The U.S. Supreme Court issued a ruling on Friday that overturns the landmark 1973 Roe v. Wade decision guaranteeing a woman's right to abortion.
"The Constitution does not confer a right to abortion... and the authority to regulate abortion is returned to the people and their elected representatives," the high court said in its opinion on Dobbs v. Jackson Women's Health Organization.
The decision sets the stage for a swift rollback of abortion rights in more than half of the United States. In that case, Mississippi's sole abortion provider, Jackson Women's Health Organization, sued the state in 2020 after lawmakers banned abortions past 15 weeks, with no exceptions for rape and incest. Thomas Dobbs has been the state's chief health officer since 2018.
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If this news leaves you concerned about what the future may hold for you, you are not alone.
"This is just a huge setback in the strides we've made for reproductive rights within this country," says Dr. Joanne Stone, chair of obstetrics, gynecology and reproductive science at Mount Sinai Health System in New York City. "It's been devastating to me to think about how this is going to impact women throughout the country."
Black women will be especially hit hard because they start with worst health outcomes, have lower incomes, lack insurance and lack access to quality health care. Black women are also more likely to seek abortions due to lower access to contraceptives and their high risk of having dangerous pregnancy complications. For many Black women, these now illegal abortions can save their lives from something devastating happening while trying to give birth.
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According to 2019 data from the Centers for Disease Control and Prevention (CDC), U.S. Black women are five times more likely to have abortions than white women, while Latina women are twice as likely.
More than one-quarter of all U.S. abortion clinics are expected to face eventual closure, as 202 facilities come under state-adopted abortion restrictions following the ruling, according to a report from the University of California, San Francisco's Advancing New Standards in Reproductive Health center.
The decision will "particularly decimat[e] abortion access for pregnant people living in the South and Midwest, where most of these closures would occur," the report said.
There are 26 states certain or likely to move quickly to ban or severely restrict abortion access following the court's decision, according to the Guttmacher Institute, a reproductive health think tank. These include 13 states with so-called "trigger laws" in place that will ban or severely restrict abortion rights immediately or through quick state action.
States with trigger laws are Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, and Wyoming.
Meanwhile, nine states still have pre-Roe abortion bans on their books that will now become active, and another 11 have bans on early gestational age abortions that until now had been blocked, Guttmacher says.
Black women disproportionately live in these states and will be more likely to suffer illness and mortality without the right to the full range of reproductive health care.
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What does this mean for Black women?
"We know that with every barrier that gets put between women and reproductive health care, we see that women's outcomes worsen," says Dr. Dana Gossett, chair of the department of obstetrics & gynecology at NYU Langone Health in New York City. "One that we anticipate is that there will be women who simply cannot access a desired and needed abortion because they don't have the resources to go beyond their local environment. They don't have the ability to drive or fly to another state, or the ability to seek care elsewhere."
But there will be more fallout.
"When barriers are put up between women and abortion services, the gestational age at which women ultimately receive their abortion is later," Gossett notes. "Legal abortion is much safer than childbirth at all gestational ages at which its conducted, but the risks do increase as you move from the first to the second trimester, and so women who delay the procedure because they can't access the care they need will be assuming greater risk to themselves."
What can women do to protect themselves?
Several organizations have been working to provide online access to medication abortions in anticipation of Roe v. Wade being overturned.
"That is an option that allows women to have a private, confidential consultation with a health care provider who provides abortion services, possibly not in their state or location, and can receive pills by mail that can safely accomplish an early abortion," Gossett explains. "That's one thing I suspect will continue to grow as local access to health care providers offering abortion services diminishes."
Going forward, women will need to be much more careful with contraception and family planning, particularly if they have risk factors that make pregnancy a potentially life-threatening condition, says Stone, who is president of the Society for Maternal-Fetal Medicine, a medical association dedicated to high-risk pregnancy care.
Women and their doctors will also face hard choices regarding fetal abnormalities, particularly regarding the expectations of carrying a fetus expected to die after birth, Stone adds.
Some women will face the prospect of either going forward with a dangerous pregnancy or undergoing a high-risk self-induced abortion, Stone shares.
If you find yourself challenged by these difficult decisions, talk with your doctor who can help guide you in making the best possible decision.
