Reproductive Rights After the Dobbs Decision

Roe v. Wade was a landmark U.S. Supreme Court case that established our right to abortion in 1973. But almost fifty years later, on June 24, 2022, the U.S. Supreme Court issued their ruling in Dobbs. Vs. Jackson Women’s Health Organization — commonly known as the “Dobbs decision”—  overturning their previous ruling on Roe and taking away our constitutional right to abortion.

It was the first time ever that the Supreme Court removed one of our rights. With the fall of Roe, the decision on whether or not abortion is legal is now up to the politicians in individual states. This has created a patchwork of unequal laws across the U.S. and an increase in the devastating consequences that come from women not being able to safely access the healthcare they need.

From being forced to carry unwanted or even non-viable pregnancies to term, to spending more money and traveling longer distances to access safe and legal abortion, to suffering preventable health emergencies, injury, and even death — women are scared and hurting. Keep reading to learn more about the post-Roe reality for pregnant people in America.

Many of us couldn’t imagine this reality two years ago, but we see now that extremist politicians are trying to make it even worse. It’s not just abortion access — they’re coming after other reproductive healthcare like IVF and birth control, too. No matter where you live, your reproductive rights are at stake this election.

What is going on with abortion in the U.S.?

A lot. In 2022, the U.S. Supreme Court ruled 6-3 to overturn Roe v. Wade, which had protected the federal right to an abortion for almost 50 years. The Supreme Court ruled in Dobbs vs. Jackson Women’s Health Organization that a Mississippi state law banning most abortions after 15 weeks could stand, paving the way for all kinds of bans all over the country. Instead of allowing women to make their own decisions about whether to have an abortion, that decision-making power now rests with state politicians.

44 million women and girls now live in states that ban or restrict abortion — that’s 6 out of every 10 women, 7 in 10 Black women. Your ability to get an abortion is now dependent on where you live and what you can afford.  When Roe fell, thirteen states had pre-existing “trigger laws” intended to ban or restrict abortion the second Roe was overturned. Other states had abortion bans on the books that were so old, they were written before women could vote. And many other states like Indiana and West Virginia moved quickly to enact new legislation taking away our reproductive freedoms.

Currently, 14 states have a full ban on abortion: Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, and West Virginia. These states have partial bans: Arizona, Florida, Georgia, Nebraska, North Carolina, South Carolina and Utah, with some starting as early as 6 weeks (most women learn they are pregnant after that point). Iowa, Montana, and Wyoming have abortion bans that are currently blocked by the courts, but this can change at any time. Many of these bans make no exception for rape, incest or the health of the woman. A majority of the states with bans neighbor each other in the southeast and midwest, making it next to impossible to get abortion care in these parts of the country.

Abortion is legal in the remaining 26 states and Washington D.C. 20 of those states and Washington D.C. have passed new protections since the fall of Roe. But even in states with protections, changes in the state government or the adoption of a federal ban if extremists take the White House or Senate could take away reproductive rights in the future.

In fact, less than three months after the fall of Roe, Republicans revealed their plans for a national abortion ban. Initially, many Republicans claimed that abortion laws should be left up to the states, but Senator Lindsey Graham introduced a federal ban on abortion care, promising to pass the legislation if Republicans take over Congress. And though we know that Donald Trump will publicly say absolutely anything about abortion if it helps him get elected, he has privately promised his most important backers that he would support a national abortion ban.

Why are they banning abortion now when the majority of Americans support access?

That is a great question! The majority of Americans support a woman’s right to choose and disagree with the overturning of Roe v. Wade, but a small minority used the power of the court to overturn Roe anyway. Abortion can be a complex and emotional issue for some people and special interests have spent years and billions of dollars to exploit these emotions and divide us. 81% of  Americans agree, abortion is a deeply personal choice between a woman and her doctor and should not be dictated by the government. Recent polling shows that regardless of whether someone aligns as “pro-choice” or “pro-life,” over two thirds of Americans want the government out of this decision. Americans overwhelmingly support reproductive freedom.

A quick look at our history will tell you that eliminating access to abortion does not reduce the number of abortions, it just eliminates the number of safe abortions. In fact, what is proven to reduce the number of abortions is easy access to birth control and affordable healthcare.

