In my medical practice, where I treat people with high-risk pregnancies, I recently treated a young woman with pulmonary hypertension. Unfortunately, this diagnosis was made late into her second trimester, well after most states allow pregnancy termination. We had to have the difficult conversation that, despite all modern medical advances, as many as one in three women with this condition will die during pregnancy. Based on that information, who should decide what level of pregnancy risk is acceptable for her? Should she? Should her government? Her case illustrates some of what’s at stake, should the Supreme Court overturn Roe v. Wade.
The risk any person accepts in continuing a pregnancy to term exceeds that of an early safe abortion by literally an order of magnitude. If women like my patient have no other option than to carry a pregnancy to term, the United States, which already ranks last out of all developed nations in maternal health, will only deepen its ongoing maternal mortality crisis.
Forcing people to undertake these risks against their will is a fundamental violation of bodily autonomy and human rights, Yet multiple states stand poised to ban almost all abortions as soon as the court revokes this right to terminate a pregancy. As noted in a recent editorial in the Lancet, a leading medical journal, the Supreme Court justices and their supporters who seek to abolish abortion will have “blood on their hands.”
Current maternal mortality statistics from the CDC paint a sobering picture. In 2019, 754 mothers died during pregnancy. In 2020, another 850 patients died because of pregnancy-related events. For each of those women who died, 70 more suffered a serious maternal morbidity event, defined as a pregnancy-related event requiring a life-saving intervention or procedure (such as blood transfusion, surgery or admission to the intensive care unit).
And maternal mortality is inextricably bound with race, class and age. Women 45 years or older experienced nearly 10 times the odds of dying from pregnancy as compared to those younger than 35. Black women are three times more likely to die of pregnancy-related causes than white women. As illustrated by my patient with pulmonary hypertension, underlying medical conditions also play a role in pregnancy-related risk—and their prevalence is positively associated with lower socioeconomic status. The systemic inequities that contribute to these outcomes will further exacerbate these disparities in a post-Roe America. In a research letter published last year, sociologist Amanda Stevenson estimated that Black women could experience a 33 percent increase in maternal deaths after a total ban on abortions, the most of any demographic group.
Although pregnancy is not a disease, even one that is otherwise uncomplicated can go unexpectedly awry. The changes that the body undergoes during pregnancy are needed to support an ongoing gestation but are still physiologically akin to running a marathon. All of an expecting mother’s organs and bodily systems are put to a nine-month endurance test. The work of the heart and lungs increases by 30 to 50 percent (or even more in a twin pregnancy!), the kidneys filter more blood, the immune system adjusts, metabolic demands increase substantially, and there are myriad other changes. The way any given individual’s body reacts to these changes is unpredictable.
The controversy surrounding pregnancy termination is exceptional in its treatment of abortion as anything but a medical procedure. By juxtaposing the risks of pregnancy against the safety of abortion, the scientific backwardness of limiting access to abortion care is exposed. Allowing states to ban abortions creates many more questions than it answers: Will women with health conditions be able to exercise their reproductive health rights to protect themselves from harm? How will the treatment of other obstetric conditions such as incomplete abortions or ectopic pregnancies be affected? Lives will hang in the balance as states navigate these issues.
Even a seemingly “safe” pregnancy is not without significant risk. The decision of whether to face pregnancy’s risks of complications and death should be left to the pregnant person alone. Not to their congressperson. Not to their governor. Not even to their family or physician, who can nevertheless provide support and information. The surest path to having healthy babies is ensuring healthy and willing mothers. We must fight to keep the rights to pregnancy-related decisions solely among those who bear the consequences.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.
