Contraceptives Are a Half Measure, Not the Solution: Post-Roe Reproductive Health Policy in Mississippi

Photo by Jon Tyson.

Immediately after the Supreme Court released its opinion in Dobbs v. Jackson overruling Roe v. Wade, Mississippi’s trigger law enacting a 15-week abortion ban went into effect. The only exceptions to the ban are rapes (reported to the police) or life-threatening complications for the mother. A number of uncertainties arose for the state’s women, especially because Mississippi has the highest infant mortality rate and one of the highest maternal mortality rates in the country. With no expanded access to Medicaid, it is unclear if or how state lawmakers plan to support the health of women going forward. Medicaid expansion means that more people will be eligible for Medicaid, taking care of many people who fall into the healthcare gap of not being able to afford private insurance while still not qualifying for government insurance. Answering these questions could give insight to the inevitable health consequences of this ruling as well as how other states with near-total abortion bans might govern in the future. Some Mississippi lawmakers, including the writer of Mississippi's trigger law, Becky Curry, propose expanding contraceptive access and increasing funding for local county health departments. While this is a good start, it will not be enough. Mississippi lawmakers should instead focus on expanding Medicaid eligibility, particularly because Mississippi is one of only twelve states without expanded access to Medicaid. 

Mississippi’s infant mortality rate, 8.8 deaths per 1000 live births, is the highest in the country compared to the national average of 6 deaths per 1000 live births. Mississippi also reports one of the highest maternal mortality rates in the country, with 88 women dying per 100,000 births, almost double that of the national average of 17 deaths per 100,000 births. These outcomes are the result of a combination of factors, including a lack of access to health insurance for women, even before they become pregnant. In 2018, 25% of newly-pregnant women reported not having health insurance before becoming pregnant. For women without health insurance, chronic health conditions like high blood pressure, diabetes, and obesity are often unstable, or even undiagnosed, because they cannot afford to have regular physician check-ups or see a doctor when a problem arises. These untreated conditions are then further exacerbated by pregnancy—which in itself is considered a pre-existing condition when signing up for insurance—leading to complications like heart conditions, blood clots, and substance abuse.

These factors also magnify racial inequalities across the state, as Black women in Mississippi have a maternal mortality rate of 51.9 deaths per 100,000 births compared to that of white women’s 18 deaths per 100,000 births. This Supreme Court ruling will undoubtedly increase the gap in racial equity. Studies show that barriers to abortion access for women of color include limited savings for emergencies, lack of vehicle access, and even immigration-related fears about traveling out-of-state. Dobbs v. Jackson will see that women of color will die at faster rates compared to their white counterparts. The ruling will also have a negative economic impact as their children are more likely to end up with lower earnings and higher participation rates in public assistance programs.

Increased availability of contraceptives can prevent unwanted pregnancies, but Medicaid expansion will target the true effect of overturning Roe v. Wade: the financial burden of a child. It will help new mothers qualify for insurance to help care for their unexpected babies. Mississippi remains one of only twelve states without Medicaid expansion because state leaders have resisted the expansion, citing it as unaffordable for the state budget. To expand Medicaid means the federal government would cover 90% of the costs, and the state government would only pay the remaining 10%. State leaders fear that Mississippi will be unable to foot its portion of the bill if the federal government was to ever decrease their funding. Recently, Mississippi House Speaker Phillip Gunn (R-56) killed a bipartisan bill that would have expanded access to postpartum Medicaid from 60 days to 12 months after childbirth. The bill had passed the Senate and was expected to pass the House as well, but the Speaker blocked the bill from being debated. Fellow legislators suspect Gunn does not want to be linked to anything potentially considered controversial because he is gearing up for a gubernatorial bid. 

Staunch opposition to Medicaid is unfounded. Reports show that half of the medical costs of premature births alone are already left for the state to pay, and expansion can create significant savings for the state. The Commonwealth Fund reports that expanding Medicaid would result in a $333 million decrease in state spending on the existing Medicaid population across the next five years. Currently 60% of the state’s pregnant population is on Medicaid. Savings acquired through the expansion of Medicaid do not have to be applied back to healthcare and can instead go towards other programs like domestic violence centers and the Children’s Advocacy Centers, which provide services for physically and sexually abused children in the state. This is one of the advantages that expanding Medicaid has in increasing the State Health Department funding and contraceptive access. 

While health department funding and contraceptive access should be a priority, it is not effective enough to combat the effects of Dobbs v. Jackson and the subsequent abortion ban. This approach would cushion the amount of women becoming pregnant, but does little to address the complications of being pregnant, like existing health conditions or postpartum pregnancy care. Medicaid expansion would also ensure that women who fall in the gap of health insurance—or those who make too much to qualify for Medicaid but too little to afford private insurance—are also taken care of. State lawmakers should run a cost-benefit analysis on the expansion of Medicaid and understand that women in Mississippi are undertaking the cost of Dobbs v. Jackson with no benefits to reap. 

Kristy Wang is a staff writer for the Columbia Political Review and a junior in Columbia College studying political science and biology. Kristy can be reached at kw2933@columbia.edu.