Abortion Restrictions Bring New Attention to U.S. Maternal Health Crisis

Maternal mortality is higher in the United States than in most developed countries and has actually increased over the past 20 years. Research shows the 2022 Dobbs v. Jackson Women's Health Organization decision, in which the U.S. Supreme Court removed federal protections for abortion, has made the country's maternal healthcare crisis even worse. Business leaders can take two steps to help resolve it: They can advocate for new federal laws guaranteeing abortion rights, and they can support holistic healthcare policies for women in all stages of maternal care. Or, they can continue not taking women’s lives seriously.

The maternal care crisis predates Dobbs

In terms of mortality outcomes for pregnant people, the U.S. has long earned a notorious reputation among its peer nations.

“The United States continues to have the highest rate of maternal deaths of any high-income nation,” according to a survey by the healthcare advocacy organization Commonwealth Fund. The report emphasized that Black women are by far the most vulnerable group in the U.S.

The survey covered 2022, the latest full year of available statistics and before the full impact of Dobbs occurred. Even without the full impact, the U.S. record on maternal mortality was abysmal. The U.S. recorded 22 maternal deaths for every 100,000 live births in 2022, while half of the other countries surveyed recorded fewer than five, according to the report. The U.S. figure was also up to three times higher than the remaining half.

Almost 66 percent of maternal deaths in the U.S. took place within the six-week period following childbirth, indicating a lethal shortfall in access to postpartum care, according to the report.

Unequal access to maternity care is also a problem

A closely related matter is access to maternity care, another problem predating the Dobbs decision. 

“Maternity care deserts are counties where there is no access to birthing hospitals, birth centers offering obstetric care or obstetric providers,” according to a report from the March of Dimes, a nonprofit focused on maternal and infant health.

The report emphasizes that “no access” literally means “not a single birthing facility or obstetric clinician” in the whole county. It identified more than 1,104 U.S. counties as maternal care deserts, covering a collective population of more than 2.3 million women of reproductive age. 

“Women living in maternity care deserts and counties with low access to care have poorer health before pregnancy, receive less prenatal care, and experience higher rates of preterm birth,” according to the report.

Texas raises a red flag on abortion rights

With the U.S. maternal care system already held together by bubble gum and baling wire, just one push was needed to send it over the edge. That is exactly what the Dobbs decision did. The Supreme Court empowered conservative state legislators to revive old abortion restrictions and invent new ones.

Texas is often held up as an example of the negative impact of Dobbs on women’s health. Though here, too, maternal care was already in crisis. As of 2022, almost half of Texas counties — 46.5 percent — were maternal care deserts, significantly higher than the national figure of 32.6 percent, according to the March of Dimes report.

In 2021, Texas lawmakers passed new abortion restrictions under Senate Bill 8 (SB8). Some business leaders responded by helping their employees in Texas seek out-of-state care, but the fallout was already in evidence. The maternal death rate in Texas rose by 56 percent from 2019 to 2022, compared to an 11 percent rise nationally, according to the Gender Equity Policy Institute. 

Infant mortality also increased far more in Texas compared to other states the year after SB8 was enacted, according to the Johns Hopkins Bloomberg School of Public Health.

Dobbs is making it worse … for everyone

Against this backdrop, the maternal care system in Texas is feeling the full impact of both SB8 and the Dobbs decision. Over and above the lethal consequences for women and their babies in Texas, the medical workforce is also feeling the effects. That should put business leaders on high alert all over the country as Republican policymakers advocate for a national abortion ban.

In August, the leading healthcare consultancy Manatt released a survey of physicians in Texas regarding the aftermath of SB8 and Dobbs. Almost 76 percent said they “cannot practice medicine according to best practices/evidence-based medicine” under the new legislative environment.

While only 2 percent of those surveyed said they moved out of state to continue their practice, a total of 35 percent said they were thinking about moving, in the process of planning to move, or would like to move but had personal reasons for staying. An additional 20 percent reported retiring early, changing their medical field or leaving medicine entirely.

"Take our lives seriously"

With the prospects of a national abortion ban looming overhead, former First Lady Michelle Obama summed up the dire consequences for women in a passionate, widely reported speech last week. Campaigning with Vice President Kamala Harris, Obama exhorted male voters to put aside any anger they may feel regarding national or personal affairs, and cast their ballots in support of women’s health.

“If we don’t get this election right, your wife, your daughter, your mother, we as women will become collateral damage to your rage,” she said. “I am asking y’all from the core of my being to take our lives seriously.” 

That exhortation also applies to business leaders. Each of them has only one ballot to cast, but many of them have an outsized voice on politics and the national culture.

As of this writing, the outlook for a Kamala Harris administration in 2025 is improving, along with the prospects for a permanent, universal restoration of abortion rights across the U.S. But if business leaders really want to be known for taking women’s lives seriously, they need to start advocating, loudly and forcefully, for a universal health care system that actually places a priority on protecting women’s lives.