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Reproductive Freedom. (n.d.). American Civil Liberties Union

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A decision about having a baby or having an abortion is a deeply personal, private decision best left to a woman, her family, and her doctor. Yet some politicians remain obsessed with interfering.

Abortion is one of the most common medical procedures performed today, and it's incredibly safe. But laws that make it difficult if not impossible for a woman to get an abortion if she needs one, particularly if she is poor, are increasing at an alarming pace. Since 2011, states have enacted more restrictions to abortion than they did in the previous 10 years combined. Extremist politicians continue to work to shut down women's health centers, cut off access to affordable birth control, and shame women who have abortions.

Through litigation, advocacy, and public education, we strive to ensure that every woman has the opportunity to make a real decision and the ability to get the care she needs. With your help, the ACLU stands ready to block efforts to take this decision away from women and their families.

Our work focuses on a range of issues, including protecting access to affordable contraception, protecting a woman's ability to make personal, private decisions about pregnancy and abortion, and fighting pregnancy discrimination.

Legislation

Federal Legislation

Shifts in the power structure of Congress have led to promises to strip away access to reproductive health care, especially abortion. Here's important information on the federal legislation we're watching.

In the States: Legislative Attacks on Abortion

Read the most recent updates on extreme bills that would rob women of the ability to make personal decisions about pregnancy free from political interference.

Cases

In the Courts: ACLU Reproductive Health, Rights, and Justice Cases

Read more about efforts to use the courts to protect women's access to abortion and other reproductive health services here.

Additional Resources
Targeted Regulation of Abortion Providers: How Sneaky Laws Are Forcing Quality Health Care Providers to Close Down (Campaign)
Leading medical groups say TRAP (Targeted Regulation of Abortion Providers) laws, which are cloaked in the deceptive language of women's health, actually put women at risk by shutting down health centers where women can get safe and legal abortions.

Here's what you need to know about these dangerous abortion restrictions.
Using Religion to Put Women's Health at Risk (Campaign)
With increasing frequency, women are being denied reproductive health services, including birth control, abortions, and even basic information and refusals, based on a health care institution's religious objections. In too many places, Catholic bishops, not doctors, are making medical decisions for women. The ACLU works hard to defend religious liberty, but religious liberty doesn't include the right to deny someone else health care services they need.

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A decision about having a baby or having an abortion is a deeply personal, private decision best left to a woman, her family, and her doctor. Yet some politicians remain obsessed with interfering.Abortion is one of the most common medical procedures performed today, and it's incredibly safe.

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an example of a pro-choice protest

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Attia. (2019, November 21). What are the different types of abortion?

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The Supreme Court overturned Roe v. Wade, which means that states can now ban abortion. Some states have banned abortion or created lots of restrictions. But abortion is still legal in many states, and it's legal to go to a different state to get an abortion. Abortion is NOT banned nationwide.

Laws about abortion are changing very quickly. You can find more information about laws in your state and how to get an abortion from your local Planned Parenthood health center or abortionfinder.org.
What are your different forms of abortion?
There are two kinds of abortion - the abortion pill and in-clinic abortion. Medication abortion (also known as the abortion pill) consists of using two different medicines called mifepristone and misoprostol to end a pregnancy. This medicine causes cramping and bleeding to empty your uterus. It's kind of like having a very heavy and crampy period, and the process is very similar to an early miscarriage.

You can take the abortion pill 11 weeks after the first day of your last period. If you're past 11 weeks, you may be able to get an in-clinic abortion. Your doctor or nurse will give you detailed directions about where, when, and how to take the medicines. You may also get some antibiotics to prevent infection.

In-clinic abortion (also called a surgical abortion) is a medical procedure. It works by using suction to empty your uterus. How late you can get an abortion depends on the laws in your state and what doctor, abortion clinic, or Planned Parenthood health center you go to. It may be harder to find a doctor or nurse who will do an abortion after the 12th week of pregnancy, so it's best to try to have your abortion as soon as possible.

You can get information on how to make an appointment for an abortion at one of our health centers or at abortionfinder.org.

Tags: Abortion, abortion pill, in-clinic abortion

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What are the different types of abortion?

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The Supreme Court overturned Roe v. Wade, which means that states can now ban abortion. Some states have banned abortion or created lots of restrictions. But abortion is still legal in many states, and it's legal to go to a different state to get an abortion. Abortion is NOT banned nationwide.

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TW: Suicide, Rape, and Gruesome Details Related to Botched Procedures

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Abortion Stories Before Roe v. Wade | Iris

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Michigan House passes “watered-down” abortion rights bills. (n.d.). The Detroit News. Retrieved November 26, 2023

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Lansing - The Michigan House voted late Wednesday in favor of putting new protections for abortion rights in state law, but legislators had to remove significant provisions from the measures in order to get the bills through the chamber.

Supporters have labeled the proposals the "Reproductive Health Act," because they attempt to add language to state law that says, "Every individual has a fundamental right to reproductive freedom."

However, before the votes Wednesday, Democrats who control the state House had to drop elements of the bills that would have allowed Medicaid funding for abortion care and that would have done away with a 24-hour waiting period before obtaining an abortion.

Rep. Karen Whitsett, D-Detroit, had opposed both provisions of the bills, and Democrats needed her vote. Without the provisions, the bills passed along party lines, 56-54, with Whitsett in support.

The House had approved "a watered-down version of the Reproductive Health Act that lacks key policy reforms that are both desperately needed and widely supported by voters across the state," said a statement from abortion rights supporters, including the ACLU of Michigan and Planned Parenthood Advocates of Michigan, on Wednesday night.

"Without eliminating the Medicaid abortion ban and the 24-hour mandated delay, access to abortion care will remain out of reach for too many across our state," the statement said. "Barriers like these make abortion care more difficult to access and often have a disproportionate impact on Black and brown people, people working to make ends meet, rural residents, and other marginalized communities.

"Moreover, voters across the state support repealing these harmful restrictions."

Whitsett previously said she believes in safe and healthy access to abortion but also believes the rules currently in place still provide that access.

"I do not think it is too much to ask when someone's terminating a life, a 24-hour pause to be able to say for sure this is the decision you want to make. 24 hours is not too much," Whitsett said.

In November, Michigan voters approved a ballot proposal to enshrine the right to have an abortion in the state constitution. The amendment, known as Proposal 3, passed with 57% of voters in support.

Democratic lawmakers had argued the Reproductive Health Act built on the ballot proposal by recognizing abortion rights in state law and by removing old policies they viewed as restricting access to abortion. Gov. Gretchen Whitmer had made the act a priority for the fall.

"Let's protect the freedom to make your own decisions without interference from politicians. Let's get it done," Whitmer said in August.

Rep. Laurie Pohutsky, D-Livonia, said supporters of the bills made a decision "to get as much done as we possibly could."

Pohutsky noted the legislation still removed requirements for abortion clinics to be licensed as freestanding surgical centers in Michigan. The requirements were medically unnecessary and onerous, Pohutsky told reporters.

"There are no abortion providers north of Saginaw in the state of Michigan," Pohutsky said. "And a large part of it is because it is so difficult to open facilities because they do have to be licensed as surgical centers.

"Even though none of that equipment is necessary."

