Abortion access and policy after Roe

Screenshot from a video recording that shows five speakers
Clockwise from top left: moderator Gabriella Borter of Reuters, Evelynn Hammonds, Elizabeth Janiak, Jane Mansbridge, Mary Ziegler.

July 19, 2022 – Patients traveling further and waiting longer for abortion care. Doctors hesitating to provide pregnant individuals with life-saving treatment. Pharmacists refusing to fill prescriptions for abortion medication.

In the wake of the U.S. Supreme Court’s June 24 decision to overturn Roe v. Wade, the impacts of losing the constitutional right to abortion have been immediate and widespread. Twenty-six states have or are expected to ban or severely restrict abortion, with effects disproportionately falling on people of color and poor people. As a result, the policy response to this public health crisis should be well-coordinated and extend beyond the realm of reproductive health, according to a panel of experts who spoke at a July 14 event at Harvard T.H. Chan School of Public Health.

“I know that for many of us who care, it will feel easy to be hopeless—but we cannot give in to despair,” said Dean Michelle Williams in her opening remarks. “Here is my message to you all: clarity is power. The American people need a clear understanding of the science and of the evidence on the consequences of depriving girls and women of this essential component to health care.”

One consequence is that patients traveling to other states to receive care are already experiencing longer wait times. “That happens very quickly, over a matter of days, weeks, and months. That in turn means that some folks are going to be too far along to get an abortion by the time they get there, so we’re going to see more denials of care,” said Elizabeth Janiak, assistant professor in Harvard Chan School’s Department of Social and Behavioral Sciences; assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School; and director of social science research at Planned Parenthood League of Massachusetts.

For instance, even before Roe was overturned, in September 2021, Texas implemented a ban on abortions after six weeks of pregnancy. At clinics in the neighboring state of Oklahoma, the wait time for an abortion increased from five to 21 days.

Meanwhile, in situations without travel, doctors are changing how they treat people who are experiencing pregnancy complications. In Texas and some other states, to avoid legal repercussions, providers are waiting for patients to lose their pregnancies spontaneously or become sick enough to justify intervening. “Sometimes they get it wrong, and people do pass away,” Janiak said.

Such changes to reproductive health care will worsen existing health disparities for people of color, according to the panelists. States with the strongest abortion restrictions also have the highest rates of maternal mortality for Black people and other people of color, the worst health outcomes for children, and the lowest rates of health care access for those groups.

Additionally, the panelists noted, laws against abortion will overwhelmingly affect poor people, since half of the individuals who seek care are below the poverty line and a quarter of them are just above the poverty line. In 60 percent of cases, these individuals already have children.

“These women care about their children,” said Jane Mansbridge, Adams Professor of Political Leadership and Democratic Values, Emerita at Harvard Kennedy School. “They realize—and they’re in a far better position than anyone else to realize—that they cannot, at that point in their lives, handle another child. … If they add another to a family that’s already stretched to the max, their existing children will suffer.”

In response to the Supreme Court’s decision and its wide-reaching public health effects, the Biden administration has begun taking steps to support abortion care through preexisting federal laws. The U.S. Department of Health and Human Services issued a memo emphasizing that under the Emergency Medical Treatment and Labor Act, hospitals are obligated to provide necessary care to patients with emergency conditions—including abortion, since federal law overrides state laws. The department also released guidance stating that pharmacists who do not fill prescriptions for abortion medications could be discriminating based on pregnancy and thus violating civil rights laws.

While states without abortion restrictions can also help—for example, by protecting their providers who prescribe medication to patients in abortion-restricted states—the most effective action happens at the federal level, said Evelynn Hammonds, Barbara Gutmann Rosenkrantz Professor of the History of Science and of African and African American Studies in the Harvard Faculty of Arts and Sciences and professor in the Harvard Chan Department of Social and Behavioral Sciences.

“There is a very serious program being put forward by those people who supported the overturning of Roe to go for a federal ban on abortion,” Hammonds said. “The federal government response cannot be piecemeal. It can’t be, let’s look at the particulars of each state’s response—but rather, look at what is the overarching role of the federal government in supporting equal protection under the law and bodily autonomy.”

Government response should also take into account the broader implications of the Supreme Court’s decision, according to Mary Ziegler, Daniel P.S. Paul Visiting Professor of Constitutional Law at Harvard Law School and professor of law at University of California, Davis. “Our democratic institutions have changed in fundamental ways to make this moment possible,” she said. Among other trends, changes to campaign finance laws have enabled greater spending by anti-abortion groups, and the Supreme Court has become more willing to rule against the country’s popular opinion of supporting abortion rights.

“When we say this is a women’s issue or this is an issue for pregnant people, that’s implying that other people shouldn’t care,” Ziegler said. “If we understand the history that brought us to Roe, we would understand this has absolutely changed things that will affect everybody.”

Jessica Lau