When Roe became law in 1973, illegal abortions were considered to be a public health crisis due to the number of women who were harmed and even killed from their prohibition. The legalization of abortion provided women a safe option in their reproductive healthcare.

So why now? It’s simple. Republicans see this issue as a way to keep extremists funding their campaigns and keeping themselves in power. It’s certainly not about reducing the number of abortions, which had been declining for years.

What’s going on with the national abortion ban?

Shortly after the fall of Roe, Republican Senator Lindsey Graham introduced legislation for a national abortion ban. Although Graham was unable to answer specifics about his legislation, it would turn control over our choices to politicians in Washington D.C. throughout the United States. A federal ban would supersede any state laws or protections of abortion access. However, the law would allow states to continue to enact even stricter abortion bans, including those with no exceptions for rape and incest. Graham made it clear that if Republicans won the Senate and the House, they would pass this legislation. Donald Trump has also privately said that he would support a national abortion ban.

WHAT ABOUT A 15-WEEK ABORTION BAN?

This is one of the most cruel “compromises” you’ll hear from extremists. Women most affected by a 15-week abortion ban are those carrying a non-viable pregnancy due to fetal abnormalities that are often not discovered until their 20-week anatomy scan. Every day we hear stories of women who desperately wanted their pregnancy but found out that their fetus would not survive. During the most painful of times, women need access to all of their reproductive healthcare choices to make the best decision for their family. The government should not be making decisions about women’s access to safe reproductive healthcare.

Why are extremist politicians supporting a federal ban now?

Before the Dobbs decision, Republican politicians claimed that the Supreme Court ruling would not result in a federal ban on abortion. They repeatedly stated that elected officials in each state would have the right to make laws protecting or banning abortion. The idea of a federal abortion ban now is in direct violation of their previous statements and shows they cannot be trusted. Republican politicians all across the country removed any mention of abortion bans from their websites. They know that their ideas are too extreme for the majority of Americans. The announcement of the proposed federal ban reminds us that extremist politicians are trying to take away our freedom. They think they can fool us by changing their websites, but suburban women know better.

ARE BIRTH CONTROL AND IVF AT RISK NOW TOO?

Yes. The same groups and people who are working so hard to ban abortion are also now trying to restrict birth control and IVF. We’re seeing this pop up at both the state and national level.

For example, in early 2024, Alabama’s Supreme Court ruled that frozen embryos are “children,” which is an anti-abortion argument that is now also being used to challenge birth control and IVF. As a result, in vitro fertilization (IVF) providers halted services in the state. Alabama lawmakers realized how unpopular the ruling was and passed a new law that aims to protect providers and patients from civil or criminal liability, but its protection doesn’t go far enough. It doesn’t address the heart of the court’s ruling, which is likely to be appealed to the U.S. Supreme Court. Both legal and medical experts say that until that issue is addressed, IVF providers and patients may be at risk, so only some IVF services in Alabama have resumed.

As long as special interest groups are making this argument and influencing politicians, our rights are at risk. As a result of this threat, Democrats in the U.S. Congress and in some state houses have introduced legislation to protect our right to IVF and birth control, but Republicans are repeatedly blocking those efforts. Red Wine and Blue has launched a whole new campaign to save IVF and birth control. Join us!

WHAT’S GOING ON WITH THE SUPREME COURT DECISION ABOUT MEDICAL ABORTION?

Mifepristone is an FDA-approved medication used for medical abortions and miscarriage treatment. For over two decades, it has been proven safe and effective — safer than Tylenol or Viagra! But because it is used for medical abortions, an anti-abortion group sued to overturn its FDA approval. The case made it all the way to the U.S. Supreme Court which recently rejected the challenge, but they left the door open for anti-abortion extremists to try again, or to challenge the medication in other ways.

HAVE THERE BEEN ANY WINS FOR REPRODUCTIVE FREEDOM SINCE THE FALL OF ROE?

