By Priya Pandey 

Fifty years ago, the Supreme Court’s ruling in Roe v. Wade enshrined the constitutional right to an abortion. But after a different Supreme Court overturned Roe last year, seeking an abortion is now criminalized in 14 states and restricted in 12 more. Inequitable access to abortion has been the reality for many communities of color and low-income communities, even while Roe stood. The ruling in Dobbs v. Jackson Women’s Health Organization has exacerbated existing systemic barriers to health care. 

In the year since Dobbs, many states have chipped away at abortion access. This has made abortion out of reach for many, especially people of color, people who work low-wage jobs, people who live in rural areas, people with undocumented status, and people with LGBTQIA+ identities. Research shows that within two months of Roe’s reversal, there were 10,000 fewer abortions across the country. Additionally, Roe has set a dangerous precedent on the criminalization of women and pregnant people. Not only have several states restricted abortion access, many have sought to criminalize out-of-state travel to seek care and prosecute individuals who have experienced miscarriages.  

One deeply concerning impact of the Dobbs decision has been the reduction of health care access and options for those seeking reproductive care. Earlier this year, anti-abortion activists challenged the approval of mifepristone—a medication used to safely end pregnancies—by the FDA and sought to restrict its use. Mifepristone has a proven track record of safety and efficacy, having been used by over 5 million people in the United States since its FDA approval two decades ago. Medication abortion and self-managed abortion are critical options for care to those living in rural areas, young people, communities of color, and communities with less access to health care providers and health care facilities like community health centers and federally qualified health centers. This medication empowers patients to make their own private medical decisions, ensuring access to reproductive health care even in areas where it is widely unavailable. Patients have the right to access the medications they need, and health care providers should be able to offer these treatments without unnecessary interference from the judiciary or politicians.  

Disturbingly, from 2020 to 2022, 1,119 counties across the United States transformed into maternity deserts following the closure of maternity care units, leaving approximately 15,933 more women without access to obstetric care, birthing centers, OB/GYNs, or certified nurse midwives. These maternity care deserts are predominantly found in rural counties, although urban centers and coastal areas have also experienced closures. Many rural hospitals were already closing their labor and delivery clinics due to financial and staffing challenges even before the U.S. Supreme Court overturned Roe v. Wade last year. That decision has only exacerbated the situation, further limiting access to vital reproductive health care services, and potentially leaving countless individuals without essential care. Ensuring accessible health care options is crucial for the wellbeing and autonomy of individuals across the nation. 

In addition to being a matter of bodily autonomy and individual agency, abortion access has proven to be a strong contributor to economic security and opportunity. Creating pathways to access reproductive care increases educational attainment, overall earnings, and labor force participation. Access to abortion is crucial for racial, economic, and gender equity. Ensuring access to safe and legal abortions has particular implications for the economic and health equity of people of color because of the systematic inequalities of the American economy and health care system. Numerous studies have found that abortion access improves economic outcomes for Black women at a higher magnitude than for white women, helping to narrow racial economic disparities. Abortion legalization also reduced Black maternal mortality by 30 to 40 percent by increasing access to safe and affordable procedures. Barriers to health care and ongoing racism and discrimination already cause worse maternal health outcomes—for example, Native American and Black communities experience 2- to 3-times higher rates of pregnancy-related deaths, respectively, than white communities. And restricting access to abortion will further exacerbate these long-standing health inequities.  

Roe never guaranteed equitable or affordable access to abortion, and it’s time to make our fight bigger than Roe. Everyone has the right to security, stability, and bodily autonomy. Maintaining access to abortion across the board is a critical part of that. We can no longer ignore that access to reproductive care is an economic justice issue as well.