Yes, Women Will Die After Roe–From Pregnancy

Illustration: Rebecca Fassola

On Friday, a Missouri man was sentenced to life in prison without parole for murdering his wife, Jennifer. Beau Rothwell admitted to killing her in 2019 following a heated argument about his affair with another woman. Jennifer was six weeks pregnant. Police said that, before she went missing, she searched on her cell phone: “what to do if your husband is upset you are pregnant.”

The horrific case highlights how pregnancy is a risk to the lives of women and pregnant people. Untreated miscarriages, dangerous deliveries, and other pregnancy-related health problems contribute to a shockingly high maternal mortality rate in the U.S. This mortality rate doesn’t even take into account homicide: Pregnant women are more likely to be killed, often at the hands of an intimate partner, than they are to die of health problems in America. Jennifer’s death is far from an isolated incident.

After the Supreme Court overturned Roe v. Wade, letting states ban abortion, the risk of people dying because they are pregnant only stands to grow.

There’s been much discussion of the pre-Roe days when people died after unsafe, illegal abortions. Women will die from back-alley abortions, some activists warned after Roe fell last month. Coat hangers are back, their imagery suggested. Unsafe, illegal abortions will—tragically, horribly—still happen, but thanks to safe and effective abortion pills, people will be less likely to seek them out than they were before 1973. The more pressing concern, experts and advocates say, is that women and pregnant people in the U.S. will die from homicide, the physical toll of pregnancy, and being denied emergency care in hospitals—the factors that were already killing pregnant people, only now, more people will be forced to stay pregnant.

“People are gonna get hurt. I think that we are going to see people die and have terrible outcomes from this,” said Nisha Verma, an OB/GYN in Georgia and a fellow with Physicians for Reproductive Health.

Make no mistake: More pregnant women will die without Roe, because in the U.S. we don’t value their lives.

Domestic Violence

“Pregnancy is one of the riskiest times for pregnancy-capable people,” Verma told Jezebel, because intimate partner violence can either worsen during pregnancy or emerge for the first time. Verma said she’s done abortions for people in abusive relationships who would have wanted to continue the pregnancy if it felt safe to do so. She also noted that the landmark Turnaway Study found that people denied abortions were more likely to stay in contact with their violent male partners than people who got an abortion. “It’s definitely a concern that people will be forced to continue pregnancies that put them at risk of escalating violence, or will continue to be forced to be tied to that person.”

Healthcare providers need more training on identifying when their patients are experiencing intimate partner violence and helping them access potentially life-saving services, said Alise Powell, senior policy analyst at the National Birth Equity Collaborative.

“Homicide is the leading cause of pregnancy-related deaths, yet it’s not talked about often in the maternal mortality crisis discussion,” Powell told Jezebel in a statement. Case in point, the CDC does not count homicide when it tallies the U.S.’s nationwide maternal mortality rate. “Now more than before, we need to have more discussions about violence before, during, and after pregnancy.”

“Childbirth is, from what we’ve seen, about 14 times riskier than having an abortion.”

Staying silent on the issue—kind of like the CDC does by neglecting to include homicide—endangers people’s lives. “We can start by shifting power to community organizations and community leaders to resolve violence in the way they see fit, and move away from the idea that law enforcement involvement is the only means to deal with violence,” Powell said. As the police have proven again and again, it’s often unsafe for Black people and other people of color to call them to intervene during a crisis.

Abortion bans will embolden abusers because they know it will be harder for their partner to end the pregnancy. This puts survivors’ lives at risk not only from abuse, but from the pregnancy itself.

Maternal Mortality

Abortion is very safe. Giving birth, less so. “Childbirth is, from what we’ve seen, about 14 times riskier than having an abortion,” Verma said. “And when you think about just, more people carrying pregnancies to term and delivering, there’s risk in that.” More people will die from pregnancy simply because more people will be forced into delivery rooms. And for every woman who dies from pregnancy or childbirth, another 70 people come close. That translates to more than 50,000 people a year almost dying because they had children. Many people in abortion-hostile states will have no choice but to play those odds.

Verma worries especially about people with high-risk pregnancies, including those with high blood pressure, which can become dangerous. “If someone chooses to continue their pregnancy, knowing they have a high-risk condition, that is completely fine and we are all there to support them and to optimize their health. But in many cases, it’s not even a choice,” she said, because they can’t access an abortion. “And that’s just going to get worse and worse.”

