Louisiana’s abortion law, maternal mortality rate a double burden to sexual assault survivors

Maternal mortality – pregnancy-related death – refers to the death of a pregnant person during pregnancy, labor, or shortly after delivery.

Aside from the United States, every other country in the G7 – France, Germany, Italy, Canada, Japan, and England – has had a steady decline in the number of maternal deaths since 1990. Even countries with extremely high maternal mortality rates such as Ethiopia, Ghana, and Pakistan have been able to reduce the number of maternal deaths.

In the U.S., however, the number of maternal deaths has continued to rise sharply for decades. And when the maternal mortality rate is high so is the infant mortality rate – of the G7 countries, the U.S. also ranks the highest in infant mortality.

In the last three decades, as maternal mortality rates have been on the rise, the U.S. has also increased its GDP spending on health care. Wealthy countries undoubtedly spend more per person on health care than lower-income countries. But the U.S. spends twice as much per person on health care as comparable countries and with no improvement to the actual health of the nation’s citizens.

Taking into account that the total amount spent on health care in the U.S. is greater than in any other country in the world and that U.S. physician salaries rank amongst the highest in the world, the high maternal mortality rate in the U.S. seems especially egregious.

According to the 2019 USA Today article, “Hospitals know how to protect mothers. They just aren’t doing it,” maternal mortality rates in the U.S. are not consistent from state to state either:

• Louisiana has the highest rate of maternal mortality at 58.1 deaths per 100,000 births.
• Georgia — the second-highest-ranking state for maternal mortality — has 48.4 deaths per 100,000 births.
• And California, which is more on par with safe countries like Sweden, Iceland, and Denmark, has 4 deaths per 100,000 births.

For context, as of 2015, the maternal mortality rate was lower in El Salvador with 48 deaths per 100,000 births than in Louisiana.

While Louisiana and California have disparate rates for maternal mortality, the two states do have a comparable number of active physicians. A report based on the American Medical Association Physician Masterfile (released in January 2022) shows that Louisiana has 270.1 active physicians per 100,000 residents and California has 287.8.

Not all pregnancies receive educated care

So if “hospitals know how to protect mothers” and there are enough physicians to carry out the proper procedures to ensure the safety of mothers, then why is the care not being offered?

The standard list of the leading physiological factors that cause maternal mortality typically includes preeclampsia, hemorrhage, cardiovascular and coronary conditions, mental health issues, embolism, and infections. Each of these things comes with warning signs and can be managed during pregnancy or after birth to ensure the health and safety of a mother.

Preeclampsia warning signs, for example, include high blood pressure, blurred vision, headaches, swelling of the face, hands, and feet, upper abdominal pain, vomiting, and shortness of breath. While preeclampsia can be detected as early as 20 weeks for expecting mothers, it is more likely to arise in the final weeks of pregnancy or after delivery. Either way, three basic forms of care are essential to treat preeclampsia and any other standard cause of maternal mortality:

• Strong and thoughtful communication
• Ample focus-time on the patient
• Educated care

But as the maternal mortality rate in Louisiana reflects, these basic things are not being offered to every expecting mother and local physicians may even lack the basic knowledge on how to treat the standard causes for maternal mortality.

Sexual assault not listed as contributing factor, but should be

A history of sexual assault is generally not something medical professionals identify as a cause of maternal mortality, nor is it a factor that is considered in how care is offered to a pregnant person. Nevertheless, a history of sexual violence can also lead to health issues during pregnancy.

Some survivors can be triggered back into the moment of sexual violence during labor and delivery, which means the neurohormone catecholamine can increase rapidly causing the person to enter tonic immobility.

Other survivors who may have experienced some form of institutional betrayal in the aftermath of their assault (typically non-white sexual assault victims who experience institutional betrayal either with the police or at the hospital) may be less likely to trust their health care providers.

If this lack of trust is compounded with a physician’s unwillingness to offer each pregnant person the time and care they need to learn about each individual patient and build a relationship that promotes communication and transparency, an overwhelming sense of alienation and disconnect could become a major threat to the pregnant person.

