As a family medicine doctor with a focus on reproductive health, including abortion care, I have been fighting against this outcome for years, and I’ve already seen a steadily increasing stream of patients who have needed to fly for compassionate abortion care. I’m lucky to live and work in New York, where Gov. Kathy Hochul recently signed several laws further codifying and protecting abortion access. Connecticut was the first to pass similar protections, and states like California and Massachusetts are working on legislation. But this is a stark contrast to what Americans in other parts of the country are facing, even though access to high-quality, evidence-based health care should not be based on where you live.
So let’s explore what’s coming next, thanks to the fall of Roe: worsening health care disparities, higher maternal mortality rates, criminalization of pregnant people and their doctors, lack of medical care for people experiencing pregnancy complications, attacks on routine medical care for people who can become pregnant, and broad assaults on human rights currently in place for marginalized groups.
‘Women Will Die’
To start, it’s important to understand that millions of Americans have already been living in a post-Roe reality. States led by anti-abortion politicians have spent decades making abortion access nearly impossible through targeted regulations of abortion providers, or TRAP laws. They have forced people to drive hours to get care, followed by a visit where doctors are legally obligated to deliver medically inaccurate information. After jumping through those hoops, many states require 24- to 72-hour waiting periods before patients can return to finally get the abortion they need.
It’s easy to see how these barriers are lengthy and expensive. However, lawmakers pretend these obstacles haven’t represented an “undue burden.” Before Dobbs v. Jackson Women’s Health Organization overturned Roe, seven states had two or fewer abortion clinics left due to the onslaught of TRAP laws.
We have already been operating in a system where people with wealth and power are able to end unwanted pregnancies, while marginalized groups, including Black people, Indigenous people, people of color, immigrants, LGBTQ people, children, and people with disabilities, have suffered and will continue to suffer the most due to harsh abortion restrictions. If you are new to abortion advocacy, I encourage you to look to long-standing reproductive justice and advocacy groups ― including SisterSong, the National Latina Institute for Reproductive Justice, New Voices for Reproductive Justice, the Afiya Center and Shout Your Abortion, among others ― and follow their guidance.
In 2022 alone, the Supreme Court’s decision will directly cause the deaths of hundreds of people as their bodies are used by the state against their will. Abortion is significantly safer than pregnancy ― period. The World Health Organization ranks the United States 57th in the world for maternal mortality. This rate has increased in past decades, unlike the decline seen in most of the rest of the world. In 2020, the Centers for Disease Control and Prevention reported the maternal mortality rate in the U.S. at 23.8 deaths per 100,000 births. Non-Hispanic Black women fared much worse, with a staggering 55.3 deaths per 100,000 births, making them 3.5 times as likely to die as non-Hispanic white women. For comparison, the death rate from abortion in the U.S. between 2013 and 2018 (the most recent data available) was 0.41 per 100,000 abortions ― which means abortion is 25 times safer than continuing pregnancy.
“The Supreme Court’s decision will directly cause the deaths of hundreds of people as their bodies are used by the state against their will.”
The politicians banning abortion falsely claim they are protecting women, while having the worst maternal outcomes in the nation. In order, the states with the highest maternal mortality rates are Louisiana, Georgia, Indiana, New Jersey, Arkansas, Alabama, Missouri, Texas, South Carolina and Arizona. Notice a pattern? They mandate forced birth, but don’t have adequate prenatal care. Sen. Bill Cassidy of Louisiana actually argued that maternal mortality rates in his state aren’t so bad if you don’t count Black women. Sorry, Bill, we do count Black women.
The American College of Obstetricians and Gynecologists, with other medical organizations, said in a statement that the Dobbs decision will “certainly lead to unnecessary patient suffering and harm.” The Lancet, one of the world’s most prestigious medical journals, went further, saying: “Women will die … [Supreme Court Justice Samuel] Alito and his supporters will have women’s blood on their hands.” The American Academy of Family Physicians and the American Medical Association have also condemned anti-abortion laws. This is not theoretical: These are living, breathing people whose deaths will be an incalculable loss.
