Abortion Laws: Impacting Healthcare, Changing Lives

Abortion laws have a direct impact on healthcare access and outcomes, particularly for women. Restricting access to safe and legal abortions does not reduce the number of abortions but instead pushes women to seek unsafe alternatives, risking their lives and health. Unsafe abortions are the third leading cause of preventable maternal deaths worldwide and result in millions of disabilities, according to the World Health Organization. Abortion restrictions also disproportionately affect marginalised communities, people of colour, and those with low incomes, who already face barriers to accessing healthcare services. The criminalisation of abortion and the enactment of restrictive laws have far-reaching consequences, including increased maternal mortality and morbidity, negative health outcomes, and violations of human rights.

The impact on maternal mortality rates

Abortion laws have a direct impact on maternal mortality rates. When abortions are restricted, women are compelled to seek out unsafe alternatives, which can lead to fatal consequences. According to the World Health Organization, 23,000 women die from unsafe abortions each year, and tens of thousands more experience significant health complications. Unsafe abortions are the third leading cause of preventable maternal deaths worldwide and result in about five million preventable disabilities.

In the United States, the risk of maternal death is 15 times higher for carrying a pregnancy to term than for abortion, and pregnancy-related complications are 2 to 25 times higher for pregnancies ending in birth compared to abortion. Restricting access to abortion care disproportionately affects Black women, who are three times more likely than white women to die from pregnancy-related complications.

The legalization of abortion nearly 50 years ago set an important international precedent. However, with the recent overturning of Roe v. Wade, abortion has been banned in several US states, and more states are seeking to further restrict access. As a result, millions of people are forced to travel to receive legal abortion care, which is often impossible due to financial and logistical barriers.

The impact of abortion restrictions on maternal mortality rates is evident in the varying rates between states with supportive and restrictive abortion laws. In restrictive states, maternal mortality rates can be twice as high, indicating that these laws undermine the delivery of basic healthcare services.

The negative consequences of abortion restrictions on maternal mortality are further exacerbated by the lack of access to community-based models of care, such as birthing centers, doulas, and midwives. Additionally, the closure of clinics that provide reproductive care, due to absolute restrictions, places many low-income women at risk of limited access to a wide range of reproductive and women's health services.

The effect on access to safe abortions

Abortion laws have a direct impact on access to safe abortions. In places where abortion is legal and accessible, and there is less stigma, people can obtain abortions safely and without risk. However, in places where abortion is stigmatised, criminalised, or restricted, people are forced to resort to unsafe abortions, which can lead to fatal consequences such as maternal deaths and disabilities.

The criminalisation of abortion has a compounding impact on those who are already marginalised. Health services are generally less accessible to people with low incomes, refugees, migrants, LGBTI+ people, and racialised and Indigenous people. This means it is more difficult for some people to seek safe services in another country or access private care.

The World Health Organization (WHO) has recognised that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being". Restricting women's access to safe and legal abortion services has important negative health implications. These laws do not result in fewer abortions but instead compel women to risk their lives and health by seeking out unsafe, illegal abortions.

According to the WHO, almost every death and injury from unsafe abortions is preventable. When access to abortion is restricted or criminalised, pregnant people, particularly those from marginalised communities who cannot afford to travel or seek private care, may resort to unsafe, clandestine abortions. Unsafe abortions are the third leading cause of preventable maternal deaths worldwide and are also responsible for five million largely preventable disabilities, according to the WHO.

In the United States, the legal framework is increasingly limiting access to abortion. Even while Roe v. Wade was in place, many people were unable to receive abortion care. If Roe v. Wade is overturned, abortion will remain legal in 21 states and could be immediately prohibited in 24 states and three territories. Millions of people would be forced to travel to receive legal abortion care, which would be impossible for many due to financial and logistical reasons.

The impact of abortion laws on access to safe abortions is clear. Restrictive laws and criminalisation of abortion push people towards unsafe and illegal abortions, leading to negative health outcomes and even deaths.

The influence on healthcare worker retention

Abortion laws have a significant impact on healthcare worker retention, with restrictive laws leading to increased workload, stress, and burnout among providers.

Increased workload and stress

Restrictive abortion laws often result in a reduction in the number of healthcare providers offering abortion services, either due to personal opposition or fear of criminal prosecution. This leads to an increased workload for those providers who continue to offer these services, as they must treat a larger number of patients. In addition, restrictive laws can make it more difficult for patients to access abortion services, leading to delays in care and increased administrative burdens for providers.

Fear of criminal prosecution

Healthcare providers in states with restrictive abortion laws may face genuine risk of criminal prosecution if they are found to be in violation of the law. This can create a "chilling effect," deterring providers from offering abortion services even when they are legally permitted to do so. This further reduces the number of providers offering these services and increases the workload and stress on those who do.

