Access to Reproductive Health Care as an Economic Multiplier

In June 2022, I had just graduated high school when Roe v Wade was overturned, and it was impossible not to react to the news. This illustrates how one of the most controversial topics in the U.S. over the past few years has been reproductive rights. The discourse on what is right and wrong is never-ending, and what should be part of human rights and necessary healthcare has become a political topic rather than a medical one.

When Roe v. Wade was overturned in 2022, many saw it as a violation of the Declaration of Human Rights, which states that everyone has a right to necessary medical care, social services, and the right to security. If medical care is a part of basic human rights, how can it be taken away? This has become an ongoing issue in the United States, as many people argue that the decision to overturn Roe v. Wade represents a clear violation of human rights, given that women in multiple states are now unable to obtain the procedures they need because doctors fear losing their licenses. Aside from the clear medical implications, this has and will continue to affect aspects of life that people don’t even think about.

Factors of Economic Growth

Economic development is an essential part of a country’s growth. Factors like human capital – defined as the skills, knowledge, and abilities provided by individuals -, natural resources, capital formation, technological development, and social and political forces all play crucial roles in the economic progress of a country. But what happens when one of these becomes compromised? Although all five are essential, one stands out as the foundation for the rest.

Without human capital, the other factors are simply not possible to achieve. Technological developments don’t happen overnight, and government policies don’t spawn out of thin air. Therefore, it is easy to understand that the more labor force participation there is, the greater the push for development and growth. With this in mind, one would assume that the biggest challenge would be encouraging as many people as possible to enter the labor force.

To achieve this, there are several key factors that are necessary for growing human capital– one of those being access to affordable healthcare. Since 1965, women’s labor force participation has been going up (with exceptions for COVID). In 1960, the FDA approved the distribution of the birth control pill, and less than a decade later, in 1973, Roe v. Wade was passed, challenging abortion bans and ruling them unconstitutional.

Labor Force Participation in the US

Woman in a contemplative state
fizkes, Adobe Stock

As of 2025, women reportedly make up 47% of the labor force, meaning the distribution between working men and women is practically equal. Access to reproductive care has given women and families an ability to have control over their lives. By delaying having kids, women have been able to increase their participation in the labor force and pursue higher education, including undergraduate and post graduate degrees. This ultimately led to earning higher wages. So, it begs the question, if the goal is to grow human capital and grow the economy, why would a government ban one of the things that allows women to have a higher labor force participation?

Abortion as a State Right

In the US, it is expected that 25% of women will undergo an abortion at some point, making it one of the most common health procedures for women. In many areas, the criminalization of abortion access is seen as a human rights violation, and it is known that criminalizing abortions causes a plethora of problems. Getting rid of safe abortion does not eliminate abortion, instead it makes it dangerous and scary (Berer, 2023).

After abortion laws were left up to individual states in the US, it became clear that the states that outlawed abortion not only have higher maternal mortality rates, but also twice as many teen births compared to the states where abortion remains legal. While teen births have been on the decline since before the ban, the same cannot be said for maternal deaths. Maternal deaths are more than twice as high in states that do not allow abortion, and worse yet, maternal deaths have been on the rise since before the abortion ban (GEPI, 2023). Although those living in states that now have abortion bans were already less likely to seek abortions prior to the ban, the rise in deaths post-ban has noticeably increased.

A hand holding a protest sign that says keep your laws off my body. — Protest sign for abortion bans
Adobe Stock, JP Photography

Future Reproductive Rights Issues

In the coming years, due to the abortion ban, more women could end up in situations where they have to stay home to take care of children and are thus unable to enter the workforce. Pregnancies in young women will likely increase, making it difficult for them to obtain higher education degrees, which could ultimately limit them to a life of staying at home or holding a series of lower-paying, temporary jobs.

