Just over a year ago, the
In a nation that already holds the record for the highest maternal mortality rate among Western countries, the U.S. is by no means the safest place to give birth. In fact, the U.S. Department of Health and Human Services declared its maternal death rates a public health crisis years ago — one the U.S. does not seem prepared to solve anytime soon.
The absence of
Read more:
"Pregnancy is not safe in this country," says Dr. Jacobson. "Abortion care is part of reproductive healthcare. It's not a separate issue."
Healthcare without abortion care
Abortion is banned or restricted by 20 states, with 15 states declaring abortion illegal under nearly all circumstances. In other words, doctors can no longer treat their patients according to their judgment, but rather the non-medical judgment of the state legislature, underlines Dr. Jacobson. For example, in Texas, the patient has to be experiencing a life-threatening emergency to be eligible for an abortion. However, it's unclear what constitutes an emergency. One lawsuit against the state provided protections in cases of serious pregnancy complications, but the state appealed the ruling just 12 hours after its release.
Only last month, Texas made it legal for a physician to terminate a pregnancy if the patient's water broke too early for the fetus to survive. In total-ban states, there is little flexibility for physicians to save their patient's life, with doctors potentially risking felony charges and lifetime prison sentences.
Read more:
"[Physicians] are afraid to practice," says Dr. Jacobson. "Let's say a patient is miscarrying, but there's still a fetal heartbeat. They won't intervene because they're concerned about getting arrested. The relationship between the patient and [doctors] has been violated by these laws."
Vulnerable populations are hit hard
According to the CDC, 60% of women who seek abortions are already moms and, according to the Guttmacher Institute, 75% are considered low-income. .
"This disproportionately impacts people who are already the most vulnerable," says Dr. Neel Shah, chief medical officer at Maven, a virtual clinic for women and family healthcare."That includes people who are living at the intersection of gender inequity, racial inequity and geographic inequity — primarily women of color in the southern part of the country."
Notably, Black women are more thantwo times more likely to die from childbirth than white women in the U.S., making it that much more dangerous to have limited access to abortion care. And despite Black women only representing 12.8% of the U.S. population, they account for 22.3% of women in poverty. If they live in a state with an abortion ban, states that already suffered from poor access to reproductive healthcare, what are the chances they get the care they need? Dr. Jacobson is haunted by that question.
Read more:
"As we reduce our rights, it affects the people who can't afford to miss work, who don't have a car, who can't drive 500 miles to access care," she says. "Maybe they'll try to terminate some other way."
At the start of the year, in the medical journal Trauma Surgery and Acute Care Open, 17 experts from medical centers and universities across the U.S. warned surgeons to prepare to treat patients suffering from complications inflicted by self-managed abortions. It's not surprising that the University of Colorado Boulder predicts a 24% increase in the U.S. maternal mortality rates following widespread abortion bans.
Employers' role in maternal and family healthcare
It's difficult to consider there could even be a silver lining under these circumstances, but Dr. Shah does point out a sliver of hope: there is much more interest and engagement around discussions of women and family health, especially in the employer space.
"Around a decade ago, when our founder started Maven, it was a little bit of an uphill battle to make the case that this is a population in need of more care and support," says Dr. Shah. "But now employers are thinking more broadly about women's health, access to family-building services like fertility care, and serving women through their menopause journey."
Dr. Shah notes that women's health has become as prominent as mental health in the benefits space, with the threat to reproductive healthcare forcing many employers to reevaluate whether their health benefits truly have the capacity to save lives and safely build families.
When Roe v. Wade was overturned, many companies like Amazon, Apple, Buzzfeed, CVS Health, Goldman Sachs, Indeed.com and Warner Brothers Entertainment announced they would provide financial assistance to any employee who has to travel out of state for an abortion — but Dr. Jacobson warns employers that this only one small part of the equation.
Read more:
If someone wishes to terminate their pregnancy, then employers must ensure they are offering paid time off and anonymity in addition to a travel stipend. Dr. Jacobson suggests employers find a third-party provider to facilitate travel, funds and information so the employer does not hold a record of employees who sought abortion care, nor be held liable for potentially breaking state laws.
As for those who wish to continue their pregnancies, they need help too.
"Give employees access to prenatal care, access to midwives and doulas, or some support team that can help them through their pregnancy," says Dr. Jacobson. "Give employees access to mental health services and therapy. One of the most common complications in pregnancy is perinatal anxiety and depressive symptoms."
Dr. Shah reminds employers to make sure they work with a benefits partner they trust to navigate the complexities of U.S. abortion laws and inequities surrounding family-planning and healthcare. At the end of the day, healthcare is a business in the U.S., and employers have to be wary, says Dr. Shah.
"This is an industry where there's a lot of people who see opportunities to make money, and there are a lot of potentially misaligned incentives," he says. "Find a trustworthy partner that has a true north."
Underrated benefits in the family health space
Dr. Shah and Dr. Jacobson agree that certain aspects of the family-building and pregnancy journey go ignored or undervalued. For example, in some cases future parents shouldn't necessarily go straight to IVF if they are having trouble getting pregnant, underlines Dr. Shah.
Read more:
"Maven provides conception coaching so we can help people track their fertility window and optimize their health or their partner's health," he says. "We treat people with irregular or painful cycles, like [patients] with endometriosis or polycystic ovary syndrome. Sometimes what people actually need is a $5 thyroid medication, as opposed to a $25,000 IVF cycle."
For Dr. Shah, good family health benefits offer the shortest pathway to a healthy baby, given the patient's circumstances. Traditional fertility benefits may leave pathways like conception coaching out.
Dr. Jacobson asks employers to ensure employees are incentivized to receive postpartum care through paid parental leave and continued guidance from their pregnancy support teams.
"A postpartum visit is a time when we obstetricians review any risk the patient can prevent," she says. "If you had a history of preeclampsia during the pregnancy, your risk of stroke is higher down the line. This is a time for education, but oftentimes once parents become parents, they take care of their child, and they don't take care of themselves."
Looking ahead
Both Dr. Shah and Dr. Jacobson are optimistic about the future of abortion care, even if it seems bleak now. Over 60% of Americans believe abortion should be legal in all or most cases, according to the Pew Research Center. As employers continue to invest in women's health, and voters push back on anti-abortion laws in their own states, there's a chance to turn the tide around, says Dr. Shah.
The question is whether lawmakers will listen.
"We have a minority promoting an agenda counter to what the majority wants," says Dr. Jacobson. "But at some point, the people are going to speak, and they're going to be heard."
