Episode Transcript
[00:00:01] Before we begin, this episode contains content that some listeners may find sensitive. Listener discretion is advised.
[00:00:26] This is the Access Pregnancy Post Roe Podcast and I am Mia Braun the history of abortion within the world has been long and complex, but in the year of 1973, the right to abortion became a constitutional right in the United States due to the case of Roe v. Wade.
[00:00:54] This right was recognized federally for almost 50 years.
[00:00:59] With this victory for body autonomy and the right to choose, Roe v. Wade was flawed from the start.
[00:01:07] The ruling stated that people had the right to abortion. However, it never protected people's access to abortion.
[00:01:16] Many states made it nearly impossible to obtain an abortion by passing laws.
[00:01:22] There have also been national policies that have impacted people's abilities to have access to abortion care, like the Hyde Amendment, which was passed in 1976.
[00:01:36] Many people in the United States found that for them, the right to abortion was a right in name only. Even with Roe in place from systematic racism, ongoing white supremacy, and coercive reproductive health policies, it undercut access to abortion in many communities.
[00:01:58] Whether you could get abortion care depended on your race, where you lived, and your access to money and health insurance.
[00:02:06] Abortion was challenging to access. For communities where barriers have stood in the way of obtaining health care, attempts to restrict and even ban abortion at the state level are part of an ongoing effort to deny people their right to make their own medical decisions.
[00:02:26] Laws that restrict access to abortion hurt people's health and endanger their safety.
[00:02:34] Abortion bans and restrictions have varied state by state.
[00:02:39] Since the ruling of Roe, politicians have been a part of an ongoing effort to outlaw abortion completely in the United States.
[00:02:49] As state politicians across the country succeeded in restricting access to abortion, real people were paying the price, particularly people with low incomes who might not have the resources to drive long distances, arrange for lodging, and jump through all the other hoops anti abortion laws foist on them.
[00:03:14] State legislature's unprecedented and dangerous attacks on access to abortion restricting insurance coverage trap laws which are targeted restrictions against abortion providers abortion bans including unconstitutional bans at specific weeks of pregnancy, non surgical abortion bans, mandatory ultrasounds, waiting periods of up to three days, and bias counseling before getting an abortion, all of which can entail multiple trips to the provider.
[00:03:53] Since the ruling of Roe v. Wade, anti abortion policy politicians have promised to appoint judges and justices who are also hostile to abortion rights.
[00:04:05] These politicians have used their power to manipulate the nomination rules like politicizing the nomination and confirmation process, shorter time frames for nominations to be expedited, especially when the President's party controls the Senate and shifting the rules so filibustering cannot occur, which means a simple majority vote would confirm a justice, which further increases the influence of the party in power.
[00:04:39] The Supreme Court, as of today is dominated by justices who are hostile to abortion rights.
[00:04:46] On June 24, 2022, the Supreme Court ruled in Dobbs vs Jackson Women's Health Organization, which was a case involving a challenge to a Mississippi ban on abortion at 15 weeks of pregnancy.
[00:05:04] This ruling overturned Roe v. Wade, thus ending the federal constitutional right to abortion in the United States.
[00:05:13] Within the first few months after roe was overturned, 18 states banned or severely restricted abortion, with more states working to pass bans as well.
[00:05:25] This means that one in three women, more than 25 million women of reproductive age live in a state where abortion is not accessible.
[00:05:37] In an article by Frontiers in Public Health in the year 2021, over 90 restrictive abortion policies were enacted in the United States, which is more than any other year on record since the Roe v. WADE Ruling in 1973.
[00:05:56] The decision to overturn Roe has paved the way for 28 states with laws in place or proposed to ban abortion almost entirely through new legislation or proceeding trigger laws that previously could not be enforced following the Roe v. Wade ruling, According to the Guttmacher Institute, Two years after the Supreme Court revoked the constitutional right to abortion, an increasingly strong body of evidence is emerging that illustrates significant harms caused and exacerbated by the Dobbs decision.
[00:06:37] Just 30 days after the Supreme Court's ruling in the Dobbs decision, 43 clinics in 11 states stopped providing abortion care. One hundred days after the decision, the number had increased to 66 clinics in 15 states.
[00:06:55] From 2020 to 2024, the total number of brick and mortar clinics providing abortion care in the United states to declined by 5%. We will likely see this trend continue as time progresses.
[00:07:10] There has also been a surge in travel for patients seeking abortion care outside of their banned state.
