After Roe, pregnancies will cause bigger health problems, health experts say – News @ Northeastern

Women with unintended pregnancies will be at higher risk of maternal mortality, increased poor pregnancy outcomes and a greater divide in access to health care as a result of the Supreme Court’s recent rejection of Roe v. Wade, Northeast health experts say.

The inability to obtain a safe, legal abortion will affect the health of pregnant people in several specific ways, whether they attempt an abortion or continue the pregnancy, says Kathy Simmonds, a nurse and women’s health researcher who will joined Northeastern’s Roux Institute this summer.

“People are going to have abortions whether they’re legal or illegal,” says Simmonds. “If they can get it legally, they can get access to clinical providers who know how to do the procedure, provide the medication and the education, and guide the patient through the process.”

Cathy Simmonds, a women’s health nurse practitioner and researcher, will join Northeastern’s Roux Institute as a clinical professor this summer. Courtesy photo

As of July 1, abortion has been completely banned in at least five states — Alabama, Arkansas, Missouri, Oklahoma and South Dakota — according to the Guttmacher Institute. Abortions are protected in 20 states and Washington, while access to abortion is limited or uncertain in the remaining states.

In recent decades, clinical abortions have become a safe procedure, with fewer than 3 percent of people experiencing complications, while severe complications occur in less than 1 percent of patients, Simmonds says. Without any contact with the standard medical system, trying to get an abortion on their own or turning to illegal providers, pregnant people are more likely to face complications even if they simply take abortion drugs without the guidance of a trained health professional.

After Roe, Simmonds also predicts an increase in late-term abortions. Roe v. Wade allowed abortions up to the point of viability, which was defined as 24 to 28 weeks. With advances in neonatal medicine, the viability of a fetus, when it can survive outside the womb, has increased to 22 weeks, while most abortions in the U.S. — nine out of 10 — occur in the first trimester, before 13 weeks of pregnancy. Late-term abortions usually occur under duress, Simmonds says, when something quite catastrophic happens to a person with a wanted pregnancy — a health condition or the discovery of a genetic problem — or when a guardian, for example, discovers a teenage girl’s pregnancy as a result of sexual abuse.

With new abortion bans and laws limiting gestational ages well beyond viability, pregnant people will have to make an appointment for a legal abortion in another state and raise funds to travel, Simmonds says. This will lead to more people facing the risk of major abortion complications.

“The earlier you can have an abortion, the safer it is, the fewer complications you have,” Simmonds says.

There is now more uncertainty about the gray line between terminating a pregnancy and performing a life-saving procedure in the case of an ectopic pregnancy, for example, or a ruptured membrane that puts the mother at risk of infection.

“If you’re in the process of miscarrying, you can no longer have the procedures that would help you terminate that pregnancy more quickly, which protects your health,” Simmonds says. “It’s a sticky, new area.”

Between the money required to travel and the fear of what will happen if you travel, should states choose to introduce legal consequences, there will be many people who will not be able to obtain an abortion and will have to continue an unwanted pregnancy, Simmonds says. It will affect poor, young and scared people; undocumented immigrants; women in rural areas, without a car or in an abusive relationship, who will be much more limited by their circumstances in their ability to travel to another country.

Northeastern Associate Professor Alison Bauer poses for a portrait on the Boston campus. Photo by Alyssa Stone/Northeastern University

“You’re actually creating a public health crisis instead of solving the problem. And we’re doing it steeped in health care disparities that vary everywhere,” says Alison Bauer, an associate professor in Northeastern’s Bouvé College of Health Sciences who specializes in health policy and public health.

Health equity issues surrounding reproductive health care stem from financial, racial, religious, geographic and gender disparities, Bauer says.

“No one is telling men … to get a vasectomy,” she says. Carrying to term and giving birth is 12 to 14 times riskier than safe, legal abortion, Simmonds says, while the U.S. is already going through a maternal mortality crisis that disproportionately affects black women. In 2020, 861 women died of maternal causes nationwide, or a 14.2 percent increase from 2019, according to the Centers for Disease Control and Prevention. The maternal mortality rate for black women was 55.3 deaths per 100,000 live births, about three times that of white and Hispanic women.

The U.S. has the highest maternal mortality rate of any developed country in the world, Bauer says: In 2019, the U.S. maternal mortality rate was 20.1 deaths per 100,000 live births, compared to 3.2 in Germany, 3 .9 in Austria, 5.3 in the Netherlands and 7.5 in Canada.

A Duke University study estimates that a complete ban on abortion in the US would increase pregnancy-related deaths by 21% for white women and 33% for black women.

One of the factors causing poor pregnancy outcomes, high maternal morbidity and mortality among black women, regardless of income, is racism, says Simmonds, which causes stress, high blood pressure and higher cortisol levels, which lead to other negative effects on the body. Poor pregnancy outcomes include preterm birth, low birth weight, hypotension, and postpartum infarctions.

If clinics that provided abortions were to close, there would be many more unintended pregnancies and other health outcomes, Bauer said, because those clinics also provide prenatal and pregnancy care, sex education, contraception and testing for sexually transmitted diseases. The shutdown will limit access to health care for some women and create a deeper divide across the country.

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