By Columbia Mailman School of Public Health
The Supreme Court of the United States overturned Roe v. Wade, which protected the right to abortion nationally since 1973. The 6-3 decision in the case Thomas E. Dobbs, State Health Officer of the Mississippi Department of Health, et al., Petitioners v. Jackson Women’s Health Organization, et al also strikes down Planned Parenthood v. Casey, a 1992 case that upheld the right to abortion established in Roe.
As an immediate consequence, millions of Americans will lose access to abortion services. Transmission reached out to three members of the Columbia Mailman faculty who are experts in reproductive health and justice for comment: Terry McGovern, professor and chair; Kelli Hall, associate professor; and Stephanie Grilo, assistant professor, in the Heilbrunn Department of Population and Family Health.
WHAT IS YOUR REACTION TO THE DECISION?
McGovern: The Supreme Court is unleashing incredible pain and harm on women, girls and pregnant people for absolutely no reason except the desire to control their bodies and decision-making around their personal autonomy. The Court has gone against its own precedent, against public opinion, and against more than a century of science and evidence promoting women, girls, and communities’ health and wellbeing. Fifty years ago, the Supreme Court said abortion is a protected constitutional right, protected by the right to privacy. Now they’re saying it isn’t. This penumbra of rights to privacy is where the right to abortion sits; it’s also where gay marriage sits and where contraception sits. It’s ominous.
Hall: The ruling is no surprise to many of us who have been working in this space and who have seen an increasingly hostile policy environment—and not just in conservative parts of the country, but more broadly. Scientists, clinicians, and advocates alike have been preparing for this day.
Grilo: Overturning Roe v. Wade will likely cause a cascading effect of increasing attacks on abortion rights across the country. As of March 2022, there are 12 states with trigger bans which will go into effect immediately when Roe is overturned. Four additional states have constitutional amendments barring the right to abortion and at least five states that do not currently have trigger bans will move to ban abortion now that Roe is overturned. Even states that are unlikely to further restrict abortion will feel the impact of this enormous step backward. Abortion is healthcare. Without it many lives will be put at risk.
WHAT DOES THIS DECISION MEAN FOR PUBLIC HEALTH?
McGovern: The U. S. maternal mortality rate is almost three times higher than all other high-income countries and much higher still for Black women and Native American women. And it’s been worsening. In just the last two years, we’ve seen a 36.8 percent increase in maternal mortality. This decision will exacerbate the problem. There is modeling that shows a 21 percent increase in pregnancy-related deaths, and 33 percent increase for Black women. We know from data from many countries that when abortion is criminalized it doesn’t stop people from seeking abortions, it just makes it unsafe.
Grilo: States where abortion is legal are bracing for increased caseloads from neighboring states. Across the country, the already vulnerable populations are the ones who will be disproportionately affected by Roe being overturned. Criminalizing abortion will disproportionately criminalize people of color.
Hall: When you remove access to abortion and limit pregnant people’s health autonomy, the implications are profound and far-reaching. They extend to social and economic wellbeing and the vitality of communities and society. People who do not have access to comprehensive care in their state are forced to go to extreme financial and logistical measures. This will exacerbate poverty, material hardship, and social inequities for generations of families.
WHERE DO WE GO FROM HERE?
Grilo: Advocates around the country are organizing and coalition-building to protect the lives and wellbeing of those who will be disproportionately affected. It is the responsibility of those of us in public health to support those advocates and provide any data and resources we can in the short- and long-term fight for basic human rights.
McGovern: We need to provide legal aid to abortion care providers and patients facing criminal prosecution. We need to make sure that prosecutors who don’t want to do these cases have up-to-date data to support their decisions. There are states where abortion is still legal that are strengthening their laws and policies to expand access and resources. We need to monitor and push to strengthen HIPAA protection of patient privacy and make sure the FDA’s decision around access to abortion medication is the law of the land. It’s time to get super strategic. If you want to do public health, there’s no way to stay out of politics. I still have a lot of hope.
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