The Policy Implications of Overturning Roe v. Wade {Guest Post}


The following is part one of a guest post from Sri Preston Kulkarni, a democratic nominee for Texas’ 22nd congressional district in 2018 and 2020. 

The end of Roe v Wade is an earthquake in American law, politics and human rights. This is a post on abortion rights, which I believe is essentially a fight over whether women have the choice to become mothers or have it forced upon them, and it can be broken down in terms of policy, legal, and political implications. This article will focus on the policy impact:  

The policy implications of overturning Roe v Wade may be the easiest to summarize, but the least salient to most people. First off, in 2019 (pre-pandemic) there were about 3.75 million live births in the US, and every one carried a risk.  Reproductive healthcare, especially for poor women, is abysmal in the United States, relative to other developed nations. Our maternal mortality rate is already the highest in the developed world (3x the UK, and 6x Germany) at a rate of almost 24 per 100,000.  (For anyone looking at absolute numbers, this can be misleading. Yes, there are fewer than 1,000 deaths per year, but the denominator is much lower than other causes of death, because it only includes pregnant women, not 6 year olds, 60 year olds, men etc.) Put differently, a pregnant woman in the US is more likely to die from childbirth than from homicide, suicide, car accident, or drug overdose, and for women under 45, childbirth is still in the top 10 overall causes of death (and about 3x higher for women of color).

This is also not equal across states, with 7 of the top 8 states for maternal mortality (TX, MO, AL, AK, IN, GA, and LA) being Republican-led and ranging from 34.5 deaths per 100,000 in TX all the way up to 58.1 in LA.  (For reference, that is higher than the murder rate in El Salvador, currently 52.02, the most dangerous country in the world.) We are also the only developed country where maternal mortality is getting WORSE, not better.

Second, in 2019, there were approximately 630,000 legal abortions in the US.  The mortality rate for these was 0.6 per 100,000. That means that forcing women to give birth against their will increases their chance of mortality by 40 TIMES. Over the last few years, state legislatures have made it more and more difficult to get an abortion, creating unnecessary financial, medical, and legal hurdles, often forcing women to leave their own state (if they have the resources). As a result of overturning Roe v Wade, 75 million women age 15-45 will now be subject to whatever individual law their state legislature passes on abortion. 13 states already have "trigger laws" which will go into effect automatically as soon as the ruling is issued (likely the end of June) and by the end of the year, most abortions will be illegal in at least half the states in America. This includes many laws that do not allow exceptions for rape or incest, and sometimes even to protect the life of the mother.  (For example, by the end of the year, Alabama will grant women fewer rights than the Taliban, literally. In Afghanistan, there are exceptions for the life of the mother, but not in Alabama, Oklahoma and probably others soon.)

The impact on women will be compounded because of how large these red states are. the ways that states cluster (many small blue states are close together) and how far a woman will have to travel. A woman in Houston, for example, will have to travel 800 miles or more to New Mexico get an abortion under a doctor's supervision.

The practical result of this ruling is that every woman who was planning to terminate her pregnancy, if she is not wealthy enough to be able to travel and see out of state doctors, will now be forced against her will to give birth by her state legislature (including the 40x higher mortality rate as well as non-fatal complications).

Moreover, because of the clustering effect, it will be harder to get appointments in blue states, with the estimated impact that maternal mortality overall in America will increase by at least 21%. We've already seen this in other countries when access to reproductive health clinics has been restricted (due to the international "gag order" also known as the "Mexico City policy").

Bottom line: women will die as a result of this ruling, especially my home state (TX) which is the 2nd most populous state, the 2nd largest by area, and the 8th most deadly for pregnant women.

Photo courtesy of Faith Gowan.