Arizona’s now repealed abortion ban is a warning for reproductive health care in the US. • Ohio Capital Journal

When the Arizona Supreme Court ruled on April 9, 2024, that the Civil War-era state law that banned nearly all abortions was enforceable, the potential consequences of leaving reproductive rights up to the states to regulate, and thereby related consequences are clearly visible. for women’s health.

The ruling, which takes effect at the end of June 2024, will only remain in effect for a few months because Arizona lawmakers repealed the law on April 30. Starting this fall, a previous state law banning abortion after 15 weeks will be reintroduced.

The rapidly changing legal landscape and conflicting information have fueled fear and confusion for women, families, hospitals, doctors and other health care providers, and have had a chilling effect on abortion services.

We are a health policy expert who examines how laws and policies affect health outcomes, especially for women and children, and an aspiring health care attorney who focuses on health law and policy.

After studying how reproductive health care has been affected by the 2022 Dobbs decision, which overturned Roe v. Wade, it is clear to us that the implications of bans like those in Arizona and dozens of other states go far beyond abortions. Examples include reduced availability of safe delivery services, pre- and postnatal care, Pap smears, testing for sexually transmitted diseases, family planning, gynecological conditions and management of miscarriages.

These downstream effects aren’t just predicted: They’re already playing out in real time in states with the most restrictive reproductive rights laws across the country.

The medical staff are staggering

Policies that restrict abortion have far more consequences than access to abortion.

First, these laws limit the supply of female health specialists such as obstetricians and gynecologists, or gynecologists. Medical students are less likely to enter the specialty and are more likely to avoid training positions, employment, or both in states with restrictive or near-total bans. These states also have problems maintaining existing gynecological care centers.

This impact on the availability and locations of future women health specialists exacerbates physician shortages, financial burdens on families, and racial and ethnic health disparities. The dampening effect on the labor force could also worsen already dismal maternal mortality rates in rural, low-income communities of color.

Having a well-trained and sufficient number of midwives is crucial for promoting women’s health. A survey of third- and fourth-year medical students found that 60% were unlikely to apply for residency in states where abortion is illegal or severely restricted.

The Association of American Medical Colleges found that there was a 5.2% decline in fourth-year medical student applications for OB-GYN residencies in the 2022-2023 application cycle. This is a steeper decline than in 2021, the year before the Dobbs decision overturned Roe v. Wade.

Most alarmingly, requests for gynecological care in the thirteen states with the most restrictive abortion laws fell 11% between 2022 and 2023, pointing to a future disparity in the supply of health care providers for women in those states.

Dobbs also had an impact on the retention of OB/GYN residents in states with abortion restrictions: 17.6%, or more than 1 in 6, said they are likely to reconsider where they practice after their training. They also noted concerns about the potential lack of comprehensive OB-GYN training opportunities in these restrictive states for procedures related to miscarriages, ectopic pregnancies and more.

Reduced access to health care for women

The Dobbs decision has exacerbated the challenges women of color and women in rural communities face in accessing women’s health care. Black women account for nearly half of all abortions in the United States, but they are more likely to live in a contraceptive desert—that is, areas where they do not have access to a full spectrum of contraceptive options—and less likely to can afford the costs of contraception. an abortion and associated travel costs.

A national survey of gynecological obstetricians found that 70% reported that racial and ethnic inequality has worsened since Dobbs.

Even before Dobbs, many rural women had to travel more than 200 miles to obtain an abortion. Due to state laws banning abortion, at least 66 clinics in 15 states stopped offering abortion services within the first 100 days of the Dobbs decision, leaving many women without access to crucial reproductive health care.

As of December 2023, more than a dozen states lack an abortion clinic. As more states continue to restrict abortion, these disparities are likely to widen.

Lesser known downstream effects

As of April 2024, women in five states, including Arizona, will not be able to divorce while pregnant. This reality, combined with a lack of access to abortion services, can be deadly for pregnant women, who often experience increased rates of intimate partner violence. One study found that in states where abortion is restricted, the homicide rate among pregnant women was 75% higher than in states where abortion is legal.

Nationally, maternal mortality rates have been increasing year over year, even before Dobbs. The US has one of the highest maternal mortality rates in the developed world, more than ten times that of some developed countries such as Australia, Japan and Spain.

Wide disparities also exist within U.S. maternal mortality rates, with Black and Native women being disproportionately affected compared to their white counterparts. In 2018, the U.S. maternal mortality rate was 17.4 deaths per 100,000 births; in 2021 the number of deaths was 32.9 per 100,000 births.

In 2018–2019, Arizona had 26 deaths per 100,000 births, a 43% increase from 2016–2017.

During this period, 89.9% of deaths were preventable. A pregnancy-related death is considered preventable if a maternal mortality review board determines that the death could have been prevented by a reasonable change in the patient’s care.

Although comprehensive post-Dobbs data on maternal mortality is not yet available, 64% of midwives surveyed report that maternal mortality has increased since the decision.

For Black and Native American women, the risk of maternal mortality is even greater. Nationally, there were 69.9 deaths among Black mothers per 100,000 births in 2021, 2.6 times higher than among white women. Experts expect the Dobbs decision and state restrictions will worsen this racial divide. The maternal mortality rate among Native American mothers has increased dramatically in 20 years, from 14 to 49.2 deaths per 100,000 births. This trend is of great importance for a state like Arizona with its large indigenous population.

Access to health care helps reduce maternal mortality

Limited access to maternal health care is a critical factor in maternal mortality. In the United States, approximately 12% of all births occur in counties with little to no access to maternal care, known as “maternity care deserts.”

Women living in states that have abortion restrictions are 62.2% more likely to have had no or late prenatal care compared to women living in states that do not restrict abortion. In Arizona, 6.7% of all births occur in counties that do not have a hospital with an obstetric department or obstetric providers.

Women who are forced to prolong their high-risk pregnancies due to the abortion ban are at increased risk of needing emergency maternity care. Without proper maternity care, many of these women will suffer serious complications and in some cases die.

In the early 20th century, famed women’s rights activist Margaret Sanger declared, “No woman can call herself free unless she owns and controls her body.”

These words continue to be tested through the political and legal battles taking place.

Swapna Reddy, clinical associate professor of health policy, Arizona State University and Mary Saxon, law school candidate, Arizona State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.