Yes! Voters overwhelmingly turned out in support of reproductive rights in 2022 and 2023, securing protections in every state where it was on the ballot. An early sign of support came during the 2022 primary elections in Kansas, when voters rejected a proposed amendment to their state constitution that would have removed the right to abortion. That success was repeated in five more states in November 2022. In Kentucky and Montana, voters defeated similar ballot measures that would have limited abortion rights in their states. In California, Michigan, and Vermont, voters approved measures to enshrine reproductive rights in their state constitutions through constitutional amendments. Candidates who supported abortion bans were also defeated in important Governor races in Arizona, Michigan, Pennsylvania, and Wisconsin. And in 2023, voters in Ohio passed Issue 1, enshrining the right to abortion in their state constitution. These successes show us that our movement is strong and if we organize and stay active, we can protect reproductive freedom in more states.

WHAT STATES HAVE ABORTION MEASURES ON THE BALLOT IN 2024?

In 2024, abortion measures may be on the ballot in up to 11 states: Arizona, Arkansas, Colorado, Florida, Maryland, Missouri, Montana, Nebraska, Nevada, Pennsylvania, South Dakota. Some of these are attempts to ban abortion, while some are attempts to enshrine the right to abortion in state constitutions. Voters in these states need to pay close attention to the measures and mobilize to vote to protect the right to abortion in their state.

But no matter what state you live in, access to reproductive healthcare is on the ballot this year. We know that birth control and IVF are already at risk, and depending on the outcome of the election, we’re also facing the threat of a national abortion ban. This is why it’s so important to vote for every race, up and down your entire ballot, for state, federal, and judicial candidates who will protect our rights wherever and whenever extremists come for them.

How do abortion rights affect maternal mortality rates?

Several recent studies show a correlation between restrictions on abortion care and maternal mortality rates. From 2015 to 2018 there was a 7% increase in maternal mortality in states with significant restrictions on abortion. A 2023 report showed that women in states with abortion bans are almost three times more likely to die during or shortly after pregnancy and birth, and that babies born in states with abortion bans are 30% more likely to die in their first month.

Before the fall of Roe, the United States already had a high maternal mortality rate for a first-world nation. Our maternal deaths are at their highest in 60 years, with a 40% increase in 2021. We are one of the only countries where the number of women dying in childbirth is going up. Now, as states continue to pass extreme bans on abortion care, the medical community is warning that maternal mortality will continue to increase nationwide. To put it bluntly, more women will die due to pregnancy and childbirth complications and the inability to get the medical care they need.

In addition, women of color are much more likely to die from pregnancy or childbirth than white women. In 2021, Native American women’s maternal mortality rate was 4.5 times that of white women, and Black women’s rate was 2.6 times the rate of white women. Roughly 60% of these deaths are preventable but restricting maternal healthcare with abortion bans will only further limit what doctors can do to save the lives of mothers.

Who gets abortions?

A big part of the disinformation around this issue says that abortions are used as a form of birth control by young, unmarried women. But in reality, more than half of the women who get abortions report using contraception. We also know that the majority of abortions performed in the U.S. are on women who are already mothers. In fact, concern for their children is a motivating factor, with nearly half of the women reporting that providing for the children they already have is their reason for seeking an abortion. 75% of women who get abortions live at or below the federal poverty level.

Despite what extremists want you to believe, almost all abortions occur within the first trimester, and the majority of those happen shortly after someone discovers they are pregnant. Only 1% of abortions are performed after 20 weeks and those are almost exclusively due to fetal abnormalities that are not consistent with life, or to save the life of the pregnant woman. Abortions performed later in pregnancy are most often on people with wanted pregnancies who discover their fetus will not be able to live outside the womb.

Approximately 1 in 4 women will have an abortion in their lifetime, which means you know — and probably love — someone who has had one.

Why do people keep comparing abortion to miscarriage?

An estimated 1 in 4 pregnancies end in miscarriage, which is the natural loss of a pregnancy. Did you know that a miscarriage is also called a spontaneous abortion? After a miscarriage, medical treatment may include surgical or medical interventions to save the life of the woman. The surgical option is called Dilation and Curettage (D&C). The medical option includes the use of the drugs mifepristone and misoprostol.

D&C, mifepristone, and misoprostol are also the surgical and medical options for abortions. Because the same procedures are used for both abortions and miscarriage treatment, many women and doctors are now calling attention to the fact that the healthcare procedures are the same, and that new abortion restrictions may have harmful consequences on women experiencing miscarriage. Keep reading to learn more about surgical and medical abortions and miscarriages.

