On June 24th, 2021 the US Supreme Court decided the case, Dobbs v. Jackson Women’s Health Organization, overturning Roe v. Wade and Planned Parenthood of Southeastern Pa. v. Casey and revoking the constitutional right to abortion. Since the passing of Dobbs, twenty states have increased restrictions or posed complete bans on abortion, despite the fact that it has been deemed a human right by the World Health Organization (World Health Organization). Those working across the reproductive health field, including doctors, researchers, and other medical professionals including Dr. Kathryn Fay at the Brigham and Women’s Hospital continue to affirm that abortion is an essential health care practice. Medical professionals regularly observe that restricting access to this care is detrimental to the health and livelihoods of people with the ability to become pregnant, and disproportionately impacts marginalized communities.

With such fast-moving developments in reproductive health legislation, researchers have suggested that changes in the maternal mortality rate can help us understand the severity of this decision. The maternal mortality ratio is defined as the number of maternal deaths in a given time period, region, etc, per 100,000 live births in the same period. This framing only captures deaths resulting  “from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy,” (World Health Organization). While a helpful and important unit of measurement,  the maternal mortality rate has not been constructed to encompass all of the discrepancies and obstructions of care that may occur in light of Dobbs; nor is there sufficient data at this juncture for this metric to fully capture the severity of the issue, as the MMR is published on a 1-4 year delay. As this is a fast-moving issue which requires immediate examination, I plan to focus on instances of maternal morbidity as a way of better understanding the damage of confusing and restrictive legislation in real-time. The maternal morbidity refers to “any health condition attributed to and/or aggravated by pregnancy and childbirth that has negative outcomes to the [pregnant person’s] well-being,” (World Health Organization). Interpreting the relationship between this new legislation and maternal morbidity allows for a  wider net to be cast in regards to the impact of Dobbs. 

One year after Dobbs, there are already numerous narratives of medical professionals frustrated or confused by the gaps and steps now in place to conduct proper care, all under the threat of losing one’s medical license, fines, or jail time. I will investigate how the post-Dobbs legislative climate, including ambiguous policy language and confusing restrictions, has led to disparities in care, thus impacting instances of maternal morbidity. I plan to analyze the language used in restrictive abortion policies and interview public health professionals on how their work has been affected by the Dobbs decision. In order to center and fully encompass the access discrepancies that have resulted due to new legislation, I will be deploying a reproductive justice framework within my work, focusing specifically on how this impacts marginalized communities. I anticipate finding that in states where abortion has been restricted in the wake of Dobbs are observing an uptick in maternal morbidity, principally in people of color and those with low socioeconomic status. By assessing these narratives of discrepancy in relation to a detailed policy analysis, I aim to provide a holistic understanding of how these restrictions are causing harm, reinforce clarity in this aspect of public health communication and create suggestions of how to best prevent and fight against disparities in care. 

Works Cited

Fay KE, Diouf K, Butler SK, Onwuzurike C, Wilkinson BE, Johnson NR, Schantz-Dunn J, Bartz D. Abortion as Essential Health Care and the Critical Role Your Practice Can Play in Protecting Abortion Access. Obstet Gynecol. 2022 Nov 1;140(5):729-737. doi: 10.1097/AOG.0000000000004949. Epub 2022 Aug 10. PMID: 35947856; PMCID: PMC9575566.

Gates, J. (2023, June 20). Informational Interview with Brie Thumm, PhD, CNM, RN, MBA, FACNM. personal. 

Grossman, D., Joffe , C., Kaller, S., Kimport, K., Kinsey, E., Lerma, K., Morris, N., & White, K. (2023). (rep.). Care Post-Roe: Documenting cases of poor-quality care since the Dobbs decision. University of California San Francisco . Retrieved from https://www.ansirh.org/research/ongoing/texas-policy-evaluation-project-txpep. 

National Institute of Health. “What Are Maternal Morbidity & Mortality?” Accessed June 24, 2023.  

PLOS Medicine Editors. Why restricting access to abortion damages women's health. PLoS Med. 2022 Jul 26;19(7):e1004075. doi: 10.1371/journal.pmed.1004075. PMID: 35881637; PMCID: PMC9321431.

World Health Organization. “Abortion.” Accessed June 13, 2023. https://www.who.int/health-topics/abortion#tab=tab_1.