With the probability that the Supreme Court will overturn Roe v. Wade, causing abortion to be restricted or banned in at least 26 states, the number of people affected by pregnancy-related illness and death is bound to worsen. The United States already has the highest maternal mortality rate among developed nations. One paper has estimated that a nationwide abortion ban would lead to a 21% increase in pregnancy-related deaths overall and a 33% increase among Black women.
Another group who is at risk? People with chronic illness.
According to the Centers for Disease Control and Prevention, 6 in 10 adults in the U.S. have a chronic illness, which runs the gamut from high blood pressure and diabetes to lupus and multiple sclerosis. An estimated 4 in 10 people have two or more chronic illnesses.
During pregnancy, chronically ill people are at an increased risk for complications such as high blood pressure, preeclampsia, placental issues, growth issues for the baby and preterm delivery, as well as pregnancy-related death, Dr. Jessica Shepherd, chief medical officer at Verywell Health, told HuffPost.
A 2017 study by the University of Michigan found that complications from chronic illness are the most common cause of pregnancy-related deaths in the U.S., accounting for half of all such deaths.
“Having a preexisting condition already puts your health at a high risk,” Shepherd said. “Becoming pregnant heightens that further as pregnancy puts a lot of strain on the body already, so the two together could potentially lead to mortality or morbidity.”
People of color, especially those with a chronic illness, are at an even greater risk for pregnancy-related complications and death.
“Black moms are already twice as likely to die during or after childbirth than any other race. Further, disparities on the condition-specific level already exist for this community, making the two combined together a real threat” to both the mother and the fetus, Shepherd said. “Together, added chronic illnesses would further complicate the matter, making pregnancy and health outcomes for BIPOC communities worse.”
During pregnancy, some medications and treatments for chronic illnesses must be adjusted, changed or stopped. For example, certain medications that treat high blood pressure, seizures, blood clots and depression can have detrimental effects on a fetus, Shepherd said. However, stopping such medications, especially suddenly due to unplanned pregnancy, can harm the person who is pregnant.
Kay, a 21-year-old in the South, takes methotrexate, an immunosuppressant drug that treats rheumatoid arthritis. In high doses, methotrexate can cause miscarriage; it’s also used to treat ectopic pregnancies, which is when a fertilized egg grows outside the main cavity of the uterus. Stopping methotrexate in the case of unplanned pregnancy could cause Kay’s RA to relapse, putting Kay at risk of serious joint damage.
“Currently, if I were to get pregnant, I would seek chemical abortion through Planned Parenthood or another medical avenue, as I do not believe it is worth the risks to attempt to carry a fetus,” said Kay, who, like others in this story, asked to keep their last name private.
Kay is concerned about losing access to methotrexate if Roe v. Wade is overturned. States like Louisiana are already introducing legislation that criminalizes all loss of pregnancy, including in the case of ectopic pregnancies.
Further, some chronic illnesses increase the risk of ectopic pregnancies. Sara, a 25-year-old in upstate New York, is currently being tested for Ehlers-Danlos syndromes, a group of genetic connective tissue diseases. People with EDS are at a much higher risk for ectopic pregnancy, miscarriage and other reproductive problems.
“Help fight for us, please,” Sara said. “Many of us do not have the means or the energy to add even more battles to the large [number] of battles we are already fighting.”
Concern is mounting that overturning Roe v. Wade would also lead to restricting access to birth control. Members of the Idaho House have already mentioned that they’re considering banning abortion pills and morning-after pills. People with conditions like polycystic ovary syndrome and endometriosis depend on birth control to reduce their symptoms and maintain quality of life.
That’s the case with Maya, a 28-year-old in Houston, Texas who currently uses birth control to help manage dysmenorrhea and possible endometriosis. Without it, she would be unable to go to school or work due to severe pain, her conditions would likely worsen due to hormone fluctuations and she would be forced to worry about the dangers of accidental pregnancy.
“I already lose several months of my life every year to disabling pain, and birth control helps keep that to a minimum,” Maya said.
This raises additional concerns that more chronically ill people will die by suicide if they can’t access the medications needed to manage their symptoms. A U.K. study found that half of all women with endometriosis reported having suicidal thoughts as a result of the condition.
“This is a battle we all have to fight, but certain groups are more at risk.”
– Kay, a 21-year-old in the south
Most abortion bans also won’t take into account cases of rape. It is estimated that 2 in 5 female survivors of rape are disabled, according to the CDC.
“I, personally, am a lesbian and only have sex with other women and non-binary people, but I am incredibly concerned about the risk of potentially being sexually assaulted and becoming pregnant by those means, which is the main reason I am on oral contraceptives currently, despite the side effects they have,” Kay said.
Although abortion is expected to remain legal in some states, people living with chronic illness are less likely to have the money, transportation and other resources needed to order abortion pills by mail or travel to an abortion clinic in another state. This will again have the largest impact on communities of color, especially for those who are also chronically ill.
“If Roe v. Wade is overturned, especially because I live in a more conservative state that has trigger laws in place, it becomes significantly more difficult for me to seek care in order to obtain an abortion, especially because I am a woman of color,” Kay said.
What You Can Do If You Have A Chronic Illness Or How You Can Support Someone Who Does
For now, Shepherd recommended focusing on preventative measures like birth control and emergency contraception. Ella is the most effective type of morning-after pill, according to Planned Parenthood, but it requires a prescription. It is most effective for people who weigh less than 195 pounds. Plan B can be purchased online or in-store at most major retailers without a prescription or ID, but it is only effective for people who weigh less than 155 pounds. Alternatively, some types of IUDs can be placed within five days after having unprotected sex and reduce the chance of pregnancy by over 99.99%.
AidAccess offers online consultations for mail-order abortion pills, which can be ordered preliminarily. Abortion pills have a two-year shelf life, according to the International Federation of Gynecology and Obstetrics. They cost $110 to $150 depending on the state.
It is important to include disabled and chronically ill people in the conversation about reproductive health, Kay said.
Now is the time to learn from chronically ill people about how reproductive health care affects them, keep emergency contraception and abortion pills on hand for your community (but don’t hoard them), donate to grassroots abortion funds (especially those in states where abortion is poised to be outlawed), and contact your state and federal representatives.
The decision of if and when to have a child — and if it’s safe to do so — should be between a person and their health care providers. Everyone, including chronically ill people, deserves bodily autonomy.
“This is a battle we all have to fight, but certain groups are more at risk,” Kay said.