There are a number of implications that the overturning of Roe will have on people in America. The likely people to carry the burden in a Post-Roe America are those who are marginalized. This is just a fancy word to identify people who are not in positions of privilege, power, or typically accepted (or highly regarded) in mainstream society. These are typically racial minorities, gender/sexual minorities, along with those who are low-income. Here I will outline some of the concerns I have with a Post-Roe America.
There are real risks associated with pregnancy. A person's body is more vulnerable to sickness and injury while pregnant than when they are not. There are a variety of health complications that can come along with pregnancy. Without adequate prenatal health care and emergency care in certain cases, there is a risk of maternal death. The United States has the highest maternal mortality rates of industrialized nations, and the maternal mortality rates in the US have been rising. Additionally, there is a disparity in maternal mortality for Black women. Currently, non-Hispanic Black women have a maternal mortality rate that is 2.9 times that of non-Hispanic White women (see CDC data). There is concern from some experts that there will be a rise in maternal mortality from the overturning of Roe, and Black women are considered to be at higher risk.
The mental health aspects of parenting are real. As a board member of PSI-DE, we work to support parents who are experiencing perinatal and postpartum mood disorders. There are higher risks for certain communities such as Black women, LGBTQIA+, Indigenous, those who are low-income, and those with few social supports. Here again, Black women tend to develop perinatal and postpartum mood disorders at over double the rate of other birthing people. The general population of birthing people have a postpartum depression rate of 1 in 8 whereas Black mothers have a rate closer to 40%. There is a lack of mental health providers trained in general to support perinatal mental health, but there are especially few that work with people from marginalized backgrounds. There are also concerns about the affordability of mental health therapy. Depending on insurance coverage, some people may have to pay out-of-pocket rates for therapy sessions due to high deductible plans. Due to the pandemic, there are many therapists with long waitlists and not all therapists offer sliding-scale fees to accommodate financial barriers. Another concern with mental health therapy is taking the time to commit to the process of therapy. Persons who are low-income with few resources may not be able to get time off work and may not have someone to watch their child(ren) to fully engage consistently in therapy. There is some hope that the expansion of telehealth services may be able to help address this barrier. Overall this is an area that needs to be revisited and re-imagined for what therapy "should" look like. However, I would anticipate there may be an increasing number of people who develop symptoms of perinatal and postpartum mood disorders when they feel they do not have the option of making informed choices on abortion care.
When people feel they are left with no real options, you will see people act in desperation. This could be seeing girls and young women try to induce their own abortion which could lead to death. Those who are not ready to parent and are against carrying a pregnancy may be more at risk for extreme behaviors to abort an unwanted pregnancy. Actions such as ordering pills on the internet without medical oversight and/or using objects to try to abort the pregnancy at home or taking pills from questionable sources will not be unheard of. Whereas people who are in families with resources can find a way to access safe abortion care.
I'm concerned with the future of the foster care system. Black and Brown families are already more policed than White communities, meaning more risk for children born to these families to enter the system. Available data from the CDC suggests that Black women seek abortions at over 3 times the rate of White women. While I believe that there are many people who are resilient, I am concerned with the current functioning of the child welfare system and how there is a disproportionate number of Black and Brown families who are investigated and active in this system. With a possible increase of Black and Brown children, there may also be an increase in referrals for an investigation into these families.
Adoption may not provide the answer for unplanned children. Before Roe, couples had fewer reproductive treatment options. The first baby born from IVF is only 43 years old today and will be turning 44 at the end of July. Since that time IVF has made some significant advancements in medicine to help increase success for many people. There is an increasing number of families who have access to insurance that are more likely to exhaust their options with fertility treatments before considering adoption. In the past, people who had blocked fallopian tubes, severe endometriosis, PCOS, etc. would have only had the option to adopt to grow their family. Another concern about having adoption as "the" answer relates to children born with significant health disorders. There are some genetic and health disorders that can be detected in the course of pregnancy and in some cases, the parents may have elected for terminating. For a pregnancy that was planned and desired, I think that these parents will do what it takes to care for their child. However, in cases where the child was never planned and the birthing parent may consider the route of giving the child up for adoption before these anomalies are even detected. However, these children are less likely to be adopted, even as infants. Finding families who are willing to undergo extensive training to take care of these children will be difficult. Lastly, with adoption, there is separation from the biological family which is an inherent trauma. This trauma is not easy to navigate. If anything, it is a long-term process. Loving parents and stable homes do not erase the desire for a person to have a connection to their biological line of who they came from. Knowing who we are as people and our purpose is tied to our family history. A lack of a connection can be hard to process and understand for any person.
So these are a few of my concerns in the Post-Roe era that we are entering in America. As a social worker, I believe it is imperative to think and consider the impacts this ruling will have on our society as social workers will be the ones at the center of the work being done with those impacted. I do not believe everything will be doom and gloom, however, without adequate support, there are sections of the population who will suffer disproportionately from this decision. I focused most of the article on the impact on Black women and mothers, however, the effects will be felt by all marginalized people. In my next post, I will talk about the Reproductive Justice framework, and how it seeks to go beyond the discussion of "pro-choice" rhetoric to talking about human rights and equity in reproductive health.
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