People with wanted pregnancies accept these risks, but it’s a different story when the state is forcing someone to give birth. Some anti-abortion politicians don’t seem to grasp this concept. As Sen. Roger Marshall (R-Kansas), also astoundingly an OB/GYN, said during a hearing on abortion Wednesday, “Members will imply today that carrying a baby to term is more dangerous than an abortion. So, using their logic, should we abort every baby? Should we stop all childbearing?” It’s a ludicrous statement meant to paint pro-choice people as extreme when in reality, what is extreme is forcing someone who doesn’t want to be pregnant to assume all the risks of pregnancy and childbirth.

Powell pointed out that maternal health outcomes in the U.S. are worsening at an “alarming rate” and the health risks of an increase in forced pregnancies will continue to fall on Black women and other marginalized people. “Many of those that die from not receiving the health care they need will be Black, brown, and Indigenous people, gender expansive and non-binary people, young people, disabled people, and low-income individuals,” she said.

Racism in the healthcare system hasn’t ended just because Roe is gone.

Chronic Conditions

If a pregnancy itself doesn’t kill (or almost kill) someone, it could interrupt care for other conditions, creating long-term effects on people’s health.

Verma said she had a patient who was thrilled to get pregnant before she was diagnosed with a rare form of cancer. The patient had to have an abortion in order to start chemotherapy to maximize her survival. “If that patient couldn’t get her chemotherapy because she’s forced to continue her pregnancy, she’s not going to die in that moment, but she probably will die much sooner. Maybe significantly sooner, decades sooner,” Verma said.

We may also see pregnant people denied life-saving antidepressants because the drugs could impact the fetus. It’s just another example of how fetal personhood prioritizes potential life over the existence of the person carrying that potential life. If she dies, so what?

Verma said we should be alarmed not only by people dying during and soon after pregnancy, but by the healthy years in anyone’s life shortened unnecessarily by abortion bans.

Medical Emergencies

When people say women will die from illegal abortions, they miss the more immediate danger: Women will die from staying pregnant.

Some well-meaning activists and lawmakers have invoked coat hangers to refer to the dangers of illegal abortions before Roe, when hospital wards treated women with sepsis following unsafe procedures. But thanks to the availability of highly effective, FDA-approved abortion pills, even in hostile states, the risks of self-managed abortions are mostly criminal, not medical.

“When people have access to information, resources, and support, self-managed abortion [with pills] is safe,” Powell said. “Symbols like the coat hanger create the false impression that abortion is unsafe and in need of regulation, which can lead to surveillance and criminalization.”

“Abortion is absolutely lifesaving.”

Women and pregnant people will still be in hospitals with sepsis—it’s just much more likely to be because hospital lawyers are too scared by criminal abortion bans to let doctors treat them for miscarriages, stillbirths, and life-threatening ectopic pregnancies. (Some of those incomplete miscarriages could be from failed medication abortions, which does happen, but rarely.) In September 2021, a Texas hospital turned away a woman with an ectopic pregnancy because of the state’s six-week abortion ban. The woman had to drive more than 12 hours to New Mexico to get care and could have died.

This is such a concern that, on Monday, the Biden administration released guidance reminding hospitals that they must perform abortions if a pregnancy threatens a woman’s life, regardless of state law. The guidance cites the 1986 Emergency Medical Treatment and Labor Act, or EMTALA. Still, enforcing that law won’t solve the problem entirely as hospitals will interpret it differently.

Some anti-abortion activists, pundits, and even bioethicists are waving ectopic and miscarriage concerns away as ridiculous fear-mongering. They’d say abortion bans have life-endangerment exceptions, abortion is a dangerous and immoral procedure, people have delayed cancer treatment and survived, and Jennifer Rothwell’s murder was an unfathomable tragedy. Don’t fall for it, Verma said. Pregnancy puts vulnerable people in danger.

“For some people [abortion] is a preventive measure to help them maintain their health, and for some people it is acute health care where someone is at a immediate or near-immediate risk,” Verma said, adding, “Abortion is absolutely lifesaving.”

That means when abortion is banned, deaths from pregnancy will follow.