When will the antiabortion movement turn its attention to saving babies?
This story originally appeared on Jill.substack.com, a newsletter from journalist, lawyer and author Jill Filipovic.
Between 2010 and 2022, some 500 maternity wards closed across the United States, leaving a majority of rural hospitals with no labor and delivery units. And those numbers are from before the Dobbs decision came down and allowed for the criminalization of abortion—a move that pushed even more obstetricians out of conservative states, and made access to maternity care even scarcer.
Now, antiabortion Republicans are putting their resources not into expanding care for the women they’re forcing into motherhood, but into enforcing abortion bans—including those that make women risk their lives and health in pregnancy, drive up maternal injury and mortality, and push healthcare providers out of the workforce or out of state.
State budgets are limited, and how lawmakers spend the money they have tells us a lot. Idaho, for example, is using some of its dollars to fight a Biden administration rule requiring that hospitals do what’s necessary to save women’s lives and preserve their health, even if that means offering them an emergency abortion.
Let that sink in: The state of Idaho, which has lost nearly a quarter of its practicing OB-GYNs and has seen several labor and delivery wards close since banning abortion, is spending taxpayer dollars to argue that they do not have to save a woman’s health in a medical emergency if she is pregnant and the best course of action is a termination.
I highlight this case next to the data on the closures of labor and delivery wards because these things are, in fact, related—and not just because abortion bans are sending doctors fleeing and forcing maternity ward closures, although they are. Abortion bans are not single issues fought for by a single-issue party; they are part of a much broader kaleidoscope of policies or lack thereof that all reflect a particular worldview. And that worldview cannot in any credible way be described as “pro-life.”
There is no way to ban abortion and fully protect women’s health.
This is why, to me, the argument that abortion is about preserving life and saving babies always feels so dishonest, coming as it does from a political party and movement that does absolutely nothing else to save lives, improve health outcomes or help babies. If that was really the motivation for people who want to ban abortion, wouldn’t we see other efforts to help babies live?
Maternity care deserts are concentrated in conservative areas. Part of that is because rural areas are more conservative than urban ones, and rural areas are, by definition, sparser than urban ones—you’d expect to see fewer services there. But even when you correct for that and look at the ratio of maternity care providers to women who may need pregnancy care, you see that states with abortion bans have far fewer maternity care providers. The states with the lowest proportion of reproductive-age women to pregnancy care providers nearly all ban abortion.
The closure of labor and delivery units is very much an outcome of bad policy. Close to half of all U.S. births are paid for through Medicaid, and Medicaid reimbursements for births are paid out on a per-baby basis, even though the particulars of a birth may be incredibly costly—something especially true in a nation with high rates of emergency C-sections, and where new mothers are less and less healthy and often need significant interventions. If labor and delivery wards are financial losers for hospitals, then those wards are going to be first on the chopping block when hospitals need to cut costs.
But this isn’t just a Medicaid issue; if it was, I think we’d see these closures distributed more evenly, and we’d see their health effects distributed more evenly. The truth is that more liberal states have also invested more in the things that improve health: In health insurance schemes and expanding Medicaid, sure, but also in environmental protections, in services to the poor, in labor protections, in early childhood development programs, in education, in school nutrition, in support for pregnant women and, yes, in abortion access. This isn’t true of every liberal state, but as a general rule, more liberal areas are devoting more of their resources to public health and wellbeing, including things like education, fair pay and employment practices that may not seem to be health-related on first glance, but absolutely shape society-wide health outcomes.
And these same liberal areas have deeper commitments to women’s rights and racial equality, and statewide policies (equal pay laws and parental leave, for example) reflect that.
There is no way to ban abortion and fully protect women’s health. But there are ways to ban abortion and also support mothers and children. That conservative states don’t do that while they do fight in court to refuse pregnant women emergency care strongly suggests that abortion bans are about something other than children. It’s not that these states refuse to spend money on anything healthcare-related. It’s that they’ll spend that money on denying women healthcare rather than making sure pregnant women can deliver babies safely, or that doctors can practice life-saving medicine without criminal sanctions.
State budgets are limited, and how lawmakers spend the money they have tells us a lot. … They’ll spend that money on denying women healthcare rather than making sure pregnant women can deliver babies safely.
Abortions bans are tools of social control. The idea of these bans as “pro-life” doesn’t fit with the rest of the conservative movement’s views on life and health: Their support for the death penalty, their opposition to significant public health investments, their hostility to programs that provide health insurance to children and food for poor families.
But these bans do fit with the rest of the conservative movement’s hostility to women’s rights: Their support for blatant misogynists, their opposition to the Equal Rights Amendment, their hostility to equal pay and equal protection laws, their fear of changing gender roles more broadly.
The antiabortion movement, remember, sprung out of segregationist movements which also couched their real agenda in the more palatable terms of state’s rights and parental rights. The conservative movement and the antiabortion movement that resides within it have long demonstrated an utter lack of care for human life and wellbeing, and we see that manifesting in both the closures of maternity wards and in the criminalization of abortion.
Some of the various policies that have caused maternity wards to shutter may have come from different politicians and different eras than those that banned abortion. But they spring from the same worldview—and it’s not a life-affirming one.
