Let's go

Let's talk about ways to protect women who find themselves unexpectedly pregnant in the coming weeks and months. I've seen estimates that the Dobbs decision will result in about a 13% reduction in abortions over the next year, meaning roughly 80,000 women will be having babies who had not planned to do so. We do not have the necessary supports in place for these women. What do we need to do in order to keep them alive and well?

I am going to ask my congresspeople for legislation establishing an emergency network of telehealth providers to address the shortage of healthcare services in the poor and rural areas where Dobbs will make the biggest difference. I am feeling this terrible urgency on behalf of the women and girls who are finding themselves pregnant in places where oversubscribed providers will be attempting to manage an influx of new patients. These are some of the things they will need in the coming weeks:

• Telehealth prenatal care can address many of the concerns of early pregnancy, including the nausea and vomiting that are probably the single most demoralizing and debilitating facet of those first weeks. Let's provide women with concrete solutions other than "maybe eat some saltines." Let's connect high-risk women with high-risk providers early on, in hopes of addressing the maternal mortality gap that continues to kill black women at an appalling rate -- 2.5 times the rate for white women.
• Telehealth social work services are needed to address the concerns about housing, transportation, and childcare that many unexpectedly pregnant women identify as their most pressing needs. Less commonly but more urgently, they are needed to help women navigating intimate partner violence. The pro-life community has not adequately addressed the connection between intimate partner violence and abortion: women in abusive relationships are more likely to seek abortions, and abusers are more likely to kill their partners when they are pregnant. 
• Telepractice mental health services can be effective in treating perinatal depression and anxiety. You guys, some of the stuff in this post is just me spitballing as a person who has been through five full-term pregnancies and two twelfth-week miscarriages. But I know this literature, and it's important: mental health challenges during pregnancy are robustly associated with mental health challenges after pregnancy, which are also associated with poorer outcomes for kids. Postpartum depression and anxiety are hard on families, not only women. So let's get women the support they need, because a surprise pregnancy raises the odds of psychological distress while simultaneously requiring a person to muster extra resilience and determination.
• Telehealth substance abuse services also seem like an important component of this network. Substance abuse leads to suboptimal decision-making-- before, during, and after pregnancy. Women beset by fear and uncertainty are unlikely to find it easy to give up their preferred mode of self-medication, which is not great for them or their babies. Substance abuse is treatable, but the church-basement twelve-step approach only works for a subset of substance abusers. Let's put more options on the table for more women in crisis.

This idea raises a ton of practical questions about licensure agreements, reimbursement, and funding. A COVID silver lining, though, is that it required us to work out a lot of the kinks with telepractice. This seems like a reasonable arena in which to exercise the same kinds of emergency authorizations that allowed for telepractice expansion in the earlier phases of the pandemic; we do not have time to get appropriate numbers of providers to the places where women will need time-sensitive and potentially lifesaving care. Another COVID silver lining: the vaccine rollout showed us that we can deliver important healthcare services to a lot of people in a hurry when we need to, regardless of their insurance situation.

This is going to be expensive, but the alternative is costlier. (And as I have said before, prenatal care is not the expensive piece of healthcare. Literally every other nation in the entire developed world has figured out how to pay for prenatal care; we can do it, America.) I do have a partial funding suggestion: what if, in the interest of protecting women and children, Congress levied new taxes on the products that currently kill the most children and far too many pregnant women? What if we tax the pants off the gun and ammunition industries, and dedicate the proceeds to making life safer for pregnant women and gestating babies? Promote the general welfare, my friends, just like the Constitution says.

I do not know how this post-Dobbs legislative turmoil is going to play out across the country, but I do know this: there are about to be a lot of women and girls with positive pregnancy tests in states where their options have recently changed. Many of them will need immediate concrete help that does not hinge on living in the right zip code or going to the right church. So let's help them already.