Republicans voted against the bills on Wednesday, arguing that they diminished standards that ensure safety at abortion clinics.

"These bills jeopardize women's health and undermine their rights to make informed decisions about their bodies," said Rep. Jaime Greene, R-Richmond.

The bills are on their way to Whitmer's desk with votes to take place on some of the bills in the Senate.
Staff Writer Beth LeBlanc contributed. cmauger@detroitnews.com

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Michigan House passes 'watered-down' abortion rights bills

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Michigan Democrats had to drop key provisions of the Reproductive Health Act to get the bills through the House.

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Abortion is the removal of pregnancy tissue, products of conception or the fetus and placenta (afterbirth) from the uterus. In general, the terms fetus and placenta are used after eight weeks of pregnancy. Pregnancy tissue and products of conception refer to tissue produced by the union of an egg and sperm before eight weeks.

(Harvard Health Publishing, 2019, January 9)

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There are two main types of abortion: Medication and In-Clinic or Surgical abortion. Medication involves using abortion pills called mifepristone and misoprostol to end a pregnancy. It causes heavy bleeding and cramping similar to a crampy period and is similar to an early miscarriage. You can take abortion pills up to 11 weeks after the first day of your last period, past this time, you may have to get an in-clinic abortion. In-clinic abortions, or surgical abortions, work by using suction to empty your uterus. How late you can get the abortion varies by state, doctors, and abortion clinics. It might be difficult to find a doctor who will perform a surgery past the 12th week of pregnancy so it's best to get an abortion as soon as possible.

(Attia, 2019, November 21)

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An abortion is one of the safest medical procedures performed. It is 99% safe according to the CDC.

(Reproductive Freedom, n.d.)

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In 1970, Jane Roe (which is an alias name to maintain privacy) filed a lawsuit against Henry Wade, the district attorney of Dallas County. The lawsuit challenged a Texas law that made abortion illegal except if a doctor deemed it necessary to save a woman's life. Roe alleged laws were vague and violated her right to privacy which is protected by the First, Fourth, Fifth, Ninth, and Fourteenth Amendments. In 1973, the Supreme Court decided to rule in favor of Roe stating that the Due Process Clause of the Fourteenth Amendment protects against state action to the right to privacy, and a woman's choice to have an abortion falls within that right. They also established that states can not regulate abortion decisions during the first trimester of pregnancy but, states can impose regulations on abortion during the second trimester that are related to maternal health and the third trimester until a fetus reaches a point of "viability". Abortion laws must also have exceptions for cases when abortion is necessary to save the mother's life.

(Roe v. Wade, 2022)

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In June of 2022, the Supreme Court overturned Roe v. Wade. The ruling in Dobbs v. Jackson Women's Health Organization marked the first time in our country's history that the Supreme Court took away a fundamental right. The Dobbs ruling stated that the constitution does not confer a right to abortion and the right is not deeply rooted in the nation's history.

(Oyez, 2022)

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The fall of Roe v. Wade made abortion rights insecure in Michigan. A 1931 statute only allows abortions to preserve the life of the mother. Due to the vagueness of the law, it was left untested in the courts for decades. A May 2022 ruling by a Michigan Court of Claims judge temporarily blocked the enforcement of the law. In addition, Attorney General Dana Nessel also stated she wouldn't charge anyone in violation of the law.

(Lobo, D. B. and A, 2022)

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In Michigan, a grassroots coalition had concerns with the 1931 abortion ban and put in many hours to create Proposal 3. The proposal secures the right to reproductive freedom in Michigan. The proposal had difficulty collecting the signatures needed to get on the ballot until the fall of Roe v. Wade. After the fall, the ballot initiative obtained 753,000 signatures. The proposal collected more signatures than any other ballot initiative in Michigan's history. Voters in the 2022 election voted in favor of proposal three.

(Lopez, 2023, July 14)

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Doctors feel trapped by vaguely written bans

Widespread confusion about the status of abortion laws in residents own states.

Women traveling out of state to have an abortion, although those without the financial means for this do not have that privilege.

Influx in psychiatric need among pregnant people, although there is still inadequate training/access for this.

The overturn of Roe v. Wade has impacted how medical students are choosing their profession.

An analysis of yearly resident applicant data from the Association of American Medical Colleges found a 7 percent drop in students who applied to OB-GYN residency programs (Psychology Today, 2023).

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They want to be the best parent possible to the kids they already have.

They’re not ready to be a parent yet.

It’s not a good time in their life to have a baby.

They want to finish school, focus on work, or achieve other goals before having a baby.

They’re not in a relationship with someone they want to have a baby with.

They’re in an abusive relationship or were sexually assaulted.

The pregnancy is dangerous or bad for their health.

The fetus won’t survive the pregnancy or will suffer after birth.

They just don’t want to be a parent.

(Planned Parenthood, 2019)

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AS PEOPLE WITH UTERI WE STAN ABORTION RIGHTS!!! We also want to be able to make decisions about our reproductive health (my body, my choice).

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Michigan Proposal 3, the Right to Reproductive Freedom Initiative, was on the ballot in Michigan as a constitutional amendment on November 8, 2022 - the measure was approved.

Proposal 3 provides for a state constitutional right to reproductive freedom. The term reproductive freedom is defined in the proposal as "the right to make and effectuate decisions about all matters relating to pregnancy, including but not limited to prenatal care, childbirth, postpartum care, contraception, sterilization, abortion care, miscarriage management, and infertility care" (SFA, 2023).

On November 22nd, 2023, The Michigan House voted in favor of putting new protections for abortion rights in the state law; supporters have labeled the proposals "Reproductive Health Act."

The House had approved "a watered-down version of the Reproductive Health Act that lacks key policy reforms that are both desperately needed and widely supported by voters across the state," said a statement from abortion rights supporters, including the ACLU of Michigan and Planned Parenthood Advocates of Michigan, on Wednesday night (The Detroit News, 2023).

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Romo, V. (2023, June 24). A year after Dobbs and the end of Roe v. Wade, there’s chaos and confusion. NPR.

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One year after the Supreme Court overturned Roe v. Wade, putting an end to the constitutionally protected right to access abortion, the health care landscape has become increasingly fragmented and complex to navigate, spawning widespread confusion.

So far, more than a dozen states have enacted extremely restrictive abortion bans, with the majority making no exceptions for rape or incest. And many more are waiting on legal challenges to make their way through the courts. In Texas, private citizens can sue abortion providers and those who assist patients seeking an abortion after about six weeks of pregnancy.

That has left approximately 22 million women, girls and other people of reproductive age now living in states where abortion access is heavily restricted or totally inaccessible. In the nine months following the Supreme Court's decision in Dobbs v. Jackson Women's Health Organization, abortions with providers fell by a monthly average of 2,849 compared to April 2022, new data collected by the Society of Family Planning shows.

With individual states empowered to ban abortion, some health care professionals say they are trapped by poorly drafted laws that criminalize care and fail to consider how women and other pregnant people might inadvertently be affected, including those who had not planned to terminate their pregnancies.

Doctors feel trapped by vaguely written bans

"States that have banned abortion are also threatening the health and well-being of people with wanted pregnancies who face obstetric emergency," Kelly Baden, vice president for public policy at the Guttmacher Institute, told NPR.

