The Supreme Court’s landmark Roe v. Wade ruling in 1973 asserted women’s constitutional right to access an abortion up to the point where a fetus can survive outside the womb — usually considered to be around 24 weeks of pregnancy. In the decades since, the ruling has faced multiple attacks through states’ anti-abortion laws. And it's now up against what many are saying is its biggest challenge yet. On Dec. 1, 2021, SCOTUS’ majority-conservative bench heard oral arguments over a Mississippi law that bans abortions after 15 weeks of pregnancy. If the Supremes decide to uphold that ban — which is something they appear inclined to do this summer — the ruling could roll back (or completely overturn) decades of legal precedent. That’s a big deal, considering that the Guttmacher Institute, a sexual and reproductive health policy and research org, estimates that nearly one in four women in America will have an abortion by age 45.
Note: The info here applies to all birthing people, but we sometimes use the words “women” and “women’s health” in this guide.
Here’s the thing: Pregnancy is not a health-neutral event. It’s like a stress test on a person’s body. That’s how Dr. Marta Perez, OB-GYN and assistant professor at WashU School of Medicine, explains it. In other words: having a baby invites plenty of risk to the pregnant person, whether their pregnancy was intended or not. Think: everything from high blood pressure and infection during pregnancy, to blood loss and breech position during delivery. And don’t forget the major physical journey that comes with being postpartum. Carrying a pregnancy can be particularly dangerous for someone with diabetes or a heart or kidney condition. And having a baby can lead to major trauma on the body, including serious surgeries like a C-section. Something else to consider: Overturning Roe v. Wade could limit access to necessary health care for people whose pregnancies are risky. Like people who experience preeclampsia, ectopic pregnancies, fetal anomalies, or miscarriages.
Pregnancy is more than just nine months of carrying a baby to term (which can be challenging by itself). It’s a life-changing event that can take away a person’s autonomy over her body, with short- and long-term mental health implications. Even for people who intend to get pregnant. There’s the risk of conditions like anxiety and postpartum depression (which is different from the baby blues). And being denied access to abortion (if that’s what you want) might compound those mental health challenges. That’s the main takeaway from the Turnaway Study, a collection of long-term research on the consequences of carrying unwanted pregnancies to term versus having abortions. It found that women who had abortions were less likely than those denied the procedure to experience anxiety and low self-esteem later on. And 95% of women who had an abortion said they made the right decision after five years had passed.
People who think abortions should be banned might say, ‘You should just put the baby up for adoption.’ Supreme Court Justice Amy Coney Barrett even suggested it as a solution during the hearing over the Mississippi law in December. But as Dr. Perez explains, adoption isn’t always a reasonable alternative to having an abortion. There are the aforementioned health risks that come with pregnancy to consider. And then there are plenty of social stigmas — as well as potential mental anguish — that may come with relinquishing parental rights to a child. ‘Giving up’ a baby for adoption doesn’t exactly have a positive connotation. Not to mention that adoption can be a challenging and complicated process. It’s a good option for some, but that doesn’t mean it’s the right path for every person who has an unwanted pregnancy.
That’s not what history has shown. Women have had abortions for millennia, whether there were laws against it or not. The surgical abortion procedures we have today are safe with only rare complications. But when pregnant people haven't had access to safe abortion procedures, some have employed dangerous and/or expensive methods to end their pregnancies. Think: poisonous medicine, secret surgeries, and the haunting image of a coat hanger. Data also shows that denying women access to legal abortion doesn’t prevent abortions, but it does increase the likelihood that a pregnancy will end in an unsafe way.
In short: low-income women (many who are already moms), especially those living in rural areas. The Guttmacher Institute found that three-quarters of abortion patients were low-income in 2014 (which is the most recent data available). Nearly half lived below the poverty line. And 59% of abortion patients were already moms with at least one previous birth. If Roe v. Wade is overturned, abortions would likely be severely restricted or banned in many Southern and Midwestern states, where abortion trigger laws would go into effect. That would make procedures inaccessible to women in rural areas, where people already have a tougher time accessing health care. For higher-income women, traveling from a state where abortion is banned to one where it’s legal may be more doable. And we’ve seen that happen with Texas’ recent abortion ban. The same can’t be said for many low-income women, particularly those who need to account for work, transportation, housing, and child care. And chances are they’ll still need to cover the cost of an abortion.
The Hyde Amendment prohibits the use of federal funds (think: Medicaid) to pay for the procedure, except in cases of life endangerment, rape, or incest. While there are only a few states that require abortion coverage in private insurance plans, there are many more that have laws restricting private insurance from covering it. But not having an abortion (when it’s something you’ve considered) is more costly — and for more than just your wallet. Sure, there are doctor’s visits, hospital delivery fees (around $15K before insurance), and potential childcare and child-rearing costs (for a middle-income family, approx $230K by their 17th bday) to consider.
But here are more key takeaways from that Turnaway Study: Women who carried an unwanted pregnancy to term were more likely to stay tethered to abusive partners. They were also less likely to have aspirational life plans for the coming years. And, when it came to the children these women were already raising, the study found they had on average lower scores on child development assessments than the children of women who had received a wanted abortion.
If Roe v. Wade is overturned, it could lead to a wave of abortion bans and restrictions in more than half the states. And that could cause serious mental and physical health consequences for women seeking abortions. Low-income women who live far from abortion providers would be impacted most intensely. And although adoption is a good option for some women, it’s no substitute for abortion. Because pregnancy is not a health-neutral event, but a life-altering one.
Dr. Marta Perez, OB-GYN and assistant professor at WashU School of Medicine, spoke to us for this guide, an episode of Skimm This, and for a story about being postpartum.
Skimm'd by Carly Mallenbaum, Becky Murray, Anthony Rivas, and Jack Ackermann
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