In early October, a judge in Fulton County, Georgia blocked a six-week abortion ban following the deaths of two women that might have been prevented had they had access to abortion care. Less than a week after the Fulton County decision, the Georgia Supreme Court reinstated the six-week ban. If anyone doubts that the nation is experiencing politically divisive and turbulent times placing people’s lives at risk, all the proof they need is in the state of reproductive and maternal health.
State and local governments shouldn’t gamble with people’s lives, but they continue to do so with unnecessary and unethical restrictions on essential health care; the criminalization of pregnancy, miscarriage, and abortion; and their failure to make sincere efforts to address maternal mortality. It’s safe to say that things have gotten out of hand. The federal government must act on behalf of its people.
A new presidential administration must prioritize reproductive and maternal health and show the American people that those they trust enough to elect to lead actually care. And calls for more research as the only action ring hollow when the problems are crystal clear. The question now is how we are going to realize the possibilities. Below are four priorities for a new administration to promote and protect the nation’s health and well-being.
Protect and Expand Access to Abortion Care
Anyone—including policymakers—can understand that some decisions are simply private and personal. Whether to have an abortion is one of them. Moreover, our nation has agreed—through policies such as the Health Insurance Portability and Accountability Act (HIPAA)—that health care is private. Why is it that some policymakers see abortion as an exception?
Abortion is safe, common, and essential health care. And in some cases, it is clinically necessary. There are many health reasons someone might need to end a pregnancy, including serious conditions that put their own lives at risk. Additionally, the same medical procedure used in abortion is the same used to treat spontaneous abortion, better known as miscarriage.
70 percent of voters believe it’s important for the next president to protect the right to access abortion care.
Decisions about abortion must remain private and in the realm of health care, not politics. Policy leaders must work to ensure that it does. Federal protection for abortion care could guarantee better access to abortion care across the United States. In fact, an October 2024 poll by The Century Foundation and Morning Consult found that 70 percent of voters believe it’s important for the next president to protect the right to access abortion care.
Support Access to Assisted Reproductive Technologies
The most important thing in life for many individuals is family, whether it be biological or chosen. The definition of family is broad and can include those who provide or receive care through formal guardianship (such as through adoption) or through less formal relationships across the broader village. Some people seek to experience family by giving birth or through surrogacy. But successful ovulation, fertilization, implantation, and pregnancy isn’t guaranteed. There are many points at which the process to a viable pregnancy could be interrupted. Assisted reproductive technologies (ART) help individuals and families overcome these hurdles.
The most commonly known ART is in vitro fertilization (IVF), a procedure that results in an embryo being placed into a person’s uterus. Recent abortion restrictions attempt to grant so-called personhood to embryos, complicating facets of IVF such as how nonviable embryos are discarded and what happens in the case that the embryo does not implant and the patient has a spontaneous abortion. When the Dobbs decision was announced, many IVF patients had cycles that were interrupted. This means they had spent thousands of dollars, taken hormones, and spent precious time that might have gone to waste. Assisted reproduction is a resource-intensive and emotionally charged process and its interruption can have long-lasting financial, emotional, and physical repercussions.
Abortion restrictions and bans not only cause confusion around what reproductive services and procedures are legal, but they also close a pathway to family formation due to fear—fear of the legality, of the cost of storing unused embryos for decades, and of not being able to get necessary treatment if something does not go to plan.
If policymakers at the state level cannot be trusted to do what’s right for people and to allow families to make the personal decisions that are best for themselves, it’s time for federal action.
Implement Proven Strategies in Maternal Health Care
According to a recent report by the Commonwealth Fund, the United States continues to have the worst maternal mortality rate among comparable nations, despite stated efforts to make improvements. While a spike in deaths during the COVID-19 pandemic has since declined to immediate pre-pandemic rates, that’s not good enough—policymakers need to keep working to bring the maternal mortality rate down.
Media attention to maternal death and complications from pregnancy and delivery (known as maternal morbidity) over the past few years has resulted in some legislative attention at the state and federal levels. Black Mamas Matter Alliance (BMMA) created and launched Black Maternal Health Week in April 2018, bringing a wave of attention to not only Black women’s adverse experiences and racial inequity, but to the state of American maternal health overall. Despite a greater focus since 2018, maternal mortality rates have generally held steady (aside from the COVID-19 spike).
Tackling the U.S. maternal health crisis will require the leadership of people with proven approaches to better maternal health experiences and outcomes. Cue the midwifery movement. Years of research indicate that the midwifery model of care improves birth outcomes, yet midwives have been largely shut out of the U.S. health care system. A small shift such as allowing more midwives to practice their craft and support birthing people would be a strong start, but unnecessary rules like those requiring oversight from a physician and lack of insurance coverage for midwifery care complicate things.
The next administration has an opportunity—nay, a responsibility—to make midwifery care, doula care, and comprehensive reproductive health services more accessible to the American people so they can achieve their desired health outcomes.
Fund Community-Based Entities to Lead the Work
The federal government, with its power and responsibility to direct billions of dollars in resources, can and must provide more funding for reproductive and maternal health initiatives. But this funding cannot be for research alone. Funneling money into research topics where the root causes of adverse outcomes are already known is ultimately inaction. Certainly, there are issues within reproductive health where questions remain, but for some problems, decades of research already point to interventions—like the midwifery model of care mentioned above—that would flourish and improve outcomes if only granted supportive policies and ample resources.
Money going to duplicative research on causes of racial inequity in maternal outcomes would be better spent on implementation of successful models.
Money going to duplicative research on causes of racial inequity in maternal outcomes would be better spent on implementation of successful models, such as by being given to community-based organizations providing direct services in response to their communities’ stated needs, especially those rooted in the reproductive justice, birth justice, and human rights frameworks. These are organizations who have a real stake in creating change because they care about the people they are serving. BMMA defines community-based organizations as those “whose leadership and staff are trusted members of the communities they serve, share the same background, culture, and/or language as their clients, and provide culturally competent care and/or services.”
These entities take a holistic approach to health, doing what they can to provide people with access to the comprehensive range of reproductive health care including abortion, as well as wraparound services to address socioeconomic factors that influence someone’s ability to access care. They must be adequately funded to provide the care and support that could help realize a reduction in maternal mortality and morbidity and other negative health outcomes.
Government Action Is Required
Almost ten years ago, Black women leaders came together at the first convening of the Black Mamas Matter movement to bring attention to the nation’s maternal health crisis. Three years ago, in advance of the Dobbs decision, advocates sounded the alarm on the harmful consequences that would come from abortion restrictions and outright bans. Now, we are living in that reality—one where women die for lack of access to appropriate health care and fear of criminalization.
The only good news is that change is possible. Will the next administration rise to the challenge? Real action is long overdue.
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