I remember being proud of living in the United States as a kid. We stood up, put our hands over our hearts, and ended with “one nation under God, indivisible, with liberty and justice for all.”
Fast-forward 30 years—moving from California to the Midwest, and working as a gynecologist in Missouri and Illinois—I no longer feel such pride in this country. I no longer believe this country protects liberty or justice for all. I see a nation under a hijacked God whose leaders use their versions of “his word” to justify increasing inequities. We have become a country where your life, how you live it, and the risks to it ending—especially if you are a woman—are determined by the state in which you live.
I’m an obstetrician/gynecologist in St. Louis City, and a Missouri resident. I’m also executive director at Hope Clinic for Women in Granite City, Illinois. In Missouri, I’m a general OB-GYN seeing patients for all of their reproductive health-care needs, except abortion. In Illinois, I provide abortion care almost exclusively. My unique perspective as a reproductive health-care provider seeing patients in two very different states highlights the extreme health-care inequities in the United States.
My own child would say, “It’s not fair!” But it’s beyond unfair—it’s tragic, and it’s illegal. The tale of two bordering states, Missouri and Illinois, highlights what is happening in 2019 across the United States, as lawmakers in some states expand abortion rights, while others do everything they can to make abortion inaccessible.
Missouri has twice the number of uninsured women compared to Illinois, and it has a maternal mortality rate that’s double the national average and almost triple the rate of Illinois. The disparities are even worse when considering access to legal abortion care. Missouri lawmakers have enacted so many targeted regulations on abortion providers (TRAP laws) that residents now face everything from an onerous 72-hour waiting period to required inaccurate abortion and pregnancy information provided verbally and in writing to parental consent requirements for minors to mandates that health insurance can’t cover abortion services. The restrictions have become so burdensome for health-care providers that there’s only one freestanding clinic able to offer abortion services in the entire state.
In the next several weeks, Missouri’s Republican-held legislature will most likely pass a six-week abortion ban, which is essentially a ban on all abortion with very few exceptions. A near total ban on abortion would continue to force women in Missouri seeking care that is legal in this country to travel outside their communities, away from their known and trusted providers.
Going just east across the Mississippi River, you enter an entirely different world of health-care access, autonomy, and respect for private medical decision-making. In Illinois, people can access abortion more like they would other health care. There are no forced waiting periods or medically unnecessary state-mandated consents. Unlike their Missouri counterparts, Illinois residents can use many private or state-funded insurances to cover the costs of their abortion. Illinois residents can see their own provider for abortion care or be referred within their own state. State leaders have made it clear that access to reproductive health care, including abortion care, is of the utmost importance.
Illinois Gov. J.B. Pritzker (D), shortly after taking office in January, on the anniversary of Roe v. Wade, said, “I’m proud to declare under my administration, the State of Illinois will be the most progressive state in the nation when it comes to guaranteeing the right to choose for every single woman.” Illinois elects legislators who believe the validated medical evidence that abortion is safe and that laws restricting abortion do not and cannot make abortion safer—the restrictions only add barriers to care. Abortion restrictions disproportionately affect patients in rural areas, patients of color, and patients with lower incomes.
There are resonating effects on patients’ families and communities. There’s evidence that women who were unsuccessful in securing abortion care, despite initial comparable financial situations, were at least three times as likely to fall into poverty and to be unemployed than those who sought care and received it. Women who were able to obtain abortion services were more likely to follow through on employment or educational goals.
The states where I provide care couldn’t be more different. And while drives to state capitols are never short, and the announcements of hearings are often last minute, it is more important than ever for me to reschedule patient appointments to lobby legislators. I have sat in the Missouri capitol and listened to legislators use false information and their version of religion to create, discuss, and pass laws that affect the entire state. I feel like I’m in another world or time in history listening to the legislators talk about what their God wants us to do, ignoring medical facts and research using just emotional pleas about “saving lives” while ignoring the lives of their constituents.
Crossing back into Illinois, a different tone is being set in the capitol to protect reproductive freedom. The Reproductive Health Act (RHA), introduced in the Illinois house by Rep. Kelly Cassidy (D-Chicago), would enshrine the protections of Roe v. Wade into Illinois law, ensuring that if conservative justices on the U.S. Supreme Court struck a blow to Roe, people in Illinois and surrounding states would have a haven in which to seek care. The RHA would repeal a decades-old law that includes criminal penalties for doctors who offer abortion care. It would also bolster access to abortion care by ensuring anyone who has private insurance coverage in Illinois can use that coverage to pay for abortion services.
This is just the tale of two states, but it is true across the United States. My patients come from many surrounding states seeking care they can’t obtain or because they are facing too many barriers created by anti-choice politicians. There is no question that near total abortion bans in Missouri and other states such as Kentucky, Georgia, Ohio, or Mississippi—all states from which I see patients—would place an undue burden on the 1 in 4 women who will seek abortion care in their lifetime.
The inequities in access to abortion care are an example of how our country is completely failing its people. This is no longer one nation, and we no longer have our liberty or justice protected. For many people, even though you are technically a U.S. citizen, your choices and your health outcomes have been determined for you based on the state in which you reside.