Some might argue that in the past, women did not obtain college degrees and worked stable income jobs their whole lives. As much as that is true, it fails to consider the fact that the world is different now than it was 30 years ago. Over the years, the competition in the job market has significantly increased, and obtaining a higher degree can be the determinant of job stability. The more people who earn degrees, the harder it becomes to compete for a job for those who don’t have one. Which makes it now, more than ever, so important for women to be able to rely on the fact that they will be able to get affordable reproductive healthcare when they need it.

Women as a Part of the Labor Force

Allowing women autonomy over their body supports economic growth. The more people who have entered the labor force, especially those who are educated, the more development and technological innovation will follow. Women will be able to work and start families when and if they want to. By doing this, there is also a higher guarantee that more children will grow up in stable households and go on to obtain higher education. There is almost a domino effect that is created which will multiply through the years. Access to reproductive healthcare serves as an economic multiplier.

Being able to obtain the necessary medical care that someone needs should never be a political issue. Stripping away the rights to abortion and possibly contraceptive care clearly violates the Declaration of Human Rights. Human rights are not and should not be rooted in political agendas. In a world full of injustices, it remains important to stand up for the greater good and bring awareness and education to those around you.

Right to Education for Teenage Pregnant Girls

by Grace Ndanu

When the head teachers and principals find out that a girl is pregnant in the Kenyan schools, they tell her that she has to leave the school immediately. They go ahead and tell her that a pregnant girl is not allowed to be in school because she will be mocked by other students and be a bad influence. Kenya is one of the countries that is associated with high numbers of teenage pregnancies. Every year, thousands of girls become pregnant at the time when they should be studying mathematics, history, science and geography. These girls who have early and unwanted pregnancies face many social and financial barriers to continuing with formal education, as they are often forced to drop out of school and to get married.

Photo of pregnant girl — Source: Upsplash

In 2013, all the countries that make up the African Union including Kenya, adopted Agenda 2063, a continent-wide economic and social development strategy. African governments agreed to commit themselves to build Africa’s human capital, which it terms its most precious resource, through sustained investments in education, including the elimination of gender disparities at all levels of education. Two years after the adoption of Agenda 2063, African governments joined other countries in adopting the United Nations Sustainable Development Goals, a development agenda whose focus is to ensure that no one is left behind, including a promise to ensure inclusive and quality education for all.

African governments have also adopted ambitious goals to end child marriage, introduce comprehensive sexuality and reproductive health education, and address the very high rates of teenage pregnancy across the continent that negatively affect girls’ education.

These member states have failed to do their duty for a long time. They continued to exclude thousands of teen girls from school because they are pregnant. There are arguments that revolve around morality; for example, they believe that, pregnancy outside wedlock is morally wrong, emanating from personal opinions and experiences, and wide-ranging interpretations of religious teachings about sex outside of marriage. The effect of this discourse is that pregnant girls – and to a smaller extent, school boys who impregnate girls – have faced all kinds of punishments, including discriminatory practices that deny girls the enjoyment of their right to education. Education is regarded as a privilege that can be withdrawn as a punishment. In the Masai community of Kenya, when a girl becomes pregnant before marriage she is regarded as a disgrace to the family, and therefore some of them are sent away from the family while others are sold out for marriage to men who can be the age of their grandfathers.

Kenya’s Parliament started debating the Care and Protection of children and parents, which is being pushed as a legal framework to help expectant girls stay in school to full term and follow their dreams once they graduate. With around 18% of Kenyan girls between the ages of fifteen and nineteen having given birth to at least one child, the proposed bill says that a student should not be denied her right to education simply because she is expectant or has a baby. The bill further advocates that the girl get adequate support – from her school, her family and the government, even after the baby is born.

Although the bill is being opposed because, it apparently bars parents or guardians from knowing the outcomes of their children’s pregnancy tests, if ever carried out in schools. Also, school principals are continually engaged in a hard balancing act. They have to balance policies and laws against the expectations and perceptions of the people they serve. The two are often in conflict because people are never sensitized properly. So, it is possible that the bill would place many school principals and head teachers at risk of imprisonment.

