less optimal health than their white counterparts who haven’t experienced racism across the life course”.
The cumulative and chronic effects of living in America as a person of color increases stress, which can also affect reproductive health. “We know that the stress pathway is what leads to infant mortality, preterm birth, and other outcomes,” Hardeman said.
Even living in a community or neighborhood with disproportionate levels of police surveillance and police contact, for instance, is associated with a greater risk of preterm birth – which can be dangerous for both the birthing person and the infant.
“We have to be thinking about the Scotus decision and abortion bans generally as a racist policy, because the burden will fall the hardest on Black pregnant people, it’s going to fall hard on Indigenous people and other people of color, people living in rural areas as well and people of lower socioeconomic status,” Hardeman said.
The supreme court decision on Friday and bans on abortion instituted at the state level “disproportionately harm people of color and reinforce a system of inequity and, frankly, of white supremacy”, Hardeman said.
The 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 child mortality rates. Mississippi, for instance, where the supreme case that overturned 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 in the country.
Some people seek abortions because they are at high risk of dying from a pregnancy – because of a health condition, an unsafe home environment, harassment because of their identity, or another reason.
“If you think about why people get abortions, it’s often because it’s not safe for them to stay pregnant,” Stevenson said. “The people who are currently having abortions are very likely to actually have higher rates of pregnancy-related deaths and maternal mortality than the 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 having an abortion.
But childbirth is just one risk of pregnancy. “It’s way, way more than 14 times more deadly to stay pregnant – that’s a massive underestimate,” Stevenson said.
While roughly half of the country is poised to ban abortion, other states and cities have worked to expand access – including to out-of-state patients.But significant limitations on getting to those sanctuaries remain.
“The question is, who is going to be able to access it?” Hardeman asked. Many people of color who face systemic barriers to healthcare may not have the tools, resources, money, time off work and childcare to travel to a sanctuary state or city to receive care, she said.
“We have to be thinking about the fact that because we live in a society where access to resources is based on racism and race, there are people who are not going to be able to access the services that are available.”
For many reproductive rights researchers, the court’s decision came as no surprise. “This has been coming for a long time,” McLemore said. “I get very grumpy when people just want me to regurgitate statistics about how Black people are going to be dying – we know that. What are we doing?”
First, she said, “Congress could act right now and render Scotus’s decision irrelevant” by enshrining reproductive rights into national law. If this Congress doesn’t, she said, the six in 10 Americans who support abortion rights should vote for a new Congress that will.
Members of the Black Maternal Health Caucus in Congress have been advocating for laws that would protect the well-being of birthing people, including the Momnibus Act of 2021.
Lawmakers could also expand the social safety net, including paid family leave and health insurance for lower-income and postpartum patients, for the swelling number of people giving birth.
All of these strategies wouldn’t just ensure that reproductive health continues to be offered to those who need it – they will also keep patients from dying, McLemore said.
“We need an all-hands-on-deck approach here – with brilliance, not fear.”