Last week, the United States joined just three other countries that have scaled back abortion rights since 1994. With the landmark Supreme Court decision overturning the 50-year-old Roe V Wade, the U.S. joins El Salvador, Nicaragua, and Poland, while nearly 60 other countries have liberalised their abortion laws in the same timeframe.
According to the World Health Organization (WHO), unsafe abortions account for 13% of all maternal deaths globally (disproportionately in developing nations), and each year 7 million women in developing countries are treated in hospital facilities for complications from an unsafe abortion. While the topic of abortion is hotly debated throughout much of the world, the evidence has shown that in countries where abortion access is restricted or illegal, the ramifications can be wide-ranging and dangerous.
“Being able to obtain safe abortion is a crucial part of health care,” said Craig Lissnerv, acting Director for Sexual and Reproductive Health and Research at WHO. “Nearly every death and injury that results from unsafe abortion is entirely preventable. That’s why we recommend women and girls can access abortion and family planning services when they need them.”
Abortion laws range around the world, which means we already know what impact the scaling back of abortion rights in the U.S. is likely to have.
Public and Reproductive Health Risks
Most international health organisations consider abortion a matter of public health and the research shows that in places where abortion is restricted by law, unsafe abortions occur far more often than in places where access is broad. In fact, the legal status of abortion doesn’t significantly affect the rate at which it occurs.
Across countries that prohibit abortion (e.g., Malta, Honduras), countries that allow abortion to save a woman’s life (e.g., Malawi, Afghanistan), and countries that permit abortion without restriction (e.g., Canada, Thailand), the number of abortions that occur ranges only between 36 to 41 per 1,000 women.
For Sara Stratton, Palladium Director of Family Planning, access to abortion and post-abortion care is part of holistic reproductive health care. Without it, she expects to see an uptick in related health issues and, most likely, deaths.
“Around the world, we’ve done so much work to reduce maternal mortality. Complicated unsafe abortions contribute to maternal mortality, especially in cases of women coming to facilities having attempted to terminate pregnancies themselves,” she explains. “The ramification is that here in the U.S, we’re likely to see more maternal morbidities and probably mortalities as women look for options to terminate their pregnancies for whatever reason they may have.”
Different than mortality rates, but serious nonetheless, maternal morbidity includes any health problems that result from being pregnant or giving birth. “Those issues can be psychological or physical and if a woman doesn’t have access to the care she needs and turns to unsafe measures to terminate a pregnancy, those morbidities are going to increase,” Stratton says.
Psychological Health and Pregnancy
The stakes are also high when it comes to mental health, both for the pregnant person and child.
Sara Bowsky, Palladium Head of Nursing, notes that beyond the physical health implications, many women suffer from the psychological effects of carrying a pregnancy to term that they may not want or be ready for. “We can’t ignore the mental health and psychological impact of this ruling,” she notes.
“Many women are already coping with perinatal depression in the best of cases, let alone when facing the trauma of carrying a child that’s a product of rape or incest. Restrictions on abortion put a burden on unborn children that may not have been wanted or who are placed in the care of social services.”
Bowsky recalls an instance while working in Lesotho in the late 1990s, when a woman with an ectopic pregnancy came to her for help. “We got her over the border to get the care she needed and the doctor there told her she shouldn’t get pregnant again. Unfortunately, a few years later, she did, and her daughter came running to my home to tell me that she was bleeding.” The woman couldn’t get access to an abortion, and it was too late to help by the time Bowsky arrived. To this day, she is not only saddened by the death, but by the lifelong impact it had on the woman’s daughter to see her mother die in such a traumatic way.
“This is going to create a psychological impact that will be passed down through generations.”
Stratton agrees that the impact extends beyond women to their families and the children themselves, explaining that “there’s a correlation between ‘wantedness’ with a pregnancy and those children later having issues throughout school and beyond.”
“The Rights of All People”
Both Stratton and Bowsky note that we won’t have a clear view of the full implications in the U.S. for some time. But the data remain clear: in countries where abortions have been restricted, abortions haven’t gone away – they have only become unsafe.
This is about “the rights of all people to control their own destiny and autonomy,” said Palladium’s Managing Partners in a message to staff on Monday. “Palladium operates on the principle that basic human rights, including access to voluntary family planning, are inviolable.” Research and experience paint a picture of the impact of countries infringing on those basic rights.
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