A Spiraling Legal Nightmare
Many of the pro-abortion rallying cries over the past few months have centered the idea that only safe abortion can be outlawed. While it’s certainly true that abortion will continue, this sentiment is not entirely correct. We are not returning to the pre-Roe era of coat-hanger and back-alley abortions. Today we have medication abortion, a highly effective and safe combination of mifepristone and misoprostol that has been used legally in the U.S. since 2000, and which received approval from the U.S. Food and Drug Administration in 2021 to be mailed via telemed. The pills can be ordered online and delivered to all 50 states through international organizations like Aid Access.
Abortion is not as divisive as hard-line opponents want us to believe. According to the Pew Research Center, 61% of Americans believe that abortion should be legal in all or most cases, while only 37% believe it should be illegal in all or most cases. Extreme abortion bans are unpopular, but many of the anti-abortion laws being passed are exceptionally cruel. Twelve states have enacted laws making no exception for pregnancy due to rape or incest, and three states don’t even make an exception to save the pregnant person’s life.
We are never going back. Instead, we are moving toward a darker future of increased legal surveillance and criminalization of all people who can become pregnant, regardless of their feelings about abortion.
One in four pregnancies ends in miscarriage ― and there is virtually no way to tell the difference between a spontaneous abortion (the medical term for miscarriage) and an induced abortion. Anyone with an adverse pregnancy outcome is open to investigation and criminalization. Indeed, this is already happening. We can expect it to increase as states pass laws offering bounties to private citizens who report their neighbors. Anyone who can get pregnant is at risk, but members of already marginalized communities are most likely to be targeted. Marshae Jones was indicted for manslaughter after being shot and suffering a miscarriage, because prosecutors felt she hadn’t tried hard enough not to get shot. She was released after public outcry, but there are countless other people in similar positions.
Even if you have a miscarriage and you aren’t criminalized, you shouldn’t count on receiving medical care. Many doctors are reluctant to treat complications from miscarriage, which aren’t rare. People can have prolonged bleeding, difficulty passing products, or serious infections. Some doctors will not even receive training on how to manage these complications due to the abortion bans within their states, putting all pregnant people at risk. Recently, for example, some pharmacists have refused to fill misoprostol prescriptions, which can be used for management of miscarriage or abortion ― or treatment of gastric ulcers.
Fetal personhood laws give the government broad authority to criminalize pregnant people. The South Carolina courts ruled that pregnant people who use drugs can be prosecuted for child abuse and murder. In Oklahoma, Brittney Poolaw was convicted for manslaughter after she had a miscarriage in a hospital and admitting to using drugs, though there was no evidence the drug use caused the miscarriage.
With these laws, people struggling with addiction are less likely to seek prenatal care and drug treatment programs, resulting in worse outcomes for parents and children. States continue this criminalization despite evidence-based recommendations from ACOG opposing the practice. People have even been criminalized for taking medications that were prescribed and monitored by a doctor. When stripping people’s bodily autonomy and freedoms in the name of health, lawmakers are unfortunately not required to enact laws based on medical evidence, or laws that improve health and safety outcomes.
By making fetuses people, you also strip the rights of potentially pregnant people in any number of ways. If a pharmacist dispenses a medication that results in abortion ― for treatment of cancer, say, or autoimmune conditions ― are they responsible for murder in the eyes of the law? If your health insurance paid for the medication, are they accomplices to homicide? Very few medications are approved for use during pregnancy because of the reluctance to perform prescription drug trials on pregnant people. How far does someone have to go to prove they’re not pregnant to access routine health care? This will worsen as states race to inflict the most punitive restrictions. Everyone who can become pregnant will have their access to basic medical care limited.
“Anyone with an adverse pregnancy outcome is open to investigation and criminalization. Indeed, this is already happening.”
Even in cases where a person’s life is threatened (and the state allows such exceptions), clinicians and lawyers are struggling to figure out exactly what that means. An ectopic pregnancy implants outside the uterus and cannot develop into a viable pregnancy. It’s the top cause of first-trimester pregnancy death, and is always a medical emergency. Yet people are being turned away for treatment because the pregnancy has not yet ruptured and caused severe internal bleeding. In this example, imminent harm is clear, but the legality is still hazy. People diagnosed with cancer, or other conditions with no identifiable “moment” when their life is at risk, will not have access to life-saving treatment.
