What the end of Roe means for health care in Pennsylvania
A former Lehigh Valley resident remembers what it was like to get an abortion before the Supreme Court’s Roe v. Wade decision made it legal across the U.S.
In 1968, she got pregnant while attending college out of state. She said at age 19 she was not ready to have a child, so she turned to her mother.
“I stayed home with her for a while,” said the woman, who asked not to be named for privacy reasons. “She didn’t tell me what she was doing, but about two weeks later she goes, ‘We’re going to Washington, D.C.'”
At the time abortion wasn’t legal in Pennsylvania or Washington, except to preserve the life or health of the woman, but her mother found a doctor that did the procedure safely.
Now the woman is worried the U.S. is heading back toward a time like that. The U.S. Supreme Court’s ruling Friday in Dobbs v. Jackson dealt a killing blow to the national right to abortion established 50 years ago under Roe. v. Wade. That, experts say, could have a dramatic impact on health care for millions of people in the U.S., which has the highest maternal death rate of any wealthy country.
The court’s ruling leaves the decision on abortion rights up to individual states. More than half of states have already started to ban or are expected to ban abortion.
Chrysan Cronin, director of the public health program at Muhlenberg College, said abortion is health care and bans or restrictions have broad public health implications.
“It’s going to set women’s reproductive health back decades,” Cronin said. “What will happen, obviously, is that unsafe abortions, unregulated abortions will still continue like they did before Roe.”
On a snowy day in March 1968, the former Lehigh Valley woman and her mother took a train from Philadelphia to Washington. They went to an office where one obstetrician-gynecologist was working alone. She said there were at least 40 other women waiting in the office. Some were American, but some were from Europe and Asia.
“He did the surgery without a nurse present, one right after the other to the other to all these women,” the woman said.
Her mother paid $6,000 for the procedure, the equivalent of about $51,000 today. She never found out how her mother knew about the doctor or how she got the money, but she was grateful.
She said many other women around that time didn’t get that kind of opportunity; she knew others who were only able to get abortions from clandestine, back-alley clinics.
“I had girlfriends that went to horrible places,” the woman said. “They went to places that were seedy and a hood was put over their face when they were being taken there so no one could see anyone’s face, the doctor or the patient, it was horrible.”
Abortion in Pa.
Pennsylvania isn’t one of the 13 states with a ban triggered by the Supreme Court’s decision, so abortion rights in the state remain unchanged. But anti-abortion activists and politicians are working to set limits in the state.
The Morning Call reached out to the Pennsylvania Pro-Life Coalition and Pennsylvania Pro-Life Federation to discuss initiatives and policies supported by each that promote the health and well-being of the mother and child during and after pregnancy. The Pro-Life Coalition referred the reporter to the Pro-Life Federation, which did not respond to repeated requests for interview or comment.
After the Supreme Court’s ruling Friday, Michael McGonagle, president of the coalition, issued a statement in which he welcomed the ruling “as a necessary step toward achieving our mission, which is to have every child in Pennsylvania welcome in life and protected by law.” Roe v. Wade, he said, “has proven to be a deadly and unjust distortion of our nation’s constitution.”
Planned Parenthood is working to add abortion availability at all its sites in Pennsylvania and is offering abortion through telemedicine and direct-to-patient care. Melissa Reed, CEO of Planned Parenthood Keystone, said the organization is also growing its “fund for choice,” which would cover the cost of the procedure, travel, child care and lost wages for taking time off work.
“We are really trying to remove as many barriers to care as we possibly can,” Reed said.
For many in the U.S., traveling out of state will be the only way to get a legal abortion, though some states are trying to make it illegal for residents to do so. Reed said Pennsylvania may see an additional 8,500 people per year coming into Pennsylvania for abortions.
“They’ll be coming from Ohio, West Virginia and perhaps Kentucky — states that are near to our borders,” Reed said.
The Allentown Women’s Center in Hanover Township sees out-of-state patients on a weekly basis.
