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The Future of Abortion Care in the United States

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

This month was a heavy time to begin interviews for my doctoral dissertation that shares the challenges and triumphs we experienced returning abortion care to Northwest Indiana. I planned this study with Dobbs. v. Jackson looming and a potential end to national abortion legalization. When Politico leaked the Alito draft, I knew people were going to experience the range of emotions and reactions I’ve been processing for years with other abortion advocates and providers. The loss of Roe impacts us all. This rapid response provides a brief overview of the Alito draft’s core issues and frequently asked questions about the future of abortion in the United States, including how you can support access.

Abortion bans are inequitable.         

The current state of abortion care is a crisis for gender, racial, and economic equity that will accelerate without the minimum legal standards under Roe and Casey. Abortion restrictions and movement violence to deny people control over their bodies and lives have eroded reproductive rights in the United States and placed high burdens on those who seek care. Anti-abortion laws, violence, and stigma compound racism, sexism, heteronormativity, and ableism in our health care systems and public policy. To quote Professor Dorothy Roberts, abortion bans attack “women’s autonomy, women’s freedom, women’s health, women’s lives.” Abortion is freedom.

Communities of color and low-income households are at most risk from the harm of abortion bans. The amicus briefs filed in the Dobbs case urge the Court to consider the impact on marginalized groups should the Mississippi 15-week abortion ban go into effect. When the Court overturns Roe, barriers to care and harm from abortion denial described in these briefs will be even more far-reaching and devastating. Due to funding and insurance restrictions, most people pay for abortion care out-of-pocket. The average cost of an abortion procedure, or medication, within the first 12 weeks is $500. Abortion is an unexpected expense that becomes more cost-prohibitive when adding up expenses from travel, childcare, and wages lost while navigating barriers to access care. We know that women are more likely than men to live in poverty, and poverty rates are even higher for women of color. Thirty-five percent of all U.S. adults would have trouble coming up with $400 for an emergency, and due to systematic racism asset poverty is much more common among Black and Latinx households. Indeed, research at IERE has continually shown that households of color, especially Black families, are disproportionately asset poor and lack financial resources for a crisis.

We should be asking what happens when people cannot access abortion care. People denied an abortion are more likely to experience adverse health outcomes, economic insecurity, and are more likely to stay in contact with a violent partner. Adoption is not an alternative to abortion and the right to parent is a key principle of the reproductive justice movement. Abortion is an essential service that must be protected.

Roe is the compromise.

As a political scientist, my first response to the Alito draft was alarm at the extremism coming from our highest judicial institution. The Alito draft is the latest egregious act in the 49-year crusade to overturn Roe v. Wade. Justice Alito’s 98-page opinion reflects an anti-rights framework with broad implications for the future of privacy and due process, from same-sex marriage equality to contraceptives. The Court has a long history of dehumanizing decisions that required later judicial intervention; these cases haunt us, from Dred Scott v. Sanford to Buck v. Bell and Bowers v. Hardwick. Yet, it was still demoralizing to see in print just how deeply opposed my government continues to be toward reproductive autonomy and gender equity.

The majority of Americans do not share Justice Alito’s reasoning, nor does it follow the precedent of the Court and its current Justices that have asserted Roe is “settled law.” Justice Alito’s draft opinion reaches beyond the 15-week abortion ban challenged in Mississippi. This draft opinion returns abortion policy to state-by-state control, a departure from federalism that has not provided fair and equitable outcomes for healthcare or elections. Five people overturning 49 years of fragile freedom in a single decision is a threat to democracy.

As Professor Anita Hill reminded us recently, this first draft majority opinion was written by one of the most extreme anti-abortion members of the Court and left little room for compromise in the final decision. The question before the Court in Dobbs is not the right to abortion, or if Roe was decided correctly, but whether states can ban abortion earlier than fetal viability (around 24 weeks of pregnancy). By arguing for the abolition of national abortion policy as his starting bid, Justice Alito forces his colleagues to engage with this decision from the most extreme anti-abortion position possible.

