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January 23, 2022 marked the forty-ninth anniversary of the landmark U.S. Supreme Court decision Roe v. Wade. Unfortunately, given the current right-wing composition of the Court, Roe v. Wade is unlikely to make it to the fiftieth anniversary.  The Court is expected to uphold a Mississippi law prohibiting abortion after fifteen weeks from a woman’s last menstrual period, which is at approximately thirteen weeks of fetal gestation.  Mississippi’s governor has repeatedly boasted that the state will continue its efforts to make Mississippi “abortion-free,” and he and his supporters have drafted a number of anti-abortion laws that will go into effect as soon as Roe v. Wade is overturned.  Conspicuously absent from any of this bluster is any attempt to improve the lot of pregnant women, including those who wish to bring their pregnancies to term.  Mississippi does a horrendous job of protecting pregnant women, mothers, and newborns.

Mississippi is not the only state whose legislators are eagerly awaiting the demise of Roe v. Wade.  It is also not the only state whose politicians style themselves as “protectors” of pregnant women and their fetuses.  As in other states in this category, the sanctimonious pronouncements hide a sordid reality of neglect and unconcern for those the grandstanders claim to value.  Mississippi is woefully inadequate in providing prenatal care to its large population of uninsured pregnant women, ranks worst in the nation in health care access and quality, and has the second-highest rate of teen pregnancies in the U.S. (after Arkansas).  It also has high rates of infant mortality, premature births, and low-birth-weight infants. 

As it turns out, the same coercive circumstances that make abortion access difficult or impossible in many parts of the U.S. also contribute to bad outcomes for pregnant women and newborns.  It’s well known that the U.S. has the highest rates of maternal and infant mortality in the industrialized world.  The rates vary widely by region of the country and economic circumstances, with anti-women states like Mississippi leading the way and with the greatest negative impacts on women of color and the poor.  Despite pious platitudes about protecting women and “the unborn,” these states stand out for their callous treatment of women seeking to carry their pregnancies to term.

Recently, I reviewed a book by Louise Marie Roth titled The Business of Birth: Malpractice and Maternity Care in the United States (New York University Press, 2021).  I confess, I wasn’t super-enthused at first.  The subtitle seemed to suggest a rather narrow focus on the intricacies of U.S. tort law and the details of malpractice suits stemming from unfortunate outcomes for pregnant women and newborns.  However, in reality the book has a much broader scope.  The author paints a fascinating, albeit often distressing, picture of the complex interactions of medical practitioners, hospital administrators, insurance providers, malpractice attorneys, and state legislators.  Often the result is a toxic mix of circumstances leading to huge numbers of unnecessary Caesarian sections and chemically induced deliveries, coercion of pregnant women (especially poor, rural, and minority women), outrageously expensive pregnancy care, and, as noted above, the highest rates of maternal and infant mortality in the developed world.  Roth supplements her analyses of changes in law codes and standards of care with interviews with obstetricians, nurse-midwives, lawyers, and insurance adjusters.  The upshot is that less affluent and less educated women can be pressured into episiotomies and repeated Caesarian sections, rendered virtually immobile during labor by the exigencies of constant electronic fetal monitoring, and have their deliveries artificially induced on a Friday so obstetrical staff don’t need to come in on the weekend (resulting in the weekend birth decline notable in many U.S. hospitals).

Roth describes the misleading and often false information medical personnel cite to compel women to consent to procedures that in many cases are unnecessary, expensive, and possibly harmful.  Repeated Caesarian sections, for example, present increasing risks of future pregnancies ending in miscarriage or stillbirth, yet hospital administrators urge or even force them on women ostensibly because of overblown fears of malpractice suits.  But nervousness about legal liability is only part of the story.  In the period 1995 to 2015 the odds of a Black woman with low risk of delivery complications being given a first-birth C-section were 35% higher than for non-Hispanic white women.  The odds of being coerced into repeated C-sections were also higher for Black women. 

There are obvious parallels to the plethora of misinformation pushed on women seeking abortion in many states.  In fact, Roth makes it abundantly clear that the same forces that constrain women’s access to abortion work to prevent many pregnant women’s access to the best care for themselves and their newborns.  

Reproductive health regimeFetus-centered  Woman-centered
 Mississippi  Oregon
Infant mortality (per 1000 live births)  11.46  5.99
Maternal mortality (per 100,000 live births)  20.8  12.8

Roth distinguishes between fetus-centered and woman-centered reproductive health regimes and persuasively argues that pregnant women and their offspring are better served in states that protect abortion rights “and prioritize women’s rights over fetal life” (p. 10).   She gives numerous examples of both types of reproductive health regimes.  Particularly striking is her comparison of Oregon and Mississippi.  Oregon has no TRAP laws, requires comprehensive health insurance to cover prescription contraceptives and abortion, permits nurse practitioners to provide both medical and surgical abortions, and covers abortion services for the poor with state funds.  The state, emphatically a woman-centered reproductive health regime, has below-average rates of teen pregnancy and infant mortality, good state-supported prenatal care, and above-average maternity care outcomes.  By contrast Mississippi, the epitome of a fetus-centered reproductive health regime, has a large number of TRAP laws, long mandatory waiting periods, and extreme anti-abortion measures that are set to become law as soon as Roe v. Wade is overturned (which will probably happen this summer).  And, Roth would argue, not coincidentally, Mississippi has some of the worst maternal and infant mortality statistics in the country.