Category: News & Press

How lack of access to abortion can impact women’s health

Story at a glance
In early May, a leaked draft opinion stated the Supreme Court plans on overturning Roe v. Wade, which protected women’s right to have an abortion.
If overturned, it would be up to individual state governments to decide whether abortion is legal. At least 26 states are poised to outlaw it entirely if Roe is overturned.
A lack of access to abortion has a number of health consequences for women including increasing rates of maternal mortality as well as depression and anxiety.
Earlier this month, Politico published a leaked draft opinion stating the Supreme Court plans to vote to overturn Roe v. Wade, the groundbreaking 1973 decision that protected women’s right to choose to have an abortion.

In the draft opinion, Justice Samuel Alito wrote that “Roe was egregiously wrong from the start” and “we hold that Roe and Casey must be overruled.” A final decision from the Supreme Court is expected in June or July and if overturned, states would be allowed to decide whether to have legal abortion care — and it looks as if at least 26 states will likely ban abortion completely.

Since the opinion leaked, activists, educators and health experts across the country have warned about how a world without Roe will be catastrophic for women’s health, particularly for poor women of color.

America is changing faster than ever! Add Changing America to your Facebook or Twitter feed to stay on top of the news.

“Women and children will die,” said Carolyn West, associate dean of special initiatives at the University of Washington, Tacoma. “That’s the bottom line.”

Expect a higher maternal mortality rate

The United States has the highest maternal mortality rate of any country in the industrialized world. In 2020, the Centers for Disease Control and Prevention reported 861 women died in childbirth and that number is going up. Some health care providers warn that with the overturning of Roe v. Wade, maternal mortality rates could go up in the country. Already some conservative lawmakers are pushing to try to enact legislation making it illegal to perform an abortion with no exceptions, even if the abortion would be done to save the life of the mother.

Expect it to become harder to treat miscarriages

Some miscarriages are treated the same ways as abortions. Although some women who miscarry do not need any medical intervention, others will need to take medication to ensure all the contents of the uterus are expelled while others will need to undergo a medical procedure called a dilation and curettage where a doctor inserts an instrument into the uterus to scrap blood and fetal remains.

In Texas, which already has very restrictive abortion laws, there are already threats to miscarriage treatment. A state law passed last year bans the use of several medications as abortion-inducing drugs but two of those medications, misoprostol and mifepristone, are used for treating early miscarriages.

“Overturning Roe v Wade certainly also opens the door to people who have a miscarriage being questioned about their pregnancy how come you know doctors being concerned about whether or not they can provide certain treatment,” Krishna Upadhya, vice president of quality care and health equity at Planned Parenthood Federation of America, told Changing America.

“Bans on abortions don’t make sense from a scientific and medical standpoint…when you overturn Roe versus Wade and allow bans to take place across the country, the potential harms are just really far reaching and devastating,” she added.

Expect mental health to become worse for some women

Making it more difficult or impossible to access abortion could harm the mental health of some women. Shortly after news broke that the Supreme Court would likely vote to overturn Roe v. Wade, the American Psychological Association released a statement expressing concern over the potential undoing of the decision. One study found that most women who receive an abortion do not regret the decision years later and that those denied an abortion actually suffer from worse mental health down the line than those who chose to terminate their pregnancy.

“Rigorous, long-term psychological research demonstrates clearly that people who are denied abortions are more likely to experience higher levels of anxiety, lower life satisfaction and lower self-esteem compared with those who are able to obtain abortions,” said APA President Frank C. Worrell. “In addition, there is no research to indicate that abortion is a cause for subsequent mental health diagnoses.”

Expect it to be more difficult for some women to leave abusive relationships

In his statement, Worrell also adds that there is a “strong relationship” between unwanted pregnancy and interpersonal violence with there being evidence to show that a lack of access to abortion increases the chances that women in abusive relationships will experience physical abuse from their partners. Between 6 to 22 percent of women seeking to terminate a pregnancy reported experiencing intimate partner violence, according to a 2014 study.

