Sexual, reproductive health and rights – including the right and ability to access safe abortion – have long been among the last priorities in health systems, not least because those who benefit from them the most are often the most marginalised and vulnerable.
As social science and public health researchers for the Social Science in Humanitarian Action Platform we read about last week’s Supreme Court ruling to overturn Roe v. Wade with alarm. Not only does this ruling remove the constitutional right to abortion, it will disproportionately impact poor, Indigenous and racialised minority women and people – endangering their lives and creating a public health and even humanitarian crisis.
A split between U.S. states where safe and legal abortion remains accessible and states that have already severely restricted or criminalised abortion or will in the near future (see for instance, Kentucky, Ohio or Texas) is threatening to overwhelm clinics in ‘haven states’, impacting their ability to provide care to all who desperately need it. Many – disproportionately the poor – will not even have the chance to access care. They may lack the means to travel interstate or be unable to take time off of work, leave caring responsibilities behind or get away from abusive partners or disapproving family members. In recent days, several large employers like Starbucks and Bank of America announced they would provide assistance to employees seeking an abortion in states where it is restricted or unavailable. While extremely important, we know this will exacerbate inequalities as many will not have this benefit.
The criminalisation of abortion is also marked by a climate of fear and repression, with states like Texas offering US$10,000 to civilians who report someone for seeking an abortion, while Oklahoma and others send some (disproportionately minoritised) women to jail for miscarriages.
The consequences of the abortion ruling also reach far beyond the borders of the U.S. Experts around the world have raised concerns about abortion becoming further stigmatised, even in countries where it remains a right. They have also observed the emboldenment of regressive movements seeking to limit access not just to abortion, but to contraceptives, and to criminalise homosexuality and extra-marital sex.
Funding for broader sexual and reproductive health programming around the world, including family planning, comprehensive sex education and gender-related public health programming – which are already under resourced – is also in danger of seeing further cuts. Ultimately, this represents a possibly seismic moment in a broader growing trend of backlash against feminist advances globally, which has seen both subtle and spectacular efforts made to reassert control over women, LGBTQIA people, and other traditionally marginalised groups.
The impact on women’s health
The World Health Organisation views access to safe abortion as a critical part of health care, as over 25 million unsafe abortions (45% of all abortions) occur globally each year. This leads to around 39,000 preventable deaths and millions more preventable hospitalisations amongst the most vulnerable. This does not even capture the psychological trauma that many will face from being forced to bring pregnancies to term, including those pregnancies that result from rape. Public health and medical experts have long acknowledged that restricting access to abortions does not reduce the number of abortions that take place. Instead, it drives women towards unsafe and often costly but unregulated procedures, putting their lives at risk. More broadly, the U.S. Supreme Court decision will have wide-ranging effects, including for women with unused embryos conceived through in vitro fertilization (IVF).
Reproductive rights and digital surveillance
The nearly 50-year legal precedent set by the U.S. Supreme Court’s decisions, including Roe v. Wade, hinged on the notion that individuals maintain specific privacy rights from the government in family planning. In the Dobbs opinion, Supreme Court justices affirmed they will seek to go after other related decisions, which have established Americans’ fundamental right to privacy, due process, and equal protection rights. This will include potentially overturning decisions such as Griswold (right to contraception), Lawrence (right to same-sex relations), and Obergefell (right to same-sex marriage).
The overturning of Roe could also be part of a larger global trend where we see expansive digital surveillance of populations and a rolling back of privacy around the world. This decision is even more pernicious as it comes at a time of increasingly sophisticated digital tools for surveillance globally. Some have predicted that personal health decisions could become subject to US state-level surveillance, as local police departments in the U.S. have tools such as license plate scanners, biometric databases, and phone location tracking services. While healthcare data are protected under the Health Insurance Portability and Accountability Act (HIPAA) in the U.S., there is a wide range of health-related apps like period trackers in which information is unprotected by the HIPAA.
From anger and fear to hope and action
Anger and fear have erupted across the U.S., and polls indicate that a majority of U.S. citizens – 61% in a Pew research poll, and 85% in a Gallup poll – believe abortion should be legal in all or most cases. Thankfully, grassroots networks and organisations have long been supporting vulnerable people to access abortion care, and have also been preparing for the possibility – and now reality – of the abolishment of constitutionally protected rights to abortion. The community-based and community-led infrastructure they have built is now critical to supporting vulnerable people living in areas where abortion is or will be criminalised.
Response to this unfolding crisis will need to be multi-pronged and supportive of efforts by communities most affected, such as racially minoritised people. Responders – from formal organisations and professionals to everyday feminists – must now pull together to turn anger and fear into hope and action.
Urgent policy action
In the short-term, there is an urgent need for policy action at the federal level to complement local grassroots efforts. We must continue to fight at the political and policy level to regain ground for human rights in law and practice in the U.S. and around the world. For example, in the United States this could include:
- Federal law and protections around digital data and privacy, especially for health-related data not protected under HIPAA.
- Federal protections for those traveling to other states to seek the care that they need.
- Federal protections for access to critical medications for reproductive health care, for example through telehealth and by mail, including contraception and medication abortion.
- Explore options such as using federal lands as ‘safe havens’ for abortion access in states that ban or severely restrict the practice.