The abortion debate is about more than just abortion. Ending a pregnancy is just one option in the continuum of choices under the heading of reproductive health. Taking away that option inevitably undermines others, including contraception, in vitro fertilization, and even more basic health care issues for women and families.

That Missouri’s maternal mortality rates are consistently among the worst in the nation cannot be laid at the doorstep of the state’s extreme abortion ban; the shameful policy failures that have endangered the health of pregnant women and new mothers far pre-dates the 2022 ban.

But the state’s current, no-holds-barred approach to stamping out choice for Missouri women has worsened the threat of maternal mortality going forward by limiting obstetric, gynecological and other medical services in myriad ways. The ban will make mitigating those death rates that much more difficult.

It’s one more reason Missourians should turn out in force on Nov. 5 to support Amendment 3, which (if it survives an 11th-hour court challenge) will allow voters to establish a constitutional right to abortion until fetal viability — and to protect other forms of reproductive health as well.

As the Post-Dispatch’s Kurt Erickson reports, the Missouri Department of Health and Senior Services’ newly released “pregnancy-associated mortality review” found that an average of 70 women in the state died annually while pregnant or within one year of pregnancy between 2017 and 2021.

Those deaths — from a range of causes including cardiovascular complications, infections and pregnancy-related or postpartum suicide — translate into a death rate of more than 32 per 100,000 live births. That lands Missouri among the bottom fifth of states in the nation. The report characterizes more than three-quarters of those deaths as “preventable.”

How did we get here? In part, we can thank a hard-right Legislature that started prioritizing partisan-ideological battles above women’s health long before the current abortion ban.

First and foremost, legislative Republicans for years resisted the expansion of Medicaid as envisioned under the Affordable Care Act (Obamacare), preferring to turn down federal money for health care services to the poor — primarily poor women and children — rather than hand a policy victory to the program’s namesake.

Even after Missouri voters overrode lawmakers’ obstinance by passing a referendum in 2020 requiring the expansion of Medicaid, the Legislature initially refused to fund it until ordered by a judge to do so. The new state report cites Medicaid expansion as a key necessity to address the maternal mortality crisis.

Separately (and belatedly), the Legislature last year finally expanded postpartum Medicaid coverage offered in the state from 60 days after birth — the stingiest allowed by federal law — to a full year.

The imposition a year earlier of the state’s draconian abortion ban appeared to be the impetus for conservative support of that expansion; if they’re going to force poor women to give birth, went the clear if unspoken rationale, they should probably at least provide them adequate postpartum coverage. Whatever it takes to get there, we suppose. As the new report notes, this, too, was a crucial development in addressing maternal mortality.

On other fronts, though, the Legislature continues in its old mantra of women, beware.

An omnibus women’s health bill that would have expanded birth control coverage, increased STI testing and increased access to mammograms died in Jefferson City this year. Some anti-abortion lawmakers warned that some contraceptives could be used as abortifacients.

That obsessive rationale is reminiscent of the recent Alabama Supreme Court ruling that briefly outlawed IVF in that state because, to the ears of some extremist justices, elements of the procedure sounded like abortion. These and other policy trainwrecks illuminate the real-life complications of reproductive issues that aren’t acknowledged by the black-or-white worldview of the anti-choice movement.

A sobering personification of those complications is Mylissa Farmer, the Joplin woman who had to flee Missouri, her life literally in danger, because her water broke at 17 weeks and Missouri doctors refused to provide the necessary abortion for fear of invoking the state’s 15-year prison term for violating its ban.

This is what happens when non-physician lawmakers — most of them men — presume to decree the decisions women and their doctors must make in circumstances that aren’t remotely anticipated by the rigid dogma of the anti-choice right.

Here’s what else hasn’t been anticipated: that all the states that have instituted abortion bans since the 2022 overturn of Roe v. Wade have seen a sharp reduction in OB-GYN residency applications, with Missouri suffering among the worst drops. Residency applications are a strong predictor of how many future doctors will remain in the state to address Missouri’s already-dire physician shortage.

At the same time, the Legislature and Gov. Mike Parson this year nixed all Medicaid reimbursement to Planned Parenthood, in a purely ideological attack on a favorite right-wing punching bag. The move won’t actually prevent a single abortion; the organization is already banned from performing the procedure in Missouri. What it will do is deny a crucial resource to the state’s most vulnerable women regarding basic services like mammograms, STI screening, contraceptives and prenatal care.

How exactly is that going to alleviate Missouri’s maternal mortality crisis?

Farmer, the Joplin woman, is lucky not to have become one of those statistics. Others certainly won’t be so lucky under this brutal policy of denying women and their doctors all the options they might need to navigate the complex, deeply personal, inherently dangerous business of pregnancy.

Missouri’s political leaders can call themselves “pro-life” all they want, but it’s a description that completely leaves out the lives of women. Voters will hopefully have the chance to remedy that on Nov. 5, by voting “yes” on Amendment 3.

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