Women of color are more likely to suffer the most from lack of abortion access given that they experience intimate partner violence at higher rates than white women. Around 40 percent of Black women will experience intimate partner violence in their lifetime while 55 percent of Native women will experience physical intimate partner violence.

GHC Member Spotlight: What to Expect Project

By Annie G. Toro, JD, MPH, President and Executive Director of the What to Expect Project

No matter where in the world they live, every expectant mom wants what’s best for their baby: a healthy beginning to a healthy, bright future.

Established in 1997 by its founder, Heidi Murkoff – author of What to Expect When You’re Expecting, the What to Expect Project (WTEP) is dedicated to informing, supporting, and empowering moms in need, in the United States and around the world, so they can expect healthier pregnancies, safer deliveries, healthier babies, and healthier futures.

WTEP harnesses the power and global reach of the What to Expect brand and mobilizes its community of more than 20 million moms to help bring about positive change, particularly on issues that impact moms and families most. We use the latest evidence-based strategies in the fields of health, education, and communication to train health care providers how to recognize if their patients do not understand health messages and to provide them tools and training to overcome these obstacles.

Tragically and wrongly, too many moms don’t receive the quality, comprehensive, respectful, responsive, supportive, empathetic, and nurturing care they need and deserve.

This July 20th, we will celebrate our 8th annual #BumpDay – a social media advocacy campaign that celebrates healthy pregnancies while raising urgently-needed awareness about maternal deaths and the need for better, more accessible maternal health care. Our goal: to ensure that every mom receives the care and support they need to deliver a healthy start in life and a healthy future for themselves and the baby they love. Last year, WTEP worked with members of Congress to pass a bipartisan resolution commemorating the ideals of #BumpDay and reaffirming the United States’ leadership to end preventable maternal deaths in the United States and across the globe.

From increasing access to doulas, midwives, and other essential health workers, to strengthening health systems’ capacity to prepare and respond to the COVID-19 pandemic and future public health emergencies, to reducing preventable maternal mortality and morbidly through working to deliver a continuum of care for all moms, from preconception through postpartum, WTEP works with policymakers and other stakeholders across the political spectrum at the local, state, national, and global level to remove barriers to essential maternal health care and services for our most at-risk moms.

It takes a village to raise a child. But first, that village must safely deliver a healthy baby…to a healthy mom.

To learn more, please visit: www.whattoexpectproject.org

About WTEP: The What to Expect Project (WTEP) is dedicated to informing, supporting, and empowering moms in need, in the United States and around the world, so they can expect healthier pregnancies, safer deliveries, healthier babies, and healthier futures. At WTEP, we focus on nurturing the nurturers.

We envision a world where all expecting moms receive the vital, empowering information and the responsive, respectful, culturally appropriate, community-specific care and support they need to plan and safely navigate pregnancy, postpartum and beyond.

Celebrating National Doula Week 2022

“This week, we celebrate the work and contributions of doulas, and the critical role they play in delivering the respectful, responsive, comprehensive continuum of care every mom needs to deliver a healthy beginning and a healthier future for herself and the baby she loves. The What to Expect Project believes that doulas are the missing link in […]

Moore, Warren, Booker Introduce Mamas First Act

Today, Congresswoman Moore, Senator Elizabeth Warren (D-Mass.), along with Senator Cory Booker (D-N.J) and Representatives Deborah Dingell (D-Mich.), Ayanna Pressley (D-Mass.), Lauren Underwood (D-Ill.), and Alma Adams (D-N.C.) announced the re-introduction of the Mamas First Act, vital legislation to address the maternal mortality crisis that would expand Medicaid to include doula and midwifery care. In […]

The U.S. Maternal Mortality Rate Surged by Nearly 20% in 2020

The rate of maternal mortality in the U.S. increased by nearly 20% from 2019 to 2020 in a potential indication of the COVID-19 pandemic’s impact on maternal health outcomes.

