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Reproductive Rights (Again) Under Attack: Bracing for a Post-Roe World

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abortion-roe v wade-abortion-gender based violence-childbirth-maternal mortality-unwanted pregnancies

Reversing Roe v. Wade will not only make safe abortion harder to access, but it also opens the door for prosecution — a burden that won’t be evenly shared.

TerryMcGovern-ColumbiaUniversity

Terry McGovern, J.D.

Chair and Professor, Heilbrunn Department of Population and Family Health; Director, Global Health Justice and Governance Program, Columbia University Mailman School of Public Health

MaliaMaier-ColumbiaUniversity

Malia Maier, M.P.H.

Senior Program Officer, Global Health Justice and Governance Program, Columbia University Mailman School of Public Health

JPEugino-ColumbiaUniversity

JP Eugenio, M.P.H. 

Senior Administrative Manager, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health

About 1 in 4 women in the United States will have an abortion by age 45. They will do so for a variety of reasons: to protect their health, for economic security, bodily autonomy in the wake of gender-based violence, and/or survival.

The U.S. Supreme Court (SCOTUS) is poised to overturn Roe v. Wade, which established access to safe and legal abortion as a constitutional right. While fierce and incremental attempts to weaken this right are not new (states have enacted 1,338 restrictions since the landmark ruling), SCOTUS will likely undo nearly five decades of precedent and unleash unfettered harm on pregnant people and children. Of note: the states leading the charge to prohibit abortion, citing concerns for unborn children, are those with the worst maternal health outcomes and horrific records of abusive adoption and foster care systems, particularly for people of color.

When Roe v. Wade is overturned, 26 U.S. states will likely ban abortion. This poses an urgent threat to the health and well-being of women, girls, nonbinary, trans, and gender queer individuals. Let’s be clear: denying people access to legal abortion does not stop them from having abortions — it just makes them less safe. In-clinic and medication abortion are very safe — even safer than childbirth. Serious complications are rare, and studies have found having an abortion does not lead to negative long-term health effects.

Unsafe abortion, on the other hand, is a leading — but preventable — cause of maternal deaths and morbidities globally. A recent study estimated that banning abortion in the United States would lead to a 21 percent increase in pregnancy-related deaths. Black women, who already bear the brunt of the U.S. maternal mortality crisis, would experience a 33% increase.

Criminalizing pregnancy

Eighteen states also have criminal laws on the books that would enable the prosecution of pregnant people and their providers. Once SCOTUS overturns Roe v. Wade, these laws will be enforceable. Criminalizing abortion will not affect everyone equally. Black Americans are incarcerated in state prisons at five times the rate of white Americans. This will invariably spill over into abortion-related prosecutions. Women of color are significantly more likely than white women to be reported to law enforcement when seeking medical care. People with low-income are more likely to be arrested and detained for pregnancy-related crimes. These issues will be compounded by the unequal distribution of who gets abortions — rates of unintended pregnancy and abortion are highest among those below the poverty level.

Criminalizing abortion will also disproportionately impact immigrants, who already have less access to sexual and reproductive health services, putting them at risk of unwanted pregnancies. A reversal of Roe v. Wade is predicted to increase average travel distance to the nearest abortion facility by 249 miles for residents of affected counties. Those without legal documentation who cross state lines or borders risk being convicted with criminal penalties, which can lead to deportation or affect immigration applications and renewals. All these conditions make it even harder for people already on the margins to access safe abortion care.

Simply put, abortion is healthcare. In fact, it is an essential component of women’s healthcare, as declared by the American College of Obstetricians and Gynecologists. State and federal restrictions like criminalization pose greater barriers and prevent pregnant persons from realizing their fundamental right to bodily autonomy and reproductive freedom. As renowned reproductive justice leader Loretta Ross recently said, “the law will only be as good as social movements demand it to be.”


In light of the recently leaked draft decision by Justice Alito, it’s important that we support those women living in states where access to safe and legal abortions will not be possible. This spreadsheet has been compiled by @helmsinki on Twitter, and includes abortion funds in every state you can support. If you can’t make a donation, consider spreading it to those who may be able to.

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