While Alabama is now under a near-total abortion ban, pregnancy outcomes remain in the top three primary health indicators in Alabama, per the 2020 Alabama State Health Assessment.
Health indicators are statistics that measure the health status of an area. Alabama rates of poor pregnancy outcomes are higher than the national average, according to the health assessment.
Experts say the same people who are already most affected by these negative outcomes in women’s healthcare are the ones who will face the repercussions of abortion laws like Alabama’s.
In 2019, Governor Kay Ivey signed HB 314, the Alabama Human Life Protection Act, which “would make abortion and attempted abortion felony offenses, except in cases where abortion is necessary in order to prevent a serious health risk to the unborn child’s mother.”
Though it had been blocked under the Roe v. Wade Supreme Court ruling, HB 314 is now enforceable after the Dobbs decision.
According to HB 314, abortion is, “the use or prescription of any instrument, medicine, drug, or any other substance or device with the intent to terminate the pregnancy of a woman known to be pregnant with knowledge that the termination by those means will, with reasonable likelihood, cause the death of the unborn child.”
This does not extend to actions taken with the purpose of preserving the life and health of the mother or of the unborn — including, but not limited to, the removal of a deceased unborn, an ectopic pregnancy, lethal anomaly, or premature birth.
However, when it comes to the risks medical emergency of pregnancy or abortion, the American College of Obsetrics and Gynocology reports “the risk of maternal death associated with childbirth is approximately 14 times higher than the risk associated with abortion.”
Pregnancy outcomes in Alabama
In 2019, one in four pregnancies in Alabama received inadequate prenatal care. Alabama ranks 47th in infant mortality, with one in 100 pregnancies resulting in stillbirth.
“Alabama rates of poor pregnancy outcomes are higher than the national average, specifically for mothers who are young, reside in rural areas, and identify with a minority racial or ethnic group,” according to the assessment.
Urban (27.2) and rural (23.8) had similar percentages of pregnancies that received inadequate prenatal care. Unwed expectant mothers (34.4) saw a higher percentage of inadequate prenatal care compared to married expectant mothers (18.8). 35.6 percent of expectant mothers under the age of 20 received inadequate prenatal care, the highest rate in Alabama.
According to the ADPH Center for Health Statistics Natality records, in 2019, there were 1,478 births in Alabama that received no prenatal care.
Socioeconomic status often contributes to a person’s inability to obtain adequate prenatal care.
“Besides health concerns, abortions may be necessary for financial purposes as well. While abortion should not be a means of birth control, it should be an option. Couples may be unable to care for an unplanned child financially, and they should not be forced to have the child. Therefore, abortion should be an important option in such cases,” said Athens resident Laura Moyers.
Negative pregnancy outcomes often occur in areas of Alabama where there is a lack of public obstetrical services.
In 1980, 45 out of 54 counties considered rural had hospitals providing obstetrical care as compared to 2019, where 16 out of 54 counties considered rural had hospitals providing obstetrical care.
The American College of Obstetricians and Gynecologists noted the disproportionate impact on certain populations of people living in states with bans and restrictions on abortions.
“The impact of this irresponsible decision will fall disproportionately on people who already face barriers to accessing health care, including people of color, those living in rural areas, and those without ample financial resources.”
Black women in Alabama have double the infant mortality rate as White women, highlighting the racial and ethnic disparities between expecting mothers. Hispanic mothers also have a high infant mortality rate, 7.2 deaths per 1,000 live births. The total infant mortality rate was 7.7 deaths per 1,000 births for 2019.
More than one out of every 10 births in Alabama were babies born with low birth weights. Black mothers experienced a low weight prevalence more than double the percentage of White mothers.
Different populations noted different experiences with reproductive healthcare.
According to the assessment, “Women with disabilities expressed concerns about the lack of accessibility and accommodations during health appointments. This population also identified the lack of education tailored toward parenting with a disability. Spanish-speaking populations identified that health education materials in Spanish were either unavailable or poorly translated. LGBTQ+ stakeholders reported that LGBTQ+ centered care was difficult to find, noting that they received poor care, were refused care, misgendered by office staff, or had the added burden of educating their service provider about their health considerations”
The assessment notes that “family planning can help reduce unexpected pregnancies” and “contraception can increase safe sexual practices.”
