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Collaboratory for Health Justice statement: access to abortion as health justice

The Collaboratory for Health Justice, in collaboration with SPH faculty Alisa Velonis, release the following statement on access to abortion as a necessity for health justice.

Statement recognizing access to abortion as health justice. On June 24, 2022, the U.S. Supreme Court dealt a huge blow to the movement for health equity. In overturning Roe v. Wade, five justices – Samuel Alito Jr., Amy Coney Barrett,  Neil Gorsuch, Brett Kavanaugh, and Clarence Thomas – effectively told millions of Americans that their agency in deciding whether, when, with whom, and how to become a parent (or not) has been effectively eliminated. As public health scientists, advocates, and scholars, we call this decision out for what it is: an unethical health injustice that will increase suffering and death. We cannot stand quietly while this happens.

Abortion is fundamental health care. It is safe, it is necessary, and it saves lives. Prohibiting abortion will increase the already high rates of maternal mortality and morbidity in this country, rates that are already well-above those of our peer-economy countries, especially for Black women.1,2 Complications resulting from childbirth are more likely to lead to death or life-threatening conditions compared to abortion,3 and individuals denied access to abortion experience more long-term chronic health issues,4 higher rates of physical violence from a partner,5 and greater levels of poverty compared to those able to terminate a pregnancy.6 Contrary to the claims of anti-abortion activists, unintended pregnancy itself is associated with psychological distress,7 and individuals denied a wanted abortion experience more short- and long-term mental and physical health problems.8 The claims that abortion is rarely necessary and costs lives are not based in fact.

Abortion is a health equity issue. Structural racism, historical colonialism, and other systemic inequities have ensured that access to quality reproductive healthcare is inequitably distributed in this country. The impacts of this ruling will be felt most strongly by Black, Indigenous, and Persons of Color (BIPOC), by LGBTQ individuals, by adolescent and younger adults, and by those with the lowest incomes.  Black and Indigenous individuals have less access to contraceptive services and high-quality maternal and reproductive health care, accompanied by some of the highest maternal mortality rates.2,9,10 Likewise, those states in which abortion bans have already or will soon take effect have more residents who live at or below the poverty level and/or identify as BIPOC compared to states where abortion remains protected by law.11,12 These same states have among the nation’s worst pregnancy outcomes and provide the least amount of support for pregnant persons, children, and families.13 The burden of this ruling will fall primarily on those communities and individuals where health inequities are already the greatest.

Bodily autonomy is health justice. The history of the U.S. is wrought with examples of how BIPOC, lower-income people, adolescents and younger adults, and women have been subject to governmental restrictions on their right to govern their own bodies and health. With this recent decision, five Supreme Court justices issued a decision overriding widespread demand for autonomy and access to abortions for all. The decision to become – or not become – a parent is a right that cannot be restricted to those with the resources to travel to obtain reproductive health care or for whom the risk of legal prosecution is lessened. Even before this decision, BIPOC and lower-income individuals have been disproportionally prosecuted for pregnancy-related outcomes (e.g., miscarriage or stillbirth);14 the potential for these outcomes to become criminalized is now substantial in many places, as is the likelihood that Black and Brown individuals will be unjustly targeted for suspicion or prosecution. Demanding health justice includes demanding that all individuals have autonomy over their bodies.

References Heading link

Tikkanen R, Gunja M, FitzGerald M, Zephyrin L. Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries. The Commonwealth Fund; 2020.

Petersen EE, Davis NL, Goodman D, et al. Racial/Ethnic Disparities in Pregnancy-Related Deaths – United States, 2007-2016. MMWR Morb Mortal Wkly Rep. 2019;68(35):762-765. doi:10.15585/mmwr.mm6835a3

Stevenson AJ. The Pregnancy-Related Mortality Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant. Demography. 2021;58(6):2019-2028. doi:10.1215/00703370-9585908

Ralph LJ, Schwarz EB, Grossman D, Foster DG. Self-reported Physical Health of Women Who Did and Did Not Terminate Pregnancy After Seeking Abortion Services. Ann Intern Med. 2019;171(4):238-247. doi:10.7326/M18-1666

Roberts SC, Biggs MA, Chibber KS, Gould H, Rocca CH, Foster DG. Risk of violence from the man involved in the pregnancy after receiving or being denied an abortion. BMC Medicine. 2014;12(1):144. doi:10.1186/s12916-014-0144-z

Foster DG, Biggs MA, Ralph L, Gerdts C, Roberts S, Glymour MM. Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States. Am J Public Health. 2018;108(3):407-413. doi:10.2105/AJPH.2017.304247

Herd P, Higgins J, Sicinski K, Merkurieva I. The Implications of Unintended Pregnancies for Mental Health in Later Life. Am J Public Health. 2016;106(3):421-429. doi:10.2105/AJPH.2015.302973

Biggs MA, Upadhyay UD, McCulloch CE, Foster DG. Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study. JAMA Psychiatry. 2017;74(2):169. doi:10.1001/jamapsychiatry.2016.3478

Sutton MY, Anachebe NF, Lee R, Skanes H. Racial and Ethnic Disparities in Reproductive Health Services and Outcomes, 2020. Obstetrics & Gynecology. 2021;137(2):225-233. doi:10.1097/AOG.0000000000004224

Pham O, Nov 10 URP, 2020. Racial Disparities in Maternal and Infant Health: An Overview – Issue Brief. KFF. Published November 10, 2020. Accessed June 27, 2022.

Guttmacher Institute. Abortion Policy in the Absence of Roe. Guttmacher Institute. Published March 14, 2016. Accessed June 27, 2022.

U.S. Census Bureau. United States – Census Bureau Profile. Accessed June 27, 2022.

IBIS Reproductive Health. Evaluating Priorities. Evaluating Priorities. Accessed June 27, 2022.

Paltrow LM, Flavin J. Arrests of and Forced Interventions on Pregnant Women in the United States, 1973–2005: Implications for Women’s Legal Status and Public Health. Journal of Health Politics, Policy and Law. 2013;38(2):299-343. doi:10.1215/03616878-1966324

This statement should not be taken as an official position of the University of Illinois Chicago.