By Heidi Fantasia
In the year since the U.S. Supreme Court’s Dobbs v. Jackson ruling struck down the constitutional right to abortion, society has been seeing the results of a post-Roe world.
While there is no law in the U.S. that regulates what a man can do with his body, the reproductive health of women is now more regulated than it has been in 50 years. And the scope of reproductive health care that women can receive is highly dependent on where they live.
This creates a system of inequalities and further exacerbates health disparities.
I am a nurse practitioner who studies women’s reproductive health across the lifespan.
My research found that college women are concerned about pregnancy, but they lack knowledge and skills about navigating sexual consent and often participate in sexual activity without explicit consent, leaving them at risk for not using contraception and exposure to sexually transmitted infections.
These findings indicate that women are at risk of pregnancy at a historic time when women’s reproductive rights in the U.S. are restricted and not guaranteed.
Current state of abortion in the US
The Dobbs v. Jackson ruling returned decisions regarding abortion to individual states. This has led to a patchwork of laws that span the entire range from complete bans and tight restrictions to full state protection for abortion.
In some states, such as Texas, Louisiana and Mississippi, abortion is banned beginning at six weeks gestational age, when very few women even know they are pregnant. Other states, such as Massachusetts, Vermont, New York and Oregon, have enacted state-level protections for abortion.
The patchwork of state laws also results in a great deal of confusion. In the past year, women’s rights organizations and women’s health advocates have brought numerous legal challenges to restrictive abortion laws. These cases have halted the implementation of some of the strictest abortion regulations until additional court rulings are finalized.
AP Photo/Jeffrey Collins
Downstream effects for health care professionals
Abortion training is considered essential health care and a core competency for physicians in obstetrics and gynecology, or OB-GYN, residency programs. Approximately 50% of OB-GYN residency programs are located in states with restricted or highly restricted access to abortion. This will logically result in not only fewer health care providers being trained to perform gynecologic procedures for abortion, but also other conditions such as miscarriage, fetal death and nonviable pregnancies.
In states with changing abortion laws and legal challenges to new laws, physicians are uncertain of what procedures can be legally done. Penalties for violating abortion laws may include arrest, loss of medical license, fines and discipline by state boards of medicine.
As a result, physicians are choosing to leave states with the most restrictive abortion laws, and clinics are closing, which is contributing to the current shortage of health care providers.
Inequalities in health care access
The unequal access to abortion procedures across the country is most directly affecting the poorest women in the U.S.
Currently, 12 states restrict abortion coverage by private insurance, and more than 30 states prohibit public Medicaid payment for abortion. Women who qualify for Medicaid are among the poorest in the U.S. Lack of access to abortion limits education and wage earning and contributes to poverty. States with the most restrictive abortion laws also have limited access to pregnancy care and supportive programs for pregnant and parenting women.
In addition, traveling to a different state to obtain an abortion is often not possible for poor women. Lack of transportation and limited financial resources reduce or eliminate options to obtain an abortion in a different geographic location.
What’s more, states with the most abortion restrictions have some of the worst pregnancy and maternal health outcomes for women, especially women of color. Pregnancy itself is associated with a risk of dying.
Maternal morbidity is the term used to describe short- or long-term health problems that result from pregnancy. Maternal mortality refers to the death of women during pregnancy or within the first six weeks after birth.
For example, Mississippi and Louisiana have the highest rates of maternal mortality in the U.S. and also have the most restrictive abortion laws. Black women have the highest maternal mortality of all races and ethnicities. Women in these states who are unable to terminate a pregnancy have a higher risk of dying as a result of the pregnancy than women in other states.
Additionally, research shows that a woman’s risk of dying related to pregnancy or childbirth is about 14 times higher than the risk of death from an abortion.
In addition to the increased risks of death, there are other physical and mental health implications associated with carrying an undesired pregnancy to term. Being denied access to abortion is associated with increased anxiety and fewer future plans for the next year. Research also shows that not being able to obtain an abortion makes women more likely to live below the federal poverty level and to lack partner support.
Conversely, research has shown that there are few if any significant negative mental health outcomes among women who have abortions.
