The Maryland state legislature approved a bill last week that expands insurance coverage of reproductive health care and lifts unnecessary restrictions on who can provide abortions. It’s now on the governor’s desk.
This bill is good news — for health.
In contrast we have seen abortion restrictions and bans moving through state legislatures in Florida, Idaho, South Dakota, Indiana, Wyoming, Arizona and too many other places in recent months. In 2021, for every one provision that would protect or expand access to abortion care, there were 11 that would restrict access or ban it altogether.
Of course, we know what’s behind all this troubling legislation. Our country is waiting on a ruling that could be the most significant change to reproductive rights in decades. In the coming months, the U.S. Supreme Court will announce its decision on the constitutionality of a Mississippi law that bans most abortions after 15 weeks, potentially overturning all or part of Roe v. Wade.
Too often this is framed as a political issue. As deans of leading schools of public health and nursing, we care about the outcome because of its importance for health, not politics. Access to the full range of reproductive health services — including abortion — is important to protect the safety of mothers and children, to support families and to advance the health and financial security of communities.
The case before the court, Dobbs v. Jackson Women’s Health Organization, pits the state of Mississippi against the only abortion clinic left in it; all the others have closed, unable to navigate the increasingly draconian laws and threats of violence that target abortion providers nationwide.
At Jackson Women’s Health Organization and other clinics around the country, nurses help people who are making exceptionally personal choices. They hear the compelling stories of their patients who seek a better education and better financial stability, who are already mothers and want to focus on the needs of their children, or who feel unprepared to have a child at this point in their lives.
Where abortions are illegal, the consequences for individuals are significant. Research shows that women denied abortions are more likely to endure physical violence from the man involved in the pregnancy. They also have higher levels of debt and experience more bankruptcies, evictions and other financial hardships.
Reliable access to safe and legal abortion does more than prevent these harms. Many nurses see firsthand how it supports the ability of families to thrive and care for children over the long term. More than half of women who receive an abortion already have children, and many go on to have babies when their families are better able to care for them. Children from intended pregnancies are less likely to experience neglect and physical and psychological aggression from their parents.
On the other hand, keeping women from planning their pregnancies can cause irreparable harms. In one study, children born after denial of abortion experienced five times higher odds of poor maternal bonding compared to children born to women who previously received an abortion and went on to have another pregnancy. Moreover, their siblings have less robust development and are more likely to live below the federal poverty level.
Access to abortion improves health across the population as well. Public health researchers have found, for example, that states with fewer restrictions on reproductive health care have a lower percentage of low-birthweight babies, particularly among Black women. Conversely, legislation that restricts abortion based on gestational age, like the Mississippi law under review by the Supreme Court, was associated with a 38% increase in maternal mortality. Already, Mississippi has the highest infant mortality rates in the U.S. and a maternal mortality ratio nearly twice as high as the U.S. average, with its mortality ratio for Black women nearly three times higher than for white women.
Some may argue that it’s possible to protect families while outlawing abortion. It is telling, however, that as Mississippi is moving aggressively to restrict abortion, it is at the bottom of rankings for childhood well-being and often lags in programs to support women and families. In fact, states with extensive abortion restrictions invest the least in the health and well-being of women and children, according to an amicus brief filed by public health scholars, professionals and organizations on behalf of Jackson Women’s Health.
The overwhelming likelihood is that overturning Roe v. Wade will undermine health in the U.S. for generations to come; very few states are joining Maryland in seeking to protect abortion rights. As many nurses and public health experts recognize, however, access to safe and legal abortion matters in every state. Before discarding decades of legal precedent, the Supreme Court justices should consider the very real consequences for the health and well-being of our nation.