On Friday, June 24, 2022, the US Supreme Court overturned Roe v. Wade, the landmark piece of legislation that made access to an abortion a federal right in the United States. The decision dismantled 50 years of legal protection and paved the way for individual states to curtail or outright ban abortion rights.
Already, because of trigger laws put in place before the ruling, abortion is now outlawed in many states automatically or through state action following the decision. In addition, Justice Clarence Thomas wrote that certain other landmark rulings should be reconsidered, including established rights to contraception access, same-sex relationships, and same-sex marriage.
Incoming Professor of Sociology Tracy Weitz is a national expert on abortion care, policy, culture, and politics. She is the co-founder and former director of the University of California San Francisco’s Advancing New Standards in Reproductive Health research program.
We asked Weitz to share her opinions on the outcomes of the overturning of Roe and what it will mean for people across the United States.
Q. Roe v Wade has been overturned. What will happen now across the country?
A. Nine states have already implemented their abortion bans. Another dozen states are in the process. Legal chaos is occurring as injunctions against individual state laws are being lifted and pre-Roe bans are being interpreted. In a few states, new injunctions are being issued before laws can go into effect. Governors who are hostile to abortion, but whose states have not yet fully banned abortion, are contemplating whether to call special sessions of the legislature to consider new abortion bans.
Abortion providers in all the banned and several of the in-process states have stopped providing abortion care or reduced the type of care they offer. People with previously scheduled appointments are scrambling to find new appointments in states where some abortion is still available. These include abortion-safe states as well as states like Florida, Ohio, and Georgia where there are new gestational limits for abortion but not yet complete bans.
Abortion clinics in states where abortion remains legal, including Illinois and Kansas, are working hard to expand appointment availability by hiring new staff, increasing the physical plant of their facilities, and adding additional clinic appointments. Clinics in the in-process states are doing their best to manage immediate increased patient demand even as they are preparing for a future in which they may not be able to continue offering abortions.
Q. Who will be most impacted by this decision? What will happen if people can’t access abortions?
A. The only alternative to abortion is childbirth, which has a 14 times higher risk of death than that abortion. So, in denying a person access to a wanted abortion, states are forcing people to assume significant medical risk against their will. A recent study out of Colorado ominously predicts a significant rise in the maternal mortality rate, especially among Black women who already experience an unacceptably high rate of death in childbearing.
Research from the Turn Away study demonstrated other deleterious impacts of being denied a wanted abortion. This study followed ~1000 self-identified women for five years after receiving or being denied a wanted abortion. They found that denying these women an abortion creates economic hardship and insecurity that lasts for years. Compared with women who obtained their desired abortion, women denied the abortion had lowered credit scores as well as increased debt, bankruptcies, and evictions. Women turned away from getting an abortion were also more likely to stay in contact with a violent partner. The financial well-being and development of prior and subsequent children was also negatively impacted. Finally, giving birth was connected to more serious long-term health problems than having an abortion.
Q. Can you tell us a bit about the people who choose to get an abortion — and the reasons why?
A. Abortion is a health care option most frequently needed by people affected by the structural inequalities of poverty, racism, and xenophobia. Almost 75 percent of US abortion patients live at or below 250 percent of the federal poverty level. More than 50 percent of abortion patients are women of color, and 60 percent of all patients already have children.
People’s reasons for abortion are as complex as their individual lives, and I fundamentally believe no one should have to justify their reason for abortion; simply wanting to no longer be pregnant, or needing an abortion to save their own life, is enough.
Q, What does this mean for doctors who perform abortions in states where it will be curtailed or outlawed?
A. In all the states where abortion is being banned, physicians stopped providing abortion care immediately after the decision, or will do so after their state law takes effect.
In some states where abortion is now banned, significant medical care was provided by physicians who traveled from outside the state. These physicians will likely start providing care in one of the places where abortions remain legal, and demand is increasing. However, there are other skilled and dedicated physicians who have provided abortion care for decades to women in their communities. Some of these physicians offer other types of health care and will continue to do so, without offering the abortion care their patients need. Those physicians who only provided abortions will need to decide whether to retire or relocate.
Other clinical staff including nurses, social workers, patient counselors, and medical assistants are also losing their jobs and their ability to provide economically for their families. Women in communities across the abortion-banned states have relied on these teams of health care providers to care for them during an important time in their lives. It is cruel what is happening to pregnant people, and it is cruel what is happening to the dedicated staff that make up the abortion providers of this country.
Q. What is the difference between emergency contraception and medication abortion?
A. Emergency contraception (EC) and medication abortion are not the same thing: they use different drugs that work differently on the body. EC stops pregnancy from happening. Medication abortion ends an already existing pregnancy. One brand of EC, Plan B, is available over the counter without a prescription. Medication abortion requires a clinical consultation (either via a telehealth visit or a visit to a clinic). EC can be used up to 72 hours after unprotected sex, while medication abortion is used between the time of a missed period (usually four weeks) and 11 weeks after the first day of the last normal menstrual period.
