By Carole Joffe, professor in the Advancing New Standards in Reproductive Health (ANSIRH) program in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco
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The present moment, to put it mildly, is a nerve-wracking one in the abortion rights world. President Trump has succeeded in placing two known opponents of abortion on the Supreme Court, giving that body a majority of Justices who are assumed to be in favor of overturning Roe v Wade. That the Court has recently agreed to hear an abortion case from Louisiana, June v. Gee, has only increased the anxiety. The case focuses on hospital admitting privileges for abortion providers, but the Court could possibly use that case to overturn Roe altogether.
Many observers, this writer included, suspect that the Court will not take such a drastic step as the outright overturn of Roe so close to the next presidential election (the decision will likely come down in June) because of fears of an electoral backlash from the majority of the country that supports legal abortion. Rather the Court will likely impose even tighter restrictions on abortion care, making access even harder.
But after the election—even assuming a Democrat wins—the conservative-dominated Court will possibly feel much freer to overturn Roe. The reproductive rights community therefore has to consider what a country without Roe’s protections will look like. And here is what we know: many would-be abortion patients are already living in a post-Roe world. The majority of abortion recipients are poor and are disproportionately women of color. As my co-author David Cohen and I found out while researching our forthcoming book Obstacle Course: The everyday struggle to get an abortion in America, for many, simply getting to a clinic, with all that entails about arranging transportation and childcare, coping with lost wages—beyond the difficulty of coming up with the money for the procedure itself, can be extremely challenging.
Assuming the Court, if it overturns Roe, leaves the decision to the states (as opposed to finding for “fetal personhood,” which would outlaw abortion everywhere), accessing abortion care will be similar to what it is now, just significantly more difficult. That is, a lot of traveling from hostile states to “haven” ones, and even more dependence on abortion funds and volunteers who help with all kinds of logistics.
One piece of, relatively speaking, good news in this dismal environment is that compared to the pre-Roe era, when many women died or were injured because of illegal abortions, these dangers will be much less of an issue in the post-Roe world. This is because people now have access to medication abortion, which involves two drugs that terminate a pregnancy, and these drugs can be ordered over the Internet. Therefore, the proverbial coat hanger and other dangerous methods of the past will not entirely disappear but will be much less of a factor in the future. Medication abortion is extremely safe and we know that already—even as abortion today remains legal in all states—many are choosing to “self-manage” their abortion by this method.
To be sure, self-managed abortion via abortion drugs will not entirely solve the access problem if Roe is overturned. First, the drugs are generally most effective only through the first ten weeks of pregnancy. Second, even if the medical environment for extra legal abortion is more favorable than in the pre-Roe era, the legal one will very likely be worse. Already there have been cases of women arrested and jailed for attempting their own abortions, as seen in Birthright: A War Story (available Hulu, iTunes or Amazon), and we can expect that this legal scrutiny will only increase, particularly in “red” states, on those who order the pills, those who supply them and the health professionals who offer consultation to those who need it. There are challenging times ahead for those who support reproductive freedom.