What is dilation and curettage (D&C)?

Dilation and Curettage (D&C) is a surgical procedure that removes uterine lining and tissue from a woman’s uterus. It is a healthcare procedure to clear the uterus of all remaining tissue and prevent bleeding, hemorrhaging, infections, sepsis, and other potentially fatal complications. D&C is also the medical procedure used to end a pregnancy during a surgical abortion. So, the exact same clinical treatment used for surgical abortions is also used for miscarriage treatment. It’s the same procedure, with the same doctors, the same instruments are used, and it’s the same in the eyes of medical insurance companies.

What is a medical abortion?

A medical abortion is when a pregnancy is ended using medicine (as opposed to surgery). The drugs mifepristone and misoprostol are used to end pregnancies. The drug methotrexate is used to end ectopic pregnancies, which are when the fertilized egg has implanted itself outside of the woman’s uterus. Ectopic pregnancies are never viable and will be fatal to the mother if untreated. Mifepristone and misoprostol can also be used as medical interventions in natural miscarriages. So again, the medical treatment for miscarriages is the same as for medical abortions.

How could abortion bans impact medical care during a miscarriage?

Because the surgical and medical treatments for abortions and miscarriages are the same, any bans on abortion care may also impact miscarriage care. Doctors and patients all over the country are already sharing stories where this has happened. Laws that restrict abortions could also apply to miscarriages. Doctors and hospital lawyers are sounding the alarm on this issue, noting that recent abortion laws are intentionally vague and difficult to interpret. With some laws not only restricting abortions, but also criminalizing medical treatment and actions, a lot is at stake for patients and providers. Meanwhile, while they struggle to figure it all out, patients are experiencing delayed care, or worse, not getting the healthcare they need at all. Women are needlessly suffering and dying preventable deaths.

Why are medical and surgical interventions necessary for MISCARRIAGE?

Without medical intervention, miscarriages can take days, weeks, and even months to occur. During this time, dangerous, life-threatening health complications may arise. Not to mention the mental toll it takes on the pregnant person, adding to her trauma. To ask someone to endure this when there are proven, safe medical interventions available is harmful and unfair. These interventions, which are safe and have become standard practices of care in medicine, should be available for all people, regardless of why they need them.

What other parts of reproductive health may be affected by this decision?

Miscarriage

As stated above, the medical treatment for miscarriage is the same treatment for abortion care. We are already seeing situations in states with bans where women who naturally experience a miscarriage are being denied medical help. In some instances, doctors are consulting lawyers and waiting for the situation to be as close to fatal as possible before providing life saving care to the woman. Pharmacies are refusing to fill prescriptions for women who need this medicine. There are also reports of women being questioned about what medications they took prior to their miscarriage to prove it was natural and spontaneous.

Ectopic Pregnancy

An ectopic pregnancy is an incredibly dangerous medical situation that can result in the death of the mother if left untreated. An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus and, despite what some politicians have said, it CANNOT be re-implanted into a uterus. It is a non-viable pregnancy and must be treated immediately to save the mother’s life. There is concern that some state legislatures will move to deny medical care for women experiencing an ectopic pregnancy, which could mean death for the mother.

Birth Control

After the fall of Roe,195 Republicans in the U.S. House voted against protecting the individual right to access contraception and the right for medical providers to prescribe it. In June 2024, all but two Republican senators voted against their version of the same bill. In some states, legislators are moving to criminalize abortion, including certain methods of birth control that stop a fertilized egg from implanting, like an intrauterine device (IUD). If laws that classify abortion as a homicide are passed, then women could even face prison time or criminal charges for an IUD, a spontaneous miscarriage, or for treatment of an ectopic pregnancy. There is also serious concern that the Supreme Court is looking to overturn another landmark case, Griswold v. Connecticut, which established the right to birth control. Justice Clarence Thomas wrote in his opinion concurring with Dobbs that Griswold should also be reconsidered.

IVF 

Going against modern science, some state legislatures — like Alabama discussed above — have decided to define the start of life as the moment of fertilization, when an egg and sperm meet. Under this definition, an embryo created for IVF would be considered a human life. Families who go through IVF often have multiple embryos created which are frozen or discarded. It is currently unknown if state governments will try to force implantation of these embryos, or if they will punish families who discard them, but many parents are rushing to store their embryos in states that protect the rights of the parents. Senate Democrats have introduced legislation to protect our right to IVF, but all but two Republican senators voted against it.

