By guest contributors Rashi Jhunjhunwala, MD MA; Arturo Cervantes Trejo MD MPH DrPH; Pablo Tarcisio Uribe-Leitz MD MPH; John Lindsay-Poland, Keith Martin…
The leaked draft from the U.S. Supreme Court signaling the court’s intent to overturn Roe v. Wade, the landmark decision that has guaranteed legal abortion in the United States for nearly 50 years, was a shocking, rights-denying move—but not one we haven’t seen coming for decades.
It’s important to contextualize the court’s apparent decision in Dobbs v. Jackson Women’s Health Organization and not see it as a singular event. The leaked draft, which seems likely to be the court’s final decision, caps off a decades-long campaign by conservative forces in the United States and around the world to take away hard-earned human rights. It comes after a steady stream of U.S. state laws restricting access to abortion, after a rise in white nationalist movements in the United States and other parts of the world, and after a Trump presidency that gave anti-abortionists something they have long desired—a Supreme Court majority willing to overturn Roe v. Wade.
This puts the United States firmly out of step with the rest of the world. Since the mid-1990s, nearly 50 countries have liberalized their abortion laws. In Latin America, a “Green Wave” of abortion activism is sweeping over Latin America and keeps swelling: Argentina liberalized its law in 2020, Mexico’s Supreme Court declared in 2021 that criminalizing abortion is unconstitutional, Colombia liberalized its law this year. And in regions such as Francophone Africa, where there is a vast, unmet need for safe abortion care, that need is beginning to be met in countries like Benin, where a new law permits abortion access in the first 12 weeks of pregnancy for a wide variety of reasons, such as continuing education, reducing economic stress, and protecting mental health. The United States, meanwhile, is joining a handful of autocratic countries—such as Poland, El Salvador and Nicaragua—that are intent on making access to abortion nearly nonexistent and have little regard for human rights.
All of this stands in stark contrast to the updated guidance on safe abortion released this year by the World Health Organization (WHO). The framework of the evidence-based guidance could not be more clear: Abortion is essential health care. Abortion is a human right. Everyone who needs an abortion should be able to access it. With respect to access, the guidelines specifically recommend against “medically unnecessary” policy barriers to abortion care, such as “such as criminalization, mandatory waiting times; the requirement that approval must be given by other family members, or institutions; and limits on when during pregnancy, an abortion can take place…Such barriers can lead to critical delays in accessing treatment and put women and girls at greater risk of unsafe abortion, stigmatization, and health complications, while increasing disruptions to education and their ability to work.”
While we must not forget that Roe v. Wade has never guaranteed access to abortion for all, what the Supreme Court seems primed to do is to force even more people to endure the kind of hardships that the WHO so plainly recommends against. For example, it’s estimated that there would be an additional 600,000-800,000 births each year if Roe falls. This would increase health risks, especially for Black and Brown women in states where abortion is likely to be almost completely banned, such as Texas, Mississippi and Louisiana. Women of color are more likely to lack access to basic health care and have higher rates of infant mortality. A 2021 study published in Demography examined what a nationwide ban on abortion in the United States would lead to in terms of maternal mortality. The study concluded it would lead to a double-digit boost in maternal mortality, with a 21% increase in the number of pregnancy-related deaths overall and a 33% increase among Black women. As the coronavirus pandemic has laid bare, the U.S. public health system is already beset with gender, racial and economic inequities that make it difficult for women, people of color, LGBTQ people and other marginalized groups to get the essential health care they need. Policy barriers against abortion access add to those inequities. In addition, how will an already struggling OB-GYN workforce handle hundreds of thousands of additional births? The U.S. Health and Human Services has projected a growing shortage of OB-GYNs, with a shortfall of more than 5,000 by the year 2030—a projection that did not factor in the possible overturn of Roe.
In our work at Ipas, we know that when abortion is criminalized, women and providers will be jailed and imprisoned, as we have seen in El Salvador, Nicaragua and Brazil. In El Salvador, abortion is completely banned and over the past 20 years more than 180 women have been prosecuted for abortion-related crimes. One was Manuela, who was sent to prison for 30 years and died while serving her sentence. Her “crime” was that she was having an obstetric emergency and was suspected of having an abortion.
