Shriya Jamakandi: Women’s health in a world after Roe

There’s been a flurry of reports recently on the effects of Dobbs v. Jackson. We're starting to see some data now.

That’s right. Since Roe was overturned in June 2022, we still don’t have a lot of immediate-term data. It typically takes a few years for data sets to be finalized and analyzed. But we did find an opportunity here: for this project, we have about six months of claims data post-Roe, and we also have access to about 10 years of claims data pre-Roe. We saw this as a chance to examine the immediate-term impacts: What’s happening just six months down the line?

What motivated you to focus on health outcomes post-Roe?

I had been doing Medicaid research, mostly focused on Medicaid Accountable Care Organizations, but last May, I came across a book at an independent bookstore in Providence, right down the street from my apartment. It’s called The Double X Economy by Linda Scott, an economist who taught at Oxford before retiring.

I read the book on a six-hour flight to California, and it honestly changed the course of my research. I was already passionate about maternal and child health, but this book really pushed me in a new direction. Scott’s book explores the “shadow economy”—the ways women operate within patriarchal norms that we don’t often see. She studies different societies across Africa and Asia, and the parallels she draws between those regions and places like U.S. business schools were striking. Essentially, she showed that no matter where you are, women are constrained by similar economic forces.

That really got me thinking. I’ve always been passionate about health care and access to health care, and I started connecting that with some previous research I had encountered on the economics of abortion denial. The research showed that women who were denied abortions had lower credit scores and worse financial health compared to those who were able to get abortions.

Often, we think of abortion as a political or religious issue, but I see it as a matter of empowerment. And it’s clear that children of single mothers tend to face worse outcomes in terms of wellness, health, and overall development. A lot of that is tied to financial strain—single mothers may not have access to higher education or be prepared to raise a child, which adds to their economic burden. 

But beyond economics, there’s also a serious medical issue at play here. Take ectopic pregnancies—those are fatal if left untreated, and in some states with tight abortion restrictions, women are being denied necessary care. This forces hospitals to transport them out of state, sometimes by emergency, and that’s a tragic scenario, especially when it could be a matter of life or death.

It’s really important to note that although abortions occurring later in pregnancy are uncommon and amount to 1% of all abortions, a lot of media attention has been focused on these cases. But most of these procedures are actually performed on women who wanted the pregnancy but ended up having severe and life-threatening complications that either impacted the fetus' viability or their own lives.

One last huge contributing factor in pursuing this line of research was the support I received from my advisers and mentors, Professors Emily Gadbois and Alyssa Bilinski in Health Services, Policy and Practice at Brown.

They were so encouraging of my passion for women’s empowerment and health, and when I mentioned that I’d been thinking about abortion and couldn't stop thinking about the impact of the fall of Roe, Emily encouraged me to come up with research questions, one of which became the topic of the proposal for the grant. 

What are the potential implications of your findings for health care policy, particularly in the states with restrictive abortion laws?

The implications could be huge. If we find that complications are increasing, that’s something we’d want to validate with more research as more data becomes available. But even if it’s just a short-term trend, it’s still critical, because many of these complications are severe and time-sensitive. For instance, if an ectopic pregnancy isn’t treated quickly, it can lead to sepsis. 

The goal is to get policymakers to see that abortion isn’t just a political issue—it’s a matter of women’s health and lives. Reducing the time it takes to access abortion is crucial. In many cases, delays in care can determine whether or not a woman survives. Conditions like ectopic pregnancies, pulmonary hypertension and pre-eclampsia are all time-sensitive, and with Roe overturned, the delays in care could easily become fatal.

The U.S. already performs poorly on maternal health indicators, especially for women of color and, in particular, Black women. We also know access to care is already a struggle for low-income groups, and now, with Roe gone, those barriers are even more pronounced. These delays aren’t based on medical need but are now tied to bureaucracy, policy, and government restrictions, which makes the situation even more dangerous.

Importantly, many of these complications can impact a woman’s future fertility. Even for those who argue from a pro-life perspective, it’s important to consider the woman’s ability to have children in the future. For example, if she suffers from sepsis or other complications leading to organ damage or failure, her fertility could be affected. So lack of access to abortion doesn’t just affect immediate health—it can also have long-term consequences on a woman’s ability to have children if she wants to.