New abortion restrictions could worsen obstetric deserts, maternal mortality rates

During the last trimester of Victoria Garcia Wilburn's pregnancy, she experienced hemorrhaging, and her son’s heartbeat dropped dramatically. She was fortunate, she said, to live in a county with a Level IV Perinatal Center.

This Level IV center provides medical care to the most acutely ill mothers and infants, according to the Indiana Department of Health.

“If I wasn’t able, by that happenstance, to have that access I don’t know if I would have a 9-year-old son today,” said Wilburn, a candidate for Indiana House District 32. “I don’t know if I would be around today.”

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Marion County is the only Indiana county offering Level IV certified OB care at Ascension St. Vincent’s Women’s Hospital, according to the Indiana Department of Health. That hospital, IU Health Methodist Hospital and Riley Children's in Marion County also have the only Level IV certified neonatal care. More than 650,000 Hoosiers live in an obstetric desert, or a county without an inpatient delivery room, according to reporting by the IndyStar.

What are obstetric deserts?

Nicole Scott, director of the Indiana University School of Medicine OB-GYN Residency Training Program, said an obstetric desert is a county that doesn’t have access to an OB provider or a hospital that has a labor and delivery unit.

“It’s more common than people think,” she said, adding her opinions are her own and do not reflect that of her employer. “We, as medical professionals, think this is one reason why Indiana is number three in maternal mortality in the United States.”

Women often have to travel upward of 100 miles for obstetric care, which affects access to contraception and prenatal care, as well as the birth of their child, Scott said.

The overturn of Roe v. Wade is expected to lead to more undesired and unplanned pregnancies, which could mean worse outcomes for Hoosiers, especially those who live in obstetric deserts, Scott said.

The proposed abortion ban in Indiana only includes exceptions for rape, incest and threats to the life of the pregnant person. Indiana legislators will discuss and vote on the bill during the special session starting July 25.

Jeff Peipert, professor and chair of obstetrics and gynecology at IU School of Medicine, said people who are pregnant are in greater danger when they live in an area without a skilled provider who can do an emergency cesarean section or provide 24-hour anesthesia. Peipert said his opinions are his own and do not reflect those of his employer.

Maternal mortality rates skyrocketing

Hoosiers often have to travel far to seek OB care, said Rima Shahid, CEO of Women4Change. Shahid said Indiana has some of the worst maternal mortality rates in the country and even the world.

From 2015-2019, Indiana's average maternal mortality rate was 52 deaths for every 100,000 births, according to the IndyStar. In 2020, the national maternal mortality rate was 23.8 per 100,000 births, according to the Centers for Disease Control and Prevention.

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Keeping abortion safe and legal is one way to prevent a worsening maternal mortality rate, Shahid said.

“Marginalized communities are going to be affected at a much higher rate because people with privilege and economic privilege are still going to be able to travel out of state to seek an abortion,” she said. “This is not going to stop abortions. This is going to increase the number of people that die from abortions.”

Prevention, specifically highly effective contraception, is more important than ever, Peipert said, to reduce infant and maternal mortality.

“We need to make all forms of contraception available to all women throughout our state,” he said. “When you make contraception available, you can reduce health disparities, reduce teen pregnancy and reduce the need for abortion.”

Often pregnant people with medical conditions require complex contraception due to the possibility of higher risk pregnancies, Peipert said. Complex contraception is for those who have medical conditions that can complicate their options, according to John Hopkins Medicine.

Physicians want to time the pregnancies appropriately to have medical conditions, such as diabetes, under control before a person gets pregnant, Peipert said. Those with unintended pregnancies also are at higher risk, meaning they have higher rates of preterm births, adverse outcomes, infant mortality and maternal mortality.

Sex education is lacking

Indiana schools are not required to teach sex education, according to Sexuality Information and Education Council of the United States. Curriculum must stress abstinence and is not required to include instruction on sexual orientation or gender identity. Furthermore, Indiana does not require medically accurate sex education, according to SIECUS.

“So we want to talk about limiting people’s reproductive freedom, but we don’t want to educate our children,” Shahid said. “We don’t want to expand birth control. We don’t want to equip folks with paid family leave, with economic relief. And we’re going to force people to carry children that they do not want and cannot support. … How does this make sense?”

Indiana does a poor job of understanding basic anatomy and reproductive health, Scott said, in addition to what basic gynecologic care looks like.

“Abortion is not a dirty word,” she said. “Abortion is a healthcare procedure that can be life-saving for some people.”

Future for Indiana providers

Indiana legislators’ decisions will affect the OBGYN specialty directly and the future of medical education in the state, as well as its ability to attract and retain new providers, Scott said. She worries about fewer people wanting to train in Indiana for their residencies or stay in the state after completion.

Some physicians, especially those specifically trained in complex family planning services, may leave the state to practice elsewhere, Scott said.

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Providers in training also are at risk of not having the necessary skills to take care of pregnant people, Peipert said. Residents or providers who encounter a pregnant person with a fetus that is not alive or with a non-viable gestation may not have the required knowledge, he said.

Peipert hopes the state government will not enact legislation to criminalize or penalize physicians for providing care.

“We will not see a marked reduction in abortion numbers,” he said. “If we make abortion illegal in our state, we will see increasing numbers of unsafe and unclean abortion cases where women will be putting their lives at risk.”

Reach Luzane Draughon at ldraughon@gannett.com or @luzdraughon on Twitter.

This article originally appeared on The Herald-Times: Indiana abortion laws could affect obstetric deserts, maternal mortality