2 Years After the End of “Roe,” We Must Demand More Than Its Restoration

Two years after the Supreme Court decision Dobbs v. Jackson Women’s Health Organization ended federal protections for the legal right to abortion, the number of people traveling across state lines to access abortions has more than doubled. Within the six-month period immediately after the decision, an estimated 27,838 more people accessed abortion outside the formal medical system than would have been expected before the Dobbs decision. Based on the first six months of 2023, researchers estimated over 30,000 people per year since the landmark decision who would have accessed abortion instead continued their pregnancies. The New York Times reported this figure to be “a relatively small increase that was in line with overall expectation,” but assuming the estimate to be accurate, the reproductive lives of over 30,000 people per year were fundamentally different as a result of the Dobbs decision and these individuals were put at higher risk of various harmful outcomes, including increased financial instability and physical health problems, than they would have been if they had been able to access wanted abortions.

Dobbs, which was the first case to fully overturn the precedent set by Roe v. Wade in 1973, was the culmination of a long and complex conservative political strategy. The anti-abortion movement has employed multiple legal avenues, including influencing legal and judicial education and appointments and funding election campaigns of anti-abortion candidates. The entities orchestrating the anti-abortion project in the United States — including politicians, judges, and religious and political organizations — have since shifted their efforts toward increasing criminal penalties for those who have abortions in states with bans; banning or restricting abortion pill access; and working toward a national abortion ban.

The Dobbs decision transformed the abortion access landscape, putting extreme strain on a system of abortion providers, clinic workers and abortion funds that was already highly over-taxed due to the significant gaps in access that Roe v. Wade never prevented. The gaps included legislation intended to induce clinic closures and make access more difficult through waiting periods and other unnecessary barriers like the Hyde Amendment, which bars federal funds from being used for abortions, with implications for abortion access for people with federally provided insurance coverage and who live in states that will not use their own Medicaid funding to cover abortions even where it is legally accessible.

Abortion has been stigmatized and exceptionalized from the rest of health care since the advent of the modern medical system in the United States. In the 19^th century, the physicians of the newly formed American Medical Association campaigned alongside politicians to make abortion an issue of morality in U.S. society in order to consolidate their power and control who could practice medicine.

Their efforts included attempts to push midwives, in particular Black Southern midwives, out of practice through the simultaneous introduction of medical practice licensure requirements and criminal penalties for providing abortion care, a service provided primarily by midwives. In the endeavor to secure social and economic power for physicians through the creation of a formal medical system requiring education at medical schools that would at the time only admit white male students, these physicians transformed the general public’s perception of abortion and opened the door to the criminalization of abortion that we are facing today. These criminalization campaigns across history have relied on xenophobic and racist ideas that have been cyclically embraced in the context of rising immigration and the popularity of eugenicist ideologies.

The Dobbs decision transformed the abortion access landscape, putting extreme strain on a system that was already highly over-taxed due to the significant gaps in access that Roe v. Wade never prevented.

Now, it is widely considered a fact among medical and human rights organizations, including The American College of Obstetricians and Gynecologists and the current American Medical Association, that abortion is essential health care. However, it is impossible to separate abortion bans from the politics and capitalism of the formal medical system, not only due to these deep historical ties but also to the present-day role of medical professionals in the criminalization of abortion patients. A recent report by If/When/How, a legal advocacy and research organization focused on reproductive health and criminalization, found that even before Dobbs, people who were criminally investigated for pregnancy outcomes were most often reported by health care workers.

In 2022, Data for Progress reviewed the evidence that companies were paying lip-service to reproductive rights by publicly stating they would cover abortion-related travel costs for any employees living in ban states while simultaneously contributing financially to the election campaigns of the politicians behind the bans themselves. They found that UnitedHealth Group, one of the largest health insurance companies in the United States and the world’s largest health care company by revenue, had donated the highest amount, over $1.1 million, to anti-abortion political campaigns. The historical pattern of powerful health care entities prioritizing capitalistic success over the health of the people they claim to serve continues.

Abortion has been stigmatized and exceptionalized from the rest of health care since the advent of the modern medical system in the United States.

It is nonetheless a common pro-abortion argument that abortion should be legal and accessible because it is a form of health care. In fact, some leaders in the movement have sought specifically to depoliticize the conversation around abortion. However, in a country that does not consider health care to be a basic human right, the only high-income country without universal health insurance, it is complicated to argue something should be accessible on the basis that it is health care. People with diabetes cannot afford insulin despite the fact it is life-sustaining, and crowdfunding to pay for cancer treatment is commonplace. Health care in the United States is deeply inaccessible to the majority of people, regardless of the type of care provided and how important it is from a medical perspective.

Reproductive rights and justice groups across the world are aware that the only effective path toward liberation from reproductive oppression is to confront the politicization of abortion and to link the abortion access movement to a broader goal of defending bodily autonomy. Feminist groups in Latin America behind La Marea Verde, or the Green Wave, a grassroots social movement that has won the liberalization of abortion laws across the region, have centered their fight on achieving free abortion on demand, not simply a theoretical legal right that is a reality for only those who can afford it. Leftist activists in the United States have similarly pointed to the necessity of demanding more than what Roe provided, emphasizing that it is crucial for our movements’ success to be focused on building a strong nationwide movement for free abortion on demand.

Abortion is health care, but it is also much more than health care. Abortion is a key part of self-determination and bodily autonomy that deeply influences not only family formation but overall life trajectory. Abortion was first politicized and criminalized in the United States through the establishment of modern professionalized medicine. If abortion is normalized as health care without dismantling the capitalist structure of the current U.S. health care system, it will reproduce the abortion access inequities seen under Roe. Achieving meaningful abortion access for all in the United States will require reimagining and rebuilding our health care systems and culture. We can only create this future if we confront and embrace the inherently political nature of not only abortion, but all types of health care, to achieve genuine bodily autonomy for all.