This post was written by our summer 2022 MPH Intern, Abigail O'Keefe
When I was offered the position to spend the summer working with Pro-Choice North Carolina, I expected to learn so much about reproductive rights in North Carolina—including studying legislation that enhances or restricts these rights and learning ways to protect reproductive rights in the state. Reflecting back, I did learn and experience much of what I expected I would during this internship, as well as so much more. But one thing I did not expect at the beginning of this internship was that by the end, one essential right millions of people have had for most of their lives would be stripped away by the decision of six people. Over the summer and following the overturning of Roe vs. Wade, thirteen states now have legislation that significantly limits access to or has completely outlawed abortion. In addition, a handful of other states are actively pursuing abortion bans to pass1. North Carolinians are immensely privileged to live in one of the states that did not quickly ban abortion and where abortion care is still legal1. However, abortion is not currently protected by state law in North Carolina2, and witnessing the onslaught of abortion restrictions and bans since June 24th, it is possible that North Carolina could face an abortion ban in the future if action is not taken to protect access. Understanding the impact an abortion ban in North Carolina would have, it is imperative that North Carolinians advocate for legislation that will keep abortion legal and safe for all in our state.
If an abortion ban is enacted in North Carolina, the health and safety of many individuals will be put at risk. Having an abortion is extremely safe3. However, the chance of experiencing complications from having an abortion increases as the pregnancy advances due to the increasing complexity of the procedure4,5. That's why it is important that abortion is easily accessible for people in North Carolina and that there aren't barriers that would prevent or delay patients from being able to receive care when they have decided to seek an abortion. If abortion were severely restricted or banned in North Carolina, people seeking abortion care might not be able to access care in a timely manner4,6. This could place them at a higher risk of experiencing complications associated with having an abortion later in pregnancy4. Access to abortion services in North Carolina is also important because abortion, which is often less risky than childbirth5,7, is a common component on the spectrum of reproductive healthcare and keeping it legal protects patients' health.
The chance of death related to having an abortion is close to "0.6 deaths per 100,000 abortions" 7,9. In contrast, the state-level mortality rate related to pregnancy was last reported to be "21.0 deaths per 100,000 live births"8. Even with the mortality rate related to pregnancy already being significantly higher than the mortality rate related to abortions, imposing an abortion ban in North Carolina could make this disparity even more extreme10,11. In states that imposed many limits on access to abortion, the state-level maternal mortality rates were higher than in the states that were more protective of abortion access10,11. If North Carolina were to pass legislation banning abortion, it would not only remove access to medical care for many but would also harm the health of North Carolinians by placing them at risk of experiencing health complications related to having later abortions or being forced to continue a pregnancy.
Laying out the health implications of a potential abortion ban in North Carolina, it is important to note that while an abortion ban will affect anyone who may need an abortion in the state, it will not affect everyone equally. In North Carolina, individuals in their 20s, those who identify as Black, and those who are not married are more likely to access abortion in the state12. If an abortion ban were enacted, these individuals would be disproportionately impacted by the loss of access to this medical procedure. These individuals in North Carolina will also be disproportionately put at additional risk of experiencing the potential health implications associated with severely restricting access to abortions and having to continue pregnancies.
The potential health risks of losing access to abortion care will also not be experienced equally. Structural racism creates social, economic, political, and built conditions that unjustly prevent Black women from accessing and using reproductive healthcare services. In addition, it impacts how healthcare personnel and the healthcare system treat Black women when pregnant13,14. The impact racism has on the health of Black women not only leads to harmful reproductive health events but to inequitable health events13,14, as Black women in the United States are almost three times more likely to experience death related to pregnancy than white women15. Banning or further restricting abortion does not address this health inequity but instead exacerbates it, as states that had restricted abortion access had significantly higher maternal mortality rates for Black women than the maternal mortality rates for Black women in the states where access is protected10. Recognizing the inequitable impact that banning abortion can have, it is imperative that a ban is not enacted in North Carolina, as it will lead to furthering already existing health inequities.
State abortion bans do not stop everyone from getting abortions17. Instead, they lead to more people traveling out of state for abortions care, and there have been increases in the percentage of people living in extremely restrictive states that have sought out abortion services in another state17. While abortion in Virginia is still legal, most states bordering North Carolina have minimal access to abortion care or have made abortion illegal16. An abortion ban in North Carolina would severely affect people seeking abortion care in the southeast.
It is also important to remember that many people living in North Carolina will not be able to travel long distances to a state where abortion is available. Traveling for abortion care requires additional time and finances to support the trip over and above the cost of the procedure18. If North Carolina were to enact an abortion ban, this would completely eliminate access to essential medical care for the people who cannot travel to another state and force the residents who have the resources to travel hundreds of miles just to receive basic medical care.
