On 20 November, when a district judge in Mississippi struck down a new law that would have banned abortions after 15 weeks, the judgment wasn’t exactly surprising. It doesn’t require a legal degree to notice that the proposed ban infringed on the constitutional right, established by Roe vs. Wade, for women to access abortions up until a fetus reaches viability (estimated to be around 23 to 24 weeks), and the legal requirement that states do not place undue restrictions on a women’s right to choose.
What is more remarkable, however, was the tone taken by District Judge Carlton W. Reeves. He noted that Mississippi legislators were taking part in a renewed effort in conservative states to force the Supreme Court to revisit abortion rights, and said that the proposed abortion ban was in the spirit of “the old Mississippi”:
“The Mississippi bent on controlling women and minorities. The Mississippi that, just a few decades ago, barred women from serving on juries “so they may continue their service as mothers, wives, and homemakers”… The Mississippi that, in Fannie Lou Hamer’s reporting, sterilized six out of ten black women in Sunflower County at the local hospital—against their will… And the Mississippi that, in the early 1980s, was the last State to ratify the 19th Amendment—the authority guaranteeing women the right to vote.”
He also accused Mississippi legislators of “gaslighting” by pretending to care about women’s rights while doing nothing to address Mississippi’s infant and maternal mortality rate, which are among the highest in the country. He wrote:
“This Court concludes that the Mississippi Legislature’s professed interest in “women’s health” is pure gaslighting… Its leaders are proud to challenge Roe but choose not to lift a finger to address the tragedies lurking on the other side of the delivery room: our alarming infant and maternal mortality rates.”
The comments pose an interesting, and provocative challenge, for the anti-abortion movement. Were the anti-abortion movement indeed pro-life, rather than anti-women, imagine how much it could achieve, given its proven focus and success at campaigning for legislative change.
Imagine how many lives could be saved if the anti-abortion movement focused on saving mothers and babies rather than only fetuses, and tried to address the US’s shocking infant and maternal mortality rates, which are the highest of any rich, developed country.
Precedent suggests, however, that the anti-abortion movement (I refuse to call them pro-life) will not be moved to action. Mississippi is not an unusual case. As research published earlier this year by the Center for Reproductive Rights demonstrates, states that place more restrictions on abortion tend to also have worse records for women and children’s health.
Set aside for a moment the demonstrable (if not universally recognized) fact that abortion restrictions are inherently bad for women’s health, not only because they infringe on a woman’s autonomy over her own body and her own future, but also because women who are denied access to abortion are more likely to experience domestic violence, poverty and and physical ill-health.
The Center for Reproductive Health instead ranked states in terms of the number of restrictions they placed on abortion (such as mandatory waiting periods, counselling and scans, restrictions on abortion providers, restricted insurance coverage for abortions and gestational age limits) and then in terms of the number of policies introduced that are supportive to women and children’s health (such as expansions to Medicaid and the children’s health insurance programme, CHIP, sex education, domestic violence screening, expanded family leave and protection against pregnancy discrimination).
It found an inverse correlation between the two, that is that the states that place more restrictions on abortion access tend to pass fewer policies in support of women and children’s health. This translates into actual health outcomes too, so that generally speaking states with more restrictive abortion policies also have worse records for maternal and children’s health.
While anti-abortion legislators often couch their policies in terms of their alleged concern for women’s well-being, their records suggest otherwise. The report observes:
“if “potential life” is a priority for legislators, is a child’s well-being also a priority? What about maternal health and supporting pregnant women? The answer is evident. In the last year alone, anti-abortion policymakers in states such as Texas, Indiana, and Louisiana have spent a great deal of energy passing laws and regulations requiring embryonic and fetal tissue to be buried or cremated and yet they all rank among the lowest in children’s health and well-being outcomes.”
According to US government statistics, the infant mortality rate in Mississippi is 8.6 deaths per 1000 live births, compared to a national average of 5.9. The maternal mortality rate has meanwhile been climbing in Mississippi for more than a decade. According to the most recent figures, which are from 2010-2012, on average 40 women died per 100,000 live births in the state. As is the case across the US, black women are significantly more likely to die in childbirth than white women.
Dr. Renate Savich, the chief of the division of neonatology and newborn medicine at the University of Mississippi Medical Center, told me that the causes of Mississippi’s high maternal and infant mortality rates were complex and there were no “magic bullet” solutions. One of the primary problems is the poor health of mothers, particularly in poor and minority populations, among which there are high rates of hypertension, obesity and diabetes, all conditions that are exacerbated by poverty and limited access to healthcare.
Mississippi is one of the states that has not expanded Medicaid under the Affordable Care Act, and so while women are insured during pregnancy many will have had limited access to medical care beforehand.
“We know there are some women who, let’s say, have diabetes and don’t have health insurance, which means they can’t afford their medication. That means that between pregnancies, they can’t get good control of their diabetes. When they get pregnant, they are covered by Medicaid, so they can get medication and help with their diabetes but it’s already too late, because their baby has already suffered the consequences, or because the mother’s health is still too bad,” Savich said.
At the same time, a lack of sex education and difficulty accessing family planning contributes to a large number of unplanned pregnancies, which do not allow for a woman to prepare physically for childbirth.
For poor women, making regular trips to the doctor can be costly and difficult, and this makes administering medication such as weekly injections of hydroxyprogesterone, prescribed to women at high risk of preterm birth, difficult. Some other states allow such vaccinations to be administered by nurses on home visits, but not Mississippi.
Savich expressed her frustration at the lack of political will to invest in preventative care. “In our political climate, nobody wants to spend $1 now to save $10 later because they won’t get reelected if they spend $1,” she said.
She wanted to underline, however, that despite the many challenges faced by the state, these problems are not insurmountable. Some US states, such as California, have made dramatic progress in reducing maternal mortality rates, and there are a number of interventions that have been shown to work.
When I asked her what she’d request should she have the opportunity to hold legislators to account and persuade them to invest in reducing infant and maternal mortality, she said she’d want to introduce a pilot in a challenged area of Mississippi that implemented all the proven best practices. She would make sure women have continuous access to healthcare, such as treatment for diabetes and hypertension, help losing weight or quitting smoking, access to contraception and access to regular treatment for women at risk of delivering pre-term. She would also introduce more programmes to support mothers, such as midwife home health visits and centering programmes.
If you want the world to believe you’re pro-life, why not campaign for that?