It’s only been six years since the Supreme Court struck down one of the most restrictive abortion laws in the nation at that time. In June 2016, the Court ruled 5–3 in favor of abortion clinics in the case Whole Woman’s Health v. Hellerstedt. Yet today, when Texas has outlawed abortion after five to six weeks of pregnancy — before most women know they’re even pregnant — that previous law seems almost quaint. And now with Roe poised to fall altogether, Texas is one of the 13 states with trigger laws that would automatically ban abortion if the Supreme Court violates precedent and overturns the 1973 landmark case.

It seems appropriate, then, to revisit what I wrote in the wake of the Whole Women’s Health decision — that it was a win for women’s health. The rest of this article is a tweaked republication of an article I wrote in 2016, with updated numbers from data that’s become available since then. Sadly, the updated data doesn’t improve the big picture if Roe v. Wade is overturned. Pregnancy and childbirth has become more dangerous while abortion has become safer since I first published the article that begins below.

When politicians, advocates, and others debate abortion and related restrictions, the conversation often focuses on the philosophical political arguments: the right of an embryo or fetus to possibly reach full term versus the right of a woman to have full autonomy over her body. But laws restricting abortion rights tend to hide under a guise of protecting women’s health, a politically more palatable motivation for the them.

That was the case with the Texas Omnibus Abortion Bill, known as HB 2, that the Supreme Court struck down 5–3 today. It was the same bill that introduced the rest of the U.S. to Wendy Davis, the Texas senator who staged an 11-hour filibuster which, with the help of fellow Democrats using parliamentary procedures, prevented the law’s initial passage until Texas Governor Rick Perry called a special session which allowed its passage.

The bill required all abortions to be done in ambulatory surgical centers, basically mini hospitals that must have corridors wide enough for two gurneys to pass, large operating rooms and compliance with other other regulations. The law also required doctors performing abortions to have admitting privileges to a hospital within 30 miles of their clinic. These requirements applied to both surgical procedures and to medical abortions, in which women take pills — and which they often can do outside the clinic.

Although legislators claimed the bill was intended to protect women’s health, the effective intent was to close dozens of abortion clinics throughout Texas because those restrictions were impossible for most clinics to meet. It succeeded, forcing the majority of Texas’ 42 abortion clinics to close and leaving fewer than 10 open. And in reality, the bill harmed women’s health. Here are five ways the Supreme Court’s decision to strike down that law actually protects women’s health.

1. The previous Texas bill reduced access to safe abortions. (The newer one is even worse.)

Medical abortions involve taking mifepristone or mifepristone with misoprostol to induce a miscarriage, which typically takes 4 to 5 hours but can take up to a few days. It causes bleeding and cramping and often comes with side effects such as nausea, vomiting, diarrhea, headache, fever, chills or dizziness. Women may bleed or spot for up to a month after the abortion. Some complications with medical abortions, such as an incomplete termination, may require a surgical abortion, but both surgical and medical abortions are very safe.

Yet before Texas’s law was struck down in 2016, it led to a 13% drop in statewide abortions and a 21% drop in abortions in the Lower Rio Grande Valley. While this may have been the objective of the lawmakers passing the bill, it means more women resorted to self-induced abortions, which is far more dangerous and potentially fatal.

For women who still got abortions, it increased wait times, sometimes quadrupling or quintupling them. In Dallas, wait time went from 5 days to 20 days after the law was enacted. Other women had to drive long distances (it can take more than 13 hours to cross Texas) or out of state to get abortions. These obstacles delayed some women into their second trimester. Although second trimester abortions have only a 1.3% risk of major complications, that’s 20 times higher than the risk of a first trimester abortion.

It’s too soon to have data like what’s above for the current Texas law banning abortion at 5–6 weeks, but there’s no reason to think it would be better than what’s above since it’s even more restrictive.

2. Abortion has lower infection and complication rates than delivering a baby.

For women forced to carry their fetus to term, the risk of infection or other complications in pregnancy is far greater than that with medical or surgical abortions — and the rate of most of these complications has been increasing.

CDC data shows a continuous increase in hypertensive disorders and postpartum hemorrhage from 1993 through 2014, a trend echoed in data since 2014 from private insurance companies. Blue Cross Blue Shield, for example, reported that childbirth complications rates rose 14% from 2014 to 2018. Out of every 1,000 pregnancies, seven involved both pregnancy and delivery complications in 2018, according to BCBS — a 30% increase since 2014.