"Doctors and hospitals do not know how to operate, or [they're] operating under a really dark cloud of suspicion and hostility," Baden added.

Half of the doctors in states with abortion bans say that they have patients who have been unable to obtain an abortion, according to a national KFF survey of OBGYNs released Wednesday. About 40% reported facing constraints on their care for miscarriages and pregnancy-related emergencies. Meanwhile, 61% of those practicing in states with abortion bansexpress concerns about legal risks when making decisions about patient care.

And a majority of OBGYNs say they believe that the Dobbs decision has also exacerbated pregnancy-related mortality, racial and ethnic inequities in maternal health and made it harder to attract new OBGYNs to the field.

Loren Colson is a family medicine physician in Idaho, a state with only about a half-dozen maternal fetal medicine physicians remaining. He described the scene across the state as one of "complete chaos."

Idaho has implemented a ban on abortion at conception. Exceptions can be made if the mother's life is in jeopardy. "But there's been a huge question of what that means," Colson told NPR.

Colson, who has testified before the Idaho Senate on the issue, said the law is written so vaguely that there is no common understanding between lawmakers and doctors of what constitutes a life-threatening situation.

"We think that they know where that line is, when it has come down to it," he said, "but when the idea of jail time is on the table, everyone gets confused."

Colson, like numerous other physicians around the country, is calling on legislators to include more precise medical language in the bans that have been enacted.

There's widespread confusion about abortion laws

Another KFF survey published last month revealed that there is broad uncertainty around the legal status of abortion among the general population. In the states where abortion is banned, about 1 in 8 residents incorrectly believes that medication abortion is still legal there. And more than half of residents say they are unsure of the legality of abortion in their state.

In the wake of the Dobbs decision, some states have passed protective legislation with the aim of expanding access and protecting providers. In all, 17 states and the District of Columbiahave laws protecting abortion. And over the last 12 months, at least 15 municipal and six state governments allocated nearly $208 million to pay for contraception, abortion and support services for people seeking abortions, according to data provided to NPR by the National Institute for Reproductive Health.

The funding, which has shot up from approximately $55 million since 2019, allocates money for abortion funds and support networks that provide financial assistance to people struggling to pay for procedures, travel and other associated costs.

Abortion will be a key issue in 2024

Politically, the Dobbs decision has mobilized both parties, and politicians are counting on the issue to bring voters to the polls in 2024. Republicans, backed by anti-abortion groups including Susan B. Anthony Pro-Life America, are seeking to codify a 15-week ban nationwide.

Democrats have also galvanized around the rollback of Roe. They are warning voters that Dobbs is only the first of future attempts to limit people'sautonomy over their own bodies and health care, including contraception and LGBTQIA issues.
NPR's Sarah McCammon and Selena Simmons-Duffin contributed to this story.

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A year after Dobbs and the end of Roe v. Wade, there's chaos and confusion

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With states empowered to regulate abortion, doctors say they're trapped by vague laws that criminalize care. And ongoing court battles make it hard to keep up with the procedure's legal status.

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an example of a pro-life protest

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Support services that fight for abortion rights such as Planned Parenthood and ACLU and provide support for loved ones who are going through with an abortion. You can also donate to Planned Parenthood as they are a non-profit organization. Protesting and writing letters to your representatives is another way to fight for abortion rights. A link is provided that shows abortion services provided through Planned Parenthood in Michigan that you can use if you or a loved one needs information about services.

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Learn about surgical and medication abortion services available at Planned Parenthood of Michigan.

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Lobo, D. B. and A. (n.d.). Supreme Court overturns Roe v. Wade, leaving abortion questions for millions in Michigan. Detroit Free Press

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Millions of Michiganders lost the national right to legal abortions Friday after the U.S. Supreme Court overruled Roe v. Wade, upending nearly 50 years of judicial precedent and changing the dynamics of reproductive health in the country for years to come.

While abortions are still legal in Michigan, that could change at any moment if a temporary injunction blocking the enforcement of a state ban is lifted or otherwise removed.
[ Want more updates on this developing story? Download our app for the latest ]
The 6-3 decision in Dobbs v. Jackson Women's Health obliterates the seminal case that legalized a constitutional right to an abortion nationally in 1973, Roe v. Wade. Chief Justice John Roberts agreed to uphold the Mississippi law at the heart of the Dobbs case but would not have ruled to overturn Roe, meaning the ultimate decision to nix national abortion rights was 5-4.

In theory, that would mean Michigan's law criminalizing most abortions is again enforceable: A 1931 statute only allows abortions "necessary to preserve the life of such woman," a vague standard left untested by doctors and the courts for decades. The law on Michigan's books does not allow exceptions for cases of rape or incest.

However, a May ruling by a Michigan Court of Claims judge aims to temporarily block enforcement of that law. Although Michigan Attorney General Dana Nessel already said she doesn't plan to charge anyone under the law, it's unclear whether law enforcement at the local level will test the court of claims' injunction.
More: More: FAQ: In wake of Texas abortion law controversy, here's a look at abortion law in Michigan Michigan court ruling not the final say on abortion constitutionality in state
The sweeping U.S. Supreme Court ruling was not unexpected - its language mirrors the text of a draft opinion published by Politico in early May. It is celebrated as a win by critics of abortion rights, who have campaigned for years against Roe and in favor of justices who may overturn the decision.

But the impact of the court's decision creates far-reaching questions, from the future of privacy rights and constitutional due process to the parameters of what constitutes a lifesaving procedure and the implications of criminalizing a process conducted more than 1.2 million times in Michigan in the last 40 years.

"The Constitution does not confer a right to abortion; Roe and Casey are overruled; and the authority to regulate abortion is returned to the people and their elected representatives," reads one brief portion of the decision, authored by Justice Samuel Alito.

Anyone who violates the state law is guilty of a felony and may be imprisoned for up to four years. The law clearly applies to doctors, but abortion rights advocates fear zealous law enforcement may go after the people seeking abortions as well. In theory, someone could be prosecuted for taking medication to induce an abortion - such abortions accounted for more than 51% of all procedures conducted in Michigan in 2021.

Nessel and seven local prosecutors vowed not to charge anyone under the law, but other local prosecutors haven't made the same promise. And even if all vowed to ignore the law, that doesn't mean abortion providers would continue to operate.

But Dr. Sarah Wallett, chief medical officer for Planned Parenthood of Michigan, fought back tears Friday as she vowed to still serve anyone who comes to a clinic seeking an abortion.

"To be clear, abortion is still legal in Michigan and our doors are still open. But my heart is breaking for the millions of patients living in states that will cut off abortion access today in the days to come," Wallett said during a virtual news conference.

"We are not going anywhere. I am going to leave this press conference and go continue to provide abortions to patients who need them here in Michigan. We will never stop fighting to protect abortion access."

Paula Thornton Greear, the new president and CEO of Planned Parenthood of Michigan, says the court's ruling blocking enforcement of the abortion ban gave her providers new hope and optimism. She also vowed to do everything in her power to ensure patients and providers are safe in the days to come.
More: More: Planned Parenthood injunction now central in Whitmer's abortion lawsuit Michigan conservative activists want Court of Appeals to overturn abortion law injunction
"We are here for you. Our doors are open, and we're going to damn well make sure that they stay open," she said.