The Sexual Abuse to Maternal Mortality Pipeline, a 2019 report by Black Women’s Blueprint, identifies the following “experiences on the continuum of sexual and reproductive violence [that] increase adverse maternal health outcomes”:

• “Exposure to sexual violence and high adverse childhood experiences (ACEs)”
• “Lack of mental health treatment or healing services after sexual violence”
• “Re-traumatization through contact with the healthcare industry, as reported by women and girls who disclose incidents with non- communicative gynecologists and obstetricians”
• Disrespect in the healthcare industry
• “Obstetrics violence like probing insertions in gynecological offices [without trauma-informed methods] which trigger PTSD
• Non-consensual transvaginal ultrasounds causing the re-emergence of trauma in pregnant women.

Black survivors have highest maternal mortality risk

The Black Women’s Blueprint report and the 2022 documentary “Aftershock” (Hulu), directed by Tonya Lewis Lee and Paula Eiselt, both highlight that the disproportionate rate at which Black women die from childbirth is not new. Situating the current maternal mortality “epidemic,” as it is described by the mother of one of the Black women who lost their lives giving birth in a hospital, on a historical continuum gives context to why Black women are more likely to die during or after childbirth.

That is, the current maternal mortality epidemic disproportionately impacting Black women and the current iterations of system racism that plague the maternal health system in such a way that Black women, specifically, are denied educated care can be understood as a direct result of, for example:

• the medical industry’s roots in the use of Black women’s bodies as experimental tools to perfect various fields, including gynecology
• the belief that Black women did not experience pain and the refusal to acknowledge the pain experienced by Black women
• the concept that Black women were commodities and that their wombs were the property of their “owner”

In an interview with Politico for the Harvard Chan School of Public Health series Public Health on the Brink, Louisiana Sen. Bill Cassidy, a licensed physician, unwittingly demonstrates how violence against women intersects with racism. As a result, Cassidy ends up revealing how the intersection of hate for both women and Black communities is central to understanding Louisiana’s terrifying maternal mortality rate:

“About a third of our population is African American; African Americans have a higher incidence of maternal mortality,” Cassidy said in the Politico interview. “So, if you correct our population for race, we’re not as much of an outlier as it’d otherwise appear. Now, I say that not to minimize the issue but to focus the issue as to where it would be. For whatever reason, people of color have a higher incidence of maternal mortality.”

The racist and misogynist logic – or as Moya Bailey would say, misogynoir logic – that Cassidy spews in this interview shows that Louisiana not only has a maternal mortality problem but it also has a maternal mortality problem that is devastating the Black community.

• One in three women in Louisiana between the ages of 18–64 is Black
• Black women account for 39% of the women who give birth and 68% of the women who suffer maternal deaths
• Black women are four times more likely than white women to experience a pregnancy-related death
• Louisiana has the largest gap in earnings between Black women and white men in the country, with Black women earning less than half of white men’s earnings (46.3 percent)

When we compound these facts with the nationwide data that shows Black women, indigenous people, and non-white communities, in general, are more likely to experience sexual assault in their lifetimes, then it is fair to say that BIPOC sexual assault survivors in Louisiana face a double burden as they are more likely to have a negative, near-death, or mortal experience if they carry a pregnancy to term in the state.

Loss of reproductive justice puts pregnant people in danger

The way maternal healthcare and reproductive justice are approached shapes a collective understanding and response to violence against women as well as gender-based violence. The higher the collective tolerance for violence against women and the more gender-based violence is deliberately overlooked, the less likely we are to have access to effective reproductive healthcare or any semblance of reproductive justice.

In other words, patchwork and reactive solutions that have become normalized within the framework of disaster capitalism will have no impact if the U.S. plans to join the world’s other richest countries in healthcare statistics. Multifaceted responses like the Black Maternal Health Momnibus Act of 2021 are what we need alongside a significant culture shift in how we understand that a person’s womb and what they choose to do with it is a personal decision that no government has the right or obligation to regulate or control.

State and federal priorities must shift away from what a person can and can’t do with their own body and toward a focus on what hospitals and medical professionals in the medical service industry must do for pregnant people.

Nationally, one in seven, or 14.29%, of all vaginal rapes result in pregnancy. Right now, in Louisiana’s especially unfair health care environment, for a rape victim to be forced to carry a pregnancy to term as a result of the state’s abortion ban (and assault on bodily autonomy), that rape could easily turn out to be a death sentence.