Melissa Dowd, senior lecturer of biology at Muhlenberg College, said traveling is not an option for those who can’t afford to take time off work or can’t make the trip due to lack of transportation. Cronin said some will have abortions at illegal clinics close to home or attempt to do it at home, putting themselves in harm’s way.
“We are going to see an increase in injury and death,” Cronin said. “There are long-term injuries that occur with abortions not done by trained health care providers. We’re going to see increased damage to internal organs, infertility, secondary infertility, pelvic inflammatory disease. All of these things can result from unsafe abortion practices.”
Pregnancy and health
Pregnancy itself isn’t without its own risks, especially in the U.S., which has the highest maternal death rate of any wealthy country — 19 deaths per 100,000 births in 2017, data from the World Health Organization showed. The U.S. was also one of the few countries where the maternal death rate rose from 2000 to 2017, according to the WHO.
By 2020, the rate was 23.8 women who died per 100,000 births, according to the U.S. Centers for Disease Control and Prevention. A disproportionate number of U.S. maternal deaths are among Black women — nearly three times the rate for white women, according to the CDC.
A growing body of scientific evidence shows limited access to abortion and other reproductive health services is linked with higher rates of maternal mortality. One study published by the American Public Health Association found that states with strict abortion laws had higher maternal mortality rates.
Most state abortion bans have an exception for when the life of the mother is at risk. Some, however, do not, including in situations where the pregnancy is nonviable, such as during ectopic pregnancies or in miscarriages where the embryo or fetus does not naturally leave the body.
Beyond death, Dowd said, giving birth can be traumatic; some women have lost their pelvic floors, resulting in bladder problems or general incontinence, or have back problems because of damage done to abdominal muscles.
In most cases, it is not possible to determine if someone is likely to be injured while giving birth, she added.
Early pregnancy complications can also be severe for some.
An employee at the Allentown Women’s Center — who asked not to be named — said she got pregnant at 18 after the birth control she was on failed. She didn’t realize she was pregnant until after she’d been sick for weeks with what she thought was a stomach bug. By the time she got an abortion about 11 weeks into the pregnancy, she’d lost 15 pounds. She said the constant throwing up played a big part in why she got an abortion, but there were other reasons — she was in an abusive relationship and also knew she wasn’t ready mentally or financially for a child.
She said many women who come to the Allentown Women’s Center are sick, as she was 10 years ago.
“They’re sick and it’s debilitating almost,” she said. “I actually had to drop out of my college classes because I was missing way too much. And I tried everything. Nothing would really stop me from being sick.”
High blood pressure and obesity, which are both common in the U.S., also increase risks during pregnancy. Gestational diabetes and preeclampsia are also both relatively common during pregnancy and put those who experience them at higher risk of serious health problems like Type 2 diabetes, high blood pressure or heart disease later in life.
Dowd said for those who face barriers to health care, prenatal care may be the first health care they have gotten in a long time. Some may have preexisting conditions they don’t know about that could affect the pregnancy.
She added the U.S. has numerous existing health crises that it is failing to manage already, such as the opioid crisis and a mental health crisis. Bans on abortion will compound such crises, she said, and exacerbate others.
Depression, anxiety or bipolar disorders that arise during or after pregnancy are well-documented, but pregnancy can have other effects on mental health. Medication to treat mental health conditions can affect a developing fetus, leading some to get off or reduce their dosage during pregnancy. If they breastfeed, the time off their medication may last longer.
Stephanie Stathas, a licensed clinical therapist with Thriveworks Bethlehem, said depression, anxiety or bipolar disorders during or after pregnancy can affect personal relationships. She said people can manage these mental health challenges with the right tools.
Pregnancy alters hormonal balances in the body, which can affect mental health and well-being. Studies have shown that untreated or undertreated maternal psychiatric disorders can affect fetal development and lead to negative outcomes during pregnancy or bad parenting practices.
“If someone can’t regulate, doesn’t have the skills to or is too stressed out, then baby takes it on,” Stathas said. “That can cause some developmental issues, early pregnancy, low birth weight, miscarriages, smaller infant head circumference, all of those things.”