Health Care

Nykia Leach: Abortion denial is a public health issue

The Reproductive Health Care Act (RHCA) to safeguard legal access to abortion at the state level despite federal overturn of Roe v Wade was passed (44-30) in the House. Now, the bill has stalled in the Senate Judiciary Committee. With the legislative session end approaching, reproductive justice has not been cemented into law. While the RHCA remains in limbo, lawmakers

Published on May 13, 2019
By Nykia Leach

The Reproductive Health Care Act (RHCA) to safeguard legal access to abortion at the state level despite federal overturn of Roe v Wade was passed (44-30) in the House. Now, the bill has stalled in the Senate Judiciary Committee.

With the legislative session end approaching, reproductive justice has not been cemented into law.

While the RHCA remains in limbo, lawmakers should seriously consider a reality that has been overlooked: Abortion denial is, fundamentally, a public health (PH) issue. Lawmakers must decisively understand that the RHCA is the truest codification of established reproductive freedom, and it functions as a preventative measure no different than any other PH intervention.

The American Public Health Association’s stance is clear: “[R]emoving access to abortion violates human rights, precludes reproductive justice, and demands public health intervention.” With 16 cases aiming to undermine Roe knocking at the Supreme Court’s chamber, alarm is warranted. No woman should fear that her constitutional right to decide whether to have a child, without coercion, discrimination, and violence, could be withdrawn. Indeed, it is time we intervene.

“So why the mad rush by abortion opponents?” asked Barth Bracy, Director of Rhode Island Right to Life. Devoting my graduate studies to this very question, I wish to provide a response reflective of past lessons and present knowledge.

America knows what happens when safe, regulated abortion is illegal. In the late 1960s after one state legalized abortion, the implications of such legislation entered the radar of PH organizations. Together, the Population Council, Guttmacher Institute, and CDC began to surveil abortion-related morbidity and mortality.

Following the Supreme Court’s landmark 1973 decision, the organizations could compare outcomes of safe, regulated abortions post-Roe with unsafe, “back-alley” pre-Roe abortions. Of those reported, annual deaths due to abortion dropped from 40 in 1970 to eight in 1976 (39 and two resulting from unregulated abortions, respectively). Today, abortion is among the safest procedures. A patient is more likely to die from a shot of penicillin and several hundred times more likely to die during pregnancy than from a legal abortion.

Annually, 800,000 abortions were performed pre-Roe. When women are denied reproductive needs, abortion does not vanish – it becomes dangerous.

Publication of my research quantifying the burdens of abortion denial for Rhode Island women and children is forthcoming, but it concludes similar grim realities as the 2008-2015 Turnaway Study, which observed health and socioeconomic consequences of receiving a desired abortion versus carrying an unintended pregnancy to term. Among women recruited at United States abortion facilities, researchers discovered those “turned away” from receiving abortions are at far greater risk of adverse outcomes.

Legislative barriers, including comprehensive denial, force women to carry pregnancies to term. This occurred before Roe and still occurs in states that heavily restrict abortion. Women denied abortions are 4x more likely to live in poverty and 3x more likely to be unemployed. They are more likely to experience end-of-pregnancy complications, stay with abusive partners, suffer from anxiety, and lack aspirational goals. The Turnaway Study also found these women are more likely to parent alone than those who received an abortion and later had a child. Imagine undertaking these hardships while raising an unplanned child. Then, imagine doing it by yourself.

Oh, and now, imagine you are an already marginalized person. To be clear, the consequences of abortion denial discriminate. Abolishing the right to abortion reinforces existing inequalities.


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Elected lawmakers swear to support the communities they represent. Ignoring the evidence presented in numerous unbiased scientific studies obstructs this remarkable political process. The future of Roe is unclear, but the outcomes of abortion denial are not. The apprehension stirring among Rhode Islanders is warranted and deserves a swift, thoroughly considered response.

Senate Judiciary Committee members: Like smoking cigarettes or driving without a seat belt, for decades we did not know the PH consequences of abortion denial. Now, we do. Learn from history and be proactive today. Protect the health of your constituents and pass the RHCA with no amendments.

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