Poverty is still a major constraint for many girls. Although the government is able to meet the aim of ensuring that more girls returned to school, keeping them in school in the long term is another dilemma. A girl might return to school for one term or session but drop out again the following term for financial reasons. Therefore, the bill should consider the financial status of Kenyans.

The bill certainly comes from the right place. Nonetheless, if there is one thing I know, it is that policies and laws do not implement themselves. A well-crafted law has to be implemented by prepared people. People need to be properly engaged and brought on board. They need to be given a chance to become familiar with the content of a new policy, bill or law. They need a chance to air their concerns and they need to feel like they have been heard. They need to understand that the government is there for them and that their needs and concerns are taken seriously.

Many other factors contribute to thousands of adolescent pregnant girls and adolescent mothers not continuing formal education. High among them is the lack of awareness about re-entry policies among communities, girls, teachers, and school officials that girls can still study when they are ready to give birth and should go back to school after giving birth. People should be told that the laws and policies set don’t encourage teen pregnancies, instead it supports pregnant girls. Also parents should be sensitized on the importance of having open conversations with their children so that their children can can be able to fully trust them. Schools should include counselors’ budget so that girls and boys can receive counseling services when they need it.

Midwifery and Misconceptions

Living in a city with some of the most well-ranked hospitals in the nation, we sometimes take our access to healthcare for granted. The wail of an ambulance is a frequent annoyance to UAB students, but it’s a noise that many people are grateful to hear – especially those who live in rural areas with limited access to healthcare.

Midwife Lorina Karway is one of those people. Karway is responsible for helping thousands of Liberian women give birth safely. She often uses the light of her cell phone, held in her mouth, to deliver babies in a facility without electricity (UN Women). It’s not an easy feat to accomplish, but courage, intuition, and years of experience guide Karway to success. Childbirth is a common, natural process that veteran midwives handle skillfully, but complications do happen. When they do happen, it can be incredibly dangerous. The nearest hospital is over sixty miles away, and emergencies without swift action can have fatal outcomes. Midwives have successfully operated for centuries without hospitals, but medical equipment and clean facilities with electricity are immensely helpful in high-risk situations.

A smiling midwife holds a newborn baby bundled in a blanket. — “Cmdr. Protegenie Reed, a Navy midwife from Miami, Florida holds a newborn baby during Pacific Partnership 2015.” Source: Sgt. Valerie Epple, Creative Commons.

Midwifery still has a reputation for being illegitimate or unsafe relative to hospital deliveries, but midwives aren’t just second-rate doctors for communities without hospital access. “Skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum from pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life,” is how the World Health Organization defines the holistic practice. Part of the negative reputation is because midwives tend to practice in areas where adequate services and equipment are lacking, creating the dangerous situations that Karway faces. Communities without access to healthcare still require some sort of healthcare, and midwives across the world bravely fill that gap.

Two midwives stand next to a curtain in a dim room with photos of babies on the walls. — “Midwives Hasina and Aya Begum wait inside the birthing centre in Koral slum, Dhaka, Bangladesh.” Source: Conor Ashleigh for AusAID.

The danger is not created by practicing midwives, but rather from the community’s lack of access to adequate local healthcare services that extend beyond a midwife’s capacities. A solution to this gap in service would enable midwives to deliver better standards of care, and to ensure midwives can collaborate with hospital assistance when required. Additionally, there is evidence that midwife-assisted births result in better care than births guided by obstetricians (Walters et al). The study by Walter investigates variation within hospitalized care, but similar conclusions were found in regards to remote midwifery. Cost analyses of prenatal and postnatal care from seven different remote aboriginal communities found that “midwife group care (MGP) was likely to be cost effective, and women received better care resulting in equivalent birth outcomes compared with the baseline maternity care” (Gao et al).