In Nicaragua, where abortion is also totally banned, a study by Ipas Central America in 2016 found that one impact of the ban was “an epidemic” of child mothers. Every year approximately 6,750 girls between ages 10-14 are victims of sexual violence, and 1,300 become pregnant, according to Nicaragua’s 2011-12 National Demography and Health Survey. But the report and an accompanying collection of testimonials from girls interviewed for the study found that, in reality, the number of young girls who become pregnant from rape is much higher. Does the United States aspire to this?
We also have seen that health centers will close when abortion is criminalized. In Brazil, where practitioners can be imprisoned and persecuted, police raided a private family planning clinic in Mato Grosso do Sul in 2007, confiscating the medical records of more than 9,600 female patients. Four staff members at the clinic were prosecuted for participating in abortions and received prison sentences ranging from four to seven years.
Despite the shock and the dismay U.S. abortion and human rights advocates are experiencing now, we must not despair. This shameful leaked opinion by the U.S. Supreme Court cannot overcome the Green Wave of abortion rights activism in Latin Americaand the decades of progress that preceded it. One powerful fact we know is that when abortion is restricted pregnant people will find a way to end an unwanted pregnancy. Fortunately, abortion pills are now much more accessible, and even in countries where abortion access is limited, people can have an abortion on their own, safely and with dignity. In the United States, abortion with pills now accounts for more than half of all abortions. Self-management of abortions in the first 12 weeks of pregnancy is safe, effective and should not be considered “a last resort” but instead as “a potentially empowering” extension of health systems, according to the updated WHO guidance.
We must also learn lessons from feminists and reproductive justice warriors around the world. We must take to the streets (and that’s already happening). One lesson is to make our voices heard at all levels. We must take the fight to the courts, the state legislatures, the Congress and the White House. There are new, drastic bans being imposed in state legislatures every day.
The court’s apparent decision to overturn Roe v. Wade underscores the intersectionality of abortion rights with other rights. One of court’s justifications for its apparent decision to overturn Roe is that abortion as a right that does not exist in the U.S. Constitution. This will fuel efforts to deny other rights not mentioned in the Constitution, such as the right to gay marriage, to interracial marriage, and even to the use of contraception. As Dr. Tlaleng Mofokeng, United Nations special rapporteur, has said, “The court will give legitimacy to an ever-growing anti-women’s rights [movement] in totality. People who are anti-women’s rights and anti-equality see abortion as a low-hanging fruit.”
As we begin to find our way in and through a post-Roe era, our task is clear: We must join with our many allies in the sexual and reproductive health and rights movement—and reach out to those involved in other progressive movements for racial equality, women’s and LGBTQ rights, health-care, and economic equity. Speaking out and making this a voting issue in the United States is imperative now. We all must go high when the highest U.S. court goes low. Persist, protest, give to abortion funds, and support groups that are working for abortion access. The time is now to voice our dissent.
Anu Kumar joined Ipas in 2002 as Executive Vice President. In that role, she had oversight of Ipas’s fundraising and communications efforts, started a new technical area working with communities and pioneered work on abortion stigma. In 2016, she became Ipas’s first Chief Strategy and Development Officer and lead the organizational strategic planning process, along with fundraising, partnership development and technical innovation. In her tenure at Ipas, she has overseen technical and operational aspects of the organization from finance to medical abortion. Dr. Kumar has been involved in the creation of several new country programs for Ipas including in Indonesia, Myanmar and Mozambique. Dr. Kumar has published in blogs, including Huffington Post, Forbes, Think Global Health, and Ms. Magazine, and in peer-reviewed journals.
Prior to joining Ipas, Dr. Kumar served for seven years as senior program officer in the Population and Reproductive Health program of the John D. and Catherine T. MacArthur Foundation. In that capacity, she was responsible for grants to organizations working in India and to international organizations, and for grants in the field of population and the environment. Prior to her work with the MacArthur Foundation, Dr. Kumar worked as a social scientist at the World Health Organization’s Reproductive Health Research Division. Dr. Kumar has a master’s degree and a PhD in anthropology and a master’s degree in public health from the University of North Carolina at Chapel Hill.
She tweets at @AnuKumarIpas