Infection rates are also higher with pregnancies than with both medication abortions and surgical abortions. Chorioamnionitis occurs in 2–4% of full-term births (more in preterm), and that’s just one type of infection that can occur in pregnancy. Both viral infections and bacterial infections can lead to death or severe long-term effects of the mother or, more often, the fetus or infant.

Meanwhile, the overall infection rate for aspiration abortion — the most common abortion procedure performed in the U.S. — is 0.27%, and the rate is 0.3% for dilation and evacuation, according to a 2018 National Academies report on abortion safety. Nearly one in four maternal deaths are due to sepsis, according to a 2019 study. That study and the CDC both report that sepsis occurs in 4 out of 10,000 deliveries. By contrast, fatal sepsis occurs in less than 1 case of medication abortion per 100,000, according to the National Academies report.

Overall, less than a quarter of a percent (0.23%) of abortions involved major complications requiring hospital care, whereas 1.4% of deliveries involved severe complications — a rate six times greater than medical abortion.

3. Pregnancy carries greater risk of complications over time than abortion.

Less life-threatening but still serious complications occur even more often in pregnancy. A federal report from 2008 reported the following numbers: 11.3% of pregnant people experience hypertension, eclampsia, or pre-eclampsia, 13.2% experience genitourinary tract infections, 9.9% experience anemia, 5.6% experience an ectopic pregnancy (also possible with medical abortion but far less likely), 5.2% experience hemorrhage, 8.2% experience gestational diabetes, and 6.3% experience hyperemesis gravidarum, a severe condition of nausea and vomiting during pregnancy that can be fatal.

Rates for most of those complications have climbed considerably from 2008 through 2014. The Blue Cross Blue Shield data show a continuation of that trend, with a 16% increase in pregnancy complications from 2014 to 2018. All but two of those risks are specific to pregnancy and therefore don’t occur with abortion. With the two that can occur with pregnancy or abortion — ectopic pregnancy and hemorrhage — the rates are far greater with pregnancy than with abortion.

4. More women die from childbirth than from abortion.

Maternal mortality has been a growing public health emergency in the U.S. for years, with rates of death among mothers being among the worst in the developed world. The risk of death from childbirth is at least 11 times greater than the risk of death from surgical abortion before 20 weeks gestation. Approximately 800 women a year die from pregnancy-related or childbirth-related conditions in the U.S., and the number is growing.

Meanwhile, only 2 women died from legal induced abortions in the U.S. in 2018, the most recent year for which data is available. And as pregnancy has become deadlier in the U.S., abortion has become even safer. Averaging mortality from 2013–2018, the rate of death related to abortion is 0.41 deaths per 100,000 legal abortions — lower than the previous 5-year periods.

5. Pregnancy and childbirth carries more long term physical and mental health risks than abortion.

Both in the short-term (3 to 6 months) and long-term (more than 6 months), pregnancy and delivery confer several health problems or risks. Approximately 87% to 94% of women report some kind of problem postpartum, such as backache, urinary stress incontinence, fecal incontinence, urinary frequency, depression and anxiety, hemorrhoids, extreme tiredness, frequent headaches, migraines, perineal pain, constipation, increased sweating, acne, hand numbness or tingling, dizziness and hot flashes.

Women who needed a cesarean section face other future risks, such as formation of adhesions, intestinal obstruction, and bladder injury during future abdominal surgeries and placenta accreta, placenta previa, and uterine scar dehiscence in future pregnancies. Long term health problems that last more than 6 months after giving birth occur in 31% of women.

Women who developed gestational diabetes have a higher lifetime risk of developing type 2 diabetes. In fact, up to half with GDM may develop type 2 diabetes. Similarly, women who develop pre-eclampsia in pregnancy have double the risk of stroke and quadruple the risk of high blood pressure over a lifetime. Pre-eclampsia is also associated with a higher risk of lifetime heart disease overall. Blood clots, which affect 1 to 2 pregnant women out of 1,000, continue to be a risk after pregnancy as well.

Mental health risks are higher with pregnancy and delivery as well. Risk of postpartum depression is approximately 10% but can range from 7% to 30% depending on how it’s measured, and prenatal depression occurs among about 10% of pregnant women as well. Similar rates do not exist among women who electively terminate pregnancies. Women who have abortions certainly may experience sadness, grief, and other negative emotions, and some do develop depression and anxiety, but there is no evidence that the depression and anxiety is connected to having an abortion. In fact, those most likely to experience depression or anxiety are women with a prior history of mental health problems or women who had little support for their choice, needed to be secretive about it, or faced stigma related to it.

Many of the supposed long-term risks of abortion, meanwhile, have been thoroughly debunked.