Data in a new report published Wednesday by the Centers for Disease Control and Prevention shows the overall maternal death rate in the U.S. rose from 20.1 deaths per 100,000 live births in 2019 to 23.8 deaths per 100,000 in 2020, marking an 18% increase. The rate has increased by nearly 37% since 2018, when there were 17.4 deaths for every 100,000 live births.

In total, 861 women in 2020 reportedly died either during or within 42 days of the end of their pregnancy, compared with 754 women in 2019 and 658 in 2018.

The report’s findings are based on data collected from the CDC’s National Vital Statistics System, and encompass maternal deaths linked to a pregnancy or its management. Deaths from accidental or incidental causes are not included.

Maternal mortality rates in 2020 went up across multiple age and racial groups in the report; notably, however, an “observed increase from 2019 to 2020 for non-Hispanic White women was not significant,” researchers said. The overall surge was fueled heavily by a spike in the rates for both Hispanic and Black women. Black women had the highest maternal mortality rate of the three racial or ethnic groups included, at 55.3 deaths for every 100,000 live births. That rate was nearly three times higher than the 19.1 deaths per 100,000 births among white women – a larger disparity than in 2019 – and more than three times higher than the rate of 18.2 deaths per 100,000 among Hispanic women.

Yet the maternal death rate among Hispanic women saw the largest increase from 2019 to 2020, rising by 44% over that year compared with an increase of 26% among Black women.

By age, women 40 and older had both the highest mortality rate and the largest increase from 2019. The maternal mortality rate for women 40 and older was 107.9 deaths for every 100,000 live births in 2020, a 43% increase from 2019 and 7.8 times higher than the rate of 13.8 per 100,000 live births for women under the age of 25. A rate increase among women under 25 was not statistically significant.

For years, the U.S. has had what can only be described as a poor record in maternal health outcomes when compared with other wealthy nations. A 2020 analysis by The Commonwealth Fund found that the 2018 U.S. maternal mortality rate of 17.4 deaths for every 100,000 live births was more than double the recent rates of a majority of other developed countries studied.

Tracking data from the CDC shows 82 deaths among pregnant women with the disease reportedly occurred in 2020. And though the latest figures do not delineate whether deaths occurred in connection with COVID-19, they come amid concern about both the direct and indirect health risks the COVID-19 pandemic has posed for pregnant women.

The CDC warns that pregnant or recently pregnant people are more likely to become severely ill from COVID-19. A CDC study published in November and focused on Mississippi also found a higher mortality rate among women with a coronavirus infection during pregnancy – none of whom had been fully vaccinated – compared with females of reproductive age who had a coronavirus infection.

The pandemic additionally disrupted maternal health care, leading to the alteration or cancellation of prenatal visits, hospitals enacting restrictions on who could be with a mother during delivery and even the shuttering of some birth-related services, at least temporarily. The number of home births rose by nearly 20% in 2020, from more than 38,000 in 2019 to more than 45,000.

Data also points to elevated levels of issues like depression and anxiety among many pregnant women during the pandemic.

“When we think about all of the stressors that a person felt even prior to the pandemic, adding all of these other things on top, it’s no surprise that we see an additive effect of the pandemic causing feelings of unsafety,” says Kristina Wint, senior program manager for reproductive and maternal health and wellness at the Association of Maternal and Child Health Programs. “Many people think that televisits is something that has been filling in the gaps, and it absolutely has, but they are just a Band-Aid on a broader and bigger issue on how (we can) ensure that people are able to access the care that they need.”

Maternal Deaths Rose During the First Year of the Pandemic

The number of women in the United States who died during pregnancy or shortly after giving birth increased sharply during the first year of the coronavirus pandemic, according to a new study, an increase that health officials attribute partly to Covid and pandemic-related disruptions.

The new report, from the National Center for Health Statistics, found that the number of maternal deaths rose 14 percent, to 861 in 2020 from 754 in 2019.