Policy solutions have not been aimed at uplifting midwives, but rather to create barriers and even criminalize. Midwifery was essentially outlawed in Alabama for the past forty years, along with a dozen other states. Even where legal, barriers were constructed make it difficult for up-and-coming midwives to obtain training, licensing, equipment, facilities, and adequate pay. This is bad for midwives, and detrimental to women in need of accessible maternal healthcare.

A woman in hijab stands in the middle of a classroom with six pupils in hijab. — “Community Midwifery Education Program.” Source: Aga Khan Foundation/Sandra Calligaro, Creative Commons.

According to the United Nations Population Fund (UNFPA)

Over 300,000 women and 2.7 million babies died in childbirth in 2015 alone.
Most of these deaths were preventable and caused by a lack of sufficient antenatal, delivery and post-natal care.
Almost ⅔ of all maternal and newborn deaths could be prevented by well-trained midwives.
Midwifery includes comprehensive reproductive health and community health practices.

Barriers faced by midwives include:

Social isolation / poor living conditions; 37% of midwives face harassment at work
Lack of professional development opportunities or support through regulation/accreditation
“Unequal power relations and gender inequality within the health system and within communities” (WHO).
“Private sector markets and medical hierarchy leading to medicalized births, which constrains opportunities for quality midwifery care” (WHO).

Human Rights Impact

Here are some reasons why it’s important to embrace midwifery as an alternative or addition to formal medical care:

Overlooking midwifery increases stigma. This makes it harder for women to access midwives – especially rural and/or low-income families cannot afford or cannot travel to medical centers.
Midwifery is a critical role in some indigenous traditions. Native women have the right to practice traditional knowledge and engage in their own culture. Legislation that stigmatizes or creates barriers for midwives will likely harm indigenous practitioners.
Women have the right to choose what kind of healthcare is best for them. Healthcare is never one-size-fits-all, and it’s important to invest in a variety of options for a variety of patient needs.
Midwifery needs to be an accessible and viable career path. Medicalization of birth and barriers to midwife accreditation essentially act as gatekeepers, forcing aspiring practitioners to attend costly medical school or, for those who can’t afford it, to abandon their dreams.

Midwifery is a quality alternative to hospitalized childbirth, but many don’t have the luxury to choose. When distance makes choosing hospitals impossible, midwives fulfill their communities’ needs for reproductive/maternal healthcare. Midwives should be empowered to provide adequate services whether in urban hospitals or rural facilities, with unhindered access to training, education, and opportunity. Per CEDAW, states have the obligation to provide “appropriate services in connection with pregnancy, confinement and the post-natal period.” Let us support midwives as they courageously provide services that no one else will. Let us encourage midwives across the globe to continue their work despite disdain, mistrust, and criminalization. Let us uplift and support midwifery to make the world a better, safer, more accessible place.

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Craven, Christa, and Mara Glatzel. “Downplaying Difference: Historical Accounts of African American Midwives and Contemporary Struggles for Midwifery.” Feminist Studies, vol. 36, no. 2, 2010, pp. 330–358. JSTOR, www.jstor.org/stable/27919104.

Parry, D. C. 2008. “We wanted a birth experience, not a medical experience”: Exploring Canadian women’s use of midwifery. Health Care for Women International, 29: 784–806.

Thomas, Samuel S. “EARLY MODERN MIDWIFERY: SPLITTING THE PROFESSION, CONNECTING THE HISTORY.” Journal of Social History, vol. 43, no. 1, 2009, pp. 115–138. JSTOR, www.jstor.org/stable/20685350.

Shaw, Jessica. “ The Medicalization of Birth and Midwifery as Resistance.” 20 Mar 2013.
Health Care for Women International. Volume 34, 2013 – Issue 6. www.tandfonline.com/doi/abs/10.1080/07399332.2012.736569?tab=permissions&scroll=top