Ethical and moral dilemmas

Healthcare providers may also face ethical and moral dilemmas when navigating restrictive abortion laws, particularly when the laws conflict with their professional ethical responsibilities. For example, providers may be forced to deny care to patients who do not meet the narrow exceptions allowed by the law, even when they believe that an abortion is in the best interest of the patient's health. This can lead to feelings of moral distress and conflict between their personal values and the legal restrictions they must navigate.

Impact on training and education

Restrictive abortion laws can also impact the training and education of healthcare workers. With abortion services becoming more limited, there may be fewer opportunities for residents and students to receive training in abortion care, particularly in states with restrictive laws. This could result in a lack of qualified providers and further contribute to the increased workload and stress on existing providers.

Impact on retention

The combination of increased workload, stress, fear of prosecution, and ethical dilemmas can lead to high rates of burnout and turnover among healthcare workers, particularly in states with restrictive abortion laws. Providers may choose to relocate to states with more supportive laws or leave the field altogether, further reducing the number of qualified providers and impacting the quality of care for patients.

Strategies for retention

To improve retention rates, it is essential to address the underlying factors contributing to the increased workload and stress on healthcare workers. This may include expanding the number of qualified providers by offering more comprehensive training and education, as well as providing supportive policies and resources to help providers navigate the ethical and legal complexities of abortion care. Additionally, destigmatizing abortion and improving access to care can help reduce the administrative burdens and delays that contribute to the increased workload.

The consequences for the cost of healthcare

Abortion laws have a significant impact on the cost of healthcare. In countries where abortion is restricted, women often have to resort to the informal health sector, and the procedures are often performed in unsafe conditions, leading to complications that require hospital care. The treatment of these complications can result in high expenses for women, with the cost of abortion and post-abortion care ranging from $23 to $564 per patient. In some cases, the costs can be catastrophic, consuming up to 15% of the gross domestic product per capita. This can force households to reduce consumption, deplete savings, borrow money at high-interest rates, or sell assets.

The cost of abortion and post-abortion care also varies depending on the type of abortion. Women with induced abortions tend to pay more than those with spontaneous abortions, as they have to cover the cost of the procedure and the treatment of complications. This can place a significant financial burden on women, especially those from low-income households.

In the United States, the cost of an abortion can range from $0 to $3,700, depending on factors such as insurance status, geography, and the type of abortion. The restriction of abortion access can lead to increased financial burdens for women, as they may have to travel long distances to receive legal abortion care. Additionally, women denied abortions are more likely to experience economic hardship and insecurity.

The impact of abortion laws on healthcare costs is not limited to direct medical expenses. In countries with restrictive abortion laws, there may be a decrease in investments in training and employing reproductive healthcare providers. This can result in a lack of providers who are trained in reproductive health procedures, which are necessary to save women's lives or in the aftermath of trauma or assault.

Furthermore, restrictive abortion laws can deepen existing inequities in access to reproductive health services, particularly for low-income women and women of color. These groups are more likely to be uninsured and have inadequate wages or employer-based coverage, making it difficult for them to afford the cost of abortion and post-abortion care.

Overall, abortion laws have significant consequences for the cost of healthcare. Restrictive abortion laws can increase financial burdens on women, deepen existing inequities, and impact the availability of trained reproductive healthcare providers.

The effect on the quality of healthcare

Abortion laws will have a significant impact on the quality of healthcare. The World Health Organization (WHO) has recognised that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being".

Restricting access to safe and legal abortions has negative health implications. It does not result in fewer abortions but instead compels women to risk their lives and health by seeking out unsafe alternatives. According to the WHO, 23,000 women die from unsafe abortions each year, and tens of thousands more experience significant health complications globally. Unsafe abortions are the third leading cause of preventable maternal deaths worldwide and cause five million largely preventable disabilities.

In the United States, the criminalisation of abortion has disproportionately impacted women of colour and those from marginalised communities. The risk of maternal death is 15 times higher for carrying a pregnancy to term than for abortion, and pregnancy-related complications are 2 to 25 times higher for pregnancies ending in birth compared to abortion. Restricting abortion access will worsen existing disparities in access to quality reproductive health care, as Black women are three times, and Hispanic women twice, as likely to seek abortions than white women.

Abortion laws also affect the quality of healthcare by limiting the availability of abortion providers. Physicians in states that ban abortion must contend with "risk management committees" that determine whether an abortion is warranted in an urgent healthcare situation, and they face the risk of criminal prosecution. This environment makes it harder for hospitals in these states to attract and retain obstetricians and gynecologists, and raises questions about the future of training for these specialties.

Furthermore, abortion restrictions can result in delays in accessing abortion care, increased financial costs, travel time and associated costs, waiting times, additional clinic visits, emotional distress, and undesired surgical interventions. These barriers particularly affect marginalised women and those in rural areas, further limiting their access to quality healthcare.

Frequently asked questions