On Monday evening, Politico published a leaked draft of a Supreme Court decision overturning Roe v. Wade, the Court’s landmark 1973 decision guaranteeing the right to abortion.
The drafted decision, written by the conservative Justice Alito would also overturn a 1992 ruling, Planned Parenthood v. Casey, which established the “undue burden” standard. Under Casey, lawmakers can’t impose any restrictions on abortion which have "the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus.”
The abortion case currently in front of the court, Dobbs v. Jackson Women’s Health Organization, which would be the impetus for overturning Roe and Casey, would kick the issue of abortion back to the states, allowing state legislatures to put draconian restrictions or eliminate entirely the right to an abortion, and possibly opening the door to a federal ban.
In the draft of the decision, Justice Alito argues that many of the arguments made in Roe no longer apply.
Americans who believe that abortion should be restricted press countervailing arguments about modern developments. They note that attitudes about the pregnancy of unmarried women have changed drastically; that federal and state laws ban discrimination on the basis of pregnancy, that leave for pregnancy and childbirth are now guaranteed by law in many cases, that the costs of medical care associated with pregnancy are covered by insurance or government assistance; that States have increasingly adopted safe haven laws, which generally allow women to drop off babies anonymously; and that a woman who puts her newborn up for adoption today has little reason to fear that the baby will not find a suitable home.
These arguments ignore several scientific and legal realities. For one, the shockingly high maternal mortality rates in the United States.
Maternal death is defined by the World Health Organization as a death that occurs during pregnancy, childbirth, or immediately after that can be traced back to that pregnancy or childbirth.
The United States has maternal mortality rates twice that of comparable nations. Data from 2020 shows that in the U.S., there were 23.8 deaths per 100,000 live births. That’s up from 20.1 in 2019 and 17.4 in 2018.
The numbers for non-Hispanic Black women are even worse, at 55.3 deaths per 100,000 births. According to the CDC, an estimated 60 percent of maternal deaths are preventable. Despite that reality, the numbers trend in the opposite direction, we’re seeing more maternal deaths than in previous years.
While Alito may be correct in suggesting that unmarried mothers face less stigma than they did in 1973, pregnancy and childbirth is not necessarily markedly safer in this country now than it was in 1973. In 1973, the average maternal mortality rate was 15.2 per 100,000 live births, according to the CDC, meaning maternal mortality has increased over the past 40 years.
Legal abortion, however, is an extremely safe procedure; a study from 2015 found that less than 1 percent of first-trimester abortions resulted in complications. Conversely, illegal abortion can be extremely unsafe. The CDC says “the legalization of induced abortion beginning in the 1960s contributed to an 89 percent decline in deaths from septic illegal abortions during 1950-1973.”
In addition to the physical dangers of pregnancy and the safety of legal abortion, the drafted decision would allow states to prohibit all abortion, including in the cases of rape, incest, the life of the mother, or major fetal abnormalities. As such, mothers could be forced to carry and birth a stillborn child.
The financial burdens of childbirth are considerable, for both the insured and uninsured.
According to a study published in 2020 in the journal Health Affairs, for the insured, the average out-of-pocket cost of a vaginal birth in 2015 was $4,314 in 2015; the average out-of-pocket cost of a C-section was $5,161. For the uninsured, the cost of childbirth can range from “$30,000 for an uncomplicated vaginal birth to $50,000 for a C-section”, according to the pregnancy website What to Expect. Those numbers have likely significantly increased in the past 7 years.
For the insured and uninsured, medical complications during childbirth can raise that number by tens or even hundreds of thousands of dollars.
Those figures don’t include prenatal care or post-pregnancy care. While the Affordable Care Act makes childbirth a qualifying event for health insurance, simply getting pregnant isn’t, an absence that can have dire implications for prenatal care and maternal health.
The costs of childbirth in this country are directly connected to the high rates of maternal mortality. When people are worried about paying for healthcare, they’re more likely to delay or refuse prenatal or postnatal care.
Abortion is a safe option for people who can’t or don’t want to carry a pregnancy to term. It saves lives.
