‘More than a ship’: North Carolina doctors raise red flags over realities of a post-Roe world

North Carolina obstetricians and gynecologists are concerned about the burden tighter restrictions on abortion could have on women as well as the medical profession.

Dr. Jonas Swartz

Dr. Jonas Swartz is an Assistant Professor in the Department of Obstetrics and Gynecology at Duke University and a researcher on reproductive health equity issues.

“Abortion is an incredibly safe and effective procedure as practiced across the United States today. It is essential health care and gives people the right to autonomy over their own bodies,” Swartz explained in a Tuesday conference call with reporters. “When I think about the loss of that right, the loss of access to this safe and effective care, it worries me for my patients and it worries me for my children. »

Swartz said that when courts or lawmakers take away the right to a safe and legal abortion, it doesn’t take away abortion. It just means people are trying less safe ways.

“Septic abortion was commonplace before safe and legal abortion was available in the United States. And before Roe vs. Wade, there were entire hospital wards filled with women who had had septic abortions and who had major morbidity and mortality, so when I think about going back to that reality, that would be a really horrific consequence.

One in four women

Dr. Beverly Gray, founder of the Duke Reproductive Health Equity and Advocacy Mobilization team, notes that many women are already living a post-Roe existence.

Dr. Beverly Gray

“We have already seen many patients who have limitations in accessing care based on where they were born, where they live, what type of insurance coverage they have, how much money they saved in the bank,” Gray said.

Gray said lead to research found that when women are denied legal abortion care, they are more likely to live in poverty and more likely to remain attached to an abusive partner.

“There’s a lot of stigma around abortion in our country, so people don’t talk about their abortion. But we do know that by the time women reach menopause, about one in four women will have had an abortion.

Dr. Richard Shannon, chief quality officer at Duke Health, worries about the broad implications that would flow from the Supreme Court’s decision to leave it to each state to determine the future of abortion access.

“The state is taking a demonstrably narrow view when it says, ‘I’m going to control your decision about living for 40 weeks gestation, but oh by the way, after the baby is born, it’s up to you how you take care of it. this.'”

Beyond that argument, Dr. Swartz believes that an abortion ban would further worsen the maternal mortality crisis in the United States.

“If we think of North Carolina, North Carolina has not expanded Medicaid under the Affordable Care Act. That means we routinely see patients reentering the medical system as a pregnancy,” Swartz said. “It’s not a way to optimize disease states. It’s not a way to control chronic disease. It’s not a way to have the healthiest pregnancy. possible.

Swartz said her practice routinely sees patients who make very rational choices about the best time to carry a pregnancy to term. Often this decision is made due to the health of the mother.

“We regularly treat patients who need to focus on their own health, and pregnancy puts that health at significant risk. They must be free to make the choice to terminate the pregnancy in this situation.

Approximately 700 women in the United States die each year from pregnancy or pregnancy-related complications.

As Policy Watch has previously reported, death rates are 3.3 times higher among black women.

“The Ripple Effect”

North Carolina is currently surrounded by states that have “trigger laws” in place. the Supreme Court leak draft and that the Roe decision be overturned, Dr. Gray firmly believes that more women will travel to North Carolina in hopes of finding care.

“We are already seeing an increase in cases due to the ripple effect,” Gray told reporters on Tuesday. “The bans in Texas and Oklahoma influence where these patients can get care, so they go to surrounding states.”

Gray said that as more people come from out of state seeking care, those in the state may experience a delay in care due to access. .

“States are already thinking about how they will care for patients who suffer from serious illnesses and other health complications. I think people are really, really worried about the impacts this is going to have immediately and later.

The future of obstetrics

Dr Richard Shannon

Dr Shannon thinks few politicians have given much thought to what Roe’s end might mean for the availability of antenatal care.

“You could be looking at 600,000 to 800,000 more births per year,” Shannon projected. “We don’t have enough obstetricians and medical care in general to take care of the women who come to see us today.”

Duke Health’s director of quality said that based on the current number of live births per year, the country needs 8,000 more obstetricians today.

“That’s before we consider the impact of 600,000 to 800,000 additional live births.”

And he fears the lack of care will fall disproportionately on rural women.

“Fifty percent of women who live in rural areas are at least 30 minutes away from the nearest antenatal care. So you plan to increase all the constraints on the existing system – a system that today produces the highest maternal mortality rate in the civilized world.

And that pressure will extend beyond today’s medical providers.

“It will influence where some of our top OB-GYN applicants apply for residency,” Gray explained. “For medical students who want to train and have the skills to provide comprehensive OB-GYN care, they will research states that can provide comprehensive OB-GYN care, including abortion care. I really see how this can have a downstream effect.

But as the abortion debate becomes a hot topic during the midterm elections, Dr. Gray ponders access to care for his patients.

“If you have a womb in this country, the rights of potential life that the womb contains seem to be more important than the vessel that carries it. I am more than a vessel. My daughter is more than a vessel. patients I care for in my community are more than vessels.

Lillian L. Pena