As a woman who is also an environmentalist and a humanitarian, I’m concerned about the impact of the decision made by our Supreme Court. I want to share this article written by Mariana Lenharo in Nature. My hope is that grassroots efforts mobilize our country, that we use our voice and our pen to persuade others of how this is walking backwards, and that we vote out those who can’t stand behind equality. If we women are losing our rights, who will be next?
After Roe v. Wade: US researchers warn of what’s to come
Years of studies on abortion access foreshadow the negative economic and health effects ahead.
The constitutional right to an abortion has been struck down in the United States. The US Supreme Court announced on 24 June that it would overturn the 1973 landmark decision Roe v. Wade, which had protected abortion access up until the point that a fetus could live outside the womb — typically set at 22 or 24 weeks of pregnancy. Public-health researchers have renewed their warnings of the harms that this decision will bring to the country.
The outcome is not a surprise to them, because an initial draft opinion was leaked to news outlet Politico in May. “All I could add at this point is how disappointing it is to see that the majority opinion, like the leaked draft, ignores the fact that there is solid scientific evidence that this decision will harm women,” says Caitlin Myers, an economist at Middlebury College in Vermont who has studied the financial impacts of abortion restriction.
The high court issued its decision with regard to the case Dobbs v. Jackson Women’s Health Organization, in which the only clinic in Mississippi that provides abortions challenged a 2018 state law banning abortions after 15 weeks of pregnancy. The law, the clinic argued, stood in direct opposition to Roe.
The 6-to-3 ruling authored by conservative Justice Samuel Alito states that “Roe was egregiously wrong from the start. Its reasoning was exceptionally weak, and the decision has had damaging consequences.”
With Roe v. Wade overturned, abortion rights will now be left to individual US states to decide. Twenty-six of them are certain or likely to ban abortion, according to the Guttmacher Institute, a research organization that supports abortion rights. Of those, 13 have ‘trigger bans’ in place — laws that will either take effect immediately or by quick state action.
Public-health researchers and economists submitted evidence to the Supreme Court ahead of the case showing that restricting abortion access has negative consequences for pregnant people, who are at increased risk of physical and mental health issues when they are denied an abortion, and for infant health. “We know from other severe restrictions in states like Texas what happens when abortion access is curtailed,” says Liza Fuentes, a senior research scientist at the Guttmacher Institute, based in New York City.
In 2013, when Texas passed legislation restricting abortion services, the state’s abortion rate dropped by 13%1. Scaled up, that represents more than 100,000 people being denied an abortion in the United States post-Roe and having the potential for negative outcomes, Fuentes says. “And that’s a pretty conservative estimate.”
Solid evidence
A significant portion of people who want, but don’t have access to abortion services, will end up carrying their pregnancies to term. The consequences of this have been thoroughly documented by research. One of the most comprehensive studies examining the effects of abortion access is the Turnaway Study, an effort that followed about 1,000 US women for five years after they sought abortions and either received them or were denied them.
Led by researcher Diana Greene Foster, a reproductive-health researcher at the University of California, San Francisco, the study showed2, for example, that women denied an abortion were more likely to live in poverty than those who received one. And it showed that those denied an abortion more often reported not having enough money to cover living expenses after giving birth, compared with those who did not give birth. Women who were unable to receive the procedure also fared worse in areas such as education, and physical and mental health.
Once people who are denied an abortion go through the experience of giving birth, they rarely choose to place the child for adoption, the Turnaway Study showed. “It means that poor families will have kids before they’re ready,” Greene Foster says. “And all the health and economic costs that we documented in the Turnaway Study will happen for these people.” She is currently working on a new national study to investigate what will happen to the people denied an abortion after their state’s law abruptly changes post-Roe.
Researcher Mary Faith Marshall, a biomedical ethicist at the University of Virginia School of Medicine Charlottesville, says that, on the basis of data collected over years, the upcoming abortion restrictions will have a deeper impact on people of colour and poorer communities. “Being forced to have a child when it is not the right time puts people who are already in poverty, further into poverty.”
The obstacle of travel
One of the most immediate consequences of Roe’s demise for people seeking an abortion is that many will now need to travel significant distances to receive abortion care. Myers, who has studied this, recently estimated that, within a few months of Roe being overturned, 54% of US women seeking abortions will have to travel farther than they would have previously to reach their nearest abortion provider. For these women, travel distance will increase from about 58 kilometres (36 miles) on average to about 441 kilometres (274 miles) on average. The updated numbers haven’t been published yet, but they follow closely results that she and her colleagues submitted to the journal Contraception back in 20193.
“Based on what we know about how women respond to travel distance, about three-quarters of them are still going to manage to get out and reach a provider, and about a quarter of them won’t,” Myers says. This quarter represents the poorest and most vulnerable, she adds.
The impact of overturning Roe will also affect the states where abortion remains legal. “What’s going to happen in the immediate aftermath is there’s going to be an enormous outflow of hundreds of thousands of women from the states that ban, to the states where abortion is still legal,” Myers says. “My belief is those providers are not currently prepared to fully absorb that huge increase in demand.”
Self-managing abortion
Another potential consequence of restricting access to abortion is that people might try to end their pregnancies without clinical supervision. Some will do this with abortion medications, which are safe and effective, according to the World Health Organization (WHO).
The problem is that many people don’t know much about medication abortion, says Heidi Moseson, an epidemiologist and reproductive-health researcher at Ibis Reproductive Health, a global research organization that supports abortion rights. She and her colleagues have studied4 abortion attempts among transgender, non-binary and gender-expansive people in the United States. One in five people in their study who had ever been pregnant tried to self-manage an abortion. “Unfortunately, no one reported using medication abortion,” Moseson says. “They reported things like physical trauma, inserting objects into the vagina and ingesting substances that are harmful.”
To bridge that information gap, Ibis and other partner organizations developed an app, called Euki, that provides people with sexual and reproductive health information, including how to have an abortion using medications. What can be more difficult to deal with, Moseson says, are the legal risks of obtaining abortion pills in the United States, she adds.
“People have been prosecuted for self-managing their abortion, and some laws have been applied outside of their intended scope to criminalize people,” Moseson says.
Marshall notes that the consequences of overturning Roe will fall on all pregnant people, not only on those seeking an abortion. In a recent article published in The American Journal of Bioethics5, she and her co-authors highlighted that people with pregnancy complications or adverse pregnancy outcomes might become vulnerable to legal surveillance and criminal prosecution.
“Roe cemented that pregnant people had constitutional rights,” Marshall says. “Now, they will no longer have these legal protections and will not be full persons under the US Constitution, which I think is a travesty.
Editor’s note: Nature recognizes that transgender men and non-binary people might become pregnant and seek abortion care. We use ‘women’ in this story to reflect how participants are reported in the studies we cite.