The United States already has a much higher maternal mortality rate than other developed countries, and the increase in deaths pushes the nation’s maternal mortality rate to 23.8 deaths per 100,000 live births in 2020 from 20.1 deaths in 2019. Maternal mortality rates in developed countries have in recent years ranged from fewer than two deaths per 100,000 live births in Norway and New Zealand to just below nine deaths per 100,000 live births in France and Canada.

Black women in America experienced the most deaths: One-third of the pregnant women and new mothers who died in 2020 were Black, though Black Americans make up just over 13 percent of the population. Their mortality rate was nearly three times that of white women.

The mortality rate for Hispanic women, which has historically been lower than for white women, also increased significantly in 2020 and is now almost on par with the rate for white women. Death rates increased among all pregnant women older than 24, but particularly in those 40 and over, whose mortality rate was nearly eight times that of women younger than 25.

“Our maternal morbidity and mortality is the highest in the developed world, and the trend is continuing despite our awareness of it, despite our maternal-mortality review committees, despite attention in the press,” said Kara Zivin, a professor of psychiatry, obstetrics and gynecology at the University of Michigan who studies access to care during and after pregnancy. “Whatever we’re doing is clearly not enough to address either the overall rate or the disparities.”

Did you know you can share 10 gift articles a month, even with nonsubscribers?
Share this article.
Although the new report is sparse on details — no maternal mortality figures were provided for American Indian/Alaska Native women, who have higher pregnancy-related deaths than white, Hispanic and Asian/Pacific Islander women — experts said some of the deaths were most likely related to the coronavirus pandemic. Pregnancy puts women at risk for more severe disease if they are infected with the SARS-CoV-2 virus, which causes Covid, and vaccines were not available for them in 2020.

Image
Dr. Chaniece Wallace died in 2020 from pregnancy complications after delivering her first child.
Dr. Chaniece Wallace died in 2020 from pregnancy complications after delivering her first child.
Credit…Chaniece Wallace Memorial Facebook Page
“We actually said when the lockdown started that we anticipated an increase in maternal deaths, both due to Covid and the responses to Covid,” said Dr. Denise Jamieson, an obstetrician at Emory University in Atlanta and a member of the Covid expert group at the American College of Obstetricians and Gynecologists, adding that she was not surprised by the increases.

Editors’ Picks

You Can Take It With You, if the Grave Is Deep Enough

How a Death-Row Inmate’s Embrace of Conservatism Led to His Release

Why We Dream About Past Loves
In addition to the greater risks faced by pregnant women who have Covid, she said, “we hadn’t figured out how to deliver obstetric care safely in 2020.”

“Our health systems weren’t set up yet to manage telehealth,” she said, “and there were other barriers: Kids were home from school, and parents couldn’t get away for medical appointments.”

Many doctors had stopped seeing patients in person, hospitals were often crowded and patients avoided emergency rooms filled with Covid patients.

Pregnant women who develop Covid face a higher risk of requiring intensive care or mechanical ventilation. And despite the relative youth of pregnant women, they face a higher risk of dying, studies found. Health experts have been urging them to be vaccinated, but their vaccination rates have remained low.

Black Americans overall suffered disproportionately from the pandemic, with higher hospitalization and death rates than their white counterparts, but the racial disparities in maternal mortality predate and extend beyond Covid, and stem from structural health inequities that have complex root causes.

Stress, mental health problems and substance abuse increased during the pandemic and might also have contributed to worse outcomes, said Dr. Mary D’Alton, chair of the department of obstetrics and gynecology at Columbia University Irving Medical Center.

New programs that provide enhanced services for patients, such as doulas, who can support and advocate for patients, are positive advances, she said.

“We also have to educate our providers on listening to patients,” Dr. D’Alton said. “My dad was a primary care doctor and he used to say, ‘Mary, if you want to know what’s wrong with the patient, ask them and they’ll tell you. But first of all, you’ve got to listen to them.’”

