photo by Luan Rezende
Abortion is a topic that inspires strong emotions, so it is worth taking time to observe a few facts.
Alabama, Georgia, Mississippi, Kentucky and Ohio have passed laws this year banning abortion after doctors can detect electrical pulses indicating a “fetal heartbeat,” about six weeks into pregnancy. Missouri’s Senate passed a bill banning abortions after eight weeks except in medical emergencies. According to the Centers for Disease Control and Prevention, Mississippi has the highest infant mortality rate in the country. Alabama is tied for fourth place, while Georgia and Ohio are tied for sixth. In other words, four of these six states are in the top 10. (Kentucky and Missouri are 11th and 13th, respectively.) Of the 12 states with the highest infant mortality rates, 11 impose “severely restricted access” on abortion, according to the abortion rights advocacy organization NARAL.
Another fact from the CDC, via America’s Health Rankings: Georgia has the highest maternal mortality rate in the United States, at 46.2 deaths per 100,000 births, compared to the national average of 20.7. That rate is even more alarming when you consider that the U.S. has the highest maternal death rate in the developed world. A USA Today report earlier this year reported that Georgia’s maternal death rate is the second-highest in the country (after Louisiana). Missouri also made the top ten.
Correlation is not always causation, as anyone who has taken statistics can tell you. But it is worth considering the source of the correlation in these particular cases.
In some instances, there may be a direct connection between barriers to abortion access and health outcomes. While Roe v. Wade means that no state can outlaw abortion outright without a court challenge, many states have made access difficult. Banning abortion at six weeks, before most people realize they are pregnant, has been a strategy for legislators since 2013, albeit one that has gained momentum mainly since late 2018. Some states have instituted waiting periods, required people to view ultrasound images before an abortion or limited insurance coverage for the procedure.
In places where abortions are inaccessible or illegal, history shows that women pursue dangerous alternatives. For example, in Romania, abortion was criminalized in 1966. The maternal mortality rate spiked to 150 women per 100,000 births by 1970, and about 500 women per year died from attempted illegal abortions. When abortion was re-legalized in 1989, the maternal mortality rate fell 50% in the first year.
This not to say that present state-specific maternal mortality rates are directly due to restrictions or attempted bans on abortion. Maternal mortality statistics in the U.S. are subject to a variety of reporting flaws and gaps. This makes it difficult, if not impossible, to draw a direct line between maternal deaths and policies designed to restrict abortion access. But it isn’t necessary to establish such a direct cause-and-effect relationship to observe a dangerous level of cognitive dissonance among anti-abortion lawmakers. State legislators who are willing to go to what opponents characterize as extreme lengths to preserve life in some instances seem less enthusiastic about policies that will require budgeting for expanded care for mothers and infants. That means that abortion access often serves as a proxy for access to a variety of pre- and postnatal health care.
The rhetoric surrounding abortion bans or restrictions often focuses on life in overtly religious terms. Alabama Sen. Clyde Chambliss, a Republican and a major backer of the legislation that recently passed, said: “Human life has rights, and when someone takes those rights, that’s when we as government have to step in. When God creates that life, that miracle of life inside the woman’s womb, it’s not our place as humans to extinguish that life. That’s what I believe.”
Yet the bill’s supporters do not have a monopoly on religious motivations. Alabama Sen. Linda Coleman-Madison, D-Birmingham, said, “The sin to me is bringing a child into this world and not taking care of them.” She continued: “The sin for me is that this state does not provide adequate care. We don’t provide education. And then when the child is born and we know that mother is indigent and she cannot take care of that child, we don’t provide any support systems for that mother.” Coleman-Madison offered her fellow lawmakers a way to show support for mothers and infants as part of the bill. She proposed an amendment that would have required the state to provide medical and prenatal care for mother and child when a woman is denied an abortion by law. The Senate rejected the amendment, 23-6.
Democratic state Rep. Merika Coleman, also of Birmingham, said succinctly of the final law: “I do support life, but there are some people that just support birth; they don’t support life.”
As these two lawmakers pointed out, their colleagues who characterize themselves as “pro-life” have a variety of policy options at their disposal beyond restricting abortion access if their true goal is to protect mothers and infants. After the Alabama law passed, Planned Parenthood President and CEO Leana Wen wrote: “In a state that has some of the worst health outcomes for women in the nation — such as the highest rate of cervical cancer — Alabama is putting women’s lives at an even greater risk. Politicians who say they value life should advocate for policies to solve the public health crises that are killing women, not dismantle what little access to health care Alabamians have left.” Human Rights Watch reported last year that more women die of cervical cancer in Alabama than in any other state. That report condemned “Alabama’s patchwork public health system.” Lawmakers concerned about women’s health might start there.
Even mothers who carry to term without health complications may face daunting financial consequences for unplanned pregnancies. For instance, an analysis from WalletHub found that Alabama was one of the five most expensive states to have a baby. It also ranked the state second-to-last in “baby friendliness,” a measure based on parental leave policies, per capita child-care centers and similar parameters. Policies designed to ease the economic burden of pregnancy and infant care could go a long way – especially since many women who seek abortions cite economic concerns as a major motivating factor. Legislators who want to reduce the number of abortions might also focus on making birth control more widely available or improving the condition of their states’ foster care systems, many of which are overburdened.
State legislators know that their bills will face significant court challenges. In most if not all cases, these bills are designed to serve as a challenge to Roe v. Wade, as their drafters and supporters frankly state. Alabama Gov. Kay Ivey acknowledged that an abortion ban has been part of Alabama law for 100 years but has been unenforceable since Roe. While the new law is similarly unenforceable for now, Ivey added, “The sponsors of this bill believe that it is time, once again, for the U.S. Supreme Court to revisit this important matter, and they believe this act may bring about the best opportunity for this to occur.”
Whether the Supreme Court is ready to overturn Roe is an open question, especially considering Chief Justice John Roberts’ commitment to preserving precedent. Yet many state legislatures clearly think they have a good chance of scuttling Roe under the newly conservative-leaning court. Liberal legislatures also seem concerned. States including Nevada and Vermont have worked to expand abortion access at the state level even in a post-Roe world.
For now, laws and bills restricting abortion are causing stress and fear among many women across the country, but especially in the affected states. Planned Parenthood Southeast created a separate phone line to field an influx of calls from women confused about their current health care options. Roe is still in force nationwide, and many of the new laws will not take effect right away even in the absence of court intervention. Alabama’s ban, for example, will not take effect for six months. When it does, it will be doctors, not patients, who could face felony charges for performing abortions in the state. Georgia’s ban, however, could theoretically lead to prosecutions for women who induce abortions themselves or travel to other states to get them. (Supporters of the law dispute this reading.) Georgia’s law does not take effect until 2020. These laws and others may be suspended even longer if federal courts agree to block them while legal challenges proceed. Even so, it is hard to blame the women in these places who are angry, fearful or both.
What exactly does it mean to care about a beating heart? The numbers on infant and maternal morality illustrate the consequences of taking a narrow view. Legislators who sincerely want to preserve life should take note.