Sarah Green Carmichael: In light of this ruling, what do you expect to be the impact on women’s health and specifically Black women’s health?
Monica McLemore: Criminalization will mean that some doctors and organizations will freak out and stop offering care, which can limit access to other reproductive care, like sexually transmitted infections, infertility care, and a whole host of other things. The places that will continue to provide abortion services will be so overwhelmed that we will have long wait times for appointments. And that’s not just on the abortion side. It is also on the side of the continuation of the pregnancy.
Joia Crear-Perry: There will also be an economic impact, and not just on people forced to get pregnant. Think of all the people who have been working in restaurants, delivering food, driving Ubers: If they don’t have control over their own bodies when it comes to reproduction, it affects those businesses. It affects any employer who has an employee who cannot control his or her own body. It’s not that black women shouldn’t be focused or that our issues aren’t important, but this impacts everyone.
SGC: Please tell more about the effect on other reproductive health services. I feel like there’s an assumption that you can draw a neat little box around an elective abortion and cut it out. Because it does not work?
MM: People assume that people who provide abortion services are different from people who provide pregnancy services and different from people who provide sexually transmitted infection services. But they are all connected, just like people who have abortions and pregnancies and carry babies to term are not different patients, they are just at different times in their lives.
SGC: Laws that would make abortion a crime sometimes have exceptions for rape, incest, or the life of the mother or very serious health outcomes. Why is that not enough to protect women’s health in practice?
MM: It means that you only have the right to bodily autonomy after someone else violates it. But you have a human right to bodily autonomy. The way I’ve explained this to students is this: There’s a reason you have to sign an organ donor card when you get your driver’s license. That’s because no one can take your organs without your consent, even after you’re dead. You have bodily autonomy in life and in death. That is irrefutable. And as long as that’s true, that means forced pregnancy is inconsistent with human rights principles.
SGC: Are there other misconceptions about abortion access that you wish the general American public understood?
JCP: What I really want people to remember is that what we call private insurance is really employer-sponsored insurance. That means your employer can choose whether he wants to cover abortion services. We already have so many layers of people controlling access to a basic health care function. In other high-income nations, abortion is free and covered by public insurance.
When [Dobbs v. Jackson Women’s Health Organization, the case that posed the challenge to Roe] was being discussed, Chief Justice [John] Roberts stated that other nations that allow abortion have a limit in the first trimester, but that is a limit for abortion to be free; If you take more than 12 weeks to decide that you want an abortion, then you may have to pay something. What we’re talking about in the US is just having access to it, period.
SGC: There have already been more than 1,300 miscarriage prosecutions in the US, and women of color are disproportionately prosecuted. Do you expect those numbers to increase if abortion becomes a crime? MM: We already know that black people are overcriminalized in the US Criminalizing abortion may mean more health care workers or Child Protective Services calling people suspected of self-monitoring an abortion to the police, even if in It’s actually a miscarriage. But these are people who have experienced a loss. Criminalization is not the way to deal with bereaved people.
SGC: One of the main reasons people seek an abortion is because they feel they cannot afford to have another child. I say “other” because most people seeking abortions already have at least one child. What is the role of economic and social policy in reducing the number of abortions?
JCP: All of these things are linked, from the child tax credit to paid leave. It’s really about creating the infrastructure so families can thrive. The states that are most likely to severely restrict abortion are the same states that have the worst infant and maternal mortality rates. And these are the same states that didn’t expand Medicaid, don’t have paid leave, and don’t protect equal pay. In the US, we have some of the worst health outcomes in the developed world. And that is not a coincidence.
SGC: The United States also has very high maternal mortality rates overall, compared to other wealthy nations. And black women are three times more likely to die from childbirth or related complications than white women. Do you think repeal of Roe will cause more black women to die in childbirth?
MM: The healthcare system that we have in the US is not working well for the Black and Latino communities. But it’s a more nuanced discussion; there are many other things that can go wrong besides death. When we talk about maternal mortality, we’re not even talking about the 50,000 near misses, [the women of all races who had] Serious pregnancy-related complications, such as bleeding, infection, a c-section wound that breaks open. We’re not talking about people like Serena Williams and Beyonce who are living, but had trauma. Black women are less likely to be believed by their health care providers, and are underdiagnosed and treated.
JCP: And I like to remind people that we can’t have the worst outcomes in the industrialized world just because black women are dying. White women are also dying who would not have died if they lived in any other industrialized nation.
SGC: Some skeptics say that US maternal mortality rates appear higher than other countries because the US measures them over a year instead of six weeks after birth.
JCP: That’s gaslighting. The World Health Organization sets the international standard for collecting data six weeks after birth. What the Centers for Disease Control does, aside from collecting the international standard, is they track the data up to a year because we know that people can die months after having a baby, people like Erica Garner, who died of heart failure from cardiomyopathy during pregnancy. four months after giving birth. The US is trying to pressure the WHO to extend it to a year because you always make up six weeks – it takes a year. But even looking at just six weeks, we’re still the worst.
SGC: What would help address some of those disparities?
MM: We will never see better health outcomes or achieve health equity if we don’t have a strong social safety net. If we were serious about having reverence for the propagation of our species, we would treat families with children accordingly. But now we have black mothers who are driving for Lyft and Uber again 10 days after a C-section, the last thing they should do with an abdominal wound, because they need to generate income in our economy. But that’s the reality of not having paid family leave. That’s the reality of not having postpartum health coverage. That’s the reality of the limitations of employer-sponsored health insurance.
SGC: What would you like to see happen next?
JCP: I would like to see more people acting bad. And I’d like to see us change the narrative; I would like our country to move forward and not try to pit state rights against human rights. Finally, I would like to see more people talking about how this affects men as well. There are many men who have a history of abortion, who have been able to move up the corporate ladder because they had access to abortion and birth control. MM: There are great bills that address many of the deficiencies that we’ve been talking about that are languishing in Congress. Take the Momnibus bill. Smart people have thought about where we can choose policies differently. Things don’t have to be the way they are now; we can make a different decision. We are on a precipice, and that requires courage.
This column does not necessarily reflect the opinion of the editorial board or of Bloomberg LP and its owners.
Sarah Green Carmichael is a Bloomberg Opinion Editor. Previously, she was managing editor for ideas and commentary at Barron’s and executive editor at Harvard Business Review, where she hosted “HBR IdeaCast.”
More stories like this are available at bloomberg.com/opinion