Pregnancy in Abortion-Ban States Is Becoming More Dangerous
Maternal care and delivery services already are lacking for many pregnant people in the United States, especially in states that have enacted the most restrictive abortion bans nationally.
The COVID-19 pandemic and subsequent healthcare labor shortages resulted in more hospitals ending maternal care and delivery. The overturn of Roe v. Wade likely will worsen this already worrisome situation as fewer ED physicians will be trained and experienced in performing an abortion procedure — even to save a pregnant patient’s life.
“In our study, physicians often felt unprepared to provide [abortion] care in an emergency situation because they had lost their skills,” says Hillary J. Gyuras, MA, a research associate in public health at The Ohio State University. Gyuras’ study is part of the Ohio Policy Evaluation Network, which received a grant to conduct research as part of an effort to expand reproductive health services in Ohio and neighboring states.1 “There also was the issue, where in the hospital setting, only a few people were trained adequately to provide D&E [dilation and evacuation] procedures, and they had to find the one person who was capable of providing that care.”
The people affected most will be those who already have the worst reproductive health outcomes: low-income Black and other women who live in rural areas of abortion-ban states like Texas, Tennessee, Ohio, Mississippi, Louisiana, and others. Maternal mortality rates in the United States were on the rise before the overturn of Roe v. Wade and have been the highest among developed nations for years.2,3
In 2022, the March of Dimes reported that nearly 7 million American women have low or no access to maternity care. Since 2020, there has been a 5% increase in maternity care deserts.4
“We know there is already a shortage of physicians in Ohio; there already are maternal care deserts in Ohio, and those deserts are expanding,” Gyuras says. “Ohio already has high rates of infant and maternal mortality, particularly among Black women.”
There is a need for comprehensive reproductive services in Ohio. The anti-abortion laws will make it difficult for physicians to provide for patient safety and well-being and will force doctors to leave the state. “The expansion of these maternal care deserts is really concerning,” Gyuras says. “The Ohio Policy Evaluation Network that I’m a part of and that’s doing this research is working to expand reproductive healthcare access in Ohio and surrounding states. We’ll continue to study what happens in the post-Dobbs world.”
Ohio’s problem with maternal care deserts is like that of other states. For instance, in large swaths of West Texas, there are no obstetricians or hospitals that provide pregnancy care and childbirth care. There is only one hospital in a 12,000-square-mile area that delivers babies — that hospital often closes its labor and delivery unit because of lack of staff.4,5
If a woman in that maternal desert area goes into labor or is experiencing a miscarriage, she must visit the ED. The ED might not offer services for high-risk births, and women are discharged after birth without an overnight stay for observation. If the new mother experiences health problems, she must be transferred miles away.5
In Texas, the anti-abortion laws are particularly chilling. Senate Bill 4, enacted Sept. 1, 2021, prohibits abortions after 49 days of gestation and allows anyone, anywhere to sue someone who assists a woman with an abortion after that period. After the overturn of Roe, the state’s trigger ban, House Bill 1280, took effect. It prohibits all abortions at any stage except for medical emergencies, which are not defined. Anyone who performs or induces an abortion can be charged with a felony and face up to five years in prison and fines of $100,000. Women who attempt an abortion face two to 20 years in prison.6
In Indiana, another state that passed an abortion ban, one-third of the counties do not have OB/GYNs or hospitals that can deliver babies, says Tracey A. Wilkinson, MD, MPH, an assistant professor of pediatrics at Indiana University School of Medicine.7
“That’s a lot of obstetric deserts,” Wilkinson says. “It wasn’t easy to get [OB/GYNs] to move to Indiana before this ban, and it won’t be easier now.”
Abortion bans exacerbate and likely will cause maternal deserts to expand because they make reproductive health providers less likely to practice in those states and regions.
Eventually, it may even affect where reproductive-age women choose to live and work. “Being pregnancy-capable in any state with an abortion ban is dangerous,” Wilkinson says. “Why would you choose to raise your family in a state like that?”
REFERENCES
- Field MP, Gyuras H, Bessett D, et al. Ohio abortion regulations and ethical dilemmas for obstetricians-gynecologists. Obstet Gynecol 2022;140:253-261.
- World Population Review. Maternal mortality rate by state 2023.
- World Health Organization. Maternal mortality. Sept. 19, 2019.
- March of Dimes. Nowhere To Go: Maternity Care Deserts Across the U.S. (2022 Report).
- Suddath C. A very dangerous place to be pregnant is getting even scarier. Bloomberg. Aug. 4, 2022.
- Sepper E, Moayedi G, Thaxton L, et al. After Roe: Criminal abortion bans in Texas. Texas Policy Evaluation Project. June 2022.
- Smith B. One third of Indiana counties don’t have pregnancy services. Indiana Public Radio. Sept. 18, 2014.
Maternal care and delivery services already are lacking for many pregnant people in the United States, especially in states that have enacted the most restrictive abortion bans nationally. The COVID-19 pandemic and subsequent healthcare labor shortages resulted in more hospitals ending maternal care and delivery. The overturn of Roe v. Wade likely will worsen this already worrisome situation as fewer ED physicians will be trained and experienced in performing an abortion procedure — even to save a pregnant patient’s life.
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