A spokeswoman for Nessel previously did not say whether the state law immediately takes effect. But lawsuits filed in April by Gov. Gretchen Whitmer and Planned Parenthood asked several different Michigan courts to temporarily bar enforcement of the law until justices can determine whether the law is constitutional and whether the Michigan Constitution includes the right to an abortion.

Court of Claims Judge Elizabeth Gleicher recently determined Planned Parenthood had a high likelihood of winning its legal case, issuing the preliminary injunction while she's pondering a final decision in that case. Because Nessel is not challenging Gleicher's decision, the GOP-led Legislature and a conservative legal organization have intervened in the case to fight Planned Parenthood's arguments.

A decision from the Michigan Court of Appeals on the requests to overturn Gleicher's injunction could come at any moment.

There are 27 free-standing abortion clinics in 13 Michigan counties. Local prosecutors representing millions of Michiganders in seven counties, including Wayne, Oakland and Washtenaw counties, vowed weeks ago to ignore the 1931 law and not use it to prosecute pregnant people or doctors.

That does not mean law enforcement won't arrest people providing or seeking abortions in those counties. But all seven prosecutors confirmed to the Free Press even if law enforcement brought their office a case under the 1931 law, they would not prosecute.

"To put it mildly, there is a tremendous amount of uncertainty here. That's because we have an archaic law that is nearly 100 years old, and that has not been enforced for the past half-century because of Roe," said Washtenaw County Prosecutor Eli Savitt before the high court's decision.

"That's part of the reason why - beyond my pledge not to prosecute - I'm strongly supportive of any and all efforts to get that 1931 law off the books. I can and will exercise my discretion not to charge abortion if the law remains. But the existence of the law means that the threat of unjust, harmful, and arbitrary results will endure."

But prosecutors in other counties promised to follow the law.

Jerry Jarzynka, the prosecutor in Jackson County, didn't join with the seven other prosecutors who expressed support for Whitmer's lawsuit. He told the Free Press his office would examine abortions individually before deciding to bring charges.

"We would handle it like any type of case, it would come out for review," Jarzynka said. "Whether you charge a case or not can be based on a case review by police, what evidence they find. That's what we normally do for any type of case we're looking to charge. You've got to go through that process, and it's a case by case review."
More: More: Michigan Court of Claims judge grants injunction against 1931 abortion law Whitmer to Michigan Supreme Court: 'Time is of the essence' on abortion lawsuit
Jarzynka, along with Kent County Prosecutor Chris Becker, have filed motions to intervene in Planned Parenthood's lawsuit. Becker's office declined a request for comment from the Free Press.

Macomb County Prosecutor Pete Lucido agreed, saying he would follow the law and pursue prosecutions if police presented evidence someone broke the law.

"Either we have laws that we're going to enforce or we don't need lawmakers," Lucido told the Free Press ahead of the Dobbs ruling.

"We are ministers of justice. We don't look at cases wholesale, we individualize them. Each judge, when they look at a case, is not supposed to say, 'this is morally improper.' It's about, did the person commit the crime? Was the law broken, as it is written? They are supposed to enforce the law."

Almost nine out of 10 of the nearly 30,000 abortions performed in 2020 in Michigan were done at a free-standing outpatient surgical facility, according to the state health department. The state does not track how many abortions were performed to save the life of a pregnant person, but under the framework of what is allowed under the 1931 law, many more abortions moving forward would likely be performed at a hospital.

However, the subjective nature of what constitutes a procedure done to save a life leaves many medical professionals nervous and scared.
Contact Dave Boucher: dboucher@freepress.com or 313-938-4591. Follow him on Twitter @Dave_Boucher1.
"What does the risk of death have to be, and how imminent must it be? Might abortion be permissible in a patient with pulmonary hypertension, for whom we cite a 30 to 50% chance of dying with ongoing pregnancy? Or must it be 100%?" wrote Dr. Lisa Harris, a gynecologist and abortion provider who works at the University of Michigan, in a recent article published by the New England Journal of Medicine.

"When we diagnose a new cancer during pregnancy, some patients decide to end their pregnancy to permit immediate surgery, radiation, or chemotherapy, treatments that can cause significant fetal injury. Will abortion be permissible in these cases, or will patients have to delay treatment until after delivery? These patients' increased risk of death may not manifest for years, when they have a recurrence that would have been averted by immediate cancer treatment."

Doctors working at Planned Parenthood are asking the same questions. But, emboldened by the injunction, Thornton Greear said before the ruling the state already saw an influx of abortion patients from as far away as Texas.

She hopes an ongoing effort to change the state constitution so that it expressly protects abortion through a ballot initiative will be successful later this year. But for now, she believes the protections offered by Gleicher's ruling, even if they are temporary, should ease concerns of people who need an abortion.

"I know that this can be a confusing time, a perhaps scary time for people who need care. And I want them to know that as I step into this role, Planned Parenthood of Michigan is not going away," Thornton Greear said.

"We're going to continue to do everything that we can to protect and expand that access ... everybody deserves access to health care. And let me be clear once again, abortion care is health care."

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Supreme Court overturns Roe v. Wade, leaving abortion questions for millions in Michigan

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The U.S. Supreme Court's decision means millions of Michiganders may soon lose the right to an abortion at the state level.

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Center For Reproductive Rights. (2022). Roe v. Wade. Center for Reproductive Rights; Center for Reproductive Rights

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The landmark U.S. Supreme Court ruling recognizing the right to abortion.

In 1973, the U.S. Supreme Court's ruling in Roe v. Wade recognized that the decision whether to continue or end a pregnancy belongs to the individual, not the government. Roe held that the specific guarantee of "liberty" in the Fourteenth Amendment of the U.S. Constitution, which protects individual privacy, includes the right to abortion prior to fetal viability.

After Roe, and up until its decision to overturn Roe in 2022, the Supreme Court repeatedly reaffirmed that the Constitution protects for abortion as an essential liberty, which is tied to other liberty rights to make personal decisions about family, relationships, and bodily autonomy.
U.S. Supreme Court Takes Away the Constitutional Right to Abortion
In June 2022, in a devastating decision that will reverberate for generations, the U.S. Supreme Court abandoned its duty to protect fundamental rights and overturned Roe v. Wade, ruling there is no federal constitutional right to abortion. The ruling in Dobbs v. Jackson Women's Health Organization abandoned nearly 50 years of precedent and marked the first time in history that the Supreme Court has taken away a fundamental right.

Since the Court's decision in Dobbs, more than a dozen states have banned abortion outright, forcing people to travel hundreds or thousands of miles to access abortion care or to carry pregnancies against their will, a grave violation of their human rights. Read more on the Court's ruling here.

>> Read the Center's "Legal Analysis: What Dobbs Got Wrong" and scroll down this page for more resources and analyses on the Dobbs ruling and its impact.

Summary

In its 1973 decision Roe v. Wade, the Supreme Court recognized that the right to liberty in the Constitution, which protects personal privacy, includes the right to decide whether to continue a pregnancy. For the first time, Roe placed reproductive decision-making alongside other fundamental rights, such as freedom of speech and freedom of religion, by conferring it the highest degree of constitutional protection, known as "strict scrutiny."