[00:07:18] The sharpest increases in out of state patients occurred in Colorado, Illinois, Kansas and New Mexico, all states that border states with total abortion ban.
[00:07:30] Accessing abortion care likely came at the great cost for those individuals who had to navigate the financial and logistical barriers to leave their state for care, according to the Guttmacher Institute. One qualitative study interviewed 54 obstetrician gynecologists practicing in states with a total ban on abortion. Doctors reported the the first concern is needing to delay necessary care until patients were at risk of death or permanent injury.
[00:08:07] Another concern is confusion about whether providers can counsel patients on abortion.
[00:08:14] Doctors have legal fears and uncertainties it was also reported they feel moral distress. Among other concerns, about 60% of physicians considered leaving their state to practice elsewhere, with 11% of these doctors doing so.
[00:08:35] As providers leave hostile states, pregnant patients may suffer. Maternity care deserts, which are areas with few or no obstetric care resources, can mean long travel times for access to both basic and emergency care.
[00:08:54] 11.3 million individuals have to travel an hour or more to reach the nearest abortion clinic. As each clinic closes, more pregnant people seek services but have to travel long distances. They also have to deal with the congestion at each center as nearby facilities close. The increase of patients at clinics that provide abortions can negatively impact the other care offered at reproductive healthcare clinics, such as preventable breast exams, mammograms, and Pap smears.
[00:09:32] A separate survey of 569ob gyns showed that nationally, one in five providers felt constraints on their ability to manage miscarriages and other pregnancy related emergencies send stops in abortion ban states. Four in ten OBGYNs felt this way. Clear majorities also believed that their ability to manage pregnancy related emergencies worsened and the racial inequalities in maternal health increased.
[00:10:09] Overturning Roe v. Wade was unpopular and politically toxic for anti abortion politicians.
[00:10:16] 85% of Americans believe that abortion should be legal regardless of age, background, or educational level. Most people supported Roe before it was overturned. A majority of Americans have wanted abortions to be legal for decades, and reproductive rights champions in states across the country have worked to protect and expand access to abortion.
[00:10:44] Banning abortion care does not stop abortion it stops safe, legal abortion care. The cost of these bans is women's lives. We are in a state of emergency for women's health. Barriers to reproductive care will only worsen health outcomes and exacerbate disparities and inequalities. We need to continue fighting to make sure women have access to reproductive health care.
[00:11:14] The rate of death for women of reproductive age is on the rise. Women in the United States are 50% more likely to die in childbirth now than 30 years ago. Black women are three to four times more likely to die than white women.
[00:11:31] Research prior to Dobbs found that certain abortion restrictions were associated with higher rates of maternal mortality.
[00:11:40] One analysis highlighted that states that have a banned abortion or are planning to ban abortion have fewer maternity care providers, more maternity care deserts, and higher rates of maternal mortality and infant death than states where abortion is accessible.
[00:11:59] These inequalities disproportionately harm Black and indigenous communities, which have historically faced significantly higher rates of maternal mortality than their white peers.
[00:12:14] Researchers have provided promotion Preliminary estimates regarding the risk of maternal mortality for individuals who can become pregnant if a national ban on abortion were to be enacted, assuming that abortions were banned in all states at the highest end, maternal mortality would increase by 24%.
[00:12:37] Non Hispanic black people would face a 39% increase in and maternal deaths. Limiting abortion care will make pregnancy more dangerous in a country that already has the highest maternal mortality rate among industrialized nations.
[00:12:56] Since the Dobbs decision, we can track tragic stories of pregnant women desperately seeking emergency care to protect their own lives and health, only to be blocked from treatment by hospitals fearful of misinterpreting their state's abortion ban or because they do not qualify for the exceptions that may exist.
[00:13:20] It has been reported that hospitals in Oklahoma could not clarify consistent policies for how clinicians should handle emergency obstetric care. There is an ongoing litigation in Texas due to the hostile clinical caused by Texas abortion ban, which has caused pregnant patients to suffer during obstetric emergencies, risking health and in some cases their lives.
[00:13:49] Advocates say it's important to gather data on the impact abortion bans are having on the health of pregnant people to help both policymakers and voters understand the life or death consequences of the restrictions. Without this accounting, the public may remain ignorant of the toll.
[00:14:12] Gathering this data is difficult, as each state has its own system for compiling the information.
[00:14:19] It is important to measure deaths that happen early in pregnancy, including murders. Homicide is a leading cause of death for pregnant or recently pregnant Americans.
