How Changes in Abortion Law Could Impact Community Health : Short Wave Depending how the Supreme Court votes on a pending case, Dobbs v. Jackson Women's Health Organization, many pregnant people may lose the right to seek an abortion in their state. Host Emily Kwong talks to research scientist Liza Fuentes about the shifting reality of abortion as health care — and how the states with the greatest restrictions generally invest the least in maternal and children's health.

Today is part two of Emily and Liza's conversation. Listen to part one of Emily and Liza's conversation to hear how abortion is used as a tool to improve public health.

How Changes in Abortion Law Could Impact Community Health

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EMILY KWONG, HOST:

You're listening to SHORT WAVE from NPR.

Hey, SHORT WAVErs. Emily Kwong here. We're picking up our conversation with Liza Fuentes, a senior research scientist at the Guttmacher Institute. Go back and listen to Part I if you missed it, where we discussed how abortion fits into health care and public health. In Part II, we're going to discuss what that actually looks like in practice, a practice that's likely to shift in communities across the U.S. depending on the outcome of a Supreme Court case, Dobbs v. Jackson Women's Health Organization.

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AYESHA RASCOE, BYLINE: It deals with a Mississippi law that shortened the window for abortion from 20 weeks to 15. The Jackson clinic is the only abortion provider in the state.

AUDIE CORNISH, BYLINE: Currently, under the 1973 ruling known as Roe v. Wade, women are guaranteed the right to have an abortion up until fetal viability, the time when a fetus can survive outside the womb, which...

KWONG: And if the court upholds the 15-week Mississippi abortion ban, it erodes the constitutional right to abortion that was established by Roe. Then each state would decide for itself how to regulate abortion access. Liza says this would have an immediate impact on families throughout the U.S.

LIZA FUENTES: The ability to decide if, when and how to have a child is integral to people being able to have - not just realize their health, but that of their families, right? A denied abortion, at the very least, could be economically devastating for a family that's already struggling to make ends meet.

KWONG: Liza's conclusion is supported by research. A five-year study led by Dr. Diana Greene Foster called the Turnaway Study tracked the health and economic outcomes of nearly 1,000 women who sought and were denied abortions.

DIANA GREENE FOSTER: People who become pregnant and are unable to get a safe, legal abortion in their state, those that carry the pregnancy to term will experience long-term physical health and economic harm.

KWONG: Today on the show, the reality of what it means to treat abortion as health care and how those states moving toward stricter abortion laws invest the least in women and children's health. You're listening to SHORT WAVE, the daily science podcast from NPR.

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KWONG: Dr. Fuentes, you co-authored a paper called "A 21st-Century Public Health Approach To Abortion." And I'm wondering if you could describe what it looks like in practice for a health agency to use a public health framework to guide the way they deal with, as described in the paper, abortion-related activities. What does it actually look like to do that?

FUENTES: One of the essential components of public health is that it's a community practice, and people should be able to protect, maintain, better their health where they live, where they work. And so in the past, to facilitate that, public health departments have, for example, run clinics. A lot of people might remember times when departments of health have offered STI testing and treatment. And so we offer a map for public health departments to think about treating abortion as it should be - primary care service of public health importance that, because of the legal landscape and because of socioeconomic inequities, isn't equally available to all people. And by definition, that's where departments of health come in.

KWONG: Liza, let's talk about this Dobbs v. Jackson Women's Health case. In particular, I want to ask you about a paradox that the American Public Health Association and the Guttmacher Institute, among others, point out in an amicus brief to the Supreme Court. I think amicus means, like, friendship, right? They're, like, friends of the...

FUENTES: Yeah, amicus brief - you're a friend of the court.

KWONG: Friend of the court.

FUENTES: Yeah.

KWONG: And it's a document filed by an outside party with knowledge about the case topic. The amicus brief points out this central paradox that 14 states with the nation's most strict abortion laws invest the least in policies and programs of proven importance to women and children's health. Liza, what do you make of that paradox?

FUENTES: It's really disappointing because the power of public policy to promote health and well-being is great. And that paradox calls into question the motivation for restricting abortion, right? Lots of politicians talk about wanting to protect the health and well-being of women and families by restricting abortion, wanting to support mothers in their choice to become a parent. But that's just not consistent or possible if basic social infrastructures are not there to support people, like high-quality prenatal and maternity care. And when you have states that have - not only among the highest maternal and infant mortality rates, but the disparities in those rates, it's simply not consistent to then deny people abortion access when that would force people to take on those risks when they don't want to.

