North Carolina obstetricians and gynecologists are raising concerns over the burden tighter restrictions on abortion could have on women as well as the medical profession.
Dr. Jonas Swartz is an assistant professor in Duke University’s Department of Obstetrics and Gynecology and a researcher in reproductive health equity issues.
“Abortion is an incredibly safe and effective procedure as it’s practiced across the United States today. It’s essential health care and gives people the right to autonomy over their own bodies,” Swartz explained during a Tuesday conference call with reporters. “ When I think about the loss of that right, the loss of access to that safe and effective care, it worries me for my patients, and it worries me for my kids.”
Swartz said when the courts or lawmakers take away the right to safe and legal abortion, it doesn’t take away abortion. It just means people attempt means that are less safe.
“Septic abortion was commonplace before safe and legal abortion was available across the United States. And prior to Roe vs. Wade there were whole hospital wards filled with women who had septic abortions and had major morbidity and mortality from them. So, when I think about going back to that reality, it really would be a horrible consequence.”
One in four women
Dr. Beverly Gray, founder of the Duke Reproductive Health Equity and Advocacy Mobilization team, notes that many women are already living in a post-Roe existence.
“We’ve already seen many patients who have limitations on their access to care based on where they’re born, where they live, what type of insurance coverage they have, how much money they have saved in the bank,” said Gray.
Gray said leading research has found when women are turned away from legal abortion care, they are more likely to live in poverty and more likely to stay tethered to a violent partner.
“There’s a lot of stigma around abortion in our country, so people don’t talk about their abortion. But we know that by the time women reach menopause, around one in four of those women will have had an abortion.”
Dr. Richard Shannon, chief quality officer for Duke Health, worries about the broad implications that would come from the Supreme Court leaving it up to individual states to determine the future of abortion access.
“The state takes a conspicuously narrow view when it says ‘I’m going to control your decision around life for 40 weeks of gestation, but oh, by the way after the baby is born it’s up to you to figure out how to care for it.’”
Beyond that argument, Dr. Swartz believes an abortion ban would further add to the maternal mortality crisis in the United States.
“If we think about North Carolina, North Carolina has not expanded Medicaid under the Affordable Care Act. That means we regularly see patients who are re-entering the medical system at the time of the initiation of a pregnancy,” Swartz said. “That’s no way to optimize disease states. That’s no way to control chronic disease. That’s no way to have the healthiest pregnancy you can.”
Swartz said his office regularly sees patients who make the very rational choice about when is the best time to carry a pregnancy to term. Often that decision is made because of the health of the mother.
“We regularly care for patients who need to focus on their own health, and the pregnancy significantly puts that health at risk. They need to be free to make the choice to end the pregnancy in that situation.”
About 700 women in the U.S. die each year from pregnancy or pregnancy-related complications.
As Policy Watch has previously reported, death rates are 3.3 times higher for Black women.
‘The spillover effect’
North Carolina is currently surrounded by states that have so-called “trigger laws” in place. Should the leaked Supreme Court draft stand and the Roe decision be gutted, Dr. Gray fully believes more women will travel to North Carolina in hopes of finding care.
“We’re already seeing an increase in cases from the spillover effect,” Gray told reporters on Tuesday. “Bans in Texas and Oklahoma influence where those patients can get care, so they’re going to surrounding states.”
Gray said as more people come from out-of-state seeking care, those in-state may experience a delay in care due to access.
“States are already thinking about how they’re going to care for patients who have severe medical illnesses and other complications to their health. I think people are really, really worried about the impacts this is going to have immediately and then down the road.”
The future of obstetrics
Dr. Shannon believes few politicians have thought about what an end to Roe could mean for the availability of prenatal care.
“You could be looking at 600,000 to 800,000 more births a year,” Shannon projected. “We don’t have enough obstetricians and medical care in general to attend to the women who come to us today.”
The chief quality officer for Duke Health said based upon the current number of live births per year, the country needs another 8,000 obstetricians today.
“That’s before we consider the impact of bringing 600,000 to 800,000 additional live births forward.”
And he worries the lack of care will fall disproportionately on rural women.
“Fifty percent of women who live in rural areas are at least a 30-minute distance to the closest prenatal care. So, you’re taking about increasing all the stresses on the existing system — a system that today yields the highest maternal mortality rate in the civilized world.”
And that strain will extend beyond today’s medical providers.
“It will influence where some of our best applications for OB-GYN apply for residency,” Gray explained. “For medical students who want to train and have the skills to provide comprehensive OB-GYN care, they’re going to be looking at states that can provide comprehensive OB-GYN care, and that includes abortion care. I definitely see how that can have a downstream effect.”
But as the abortion debate becomes a red hot issue in the midterm elections, Dr. Gray is thinking about access to care for her patients.
“If you have a uterus in this country, the rights of the potential life that uterus holds seem to be greater than the vessel that carries it. I’m more than a vessel. My daughter is more than a vessel. The patients I care for in my community are more than vessels.”