Now that the Supreme Court has overturned Roe v. Wade, the states will be free to criminalize abortion at any point in pregnancy. To get a sense of how the ruling will affect women’s health, as well as the particular risks Black women face, I spoke with Joia Crear-Perry, a physician and founder of the National Birth Equity Collaborative, and Monica McLemore, an associate professor at the University of California, San Francisco School of Nursing. The conversation has been edited for length and clarity.
Sarah Green Carmichael: In light of this ruling, what do you expect the impact to be on women’s health, and on Black women’s health specifically?
Monica McLemore: Criminalization will mean that some physicians and organizations are going to get spooked and stop offering care, which may limit access for other reproductive care — things like sexually transmitted infections, infertility care and a whole variety of other things. The places that will continue to provide abortion services are going to be so overrun that we’re going to be looking at long waiting periods for appointments. And that’s not just on the abortion side. It’s also on the pregnancy continuation side.
Joia Crear-Perry: There will also be an economic impact, and not just on the people forced to be pregnant. Think about all the people who’ve been working in restaurants, delivering food, driving Ubers — if they have no control over their own bodies when it comes to reproduction, then that impacts those businesses. It impacts any employer who has an employee who cannot control their own body. Not that Black women shouldn’t be centered or that our issues aren’t important, but this impacts everyone.
SGC: Say more about the effect on other reproductive health services. I feel like there is an assumption that you can just draw a neat little box around an elective abortion and excise it. Why doesn’t that work?
MM: People assume that the people who provide abortion care are distinct from the people who provide pregnancy care and distinct from the people who provide sexually transmitted infection care. But they’re all connected, just like the people who have abortions and pregnancies and carry babies to term are not different patients — they are just at different points in their lives.
SGC: The laws that would make abortion a crime sometimes have exceptions for rape, incest or the life of the mother or very severe health outcomes. Why doesn’t that suffice to protect women’s health in practice?
MM: It means you only are entitled to bodily autonomy after somebody else violates it. But you have a human right to bodily autonomy. The way I’ve explained this to students is this: There’s a reason you have to sign an organ-donor card when you get your driver’s license. That’s because nobody can take your organs without your consent, even after you’re dead. You have bodily autonomy in life and death. That’s irrefutable. And as long as that’s true, then that means forced pregnancy is incongruent with human rights principles.
SGC: Are there other misconceptions about abortion access you wish the broader American public understood?
JCP: What I really wish people would remember is that what we call private insurance is really employer-sponsored insurance. That means your employer can choose if they want to cover abortion services. We already have so many layers of people controlling access to a basic health-care function. In other high-income nations, abortion is free, covered by public insurance.
When [Dobbs v. Jackson Women’s Health Organization, the case that posed the challenge to Roe] was being argued, Chief Justice [John] Roberts stated that other nations that allow abortion have a first-trimester cut-off, but that’s a cut-off for abortion being free; if you take longer than 12 weeks to decide you want an abortion, then maybe then you have to pay something. What we’re talking about in the US is just having access to it, period.
SGC: There have already been more than 1,300 prosecutions for miscarriages in the US, and women of color are disproportionately targeted in those. Do you expect those numbers to increase if abortion becomes a crime?MM: We already know that Black people are over-criminalized in the US. Criminalization of abortion may mean more health-care workers or Child Protective Services calling the police on people they suspect of self-managing an abortion, even if it’s actually a miscarriage. But these are people who have experienced a loss. Criminalization isn’t the way to deal with grieving people.
SGC: One of the biggest reasons that people seek abortions is because they feel like they can’t afford to have another child — I say “another” because most people who seek abortions already have at least one child. What is the role of economic and social policy in reducing the number of abortions?
JCP: All of these things are tied together, from the child tax credit to paid leave. It’s really about creating the infrastructure so that families can thrive. The states that are most likely to severely restrict abortion are the same states that have the absolutely worst rates of infant mortality and maternal mortality. And it’s the same states that didn’t expand Medicaid, don’t have paid leave, and don’t protect equal pay. In the US, we have some of the worst health outcomes in the developed world. And that’s not a coincidence.
SGC: The US also has very high rates of maternal mortality in general, compared with other wealthy nations. And Black women are three times as likely to die from childbirth or related complications as White women. Do you think the repeal of Roe will see more Black women dying in childbirth?
MM: The health system we have in the US isn’t functioning well for Black and brown communities. But it’s a more nuanced discussion; there are a whole lot of other things that can go wrong than just death. When we talk about maternal mortality, we aren’t even talking about the 50,000 near misses, [the women of all races who had] serious pregnancy-related complications, like a hemorrhage, an infection, a C-section wound coming apart. We’re not talking about people like Serena Williams and Beyonce who live, but had trauma. Black women are less likely to be believed by their health-care providers, and they are undertreated and under-diagnosed.
JCP: And I like to remind folks that we can’t have the worst outcomes in the industrialized world just because Black women are dying. White women are also dying who wouldn’t have died if they lived in any other industrialized nation.
SGC: Some skeptics say that US maternal mortality rates just look higher than other countries because the US measures it over a year instead of six weeks post-birth.
JCP: That’s gaslighting. The World Health Organization sets the international standard for collecting data six weeks after birth. What the Centers for Disease Control does, in addition to collecting the international standard, is track the data up to a year because we know that people can die months after having a baby — people like Erica Garner, who died from heart failure from pregnancy cardiomyopathy four months after giving birth. The United States is trying to push the WHO to extend it to a year because six weeks was always made up — you need a year. But even looking at just six weeks, we are still the worst.
SGC: What would help address some of those disparities?
MM: We’re never going to see improved health outcomes or achieve health equity if we don’t have a robust social safety net. If we were serious about having reverence for the propagation of our species, we would treat childbearing families accordingly. But now we have Black moms going back to drive for Lyft and Uber 10 days after a C-section — the last thing they should be doing with an abdominal wound — because they need to generate revenue in our economy. But that’s the reality of not having paid family leave. That’s the reality of not having postpartum health coverage. That’s the reality of limitations of employer-sponsored health insurance.
SGC: What would you like to see happen next?
JCP: I’d like to see more people acting up. And I’d like to see us change the narrative; I’d like our country to move forward and not try to pit states rights against human rights. Finally, I’d like to see more people talking about how this affects men, too. There are plenty of men who have an abortion story, who have been able to climb the corporate ladder because they had access to abortion and birth control.MM: There are great bills that address many of the shortcomings we’ve been talking about that are languishing in Congress. Take the Momnibus Bill. Smart people have thought about where we can choose policies differently. Things don’t have to be like they are now; we can make a different decision. We’re at a precipice, and that requires courage.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Sarah Green Carmichael is a Bloomberg Opinion editor. Previously, she was managing editor of ideas and commentary at Barron’s and an executive editor at Harvard Business Review, where she hosted “HBR IdeaCast.”
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