On June 24, 2022, the Supreme Court of the United States (SCOTUS) released its ruling in Dobbs v. Jackson Women’s Health Organization, summarily overturning Roe v. Wade and Planned Parenthood v. Casey.
I am sandwiched between my mother—who lived her prime reproductive years without the federal protection of the right to access legal abortion—and my daughter, who is now without that same federal protection. My now-deceased mother was once a young, newly married Black Cuban immigrant working in New York City’s garment district sweatshops in the 1940s and 1950s. She became pregnant and experienced debilitating nausea and vomiting and, at that time, simply could not afford to miss work. She got an abortion—illegally—risking her physical health with an unprotected and unsafe procedure because her economic health and the well-being of her family depended on it.
I begin this editorial with that short personal reflection, one that hit me hard on June 24, not because I am unique, but precisely because I am not. My anecdote, that N of 1, is merely a narrative illustration of the compelling evidence and hard data compiled by three original articles reprinted in this special issue and the respective accompanying new commentaries that I have the pleasure of introducing.
In their 2018 publication, Foster et al. (p. 1290) go beyond examining abortions sought for economic reasons (as was the case for my mom) to the less well-examined but vitally important question of the socioeconomic consequences faced by women who are unable to obtain a sought-after abortion. The Advancing New Standards in Reproductive Health (ANSIRH) Turnaway Study 1, 2 enrolled nearly 1000 women across 30 US abortion clinics between 2008 and 2010 and followed them for 5 years. In the 2018 article reprinted in this issue (p. 1290), the authors found that at both 6 months and 4 years after the abortion was obtained or denied, women who gave birth after being denied an abortion were more likely to live in poverty and more likely to receive public assistance than were women who obtained an abortion. In an accompanying commentary for this issue, Foster updates these findings and describes corroborating evidence of adverse economic consequences experienced by women who were turned away, as well as by their children.
In a 2014 article (Upadhyay et al., p. 1305), collaborators from ANSIRH and the Guttmacher Institute combined expertise and shared their data from the Turnaway Study and the Abortion Provider Census (APC), 3 respectively, to look at factors that influence delays in seeking abortion. Specifically, Upadhyay et al. compared women who had pregnancies just under the clinic’s gestational age limit for abortion (and who received the abortion they sought) with women who had pregnancies just over the clinic’s gestational age limit (and who were therefore denied the abortion they sought). The authors found that there was no significant difference between the two groups in reasons for delay in seeking an abortion. The most common reasons were cost of travel and the procedure and not recognizing they were pregnant. By using Turnaway Study and APC data, the authors were able to estimate that annually more than 4000 women in the United States would be forced to carry a pregnancy to term because they presented to an abortion provider after the gestational age limit. In her accompanying commentary in this issue, Upadhyay points out that in the years since the original 2014 publication, a slate of restrictive state laws has lowered gestational age limits and led to clinic closures. Upadhyay also cites a SCOTUS amicus brief that estimated 100 000 women would be unable to reach an abortion provider in the first year after Roe v. Wade was overturned. 4
One of the articles reprinted in this issue (Gerdts et al., p. 1297) unpacks some of the outcomes observed after the 2013 introduction of one specific restrictive state law—Texas House Bill 2 (HB2). This was one of many “targeted regulation of abortion providers,” or TRAP, laws that have been passed at an increasing pace since 2010. 5 Gerdts et al. identified that the number of clinics providing abortions in Texas fell by 54% after HB2 was introduced. The authors surveyed women who obtained an abortion in five Texas cities between May and August 2014 and compared the experiences of women whose nearest abortion clinic had closed after HB2 with those of women whose nearest clinic had remained open. The authors found a fourfold increase in the average distance traveled to obtain an abortion among women whose nearest clinic had closed compared with the travel distance among women whose nearest clinic remained open. Women whose nearest clinic had closed also experienced other burdens, such as increased out-of-pocket costs and difficulties accessing medication abortions. In the accompanying commentary, Gerdts et al. highlight the additional restrictions imposed by Texas since the original publication, as well as the robust on-the-ground response of abortion providers and advocacy groups who have been attempting to mitigate the harms of those restrictions.
