Last night, a draft Supreme Court opinion on a pending Mississippi case was leaked—one that, if finalized, would reverse the 1973 Roe v. Wade decision affirming the Constitutional right to abortion. While the draft opinion does not rely on a scientific argument, it would have a huge impact on science-based policies about reproductive health and family planning—policies that should be grounded in scientific evidence, not political ideology.
A cascade of consequences
Roe v. Wade, has allowed for improved access to reproductive health care for generations of people. Overturning it will empower states to enact laws that are even more distant from the best available science than the hundreds of restrictions that have already been attempted. Some 28 states are poised to prohibit abortion, 13 of those with “trigger bans” already in place which will ban abortion once Roe v. Wade is overturned.
The public health implications of overturning Roe v. Wade are clear: it means pregnant people will needlessly suffer. Thirty-six million women—nearly half of the women of reproductive age (18-49) in the United States—plus people who can become pregnant, risk losing access to vital reproductive health care. It means Black and Indigenous women, who already experience stark inequities in maternal health care will bear the brunt of that harm. It means people who don’t have the financial resources to travel out of state may seek risky and potentially dangerous abortions outside the health care system or be forced to carry a pregnancy to term. It means that people elected as a result of unfair, gerrymandered districts will make decisions for an electorate they hardly represent. This is a process that is not just unfair, it is an affront to what the best available science tells us about how best to protect reproductive health.
When science fiction becomes reality
As my colleague Dr. Michael Latner wrote in 2019, there have already been hundreds of restrictions on abortion passed in the states that advance “science fiction” with little regard for public health outcomes, ranging from those requiring extended waiting periods, insurance restrictions, and restrictions on clinics and doctors, to bills that ban abortion as early as six weeks into a pregnancy, such as the Texas “SB 8” legislation signed into law by Gov. Abbott last month.
Six weeks. This is before most people even know they’re pregnant.
At my eight-week prenatal appointment, an ultrasound scan didn’t even catch an image of the embryo that would become my daughter.
Such a policy is designed to cut pregnant people out of a decision about their own health before they even know there is a decision to be made. The American College of Obstetricians and Gynecologists (ACOG) vehemently opposes SB8, calling it “a clear attack on the practice of medicine in this country.” Not only do these policy proposals disregard science, but as my colleague Gretchen Goldman and Shaina Goodman from the National Partnership for Women & Families wrote in 2019, they rest on an “underlying hostility toward women’s dignity and self-determination.”
Overturning Roe v. Wade risks drastic consequences for women’s health which is already undervalued and insufficiently protected in the United States. A recent Commonwealth Fund report comparing health access among high-income countries illustrated what people who identify as women in this country know to be true: Our health system is failing us. Its findings reveal that the rates of death from avoidable causes, including pregnancy-related complications, are highest among women of reproductive age in the United States.
US Black and Indigenous women are three times as likely to die from maternal complications as white women. Not only are people who identify as women suffering and dying at alarming rates, but we are more likely to have problems paying medical bills or skipping treatment because of cost and less likely to have a regular doctor to go to for care. In other words, there is no support system that adequately prioritizes women’s health in this country. Add that to the fact that US healthcare is predominantly tied to employment; most employers do not offer more than the bare minimum of job protection for childbirth, and our government offers no assistance with childcare. People who identify as women are set up to fail all while trying to hold onto what’s left of our physical and mental health, and that of our family members.
Even worse, the laws restricting abortion coming out of many states are not likely to contain provisions providing any type of support for women forced to carry their pregnancies to term. Without these supports, the mental and physical health disparities and socioeconomic challenges associated with childbirth and child rearing will only get worse.
We’ve already seen a glimpse of what can happen when protections aren’t afforded to pregnant people. When the Trump administration removed funding for the Title X program—a federal grant program that supports family planning services for low-income individuals—it meant that, in just one year, hundreds of thousands fewer low-income, Black, and Latinx people were served. There were 280,000 fewer cancer screenings, 3 million fewer sexually transmitted disease screenings and 278,000 fewer confidential HIV tests. The science is clear: Restricting care has direct public health consequences for those who need it most.
A harmful attack on individual autonomy
An insidious aspect of this draft opinion that would overturn Roe v. Wade is that it will likely lead the Court to pull a thread that begins unraveling other decisions affording protection for individual autonomy, including same-sex marriage and other LGBTQ+ rights, the use of contraception, and the right to privacy.
Women’s health might be the first to suffer, but this decision will ultimately affect us all. And that’s why we all need to be engaged in the fight to ensure that science fiction and junk science don’t get in the way of our ability to make our own decisions.
The Biden administration and elected officials must act now to harness the best available evidence which points to the public health benefits of increased access to reproductive health care, including abortion and contraception. Congress needs to step up and fill the gaps to protect reproductive health and shore up voting rights and election systems to make them fair and ensure all voices are represented. And this fall, we must turn out to vote in the midterms to elect individuals who value science-based policy decisions, democratic processes, and the autonomy afforded to us in the Constitution to make decisions about our own lives and futures.
My decision if, when, and how to have my two children was just that: my decision. I hope you’ll join me in the fight to protect that sacrosanct choice for all people, now and in the future.