The Supreme Court required the state to justify any interference with the right to access abortion by showing that it had a "compelling interest," and held that no interest was compelling enough to ban abortion before viability. After the point of viability, the state could ban abortion or take other steps to promote its interest in protecting the fetus. Even after that point, however, abortion must be permitted to protect a patient's life and health.

In recognizing the right to abortion, Roe was consistent with earlier Supreme Court rulings recognizing a right of privacy that protects intimate and personal decisions-including those affecting child-rearing, marriage, procreation, and the use of contraception-from governmental interference. By guaranteeing the right to make decisions in pregnancy, Roe was critical to advancing gender equality in educational, economic, and political spheres.

At the time Roe was decided in 1973, nearly all states banned abortion, except in certain limited circumstances. Criminal abortion bans contributed to the death of scores of people who were unable to access safe, legal abortion. Under Roe, these bans were unconstitutional, making abortion legal, more accessible, and safer for many pregnant people throughout the country.

While Roe's legal implications were enormous, even Roe could not make access a reality for everyone, and low-income people, people of color, young people, and others continued to face obstacles to abortion care.

The Case in Depth: Roe v. Wade, 410 U.S. 113 (1973)

Holding: 7-2 decision invalidating a Texas law that prohibited abortions except when necessary to save the life of the mother. The Supreme Court recognized that the right to decide whether to continue a pregnancy comes within the constitutional protection that the liberty clause in the 14 th Amendment affords to privacy.

Majority: Blackmun, Burger, Douglas, Brennan, Stewart, Marshall, and Powell

Writing for the majority, Justice Blackmun described the right of personal privacy as fundamental, which meant that the most searching legal test would apply to restrictions. He concluded that the right "is broad enough to encompass a woman's decision whether or not to terminate her pregnancy." At the same time, the Supreme Court rejected arguments that favored "personhood" for fetuses.

Dissent: White and Rehnquist

Justice Rehnquist expressed his "difficulty in concluding . . . that the right of 'privacy' [was] involved in this case," and argued that the rational basis test "traditionally applied in the area of social and economic legislation" was the more appropriate standard. Justice White argued for fetal personhood and accused the majority of an exercise of "raw judicial power."
The Ruling Explained
On January 22, 1973, the Supreme Court struck down Texas's criminal ban on abortion and held that the right to abortion is a "fundamental right."In the 7-2 opinion, the Court held that, along with decisions relating to marriage, contraception, education, and family relationships, the decision about whether to continue or end a pregnancy is fundamental to "personal liberty." In doing so, the Court recognized the great "detriment that the State would impose upon the pregnant woman by denying this choice," including the health and economic risks of being forced to continue a pregnancy.

Roe had two key parts: First, the Court ruled that, before viability, it is a pregnant person's decision-not the government's-whether to continue a pregnancy. Accordingly, the government cannot ban abortion for any reason prior to viability.

Second, Roe held that, as with other fundamental rights, restrictions on the right to abortion were subject to the most stringent level of constitutional review, often called "strict scrutiny." This legal standard required that infringements on the right be narrowly tailored to serve a compelling government interest. Applying a trimester framework, Roe permitted more regulation of abortion as pregnancy advanced but only when that regulation was evidence-based and consistent with how other similar medical procedures were treated; crucially, under Roe, the government was not permitted to put its thumb on the scale to pressure pregnant people about their decision whether to continue or end a pregnancy.

The Roe decision made state abortion bans unconstitutional-and abortion care legal, more accessible, and safer throughout the country.

Soon after, abortion opponents pressed state and federal lawmakers to enact a wide range of restrictive abortion laws attempting to reverse, directly or indirectly, Roe's guarantee of reproductive freedom. Lawsuits against such restrictions multiplied, with some reaching the Supreme Court. A changing Court issued a series of decisions diluting Roe.

After 1992, the Court evaluated abortion regulations under an "undue burden" standard that permits states to restrict abortion as long as burdens on access are not too severe. In practice, courts have upheld a range of restrictions that make abortion more difficult to access, especially for people of color, people living on low incomes, young people, immigrants, and others with limited resources.

In 2022, the Court overturned Roe v. Wade and eliminated the federal constitutional right to abortion.
Footnotes

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Roe v. Wade - Center for Reproductive Rights

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The landmark U.S. Supreme Court ruling recognizing the right to abortion.

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Lopez, E. (2023, July 14). How Michiganders Showed Up for Reproductive Freedom and Won | ACLU. American Civil Liberties Union

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Last year's decision overturning proved to be a major galvanizing moment for people who support abortion rights in communities across the country as bans began to go into effect. One of those states is Michigan, where a grassroots coalition had growing concerns about an archaic 1931 abortion ban that could take effect if the Supreme Court overturned Roe v. Wade, and had already been working to prepare for that possibility. Their tireless work put abortion rights on the ballot with Proposal 3, which secured the right to reproductive freedom in Michigan, protecting abortion, prenatal care, birth control, and all pregnancy-related care.

Here, two of the advocates who led the Proposal 3 charge with community partners discuss how they showed up to protect reproductive freedom for Michiganders.
These interviews have been edited and condensed for clarity.
Bonsitu Kitaba-Gaviglio

Deputy Legal Director, ACLU of Michigan

"In 2019, an unprecedented number of state legislatures passed laws across the country banning abortion, including at very early stages in pregnancy. That effort led to a circuit split, and just two years later, the U.S. Supreme Court took up a case from Mississippi called Dobbs v. Jackson Women's Health Organization. Dobbs squarely put in front of the court once again the question of whether abortion was a constitutional right and at what stage of pregnancy it should be protected. By taking that case, the Supreme Court sent a clear message to the country that they were ready to reexamine the Roe v. Wade decision, which had protected the right to abortion for nearly 50 years.

"We knew we could not sit idly by and needed to do something in Michigan to defend the longstanding right to bodily autonomy. After a series of discussions with various stakeholders and impacted people, it was clear that the most enduring way to protect the full spectrum of reproductive rights was to initiate and pass a state constitutional amendment.

"A ballot initiative is, at its core, direct democracy. It's voters and the people of Michigan coming together to say we believe in this issue, we believe in passing this law or this constitutional amendment, and we're going to collect the signatures to put this on the ballot so voters, not politicians, get to decide. And so the idea for Proposal 3 - a constitutional amendment that would enshrine the right to reproductive freedom in our state constitution - really came from the people. We couldn't rely on the Supreme Court anymore, so we as the people of Michigan had to take that fight into our own hands.

We couldn't rely on the Supreme Court anymore, so we as the people of Michigan had to take that fight into our own hands.

"ACLU of Michigan, Michigan Voices, and Planned Parenthood Advocates of Michigan were three of the organizations leading a diverse coalition of groups and individuals in the fight to secure reproductive freedom in our state through Proposal 3. We needed to achieve justice together with Black and Brown communities and women in particular who have been historically denied access to full reproductive rights. The language of Proposal 3 is expansive and protective; it not only protects your right to seek an abortion, but it protects your right to make all decisions related to pregnancy, including contraception, prenatal care, childbirth, miscarriage care, and infertility. It also prohibits the government from passing laws to make it harder for you to get an abortion or to exercise your right to any other form of reproductive health care.