Q. How will this ruling affect women’s access to each?
A. At this time, abortion bans include bans of medication abortion. Emergency contraception is not included in abortion bans. However, many politicians who are hostile to abortion also disagree with emergency contraception, and we may see efforts to restrict access to EC in the future. The FDA could help expand access to EC by approving the second EC option, Ella, as an over-the-counter drug. Plan B is less effective for people of higher body weight, and Ella helps ensure these people also have access to an EC option.
At this time, clinicians who provide medication abortion via telehealth can only provide it in states where abortion remains legal. Abortion-supportive states that wish to ensure access to abortion in states where it is banned could protect clinicians in their state who provide abortion care to people in banned states. The Federal government could explore ways to protect this practice. Until then, people who need medication abortion in states where abortion is banned can self-source these medications from international telehealth providers or international pharmacies.
Q. Almost 90 percent of abortions occur in the first 12 weeks of pregnancy. Can you tell us some of the reasons why women need to have abortions later in pregnancy?
A. Many people do not know they are pregnant until after the 12th week: some are still bleeding, others are on medications that caused cycle changes, and still other people do not have pregnancy symptoms.
Another reason people pass the 12th week of pregnancy is that gathering the money to pay for the abortion is extremely hard. Currently, the Federal government and 33 states prohibit people from using Medicaid to pay for abortions. Yet the majority of people who need abortion live at or below poverty. In order to gather the money, they forgo paying rent or food bills, and all of this delays their ability to obtain an abortion when they first want one. And after they pass the 12 weeks mark, the cycle perpetuates itself. The cost of the abortion begins to increase as the clinical care becomes more complex, thus requiring more money and causing more delays.
For still other people, the abortion decision is made following learning something about their own health status or the health status of the fetus. Medical complications in pregnancy increase as people become more pregnant, and some do not onset until later in pregnancy. Issues with the growth of the fetus occur as the fetus develops and are not diagnosable until later in pregnancy.
Q. Then what will happen now if a mother’s life is in danger?
A. We do not have data on how often a pregnancy threatens a person’s life because this care has often occurred in hospital settings, which do not routinely advertise that they do abortions. Physicians who treat these pregnancies, including maternal fetal medicine and complex family planning physicians, rarely discuss these cases publicly, in part because of the social discomfort with abortions later in pregnancies. Limited research on hospital policies regarding abortion care demonstrates significant barriers to obtaining institutional support for abortions, regardless of the reason.
Now that abortion is banned in some states, it is likely that access to abortion care in life- threatening circumstances will be even harder to provide. The media is already reporting cases in which life-saving care was denied to pregnant patients. We can expect to see more of this since the penalty for violating an abortion ban is criminal jail time for the physician and other legal consequences for the institution. The Federal government can help ensure that needed care is provided by identifying and prosecuting denials of care under the federal Emergency Medical Treatment and Labor Act and covering such life-saving care under the exceptions to the federal Hyde amendment.
Q. Are you concerned about the fate of other rights that are not explicitly outlined in the Constitution, including the right to access contraception? Do you think this is a real possibility, and what would this mean for our society?
A. I am not a legal scholar, so I cannot predict what the Court will do to other legal rights based in the constitutional right to privacy. What I can speak to is that most social conservatives do not draw a hard-line distinction between abortion and contraception.
The Hobby Lobby Supreme Court decision allowed a corporation to not cover contraceptive methods that its owners believed were abortifacients, namely emergency contraception and intrauterine devices (IUDs). So, it is likely that some state legislatures will seek to limit access to some contraceptive methods or to further limit contraceptive access to people whose sexual lives they disagree with. Too frequently, people see abortion as the exception in law and policy. I would suggest that it is exemplar. The 50-year effort to overturn Roe is part of a larger effort to reverse the wider progressive gains in social, economic, gender, and racial advancement.
Q. What is the bottom line? As someone who has focused on abortion care and policy for your entire career, what do you think American should know right now?
A. I have heard a lot of people concerned about the risk of people dying from unsafe abortion. One positive advancement since the pre-Roe days is the availability of abortion pills that people can use to end a pregnancy safely with minimal clinical involvement. Today in the United States, these pills are dispensed by abortion clinics as part of a health care visit, increasing through telehealth. As abortion providers become unavailable in many places, people will turn to the Internet to order these pills directly, either through an international telehealth service like Aid Access or from an online pharmacy operating outside the United States.
Data from studies around the world show us that such self-sourcing of abortion pills is safe, effective, and acceptable for people. So even as the public expresses their anger about the elimination of the fundamental rights of people to bodily autonomy, they should not exaggerate the medical risk of self-managed abortions. Deaths will happen, but likely resulting from people carrying pregnancies to term against their will. Self-managed abortion with pills is safe — that is what I want people to know. What is so wrong is that people who would prefer to receive this care from a trusted health care provider will instead have to shop for drugs online, potentially putting themselves at criminal risk for breaking the law.
The opinions in this interview represent the views of the interviewee and do not necessarily reflect the views of American University or the American University College of Arts and Sciences.