The US abortion access landscape is changing at breakneck speed. A large number of states are now rushing to eliminate legal access to abortion, and the Guttmacher Institute predicts that 26 states will ultimately do so. 6 This rush to eliminate access is happening even as the need for this essential health care service increases. Recent data from the APC show an 8% increase in abortions (and a 7% increase in the abortion rate) between 2017 and 2020—the first increase in US abortions in 30 years. 7 The reprinted articles from the US-based studies and the invited commentaries in this special issue constitute a compelling body of evidence on just how much is at stake for individuals and families.
We can also look to recent global data from the Guttmacher Institute and World Health Organization study of abortion incidence—evidence that is similarly compelling—to foreshadow population outcomes. Globally, abortion rates in countries where abortion is highly restricted are no different from those found in countries where abortion is broadly legal. 8 This pattern speaks to how motivated many women are to avoid carrying unwanted pregnancies to term, and it suggests that many living in restrictive states in the United States will continue to seek out abortions despite the logistical hurdles and legal risks. Poor and low-income women make up the majority of US abortion patients, so it is these individuals who are likely to bear those risks disproportionately. Similarly, Black women have higher rates of abortion than their White counterparts and also are more likely to live in communities that are under close governmental and societal scrutiny, suggesting that the criminalization of abortion could exacerbate already-stark racial inequities in criminal prosecution and punishment. Research also suggests that maternal mortality rates will see an alarming rise as a result of abortion bans, 9 with Black women again bearing the brunt and already shameful racial inequities becoming even wider. These are only a few of the many equity concerns that the SCOTUS decision raises.
In the Dobbs SCOTUS decision, Justice Thomas unequivocally signals that stripping of the right to legal abortion is likely just the beginning, not the end. I opened this editorial with a vignette about my mom. I close by sharing a few thoughts about my now-adult children—again, not because their stories are unique, but precisely because they are not. My children were born into a different socioeconomic stratum than my mom and have infinitely more educational and employment opportunities than she ever did. Yet, as the multiethnic grandchildren of Black Cuban immigrants on one side and a Mexican immigrant on the other side, I know from the evidence (and lived family experiences) that, as people of color, they are nevertheless at risk for experiencing one or more of the biological legacies that spring forth from past and current social constructs of racism in the United States. Should Justice Thomas achieve his goal, my bi/queer son may soon lose federal protections regarding who he can legally have sex with or marry. My daughter has already lost federally protected access to legal abortion. So, I conclude this editorial with a quote from a book that frames the past as it illuminates a way forward for sexual and reproductive health, rights, and justice. In a primer on reproductive justice, Ross and Solinger write, “Reproductive oppressions are not about genital anatomy. Reproductive oppressions stem from a determination to exercise power over vulnerable persons.” 10(p6) The authors also describe how women of color have been targeted in distinctive, brutal ways across US history. The reproductive justice framework derives its vital depth from drawing attention to the persistence of this history. . . . In this case, past abuses of women’s reproductive bodies live on in contemporary harms and coercions, stimulating reproductive justice activists to define the arena of reproductive dignity and safety in terms of human rights. 10(p11)
women of color have been targeted in distinctive, brutal ways across US history. The reproductive justice framework derives its vital depth from drawing attention to the persistence of this history. . . . In this case, past abuses of women’s reproductive bodies live on in contemporary harms and coercions, stimulating reproductive justice activists to define the arena of reproductive dignity and safety in terms of human rights. 10(p11)
The evidence highlighted in the reprints and commentaries I introduced here, the public health mission of the Journal, and the human rights imperative articulated by reproductive justice leaders converge into a powerful clarion call for our nation to fully understand our oppressive past so we can successfully fight for a liberated future.
See also Foster et al., p.
CONFLICTS OF INTEREST
The author has no conflicts of interest to disclose.