Greater Good Blog

One year ago tomorrow, the Supreme Court reversed nearly 50 years of legal precedent and severely curtailed access to standard medical health care in one fell swoop. The Dobbs decision unleashed uncertainty and heartbreak as scores of women and their medical care providers were forced to navigate—in real time—the changing state laws and their immediate application to intensely private medical decisions. As predicted, we now have ample evidence that overturning Roe’s protections and guaranteed access to abortion care has not just robbed countless women of bodily autonomy, it has endangered their lives. 

Amanda Zurawski’s stunning testimony to the Senate Judiciary Committee in April served as just one example. Amanda’s story—made even more impactful due to her matter-of-fact portrayal of a horrific yet completely preventable health care outcome—depicts the sad state of declining obstetric care in states that rushed to pass laws severely limiting women’s access to standard medical services needed to treat pregnancy complications.  

It is shameful that in 2023, in Texas and across the country, a practitioner’s ability to provide medically appropriate care is hardly a given, as Amanda’s experience clearly demonstrates. There is no standard interpretation of what exceptions are permissible under Texas state law, leaving providers and their hospitals to make judgment calls based not on medical necessity but on the likelihood of facing legal action. In fact, five Texas women joined with two providers to sue the state over the law’s ambiguity and overly punitive standards, arguing that the uncertainty around permissible medical emergency exemptions has put women’s lives and future fertility at risk. 

And the crisis isn’t limited to Texas, of course. As of this writing, 14 states have banned abortion outright, of which only three permit exceptions in the case of rape and incest. Another six states have banned abortions after a certain number of gestational weeks, ranging from six to 22 weeks. And a further seven states had so-called “trigger laws” banning abortion already in place that were designed to automatically go into effect if Roe were overturned. Some of those bans, however, are currently blocked due to ongoing litigation. Fortunately, abortion remains legal in 25 states and the District of Columbia, and 20 of those jurisdictions have added new protections to their existing laws, though five of the states where abortion remains legal do have gestational limits, ranging from 22 to 24 weeks of pregnancy.[1] These restrictions, and the variation from state to state, have sown chaos across the country, leading to significant confusion and concern among those seeking and providing care. 

Further, the reduction and variation in access to abortion care across the country has a disproportionately negative impact on low-income women, women of color, and all women located in regions where access is banned or limited across multiple contiguous states, such as in the South and the Midwest (as this makes traveling to a neighboring state for an abortion more difficult). Moreover, providers located in states where access remains legal report a significant uptick in cases of severely sick women coming to them with complicated emergency cases that not only have grave impact on their health but cost significantly more to treat.[2] This indicates that as women are forced to travel farther and longer for abortion care, they face graver outcomes and increased financial burden. 

While the Dobbs decision came as a shock to millions of people nationwide, it was no fluke: it was the result of a decades-long, concerted effort by the anti-choice movement. While the outcome was not surprising to the many advocates, practitioners, and organizers who have dedicated their lives to ensuring reproductive rights for all, it was nevertheless a devastating blow. 

Yet there is still hope. Organizations across the reproductive access movement have risen to the occasion over the last year, and we are inspired by the amazing work they have done over a relatively short time frame to adapt their strategies in light of this new reality. With abortion access varying state by state, the fate of reproductive and gender equity increasingly rests in the hands of local courts and decision-makers. 

For example, just weeks after the Dobbs ruling, voters in Kansas rejected a ballot initiative proposal that would have asserted that women in the state have no right to an abortion. And, within the past year, Gender Equity Action Fund’s work to channel national funders’ support to local, state-based strategies has led to huge wins for reproductive rights.  

As another example, in April, voters in Wisconsin turned out in huge numbers for the traditionally low-profile Wisconsin Supreme Court race, in which Janet Protasiewicz defeated the anti-choice candidate, Dan Kelly. Wisconsin will likely see a legal challenge to its abortion ban in the year ahead, and with Justice Protasiewicz on the bench, the state Supreme Court now has a liberal majority. These local wins are part of an ever-growing state-by-state network of protections that advocates have fought for and secured over the last year.  

The movement has not abandoned the federal fight, and this year the All* Above All network continued its bold pursuit of federal policy that ensures abortion care is affordable, available, and accessible for anyone who needs it. And in recent months, the All* Above All network has been working to introduce a new, visionary federal bill that addresses the many barriers to abortion care. More than 50 partner organizations dreamed about bold policy solutions in listening sessions last summer, creating the Action Plan for Abortion Justice. Now, that work is culminating in the Abortion Justice Act, a bill that legislators just introduced in the US House of Representatives, led by Congresswoman Ayanna Pressley.   

While this crucial advocacy work has been underway, organizations like Resources for Abortion Delivery (RAD) have been working to ensure that women navigating this new landscape still have access to the life-saving health care they need. RAD makes grants and loans to independent abortion providers across the United States—both 501(c)(3)s and taxable businesses—to help them protect or expand abortion access. After the Dobbs decision, RAD established a program called the Access Fund, which provides no-cost abortions to low-income people from states where abortion is now banned. 

This is just a small sampling of the amazing work the repro movement has done over the past year. So many organizations across the country have stepped up to preserve the right to bodily autonomy, and their efforts are making a real difference for many individuals nationwide. 

As the fight for access to abortion care services moves on in the aftermath of the Dobbs decision, new frontiers of legal action are emerging. At the state level, in February, 21 governors announced they are convening a nonpartisan effort called the Reproduction Freedom Alliance, with philanthropic support from the California Wellness Foundation and the Rosenberg Foundation. In a statement, the governors said: “In the face of this unprecedented assault by states hostile to abortion rights and their enablers in the courts, we are pledging to work together to strengthen abortion firewalls across America.”[3] The governors are sharing strategies to protect abortion care providers from prosecution, helping to maximize federal funding for reproductive health care, and coordinating responses to the Texas lawsuit that threatened to remove FDA approval for mifepristone, a key medical abortion drug.   

Ensuring continued access to medical abortion drugs is currently the most active new frontline in the battle for reproductive rights. While the US Court of Appeals for the Fifth Circuit preserved the use of mifepristone for the time being (overruling US District Judge Matthew Kacsmaryk’s February decision in the aforementioned Texas lawsuit to rescind FDA approval of the drug), there are new limitations on this access. Previously, the drug could be mailed and used up to 10 weeks of pregnancy. As the case winds its way through the legal system, it is now only approved for use up to seven weeks, and it can no longer be mailed. 

A year after the Dobbs decision overturned Roe, we are still grappling with a new reality of abortion care in the United States. As we have seen, these ceaseless attacks will not stop with abortion access. Contraception, LGBTQIA+ rights, and gender-affirming care are under attack as well. Even with the extraordinary work and impact of the above-mentioned organizations and many others, the need continues to grow for philanthropic support, policy protections, and intersectional movement-building. We look forward to supporting, learning from, and fighting alongside movement leaders to reinstate and permanently preserve bodily autonomy so that individuals retain the freedom to exercise self-determination in the pursuit of their medical care. 

 

Sources: 

[1] New York Times, “Tracking the States where Abortion is now Banned,” updated June 5, 2023. 

[2] New York Times, “What It Costs to Get an Abortion Now,” by Allison McCann, September 28, 2022. 

[3] February 21, 2023. Office of Governor Gavin Newsom, CA.