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Opinion | Dr. Michelle Williams

Anti-abortion laws have dire public health consequences

Women invoked “A Handmaid’s Tale” to protest the fetal heartbeat bill at the Georgia Capitol in April. John Bazemore/AP/Associated Press

THIS WEEK, ALABAMA passed a law that can only be described as anti-life. It aims to criminalize abortion from the moment of conception — even in cases of incest and sexual assault. Notably, all 25 senators who voted in favor of this measure, the most restrictive in the country, are men. Yet, the people who will bear its consequences are women — specifically, poor women from rural areas, who already face significant challenges. Not only is this unspeakably cruel, it’s accelerating a public health crisis already in the making.

I cannot make a judgment on the intentions of the men behind this dangerous, severely oppressive law — that is something only they can know. But claims that it is meant to protect the lives of women or children border on absurd.


The same lawmakers who voted for forced pregnancy have a dismal track record when it comes to promoting reproductive and maternal health. They voted against protecting access to contraception. They’ve also refused to expand Medicaid, which currently pays for more than half of the births in the state. The women who do qualify for Medicaid face a cumbersome enrollment process, often waiting weeks to get approved and make their first prenatal appointment — sometimes well into their second trimester. And currently, more than half the counties in Alabama have no OBGYN.

To put it bluntly, politicians with no medical background are chipping away at women’s autonomy over their own bodies and lives — and leaving them to contend with an already overburdened, insufficient healthcare system they’ve done nothing to fix. And that will mean increased hardship, maternal deaths, and birth complications in a state that already ranks 50th in the country for infant mortality.

What’s happening in Alabama is a disgrace, but sadly, it’s not an anomaly. Six states are down to a single abortion clinic. In recent weeks, Georgia has moved to ban women from receiving abortions after six weeks — before most women even know they’re pregnant. Meanwhile, if enacted, an Ohio bill would prevent most private insurance companies from covering the procedure.


Across the country, states have enacted more than 400 abortion restrictions in the past decade, harming millions of women in the process.

We know from the days before Roe v. Wade that banning abortion doesn’t eliminate the demand for abortion — it only eliminates access to safe, legal abortion. Some women will be compelled to seek risky underground procedures which put them in danger of criminal prosecution and life-threatening complications. Others will have to travel farther and wait longer for legal abortions in other states. This will result in lost wages and, in many cases, costly hotel stays in neighboring states due to mandated-yet-medically unnecessary waiting periods.

Women who are unable to get an abortion will suffer the costs that so often accompany unintended pregnancies — and there are many. The majority of women who seek abortions are already poor or low income, and when they can’t access them, their circumstances are threatened further. They are held back from pursuing their education and advancing in their careers, perpetuating their economic marginalization. A recent study found that women who were denied abortions were more likely to be marginally employed, unemployed, or on public assistance for months and even years after the fact.


Then there are the health consequences. The risk of death associated with childbirth — regardless of the circumstances — is approximately 14 times higher than the risk associated with an abortion. That risk is especially high for black women, who suffer maternal mortality at rates comparable to women in poorer countries like Mexico and Uzbekistan. And unintended pregnancies, in particular, are associated with higher incidence of delayed or insufficient prenatal care, lower birth rates, and postpartum depression.

This is to say nothing of the mental anguish for women whose pregnancies are the result of sexual violence. Under the Alabama abortion ban, survivors will be forced to relive the trauma of their assaults as they carry their pregnancies to term. And we know that such trauma can lead to a range of adverse health outcomes — from depression and substance abuse to obesity and cardiovascular disease. When these victims give birth, they could even be forced to share custody with their attacker. Meanwhile, doctors who perform abortions on rape victims could face longer prison sentences than the rapists.

The facts are abundantly clear: The consequences of restricting abortion access are physically, psychologically, and economically devastating — and the impact ripples far beyond the millions of women who experience an unintended pregnancy.

When women don’t control their own reproduction, they don’t control their own health, their economic prospects, or their ability to reach their full potential. That disempowerment extends to their partners, their children, and their communities. It exacerbates health disparities and perpetuates inequality. And the consequences for public health will be far-reaching and detrimental to us all — unless we stand up, together, and stop this madness.


Dr. Michelle Williams is dean of the faculty at Harvard T.H. Chan School of Public Health.