This article includes discussion of abortion that may be challenging for some readers.

March 20, 2023
By Lauren Wells, Drexel University College of Medicine

In January of 1973, the U.S Supreme Court sided with “Jane Roe” in Roe v. Wade’s pivotal declaration of existing anti-abortion law as an encroachment of several personal freedoms outlined in the Constitution⁶. Most notably, legislature protecting privacy and due process appear in the Fourth, Fifth, and 14th Amendments. Specifically, the 14th Amendment reads that “no state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law”². Roe argued that Texas’s anti-abortion legislature was supported with intentionally vague language that infringed upon her rights as outlined by the amendments above. Specifically citing the 14th Amendment, Supreme Court justices voted 7-2 in favor of Jane Roe and rendered state prohibition of abortion unconstitutional on the basis of privacy and freedom of personal choice.⁶

As expected, in the time after Roe v. Wade’s 1973 ruling, the number of legal abortions increased to nearly 1.6 million in 1980 while the number of illegal abortions steadily decreased¹. The most drastic change, however, was who was getting them. Before Roe v. Wade, access to safe, yet still illegal, abortions was expensive, time-consuming and largely reserved for married white people. After Roe v. Wade, the proportion of non-white and unmarried women receiving safe abortions skyrocketed¹. By legalizing abortion across all states, pregnant people were now staying closer to home and spending less money for their care. Abortion-related maternal deaths fell drastically too¹. Expanding access to quality, equitable care was working as it should.

In May of 2022, after nearly 50 years of federally protected abortion rights, Politico leaked a majority draft opinion in which the Supreme Court stated their intent to overturn Roe v. Wade⁵. Specifically, Justice Samuel Alito posed that “Roe was egregiously wrong from the start” and “Its reasoning was exceptionally weak, and the decision has had damaging consequences”⁵. Abortion has been a hot topic issue for most of recent history, and the Supreme Court’s movement to overturn Roe v. Wade sparked further debate, protest and pushback. The draft opinion became official law on June 24, 2022, and handed legislative power regarding reproductive freedoms back to the states.

Several states like Texas, Louisiana and Mississippi had so-called “trigger laws” on their shelves³. These laws were automatically brought into effect to restrict abortions should Roe v. Wade fall. While they all uphold the same goals, there is some diversity in the timeline of their effects. Some would be immediately placed into action while some would wait 30 days to take effect. These trigger laws approached term-limits on abortion in varying ways as well. Some restrict abortion care any later than six weeks from conception, a time when many individuals might not yet know they’re pregnant. Other states extend this limit to 8 or 15 weeks. Though the specifics of these various anti-abortion laws vary, the end result is the same: Reproductive choice and bodily autonomy are no longer freedoms granted to pregnant people.

As has been argued before, outlawing abortions only outlaws safe abortions. Pregnant women (as well as trans, nonbinary and other LGBTQIA+ people) will still pursue abortion care in ways that circumvent the law, no matter how dangerous or difficult. However, only those that can access the appropriate resources will benefit (as seen in the pre-Roe era)¹. Families of lower socioeconomic status and those facing institutional barriers will not have the same opportunity and will be forced to carry an unwanted or unsafe pregnancy. Unsafe and insufficient abortion procedures will undoubtedly lead to a stark increase in maternal deaths. In 2021, Amanda Jean Stevenson conducted research to estimate pregnancy-related deaths following a ban on abortion⁷. In the first hypothetical year, pregnancy-related deaths increased by 7%. In subsequent years, they estimated an increase of 21%. Racial disparities are also evident in this conclusion: Stevenson’s 2021 research estimated that Black mothers would experience the greatest increase in pregnancy-related deaths at 33%⁷.

Further, the deleterious effects of a post-Roe world on infant health cannot be overstated. Infants (with or without extraneous medical conditions) born to mothers unable to support them financially, physically or psychologically will certainly face higher mortality rates as a result. In 2020, Pabayo et al. explored this relationship by comparing infant mortality rates in states with abortion bans to those without. It was found that infants living in states with restricted abortions were more likely to die than in states with reproductive freedoms⁴. Similarly, it has been argued that infants will be forcibly birthed into an economy and social structure that cannot support them. In the wake of a nationwide formula shortage, an overrun and under-resourced foster care system, and the highest inflation rate the United States has seen since 1981, this concern becomes increasingly valid⁸.