Unsafe abortions
Restricting legal abortion increases the risk that women will seek out pregnancy termination from unskilled people in unsafe settings. Or they may not seek care quickly for pregnancy complications due to fear of being accused of a crime.
In Texas, physicians are reporting an increase in sepsis, or an overwhelming response to infection, from incomplete abortions. These physicians predict that sepsis will become the leading cause of maternal death in Texas.
Prior to 1973, when Roe v. Wade established constitutional protection for abortion in the U.S., women often resorted to unsafe methods to induce abortion that resulted in a high death toll. Septic abortion wards – or designated areas of hospitals where women were treated for sepsis as a result of illegal abortions – were common. In 1965, 17% of all deaths related to pregnancy were attributed to illegal abortion.
Now that the constitutional right to abortion has been eliminated, more women will inevitably die or become seriously ill due to lack of safe access to abortion services. In states with the most restrictions on abortion, whether a woman meets the criteria for an exemption to save the life of the mother may be decided by a hospital committee. This can delay necessary care and increase the risk to the mother.
Women affected by violence
In the U.S., more than 25% of women will experience physical or sexual violence in their lifetime. Violence from an intimate partner is a leading reason for abortion. My research shows that women affected by violence have a higher risk of pregnancy and that college women are at increased risk of nonconsensual and forced sexual encounters.
Currently, there are 14 states with abortion bans that contain no exception for rape or incest or require that the sexual assault be reported to law enforcement to qualify for exception.
Research has shown that women often don’t report sexual assault due to stigma, embarrassment or fear of not being believed. Even if women qualify for an abortion as a result of sexual violence, those who have not filed a formal police report lack “proof” that their pregnancy resulted from assault.
While the changes that have occurred since the fall of Roe one year ago are already deeply concerning, the full effect of eliminating the constitutional right to an abortion won’t be known for years. And as laws are enacted and subsequently challenged, uncertainty and confusion regarding women’s reproductive health care will undoubtedly continue for years to come.
Heidi Fantasia is Associate Professor of Nursing at the University of Massachusetts at Lowell.
The Conversation arose out of deep-seated concerns for the fading quality of our public discourse and recognition of the vital role that academic experts could play in the public arena. Information has always been essential to democracy. It’s a societal good, like clean water. But many now find it difficult to put their trust in the media and experts who have spent years researching a topic. Instead, they listen to those who have the loudest voices. Those uninformed views are amplified by social media networks that reward those who spark outrage instead of insight or thoughtful discussion. The Conversation seeks to be part of the solution to this problem, to raise up the voices of true experts and to make their knowledge available to everyone. The Conversation publishes nightly at 9 p.m. on FlaglerLive.
For Real says
Over 70 per cent of the American people are against this abortion ban, for the safety of all women. Why why can’t the Cult GOP party for once do what the American people want? And read the news not to many now even trust our Supreme Court Judges that are on the take from billionaires who give them large amounts of money and lavish vactions. NOT RIGHT.
Laurel says
For Real: Because the far right, GOP cult does not serve the American people, it serves the funders which want to control the American people. They don’t give a damn about babies, they sure don’t want to take care of them once born. They don’t give a damn about women, if they did they wouldn’t be legislating their uterus.
It’s not about saving lives, it’s all about manipulating and controlling the public.
Dennis C Rathsam says
In this day and age, thier are many options in birth control. Why is it that so many refuse to use them? Why do they have unprotected sex, when they know what the out come could be. Killing inocent babies is wrong, & I will go to my grave believing this. Its time for all the fools out there to take responsabilty for thier actions. I know your not that stupid.
Tony Mack says
But Republicans don’t want people to have access to contraception…to wit:
SENATE REPUBLICANS BLOCK MARKEY EFFORT TO PASS HIS LEGISLATION TO PROTECT RIGHT TO CONTRACEPTION
Washington (June 21, 2023) – Today, Senator Edward J. Markey (D-Mass.), chair of the Senate Health, Education, Labor and Pensions (HELP) Subcommittee on Primary Health and Retirement Security, sought unanimous consent to pass his Right to Contraception Act to protect every American’s fundamental right to use contraception, but Senate Republicans blocked the bill on the floor.
