By Douglas Riddle, The Carol Emmott Foundation Curriculum Director
You can never do just one thing. Everything is connected, which means that the consequences of certain choices reverberate through whole systems. That certainly is the case with the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization. The case ended the right to abortion prior to the viability of the fetus. The downstream consequences of that choice go far beyond the plaintiffs’ wish to prevent the deaths of those they call “the unborn,” and the net result may very well result in more human death than what they hoped to prevent.
Let’s start with the most immediate consequence of Dobbs.
In many states with new restrictions on abortion, Sg2 (Vizient’s analytics and consulting company) estimates that Dobbs will result in over 150,000 new live births. Of those, 17,000 or more will be pre-term births with an unknown impact on nursery intensive care. Think carefully about the societal consequences of this many new children added to social safety net services, like food stamps, Medicaid, and so on. This impact will be disproportionate because 49% of current abortions are to patients living below the poverty line. The already disturbing generational patterns of poverty and exclusion can be expected to be amplified, particularly because the most strict limitations or outright bans on abortion are governed by legislatures and governors with known antipathy toward funding social services. Our cultural habit of blaming the victims of unjust systems will be fed more fuel if past patterns are continued.
How about the impact on healthcare, especially women’s care? The news is full of articles describing the reluctance of obstetricians to move to states where reproductive rights are being targeted by lawmakers. The Washington Post reported last year that the president of Merritt Hawkins cited 20 situations where candidates refused to consider moving to states with abortion bans. Hospitals across the nation have closed or indicated their intention to close labor and delivery services in states that have restricted abortion and, in many cases, criminalized physicians for care that politicians have decided violates the law. The uncertainty generated by shifting rules and political climates that encourage vigilantism with respect to women’s health services are expected to increase the areas across our country where access to maternity care is limited or inaccessible. Beyond maternity care there are hospital and provider liability issues which increase the cost of all healthcare and may reduce access to emergency contraception and preventive health services, not to mention fertility services.
This is all taking place in an environment where we are seeing an increased incidence of high-risk deliveries, requiring expensive NICUs. At current trends, 40% of pregnancies will be high risk by 2033 according to Sg2, exacerbating the distressing rates of maternal mortality that are also rising significantly for all racial and ethnic groups in the United States, especially Black women.
The truth is that the focus on abortion as the single issue misleads us. The restrictions and bans on abortion are part and parcel of a governance culture that ignores or punishes care for women and those who care for women. The habits of underestimating women and dismissing women’s experiences and viewpoints are woven into our history and practices. We are still at the beginning of taking the unique needs and resources of women into consideration, and the consequences of Dobbs are an indication of how far we have to go.