Why restricting access to abortion damages women’s health

In late June, the landmark Roe v. Wade ruling was overturned by the United States Supreme Court, a decision, decried by human rights experts at the United Nations [1], that leaves many women and girls without the right to obtain abortion care that was established nearly 50 years ago.The consequences of limited or nonextant access to safe abortion services in the US remain to be seen; however, information gleaned from abortion-related policies worldwide provides insight into the likely health effects of this abrupt reversal in abortion policy.The US Supreme Court's decision should serve to amplify the global call for strategies to mitigate the inevitable repercussions for women's health.Upholding reproductive rights is crucial for the health of women and girls worldwide, and access to a safe abortion is central to this, yet policies in several countries either severely limit or actively prevent access to appropriate abortion care and services [2].However, there is little to suggest that those countries and jurisdictions with abortion bans or heavily restrictive laws see fewer abortions performed.According to a modeling study of pregnancy intentions and abortion from the 1990s to 2019, rates of unintended pregnancies ending in abortion are broadly similar regardless of a country's legal status of abortion, and unintended pregnancy rates are higher among countries with abortion restrictions [3].Abortion is widely considered to be a low-risk procedure.Abortion-related deaths most likely occur in the context of unsafe abortion practices and are reported to account for 8% (95% UI 4.7-13.2%) of maternal deaths [4], making them a top direct contributor to maternal deaths globally, alongside hemorrhage, hypertension, and sepsis.Restrictive abortion policies may not lower the overall rates of abortion, but they can drive increasing rates of unsafe abortions, as women resort to seeking abortions covertly.Such abortions are often performed by untrained practitioners or involve harmful methods.Perhaps unsurprisingly, most abortions that take place in countries with restrictive abortion access policies are not considered safe [5], potentially contributing to maternal morbidity and mortality.A study of 162 countries found that maternal mortality rates are lower in countries with more flexible abortion access laws [6], suggesting that changes in abortion policies could have grievous implications for maternal deaths.It is not yet known if the reneging of federal protection of abortion rights will impact maternal deaths in the US; however, in the years following the 1973 Roe v. Wade decision, numbers of reported deaths associated with illegal abortions, defined as those performed by an unlicensed practitioner, declined, hovering between zero and 2 deaths from the 1980s to 2018, down from 35 in 1972 [7] and 19 reported in 1973 [8].It is possible that limits on access to timely and safe abortion care could drive this number back up and add to the already unacceptably high maternal mortality rate in the US, potentially exacerbating the persistent disparities in maternal mortality based on socioeconomic deprivation, race and ethnicity, and other factors [9].