KWONG: Let's name these 14 states that are in this brief - named is Alabama, Arkansas, Indiana, Kansas, Kentucky, Mississippi, Louisiana, Nebraska, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota and Texas. And in discussing these 14 high-restriction abortion states, these states also generally have poorer health outcomes overall compared to states with greater abortion access - public health outcomes. What does that mean for intergenerational health to you?

FUENTES: From a public health perspective, that suggests that it's not just about abortion, that whole communities are suffering, and particularly if they are from communities that experience health disparities across the U.S. - so low-income people, people living with disabilities, Black and brown communities. It means that we're denying people the chance to really live their fullest lives, spend quality time with their families late into their life - you know, all of the basic things that, frankly, everyone wants, and that can be achieved through good public policy. But for political reasons, those things are not being offered. And so just as we've seen the health care system fail Black and brown communities, fail low-income communities, you know, abortion is no different. Certainly, those states that you mentioned, many of them are also states that have failed to expand Medicaid under the Affordable Care Act. They're states that, for that reason, may continue to have high rates of a lack of health insurance.

KWONG: I want to bring up a different amicus brief that argues something very different in the Dobbs v. Jackson case. It was filed by 240 feminist organizations, scholars and activists opposing abortion rights. They argued that abortion does not move us as a society closer to gender equity, and they favor family planning policies that don't include abortion. They say basically it's in society's interest to support pregnancy and the raising of children and that abortion is the opposite of that. As a public health professional, what do you make of that argument?

FUENTES: I mean, it's complete nonsense, and I'll tell you why. First of all, the fact that someone chooses to have an abortion doesn't mean that they're not also a parent, right? It's a false dichotomy that having an abortion means that you're not raising a family. Sixty percent of people seeking abortion care or obtaining abortion care are already mothers. An abortion allows people to plan to have a child when they're ready, when they feel they have the resources and the space to be able to be a good parent. And this other reasoning that abortion doesn't move us closer to gender equity - so much of the ways in which we are able to support people in this country, from education to jobs to who they marry, is about people being able to make the best choice for them, right? So denying somebody the ability to make the best choice for them about their pregnancy simply is not consistent with how we value all the other ways that people build their lives.

KWONG: There's a lot of debate about abortion rights on social media, too. And one of the frequent statements we've been seeing on Team SHORT WAVE is, you know, looking around the world and at other countries, this idea that banning abortion won't end it, that the practice of abortion will continue regardless of what the Supreme Court decides. Is that true?

FUENTES: Yeah. I mean, at Guttmacher Institute, we do the work of estimating abortion rates worldwide, even in countries where it's restricted or illegal. So certainly it is true that when abortion is in a legal context in which it is highly restricted or banned, people will still seek abortion care. That's true. And we certainly can expect that to happen in the United States, for example, if Roe falls.

KWONG: Have you even allowed yourself to think like this fully?

FUENTES: I am, I would say, in a state of grief because in my career, I didn't start out as a scientist. I started out as a person working on a hotline, helping people find the money to get an abortion. And there were many, many times when we just couldn't pull it off, and somebody had to continue a pregnancy. So the reality is is that's already happening in this country. What was the very first abortion restriction? It was the Hyde Amendment saying that federal funds can't be used to cover abortion care through Medicaid. The strategy has been to go after the most vulnerable people first, and it is heartbreaking.

We've done research for decades showing how important it is for people to be able to make decisions about their pregnancies. The good news, though, is that many states have moved to do the opposite - really overtly protect abortion care as part of reproductive health in their state. So I look to the bright side, that even though many people won't be able to get abortion care in their community, so many cities and towns and communities and states and activists are doing all that they can to ensure that people will still be able to get care, no matter what happens after June.

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KWONG: Dr. Fuentes, thank you so much for your time and for this conversation.

FUENTES: Thank you, guys.

KWONG: This episode was produced by Berly McCoy, edited by Rebecca Ramirez and fact-checked by Margaret Cirino. The audio engineer for this episode was Natasha Branch. Gisele Grayson is our senior supervising editor. Andrea Kissack is the head of the science desk. Edith Chapin is vice president and executive editor at large. Terence Samuel is vice president and executive editor. And Nancy Barnes is our senior vice president of news. I'm Emily Kwong. Thanks for listening to SHORT WAVE, the daily science podcast from NPR.

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