What happens to pregnant patients facing life-threatening medical conditions when abortion is illegal or severely restricted? We don’t have to wait until the Supreme Court rules on the legality of abortion bans passed in Texas and Mississippi to find out.
A new report by Columbia Law School’s Law, Rights, and Religion Project, where I serve as director of racial justice policy and strategy, shows that numerous hospitals across the South already restrict access to abortion care even with Roe v. Wade in place. In these facilities, what doctors define as a “medical emergency” can vary considerably, leading to substandard care for pregnant patients facing conditions ranging from preterm labor to cancer. This failure to meet the standard of care for pregnant patients is particularly disturbing given the widely covered Black maternal health crisis.
This Wednesday, the Supreme Court will hear the first direct challenge to Roe v. Wade in nearly 50 years. In Dobbs v. Jackson Women’s Health Organization, the court will determine whether Mississippi’s current 15-week ban on abortion will be upheld or struck down. Although that outcome will have widespread repercussions for Mississippians and everyone in the United States, much less discussed has been the fact that, as we note in our report, “state law [already] prohibits public hospitals in Mississippi from providing abortions, with no exception for protecting the health of the patient.” And while the media has reported on the abortion restrictions at Catholic Church–affiliated hospitals, “relatively little has been published on reproductive health policies at Protestant hospitals—even though these facilities are as or more prevalent than Catholic hospitals in some Southern states,” according to the report. These hospitals have adopted policies restricting access to abortion care and other reproductive health procedures for various reasons, including religious affiliations and abortion stigma.
Anti-abortion restrictions, religious directives, and systemic discrimination create a perfect storm for the disproportionate number of Black women who experience preterm labor, or any other Black, Indigenous or other person of color, LGBTQIA+ individual, femme, woman, immigrant, young person, person with disabilities, or anyone with low and no income who seeks abortion care for any reason. We know with certainty that things will only get worse should the Supreme Court rule in favor of the states with these abortion restrictions and against pregnant people, who are already suffering.
Mississippi is in the deep Confederate and Christian-leaning South, and many Mississippians must navigate the seen and unseen influence that conservative religions and religious culture play in the provision of medicine, including abortion care. However, it is important to note that many religions and progressive voices of faith support abortion and indeed work to ensure that abortion is actually accessible for all people. This report speaks to more conservative sects that are devotedly anti-abortion. For instance, the Mississippi Baptist Convention Board nominates one-third of the members that sit on the board of trustees for one of the state’s largest health systems—Baptist Memorial Health Care—which governs 22 hospitals across three states, including Mississippi. As Jim Futral, former executive director of the board, explained in the report, the “reason that the Baptist hospital was started in Jackson years ago was to have an extension of the healing ministries of Jesus. That pretty much continues to this day.”
The board of trustees for Methodist Le Bonheur Healthcare, with six hospitals in Tennessee and Mississippi, includes bishops from the United Methodist Church Conferences in Mississippi and other Southern states. Both of these health systems—and many others across the region—prohibit abortion in their facilities unless necessary to save the life or health of the patient.
Thus, in Protestant and secular hospitals in Mississippi and across the South, access to abortion, including during medical emergencies, is even more severely curtailed than already-restrictive state laws may suggest. Many Protestant and secular hospitals even use dedicated abortion committees to determine whether a particular patient facing a medical complication is sick enough to be able to receive an abortion in the facility. Moreover, our report demonstrates that life and health exceptions to hospital abortion bans can be interpreted narrowly—with devastating impacts for pregnant patients. Through a survey and follow-up interviews with medical doctors, the report uncovered how hospital abortion bans can prevent doctors from offering pregnant patients a range of care considered routine in other facilities.
Many doctors told us, for example, that hospital bans limited the care provided to patients whose water breaks before their fetus can survive outside the womb. One doctor we spoke with explained that at the Baptist hospital in Kentucky where she used to work, when a patient’s water broke before viability—making the pregnancy very high-risk—“we would have to transfer the patient to another hospital if she decided she didn’t want to continue the pregnancy and there was no sign of her being infected or having her life at risk,” because the hospital “would not approve that.”
Another OB-GYN told us of a patient at her hospital who had leukemia, and was refused an abortion even though this limited treatment options for the patient’s cancer. The doctor explained, “She ultimately got a spinal abscess that caused quadriplegia, and she was still not allowed to have a termination.” And in Texas, a doctor working at a public hospital told us of a patient with kidney disease who was unable to get abortion care at the facility, even though doctors acknowledged that continuing the pregnancy could have “shorten[ed] her life significantly.”
Furthermore, we know that Black women are more likely to experience higher rates of early labor and other pregnancy complications that could lead to a medically indicated abortion. One recent study of 4.6 million pregnancies in seven countries (including the United States) found that the rate of miscarriage was 43 percent higher for Black than for white women. The Centers for Disease Control and Prevention states that Black women are more than twice as likely as white and Hispanic women to experience a stillbirth, in part due to disparities in underlying medical conditions. Black women are over three times more likely to die from a pregnancy-related cause than white women. Because abortion is less medically risky than childbirth, one recent study even found that a nationwide ban on abortion “would lead to a 21% increase in the number of pregnancy-related deaths overall”—but “a 33% increase among Black women.”
Thus, any restrictions on the care pregnant patients are able to receive when they walk into a hospital pose a special threat to people of color, and Black patients in particular. We must center the lived experiences of Black pregnant patients, and all people of color, as we move to ensure that all patients receive the highest standard of care during pregnancy, and make abortion more accessible for everyone.
There is plenty that policy-makers, medical providers, grassroots organizations, and individuals are or could be doing to expand access to reproductive health care in Southern hospitals. Legislators could pass measures to make it clear that hospitals must provide comprehensive reproductive health care during medical emergencies. Doctors could advocate within their hospital systems for improved practices and policies. And nonprofits could educate the public about abortion bans at local hospitals, as well as the circumstances under which patients may need a medically indicated abortion. Meanwhile, everyone else could advocate for access to the full spectrum of reproductive health care that is most favorable to a patient’s needs and not the dictates of any religious body.
It’s an incredible amount of work, but we have to do it if we want to ensure that all people have unimpeded access to the best quality, most comprehensive health care, including abortion care. Let’s roll up our sleeves and get to work!