"We launched the campaign in January 2022 and quickly began collecting signatures on the ballot initiative. But frankly, we were having a hard time because not many people realized that the Supreme Court was poised to overturn Roe until the leak of the draft opinion happened.

"I remember the moment the Dobbs draft decision was leaked as a moment of sheer disbelief. I remember getting on a call with my colleagues at the ACLU of Michigan asking each other, 'Is this real? Can we really believe what we're seeing?' Reading the words in that opinion were gut wrenching because it was stripping our choice, stripping our futures. In that moment, we had to strategize and think quickly about what to do next, even though we were in shock.

"The leak galvanized so many people in Michigan and across the country because I think it made them scared that this court could really overturn Roe, 50 years worth of constitutional protections, and that it did not believe in their right to bodily autonomy. When the leak happened, many Michiganders quickly understood that Michigan was not a safe haven for reproductive rights, and that fired people up and it fired me up to continue our work. That was a pivotal point in the campaign where people came out of the woodwork to help - people were collecting signatures, talking to their families and communities about what reproductive freedom meant to them, how they could volunteer, and why they should vote for Proposal 3.

"During the campaign and on election night, all eyes were on Michigan. There were a couple other ballot initiatives being run at the same time, but really Michigan was the test to see if we could win on abortion in the Midwest, in a purple state.

"And it was a resounding success! We collected more signatures than any other ballot initiative in our state's history. On election night it was surreal to see the results of Proposal 3 passing. It was a fantastic feeling - years of hard work finally actualized. Michiganders sent a message back to the Supreme Court and country that abortion rights can win. Michigan is a safe haven now for reproductive rights and reproductive freedom.

"I hope the energy of what we did here in Michigan will spread across the country. We set the course, and hopefully created a blueprint for other states to do the same."

Sommer Foster and Shanay Watson-Whittaker

"We had an inkling that Roe v. Wade could be overturned for a long time. It was part of the reason that we formed the Reproductive Justice Work Group.

"The language in Proposal 3 was developed by our partners who made it really clear they didn't want something that just talked about abortion because that wasn't enough for them and for their communities. We wanted to center our work around reproductive justice. Reproductive rights has been around for a very long time, but BIPOC people have felt disconnected from that movement. For us, it goes beyond the right to have an abortion, and so Proposal 3 is the most inclusive law that we have to protect reproductive freedom. It protects the right to contraception, the right to infertility treatment, the right to miscarriage management, the right to be treated with dignity [during childbirth], and the right to have an abortion.

"We are really proud of that law. We're proud that we got it on the ballot and that the voters passed it.

" Roe being overturned was shocking to us for the campaign. It let people know that we were really in danger of losing our rights and that people had to get involved and engaged in this campaign in order to save reproductive rights and abortion access in Michigan.

"So it got real and personal for people and they got involved. We had folks out on the street, at farmer's markets, in community meetings getting signatures. Folks went to talk to their neighbors, their family members, and they told their own personal abortion stories or why it was important to them. We were at grocery stores, churches, and barbecues. We were out there. Wherever you could find us, we were there. We went door to door. About 753,000 people signed the petition for Proposal 3 and it was history making. Michigan never had that many folks sign a petition to get something on the ballot. This is about lives and people and the right to make decisions about their own bodies. And this ballot initiative was about putting the decision in the hands of voters of Michigan. And they once again proved us right, that they want reproductive care and they want reproductive freedom.

This is about lives and people and the right to make decisions about their own bodies. And this ballot initiative was about putting the decision in the hands of voters of Michigan.

"When the numbers came in on election night, it was just a huge sigh of relief. I cried. Victory was wonderful. It was just a wonderful night. In Michigan, we've shown that our voters really care about their reproductive rights and that we have the most comprehensive and the most inclusive law to protect those rights in the state of Michigan

"Michiganders saved ourselves. We didn't wait for politicians to save us. We didn't wait for an elected official to save us. We decided to take this chance and take this opportunity. And we did this. We did this as a coalition. The ACLU of Michigan, as well as Planned Parenthood, Advocates of Michigan, and Michigan Voices moving forward together. And we're still moving forward together. We have a lot of work to do, and I look forward to working together more in the future."

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How Michiganders Showed Up for Reproductive Freedom and Won | ACLU

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Two advocates reflect on the historic campaign to enshrine reproductive freedom in the Michigan constitution.

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Harvard Health Publishing. (2019, January 9). Abortion (Termination Of Pregnancy) - Harvard Health. Harvard Health; Harvard Health

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Abortion (Termination Of Pregnancy) - Harvard Health

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What Is It?Abortion is the removal of pregnancy tissue, products of conception or the fetus and placenta (afterbirth) from the uterus. In general, the terms fetus and placenta are used after eight weeks of pregnancy. Pregnancy tissue and products of conception refer to tissue produced by the union of ...

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Coen-Sanchez, K. (2022). Repercussions of overturning Roe v. Wade for women across systems and beyond borders. Reproductive Health, 19(1), 1–5

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Abstract

June 24th, 2022, a day that will be etched in today and future generations' textbooks as a historic day, the United States of America revoked the constitutional right to seek safe abortion care. Overturning Roe v Wade allowed the divided individual states to independently decide the legal parameters regarding abortion care. A decision that disproportionately effects the reproductive lives of women residing on the land of America. Given the systemic impacts of racism, neoliberalism and white supremacy, it is the Black, racialized and poor women who suffer terrible repercussions. In this commentary the authors begin by discussing the historical biopolitical perspective, colonial systems and longstanding impacts on racialized women's bodies in America. The discussion transitions to the implications of geopolitics at play nationally and cascading impacts globally, focusing on humanitarian and emergency settings. Using a medical humanities perspective, authors highlight the collision between politics and reproductive health policy and its implications on social determinants of health, such as women's education, employment, housing, racial and gender equity and wellbeing. Long standing advocates, community leaders and healers, leading scientists, birth attendants, doctors, nurses, allied health professionals/providers and humanitarian workers - and many others - are reminded and live the weight of the continuous battle of population control, stemming from the oppressive history of control and exploitation.

Background

The US Supreme Court's majority decision to overturn Roe v. Wade on June 24th, 2022, has taken away the constitutional right to seek abortion; a decision that will have harmful and inequitable repercussions on the reproductive health of many Americans, particularly Black and Hispanic women in the US. This decision sets the stage for each state to independently decide the legal parameters regarding abortion. According to the Guttmacher Institute, 26 US States have multiple bans ready to enact, 13 of which were trigger laws that automatically took effect when Roe v Wade was revoked, and 11 states had early gestational age bans [ 1]. Additionally, Justice Samuel Alito's opinion stated that "they need not even have an exception for incest or rape", taking away women's autonomy to make decisions over their bodies [ 2]. In this editorial, the authors discuss this decision and its impacts on the reproductive health of women, particularly women of colour, through biopolitical, geopolitical and medical humanities perspectives. The idea that "the Constitution makes no reference to abortion" and that this question is to be decided by the people of each state is flawed in both theory and practice. We underscore the injustice of taking away bodily autonomy as well as the disproportionate impacts on already oppressed communities in the US. By women, we mean Black, Indigenous, Women of color, Trans women, and non-binary people who have historically faced, and continue to face, the repercussions of the oppression of white supremacy and the glorification of able white-cis hetero women. We thank those who have come before us to advocate, teach, and heal the wounds in our society.

