Abortion bans alienate doctors and close clinics, putting primary health care at risk

The rush in conservative states to ban abortion after the overturn of Roe versus Wade it’s translating into a surprising consequence that abortion opponents may not have considered: fewer medical services available to all women living in those states.

Doctors are proving, through their words and actions, that they are reluctant to practice in places where making the best decision for a patient could result in huge fines or even a prison sentence. And when clinics that provide abortions close their doors, they also close all other services they offer, including regular exams, breast cancer screenings and contraception.

The concern about the repercussions on women’s health is raised not only by supporters of the right to abortion. A recent warning comes from Jerome Adams, who served as surgeon general in the Trump administration.

In a thread of the tweet in April, Adams wrote that “the trade-off of limited access (and the criminalization of doctors) just to reduce abortions could end up making pregnancy less safe for everyone and increasing infant and maternal mortality.”

An early indication of that impending medical “brain drain” came in February, when 76% of respondents in a survey of more than 2,000 current and prospective physicians she said they would not even apply to work or train in states with abortion restrictions.

“In other words,” the study authors wrote in an accompanying article, “many qualified applicants would never even consider working or training in more than half the states in the United States.”

In fact, states with abortion bans saw a larger decline in medical school seniors applying for residency in 2023 than states without bans, according to a study by the Association of American Medical Colleges. While applications for OB-GYN residencies have decreased nationwide, the decrease in states with complete abortion bans was more than double that of those without restrictions (10.5% vs. 5.2%).

That means fewer doctors need to perform critical preventative care like Pap smears and screening for STIs, which can lead to infertility.

Care for pregnant women is specifically at risk, as hospitals in rural areas close their maternity wards because they can’t find enough professionals to care for them – a problem that preceded the abortion ruling but has only gotten worse since.

In March, Bonner General Health, the only hospital in Sandpoint, Idaho, announced it would discontinue its labor and delivery services, in part due to the “legal and political climate in Idaho” which includes state lawmakers who continue to “introduce and pass bills criminalizing doctors for medical care nationally recognized as a standard of care”.

Heartbreaking reports from across the country show abortion bans are also endangering the health of some patients who experience a miscarriage AND other non-viable pregnancies. Earlier this year, a pregnant woman with a non-viable fetus in Oklahoma was told to wait in the parking lot until she got sick after being told the doctors “can’t touch you unless you crash in front of us.”

A study by researchers at the State University of New York-Buffalo published in Women’s Health Issues found that doctors practicing in states with restrictive abortion policies are less likely compared to those in states with supportive abortion policies for being trained to perform the same early abortion procedures used for women experiencing miscarriages in early pregnancy.

But it’s more than a lack of doctors that could complicate pregnancies and births. Even the states with the strictest abortion restrictions are less likely to offer support services for low-income mothers and children. Even before the rollover of roe deerA A report by the Commonwealth Fund, a nonpartisan research group, found that maternal death rates in states with abortion restrictions or bans were 62 percent higher than in states where abortion was more readily available.

Women who know their pregnancies could become high-risk are thinking twice before getting or becoming pregnant in states with abortion restrictions. Carmen Broesder, an Idaho woman who told of her difficulties caring for a miscarriage in a series of viral videos on TikTok, he told ABC News she has no intention of trying to get pregnant again.

“Why would I want to go through my daughter who almost lost her mother again to have another child?” she said. “She seems selfish and wrong.”

The anti-abortion movement once seemed more sensitive to arguments that its policies neglect the needs of women and children, an accusation made most famous by the former Representative Barney Frank (D-Mass.), who once said, “Conservatives believe that from the perspective of the federal government, life begins at conception and ends at birth.”

Indeed, an icon of the anti-abortion movement – Rep. Henry Hyde (R-Ill.), died 2007 – made a point of partnership with Liberal Rep. Henry Waxman (D-Calif.) on legislation to expand Medicaid coverage and provide more benefits to address infant mortality in the late 1980s.

A few anti-abortion groups are following that example by pushing policies to make it easier for people to get pregnant, give birth and raise children. Most of these efforts are flying under the radar.

This year, Americans United for Life and Democrats for Life of America launched a joint position document urging policy makers to “make birth free”. Among their suggestions are automatic insurance coverage, without deductibles or quotas, for pregnancy and childbirth; eliminate payment incentives for caesarean sections and hospital deliveries; and a “monthly maternal stipend” for the first two years of a child’s life.

“Making birth free for American mothers can and should be a national unifier in a particularly divided time,” the paper said. Such a policy could not only make it easier for women to start families, but could also address that of the nation dismal record on maternal mortality.

In a year when the same Republican lawmakers supporting a national abortion ban are pushing even more vehemently for huge federal budget cuts, however, a free-birth policy seems unlikely to advance very far or very quickly.

That leaves opponents of abortion at something of a crossroads: Will they follow Hyde’s lead and support policies that expand and protect access to care? Or will women’s health suffer under the victory of the anti-abortion movement?

This story was originally published by KFF Health News on May 24, 2023. It is republished with permission.

HealthBent, a regular feature of KFF Health News, offers insights and policy and policy analysis from KFF Health News’ Washington Chief Correspondent, Julie Rovner, who has covered health care for more than 30 years.

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