Someone who wants to deliver a healthy child can also face criminalization if they disagree with their doctor on any aspect of the pregnancy management. Vaginal birth after cesarean is common, and most obstetricians agree it’s safe and can reduce pregnancy complications. Laura Pemberton’s doctors didn’t agree, however, so they obtained a court order for her to undergo a C-section against her will.
Pemberton, a Florida woman, was taken into custody, had her legs strapped legs together and was forced to go to the hospital. She later sued, but Florida courts decided that the fetus’ best interests outweighed her own First, Fourth and 14th Amendment rights. Despite this horrific medical abuse, and despite being put at increased risk of future pregnancy complications by the repeat C-section, Pemberton went on to deliver three children vaginally.
The Lie Of ‘Pro-Life’
Anti-abortion lawmakers manifestly have no intention of helping pregnant people have successful pregnancies, safe deliveries or healthy children. Republicans have voted against access to baby formula and free school lunches. They’ve unanimously voted down paid parental leave (with the help of Sen. Joe Manchin of West Virginia), even though it improves health outcomes for infants. This means the U.S. is one of only 41 countries in the world without parental leave. States with abortion bans are less likely to have adopted Medicaid expansions to provide health insurance for postpartum parents and their children. Minimum wage is so low that millions of Americans can’t afford to feed an additional mouth while keeping a roof over their heads. Yet politicians focus on forced birth and the criminalization of pregnant people and their doctors instead of meaningful policy solutions.
Safety considerations aside, abortion access tangibly improves lives. The Turnaway Study, conducted by a research program at the University of California, San Francisco, found that people who are “turned away” from obtaining desired abortion care have worse outcomes across the board. When someone who wants or needs an abortion cannot have one, it increases the likelihood of being tethered in an abusive relationship, increases anxiety and mental health problems, and leads to higher rates of unemployment, poverty and reliance on public programs, among other things.
All people of all genders should have the right to control their bodies and be respected, whether or not they choose to explain their reasoning to you. People’s reasons for seeking abortions are personal and fundamental to the core of their being. Studies like this just give us the scientific data to prove it.
The fall of privacy protections from Roe has far-reaching implications. Justice Clarence Thomas offered a grave preview in his Dobbs opinion, writing that the court should re-evaluate all rulings that deal with privacy, due process and equal protection legal standards set by Roe ― specifically citing cases that legalized contraception, same-sex relationships and same-sex marriage. Sen. John Cornyn of Texas tweeted: “Now do Plessy vs Ferguson/Brown vs Board of Education,” referring to the decision desegregating public schools. Everyone who believes in basic human freedoms needs to fight against abortion criminalization, or the courts will take us back to a time when only property-owning white men were legally considered people.
We have to collectively fight back against this dehumanization. Organize with the reproductive justice and advocacy groups mentioned, and donate to groups that directly support people seeking abortions. The National Network of Abortion Funds pays for travel, child care, medical bills and other abortion-related costs. The Abortion Care Network keeps independent abortion clinics open by funding equipment, security, legal costs and more. The M+A Hotline provides free medical advice from licensed clinicians to people self-managing abortion. Plan C provides medically accurate information, including how to get abortion pills online. Aid Access offers physician-led medication abortion via Austria to ensure access regardless of borders. The Reproductive Health Access Project and Physicians for Reproductive Health train and mobilize doctors who provide abortion care across the country.
If you need abortion resources, don’t trust a Google search. Fake clinics, called crisis pregnancy centers, pose as abortion clinics to make it more difficult to obtain care. I Need An A and Abortion Finder are two trusted organizations that can help you find a real abortion clinic.
Lastly, take action. Go to pro-abortion rights protests. Vote for pro-abortion rights policies. Advocate for laws that support parents and children. Call your legislators. Refuse to be silent, until pregnant people, and everyone who benefits from “equal protection” under the law, are respected as fully human in this country. If it’s safe, show up for people seeking abortion care by sharing medically accurate resources or being a trusted confidant. We build power by strengthening our communities.