“Congress has an obligation to fulfill its duty to protect the rights of Americans – from marriage equality to civil rights and worker safety,” said Senator Markey. “Yet, today, when I asked Republicans for the second time to stand up for the right to contraception – a policy that a vast majority of Americans support – they said no. Each and every Republican who refused to protect the right to contraception told Americans loud and clear that they’re willing to risk the health of millions of Americans for politics. It is time for them to get out of the doctor’s office and start representing the American people. As the Supreme Court and extremist Republicans hack away at our rights, we cannot and will not give up. I will continue to fight to pass the Right to Contraception Act.”
The Right to Contraception Act would codify and strengthen the right to contraception, which the Supreme Court first recognized more than half a century ago in its Griswold v. Connecticut decision. Senator Markey and his colleagues first introduced the legislation in July 2022 in the wake of Justice Clarence Thomas’ concurring opinion in Dobbs v. Jackson Women’s Health Organization—which overturned Roe v. Wade—in which he urged the Supreme Court to “reconsider” its substantive due process precedents, including Griswold. Moreover, Republican lawmakers in several states across the country have placed restrictions on birth control by eliminating funding for it, defining abortion broadly enough to include contraception thereby restricting it, and allowing health care providers to deny service related to contraception based on their own beliefs.
What is the Republican position on birth control?
“Just last week, 195 House Republicans voted against the Right to Contraception Act. And now they have blocked action in the Senate as well. The evidence of where Republicans actually stand on birth control is overwhelming. They aren’t standing for women. Jul 27, 2022
Sam says
Young girls that get raped aren’t on birth control pills. There is a larger picture of what is going on.
Mary Fusco says
In reality, every woman has control over her body. Either do not have sex or use birth control if a pregnancy is not wanted. However, in the case of incest, rape or a child that has serious birth defects and will have no quality of life, I can understand using abortion. Many years ago, I had 3 children under 5, husband and I were in the process of building a house when I discovered I was pregnant with #4. I was using an IUD at the time so I am aware that birth control can fail. However, abortion was never even in the picture. What I did after my daughter was born was have tubal ligation so I wouldn’t have any more “oops”. I was in control of my body. Any woman who is sexually needs to be on birth control. That way she is in control of her body. Abortion is not a form of birth control. There can be complications from abortions such as infertility down the line. Everyone screaming that the whole universe must take the jab in order to avoid covid can’t scream USE BIRTH CONTROL to avoid pregnancy? If people acted responsibly, abortion clinics would have to close down due to lack of business.
Sherry says
@ mary. . . your usual “holier than thou” judgement aside. . . please understand that the Republicans in Congress are doing everything they can to STOP the RIGHT TO CONTRACEPTION. Take a good read:
This from The Hill:
The Republican Party’s war on abortion has largely overshadowed its attempts to ban our right to contraception and its refusal to preserve this well-established right. Given that 90 percent of Americans support the right to use birth control, this commonsense issue should be noncontroversial.
Despite this, last year, 195 House Republicans voted against the “Right to Contraception Act,” which only passed the House thanks to the support of all 220 Democrats then in the majority. Senate Republicans proceeded to block all action in the Senate. There can be no confusion here about what these politicians did. They refused to pass a clean and simple bill that would have enshrined the right to contraception in federal law.
Just last week, I reintroduced my bill on June 14 at the steps of the U.S. Capitol with Senate co-lead, Sen. Ed Markey (D-Mass.). Moreover, this week, my colleagues in the Senate again blocked the “Right to Contraception Act,” from unanimous consent. This comes on the heels of Nevada Gov. Joe Lombardo (R) vetoing a right to contraception bill in Nevada, despite it passing with bipartisan support including the Senate minority leaders in his own party. It is clear that congressional Republicans and Republicans in the states care far more about appeasing their MAGA base than representing the American people.
