In this video, Jeremy Faust, MD, of Brigham and Women’s Hospital in Boston and MedPage Today‘s editor-in-chief, discusses his recent article on Inside Medicine on the potential maternal health impacts of a repeal of Roe v. Wade.
The following is a transcript of his remarks:
Hi, this is Jeremy Faust, editor-in-chief of MedPage Today. Thank you for joining us.
Today, I am going to talk about an article that I wrote in my newsletter over at Inside Medicine on Bulletin. And it’s about the health implications of the possibility of the Supreme Court overturning Roe v. Wade, which of course, if that is what happened, would make abortion not necessarily legal in every state.
What I did for this piece was to go back and look at the ’60s and ’70s, and just look at what happened in response to the Roe decision in terms of maternal outcomes. For a long time, the rates of [maternal] death around the time of birth had been falling, and certainly in the ’60s that was getting better. Then really in 1973, right after Roe was decided and a whole bunch of U.S. states now had to allow legal and safe abortions in medical settings, all of a sudden you had a major decrease in maternal mortality.
So I just want to talk about a couple of statistics. First of all, you can see in the graph that over time there had been this decrease in deaths, which was a good thing. And then Roe happened and there’s another 50% drop basically overnight. A lot of that is baked into the South of the United States, which is unsurprisingly where a lot of the laws had it the other way. Roe made it so in these areas now women had access to safe and medical abortions.
And this matches, I think, a lot of data that we’ve seen since, which is that having legal abortion doesn’t seem to have much of an impact on the actual numbers of elective terminations of pregnancies that occur in a country. Countries that have legalized medical abortion and countries that don’t – their rates of abortion actually in the real world are pretty similar. And so banning abortion doesn’t seem to really ban abortions. It seems to ban safe ones, or at least make them less likely. So we know that that’s not the solution to that problem, if you’re trying to reduce the number of terminations.
One thing that I think is very interesting is that essentially what Roe did was make medical and safe abortion more available to people who didn’t have that access in those states. So one thing that happened was that the percent of abortions that occurred in a mother’s home state actually went way up after Roe.
What happened before would be 40-some-odd-percent of women who got abortions had to cross state lines to do so, and we know in order to do that, you have to have money, you have to have access, you have to have everything lined up. So the idea that going across state borders is the solution to this doesn’t seem to play out, because we know that it’s just essentially a regressive tax on people. After Roe, the number of abortions that occurred over state lines plummeted to 7%.
Another thing that I think is interesting is in terms of numbers and access. First of all, in terms of legal medical abortion, certainly after Roe was decided the number of legal medical abortions did increase. Again, as I discussed, it’s not necessarily that the total societal numbers increased, but that the medical legal ones did. But what’s also interesting is that there certainly was an equity piece here, which was that Roe made it so that, in places where people of color really didn’t have access, now they increasingly did. That leveled the playing field somewhat. Certainly access has been an issue, but this made a huge difference really overnight.
The next thing that I think people don’t always know and don’t realize is the effect that Roe had in terms of when abortions occur. And I think there’s broad agreement that if there’s going to be abortion, if there’s going to be safe, medical termination of pregnancy, earlier is better in terms of every aspect of this. In terms of maternal health, in terms of any ethical or moral implications – some people feel very strongly about when viability might begin.
Before Roe, a majority of terminations happened after 9 weeks. Then after Roe, that actually changed. And many more, up to 58% of elective terminations of pregnancy by 1999 were occurring before 9 weeks. So this is important and it makes sense. When you know that elective termination of pregnancy is legal and available, and it’s not something that is frowned upon and that maternal health is accessible to everyone, people are plugged into the system earlier and they can make whatever decision they have to make earlier. And that’s a good thing.
We don’t want these decisions to be delayed and delayed and delayed until it becomes harder to make that decision for people, until it becomes more dangerous for those decisions to be made. And of course, at some point, it’s not a decision any longer, because it’s just not feasible and it’s not right.
So earlier is better. And Roe actually moved things earlier, which also tells me that people were actually getting to their maternal care, their prenatal care, sooner in general. That’s a good thing across the board. So that’s really another outcome.
So what’s interesting here – and we’ll see what happens with the final decision from the Supreme Court. Obviously we’re all waiting to see whether the leaked draft is the final. What we’re all waiting to see is what’ll happen. But what I can tell you is that the ’60s and ’70s was a period of time during which maternal health improved drastically, and a lot of this was due to access. And it was also due to other things that could be at risk if these legal standards become more widely applied.
For example, the idea that you’re not necessarily guaranteed the access to protection – to an IUD [intrauterine device]. The idea that you could have laws that would actually make that more difficult –
These are things that as a society, we know what will happen, because we’ve seen it. Just play the tape backwards and you’ll see what happens. You see there’s less care, which means more maternal mortality. That’s something that I think we shouldn’t ignore when we’re having this conversation. Very often, it’s a conversation about what’s right in terms of the actual issue itself. Clearly, we’re not going to solve that. But what I think we can say is that, no matter what, maternal outcomes — people dying and having other complications — is something we very much want to and need to address.
If we turn back the clock on those policies, we can expect that there will be increases in these horrible outcomes. And that’s something that we don’t want to do. So as we move forward, we want to see and watch very carefully what the implications are of these choices. And I fear that any progress we have made might be dialed back.
So this is what I was writing about. You can check out the full article at Inside Medicine. I know this is a controversial topic, but when we look at outcomes and data, the data don’t lie.
We can have a discussion about which policy or another is responsible, what’s the best lever that we can use to make it safe for everyone. But I think that the idea that a change in policy like this would have no effect is clearly a fantasy. We have to live in the world with data. And when we’re armed with that data, we can make better decisions that help us all.