An alarming landscape after Roe for the health of mothers and their babies

Texas was one of the first states to pass a “trigger law” banning abortion in most circumstances 30 days after the Supreme Court ruled Roe v. Wade unconstitutional. When the court’s draft opinion striking down Roe expired in May, Republican lawmakers said they were preparing for the next step: strengthening health care and other services for women and children. “It makes sense,” Congressman Steve Toth told reporters. “Now the dog’s got the car.”

Congressman Giovanni Capriglione agreed. “Now we have to work really hard to help these new mothers and these new babies.” For Toth, “that means prenatal care, helping them stay in school. That means making sure we help women after the baby is born, that means adoption services.”

For Texas mothers facing post-Roe however, there is a huge mountain to climb in the world to find that help now. In recent years, the state has ranked 40th in the country for maternal health as measured by maternal mortality, 49th in the proportion of children with health insurance, and 22nd in adoption rate. To say that Texas had to work really hard to help its mothers and babies was a huge understatement.

Texas is certainly not alone. The Guttmacher Institute, which researches reproductive health, counted 26 states that either had banned abortions when the Supreme Court issued its decision in June or were likely to do so soon after — 13 states that already had triggering laws and another 13 which are expected to follow their own bans.

Compared to states likely to continue to allow abortion, the 26 states that have banned abortion only insure two-thirds more children 18 or younger. Maternal mortality is two-thirds higher. Infant mortality is 30 percent higher. Their average ranking in one of the most comprehensive comparisons of health care performance, conducted by The Commonwealth Fund, was only half as high.

The differences spill over into other health issues as well. States that ban abortion, for example, have a 30 percent higher death rate from COVID-19 than states that allow abortion. Their rate of vaccination against COVID-19 lags 15 percentage points behind that of states expected to continue to allow abortion. Twenty-five percent more people in states with abortion bans have poor dental and oral health. A quarter more children suffer from food insecurity. And of the dozen states that did not expand Medicaid under the Affordable Care Act, 10 have abortion bans.

As always in American federalism, there are differences even among states that ban abortion and those that are expected to continue to allow it. The infant mortality rate in Iowa, which bans abortion after 22 weeks, is 4.27 per thousand live births, far below the average for all states that ban abortion or are expected to do so. By comparison, the infant mortality rate in North Carolina, which allows abortion, is 6.76 per thousand live births, far above the average for abortion states. In West Virginia, a state that bans abortion, the maternal mortality rate is 12.9 per 100,000 population, half the average for all states with abortion bans. New Jersey, which allows abortion, has a maternal mortality rate of 38.1 per 100,000, more than twice the average for abortion states.

But when all states with abortion bans or pending abortions are compared to those where the procedure is expected to remain legal, a clear picture emerges:

The trigger states’ promise to help new mothers and babies in this way has fallen far short of their performance. Catching up will require huge investments in health care among countries that have for the most part already proven unwilling or unable to significantly increase this category of spending.

The federal government has grant programs available for many of these challenges. The Department of Health and Human Services, for example, has a $350 million program “to support safe pregnancies and healthy babies,” as HHS puts it, and has an ongoing grant program for maternal and child health. There is a large collection of other initiatives, from CDC research to newborn screening and research funded by the National Institutes of Health. Federal efforts total billions of dollars.

However, across the country there are what the March of Dimes calls “maternity deserts”: places where women do not have adequate access to maternity care. The result, the organization concluded, is higher rates of serious health problems and deaths for both mothers and babies. And the United States does not fare well in international comparisons: It has double the maternal mortality rate of other high-income countries—in fact, 10 times that of New Zealand and Norway.

The nation’s great problems in providing health care for mothers and babies are an extremely important background to the Supreme Court’s decision in Dobbs v. Jackson, and there is no escaping the fundamental point: for the most part, states that enact bans on abortion, lag far behind those allowing abortions when it comes to health care in general and for mothers and children in particular. While some lawmakers in abortion-ban states may be sincere in their promises to do more for mothers and their babies, they have a long way to go to catch up.

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Donald F. Kettle is professor emeritus and former dean of the School of Public Policy at the University of Maryland, College Park. You can find him at [email protected] or on Twitter at @DonKettl.

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