January 22 marks the forty-ninth anniversary of Roe v. Wade—and potentially its last. Before this legal precedent can reach its half-century mark, the newly reshaped U.S. Supreme Court is poised to overturn or gut the right to abortion entirely. On December 1, the Court heard arguments in Dobbs v. Jackson Women’s Health Organization, a case regarding Mississippi’s fifteen-week ban on abortion and a direct challenge to Roe. The justices’ questions in those oral arguments offered little hope that they will uphold Roe v. Wade in their decision this spring.
The legal right to abortion under Roe v. Wade has never been enough to guarantee actual access—particularly for people struggling to make ends meet and people of color. Because of the Hyde Amendment and related budget riders, as well as funding restrictions created at the state level, coverage of abortion care is limited, even for those who have insurance. The prevalence of other medically unnecessary and politically motivated state laws that restrict access, such as TRAP laws and multiple-visit requirements, push abortion out of reach for too many. As a result, there are multiple states with only one abortion clinic, and twenty-seven cities with populations of over 100,000 that are classified as abortion deserts—areas without a clinic within 100 miles. But an end to Roe entirely will further fracture access by state, and put abortion out of reach for the millions of people who cannot afford to travel for their care.
Texas Offers a Glimpse into a Grim Future
Unfortunately, the Supreme Court did not wait until a decision on Dobbs to strip abortion access even further. On December 10, Texas’ SB8—which allows any person (other than a state official) to sue anyone who “aids or abets” access to an abortion past six weeks of pregnancy—was allowed to remain in effect. This law has survived challenges so far because it is working precisely as designed—in relying on someone other than state officials as the means of enforcement the law removes officials as would-be defendants and thus eliminates the traditional method of challenging the law in court. The December opinion made things even worse by handing a win to Texas and thus preventing similar federal challenges to the many copycat laws already being prefiled and introduced in other state legislatures.
Meanwhile, on Roe’s anniversary, Texas—with Roe theoretically still in place—will have been without meaningful access to abortion for 148 days and counting. The impacts reach beyond Texas, as clinics in other states receive Texas residents for care. Given that SB8 remains in effect, and if Roe falls completely, the states where abortion remains legal will be overwhelmed by an influx of patients. The implications of abortion care being restricted at this scale are unprecedented in recent times—but existing evidence gives us an idea of what to expect.
When Abortion Is Out of Reach
There is a wealth of evidence on what happens when people are denied abortion care. By studying the experience of women who were turned away from clinics due to gestational limits, the researchers from the Turnaway Study were able to compare their outcomes with those of women who received their wanted abortion care. This research showed that denial of abortion care places women at greater risk for physical violence from the man involved in the pregnancy, and make women more likely to raise their children alone.
Abortion denial has also been linked to economic harship and financial insecurity, including greater odds of living in poverty and being unable to pay for basic needs such as food and housing. A separate body of research demonstrates that abortion legality resulted in economic gains for women, including greater educational attainment. Reproductive and economic justice go hand-in-hand: women’s contributions to the economy rely in part on reproductive health supports such as abortion access. For instance, reproductive health access bolsters women’s participation in the workforce by reducing job lock and fostering mobility in the labor market.
Of course, when legal abortion is out of reach, people may use available online resources to obtain medication abortion pills outside of the formal health care system. Although medication abortion care is overwhelmingly physically safe, it can carry legal risks: a post-Roe future will likely mean an increased risk of criminalization of self-managed abortion in some states. These risks will be highest to communities that are already criminalized at disproportionate rates, particularly Black women and girls.
In order to address the assault on reproductive freedoms, it is necessary to understand its connections to attacks on another freedom facing a similar onslaught: the right to vote.
Voter Suppression Is a Reproductive Justice Issue
Crucially, this last anniversary of Roe comes at a time when the Senate is debating protections to voting rights. Reproductive justice organizations—and Black women leaders in particular—have long sounded the alarm on the need to recognize the connection between reproductive oppression and voter suppression. Attacks on these rights impact the same communities disproportionately: Black, Indigenous, and other people of color, people living on low incomes, the LGBTQ community, immigrants, people with disabilities, and young people. And as people are disenfranchised of their right to vote largely in the South, these same states pass increasingly restrictive abortion laws.
As articulated in a 2012 report from the Center for American Progress:
Women of color stand at the crossroads of what is in essence a double disenfranchisement. When they are denied the opportunity to participate in civic life, they also lose the ability to voice their opinions and hold lawmakers accountable on the reproductive health issues that directly affect them.
The ties between white supremacists and anti-abortion groups are no secret, so it should not be a surprise to see anti-abortion groups engaging actively in voter suppression. In order to address the dual crises of voting rights and abortion access, it is past time that we heed the calls of reproductive justice leaders and recognize the intrinsic connections between the two.
A Way Forward
Despite the warning signs at the Supreme Court and restrictive laws proliferating at the state level, there are still reasons for hope and opportunities for proactive policy. First, the Senate must overcome the obstacle of the filibuster to pass voting rights reform to halt voter suppression efforts at the state level, where the vast majority of abortion policy is made.
The Senate must also vote and pass the Women’s Health Protection Act (WHPA), which has already passed the House of Representatives. WHPA would create a statutory right to provide and receive abortion care, free from medically unnecessary restrictions such as the hundreds currently in place across the country. In addition, the Senate must take up the Equal Access to Abortion Coverage in Health Insurance (EACH) Act, and pass annual appropriations legislation free from harmful abortion riders such as the Hyde Amendment.
Recent changes to the FDA’s restrictions on mifepristone, a drug used for medication abortion care, are steps in the right direction for abortion access. With the permanent removal of unnecessary in-person dispensing requirements, more people will be able to access abortion care without expensive, burdensome, and potentially prohibitive travel. However, this change will not benefit abortion patients who live in the nineteen states that already ban the use of telemedicine for abortion care. And for patients who are ineligible for medication abortion care, such as those beyond the gestational limits, as well as those who prefer to receive care in-person, brick and mortar clinics must be kept open and accessible. Additionally, it is time to consider innovative ideas that have been proposed for the Biden–Harris administration to secure abortion access, both in-clinic and for medication abortion care. Abortion care should always be offered with compassion, centering the pregnant person, and promoting dignity and respect in the way they recieve health care.
On this (likely final) anniversary of Roe v. Wade, it is necessary to be realistic about the state of abortion access in the United States. Roe has always been the floor, not the ceiling, of making abortion care available to all, but come June we will likely lose the protection it does offer. We must follow the leadership of Black women and reproductive justice organizations in recognizing attacks on abortion access as part of a broader movement to restrict the rights of oppressed communities—including voting suppression—and use all avenues possible to ensure that abortion is accessible, with or without Roe.
header photo: Participants hold signs at the Women’s March “Hold The Line For Abortion Justice” at the U.S. Supreme Court in Washington, DC. Source: Shannon Finney/Getty Images for Women’s March Inc.