What other medical treatments might be impacted by abortion bans?

The medicines that are used to treat miscarriages and abortions also have other uses. Misoprostol can be used to treat stomach ulcers and arthritis symptoms. It also helps open a cervix for other procedures, like IUD insertion, and to induce labor. Mifepristone is used to treat high blood sugar (hyperglycemia) in patients with Cushing’s disease and type 2 diabetes. Methotrexate, used to end ectopic pregnancies, is also the “gold standard” treatment for several common autoimmune disorders including: rheumatoid arthritis, juvenile arthritis, inflammatory bowel disease, ulcerative colitis, Crohn’s disease, Multiple Sclerosis, lupus, psoriasis, and many cancers. If restrictions are placed on prescribing these medications for abortion or miscarriages, it can also impact patients who need them for all these other conditions. In fact, many patients across the country are starting to report challenges with getting their methotrexate prescriptions because of recently introduced abortion bans.

WHO DO ABORTION BANS AFFECT?

Abortion bans affect every single person who can get pregnant — all women and families in the United States. As you read above, many medications used to treat abortion and miscarriage are being denied to patients using them for other healthcare reasons. All across America, women are experiencing greater difficulty getting medication that treats auto-immune diseases, cancer and a variety of different health issues. Some women have also reported trouble filling their birth control prescriptions.

For women seeking abortions, the bans will force them to travel hundreds of miles, across many state lines to access safe abortion. They will need to take time off work, look for child care, and pay for travel expenses in addition to the cost of an abortion. The costs rise considerably as less options for safe care are available.

We all know that banning abortions does NOT stop abortions from happening, it just leads to unsafe, back-alley attempts. Women with the financial ability to travel out of state, take time off work, and provide for childcare will have an easier time accessing a safe abortion in states that are still protecting women’s rights. Black, brown, and Indigenous women will be disproportionately affected by state bans on abortion, and women who live in poverty may be unable to afford the increased expense of an abortion. Women who live in the south and midwest will have longer distances to travel to find access to abortion care.

What is the economic impact of the fall of roe?

Studies have shown that when a woman is denied an abortion, she suffers economic harm both immediately, and in years following.

Delivering a baby is expensive. One study found that the average cost of delivering a baby is close to $3,000 if the mother has private insurance through a large employer. That’s what the mom ends up paying out of an average billing just under $19,000. And these are just costs related to the pregnancy, birth, and immediate postpartum care. This doesn’t include earlier prenatal care or other expenses related to pregnancy like over-the-counter pain meds, comfort care, maternity clothes, or psychiatric needs.

The $3,000 estimated cost also doesn’t account for higher risk pregnancies that require more healthcare services at additional cost. The Turnaway Study showed that women who were denied an abortion had more life-threatening complications during their pregnancy and more long-term health issues, all of which adds personal financial burden.

Many people do not have this kind of cash readily available. A study found that 45% of single person households, and about ? of multi-person households, don’t have more than $2,000 available to pay for medical bills.

Raising a child is also expensive. The costs don’t end once a baby is born. In fact, they are just beginning. First, there may be lost income if the mother doesn’t have paid parental leave from her employer. Then there is the cost of infant and child healthcare, and all the other non-medical costs like child care and support over the years as the child grows up. These expenses increase the odds of the parents taking on new debt, medical or otherwise, which compounds over time.

This all equates to economic harm. The Turnaway study found that women who were denied an abortion are four times more likely to live below the Federal Poverty Level than counterparts who sought and did have an abortion. 72% of women who couldn’t get an abortion lived in poverty, compared to 55% of women who were able to get an abortion. For years following, the women who had children were more likely than the women who had abortions to not have enough money to cover their living expenses. They were also more likely to be late paying their bills, had lower credit scores, and saw those scores decline. They saw their debts increase and experienced more negative events like bankruptcies, evictions, and tax liens. All of these factors mean that women who are unable to get an abortion when they want one are more likely to have decreased financial security and less stable economic conditions in which to support their family.