Abortion is a controversial and politically charged topic, with people often sorting themselves into “pro-life” or “pro-choice” despite the fact that most Americans have a range of views on the timing and conditions where abortion should be allowed. Those deeply personal views and beliefs aside, there’s a significant amount of research showing that the Supreme Court’s decision in Dobbs v. Jackson to effectively overturn Roe v. Wade will have broad and lasting public health impacts on women, their families and their future pregnancies.

With the legal status of abortion across the U.S. changing rapidly and access to services in flux in many states, understanding the public health consequences around abortion access is critical to achieving health policies that provide the best possible health care and health outcomes.

“The U.S. Supreme Court’s ruling to overturn Roe v. Wade will likely make it even more difficult for women to access high-quality health care in this country. The risks are especially acute for women of color, women from low-income backgrounds and women living in rural areas,” read a statement from the National Academy of Sciences and National Academy of Medicine.

Health Impacts on Women and Their Children

When examining access to abortion through a public health lens, the landmark Turnaway Study is a valuable tool. It compared women who were able to receive an abortion with women who carried an unwanted pregnancy to term. The results showed that being denied an abortion resulted in worse health, financial and family outcomes. Without abortion access, women were:

• More likely to experience serious medical complications during pregnancy, including eclampsia and death
• More likely to experience poor physical health, including chronic pain and hypertension
• More likely to experience poor mental health, including anxiety and depression
• More likely to face financial hardship, including food instability, eviction and bankruptcy
• More likely to experience domestic violence from abusive partners

“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 Frank C. Worrell, Ph.D., the president of the American Psychological Association. “In addition, there is no research to indicate that abortion is a cause for subsequent mental health diagnoses.”

The Turnaway Study also found that being denied an abortion has serious health consequences for a mother’s existing children and the child born at the conclusion of pregnancy. Existing children are more likely to live in poverty and less likely to achieve developmental milestones.

In specific cases, such as with an ectopic pregnancy, cardiac events or several other conditions, abortion can be the only medical option to preserve a woman’s health or save her life. In other cases, access can prevent women from having to carry fetuses with fatal conditions to term, or allow doctors to reduce the number of fetuses in a pregnancy when there are too many for all of them to survive.

“We’re going to see worse physical health, greater economic hardship, lower achievement of aspirational plans, kids raised in more precarious economic circumstances and people’s lives upended,” said Diana Greene Foster, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco and the leader of the Turnaway Study.

Even when women aren’t pregnant, laws restricting access to abortion can affect women’s health. For example, women with autoimmune conditions such as rheumatoid arthritis and lupus have already been denied access to the drug treatment methotrexate because it can also be used to end a pregnancy. The same drug is also commonly used to treat arthritis.

Distance Increases Barriers to Care, Creates Disproportionate Impacts

For many women, the decision to get an abortion or continue a pregnancy will now come down to resources and their ability to travel to another state. Before the SCOTUS decision, about one percent of U.S. women had to travel more than 200 miles to get an abortion. Now, about 25 percent of women will have to make that trip. Research shows that as distances from clinics increase, fewer women are able to obtain abortions due to the cost of travel, child care, transportation issues and other logistical obstacles. Missing work due to out of state travel further increases the cost burden.

These barriers disproportionately affect women of color, who already experience reduced access to health care and other inequities due to ongoing racial and ethnic disparities. Many of the states now restricting abortion access are in the South, which has a large population of Black and Hispanic women, and the Midwest, which has a large Indigenous population. Overall, over 40 percent of women age 18-49 where abortion is already restricted or likely to become restricted are women of color. Social and economic inequities around income, safety and education that limit access to health care also limit access to birth control and family planning services.

It’s estimated that a total abortion ban in the U.S. would increase the number of pregnancy-related deaths by 21 percent. Among Black women, the estimated increase would be 33 percent.

Providing Necessary Health Care

Many factors influence a woman’s deeply personal decision to seek an abortion, and the circumstances, timing and reasons behind that decision are central to the abortion debate. The wide differences in opinion and morality Americans have on the topic are how we got to this point, with abortion being one of the most emotionally charged issues in our country today.

When it comes to the topic of abortion, for some people there’s no middle ground, while others see room for compromise. How can we chart a path forward on such a divided issue? The LHSFNA has always let science and evidence-based information be our guide in working to protect the health and safety of LIUNA members.

The LHSFNA works closely with LIUNA health and welfare funds and is already communicating with them about the potential impacts of Dobbs v. Jackson. The LHSFNA will continue to provide guidance to ensure health and welfare funds comply with applicable laws while still providing benefits that align with the needs of members and their dependents.

The American College of Obstetricians and Gynecologists (ACOG) said in a statement that “sound health policy is best based on scientific fact and evidence-based medicine. The best health care is provided free of political interference in the patient-physician relationship.” The ACOG statement was even more straightforward in another area: “The fact is, abortion is an essential component of women’s health care. Like all patients, women obtaining [an] abortion are entitled to privacy, dignity, respect and support.”

[Nick Fox]