[00:14:31] Overturning Roe did not resolve the debates on abortion that have characterized the US political system for the past 50 years.
[00:14:41] Instead, it enabled the implementation of policies and laws that have significantly altered the provision of abortion care, increasing the harms faced by those who who are most marginalized in the health care system. According to the Guttmacher Institute, in the first quarter of 2024, four states introduced legislation, with one passing a law that criminalizes adults who support adolescents seeking abortion care.
[00:15:15] Abortion care is not the only area of reproductive healthcare that has been impacted due to the fall of Roe.
[00:15:25] Earlier in the year, the Alabama Supreme Court's decision to classify frozen embryos as children wreaked havoc on fertility treatment services and patients seeking in vitro fertilization or ivf.
[00:15:42] Many doctors and patients are confused about which elements of fertility treatment are restricted. Following the Alabama Supreme Court decision, at least three Alabama providers have paused IVF services.
[00:15:57] Some IVF patients have considered moving their embryos out of the state to continue the process elsewhere, only to learn that the option isn't available to them right now.
[00:16:11] Another area that has been impacted in the Dobbs decision has been contraception care. According to the Guttmacher Institute, data was collected pre and post Dobbs in Arizona, Iowa, New Jersey, and Wisconsin of women aged 18 to 44. They found that barriers to accessing contraceptives increased and reports of receiving high quality contraceptives care decreased a year after the Dobbs decision.
[00:16:44] The post Dobbs legal landscape also impacts medical training. Medical students and states with total abortion bans must seek abortion training. Out of state students may take a state's abortion legality into effect when considering residency applications.
[00:17:04] Diminished training opportunities can potentially lead to a decline in clinical skills, knowledge, and experience, which will ultimately impact patient experience and access to care.
[00:17:21] It is imperative that future physicians have access to training on essential health care such as abortion.
[00:17:29] Similarly, abortion providers who have academic appointments in hostile states may be limited in what they can teach, and the number of clinical learning opportunities for abortion during the final two years of medical school will likely decrease.
[00:17:47] This will not only make it more difficult for providers to perform abortions, but could also affect training in and care for patients. Patients requiring life saving, miscarriage and ectopic pregnancy care.
[00:18:01] Residents find themselves weighing the options between facing criminal charges for performing an abortion or losing their patient whose survival depends on access to an abortion.
[00:18:16] It is important to examine this growing evidence to form a deeper understanding of how the volatile, chaotic legal landscape that erupted in the wake of Dobbs has affected abortion access in the United States. It is also important to acknowledge that our understanding remains incomplete and that the full scope of harm caused by this ruling may not be clear for years to come.
[00:18:43] Evidence suggests that it will not be easy to repair the devastation caused by the Dobbs decision.
[00:18:51] Documenting its negative effects is critical to our goals of alleviating and reversing the decision's impact and ultimately restoring and reimagining abortion rights nationwide.
[00:19:06] Moreover, the decision advanced the anti abortion movement's long term goals to enshrine fetal personhood in both law and policy.
[00:19:18] These attacks on bodily autonomy, coupled with major cases before the US Supreme Court on abortion this term signal that the policy and legal landscape will continue to shift significantly affecting abortion provision.
[00:19:38] Current research confirms what advocates have long known the loss of Roe will only create confusion, chaos and deeply fractured landscape where a person's zip code plays a consequential role in determining whether, where, when, and how they can receive care.
[00:19:59] Future research will need to make sense of how policies that are either supportive or antagonistic toward abortion rights will affect the sexual and reproductive health care delivery system. Overall, it is imperative that advocates and policymakers at all levels of government take heed of this evidence and use it to champion a bold vision of abortion care that goes beyond what Roe promised.
[00:20:29] Only policies rooted in evidence and human rights will guarantee that all people have meaningful access to high quality, affordable abortion care where they live and via the method they choose.
[00:20:45] We are just beginning to understand the scale of the overturning of Roe v. Wade. The effect on providers, clinics, patients, support networks, maternal health and contraceptive care have and will continue to be affected.
[00:21:04] If you or someone you know need more information about abortion bans within the United States, you can refer to the center for Reproductive Rights. This site provides a tool that is updated in real time, informing on all of the bans and and restrictions currently on the books in each state. You can use this map to explore the breakdown of abortion laws by state in real time and understand abortion bans, types of abortion restrictions, what trigger bans are, and more.
[00:21:41] Next week we will start looking deeper into stories of women whose pregnancies and health have been at risk in abortion ban states.
