By Aria Bendix and Dana Varinsky -
NBC News
Should the Supreme Court overturn Roe v.
Wade, the change would pose a profound threat to maternal health in the United States, according to experts.
A leaked draft opinion published Monday by Politico suggests the court is likely to reverse the seminal ruling that enshrined the constitutional right to abortion nearly 50 years ago.
The court confirmed the authenticity of the draft, although the final decision is not expected until late June or early July.
[What will happen if the Supreme Court strikes down the right to abortion in Roe v. Wade?]
If it is struck down, nearly two dozen states are likely to ban abortion or severely restrict access to it.
Thirteen have "trigger laws" that would ban abortion almost immediately, according to an analysis by our sister network NBC News of data from the Center for Reproductive Rights.
Research suggests that bans and restrictions would have multiple effects on maternal health.
First, if more pregnant women are unable to have abortions, they will risk the relatively high -- and rising -- pregnancy-related death rate in the United States, which is especially high among people of color.
“There will be women who will die from pregnancy because of this decision.
Period,” said Dr. Amy Addante, an Illinois gynecologist and member of Physicians for Reproductive Health.
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In addition, pregnant women would face the risk of prosecution for attempting to terminate pregnancy in states where abortion is prohibited, and research has shown that unwanted pregnancies have many detrimental long-term consequences for mothers, including increased likelihood of financial hardship and serious mental health impairment.
Experts are concerned about the rise in maternal deaths.
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The United States has the highest maternal mortality rate of all developed countries.
Overall, about 700 women die each year from pregnancy-related complications in the US, and about 3 in 5 of those deaths are preventable, according to the Centers for Disease Control and Prevention (CDC). in English).
“One of the things that worries me the most is that we are going to see an increase in maternal deaths in this country” if Roe v.
Wade, according to Lauren Ralph, an epidemiologist at the University of California, San Francisco.
An ultrasound machine sits next to an exam table in an exam room at Whole Woman's Health of South Bend on June 19, 2019 in South Bend, Indiana. Scott Olson/Getty Images
The maternal mortality rate in the United States in 2020 was 23.8 deaths per 100,000 live births, the highest since before the overturning of Roe v.
Wade, according to the Commonwealth Fund, which promotes better health care for underserved communities.
The rate was much higher among the black population: 55.3 deaths, which is nearly triple the rate for the white population.
Thus, an increase in maternal deaths "would be concentrated in people living below the federal poverty line, people of color," Ralph said.
The maternal mortality rate in the United States more than doubled between 1987 and 2017, according to data from the CDC.
By contrast, maternal mortality in high-income countries fell slightly each year on average over roughly the same period, according to a 2016 study.
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Some research suggests that women who are denied abortions face an especially high risk of pregnancy-related health problems, due in part to a greater chance of delaying prenatal care.
A study published last year found that while most US states had similar maternal mortality rates in 1995, those that restricted access to abortion had significantly higher numbers in 2017 than those with more protective policies.
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"Unwanted pregnancies have a higher risk of medical complications, which can extend beyond once the baby is born," Addante said.
That was also the finding of a five-year research project at the Bixby Center for Global Reproductive Health at the University of California, San Francisco, called
The Turnaway Study
, which looked at 1,000 women who sought abortions across 30 facilities in USA
Of that group, women who were denied abortions had more serious health problems, such as high blood pressure or seizures, than those who had abortions.
Two women who were denied abortions died from conditions related to their pregnancies.
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"We can say without a doubt that if these people had been able to get the care they wanted, these maternal deaths would have been prevented," said Ralph, one of the study's researchers.
Aborting safely could be difficult
Experts note that the annulment of Roe v.
Wade causes more unsafe abortions in the United States, although the possibility exists.
“As for unsafe abortions, I hope the scenario is not one of women dying from having abortions with unskilled abortion providers.
It's a risk, but I hope not," said Susan Wood, director of the Jacobs Institute for Women's Health at George Washington University.
An important difference for women seeking abortions now, compared to the time before Roe v.
Wade, are the abortion pills that the Food and Drug Administration (FDA) approved in 2000.
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The regimen consists of mifepristone, which blocks progesterone, and misoprostol, which induces contractions.
The combination can be taken up to 10 weeks after the patient's last menstrual period.
FDA regulations require that pills be dispensed only by registered providers.
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In 2020, the drug combination was used in half of all abortions in the United States, according to the Guttmacher Institute, an abortion-rights group.
In December, the FDA decided to permanently allow patients to receive pills by mail after telehealth appointments.
But six states - Arizona, Indiana, Montana, Ohio, Oklahoma and Texas - have made it illegal.
Medical abortion is very safe: A 2018 National Academies of Sciences report revealed in 2018 that complications arise in only a fraction of a fraction of 1% of patients.
A more recent study, published in February, found that about 1% of people who had self-managed medical abortions experienced adverse effects, none of whom died.
[Opposing abortion doesn't stop some Americans from helping loved ones end a pregnancy]
Still, it's not the right option for everyone who wants an abortion, according to Addante.
“It does not replace the need for procedural abortion to be available, because there will be some people for whom it is the safest option or, for personal reasons, it is the most appropriate,” he opined.
If Roe v.
Wade, some pregnant women would not have access to either option.
Experts worry about the legal repercussions.
"People are more likely to be criminalized, incarcerated, prosecuted and incarcerated for arranging their own abortion than they are to experience any medical complications," said Dr. Jamila Perritt, president and CEO of Physicians for Reproductive Health.
[Why 2022 will be a “dramatic” year for abortion rights in the United States]
Communities of color, immigrants and LGBTQ people are among the top targets for criminalization, he added.
“My greatest concern is to see an already highly marginalized population being pushed even further to the brink of their ability to access reproductive health care,” Addante said.
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Long-term consequences of unwanted pregnancies
In a 2020 analysis of data from the Turnaway Study, researchers found that just over half of participants said the decision to abort was difficult.
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Those women were more likely to say they felt sadness, guilt and anger soon afterward.
However, at five years, 84% reported positive or neutral feelings.
Experts characterized the negative effects of denying someone a wanted abortion as long-lasting and intergenerational.
A 2017 UK study looked specifically at the mental health impacts of unplanned motherhood on women with a partner and found that nine months after birth, they were almost twice as likely to experience psychological distress as women with planned pregnancies .
"We're going to potentially see an increase in adverse mental health outcomes if people are forced to continue the pregnancy and either don't want to or it's not safe for them to do so," Addante said.
In the Turnaway study, women who were denied abortions were found to be more likely to remain in contact with violent partners and to have problems meeting basic living expenses than women who had had abortions.
Their children were more likely to live below the federal poverty line than the children of women who had previously aborted.
“Most people who request an abortion are already parents, so they know what it means to have children,” Perritt said.
“They are making decisions about access to abortion care in a way that allows them to continue to care for the children they already have,” she added.