The Supreme Court’s decision overturning Roe v. Wade — in the Dobbs v. Jackson Women’s Health Organization case — will send shockwaves through American health care. Already, our health system is failing women of reproductive age. Women in the U.S. are more likely than those in other high-income countries to die of preventable causes, including complications from pregnancy, with severe inequities by race and ethnicity.
Let’s be clear. This decision will reduce access to care and further deepen such inequities by:
- making reproductive services inaccessible to women and families in many states
- providing fewer options for providers and for women suffering from ectopic pregnancy (i.e., tubal pregnancy), pregnancy loss, or other complications, particularly in states that have the most restrictive abortion policies
- creating anxiety, fear, and hesitancy to seek or provide care in states where abortion is criminalized
- resulting in thousands of unplanned births and thus the increased likelihood of maternal morbidity and mortality
- increasing the long-term risks to life and health of children, since evidence shows that children of unintended pregnancies are more likely to suffer preterm birth, low birthweight, impaired child development, and adverse childhood experiences.
Given the racial distribution of poverty, discrimination, and lack of access to high-quality care, any systemic failure or shortcoming in the U.S. is felt most acutely by marginalized people —people of color, poor people, and those living in rural communities.
As a health care foundation dedicated to fostering an equitable, high-quality health care system, we are focusing on assessing the immediate impact of abortion restrictions on access to care; measuring and reporting the disproportionate impact for people of color, people with low incomes, and people in rural communities; and understanding how our health system must adapt to ensure women have the best possible health outcomes.
We are particularly concerned about the impact of this decision in the following areas:
Health Care Access and Outcomes
Unplanned pregnancies are most common among people with low incomes, or with jobs that do not provide health care coverage. In a post-Roe world, it will be these women, disproportionately women of color, who will no longer be able to choose an abortion, and will be unable to access the health care they need throughout their pregnancies and postpartum period. The health care workforce also will suffer, as states that ban or restrict abortion coverage are less likely to invest in training and employing reproductive health care providers who can counsel people on their full range of options in the event of an unplanned pregnancy. It is also likely that fewer providers will be trained in the reproductive health procedures that are needed to save women’s lives or in the aftermath of trauma or assault.
Health Equity Implications
Women affected by racism and poverty already have fewer options for high-quality contraception and other health care services. As a result, these women are more likely to seek abortion services. This is particularly true in southern states, which also have some of the nation’s highest rates of maternal deaths. In addition, nationwide, women of color are less likely to have early access to maternal health care, contraceptive care, and other reproductive health services, which puts them at a higher risk for poor maternal health outcomes. Finally, people of color have long experienced racism and unequal treatment in their interactions with the health care system. Criminalizing basic health care services and surveilling patients who may seek such services will create further hostility, and potentially turn people away from the health care system.
The Fund has committed to raising the voices of those affected by this ruling. Women need access to a full range of reproductive health services, including abortion. Policymakers at the federal and state levels should take immediate steps to protect women’s health, including examining all available levers for advancing equitable access to reproductive health services; building capacity for many more unplanned births; addressing a rise in already high maternal mortality rates; investing in infrastructure to lessen the health inequities affecting pregnant and birthing people; and closely monitoring the disproportionate impact on women of color.