West Alabama Women’s Center was one of the only places in the state where people could access abortion care before Alabama began enforcing a total abortion ban after the overturn of Roe v. Wade. Like many clinics, the center, now WAWC Healthcare—a free and sliding scale reproductive and sexual health center in Tuscaloosa—is struggling to stay afloat while the local community struggles to access care.

Because we know maternal health care and abortion access is so inextricably linked, the center is now working with Dr. Stephanie Mitchell, a certified nurse midwife, to explore the possibility of opening a birthing suite in their clinic (Mitchell is also working on opening a freestanding birth center in Gainesville). This holistic approach to reproductive health is key when it comes to the many challenges we face.

Alabama currently has the highest maternal mortality rate in the South and has the third highest rate in the country. Across the state, maternity units and hospitals have closed, and many more are at risk of closing. In fact, according to a 2023 March of Dimes report, around 34.3 percent of the state’s counties are considered maternity care deserts, making access to appropriate preventive, prenatal, and postpartum care difficult. Alabama is also one of only ten states that have not adopted Medicaid expansions, leaving many residents uninsured.

That’s not all. Alabama also has the country’s highest cesarean section rate, partially due to the lack of access to continual and culturally competent care. And on top of all of this, the state has made it incredibly difficult for those who want to provide much-needed care amid this crisis.

Yet, despite the many challenges that come with being pregnant and giving birth in Alabama, the state now prohibits abortion at all stages of pregnancy. Lawmakers have essentially mandated that all pregnancies must be brought to term in one of the most dangerous places in the country to give birth. Because of this, some folks must travel far distances at great costs to obtain abortion health care, while others are forced to be pregnant and give birth in a state that already has some of the worst maternal care outcomes in the country.

It is unconscionable that Alabama lawmakers, without any medical knowledge, skill, or background, are forcing people to keep their pregnancies and give birth considering everything the state has going against it when it comes to maternal outcomes. And Alabama isn’t alone.

In 2022, immediately following the Supreme Court’s decision to overturn Roe, states across the country started enforcing abortion restrictions and, in some places, total bans. The lawmakers behind these changes pushed a narrative of “protecting life.” But two years later, we’re seeing what we knew would happen: States with the most restrictive abortion laws have the worst maternal and infant health outcomes, particularly for Black women.

This correlation is not a coincidence, but a direct consequence of policies that undermine people’s autonomy over their bodies and health. The repercussions are dire, and just another facet of the maternal health crisis, which disproportionately affects marginalized communities and exacerbates existing disparities in health-care access and outcomes.

What’s happening in Alabama is also taking place in Idaho, Louisiana, Oklahoma, South Dakota, Tennessee, and elsewhere. People in states with abortion bans are nearly three times more likely to die during pregnancy, birth, or within the first year postpartum. And, like most maternal health-related concerns, Black women continue to be the most impacted. People in Louisiana are facing risky procedures, including unnecessary c-sections, as providers fear being mistaken for providing abortion care in the wake of the state’s ban. As doctors decide to leave states where restrictions and bans persist, we’ll continue seeing the impact as people lose more and more access to maternal care.

It’s bad—and it will continue to get worse.

The worst part about all of this is that we knew. We knew that restrictive abortion legislation contributes to poor maternal health outcomes. There is no way to claim you care about life when you ignore the facts that were in front of you. There is no hiding behind the unknown. Alarm bells sounded loudly, warning of the devastating impact that has come to fruition from demolishing the protections of Roe.

If we’re serious about protecting life, then let’s start with those who are actually living. If states are going to politically enforce the continuation of pregnancy, they then must be responsible for creating an infrastructure to care for these upcoming pregnancies, particularly in areas where increasing pregnancies will only exacerbate already high maternal mortality rates. It is incredibly shortsighted to enforce pregnancies, yet not adopt any measurable efforts to reduce harm. Until better, safer, and more equitable laws are passed, we need to make pregnancy, birth, and postpartum time safer, both for those who choose it and for those forced into it.

It’s why places like Western Alabama Women’s Clinic are so important. They get creative while state governments continue to force people to give birth and refuse to support midwives, refuse to enact policies that would reduce mortality rates, refuse to expand health insurance, and allow a dangerous lack of access to care to continue.

At the moment, it is safer to continue a pregnancy and give birth in a state that has greater access to abortion care. Banning abortion doesn’t mean you care about life, especially when you ignore the harm and death already occurring in your state because of the heightened risks of complications and death. How many more people with full lives and families need to die before something is done?

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