What the conversation on abortion is missing

Something important is getting lost in the conversation around the recent Supreme Court decision about abortion: its impact on reproductive health because of the inherent risks of every pregnancy.

Before being appointed as Pennsylvania’s acting secretary of health and physician general, I spent decades of my career as a board-certified OB-GYN physician caring for people during their pregnancies. Though it’s not talked about often enough, no pregnancy comes without the chance of negative outcomes or even death. The rate at which birthing people die during pregnancy, delivery, or soon after delivery is high and rising in Pennsylvania and across the country. That is why all people who can become pregnant must have access to a full range of reproductive health-care services and the right to decide what is right for them individually. This includes the right to an abortion, which is statistically a much safer procedure than childbirth itself.

In Pennsylvania, the overall maternal mortality rate is 82 deaths per 100,000 live births. For people of color, who are already disproportionately impacted by poverty and have less access to adequate health care, the mortality rate is 163 per 100,000 live births. This disparity is another concern, and one that we know would be made worse by banning abortions. For example, Black Americans do not have significantly greater prevalence rates of pregnancy complications such as preeclampsia or postpartum hemorrhage than their white counterparts. However, Black people with these conditions were found to be two to three times more likely to die from them than white people. Not allowing Black individuals who are at risk for these conditions to access an abortion can lead to even more deaths. Forcing people to carry unwanted pregnancies against their will can only worsen these risks.

For every person who dies from pregnancy, many more are impacted negatively, physically, emotionally, and mentally. Every individual’s experience is different, and even much-desired pregnancies can lead to health problems and anguishing decisions. When reproductive health services are restricted, there are unintended consequences for those undergoing pregnancy losses.

To those who assert that miscarriage care will not be impacted by bans on abortion, I say there is a lack of understanding of the continuum of pregnancy care. Health-care providers can become hesitant to render treatment for fear of breaking the law, even in situations where abortion is the best medical practice. We have already seen this in other states that have implemented bans, such as a case reported to the Texas Medical Board alleging that a hospital repeatedly told a physician not to treat an ectopic pregnancy until it ruptured. Any delay of treatment in those instances represents an increased chance of mortality and long-term disability for the pregnant person, in addition to needless suffering that may be experienced by the patient. We should respect that an individual and the doctor who knows them are the people best equipped to determine what medical care is needed in each situation.

As a physician who has cared for pregnant people for over 25 years, it is very important to me that they have access to the full range of reproductive health-care services. Many people don’t realize that the term “abortion” covers a vast variety of procedures in countless different circumstances. Whether it is saving someone from the danger of an ectopic pregnancy that will never be viable, assisting in delivering a miscarriage, or prescribing medication to terminate a pregnancy for someone in the first trimester for whom pregnancy is not a safe option — these all fall under the same medical terminology of “abortion.” There are many different reasons people need to have abortion as a health care option.

» READ MORE: Abortion is still legal in Pennsylvania — but it’s hanging by a thread | Expert Opinion

This is why reproductive health-care services, including abortions, remain legal, safe, and available in Pennsylvania. In our American society, we prize the right of self-determination and individual freedoms. In the case of a pregnant individual, their rights should not be taken away because they are pregnant. It is for the sake of all birthing people that I, as a board-certified OB-GYN, strongly recommend the preservation of the human right of bodily autonomy. Everyone must be offered the dignity to make their own informed choices related to their own health care needs.

Denise A. Johnson is the acting secretary of health and physician general for the Commonwealth of Pennsylvania. She is board certified in obstetrics and gynecology, a fellow of the American College of Obstetricians and Gynecologists, and a fellow of the American College of Healthcare Executives. She is a former commissioner of the Governor’s Commission for Women. @pahealthsec