“Pregnant women’s complaints are often dismissed, and that is probably much more significant for Black and brown women,” she added.

Generally speaking, the leading causes of pregnancy-related deaths are cardiovascular conditions, other medical conditions and infections. Research has found that cardiomyopathy, a disease of the heart muscle; blood clots to the lung; and hypertensive disorders of pregnancy contribute to a higher proportion of pregnancy-related deaths among Black women than among white women.

One of the new mothers who died in 2020, whose story was widely reported, was Dr. Chaniece Wallace, a Black physician who was the chief pediatric resident at the Indiana University School of Medicine in Indianapolis.

Dr. Wallace developed a pregnancy complication called pre-eclampsia and her baby girl was delivered early by cesarean section in October 2020. But Dr. Wallace went on to develop additional complications, and she died just days after giving birth.

Severe Maternal Morbidity Is Substantially Underestimated in US

Severe maternal morbidity (SMM), which refers to unexpected labor and delivery outcomes that can cause life-threatening maternal health problems, is on the rise in the United States and has been estimated to impact between 50,000 to 60,000 birthing people each year, according to the latest data compiled in 2014 by the Centers for Disease Control and Prevention.

However, these estimates have been based on cases identified during hospitalization for delivery, and do not reflect maternal health complications that may occur during pregnancy or the postpartum period.

A new study led by a School of Public Health researcher has found that excluding prenatal and postpartum health complications in SMM measurements substantially underestimates the burden of maternal morbidity in the US.

Published in the journal Obstetrics & Gynecology, the study examined cases of SMM during prenatal, delivery, and postpartum hospitalizations from 2009 to 2018 in Massachusetts and identified an additional 22 percent of cases that met SMM criteria. If the 2018 rates of SMM in Massachusetts with this expanded measurement were applied nationally, the true number of cases could be closer to 90,000 per year.

Using a longitudinally linked database, the study is the first of its kind to examine SMM during pregnancy, at birth, and postpartum.

“For this project, we expanded the focus of SMM from birth to women’s health through the entire perinatal period,” says study lead author Eugene Declercq, professor of community health sciences. “The data overwhelmingly show that it is time to develop measures that more sensitively identified severe morbidities during pregnancy and postpartum.”

Declercq and colleagues analyzed data from the Pregnancy to Early Life Longitudinal (PELL) database, a Massachusetts data system that links records from birth certificates, delivery hospital discharge records, and non-birth hospital records for all birthing people. Using CDC algorithms that define SMM criteria, the researchers examined nearly 600,000 deliveries, as well as hospitalizations during pregnancy and through 42 days postpartum, from January 2009 to December 2018. SMM increased steadily over the study period, from 129.4 cases per 10,000 deliveries in 2009 to 214.3 cases per 10,000 deliveries in 2018.

Aside from blood transfusions, which cause the largest percentage of SMM cases, the leading causes for additional cases of severe morbidity during pregnancy and postpartum were sepsis, thrombotic embolism, and adult respiratory distress syndrome.

“Our findings underscore the need for a greater investment in outpatient, community-based programs and quality improvement initiatives,” Declercq says, citing examples such as standardized, outpatient risk assessment screening for venous thromboembolism, prevention of maternal peripartum infections via screening and vaccinations, and postpartum home blood pressure monitoring for birthing individuals at increased risk.

The study is the first of several publications by the research team, as part of a larger project on SMM that is funded by the National Institutes of Health. The next two studies, informed by this first publication, will examine differences in SMM by race/ethnicity and an intervention at five hospitals in Massachusetts to assess the impact of doula care on pregnancy outcomes among Black women.

Black women face higher risk of death during pregnancy

nion, New Jersey — The U.S. has the highest maternal mortality rate for a developed country: About 700 women die during childbirth or soon after every year, according to the Centers for Disease Control and Prevention.  Danisha Baughan delivered her first two children in a hospital, and said both times she felt neglected. A week before she was due to […]