On April 9, 2024, the Arizona Supreme Court ruled that the state’s Civil War-era law banning nearly all abortions is enforceable, potentially leaving reproductive rights up to each state’s regulation. impact and associated consequences have become a clear reality. For women’s health.
The ruling is scheduled to go into effect in late June 2024, but will only be in effect for a few months after the Arizona Legislature repealed the law on April 30. Starting in the fall, the state’s previous law banning abortions after 15 weeks will be reinstated.
The rapidly changing legal landscape and conflicting information have a chilling effect on abortion services, inciting fear and confusion among women, families, hospitals, doctors, and other health care providers.
We are health policy experts who study how law and policy affect health outcomes, especially for women and children, and we are also future health care attorneys focused on health care law and policy. there is.
After studying how the 2022 Dobbs decision, which overturned Roe v. Wade, affected reproductive health care, we found that the impact of bans like the one in Arizona and dozens of other states could significantly impact abortion access. It is clear that it exceeds. These include reduced availability of safe childbirth services, antenatal and postnatal care, pap smears, testing for sexually transmitted infections, family planning, gynecological diseases, and miscarriage management.
These downstream effects are not just predicted, but are already occurring in real time in states with some of the most restrictive reproductive rights laws in the nation.
hindering medical workers
Policies that restrict abortion affect more than access to abortion.
First, these laws limit the supply of women’s health professionals, such as obstetricians and gynecologists. Medical students are less likely to enter the specialty and more likely to avoid training positions, employment, or both in states with restrictive or near-total bans. These states also have difficulty retaining their existing gynecologists.
This impact will impact the recruitment and deployment of future female health professionals, further exacerbating physician shortages, economic burdens on families, and racial and ethnic health disparities. Depressing effects on the workforce could also exacerbate already dire maternal mortality rates in rural areas and low-income communities of color.
Having an adequate number of well-trained obstetricians and gynecologists is essential to improving women’s health. One survey of third-year and fourth-year medical students found that 60% were less likely to apply to reside in a state where abortion is illegal or severely restricted.
The Association of American Medical Colleges revealed a 5.2% decline in fourth-year medical student applications for obstetrics and gynecology residency positions for the 2022-2023 application cycle. This is a sharper decline than in 2021, the year before the Dobbs decision overturned Roe v. Wade.
Most alarming, applications for obstetrics and gynecology residency in the 13 states with the strictest abortion laws will decline by 11% between 2022 and 2023, potentially affecting the future supply of female health care providers in these states. This suggests that there will be significant disparities.
Dobbs also influenced the retention of obstetricians and gynecologists in states with abortion restrictions. 17.6% of respondents, or more than one in six, said they were likely to reconsider where they would practice after the training. They also raised concerns that these restricted states may lack comprehensive obstetrics and gynecology training opportunities for procedures related to miscarriages and ectopic pregnancies.
Reduced access to health care for women
The Dobbs decision further exacerbated the challenges women of color and women in rural areas face accessing women’s health care. Black women account for nearly half of all abortions in the United States, but they are more likely to live in contraceptive deserts, areas where all types of contraception are unavailable, and less likely to be able to afford the cost of an abortion. low. Abortion and associated travel costs.
A national survey of obstetricians and gynecologists found that 70% reported that racial and ethnic disparities have worsened since Dobbs.
Even before Dobbs, many rural women had to travel more than 290 miles to obtain an abortion. State laws banning abortion caused at least 66 clinics in 15 states to stop providing abortion services within 100 days of the Dobbs decision, leaving many women without access to critical reproductive health care.
As of December 2023, more than a dozen states lack abortion clinics. These disparities are likely to worsen as more states continue to restrict abortion.
Little-known downstream effects
As of April 2024, five states, including Arizona, cannot divorce a woman if she is pregnant. This reality, combined with a lack of access to abortion services, can be deadly for pregnant women, who often experience increased intimate partner violence. One study found that in states where abortion is restricted, the murder rate of pregnant women was 75% higher than in states where abortion is legal.
Nationally, the maternal mortality rate has been increasing year by year since before Dobbs. The U.S. has one of the worst maternal mortality rates in the developed world, more than 10 times higher than some developed countries such as Australia, Japan and Spain.
Clear disparities also exist in maternal mortality rates among Americans, with Black and Indigenous women disproportionately affected compared to white women. In 2018, the maternal mortality rate in the United States was 17.4 deaths per 100,000 live births. In 2021, the mortality rate was 32.9 per 100,000 live births.
From 2018 to 2019, there were 26 deaths per 100,000 live births in Arizona, a 43% increase from 2016 to 2017.
During this period, 89.9% of deaths were preventable. A pregnancy-related death is considered preventable if the Maternal Mortality Review Committee determines that the death could have been avoided with a reasonable change in the patient’s care.
Although extensive data on post-Dobbs maternal mortality rates are not yet available, 64% of obstetricians and gynecologists surveyed reported that maternal mortality rates have increased since this decision.
For Black and Native American women, the risk of maternal mortality is even higher. Nationally, black mothers died at 69.9 deaths per 100,000 live births in 2021, 2.6 times as many deaths as white women. Experts predict that Dobbs’ decision and the state’s regulations will exacerbate this racial disparity. Maternal mortality rates for Native American mothers increased significantly over the past 20 years, from 14 deaths per 100,000 live births to 49.2 deaths per 100,000 live births. This trend is extremely important for states like Arizona, which have large Native American populations.
Access to healthcare helps reduce maternal mortality
Limited access to maternal health care is a significant cause of maternal mortality. Nationally, approximately 12% of all births occur in counties with little or no access to maternal care, known as “maternal care deserts.”
Women living in states with abortion restrictions are 62.2% more likely to have received no prenatal care or to have received no prenatal care compared to women living in states without abortion restrictions. In Arizona, 6.7% of all births occur in counties without a hospital with a maternity ward or obstetric provider.
Women forced to prolong high-risk pregnancies due to abortion bans are at increased risk of needing emergency maternity care. Without proper obstetric care, many of these women will suffer serious complications and even die.
In the early 1900s, famous women’s rights activist Margaret Sanger said, “A woman who does not own and control her own body cannot call herself free.”
These words continue to be tested through ongoing political and legal battles.
Swapna Reddy, Clinical Associate Professor of Health Policy; arizona state university Mary Saxon, law degree candidate; arizona state university
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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