How the SCOTUS Dobbs decision is affecting maternal mortality

Transcript

NIALA: Good morning! Welcome to Axios Today!

It’s Wednesday, December 14th.

I’m Niala Boodhoo.

Here’s what we are covering today: the real relationship between high blood pressure and stress. Plus, President Biden signs the Respect for Marriage Act into law. But first, how overturning Roe v. Wade could be affecting maternal mortality in America. That’s today’s One Big Thing.

NIALA: The Supreme Court decision in Dobbs versus Jackson that ended that constitutional right to abortion has had a negative effect on maternal health in the U.S. That’s according to Biden administration officials yesterday.

And per another report out today from The Commonwealth Fund - in 2020 maternal death rates were 62% higher in states that banned or restricted abortion than in those states where the procedure was still available.

Axios’ Oriana Gonzalez is here with the latest on this. Hi Oriana!

ORIANA GONZALEZ: Hi Niala.

NIALA: So Oriana, why is the Biden administration saying that this is having such a devastating impact on maternal mortality? Especially since the Dobbs decision just came out earlier this year?

ORIANA: The US is already grappling with having the highest maternal mortality rate among developed nations. And according to data from the CDC, actually states that have banned abortion prior to Dobbs, where the states that had the highest, maternal mortality rates. So in the US what a lot of advocates say, a lot of health experts say is that the big issue is accessibility.

A lot of people do not have access to maternal healthcare or reproductive healthcare in general, and that has been a big driver as to why the US is facing this.

NIALA: And is that connection because abortion is banned or because there are other reasons?

ORIANA: So the states that have banned abortion are also states that are known to not have put much funding into childcare. So for example, the Biden administration gave states this year the authority to extend Medicaid postpartum coverage to one year because they understood that extending from 60 days to one year that postpartum coverage was essential, to handle what the administration calls the maternal health crisis.

NIALA: And can you explain the effect then that that lack of funding has on maternal mortality across the country?

ORIANA: As you mentioned, the Commonwealth Fund released this, report today that said that maternal death rates in states that have banned abortion were around 62% higher versus those where the procedure is still accessible. These states also have what are known as maternal care deserts. So, for example, another finding from the report is that these states had a 32% lower ratio of OBGYNs to births and a 59% lower ratio of certified midwives to births. Another finding that was actually kind of big for this report was that overall death rates of women of reproductive age, meaning those women between the ages of 15 and 44 were 34% higher that in states where abortion is still accessible.

NIALA: How has the Biden administration responded to all this?

ORIANA: I attended a event from the Centers for Medicare and Medicaid Services. The White House Domestic Policy Advisor and former ambassador Susan Rice was there. And one of the things that she said was, Dobbs was, and I quote, “devastating, and that it underscores that the administration needs to keep battling relentlessly to protect and advance women's maternal health.” The Biden administration has said that they want to increase health provider training around maternal health and, you know, diversify the maternal care workforce in terms of funding. The administration is calling on Congress to approve around $470 million as part of the President's 2023 budget to advance maternal healthcare in the US.

NIALA: Oriana Gonzalez is a healthcare reporter at Axios. Thanks Oriana.

ORIANA: Thanks, Niala.

President Biden signs the Respect for Marriage Act into law

NIALA: President Biden signed the Respect for Marriage Act into law yesterday – which codifies federal recognition of same-sex and interracial marriage. We were just talking about the Supreme Court Dobbs decision — well, this act was pushed through Congress because of concerns raised by that ruling.

JOE BIDEN: Marriage is a simple proposition. Who do you love? And will you be loyal to that person you love? Is not more complicated than that. And the law recognizes that everyone should have the right to answer those questions for themselves without the government interference.

NIALA: That’s Biden from the South Lawn of the White House. Under the new law, all states must accept valid marriages conducted in places where they are legal – regardless of sex, race, ethnicity or national origin.

Coming up: a new understanding of what causes high blood pressure.

[AD SPOT]

The real relationship between high blood pressure and stress

NIALA: Welcome back to Axios Today. I'm Niala Boodhoo.

Almost half of American adults have high blood pressure or hypertension and everything you thought you knew about the connection between high blood pressure and stress could be wrong. Here to help us do some medical myth busting is Axios’ Chief Correspondent Jennifer Kingson. Hey, Jennifer.

JENNIFER KINGSON: Hi Niala.

NIALA: So people tend to think that things like a hectic job, difficult relationships or financial problems can cause high blood pressure. Is that accurate?

JENNIFER: It turns out that all the stress we associate with hypertension is bad and can raise your blood pressure in the moment, but it does not lead to the type of hypertension that requires medical attention. Only if high blood pressure runs in your family or you don't take care of yourself in ways that lead to elevated blood pressure do you really need to see a doctor and take pills or do other things that will reduce your pressure. But no, stress is not causing your medically significant blood pressure. Stress can raise your blood pressure in the moment, but then it's gonna go away unless you have one of the long-term problems that is, medically important to doctors.

NIALA: And what are those long-term problems? What does cause medically problematic high blood pressure.

JENNIFER: So many people have it because of heredity, poor diet, they drink too much, they smoke, they're overweight. These are all hard things to control, but it can result in high blood pressure, which is a huge killer. Heart attack, stroke. Doctors emphasize to me that while stress itself won't raise your blood pressure in the long term, stress can cause the bad habits that will create the hypertensive problems that they worry about. One doctor I spoke to interestingly said that during the pandemic, his hypertension patients by and large saw their blood pressure go down because they weren't eating out at restaurants and having all those salty meals, which are such a big contributor. I was very surprised by that.

NIALA: Can trauma or traumatic events cause high blood pressure?

JENNIFER: It's such an interesting question. One of the people I spoke to for this story, Dr. Samuel Mann, is a longtime hypertension expert who has a new book out saying that, well, the type of short term stresses we've been discussing don't cause hypertension, his experience shows that in some cases where all other explanations can be ruled out, he found a link among people who had very big traumas in their life. They lost a child, they lost a parent at a very early age, one patient was a Holocaust survivor who had been in a concentration camp. Dr. Mann connected the dots and said that repressed emotion can lead to hypertension, as well as other medical conditions such as chronic fatigue syndrome and migraine headaches. Really interesting and novel finding.

NIALA: So how does this research change how doctors think about treating high blood pressure?

JENNIFER: One thing that many people take for granted is that stress is a factor in blood pressure and cardiovascular conditions that you should seek out treatments like, stress reduction, anger management, biofeedback, relaxation. All those things can only be helpful to your peace of mind and wellness. But they're not going to make a dent in the type of blood pressure that needs medication and lifestyle adjustments to address. So that's, that's the biggest takeaway. There is, I think, even among doctors and certainly among the lay public, this lingering feeling that stress is a factor and that managing stress is an essential part of blood pressure management, but it really isn't. And study after study has, has shown that, there, there really is no medical link that we can find. And that's a, for many people, perhaps a reassuring conclusion.

NIALA: Jennifer Kingson is Axios’ Chief Correspondent. Thanks, Jennifer.

JENNIFER: Great to talk to you.

NIALA: That’s it for us today! I’m Niala Boodhoo - thanks for listening - stay safe and we’ll see you back here tomorrow morning.

Join Tyler Foggatt and her colleagues as they go beyond the headlines and deepen your understanding of the forces shaping our world today on “The Political Scene,” a podcast from The New Yorker. With episodes three times a week, “The Political Scene” accesses the sharpest minds in politics for insight and analysis about everything, from abortion rights to the war in Ukraine. Make sure you’re following “The Political Scene," available now wherever you get your podcasts.