Why both abortion and infant mortality rates have gone up in post-Roe America

Read the Full Transcript

• John Yang:

  Reproductive rights are front and center as the presidential campaign enters the home stretch more than two years after anti-abortion forces achieved their long held goal of overturning Roe versus Wade.

  Despite the state bans that followed the Supreme Court ruling, the number of abortions has actually gone up, even in states with the strictest bans. At the same time, infant mortality rates have been rising.

  Shefali Luthra is reproductive health reporter at the 19th, which covers gender politics and policy. She's also the author of "Undue Burden: Life and Death Decisions in Post-Roe America."

  Shefali I want to start by talking about the issue of abortions. Now, the Society of Family Planning, which advocates for reproductive rights, tracks this with a project called We Count. And they say that since March 2023, there's been a small but steady increase in abortions, including in 10 of the 13 states with the strictest law. So what's going on here?

  Shefali Luthra, The 19th News: What's happening is very interesting, and in some ways not surprising for those of us who've been following the data since Roe v. Wade was overturned. And what we've seen is this patchwork network has been developed to help people get around abortion bans in their state.

  The two ways that we're principally seeing people use to get around these bans are one, traveling out of state. So, maybe driving, maybe flying, maybe taking on some credit card debt, taking on immense financial hardship to travel from a place like Texas to Kansas or Illinois or New York to get an abortion. But the other trend that is really important is the rise of telehealth. And so what we are seeing is doctors, largely in states with abortion rights protections and these laws called shield laws.

  States like New York, Massachusetts, California, Maine are prescribing and mailing abortion pills to people who live in states with abortion bans. It's very medically safe, it's very effective. You can take these pills at home and terminate your pregnancy, and the doctors are protected as long as they stay in their home states.

• John Yang:

  Just as there are limits on who can travel out of state, who has the money, the resources, the ability to take time off of work, are there limits to telehealth as well?

• Shefali Luthra:

  Absolutely. There are issues around who has access to the Internet and can find these websites. Who knows about websites that will connect you to a doctor that will prescribe pills and mail them to you? Do you have an independent bank account that you can use to pay for medication? A lot of minors might not have that resource.

  We are seeing abortions continue to increase, but we are also seeing inequalities amplify. And some people are finding ways to get around these abortion bans and to continue to access care. And others are being left behind. And the inequalities that always existed are in fact getting bigger and deeper.

• John Yang:

  You mentioned shield laws. Explain what those are.

• Shefali Luthra:

  These are a relatively new legal approach. They're very interesting. And so they exist in a few of these more abortion friendly states. They protect healthcare providers in these states. And they say, if you are in our state and you practice healthcare that is legal here, for instance, providing abortions, even if it is for people in other states, we will protect you from out of state prosecution. We will not comply with efforts to try and bring you to court, bring you to trial.

  These have been very effective so far because we see doctors taking advantage of shield laws to prescribe and mail abortion pills to people in stays with bands. But they also are relatively new, and there are some questions about will they stand up if they ever meet a legal challenge. If a doctor who has relied on a shield block in, say, Massachusetts at some point travels to Texas, the protections don't apply once they've left their home state. And so there is a legal risk that I've heard some doctors quite worried about someday affecting them.

• John Yang:

  Let's talk about the infant mortality issue. There have been two papers recently in JAMA Pediatrics that looked at this issue. They say the infant mortality rate has been rising since the Supreme Court decision, with the most significant increases in babies with congenital abnormalities or birth defects. What does this tell us?

• Shefali Luthra:

  This also shows us something that I think is really important, which is that even as people are getting around abortion bans, many are not. And they are being forced to carry pregnancies to term that in a different world would have been terminated and with congenital abnormalities in particular. Many states with abortion bans don't have exceptions for fetal abnormalities. Even those that do are quite narrow. They only allow abortions for very, very obviously lethal cases.

  And so as a result, what we are seeing is people being forced to carry pregnancies to term where they know that they cannot give birth to a baby who will live. We are seeing people have to give birth and watch their children die in front of them because of an abortion ban. And so in Florida, for instance, I've spoken to a lot of doctors there about their experience.

  There was a 15 week ban in Florida. They more recently switched to a six-week band. And in both scenarios, they saw patients develop these fetal abnormalities and not be able to receive abortions in their states and instead have to travel from Florida to the closest option, Virginia, for an abortion, if that is what they choose.

• John Yang:

  Taking these two trends together, what does it tell us about post Roe America, not only in health care, but in politics? Because in Florida, for instance, the abortion ban is on the ballot.

• Shefali Luthra:

  What this shows us is how personal and how essential abortion as an issue is for a lot of American voters and especially a lot of women and people who can get pregnant. The data showing that abortions went up underscores that people are going to remarkable lengths to try and get abortions.

  The data around infant mortality shows that people who cannot get around these bans are suffering really intense emotional and in some cases financial harm as well because some of them actually have medical debt after they give birth. And they help us understand, I think, why this is such a critical issue for so many Americans. It is so personal, so ubiquitous and so essential as we think about where the election will take us.

• John Yang:

  Shefali Luthra, the 19th thank you very much.

• Shefali Luthra:

  Thank you for having me.

Improved audio player available on our mobile page