The Sweeping Consequences of Abortion Restrictions on Sexual and Reproductive Health

“There is more at stake than just protecting a woman’s choice to give birth.” Former First Lady Michelle Obama spoke of this reality during a Michigan campaign event for Vice President Kamala Harris on October 26th.¹

This November marks the first presidential election since the overturning of Roe v. Wade and the revocation of a once-established national right to abortion, an essential healthcare service. The resulting hostile restrictions on abortion and their devastating health impacts have propelled the issue to its current political salience.

Restrictions on abortion care are associated with increased maternal morbidity and mortality, with these burdens disproportionately harming Black birthing people.² Further, a recent JAMA cohort study illustrated the detrimental impact of abortion bans on infant mortality, with researchers identifying an excess of infant deaths in Texas associated with the state’s 2021 abortion ban.³ These restrictions will also exacerbate inequalities and health systems barriers that prevent low-income patients, who are more likely to report an unintended pregnancy, from accessing services.⁴ As such, abortion care is an issue of economic and racial justice.

“As such, abortion care is an issue of economic and racial justice.”

Meanwhile, the constraints of abortion restrictions are prompting providers to leave hostile states and are likely to discourage medical residents from practicing in these areas.⁵ Such legislation is known to cause provider shortages and prompt health center closures. These closures reduce access to a variety of sexual and reproductive health services, including STI and cancer screenings.

Abortion bans strip people of the fundamental right to decide if, when, and how they are able to give birth. This flagrant interference in evidence-based healthcare itself constitutes a violation of human rights.⁶ However, as the former First Lady emphasized, far more is at stake.

In 2023, NPR described some of these downstream harms as consequences “that abortion opponents may not have considered”.⁷ Many of these adverse and fatal effects have become increasingly apparent and widely publicized. If these harms were never before understood, now they demand to be solemnly considered. Yet, anti-abortion agendas remain a threat to public health. For instance, if the present anti-abortion supermajority in the North Carolina legislature holds, the state is likely to impose further dangerous restrictions on abortion beyond those already delineated in the present 12-week ban.

“If these harms were never before understood, now they demand to be solemnly considered. Yet, anti-abortion agendas remain a threat to public health. “

At the national level, Vice President Kamala Harris has demonstrated a capacity to speak about the issue of abortion with a recognition of the wide-ranging effects of restrictions, emphasizing the principle of bodily autonomy and highlighting the narratives of patients and providers impacted by bans. Similarly, in her remarks, Mrs. Obama discussed the concrete impacts of abortion bans that will leave “untold numbers of women and communities throughout this country without a place to go for basic gynecological care, which in turn will leave millions of us at risk of undiagnosed medical issues like cervical and uterine cancers.” She concluded with a plea that in many ways characterizes the basis of sexual and reproductive rights advocacy, “I am asking you all from the core of my being to take our lives seriously.”

Early voting in North Carolina continues through November 2 at 3pm with election day on November 5. Register and make a voting plan at vote.gov/register/north-carolina.

References

1. CNN. (2024, October 27). Michelle Obama makes impassioned plea to protect women while campaigning for Harris [Video]. YouTube. https://www.youtube.com/watch?v=xt9fgCqMfO0
2. Kozhimannil, K. B., Hassan, A., & Hardeman, R. R. (2022). Abortion Access as a Racial Justice Issue. The New England journal of medicine, 387(17), 1537–1539. https://doi.org/10.1056/NEJMp2209737
3. Gemmill, A., Margerison, C. E., Stuart, E. A., & Bell, S. O. (2024). Infant deaths after Texas’ 2021 ban on abortion in early pregnancy. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2024.0885
4. Harvey, S. M., Larson, A. E., & Warren, J. T. (2023). The Dobbs Decision – Exacerbating U.S. Health Inequity. The New England journal of medicine, 388(16), 1444–1447. https://doi.org/10.1056/NEJMp2216698
5. Weiner, S. (2023, August 23). The fallout of Dobbs on the field of OB-GYN. AAMC. https://www.aamc.org/news/fallout-dobbs-field-ob-gyn
6. Amnesty International. (2024, August 5). USA: Abortion bans and restrictions cause extensive harm, violate human rights. https://www.amnesty.org/en/latest/news/2024/08/usa-abortion-bans-restrictions-cause-extensive-harm-violate-human-rights/
7. Rovner, J. (2023, May 23). Abortion bans drive off doctors and close clinics, putting other health care at risk. NPR. https://www.npr.org/sections/health-shots/2023/05/23/1177542605/abortion-bans-drive-off-doctors-and-put-other-health-care-at-risk