A study published last week by Tulane University researchers found that people living in areas lacking both abortion and maternity health care were more likely to give birth prematurely than those with more reproductive health services.
While previous studies have documented adverse birth outcomes for those who live far from abortion clinics or obstetric care, the new study looks at those two measures in conjunction with each other, said Maeve Wallace, an epidemiologist at Tulane and one of the study’s authors.
The researchers mapped the locations of all live U.S. births that occurred in 2020 by county. They classified each county by having full reproductive care, some reproductive care, or no reproductive care. They found that people without access to reproductive health care were 10% more likely to experience preterm birth than people with greater access to care.
In Louisiana, though, researchers found that people in parishes with full access to reproductive care and no access to reproductive care both experienced preterm birth about 14% of the time, compared to 12% for those living in parishes with some access to care.
According to Wallace, that’s likely because places where Louisianians have more access to this health care are in the state’s majority-Black urban centers, where racial and economic factors may outweigh the risks of living far distances from reproductive care.
Louisiana’s three “full access” parishes, where people could more readily visit an OB-GYN or obtain an abortion, were in urban, majority-Black centers: New Orleans, Baton Rouge and Shreveport.
Other factors — like income inequality, police violence and poor housing quality — that have been shown to disproportionately impact Black people could also affect health outcomes in these parishes, Wallace said.
Louisiana has some of the highest rates of preterm birth, maternal and infant mortality in the country. The health crisis particularly harms Black women, who are four times more likely to die from pregnancy complications than their white counterparts.
Previous studies have also found that Louisianians residing in maternity care deserts face adverse outcomes. In 2016 and 2017, they were almost twice as likely to die from pregnancy complications than those with greater access to care.
‘An attack on women’
The new study drew on definitions from the maternal health nonprofit March of Dimes to categorize counties by the level of maternal care access. Counties without any hospitals or birth centers offering maternal care were deemed maternal health deserts, those with more than two places offering maternal care were deemed full access regions, and those in the middle were classified as having low or moderate access to care. Researchers also factored in the number of maternal health providers in a county and the proportion of women without health insurance.
Researchers also put counties in three categories depending on their level of abortion access: abortion care deserts had no abortion clinic within said county or a neighboring one; counties were classified as having limited abortion access if there was an abortion provider in a neighboring county; and they were classified as having full abortion access if they had an abortion provider within the county.
According to the study, there are now no parishes in Louisiana that have “full access” to reproductive health care — places that have both abortion and maternal health care. The ban on abortion that went into effect last year shut down the state’s three remaining abortion clinics. But the study found that in 2020, when abortion was legal yet still restricted, rates of preterm birth in Louisiana were higher than the national average no matter how much access people had to reproductive health care.
The study uses data recorded before the U.S. Supreme Court overturned the constitutional right to abortion. Authors of the report believe their findings still have present-day public health implications, given that access to reproductive health services has only decreased since then.
Following the end of Roe v. Wade, abortion has been banned after conception or six weeks in 16 states. Wallace anticipates that this will lead to a nationwide increase in preterm birth rates, as more births occur in reproductive care deserts.
“Persons continuing a pregnancy—by choice or by necessity—may experience delayed and inadequate prenatal care or adverse reproductive health outcomes as a result,” the study’s authors wrote.
Meg Autry, a San Francisco-based OB-GYN working towards opening a floating abortion clinic in the Gulf South who reviewed the study, noted that abortion restrictions have also limited doctors’ capacity to provide medical care in medically futile and ectopic pregnancies.
“The overlap of reproductive rights restrictions and pediatric and maternal outcomes is not surprising,” Autry said.
In May, Louisiana Republicans shut down two bills in the state legislature that would have clarified medical language to allow abortions in the case of nonviable pregnancies. “Despite the fact that they’re dedicated to the community, they’re unable to provide the care that they know is right,” Autry said of doctors.
For Rep. Delisha Boyd, D-New Orleans, the state’s strict abortion ban exacerbates the health risks her constituents face amid Louisiana’s maternal mortality crisis. Carrying a baby to term without receiving the proper health care is a dangerous situation, she said, as is carrying an unintended pregnancy to term under these circumstances.
Last year, she sponsored a bill that would have made exceptions to the state’s abortion ban for cases of rape or incest. The proposed bill is personal for Boyd, who said her mother got pregnant with her after being raped.
“But I’m a baby of the 60s,” she said. “My mother didn’t have a choice.”
Though state Republicans killed the bill in committee, Boyd said she plans to refile the legislation next year.
“It is for me, an attack on women,” she said. “And women should pay attention to what’s going on around them and understand the magnitude of what’s being done to them by men.”
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