A worrying post-egg landscape for the health of mothers and their babies

Texas was one of the first states to pass a “trigger law,” which bans abortion in most cases 30 days after the Supreme Court ruling Roe v. Wade unconstitutional. When the court’s draft opinion overturning Roe leaked in May, Republican lawmakers said they were preparing for the next step: strengthening health care and other services for women and children. “It just makes sense,” Rep Steve Toth told reporters. “The dog has taken the car now.”

The representative Giovanni Capriglione agrees. “Now we have to work hard to help these new mothers and these new babies.” For Toth, “it means antenatal care, helping them stay in school. It means making sure you help women once the baby is born, it means adoption services ”.

For Texas moms facing post-Roe world, however, there is a huge mountain to climb to find that help now. In recent years, the state has ranked 40th in the country for mothers’ health measured by the maternal mortality rate, 49th for the share of children with health insurance and 22nd in its adoption rate. To say Texas had to work hard to help its moms and babies was a huge understatement.

Texas certainly isn’t alone. The Guttmacher Institute, which deals with reproductive health research, has counted 26 states that banned abortion when the Supreme Court ruled in June or likely would do so soon after: 13 states that already had in place activation laws and 13 others should follow with their own prohibitions.

Compared to states that may continue to allow abortion, the 26 states that prohibit abortion only insure two-thirds of children 18 years of age or younger. Maternal mortality is two thirds higher. Infant mortality is 30 percent higher. Their average position in one of the most comprehensive health performance comparisons, conducted by the Commonwealth Fund, is only half.

The differences also affect other health problems. States pursuing abortion bans, for example, had a 30% higher death rate from COVID-19 than states that allow abortion. Their COVID-19 vaccination rate lagged 15 percentage points behind that of states that should continue to allow abortions. 25% more individuals in abortion-free states have poor dental and oral health. A quarter of more children suffer from food insecurity. And of the dozen states that have not expanded their Medicaid program under the Affordable Care Act, 10 have abortion bans.

As always in American federalism, there are also variations between the states that prohibit abortion and those that should continue to allow it. Infant mortality in Iowa, which bans abortion after 22 weeks, is 4.27 per thousand live births, far below the average for all states that ban or are expected to ban abortion. By comparison, infant mortality in North Carolina, which allows abortion, is 6.76 per thousand live births, far above the average for states that allow abortion. In West Virginia, a state that prohibits abortion, maternal mortality is 12.9 per 100,000 population, half the average for all non-abortion states. New Jersey, which allows abortion, has a maternal mortality rate of 38.1 per 100,000, more than double the average for states that allow abortion.

But when all states with or planning to adopt abortion bans are compared with those where the procedure is expected to remain legal, a clear picture emerges:

Trigger states’ promise of helping new mothers and babies therefore falls far short of their performance. The recovery will require a massive investment in health care among states that for the most part have already proved unwilling or unable to significantly increase that category of spending.

The federal government has grant programs available for many of these challenges. The Department of Health and Human Services, for example, has a $ 350 million program “to support safe pregnancies and healthy babies,” as HHS says, and an ongoing maternal and child health block grant program is underway. . There is a large collection of other initiatives, from CDC research to newborn screening and research funded by the National Institutes of Health. Federal efforts total billions of dollars.

However, there are what the March of Dimes calls “maternity care deserts” across the country – places where women do not have adequate access to maternity care. The result, the organization concludes, are higher rates of serious health problems and deaths for both mothers and babies. And the United States is not doing well in international comparisons: it has double the maternal mortality rate of other high-income countries, 10 times higher than that of New Zealand and Norway, in fact.

The nation’s major problems in providing health care to mothers and babies is an extremely important background to the Supreme Court’s decision in Dobbs v. Jackson, and there is no escaping the fundamental point: For the most part, states that create abortion bans are far behind those that allow abortion when it comes to health care in general, moms and babies in particular. While some lawmakers in states that ban abortion may be sincere in their promises to do more for moms and their babies, they still have a long way to go to catch up.

To governOpinion columns reflect the views of their authors and not necessarily those of To governeditors or management.

Donald F. Kettl is a professor emeritus and former dean of the University of Maryland School of Public Policy, College Park. He can be reached at [email protected] or on Twitter at @DonKettl.

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