Abortion restrictions spark concern over access to maternal health services

The push by lawmakers in several states to restrict or ban abortions has reignited debate over the future of guaranteed access to reproductive health services for women. And public health experts are cautioning that there could be a ripple effect on overall maternal care services, especially in states that already struggle with higher than average mortality rates.

So far this year, 10 states have enacted laws that would either narrow the number of weeks a woman is legally allowed to get an abortion or ban access completely, such as in Alabama. None of the new laws have gone into effect and all face legal challenges, with many supporters saying the ultimate goals is overturning Roe v. Wade. In total, more than 370 abortion restrictions have been introduced nationwide since Jan. 1, according to the Guttmacher Institute.

Many of the states with the most restrictive abortion laws ranked near the bottom in maternal and infant health outcomes and in the bottom half of states in clinical care access for women and infants, based on data from the Centers for Disease Control and Prevention compiled by America’s Health Rankings.

“We fully expect that ‘heartbeat bills’ and other life-affirming legislation will save lives and lead to a greater sense of respect and dignity of every person,” said Jim Daly, president of Focus on the Family, one the nation’s largest Christian conservative organizations that supports eliminating abortion. “As for the ongoing care of both mothers and their children, Christians will continue to come alongside families both before and after birth to offer practical and loving assistance.”

In Georgia, Gov. Brian Kemp signed a bill in early May prohibiting abortion in cases where a fetal heartbeat is detected, which can be as early as six weeks of pregnancy. Georgia’s maternal death rate in 2018 was 46.2 for every 100,000 live births, the highest rate among 48 states studied, according to America’s Health Rankings. Georgia also had one of the highest rates of infant mortality at 7.7 deaths for every 1,000 live births, well above the U.S. average of 5.9 deaths in 2018. 

Alabama, Arkansas, Louisiana, Mississippi, Missouri and Ohio—all of which have enacted tighter restrictions on abortion—similarly rank higher than the national average in rates of pre-term births, low birth weight, and neonatal deaths after the first 28 days, according to America’s Health Rankings. Many of those states tend to have a lower proportion of women of reproductive age receiving prenatal care before their third trimester and have higher rates of cesarean sections performed, as well as high uninsured rates for women of reproductive age.

An estimated 75% of women who get an abortion are living at low income levels, according to the Guttmacher Institute, with nearly half in households that earn less than the federal poverty level. An analysis released in May by the Center for Children and Families at Georgetown University found access to Medicaid in expansion states was associated with 1.6 fewer maternal deaths per 100,000 women compared with states that did not expand the program. 

The number of abortion clinics has been dwindling in many states. The majority of the clinics’ patients are low-income women, with the clinics providing a variety of sexual health services, ranging from testing for sexually transmitted infections to family planning and prenatal counseling. 

Recent reports indicate there are currently six states with just one operating abortion clinic, with expectations that Missouri might become the first to have none.