A panel of health care leaders attempted to answer a vital question in the aftermath of the Supreme Court’s decision to strike down Roe v. Wade. What does the future of reproductive health care look like? It’s a complicated question—especially in the midst of a maternal mortality crisis and a health care system built on the back of white supremacy.
At the panel for the National Association of Black Journalists and National Association of Hispanic Journalists on Friday, Dr. Joia Crear-Perry, founder and president of the National Birth Equity Collaborative, emphasized that when Black women are three to four times more likely to die during childbirth than their white counterparts, we as a country have to look at the structural issues in place. The United States is the only high-income nation in the world where this many people die during childbirth every year, Crear-Perry said. That didn’t just happen.
“Until we look at structural issues like racism, we are never going to solve this maternal mortality problem,” Crear-Perry said.
She later explained while answering a journalist’s question that she is from the deep South, and that for the South to rise again, Southern white women are going to have to do something about the policy decisions of their husbands and other men in their lives—for example, not expanding Medicaid and not offering paid leave. It is killing them, Crear-Perry said.
She later added that hospitals also have to be more responsive to the needs of patients. They can’t continue to approach healthcare from the mindset of medical equipment needs to solve this problem of maternal mortality. Patients who have doulas and midwives have better outcomes, Crear-Perry said. So she started advocating for them.
“We don’t need things,” the doctor said. “We need empathy. We need love. We need care.”
Dr. Jack Resneck, president of the American Medical Association, said there are huge drivers of healthcare that hospitals have traditionally ignored, like housing insecurity, food insecurity, and gun violence. The American Medical Association is advising physicians to get out into their communities and do something about those issues as an approach to improving healthcare.
On the policy side of the conversation, there are gaping holes in insurance coverage and healthcare services for poor communities. Sen. Patty Murray, chair of the Senate committee on health, education, labor, and pensions, issued a report on the state of abortion policy in the aftermath of Roe v. Wade.
In the report, the committee wrote, citing added research:
“Prior to 1973, access to abortion was challenging or nearly impossible in most of the United States. Because providers in most states could not openly provide abortions without the threat of legal action, many pregnant women resorted to attempting abortions themselves or turned to unlicensed providers who operated in secret, were often not sufficiently trained to deal with potential complications, and did not have access to the facilities or equipment needed to keep their patients healthy. (…) These abortions were extremely risky, causing shocking rates of maternal injury and death. (…) The lack of access to safe abortions was particularly deadly for women of color, who made up seventy percent of the women who died from abortions conducted without physician supervision.”
Maternal mortality dropped 45% from 1972 to 1974, the year after the Supreme Court legalized abortion federally, the Senate committee reported.
“Research makes clear women who live in states with these restrictive bans are likely to face significant health consequences,” the committee said in its report. “Self-managed abortions, health care providers who are hesitant to provide care for pregnancy complications, lack of access to other reproductive health services, and delays in care for cancer and other serious illness are all likely to contribute to rising rates of maternal death and serious illness.
“These health impacts will extend to women across the country if Republican legislators are successful in enacting a national abortion ban and as more states seek to prohibit or severely restrict abortion access.”
Resneck said the Medicaid and Children’s Health Insurance Program already don’t cover people long enough after giving birth. Major cities and rural areas alike are reporting maternity center closures, and physicians are operating with both unconscious and conscious biases.
Dr. Diana Contreras, chief healthcare officer at Planned Parenthood, said the most difficult aspect of post-Roe healthcare right now is confusion. People don’t know their rights, where they can go for reproductive health care, or when they can get an abortion. They’re asking themselves if they can have an abortion, if they should get an intrauterine device (IUD), a form of birth control, now— because they may not be able to in three years when their rights may be further infringed upon.
”The fall of Roe has caused chaos in the medical community,” Contreras said. “Legislators are interfering with medical care, and this is very dangerous.”
She referenced the 10-year-old rape victim who had to travel from Ohio to Indiana for an abortion.
Not only was she brutalized, but the “physician who took care of her was brutalized,” Contreras said. She also mentioned one of her patients who came in with vaginal bleeding and ended up having cervical cancer. That patient also learned she was 14 weeks pregnant, and she got to make the decision about her medical care, Contreras said.
Others may not.
“It is unbelievable where we’re going, and it is imperative that we don’t allow this to stand,” Contreras said, calling the current healthcare state “unconscionable.”
Contreras said Planned Parenthood is trying to work with the administration, reproductive health groups, anyone who is willing to partner to help connect patients to resources and make accessing reproductive health care easier. Journalists’ ability to educate the public is vital to that work, she added.
Dr. Elena Rios, president and chief executive officer of the National Hispanic Medical Association, said while we also need to educate ourselves and our family members, we need journalists to help combat mistrust of the medical community. That mistrust formed as a result of decades of racist medical practices like forced sterilization in Los Angeles in the 1960s in 1970s.
She recommended Hispanic Health, a health portal the National Hispanic Medical Association partnered with other health advocacy organizations to form a resource for people of color. Rios also applauded President Joe Biden’s decision to sign an executive order protecting travel for abortions and called on communities of color to show up for their local elections and vote.
“We have been involved in voting all our lives, but not for a cause. This is a cause,” Rios said of access to reproductive care.
After the Dobbs v. Jackson Women’s Health Organization decision that effectively reversed the ruling of Roe v. Wade, there was not only the active spread of misinformation, but also disinformation. Meanwhile, many physicians are faced with having to decide between what’s best for their patients and obeying state law.
Resneck said, on the one hand, physicians have an ethical duty to do what’s best for patients, and on the other hand, state attorneys general and other government officials are interfering with those decisions. It’s “incredibly dangerous” for patients, the doctor said.