Biopolitical perspective on Roe v. Wade

Procedures to restrict population growth in "undesirable groups'' in the US has taken place since the nineteenth century. The Eugenics movement focused on eliminating negative traits, a practice aligned with longstanding colonial systems that led to inequities for and harm to Black, Indigenous and racialized American populations, particularly the reproductive health and rights of women [ 3, 4, 5]. Kimberlé Crenshaw's concept of intersectionality illustrates "how racial and gender oppression interact" in the lives of racialized women [ 6]. Despite these practices now being banned, women of colour still do not have complete autonomy over their bodies and governments have used women as a means to an end rather than as an end in themselves.

As stated by Michel Foucault, biopolitics is a political regulation of the biological aspects of human beings insofar as they were members of given cities, nations or other groupings of people [ 7]. In the Will to Knowledge (1976), "sexual matters" from the eighteenth century and onward are described as a kind of contact point between a disciplinary anatomy-politics of the human body and regulative biopolitics of the population [ 8]. Similarly, Giorgio Agamben argues that "the production of a biopolitical body is an original activity of sovereign power", wherein women are reduced to reproductive life exposed to state intervention [ 9]. In this sense, the biopolitics of the racialized women's body is not new. For example, racial capitalism is an example of white supremacy structures, manifested in statements such as "Overturning Roe v. Wade was a victory for "white life" by U.S. Rep. Mary Miller of Illinois, a political declaration that evoked segregation and control over racialized women's bodies [ 10, 11]. There is a long and complicated relationship between people of colour and reproductive health in the US; a dismal history of forced birth or forced sterilization of Black and racialized women [ 4, 5]. These negative experiences continue in the form of systemic racism within the healthcare system. By design, existing healthcare structures create more opportunities for dominant racial groups and reinforce white privilege. Scars from racist policies or medical experimentation on Black people and racialized communities also contribute to a legacy of mistrust. Examples of these are rampant. A case in point, is the Tuskegee Syphilis Study that began in the 1940s in the US where hundreds of Black men with late-stage syphilis were rounded up without prior consent and not offered treatment [ 12]. There is also the testing of birth control pills by the US on women in Puerto Rico in the 1960s [ 13, 14]. The Supreme Court's recent decision only reinforces Foucault's notion of biopower, allowing government control of reproduction by regulating who gets pregnant and determining who is "fit to reproduce" [ 15].

Once conceived as a cultural problem for the dominant group-white women-these existing inequalities are reinterpreted as a social problem. The 2022 decision to overturn Roe v. Wade has become a global topic of interest for all media outlets, drawing attention to rooted systematic issues that now seemingly apply to ALL women, so the public is taking stock! The history of Black and racialized women receiving forced and non-consensual sterilizations are not a bioethical dilemma; they are the result of longstanding colonial practices that inflict disproportionate, irreparable harm on racialized women. There is a historical dichotomy in the women's rights movement, as Sojourner Truth, an ex-slave delivered a speech highlighting the lack of inclusivity of Black women in the women's movement. She questioned the objective to accommodate only the "needs" of white women and asked "Ain't I a woman? [ 16]. She argued that her claim to equal rights was no less legitimate than those of the white women who were fighting for equal rights to men [ 17]. This caused a division in the movement, with some Anglo-Saxon women believing that their struggles were superior to those of Black women-perpetuating discrimination and racism experienced by Black women-a failure by white women's feminist movement to recognize and integrate their anti-slavery consciousness. Historically, racialized women's bodies were framed by social scientists as something that was welcomed by the victims and their bodies were approached by white men as property [ 18].

Political perspective

In overturning Roe-vs Wade, we see the use of political power and the voting process within the Supreme Court to give certain sections of society the power and preference over others, thereby influencing the ability of those sections to make choices about their own reproductive health. A key barrier for access to abortion care in the US is mobility. This is reinforced by the interaction of systemic racism and moral conservatism. Mobility and stasis for Black and women of colour to access safe and legal abortion care nationally will have inequitable and negative financial, social and health effects [ 19]. Unfathomable hurdles exist for oppressed communities-namely Black and brown women, undocumented immigrant women, refugees and asylum seekers-who need to travel transnationally to access an abortion. As Rafia Zakaria states, "In 2022, opposing abortion is not only sexist, it is also racist", reaffirming that, educated white women will have access to care, while women of colour carry the brunt of this decision [ 2]. Expectedly, internal political events in the US often have a cascading effect geopolitically.

The entrenchment of the anti-choice standpoint in the Republican party has undermined access to health care in the US-the same consciousness that has also shaped US foreign policy with impacts on abortion access in what North America refers to as the 'Global South'. The US government has used its power as a leading donor to family planning programmes to pursue policies that conflict with global agreements on reproductive rights including the "global gag rule" that prevents foreign nongovernmental organizations (NGOs) from using their own, non-U.S. funds, to provide abortion services, information, counselling, referrals, or advocacy [ 20]. Since it was first created in 1984, the policy has historically been enacted by Republican presidents and rescinded by Democratic ones [ 21]. These decisions have additionally impacted on access to HIV care and support, and increased unwanted/unintended pregnancies and unsafe abortions, all of which led to highly politicized maternal and neonatal mortality and morbidity outcomes continuously monitored by the World Health Organization and the United Nations on the global scale.

Regrettably, NGOs and developing country representatives are not even on the playing field where they can state or discuss how the Global gag rule violates their Global agreement and negatively impact their work in sexual and reproductive health and rights (SRHR) [ 22]. There is an increased likelihood that NGOs may be deterred from including family planning (FP) in their services given the likely international repercussions of the Roe v. Wade decision. Existing fears surrounding funding will be reinforced, resulting in further fragmentation of SRHR and HIV services, staff and trained healthcare provider shortages, increased FP stockouts, and decreased safe abortion commodities. Unfortunately, the funding structure and strength of US' geopolitical influence on the global stage has implications for strengthening opposition to abortion in governments and civil societies globally.

Medical humanities perspective

The impact of political power over abortion means greater biopolitical governmentality of women's bodies and their daily lives in the way that the American state seeks to discipline women and teenage girls [ 7]. The collision between politics and reproductive health policy has led to a redefinition of women's 'personhood' not only in terms of the 'foetus', over questions related to when exactly life begins, but also in terms of people questioning the limits imposed on their self-autonomy and agency over their own relationships and lives. Similarly, the collision between the Supreme Court's legislative decisions and reproductive health policy has polarised debates in the popular press that may not align with the nuances and complexities about how and why women and their families make decisions about seeking a medical termination or having a surgical abortion. The realities are that abortion is gendered. Abortion impacts on the embodiment of women and girls, care for their physical and psychological wellbeing and involving mainly female healthcare providers and organizations. These realities are further impacted by the Supreme Court legislation and its implications in the 13 Republican-run US states with abortion trigger bans and the ways in which they interpret the law, some in highly restrictive terms that make abortion illegal even in cases of rape and incest [ 1, 2]. As stated earlier, biopolitics will impact the "North-South" divides, both nationally and internationally, to restrict access to surgical abortion and worsen already existing inequalities of health access. It is yet unclear how this will impact medical abortion (i.e., alternative services such as provision of contraception, the after-morning pill or self-management of abortions at home) [ 23].

