Disclaimer: Posts are solely the views of the author and do not represent the views of Brandeis University or the Institute for Economic and Racial Equity.
Jamie Morgan, ERE Doctoral Candidate
The Supreme Court decision in Dobbs has triggered abortion bans in states that are home to 40 million women. Abortion provision in the United States has been a fragmented system fraught with challenges for patients trying to exercise their fragile rights. The loss of abortion care will exacerbate and intensify inequities experienced by people of pregnancy capacity. The harms to come will be both swift and slow as we claw back our reproductive rights in the purist of justice and freedom. How we respond to this crisis of care will shape the next 50 years of reproductive health policy in the United States.
The Dobbs decision is expected to close 202 clinics, 26% of facilities nationwide with a near total loss in the South and Midwest. Many clinics in “trigger states” were forced to pause services immediately following the decision and staff the heart-wrenching job of breaking the news to patients in the waiting room. This loss of care infrastructure will place enormous strain on the remaining places where care is legal. Even in places where the right to abortion is protected, access isn’t guaranteed. The Boston Globe recently reported on the experience of a local woman who was denied an abortion at Massachusetts General Hospital because doctors interpreted the Roe Act as not applying to her condition and circumstances. These stories are too common and will only continue reflect the reality of care as we continue to criminalize and constrain abortion.
The six-week Texas abortion ban (SB8), enacted without injunctive relief since September 2021, provides insights into changes in abortion provision from Dobbs in places where abortion is banned or limited now. The Texas Policy Evaluation Project has documented the efforts of abortion providers to expediate care that meets state timing restrictions, wayfaring patients to out-of-state facilities, and connecting people with funding to overcome increased out-of-pocket expenses. This complex, timely, and resource heavy work to connect Texans to abortion care is now more difficult as the nearest border states providing care are now Kansas and New Mexico which have state-level restrictions and limitations. People who were denied an abortion because of SB8 are now having children.
Affording the cost of care, travel, and time to obtain an abortion will be a barrier for more people than we will ever know for certain.
Demographics indicate who will bear the burden of social and economic inequalities due to abortion bans. One in four women will have an abortion in their lifetime. The majority of people obtaining abortions are in their early 20s and have incomes below the federal poverty line. Due to insurance restrictions and limitations, they must pay out-of-pocket for care. Most people who have abortions already have a child who needs to be cared for during their appointments. People in banned states will need to travel 500 miles or more to reach an abortion provider. State mandated waiting periods add days to the time someone needs to complete abortion care. Affording the cost of care, travel, and time to obtain an abortion will be a barrier for more people than we will ever know for certain.
We must also consider the needs of people whose bodies are controlled by the government. The U.S. legal system has long controlled women’s bodies through the allowance of gender-based violence and prohibitions against full participation in society. Abortion exceptions for sexual violence are practically impossible for survivors to receive and many exceptions are being eliminated by state governments.
Harms from gender inequality are compounded with racism, ableism, heteronormativity and other mechanisms of structural oppression. Women of color have endured a long history of coercive government policies that deny bodily autonomy.
Harms from gender inequality are compounded with racism, ableism, heteronormativity and other mechanisms of structural oppression. Women of color have endured a long history of coercive government policies that deny bodily autonomy. While the promise of Roe was never actualized for everyone, the loss of national abortion protections places women of color at risk for disproportionate harm. U.S. immigration policy is a means of racially and ethnically restrictive population control through forced sterilization, family separation, and denial of reproductive healthcare. In 36 states, minors must receive parental consent for abortion or obtain an order from a judge. Judicial by-pass to allow minors access to abortion without parental involvement is likely to end now. Trans men, nonbinary, gender fluid, and genderqueer people have abortions. Places hostile to abortion are also hostile to LGBTQ people and their healthcare needs. Authorities police disabled people’s bodies to control reproduction which denies sexual freedom and safety. Reproductive justice demands and requires full freedom to control our bodies, gender, sexuality, and reproduction. Abortion restrictions deny this necessary freedom.
Not everyone who wanted to have an abortion before Dobbs was able to obtain care and we know the harms from being denied an abortion are vast and compounding. Denial of care is now an immediate and accelerating crisis nationwide, as half the country has banned abortion or have legislators in the process of stripping reproductive rights. The gap between people who want an abortion and those who obtain an abortion will only continue to widen as access is lost and availability is concentrated by political geography. Experts have shown that restricting access to abortion increases maternal mortality, another crisis where systematic inequalities across race, age, and class determine life and death.
Advances in medication and telehealth mean that people have more options for safe abortion than they did 50 years ago. In the absence of Constitutional protections for abortion and the rise of surveillance technology, the further criminalization of pregnancy and expansion of punishment is a critical concern as more people self-manage care. In April, a Latina woman in Texas was charged with murder after emergency room staff accused her of self-inducing abortion. Over 1,700 women have been prosecuted for miscarriages since Roe and the targeted accused reflect the overcriminalization of Black women in the United States.
We know who has abortions because most states require mandatory surveillance. In Indiana, I campaigned against a law that requires abortion providers to report private patient information to the state including: marital status, education, race, ethnicity, number of live births, number of deceased children, date of last menses, and 25 types of psychological or emotional conditions to screen. Patients have no rights to refuse this invasive reporting. “Crisis Pregnancy Centers” are another threat to safety and privacy. These unregulated fake clinics are a strategy of the anti-abortion movement to lure in pregnant people looking for all options. Fake clinics currently outnumber actual clinics 3 to 1 and are not bound by patient privacy laws or health regulations. Abortion seekers who visit to fake clinic are at risk of having their experience and information exposed and shared with authorities.
A policy agenda to repair the damage to Dobbs will need to address what Roe did not. Clinics, abortion funds, and doulas have been preparing for Roe to fall, but they face increasing violence and misinformation from the anti-abortion movement. Abortion access is a problem we must all be called on to solve. We must stop abortion exceptionalism that silos and sidelines abortion in U.S. politics. Policy approaches to reproductive freedom must be varied because threats to abortion care are many and multiplying. The venues for policy change must include actions and accountability for local, state, and federal governance. Proactive policy to shift state power toward reproductive freedom is possible, and some states are leading the way. The Black Reproductive Justice Policy Agenda, NIRH Local Reproductive Freedom Index, and Interrupting Criminalization and the Center for Advancing Innovative Policy provide roadmaps to advancing reproductive equity.
The focus on gendered liberation through reproduction freedom has been dominated by a white rights-based agenda that achieved abortion legalization through Roe but did little to intervene in the lengthy history of abuse that shaped our reproductive lives.
The power to access abortion must be returned to the people, and the state must be stripped of its authority to regulate our bodies. We must leverage our collective power to reverse the erosion of abortion access and reduce anti-abortion violence. The focus on gendered liberation through reproduction freedom has been dominated by a white rights-based agenda that achieved abortion legalization through Roe but did little to intervene in the lengthy history of abuse that shaped our reproductive lives. A reliance on Roe focused on the liberation of the individual and not on the communal or social construction of the individual embedded in interdependent relationships at the intersections of oppression. The fragile and fragmented system of abortion care in the United States was built on a legal foundation that has been destroyed by a coordinated anti-rights agenda. To advance abortion justice, we must understand the multiple manifestations of anti-abortion violence and respond collectively to ensure everyone has access to all options of care.
If you, or a loved one, needs care, visit http://www.ineedana.com to find nearby abortion providers. Call the All-Options Talkline at 1-888-493-0092 to speak to someone about pregnancy options.