On January 22, 2024, we commemorated the landmark US Supreme Court decision in Roe v. Wade, establishing a constitutional right to abortion in the US. For 49 years, until the US Supreme Court overturned Roe in Dobbs v. Jackson Women’s Health Organization, in all 50 states, women made the decision that was right for them about if and when to terminate a pregnancy. Abortion was a part of women’s reproductive healthcare and women’s lives were less at risk during pregnancy. Abortions were safe and available in many circumstances –in the event of rape or incest, when contraception failed, the mother’s health was at risk, the fetus was unviable, or a miscarriage wasn’t complete. And with the introduction of medication abortion in 2000, abortions during early pregnancy became less costly and more accessible.
In June 2022, all this changed when the US Supreme Court in the Dobbs decision ended the federal constitutional protections to abortion. Over the past 18 months, this decision has led to increased state restrictions which have had a significant impact on the access to and provision of abortion care in this country. So far, 14 states have implemented total abortion bans and seven have imposed severe restrictions. In addition, while telehealth prescriptions for abortion pills and mail delivery are legal in 25 states and Washington, D.C., they are banned in 25 states. Some states have restricted medication abortion access by blocking telehealth, requiring waiting periods, and limiting dispensing to MDs, generating a functional ban.
These bans and restrictions have created significant obstacles to accessing abortions, particularly for marginalized groups such as the poor, teenagers, immigrants, women of color, and those with limited time off from work. Numerous women, especially in the South, have had to travel across state lines or country borders to obtain abortions. Some have been compelled to undertake self-managed abortions, and too many women have had to unwillingly carry pregnancies to term.
At the same time, in the aftermath of the Dobbs decision, abortion providers and concerned women have tirelessly worked to maintain optimal health care for pregnant women and provide access to abortion. Despite increased state bans and restrictions, over the past year 18 months, legal abortions in the U.S. actually increased by about 0.2 percent. Larger increases were noteworthy in states bordering those with bans, especially New Mexico and Illinois, but extended to states which have remained legal, with marked rises in California and New York.
Moreover, in response to the end of Roe v. Wade, some “legal” states have in fact enhanced abortion access by eliminating out-of-pocket costs, investing in new clinics, and expanding telemedicine for mail-order abortion pills. 22 states and D.C. have also passed “shield laws” that protect healthcare providers from legal and professional consequences when they provide care or telemedicine to patients from states with bans. Efforts by Reproductive Justice organizations at workarounds in “ban” states have included cost assistance, increased support for women traveling to get abortion care, and heightened awareness about abortion options, such as alerting women to companies online which offer self-managed abortion services.
Nevertheless, the assault on women’s abortion care continues. Currently, close to 60% of abortions in the U.S. are medication abortions, involving the use of mifepristone and misoprostol. Mifepristone is safe and effective, and has been used successfully by more than 5 million people in the United States since FDA approval over the last 20 years. The Supreme Court, however, is hearing a case in this term that could limit its use, potentially banning mailing mifepristone in every state, as early as this summer. Abortion funds report a decline in donations after an initial surge post-Dobbs, signaling ongoing uncertainties in all spheres of the abortion outlook.
This year, as we celebrate the anniversary of Roe v. Wade, many women will continue to struggle to get their basic reproductive health care needs met. It is unacceptable that our ability to access safe and effective reproductive health care, which can also determine our future, should be contingent on the state we live in and our ability, financial or otherwise, to travel for such care. Millions of individuals across this country need our continued vigilance, additional funds, protective policies and activism.
To learn more about American women’s fight for reproductive freedom, then and now, watch:
Stand UP, Speak OUT Episode 3: Reproductive Rights.
Resources
National Network of Abortion Funds
Guttmacher Institute
#We Count Report
Institute of Labor Economics – The Effects of the Dobbs Decision on Fertility
KFF – The Availability and Use of Medication Abortion
