A draft Supreme Court opinion authored by Justice Samuel Alito and leaked to Politico indicates that as of February, five justices had agreed to overturn the 1973 Roe v Wade decision that prohibited states from banning abortion prior to fetal viability. The final decision—in the case Dobbs v Jackson Women’s Health Organization, which concerns Mississippi’s 15-week abortion ban—has not been released, and it’s possible that one or more of the justices who took that position in February will change their minds before it comes out (likely in June near the end of the Court’s term). For the moment, abortion is still legal in the United States.
That could change quickly if the Supreme Court overturns Roe v Wade, which it appears poised to do. Many states either have pre-Roe bans still on their books or have passed bans that will be triggered if Roe is overturned, and others have expressed an intent to limit abortion to the maximum extent permitted. Only 16 states have laws that protect the right to abortion, and their clinics will quickly be overwhelmed—though some abortion-banning states seek to prohibit their residents from crossing state lines to access this form of healthcare. Politicians opposed to reproductive autonomy are also restricting access to medication abortion, which federal policy now allows to occur via telehealth. Those prevented from acquiring abortion pills through sanctioned channels are likely to order them online, either from commercial sellers or from organizations like Aid Access that provide online consultations and send the drugs by mail. We’ve already seen women jailed for miscarriages and stillbirths, and prosecution for pregnancy outcomes is likely to increase—and be particularly harsh for Black and brown people and those with low incomes, who already suffer disproportionately under current laws.
Many things about the current situation enrage me, like the fact that four of the five justices who in February were ready to strip the right to bodily autonomy from a huge portion of the U.S. population were appointed by presidents who lost the popular vote—and one of them holds a seat that if not for Mitch McConnell’s hypocrisy would be held by Merrick Garland. One thing that’s particularly galling is the fact that in drafting his opinion, Alito ignores extensive evidence about how important the right to abortion has been to U.S. society and that removing it will cause tremendous suffering.
In the Washington Post, the ACLU’s Ria Tabacco Mar condemns “the rosy picture of pregnancy painted by Justice Samuel Alito, who has never been pregnant.” She notes that he lists “modern developments” that lessen the financial toll of pregnancy: discrimination bans, leave for pregnancy and childbirth, and coverage of medical care associated with pregnancy. However, she points out, women are routinely fired or forced into unpaid leave for being pregnant, most people can’t afford to take the unpaid leave that the Family and Medical Leave Act offers, and childbirth is often costly with private insurance and a particular financial hardship for those with low incomes who live in states that haven’t expanded Medicaid (a list that overlaps with states that will ban abortion if Roe is overturned). “I, for one, would love to live in the country that the draft opinion describes, where pregnancy is physically and economically safe, valued and supported,” she writes. “Unfortunately, we live in this one — where even a wanted pregnancy and birth can be among the most economically disruptive experiences most people can expect to face.”
Alito’s leaked opinion also claims it’s too hard to assess “the effect of the abortion right on society and in particular on the lives of women.” This is demonstrably false. Although designing a rigorous study to assess the impacts of abortion access is challenging, researchers have risen to that challenge. The longitudinal Turnaway Study conducted by Advancing New Standards in Reproductive Health (ANSIRH) at the University of California, San Francisco, recruited a cohort of women who sought abortions near the gestational limit; some were just under the limit and received the abortions they sought, while others were turned away. The researchers compared these otherwise similar groups and found that those denied abortions were more likely to face worse outcomes years into the future, including being more likely to be living in poverty and to continue to experience violence from the man involved in the pregnancy.
The worse outcomes ANSIRH researchers identified are among those who survived—an important distinction, given that in the U.S. maternal mortality is a serious problem that disproportionately affects Black and American Indian/Alaska Native women. Amanda Jean Stevenson of the University of Colorado Boulder calculated the mortality impact of denying all wanted abortions in the United States: a 21% increase in pregnancy-related deaths overall, and 33% for Non-Hispanic Black people. Despite the “modern developments” Alito references, being forced to carry an unwanted pregnancy to term can still result in death.
There are other problems with evidence that Alito ignores or misrepresents in his draft, but as a women’s health researcher I’m particularly aware of these glaring blind spots. Briefs submitted to the Supreme Court in the Dobbs case (including a public health-focused brief, on which I’m a signatory) reference the Turnaway Study and other high-quality research that demonstrates banning abortion is harmful to public health. Yet Justice Alito claims it’s too hard to assess the effect of abortion access “on the lives of women.” The harms to the lives of women—and on trans and non-binary people who can become pregnant—of banning abortion are well documented, and a failure to recognize that seems like willful ignorance.
Alito seems to be living in an alternate reality in which pregnancy and parenting are easy and being forced to bear a child against one’s will is no big deal. His apparent ignorance is poised to thrust our country into a much harsher reality, in which pregnant people must impoverish their families and risk criminal prosecution in order to exercise control over their lives.