Reviews | Roe’s end need not lead to increased maternal mortality

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Evidence from Europe demonstrates that it is not necessary or inevitable that restricting abortion will lead to adverse health effects for women.

Yet in the United States, the uncomfortable truth for Republicans is that, according to a 2019 analysis by America’s Health Rankings, eight of the 10 states with the lowest maternal mortality are blue states, while eight of the 10 states where maternal mortality is highest in red states. Mississippi, whose bill was at the center of the Dobbs case, is in the bottom half of the maternal mortality chart. It also received the lowest ranking of any state for overall women’s and children’s health. Dobbs’ dissenting minority notes that Mississippi “does not prohibit pregnancy discrimination or require the provision of paid parental leave”, has “strict eligibility requirements for Medicaid and nutritional assistance and “rejected federal funding to provide a year of Medicaid coverage to women after giving birth.”

If Mississippi and other red states wish to demonstrate that they are truly “pro-life,” then they must address their shameful levels of maternal mortality. The first priority is to address “concentrated disadvantage” among their poorest citizens, and especially among women of color. This measure has been shown to be an important determinant of maternal health. Second, it is essential to ensure that women have access to health care not only before and during, but also in the weeks following childbirth. Third, according to the World Health Organization, midwifery-led maternity services offer an evidence-based approach to reducing maternal mortality. Currently, there are only four midwives per 1,000 births in the US, compared to 43 per 1,000 births in the UK. There’s a lot to be done, but it’s not being done, and maternal mortality in the United States isn’t going down, it’s going up.

The right to abortion granted by Roe v. Wade did not prevent this ongoing scandal, and restricting abortion access will not inevitably make matters worse. The situation is perpetuated, in part, by a national debate that remains hyper-focused on access to abortion (whether against or for) rather than on the causes and remedies of maternal mortality. While this remains the case, hundreds of women and disproportionately women of color will continue to die unnecessarily every year in the world’s wealthiest country.

David Albert Jones is Director of the Anscombe Bioethics Center in Oxford, England, Fellow of Blackfriars Hall, University of Oxford, and Professor of Bioethics at St. Mary’s University, Twickenham.

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