Roe is a compromise. The Roe decision, and every case that followed, has balanced the right to choose and government interest in regulating abortion. Today, the government controls every facet of abortion, from who can provide care to how people can pay and what procedures are available. People who choose abortion have limited options to receive care because the Courts have favored government interest over reproductive freedom. One in four women will have an abortion in their lifetime; these diverse experiences matter. Abortion policy must center the voices of those who have had an abortion or have the capacity for pregnancy.

Future of Abortion Care FAQs

The Alito leak has produced more questions than answers about the future of abortion care in the United States. These FAQs provide a launchpad to learn more and prepare for what’s next.

Q. Has Roe v. Wade been overturned?

Abortion is legal, and clinics are open in all 50 states. If you, or a loved one, needs care visit www.ineedana.com to find nearby providers. Call the All-Options Talkline at 1-888-493-0092 to speak to someone about pregnancy options.

Q. When will we know the final decision on Dobbs v. Jackson?

The Alito opinion is not the final decision of the Court. Following public oral arguments, the Supreme Court decision-making process is private, and it is unprecedented for documents to be leaked to the public before a final decision is released. The Court announces opinions starting in May and concluding with the June recess. Typically contentious opinions, like this one, are released towards the end of June.

Q. What will happen if the Court overturns Roe?

Access to abortion care will be determined by each state individually, and providers in half the country will be forced to halt services. Currently, 26 states are expected or likely to immediately prohibit and ban abortion if Roe is weakened or overturned. Most of these states, like Michigan, have pre-Roe bans that could go back into effect, and some states have “trigger laws” passed in recent years that ban abortion if Roe is overturned. These political choices will have a vast impact on gender equity – denying reproductive autonomy will raise maternal mortality rates, limit citizenship rights, and embolden further anti-democratic violence.

Image from Guttmacher Institute(https://states.guttmacher.org/)

Q. Where will abortion be legal if Roe is overturned?

The right to abortion is protected by state law in 22 states and the District of Colombia – including Massachusetts. State lawmakers and advocates in Massachusetts codified the right to abortion access in 2020 after previously removing an unenforced statute that prohibited abortion dating back to 1845. However, many states that recognize the right to abortion also have restrictions on access for patients, providers, and facilities.

Q. How will people receive abortion care in a Post-Roe America?

Advances in medication and telehealth mean that people have more options for safe abortion than 50 years ago. Advocates mobilized in Texas following extreme restrictions to provide abortion pills and abortion funds continue to expand the infrastructure of community care to help people navigate financial and logistical barriers. Without a national policy legalizing abortion, the burden of care will fall to liberal states, creating interstate conflict and placing a strain on an already fragmented and fragile system. 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. The United States has a long history of policing pregnancy and reproductive coercion against women of color, which most recently made headlines this April when a Latina woman in Texas was charged with murder after emergency room staff accused her of self-inducing abortion. In the post-Roe era, we must care for each other and center those most at risk for harm.

Q. What is being done to stop Roe from being overturned?

Abortion advocates have been preparing for this possibility. The movement for reproductive justice was birthed by BIPOC and LGBTQ+ people, and we must continue to follow their lead to ensure everyone who wants an abortion can get an abortion.

Q. How can I stay informed and get involved?

The leaked draft has the potential to create productive rage that uplifts community care. Here are some options for how to find more information and get involved:

Jamie Morgan, ERE doctoral candidate

Jamie Morgan is a doctoral candidate at the Heller School in the Economic and Racial Equity concentration and an instructor at the Tufts University School of Medicine. Her forthcoming dissertation research examines the effects of contentious politics on gender-based violence at abortion clinics. As the founding director of Pro Choice South Bend, she spent three years helping Whole Woman’s Health Alliance open the only abortion clinic in Northern Indiana. Today, she volunteers her time to advance anti-racist clinic defense efforts and access to gender-inclusive queer-affirming reproductive care.