A little over an hour after Politico reported the Supreme Court had drafted an opinion overturning Roe v. Wade, the American College of Obstetricians and Gynecologists released its own statement. It said, in part, "We will continue to affirm that the ability of patients to access safe, legal abortion is critical for their health and well-being." Other medical groups and professionals, including the World Health Organization, later echoed the sentiment.
Staunch solidarity from the medical community on a hot-button issue such as this? Perhaps that's a surprise, especially for those who think the crusade against abortions is all about preserving the life of the unborn. But to many obstetrician-gynecologists and other health providers, that misses the point entirely.
"I think it's important to center on the fact that pregnancy is dangerous," says Dr. Sarah Prager, a UW Medicine obstetrics and gynecology professor. Purely looking at things from the perspective of patient health, "abortion is always safer than continuing a pregnancy."
That may seem jarring, but the data backs up the sentiment. Prior to the advent of modern medicine, about 1 in 5 people died from pregnancy- or childbirth-related causes. Though that number has dropped steeply in recent decades, it's still an issue of concern. In 2017, the WHO reported that more than 800 people died each day during pregnancy or from childbirth.
It affects, in particular, low-income populations and communities of color who have limited access to quality maternity care. But even wealth isn't a guarantee of a safe pregnancy. The United States, one of the richest countries in the world, comes last among industrialized nations in maternal mortality ratios, according to the Commonwealth Fund. Black people living in the U.S. are 2.5 times more likely to die from maternity-related causes than their white counterparts.
Whether you decide to pursue a pregnancy or have an abortion is all about your risk tolerance, Prager says. "How much risk is too much risk? Is it a 50 percent chance of dying? Is it a 75 percent chance of dying? And who gets to make that decision?"
Aside from the well-being of the pregnant patient, Prager adds that the effects of maternal mortality or unwanted pregnancies ripples out to the health of family members. It may show up in less obvious ways—lost child care, lost wages, declining mental health, a lower quality of life—but it all leads back to the same thing. "It has significant impacts on the health and well-being of our entire society."
As for the protection of fetal life, one of the top anti-abortion talking points, Prager calls it "an incredibly clever deflection." It's not that the people choosing or performing abortions negate the potential value of fetal life, she says, it's that the "value should only be ascribed by the person carrying that life because there is zero way for that life to exist outside of that person's body, at least until significantly late in pregnancy."
According to the Centers for Disease Control's 2019 statistics on abortion, 92.7 percent of abortions were performed at or before 13 weeks gestation and 6.2 percent were performed between 14–20 weeks. Only 1 percent were performed at or after 21 weeks. With first-rate medical technology, Prager says, the earliest gestational age viable outside the womb is around 23 weeks—but that number is more like 28–30 weeks in less well-resourced communities and countries.
A 2018 report released by the National Academies of Science, Engineering, and Medicine stated, "abortion-specific regulations in many states create barriers to safe and effective care."
Prager is more direct: "Anti-abortion laws, just like anti-contraception laws, are always phrased as protecting women and protecting women's health, and even sometimes protecting women from the decisions that they make.... Those arguments are really, really false and they're incredibly disingenuous. What they show, in my opinion, is the unbelievable sexism and racism...at the root of controlling people's bodies."