Pregnancy is right up there with aging on the list of human experiences that will permanently change a person’s body. Scars and complications from C-section surgery, lasting pain and sexual dysfunction after some vaginal births, urinary incontinence and other pelvic floor problems, separation of the abdominal muscles, lingering high blood pressure, increased risk of heart problems, and more can await those who experience pregnancy and childbirth, to say nothing of the more “cosmetic” but no less lasting changes in bone structure, breast shape, and even shoe size.
And that’s just for those of us who survive. For far too many pregnant people in the U.S., especially Black women and other women of color, carrying a fetus to term results in the most permanent and final body change of all: death. The U.S. maternal mortality rate is more than double that of most other high-income countries, and has been on the rise since 2000. Black women in the U.S. are at the highest risk, being three-to-four times more likely than white women to die as a result of pregnancy or childbirth. Unsurprisingly, research has found that banning abortions is likely to make the situation far worse, resulting in a 33% increase in pregnancy-related deaths among Black women, and 21% overall.
But to hear the State of Mississippi and Supreme Court Associate Justice Amy Coney Barrett tell it at Wednesday’s oral arguments in Dobbs v. Jackson Women’s Health Organization, the state forcing people to carry unwanted pregnancies to term is a perfectly defensible legal and moral act because the burden of mere pregnancy is more “narrow”—less permanent—than that of parenthood. Coney Barrett argued from the bench—via a comment masquerading as a question—that while landmark abortion rights cases Roe v. Wade and Planned Parenthood v. Casey emphasized the “burdens of parenting” as a reason why it was unfair to unduly restrict abortions, that the right to abortion care is no longer needed since nearly every state now offers safe haven laws and adoption to terminate parental rights after birth. The argument is a willful erasure of the considerable physical and financial burdens of pregnancy, many of which don’t simply evaporate when a child has been born and given up for adoption.
I should know—I’ve been pregnant twice, and have seen firsthand the impact of pregnancy and childbirth not just on the body, but on one’s life as a whole. After an easy pregnancy with my first child, I was still left with hip joint pain that didn’t subside until nearly two years after he was born, and only then after a more than $1,000 course of physical therapy that wasn’t covered by insurance. My second pregnancy was more challenging—I got gestational diabetes, which means that for the rest of my life, I’m at higher risk of developing Type II Diabetes. Getting medical care for permanent or semi-permanent effects like these and others is no guarantee, especially for low-income women, those without health insurance, or those who simply lack the time and resources to hunt down the specialists who can help. While other countries like France ensure women are supported in managing the lingering effects of pregnancy—offering postnatal pelvic floor therapy as standard care, for example—in the U.S. many of us are given a single postpartum check-up at six weeks and sent on our way, despite recommendations from the American College of Obstetricians and Gynecologists for doctors to provide more follow-up care.
Even for those of us who can seek out and afford follow-up care after pregnancy, medical sexism and racism mean Black women and other women of color face an uphill battle getting doctors to take our health complaints seriously, meaning we can go without treatment until it’s too late. The risks are exacerbated since people who give birth in the U.S. have almost no time to recover before returning to work, thanks to the country’s lack of mandated paid parental leave. In fact, one in four mothers returns to work just two weeks after giving birth, putting them at risk of both long-term physical effects and mental health issues like postpartum depression.
Still, as far as pregnancy impacts go, I recognize that comparatively, I got off light: My own mother very nearly died after giving birth to me, and in just the last few years I’ve seen close friends struggle with painful and sometimes life-threatening complications both during pregnancy and after giving birth. All this against the backdrop of a country with some of the most abysmal maternal mortality rates in the world, both for Black women like us and for pregnant people across every race and ethnicity. But those are all risks we chose for the sake of bringing very much wanted children into the world. The notion that that those risks should be forced for the sake of carrying unwanted pregnancies to term, that people’s bodies should be pressed into service even at the risk of permanent damage or death is incredibly violent, no matter how anti-abortion advocates and justices try to normalize it.
And the lasting burdens of pregnancy aren’t just physical, they’re economic. Being pregnant is a task, one that requires significant investments of time and money that many people simply do not have. The doctors appointments alone, which start out being only once a month but ramp up to weekly by the end of a pregnancy, can eat up hours of time in travel, sitting in waiting rooms, and finally meeting with doctors. And for anything other than a perfectly standard and healthy pregnancy, the required time investment multiplies. While my first pregnancy was uneventful, my second came with complications, which meant that on top of the regular OB-GYN appointments, I was subject to additional testing and monitoring, so I was regularly missing hours of work at a time. Before all is said and done, pregnant people can easily spend upwards of 20-to-40 hours in less than a year dealing with pregnancy and childbirth-related medical care, and that’s not accounting for a postpartum hospital stay of two days or more and the recommended recovery period of six-to-eight weeks. While I was able to use paid sick leave and vacation days for all the appointments during both my pregnancies, there’s no U.S. law requiring employers to offer either, let alone paid leave to recover from childbirth.
People working low-wage jobs without flexibility, paid sick time, or paid leave—jobs where Black women are overrepresented— feel these burdens disproportionately, as every hour spent on prenatal care may be an hour of lost wages, or could even get them fired. And while anti-abortion advocates argue those challenges are temporary, in reality the consequences of lost wages and job loss can be catastrophic and long lasting, from psychological distress to long-term earnings reductions, and difficulty reentering the workforce.
What’s more, all that medical care costs huge amounts of money. Even with insurance, families end up paying upwards of $3,000 out of pocket for prenatal care and childbirth-related expenses. Those without insurance can end up staring down costs of up to $30,000. The resulting medical debt can keep people from seeking and obtaining health care they need later in life, and working to pay it down long term means that some go without food and other basic necessities. And because most women who seek abortions already have children, the high costs of pregnancy can also make it more difficult to provide for any children they already have—unless Coney Barrett proposes they give those kids up for adoption too.
Coney Barrett’s cavalier attitude toward forced birth willfully ignores all those consequences to make a bad faith argument that the sole burden of pregnancy lies “narrowly” in the “the state requiring the woman to go 15, 16 weeks more” to complete a pregnancy rather than getting an abortion at 23 weeks gestation. In reality, states poised to ban abortion are prepared to force those who can become pregnant to put their lives at risk and endure permanent physical changes and lifelong financial consequences to bear children against their will, whether they give them up for adoption or not.
Notably, at least one Supreme Court associate justice took note of the real stakes of the argument before the court: “When does the life of a woman and putting her at risk enter the calculus?” asked Justice Sonia Sotomayor. For anti-abortion advocates and the Supreme Court’s conservatives, the answer appears to be never.