Originally published on the PLOS blog.
By guest contributors Laura Fitzgerald, Stephanie Gallagher, Rena Greifinger, and Lyudmila Nepomnyashchiy (WomenLift Health Leadership Journey, US 2021 Cohort)
Take a moment to think about all the people in your life who can get pregnant. Your partner, your child, a parent, friend, coworker, you. With one in four American girls and women under the age of 45 [1] having had an abortion, chances are you or someone you love has had one. As leaders in global health, we are outraged by what we see happening in this country; and terrified of the continued impact it will have here, and on the rest of the world. We are midwives, mothers, policy-influencers, researchers, technical experts, and trauma survivors. We have lived and worked all over the world. We have had abortions and are grateful for them. We can unequivocally state that the devastation caused by the overturning of Roe in the U.S. will reverberate across the world, impacting the lives of people that can get pregnant and all who love them, and we must speak up.
With over 50 countries [2] having liberalized abortion laws since the 1990s, tens of millions of people who can get pregnant in the US will face greater legal restrictions than those in many other countries, including Argentina, Ireland and Benin. Roughly half of US states [3] are likely to ban abortion and include states with already dire maternal health outcomes. In 15 of these states [4], 40% or more of their counties are characterized as ‘maternity deserts’ with no hospitals, birth centers, or other providers offering obstetric care. These states have some of the worst outcomes for women and babies in the country: high rates of women with no prenatal care during the first trimester, high rates of babies born with low birth weights and high rates of children without health insurance. These outcomes disproportionately affect Black women [5] who have always experienced higher maternal mortality and lower life expectancy rates.
Inadequate birth care and lack of access to safe abortion services [6] increases the risk of maternal and infant mortality, and the chances of driving families into poverty [7].
With Roe now overturned, these rates will worsen across the board, most dramatically in those states that will immediately enact bans, but also in those states that will not as they become inundated with patients from elsewhere. And this comes at a time when “the COVID-19 pandemic shuttering women-led businesses, limiting women’s employment opportunities, and increasing the gender gap in unpaid care work.” [8] When people who can get pregnant are stripped of their sexual and reproductive rights, they are not the only ones who suffer. Their children, families, communities, the economy, and our society as a whole suffer too.
It cannot be understated what a profound and irreversible impact the decision will have, not only in the US, but globally as well.
We can look at the impact of the Global Gag rule [9] as one example. This rule, an Executive Order, instated during Republican administrations and most recently rescinded under the Biden administration, prohibits international, non-U.S. organizations that provide safe abortion services or referrals from receiving any U.S. government funding. While we cannot predict with certainty what will happen under future potential Republican administrations, its historical fluctuation according to which party holds the White House compromises care at health clinics across the globe and increases preventable maternal deaths [10]. In some countries, US-supported service delivery points provide a significant percentage of women’s reproductive health care. It is not yet known how the recent Dobbs v. Jackson Women’s Health Organization ruling will impact the protection Roe v. Wade had afforded US global health organizations, which helped fill a critical reproductive health care gap during times when the Global Gag rule was in place. In the near future, US global health organizations, alongside their international counterparts, may have to choose between accepting vital US Government funding or significantly reducing access to safe abortion services, jeopardizing the lives [11] of countless women and girls who may have no other safe option.
For decades, the U.S. has wielded an extraordinary foreign policy influence, including in countries that benefit from its funding for reproductive and maternal health services. The decision to overturn Roe v. Wade will no doubt further negatively impact long standing concerns about the way the U.S. (as the single largest provider of overseas development assistance for global health) [12] delivers aid. While other countries may rightfully reject the US’s global role in moral or political terms, the consequence of its funding policies exert a very real influence on access to essential, life-saving care.
The U.S. must fully recognize that politically-motivated domestic actions have an out-sized, long-term impact on countless human lives well beyond its borders.
It is flat-out wrong for the U.S. to divide along political lines as our women and children and those elsewhere, die. While we believe other countries will continue to step in to fill the gap, we can only hope that this will be a pivotal moment for a more humbled America to emerge.
About the authors:
Laura Fitzgerald is a 2021 US cohort member of the WomenLift Health Leadership Journey. As a certified nurse-midwife and program manager, she brings 20 years of technical and programmatic experience in health systems strengthening, health worker capacity building, nursing and midwifery, reproductive and maternal health, and HIV. Laura has lived in Malawi, Tanzania, Eswatini, Pakistan, and Myanmar and is currently based in the US.
