How repealing Roe v Wade in the US will lead to more women’s deaths

A large body of evidence shows that restricting access to abortion doesn’t reduce the number of abortions, only increases the risk of death for those who need them

By Dana G. Smith

Abortion rights protestors outside the US Supreme Court

Shutterstock / Rena Schild

A leaked US Supreme Court opinion draft suggests the nation’s highest court is on the verge of overturning Roe v Wade, the seminal 1973 ruling that protects the right to abortion in the country. The draft written by Samuel Alito, one of the court justices, was published by the news site Politico on 2 May. If – or as many now believe in the wake of this leak, when – the ruling is repealed, the consequences for women’s health will be dire.

Research shows that making abortion illegal doesn’t reduce the number of abortions performed. In fact, countries with more restrictive laws actually have higher abortion rates than countries where abortion is widely available, according to a 2009 study by researchers at Brigham and Women’s Hospital in Boston. What laws that restrict abortion do instead is substantially increase the risk of death for the people who receive them. The same study reported that abortion-related deaths are 34 times higher in countries with restrictive abortion laws.

When performed properly, an abortion, either through medication or surgery, is one of the safest gynaecological procedures – much safer than childbirth. The most recent figures from the US Centers for Disease Control and Prevention (CDC) show that in the US there are 0.41 deaths per 100,000 legal abortions compared with 23.8 deaths per 100,000 live births.

However, when abortions are performed in unsanitary conditions or by untrained providers, they can be deadly. According to the 2009 study, 68,000 women die worldwide from unsafe abortions every year, primarily from haemorrhage and infection, and another 5 million have long-term health complications from these procedures.

Risks of unwanted pregnancies

Pregnancy and childbirth in and of themselves can be debilitating and even deadly. In 2020, 861 women in the US died of causes related to pregnancy or childbirth. Perinatal medical conditions like preeclampsia and gestational diabetes affect between 6 and 8 per cent of pregnant people, and developing these conditions during pregnancy increases the likelihood of high blood pressure and diabetes later in life.

Black women in the US are especially at risk for pregnancy-related complications: their maternal mortality rates are nearly three times higher than those of white women, according to the CDC. If people are forced to give birth, they will also be forced to face these risks.

Limiting access to abortion can cause emotional distress, too. A survey of 956 women in the US who sought an abortion found that those who were denied the procedure had higher rates of anxiety, lower life satisfaction and lower self-esteem in the following weeks than women who received an abortion.

Another consequence of restricted access to abortion is the negative impact on the children born from unwanted pregnancies. According to the American Psychological Association, “unwanted pregnancy has been associated with deficits to the subsequent child’s cognitive, emotional and social processes. These children are more likely to experience negative long-term outcomes in adulthood, such as an increased likelihood of engaging in criminal behavior, dependency on public assistance, and having an unstable marriage.”

What happens next?

The US Supreme Court hasn’t yet officially ruled to overturn the decision protecting the right to abortion in the country. The leaked document was an early draft of a majority opinion, and an official decision is expected by June. People who need an abortion now can still receive one.

Should Roe v Wade be repealed, it won’t make it illegal to have an abortion in the US as a whole, but some states will ban it. The Supreme Court draft decision comes on the heels of the highest number of state-level abortion restrictions made into law in a single year.

Thirteen states have so-called trigger laws ready that would effectively ban all abortions as soon as Roe v Wade is overturned. Another nine states have existing laws banning abortion that became unenforceable when Roe v Wade was passed but that will likely go back into effect if it is repealed. The reproductive rights research group the Guttmacher Institute says that 26 states would probably ban abortion if Roe is overturned.

The result would be that access to safe abortion will depend on geography and resources, putting the most disadvantaged at even greater risk.

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