Researchers including Lewandowska (2022) and Guillaume & Rossier (2018) note that in countries where abortions are illegal (Egypt and Jamaica) or permitted only to save a woman's life (Nigeria and Mexico) and on the basis of health or therapeutic grounds (the Bahamas, Poland and Qatar), women resort to self-management of abortions at home [ 24, 25]. This raises further questions about how far the State will go in terms of surveillance of women's bodies to access contraception, essential medicines or services and if or how surveillance technologies will be implemented to impact the services provided by governmental and non-governmental organizations nationally and internationally [ 25]. People have reported being warned about using social media and/or accessing apps for reproductive services akin to criminalization of abortion and incarceration of Black, Indigenous and racialized communities already affected by inequalities and high rates of deaths [ 25, 26, 27]. Women who cannot gain access to abortions or self-manage abortions at home, and are impacted by socio-economic and socio-cultural inequalities, will potentially give birth to children they do not want and/or cannot care for [ 28] just as periods of austerity and socio-economic difficulties tend to increase abortions.

The Supreme Court's decision to overturn Roe v Wade will worsen people's grappling with health-related needs whilst leaving them powerless to solve their reproductive health problems, especially where there is little attention to reproductive justice. People will not have access to abortions if they have 'miscarriages, ectopic pregnancies, obstetric complications' [ 25], if they need 'lifesaving' abortions or aftercare [ 28] and will not have choice over pregnancies (for example if they have cancer or during IVF) [ 29, 30] nor be able to prepare if their child has significant medical issues/disabilities or if they have a non-viable pregnancy. Taking away that choice to have children or not have children, when to have the children and the ability to nurture the children in a safe and healthy environment, is a clear injustice. Such lack of reproductive justice and choices will once again disproportionately impact Black, Indigenous and racialized women who already have worse maternity and neonatal health outcomes [ 31], struggle to access essential medical services and are impacted by structural racism across many systems (i.e., education, health, labour). In short, criminalizing abortions nurtures an environment of fear, while stigmatization makes them more deadly as women will pay the price with their lives.

Put differently, the social determinants of health lens [ 32] facilitates an understanding of how governmentality and lack of reproductive justice in the personal realm, can impact women's education, employment, and housing and raises ethical quagmires about ensuring gender equity to combat those inequalities. For instance, will the state guarantee affordable nursery care or fund more disability services for those already facing inequalities? The impacts of such governmentality are likely to delay the achievement of many UN sustainable development goals (SDGs) which in the case of women include delaying: Goal 3 of ensuring healthy lives and improving well-being, Goal 4 of ensuring inclusive education and lifelong learning, Goal 5 of achieving gender equality, Goal 8 of promoting full and productive employment for all, and Goal 10 of reducing inequalities with and between countries.

Conclusion

Taking away the constitutional right to abortion in the US has allowed several states to ban abortion, in turn causing women to not only travel to other states or countries to access abortion but has denied them of choice in their reproductive lives. While the Supreme Court's decision mainly benefits individuals, organizations and companies who promote, manufacture, distribute and/or sell contraceptive drugs and technologies via globalized supply chains it is a gross reproductive injustice that is not only gendered but is also racialized. Understanding the biopolitical implications of population control, stemming from an oppressive history of control over women, colonization, and slavery, as well as the current US political stage, filled with polarization and racial turmoil, have geopolitical implications globally. The authors acknowledge the hard work of the individuals and groups who have diligently and continuously fought for reproductive health, reproductive rights and reproductive justice for Black, Indigenous, and racialized communities who have been and continue to be marginalized and oppressed. While the magnitude of this Supreme Court ruling will likely accelerate a process that has been evident in recent years, the work is far from over. As the president of the Guttmacher Institute, Dr. Herminia Palacio states, "all of us seeking to defend policies that support bodily autonomy must be ready to meet them [anti-abortion movement] ... must protect abortion rights and access in as many states as possible to achieve federal legislation to ensure that anyone, anywhere who needs an abortion can get one freely and with dignity" [ 1].

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Kariane Coen-Sanchez and Bassey Ebenso are joint first authors.

Authors and Affiliations

1. School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, Canada

Karine Coen-Sanchez

2. Leeds Institute Health Sciences, University of Leeds, Leeds, UK

Bassey Ebenso

3. NORImpact, Stavanger, Norway

Ieman Mona El-Mowafi

4. Unit for the Social Study of Thalassaemia and Sickle Cell, School of Allied Health Sciences, De Montfort University, Leicester, UK

Maria Berghs

5. Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada

Dina Idriss-Wheeler

6. School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada

Sanni Yaya

7. The George Institute for Global Health, Imperial College London, London, UK

Sanni Yaya

Contributions

SY and BE conceived the editorial topic. KCS, IME, DIW, BE, and MB met, discussed and outlined sections to be written; they worked closely together as a team to draft the manuscript. SY provided guidance and critically reviewed the manuscript. SY had final responsibility to submit. All authors read and approved the final manuscript.

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Correspondence to Sanni Yaya.

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Coen-Sanchez, K., Ebenso, B., El-Mowafi, I.M. et al. Repercussions of overturning Roe v. Wade for women across systems and beyond borders. Reprod Health 19, 184 (2022). https://doi.org/10.1186/s12978-022-01490-y
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Repercussions of overturning Roe v. Wade for women across systems and beyond borders - Reproductive Health

# data[].attributes.attachment_link.description
June 24th, 2022, a day that will be etched in today and future generations' textbooks as a historic day, the United States of America revoked the constitutional right to seek safe abortion care. Overturning Roe v Wade allowed the divided individual states to independently decide the legal parameters regarding abortion care.

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Senate Fiscal Agency, Reproductive Health Act. (2023)

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How to Support Someone who is Having an Abortion

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How to Support Someone who is Having an Abortion

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The first thing to do above all is to let that individual know that they can keep coming to you for help and support throughout their abortion journey. Knowing that someone cares and that they will be there no matter what can be one of the most comforting things to hear. Other ways to help include:

Listening to them

Reminding them of your love and support

Helping them receive accurate information

Offering to be there for them on the day of their appointment if they want. If it's a medication abortion, offer to stay with them or to be nearby

Offering other practical help (I.E: driving them home, having pads and pain meds on hand, watching their kids, or preparing food or a comfy place to rest)

Don't tell anyone unless they ask you to as it is up to them to decide who they want to tell

If they are having a really hard time, offer to help find them a professional to talk to

(Parenthood, 2023, May 24)

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An Update on the Consequences of Overturning Roe v. Wade | Psychology Today. (2023).

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An Update on the Consequences of Overturning Roe v. Wade

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Personal Perspective: The Dobbs decision negatively impacted women and children.

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Parenthood, P. (2023, May 24). How can I support someone who’s having an abortion? Planned Parenthood. https://www.plannedparenthood.org/blog/how-can-i-support-someone-whos-having-an-abortion

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Planned Parenthood. (2019). Planned Parenthood.

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Should I Get An Abortion? | Information to Help You Decide

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Having an unplanned pregnancy is common, and many people decide to have an abortion. Good information & support can really help you make the best decision.