Birth control and abortifacients
Some Republican lawmakers have begun targeting copper ion IUDs and other contraceptive methods that prevent implantation into the uterine wall and emergency contraceptives, as well as abortifacients.
The News Courier spoke with District 54 Representative Neil Rafferty (D) regarding Democratic efforts pertaining to protecting the reproductive privacy of Alabama residents.
Rafferty spoke regarding a bill introduced last session by Republicans that would restrict the distribution of materials that prevent fertilization.
“It would be abortifacients. So, I imagine it’d be things like the copper ion IUD, something where the fertilization can take place, but can’t plant into the uterine wall. Plan B, I’m not going to pretend to be a doctor, but there was a bill that was introduced last year that had those provisions in it that would restrict school or state institutions from distributing those, which is a big deal. If you want to talk about Medicaid. If you want to talk about health departments. If you want to talk about Student Wellness Centers at universities and colleges, where they would be able to have access to that,” said Rafferty.
He said a bill like that affects Medicaid as well as health departments and student wellness centers at universities and colleges that would have access to medication like Plan B. The commonly known morning after pill states on its website that “Plan B is not an abortion pill — if you take Plan B, you will not be terminating a pregnancy.” It notes the ways that the pill could potentially prevent a pregnancy: temporarily stopping the release of an egg from the ovary, preventing fertilization, or preventing a fertilized egg from attaching to the uterus by changing the uterine lining.
Sommer Adams who is an ambassador for Let Them Live, a charity dedicated to financially and emotionally supporting expectant parents, said that because of the belief that life begins at conception, preventing a fertilized egg from implanting would not be acceptable.
“If the egg does get released and a pregnancy does occur, they will then end the pregnancy. I suspect those are the ones being targeted. If we believe the recent study from University of Chicago (where Dr. Jacobs found that 96 percent of nonreligious biologists state that a human life begins at conception), then we would then also believe that those types of ‘birth control’ actually cause abortions and are not appropriate in states that have banned abortion,” she explained.
“I did hear that some lawmakers in certain states were targeting birth control. I am not an expert on this subject, but I do understand that some types of birth control prevent ovulation, or perhaps prevent the egg and sperm from meeting (like a barrier method). I don’t believe those should be targeted. In fact, they should be encouraged for those who would otherwise choose to abort,” said Adams.
Alabama abortion statistics
In 2017, there were seven facilities in Alabama providing abortion services, five of which were clinics which saw more than half of their patients for abortions. 93 percent of Alabama counties had no clinics that provided abortions, and 59 percent of Alabama women lived in those counties.
Comparatively, 89 percent of U.S. counties had no clinics providing abortions, with 38 percent of reproductive-age women living in those counties.
The ACOG notes “abortion is a safe, essential part of comprehensive health care, and just like any other safe and effective medical intervention, it must be available equitably to people, no matter their race, socioeconomic status, or where they reside.”
The Alabama Center for Health Statistics published a report on Induced Terminations of Pregnancy in 2020. Of those demographics, two-thirds (more than 3,800) of women who got abortions in Alabama were Black. Thirty percent of the women were White, and less than 3 percent were another or unknown race.
But race isn’t the only disparity to take into account. While there are not statistics for income of abortion patients in Alabama, in 2014 around 75 percent of abortion patients in the nation had low incomes according to the Guttmacher Institute. The study used to determine that statistic, noted in the conclusion “laws and policies that make abortion more difficult to access have a disproportionate impact on groups overrepresented among abortion patients, particularly those who are poor or low income.”
Between 2014 and 2017 there was a 23 percent decline in abortion rates in Alabama from 8.3 to 6.4 abortions per 1,000 women of reproductive age. Alabama accounted for 0.7 percent of abortions in the United States.
In 2017, 6,110 abortions were provided in Alabama. Continuing the decline that was seen prior to that, 5,713 were provided in the state in 2020.
Some patients may have traveled from other states, and some Alabama residents may have traveled to another state for an abortion, meaning not all abortions were Alabama residents, and some Alabama residents who received abortions elsewhere may not be accounted for.
“When abortion is legal, it is safe. Allowing states to set individual restrictive abortion policies, including restrictions and outright bans on this essential component of medical care, results in an increase in the inequities that already plague the health care system and this country,” according to ACOG.
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