In July 2022, the United States Supreme Court issued a decision in the Dobbs v. Jackson Women’s Health Organization case, in which the Roe v. Wade Supreme Court decision of legalized access to abortion in the United States was overturned. As per this decision, women living in the U.S. do not have the constitutional right of having complete autonomy of their own bodies anymore - since each state can now independently decide the legality of abortion.
In 2022, 26 US states were already prepared to enact multiple abortion bans. Thirteen states out of the aforementioned 26 states, had abortion bans that were automatically implemented when Roe v. Wade was revoked. Abortion was not allowed past the first trimester or another time point in the pregnancy (aka gestational age bans) in eleven U.S. states.
Fortunately, there are 15 states-alongside the District of Columbia, that have laws in place to protect a woman’s choice of abortion. Out of these 15 aforementioned stated, Maryland, Connecticut, and California introduced more far-reaching and all-encompassing protections to protect woman’s choice of abortion - in anticipation that women from the 26 states with abortion bans would travel to the protective states to seek reproductive health services.
Having a safe abortion is not necessarily dangerous or harmful to women, but being denied an abortion is. Decades of research consistently show that abortion bans and abortion restrictions do not reduce unintended pregnancies, does not decrease the demand for abortion and does not improve women’s health. Instead, they impose significant hurdles to obtaining care, causing stress for people in need of abortion and leading some to experience forced pregnancy with all its consequences. Abortion restrictions already have a disproportionate and unequal impact on Black and Brown communities, other people of color, people with low incomes, young people, LGBTQ communities, immigrants and people with disabilities.
The heavy concentration of states in the South that restrict or ban abortion have a greater impact on communities of color, because more than half of all US Black women and a high proportion of Latina women live in the South.
Many women of color have more limited financial resources and transportation options than White women, which would make it more difficult for them to travel out of state for an abortion. Out of state travel is likely to raise the cost of abortion due to added costs for transportation, accommodations, and childcare. Coupled with the childcare needs of existing children, limited transportation options may truly make it impossible for these women to travel for services. There may also be more missed work, meaning loss of pay, increasing the economic cost of abortion (current employment may make it impossible for women to leave work for the length of time it takes to travel to a state that has abortion care access).
Factors associated with multiple unintended pregnancies include:
Age (increasing age)
Race (Black, Hispanic)
Socio-Economic Status ( below poverty level income)
Trauma (Experiencing a non-voluntary first sexual intercourse especially at a young age, Participating in the sex trade, Experiencing stressful life events)
Sexual Health (Having had a previous abortion)
The sexual health of midlife women, is often overlooked by health care providers - despite increased rates of sexually transmitted infections and unintended pregnancy during this part of the lifespan. Many women in their 40’s become pregnant because they incorrectly believe reduced fertility means they no longer need contraception. With little attention to midlife women’s sexual health, contraceptive needs may go unaddressed and unintended pregnancy will be more likely to occur.
Alternatively, midlife women might be told they are no longer fertile when, in fact, fertility can be erratic for years before women stop ovulating completely. Some authorities recommend women under 55 continue to use contraception if they do not want any more children.
As women age, they are more likely to have needs that require ongoing medical care, especially because chronic health conditions increase risk for pregnancy complications. The consequences of miscarriage later in pregnancy, in the absence of access to abortion, may prevent women from obtaining necessary care to insure their best mental and physical health. As well, lack of access to abortion may force a woman to carry a dead fetus longer than necessary, because the procedure for treatment for miscarriage and abortion are the same.
There is uncertainty about the capacity of providers and clinics in abortion protective states for providing abortion care to additional numbers of women from states that ban abortion. Health risks associated with pregnancy in midlife women may be life threatening, particularly because health care provider education may not include abortion care and management of complications.
A health care workforce untrained in managing pregnancy and/or abortion complications may contribute to the health risks of midlife women, especially if these women are by circumstances, unable to terminate an unintended pregnancy. Medical school graduates without abortion training will be limited in the skills necessary to manage pregnancy complications including placental abruption, infection, ectopic pregnancy, and eclampsia, because the same medications and surgical techniques utilized for abortion also treat obstetric complications.
In addition, the US health care system has a history of racist practices targeting the sexual and reproductive health of people of color, including forced sterilization, medical experimentation, the systematic reduction of lay midwifery, and discrimination by individual providers including dismissive treatment, assumption of stereotypes, and inattention to conditions, such as fibroids, that take a disproportionate toll on women of color. Social determinants of health (income, housing, safety and education) affect decisions related to family planning and reproductive health.
Strategies that support abortion access and that can be implemented immediately include:
· Strengthening sexual health education provided in schools to increase awareness of options for preventing unwanted or unplanned pregnancy
· Improving access to information about fertility and fertility management, including monitoring menstrual cycles and menopausal status, and reliable and effective birth control approaches for all reproductive life stages, with attention to the specific needs of midlife women
· Advocating for inclusion of explicit coverage of effective and reliable contraception and other pregnancy prevention methods in health insurance plans
· Providing readily accessible and affordable early pregnancy detection
· Providing “morning after” contraception to women to have on hand “just in case” (Plan B)
· Advocating for policies that would insure women’s right to agency over our bodies.
Resources:
1. Berg JA, Woods NF. Overturning Roe v. Wade: consequences for midlife women's health and well-being. Womens Midlife Health. 2023 Jan 6;9(1):2. doi: 10.1186/s40695-022-00085-8. PMID: 36609311; PMCID: PMC9824972.