Understanding what the reality could be for residents of North Carolina if abortion were to be severely restricted and outlawed, we all need to take a stand to fight for legislation to protect abortion access in our state. Just because abortion is still legal in North Carolina, the fight for abortion access and reproductive freedom will not stop until abortion is protected and accessible in our state. Every person in North Carolina should have abortion care that is easily accessible and close to them, and no one in our state should be denied access if they have decided to seek abortion care.
Guttmacher Institute. Interactive Map: US Abortion Policies and Access After Roe. Guttmacher Institute. Accessed July 27, 2022. Interactive Map: US Abortion Policies and Access After Roe | Guttmacher Institute
Pro-Choice North Carolina. Protecting abortion access in North Carolina. Pro-Choice North Carolina. June 16, 2022. Accessed July 27, 2022. Take Action! | Pro-Choice North Carolina (prochoicenc.org)
Raymond EG, Grossman D, Weaver MA, Toti S, Winikoff B. Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States. Contraception. 2014;90(5):476-479. doi:10.1016/j.contraception.2014.07.012
Ganatra B, Faundes A. Role of birth spacing, family planning services, safe abortion services and post-abortion care in reducing maternal mortality. Best Pract Res Clin Obstet Gynaecol. 2016;36:145-155. doi:10.1016/j.bpobgyn.2016.07.008
Bartlett LA, Berg CJ, Shulman HB, et al. Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol. 2004;103(4):729-737. doi:10.1097/01.AOG.0000116260.81570.60
White K, Baum SE, Hopkins K, Potter JE, Grossman D. Change in Second-Trimester Abortion After Implementation of a Restrictive State Law. Obstet Gynecol. 2019;133(4):771-779. doi:10.1097/AOG.0000000000003183
Raymond EG, Grimes DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol. 2012;119(2 Pt 1):215-219. doi:10.1097/AOG.0b013e31823fe923
Gerdts C, Dobkin L, Foster DG, Schwarz EB. Side Effects, Physical Health Consequences, and Mortality Associated with Abortion and Birth after an Unwanted Pregnancy. Womens Health Issues. 2016;26(1):55-59. doi:10.1016/j.whi.2015.10.001
N.C. Department of Health and Human Services. State Center for Health Statistics. Figure 3: Trends in Pregnancy-related Death Rates, North Carolina Residents 1999-2013. N.C. Department of Health and Human Services; 2019. Accessed July 27, 2022. Figure3_MaternalMortality2013.pdf (ncdhhs.gov)
Addante AN, Eisenberg DL, Valentine MC, Leonard J, Maddox KEJ, Hoofnagle MH. The association between state-level abortion restrictions and maternal mortality in the United States, 1995-2017. Contraception. 2021;104(5):496-501. doi:10.1016/j.contraception.2021.03.018
Vilda D, Wallace ME, Daniel C, Evans MG, Stoecker C, Theall KP. State Abortion Policies and Maternal Death in the United States, 2015‒2018. Am J Public Health. 2021;111(9):1696-1704. doi:10.2105/AJPH.2021.306396
N.C. Department of Health and Human Services. State Center for Health Statistics. NC RESIDENT ABORTIONS: CHARACTERISTICS OF WOMEN RECEIVING ABORTIONS NORTH CAROLINA RESIDENTS, 2010 - 2019. N.C. Department of Health and Human Services; 2020. Accessed July 15, 2022. Version 9.4 SAS System Output (ncdhhs.gov)
Prather C, Fuller TR, Jeffries WL 4th, et al. Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity. Health Equity. 2018;2(1):249-259. Published 2018 Sep 24. doi:10.1089/heq.2017.0045
Taylor JK. Structural Racism and Maternal Health Among Black Women. J Law Med Ethics. 2020;48(3):506-517. doi:10.1177/1073110520958875
Hoyert DL. Maternal Mortality Rates in the United States, 2020. National Center for Health Statistics ( U.S.), ed. NCHS Health E-Stats. Published online February 23, 2022. https://stacks.cdc.gov/view/cdc/113967
Planned Parenthood. Is Abortion Still Accessible in My State Now That Roe v. Wade Was Overturned?. Planned Parenthood Action Fund. Accessed July 27, 2022.
Maddow-Zimet I, Kost K. Even Before Roe Was Overturned, Nearly One in 10 People Obtaining an Abortion Traveled Across State Lines for Care. Guttmacher Institute. July 21, 2022. Accessed July 27, 2022. Even Before Roe Was Overturned, Nearly One in 10 People Obtaining an Abortion Traveled Across State Lines for Care | Guttmacher Institute
Fuentes L, Jerman J. Distance Traveled to Obtain Clinical Abortion Care in the United States and Reasons for Clinic Choice. J Womens Health (Larchmt). 2019;28(12):1623-1631. doi:10.1089/jwh.2018.7496