Roe v. Wade Reversal Has Far-Reaching Implications for the Future of Maternal Health in the U.S. How Do We Prepare and Respond?

Abortion is a highly personal and polarizing topic that has been heavily politicized in the U.S.  The recent Supreme Court decision to overturn Roe v. Wade has opened the floodgates and sparked strong emotions on both sides of the debate. Regardless of whether you agree or disagree with the Court’s ruling, it is important to understand the real-world implications this decision brings to the broader healthcare system, particularly for maternal-child health.
 
In this country, we already have the worst maternal outcomes in the developed world, despite paying more for care than any other developed country. Women in the US die from pregnancy-related complications at 3X the rate of other developed countries, with black women dying at 3-4x the rate of white women. If restrictions and bans on abortion and other reproductive health services proliferate in some states as expected, we need to be prepared for the realities we will encounter, including:
 
Worsening maternal health outcomes and growing disparities by race and income

A ban on abortions means that people with unplanned pregnancies will be forced to continue them even if the pregnancy creates serious health, emotional, or economic risks for themselves or their babies.  Leading clinical organizations including ACOG have described in detail the predicted health consequences, including increased rates of pregnancy complications and maternal mortality.  What’s more, these risks are expected to have an outsized impact on Black and low income women due to existing health and social inequities.   As such, we can expect the gaps in safety, quality and outcomes for childbirth to widen in the US versus the rest of the developed world.

Decreased access to evidence-based healthcare services across women’s health

Banning all pharmacologic and surgical tools used for abortion services will adversely impact women's healthcare services broadly. The same drugs and procedures used in abortion are also used to save a woman’s life from ectopic pregnancy, as well as difficult miscarriages and as an alternative to more invasive surgery during menopause. Criminalizing the use of these medical tools will severely complicate the delivery of medical care for women and subject OB providers to ethically untenable positions. 

Additional burden on already-strapped OB providers 

We are currently experiencing a dramatic OB labor shortage and some of the highest medical malpractice rates we’ve seen. The providers who are left to care for women are experiencing significant burnout. In much of the country, there is not adequate access to women’s health services as documented by the widespread existence of maternal health deserts.

OB providers will face a patchwork of regulations and a high degree of uncertainty when it comes to advising or referring patients who want to, or need to, terminate a pregnancy. This will add yet another layer of stress and pressure on overburdened clinical teams.
 
An exacerbated system of haves and have nots
 
Many employers, including Wildflower, have made it clear that they will work within the law to ensure their employees and dependents continue to have access to abortion and other reproductive services that may be restricted or banned. The problem is that women who have supportive employee benefits are more likely to have the means to travel should they need to do so on their own. Lower income women are much less likely to be in a position to afford travel and have supportive employee benefits to back them up as well. This will create even larger gaps in access to equitable care.

A predictable consequence will be higher rates of unintended pregnancies among low income women and increased cost pressure on state Medicaid budgets.

Where We Go from Here

At Wildflower Health, we have dedicated ourselves to improving outcomes, safety and access in women’s healthcare for the past 10 years.  Our ability to fulfill that mission was dealt a blow when the Supreme Court repealed the right to legal and safe abortion services. 
 
Today, we reaffirm our position supporting women and their providers on the journey to deliver the best care possible. To that end, we continue to advocate for full access to all evidence-based, safe reproductive health services. The path forward will be unsteady and uncertain, but every step of the way, we have to put patients first. We have to collectively address the implications outlined above, as well as others that likely will present themselves in the near future. Being aware of the challenges we will face is a good start, but we must move quickly to mitigate threats to the delivery of high-quality, equitable healthcare for all women.