Beyond both maternal and infant health, a simpler and more prominent rebuttal to the overturning of Roe v. Wade concerns reproductive choice. Freedom to control one’s own body and autonomy of choice in what to do with it is a most basic right. Since the politicizing of female reproduction, this freedom has been erased. Personal choice allows pregnant people to make healthy, intimate decisions for the benefit of themselves and their families. Whether that choice is pregnancy termination or continuation, one’s right to choose should not be up for debate. In addition to the outrage, disappointment and hopelessness felt from Roe v. Wade’s rejection, many also worry that the trajectory of recent legislature will next curb other rights connected to privacy including contraception use and freedom to marry regardless of gender or race.

Since the initial leak of the Supreme Court’s majority draft opinion, health care providers have been under the microscope as well. What legal ramifications will be in place for physicians providing abortions in states with existing bans? There is also an ever-present worry that physicians who support abortion rights may avoid states that restrict the procedure. These states and their constituents may feel significant pressure from a lack of health care in several different ways. Further, will patients overwhelm care resources by flocking to states that uphold abortion rights? Pressing questions like these are still on the table and America’s public will soon, unfortunately, find the answers.

The complete loss of bodily autonomy, an essential human right, at the Supreme Court’s hand has been met with fierce retaliation. Protests in support of Roe v. Wade have filled the streets in an outcry for accessible, affordable and quality health care as a fundamental right, regardless of the reason. While there are still many unknowns surrounding the future of abortion as health care in the United States, the voices of those seeking democracy, choice and change are present and promising.

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Sources/Resources:

1. Cates, W., Grimes, D. A., & Schulz, K. F. (2003). The Public Health Impact of Legal Abortion: 30 Years Later. Perspectives on Sexual and Reproductive Health, 35(1), 25–28. http://www.jstor.org/stable/3097801
2. Fourteenth Amendment | Browse | Constitution annotated | congress.gov ... (n.d.). Retrieved June 29, 2022, from https://constitution.congress.gov/browse/amendment-14/
3. Nash, E., Guttmacher Institute, & Guarnieri, I. (2022, June 15). 13 states have abortion trigger bans-here's what happens when Roe is overturned. Guttmacher Institute. Retrieved June 29, 2022, from https://www.guttmacher.org/article/2022/06/13-states-have-abortion-trigger-bans-heres-what-happens-when-roe-overturned
4. Pabayo, R., Ehntholt, A., Cook, D. M., Reynolds, M., Muennig, P., & Liu, S. Y. (2020). Laws restricting access to abortion services and infant mortality risk in the United States. International Journal of Environmental Research and Public Health, 17(11), 3773. https://doi.org/10.3390/ijerph17113773
5. Read justice Alito's initial draft abortion opinion which would overturn Roe v. Wade. POLITICO. (n.d.). Retrieved June 29, 2022, from https://www.politico.com/news/2022/05/02/read-justice-alito-initial-abortion-opinion-overturn-roe-v-wade-pdf-00029504
6. Roe v. Wade, 410 U.S. 113 (1973). Justia Law. (n.d.). Retrieved June 29, 2022, from https://supreme.justia.com/cases/federal/us/410/113/
7. Stevenson, A. J. (2021). The pregnancy-related mortality impact of a total abortion ban in the United States: A research note on increased deaths due to remaining pregnant. Demography, 58(6), 2019–2028. https://doi.org/10.1215/00703370-9585908
8. U.S. Bureau of Labor Statistics. (2022, June 14). Consumer prices up 8.6 percent over year ended May 2022. U.S. Bureau of Labor Statistics. Retrieved June 29, 2022, from https://www.bls.gov/opub/ted/2022/consumer-prices-up-8-6-percent-over-year-ended-may-2022.htm
9. https://www.guttmacher.org/ (Extra Resource)