Let’s not be fooled into thinking this right is not at risk. In Supreme Court Justice Clarence Thomas’s concurring opinion of Dobbs v. Jackson Women’s Health Organization last year, Thomas voiced support for overturning the constitutional right to contraception — a right established in Griswold v. Connecticut in 1965. Specifically, Thomas wrote that because the legal basis for Roe v. Wade is also the basis for other rights, including the right to contraception, the decision recognizing that right (Griswold) should therefore be “reconsider[ed].”
We cannot afford to leave such a fundamental right to the whims of a far-right court, which is why passage of the Right to Contraception Act is critical.
Thomas and others on the far-right simply fail to recognize that the right to contraception is central to an individual’s privacy, health, well-being, career growth, and participation in our nation’s social and economic life. Contraception is also used for preventing and treating various medical conditions like endometritis, iron deficiency, ovarian cancer and other cancers.
Many Americans that support the right to contraception are unaware of the GOP’s attacks on it. Polling conducted weeks before the 2022 Election Day found that most voters heard little about congressional Republicans’ attempts to block the “Right to Contraception Act.” The survey also found that 59 percent of voters, including 74 percent of Democrats, 63 percent of independents, and 40 percent of Republicans, said they were “less likely to vote for a candidate who opposes protecting the right to contraception.”
Given the enormous stakes, Americans must be made aware of all the ways in which extremist Republican lawmakers and far-right courts are attempting to infringe on this fundamental freedom. The MAGA Republican Party is counting on the 90 percent of the American people in favor of contraception not to notice, and sadly, thus far, they’re largely succeeding.
Equally alarming are the recent efforts of Republican-led state legislatures and MAGA politicians to restrict access, affordability and availability of contraception.
Late last year, a Texas judge ruled that Texas teens would need parents’ permission to get birth control at federally funded clinics. In Florida, Gov. Ron DeSantis (R) blocked funding for contraception — specifically for LARCs (long-acting reversible contraception, or IUDs and the Implant) for low-income constituents. In Virginia, legislators introduced bills that could ban certain forms of birth control, including IUDs. The list of states extends to Ohio, Louisiana, Tennessee and beyond.
The public needs to be made aware of the right-wing extremists’ war on contraception and outright assault on Americans’ fundamental rights, personal freedoms and well-being. In their efforts to satisfy their fringe MAGA base, the GOP has made clear they do not and will not represent the 90 percent of Americans in favor of contraception.
For these reasons and more, we’re launching a movement to protect our freedoms and right to contraception. We must expose the MAGA Republican Party’s efforts to restrict our right to contraception at every level and make clear to lawmakers that we will not stand for such attacks on our fundamental rights.
Skibum says
I wish to hell that somehow, somewhere, lightbulbs would go off in more of our dimwit lawmakers’ heads. Just exactly how many women on this planet become pregnant by immaculate conception? Zero, nada, NONE! Every single developing fetus had its beginning with the overt act of a male’s sperm, yet no lawmaker anywhere has had the balls to introduce a single state or federal law which would put any type of restriction on a man’s fertility, virility or ability to procreate whenever he desires. No, all legal restrictions put into our laws of the land ONLY restrict and penalize the other half of the biological birth producing species, women. Men can obtain the little blue pills anonymously, through the mail, in unmarked packages. Many health insurers actually cover the cost of the male penile enhancement meds and treatments. This is happening at the same time that conservative republicons in several states are forcing Medicare and other insurers to NOT cover any type of female contraception medication or treatment. Why? Well, this all makes sense apparently when you stop to consider how many men there are making these asinine laws to the detriment of women. What we need in America is a body of lawmakers in every state who would be tasked with enacting laws pertaining to male contraception… you know, deciding when men could or could not legally purchase the little blue pills that so many of them are needing and using that have a tendency to result in a woman’s pregnancy. And, of course, it would be important that this body of lawmakers be all female so there would finally be tit for tat consistency in our nation’s laws that currently restrict a woman’s contraception and health care rights that are legislated by an overwhelmingly male body of lawmakers who think they have the right to legislate over a woman’s body and her healthcare. Such changes is what is needed, and what would only be fair. But that’s probably why it would never, ever happen in this country of ours.
Sherry says
@Skibum. . . Right On! As usual. . . BTW!