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The decision of the US Supreme Court to repeal its 1973 ruling on abortion, Roe vs Wade, means 26 states are certain or likely to ban abortion, instantly stripping women and girls of their right to choose and make an informed decision about their own bodies. Criminalizing abortion doesn’t remove abortion practices – it just removes access to safe abortions, leaving many vulnerable and plunging sexual and reproductive health and rights for American women and girls into turmoil.
If you want to understand the danger, shame and stigma of trying to get an abortion in the US before Roe vs Wade, just read the testimony of a woman who experienced it.
Fran Moreland Johns, now 88, was raped aged 22 by her boss. “Getting an abortion was more shameful than having been raped,” she said. “[After the abortion I] went to my obstetrician. ‘Who did this to you?’ he said. I would not have told him, or anyone else, in a million years. My allegiance was to the abortionist – he had given me my life back.”
Tragically, we might now see a return of these practices and attitudes.
Even now, the decision for an abortion is never easy with women often placing first and foremost the welfare of their unborn child. As was the case for Sarah. “If I had a child with my abuser, my child’s life would have been broken from the start. That’s not fair to them.”
Women in poor and marginalized communities will bear the brunt of the repeal, and there is a definite racial dimension to this. We already know that black women at all educational levels in the US are most likely to suffer from restrictive abortion policies associated with decreased access to abortion care and increased risk of unintended teen births.
Women and girls were already facing an increased struggle to access reproductive health services before the repeal hit. For example, at the height of the COVID-19 pandemic, 68% of reproductive services, including safe abortion and post abortion care, were at least partially disrupted.
The effects of the repeal will extend way beyond US borders. As often said, when America sneezes, the world catches cold. Due to the repeal, experts predict a fall in US bilateral and multilateral funding, thus reducing US ability to support the millions of people worldwide who need access to family planning and abortion services.
The US ruling will lend spurious legitimacy to those worldwide who seek to restrict the rights of women, and may encourage some countries to move towards regressive and restrictive abortion laws. This will have massive implications, particularly when so many people globally are on the move due to conflicts and other disasters. For example, more than 7.5 million refugees have fled Ukraine to date to nearby states, putting women and girls who need safe abortion services at dire risk. Evidence shows that family planning, abortion and post-abortion services are some of the most neglected interventions in conflict settings, where rape and tackle sexual and gender-based violence are rampant.
Adolescents are particularly at risk. By virtue of their age, they may struggle to pay for safe care or have to travel long distances, which could dangerously delay access to abortion. These factors, and the fear of stigma and shame, may make it more likely they will seek unsafe alternatives. Some 3.9 million unsafe abortions among girls aged 15–19 years occur each year, contributing to maternal mortality, morbidity and lasting health problems. If adolescents do give birth, other problems may last a lifetime. Pregnancy and childbirth complications are the leading cause of death among girls aged 15–19 years globally.
Paradigm shift
It is now more important than ever that leaders firmly protect the sexual and reproductive rights of women and girls. G7 leaders meeting in Germany this year are championing measures to tackle sexual and gender-based violence. The G7 next year, under Japanese leadership, has a crucial opportunity to position these issues within an expanded agenda for sexual and reproductive health and rights and universal health coverage.
Commitments must be backed by rights-based legal frameworks, which support progressive policies on abortion and sexual and reproductive health and rights. Women have to take the lead in discussions and policy-making, calling for much-needed reproductive justice that recognizes women’s and girls’ right to choose, and autonomy over their own bodies.
All of this requires a paradigm shift that puts the rights of women and girls front and centre in country policies and plans. Funding decisions must be guided by empirical public health data rather than by constitutional and socio-cultural conflicts. Countries should put in place explicit, non partisan funding streams for essential sexual and reproductive health services.
All countries must be held accountable for achieving these goals. Young people in particular, who are most directly affected, can play a powerful and direct role in holding the global community to account. The world needs to hear their voices and protests loud and clear if we are to get sexual and reproductive health and rights back on track after the bombshell of the Roe vs Wade repeal.