The Republican War on Families

Since the Supreme Court struck down Roe v. Wade, leading to over 20 states enacting some kind of abortion ban, reporters have published story after story of women and girls nearly dying because they could not get a timely abortion, or being forced to flee to another state to get an abortion after being raped, or being forced to carry a doomed pregnancy to term.

Now we have the most harrowing account yet, courtesy of Charlotte Alter at Time magazine. She tells the story of “Ashley” (the name is a pseudonym, for privacy reasons), a 13-year-old Black girl living in Clarksdale, Mississippi. At age 12, Ashley was raped, became pregnant, and, thanks to the Court and the state’s Republican government, was forced to give birth to her rapist’s baby—just as she is getting ready to start the seventh grade.

The most immediately relevant part of the story in terms of policy is how it bears on the so-called exceptions in Republican abortion bans. Rape victims can theoretically get an abortion in Mississippi, but these stipulations are “largely theoretical,” Alter writes. “Even if a victim files a police report, there appears to be no clear process for granting an exception.” And in any case, Mississippi does not have a single abortion provider since the Dobbs ruling. Doctors told Ashley’s mother that the closest clinic she could go to would be in Chicago, a nine-hour drive. She simply could not afford the cost of travel or the time it would take up.

More from Ryan Cooper

Yet that’s only part of what is going on. Alter wisely situates Ashley’s story in the broader context of an ongoing crisis of maternal care that afflicts the entire country but is much, much worse in impoverished Black regions like the Mississippi Delta, and is getting worse still in conservative states because of Dobbs.

First, as we covered in detail in our latest print issue at the Prospect, there is the yearslong trend of private equity rolling up regional hospital monopolies and slashing costs, and the broader penetration of a ruthless profits-over-people mentality into the medical sector, which often means a cutback in obstetrics/gynecology services and closure of labor and delivery units. The effect is worse in places like Mississippi, where chronic poverty already meant thin provider coverage. As Alter writes, “More than 24% of women in Mississippi have no birthing hospital within a 30-minute drive, compared to the national average of roughly 10% … there are just nine ob-gyns serving a region larger than the state of Delaware.”

Something Alter doesn’t mention is that Mississippi is one of ten states where Republicans are still refusing to accept Obamacare’s expansion of Medicaid, which is inflicting yet more devastating damage on its hospitals. Nonprofit hospitals are required to provide free care to the indigent, and so refusing to accept Medicaid means a far greater burden of uninsured patients. Sharon LaFraniere reports at The New York Times that free care costs Mississippi’s hospitals “about $600 million a year, the equivalent of 8 percent to 10 percent of their operating costs,” as compared to a national average of 1.4 percent. Accepting the Medicaid expansion, by contrast, would grant insurance to 100,000 Mississippians and “uncork a spigot of about $1.35 billion a year in federal funds.”

Republicans could have taken steps to ameliorate this crisis and chose to make it worse instead.

All these problems are rapidly worsening thanks to Dobbs. Alter reports (and the Prospect has reported as well) that the upcoming generation of doctors are repulsed by what’s happening in conservative states—and not just those considering careers as ob/gyns. According to one survey, “three-quarters of students across all medical specialties said that Dobbs was affecting their residency decisions.” After all, doctors or their spouses might also need abortion care themselves, or want to start a family but not to be killed by a doomed pregnancy.

Reading Alter’s piece, one gets a sense for why the Black maternal mortality rate in this country is so high—55.3 deaths per 100,000 live births, or more than 46 times higher than in the Netherlands. Thanks to poverty and a dearth of providers, mothers often get little or no pregnancy care, and so dangerous conditions like preeclampsia or maternal diabetes are missed. Others have to drive themselves for hours to get to a hospital while in labor, while others get to the hospital only after actually delivering. As she concludes: “More women are delivering more babies, in areas where there are already not enough doctors to care for them, while abortion bans are making it more difficult to recruit qualified providers to the regions that need them most.”

At numerous points, Republicans could have taken steps to ameliorate this crisis and chose to make it worse instead. Mississippi Republicans could take the Medicaid money and help rescue their rural hospital sector. They refuse to. They could have not banned abortion, or at least made the exceptions for rape and incest clear and accessible. They refused to. National Republicans could have voted for President Biden’s child allowance and cut the child poverty rate by about 41 percent. They refused to. They could get behind efforts to stop the financialization of health care. They refuse to.

I conclude that this is what Republicans want. If a middle school girl is raped, they want her to be forced to bear her rapist’s child, and then give birth in a rattletrap medical system where she will be dozens of times more likely to die than in peer nations, and then get little or no help from the government raising that child. This is what conservative policy produces, and there’s no sign of it changing.