People often say that pregnancy is a time of happiness and excitement, which is true for many people. It is hard to ignore the health risks and fears that can come up from some vulnerable patients getting a positive pregnancy test.
In the United States, just being pregnant poses serious short-term and long-term health risks, with the most serious pregnancy-related problems of any developed country, and about 700 people die every year as a result. This health problem affects women of color and low-income women the most. In fact, Black women are three times more likely to die from pregnancy-related complications than white women.
From a health point of view, what makes pregnancy extremely difficult?
Pregnancy is like a long-term stress test that puts a lot of strain on the body's systems and creates new health risks. It changes how the kidneys, lungs, and heart work. It also changes the immune system and the way the body uses energy by affecting many organs. It gets more blood to all parts of the body. People who already have high blood pressure, diabetes, or other health problems will be hurt more by this. Furthermore, pregnancy can aggravate mental health issues like depression and anxiety, exacerbating the symptoms.
Two health problems that are specific to pregnancy are:
Preeclampsia. This can lead to high blood pressure and damage to the kidneys, liver, and brain, among other organs. Just being pregnant puts more pressure on the heart and blood vessels. According to the Preeclampsia Foundation, having a preeclampsia pregnancy more than triples a person's lifetime risk of having a heart attack or stroke. Preeclampsia is more likely to happen if you are younger than 18 or older than 40, have an autoimmune disease (like lupus), already have high blood pressure, or had preeclampsia in a previous pregnancy.
Too much blood loss after birth (postpartum hemorrhage). Even though some things put people at a higher risk, any birth, even those with no problems, can cause a hemorrhage.
Most of the time, a person with health problems can still have a safe pregnancy. Still, if you already have a disease like heart disease or diabetes, you are more likely to have complications and die. More women are getting pregnant later in life, which makes it more likely that they already have heart disease. Large, multidisciplinary teams of health professionals are now often needed to care for pregnant women with complex cardiac needs or other health conditions. This wasn't always the case in the past.
Unintended pregnancy rates are high.
In the United States, almost half of all pregnancies are not planned. In some cases, this means that a pregnancy is wanted in the future, and in other cases, it means that a pregnancy is not wanted.
Why do so many people get pregnant when they don't want to? Nine out of ten sexually active women who don't want to get pregnant say they use some kind of birth control. Of course, not every method of birth control is very good. If you only use condoms, 13 out of 100 people will get pregnant in a year, while up to 23 out of 100 people will get pregnant if you also use other methods to figure out your fertility.
Even when people use very effective birth control, unintended pregnancies can happen. Less than one in 100 women who take birth control pills for a year will get pregnant, even if they use them perfectly, which is hard to do. With normal use, seven out of every 100 people will get pregnant. More than 13 million women in the United States use surgical sterilization, like tubal ligation, as a permanent way to stop having children. With a failure rate of almost 1 in 100, research shows that more than 65,000 unplanned pregnancies may happen after these procedures each year.
Health is also important. Some medical conditions or medicines, like those used to treat epilepsy, can also make it more likely that birth control won't work. Only those who can use them due to their health can use some of the most effective forms of birth control.
Fewer options for health care and other things in life
Even when people choose this path, pregnancy, giving birth, and being a parent changes the course of many lives, including those of the parents, siblings, and wider family. At least 14 states have outlawed or limited the capacity to make decisions once pregnant since the Dobbs Supreme Court decision in June 2022, which invalidated a federal constitutional right to an abortion. Even before Dobbs, almost 10% of Americans who wanted an abortion had to go out of state.
Researchers have found that women who want an abortion but are turned away are more likely to have health problems during their pregnancy and to have money problems or live in poverty in the future. State bans on abortion care will hurt black and low-income women the most since they are already more likely to have problems with or die during childbirth. In the end, medically, financially, and socially, all people who can get pregnant are put at risk by laws that limit or ban comprehensive health care that includes abortion care.
Like being pregnant, the choice to stay pregnant is a very personal one. As with all health care, patients and doctors should be free to talk about all medical options, including ending a pregnancy, before making a choice. Even though abortion care is more limited now than it was in 1973, there are still options, and abortion care is still an important part of women's health care.
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