Stephanie Gallagher is a 2021 US cohort member of the WomenLift Health Leadership Journey. She brings nearly 15 years of programmatic and technical assistance experience in mixed health systems and governance, health market development, policy and financing, and private sector engagement. Her experience stems from a range of leadership and technical advisor roles supporting over 20 countries in Africa and Asia on sexual and reproductive health- related issues, including long-acting family planning methods, medication abortion and post-abortion care, and increasing service delivery through the private sector.
Lyudmila Nepomnyashchiy is a 2021 US cohort member of the WomenLift Health Leadership Journey. Mila is a health systems specialist with 15 years of experience collaborating on and leading projects to improve health outcomes for vulnerable populations across public and private sectors. She spent seven years in various roles with the Clinton Health Access Initiative focusing on commodity access related to maternal, newborn and child health, malaria and vaccines with a focus on sub-Saharan Africa.
Rena Greifinger is a 2021 US cohort member of the WomenLift Health Leadership Journey, and an award-winning social entrepreneur, philanthropy leader, and advocate for women and girls. She has spent the last 15 years working with global and US non-profit organizations on sexual and reproductive health and rights, adolescent health, and birth justice. Her current work focuses accelerating gender equity through feminist and experiential approaches to philanthropy.
The authors are writing as individuals and not as representatives of their employers. As such they declare no conflicts of interest.
Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.
References
- Population Group Abortion Rates and Lifetime Incidence of Abortion: United States, 2008–2014. American Journal of Public Health (AJPH). 08 November 2017. Available from: https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.304042
- US Dangerously Out of Step on Abortion Access. Plos Blogs. 26 May 2022. Available from: https://speakingofmedicine.plos.org/2022/05/26/us-dangerously-out-of-step-on-abortion-access/
- 26 States Are Certain or Likely to Ban Abortion Without Roe: Here’s Which Ones and Why. Guttmacher Institute. October 2021. Available from: https://www.guttmacher.org/article/2021/10/26-states-are-certain-or-likely-ban-abortion-without-roe-heres-which-ones-and-why
- Red states aren’t prepared for a post-Roe baby boom. Axios. 24 June 2022. Available from: https://www.axios.com/2022/05/20/abortion-roe-supreme-court-babies-mothers
- CDC: Maternal mortality disparities have worsened. Axios. 23 February 2022. Available from: https://www.axios.com/2022/02/23/us-maternal-mortality-disparities-by-race?campaign_id=118&emc=edit_ptg_20220622&instance_id=64649&nl=jessica-grose-on-parenting®i_id=36428177&segment_id=96425&te=1&user_id=f41f6ba98d5bcd6870a0b48ae7006ff1
- The Turnaway Study. University of California San Francisco. Available from: https://www.ansirh.org/research/ongoing/turnaway-study
- Diana Greene Foster, PhD, M. Antonia Biggs, PhD, Lauren Ralph, PhD, MPH, Caitlin Gerdts, PhD, MHS, Sarah Roberts, DrPH, and M. Maria Glymour, ScD, MS. NIH. March 2018. Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803812/
- To Really Lead on Global Gender Equality, the United States Needs Dedicated, Sustained Leadership. Center for Global Development. 16 June 2022. Available from: https://www.cgdev.org/blog/to-really-lead-global-gender-equality-united-states-needs-dedicated-sustained-leadership?utm_source=20220622&utm_medium=cgd_email&utm_campaign=cgd_weekly
- The Mexico City Policy: An Explainer. 28 January 2021. Available from : https://www.kff.org/global-health-policy/fact-sheet/mexico-city-policy-explainer/
- The Gender Policy Report: Once Again, the Global Gag Rule Increases Maternal Deaths. University of Minnesota. 5 November 2019. Available from: https://genderpolicyreport.umn.edu/global-gag-rule-increases-maternal-deaths/
- Abortion Care Guideline. World Health Organization. 8 March 2022. Available from: https://www.who.int/publications/i/item/9789240039483
- The US is the largest donor to global health. Donor Tracker. Available from: https://donortracker.org/united-states/globalhealth#:~:text=The%20US%20is%20the%20largest%20donor%20to%20global%20health&text=The%20US%20spent%20a%20total,of%20its%20ODA%20to%20health.
