It is June 2022, nearly 50 years after restrictions on abortions in the US were made unconstitutional by Roe v. Wade in 1973. When Politico leaked obtained a leaked initial draft majority opinion written up by Justice Samuel Alito earlier this year, it became clear that Supreme Court was preparing for its overturn.
The majority opinion, which has not yet been ratified by an official bill but is expected to pass this month, augurs the severe restriction of reproductive rights across the US. Setting out punitive procedures following abortions that include fines, imprisonment, and hard labour, the document summarises the opinion that: ‘the inescapable conclusion is that a right to abortion is not deeply rooted in the Nation’s history and traditions’.
A nationwide ban on abortion sets women back decades, in terms of bodily autonomy and, as the public is now beginning to realise, economic freedoms. The imminent decision represents an intersection between moral, religious, social and economic issues debated in a red versus blue partisan environment, exposing ever-growing rifts in the American political system.
Reproductive rights in the US are already fraught with economic disparity
Constitutionally, federal Medicaid funds cannot be used to fund abortions; 33 states follow the federal standard as dictated by The Hyde Amendment (1977) and only offer Medicaid coverage for abortion in the case of rape, incest or life endangerment. Though the Amendment does not block states from using its own funds for abortion procedures, access to safe free or low-cost abortions are entirely dependent on location, gestational age and the discretion of individual states. Women seeking abortions in South Dakota, for example, where legislators have taken the Amendment a step further by banning federal Medicaid coverage of abortion in any circumstances (including rape and incest), are forced to take expensive journeys across state lines to access safe reproductive care.
The Hyde Amendment severely restricts availability of abortion, disproportionately affecting women of colour and those in low-income households. In states which follow the legislative restrictions of the Hyde Amendment, women are required to use their own funds to pay for abortions. These abortions averaged, in 2014, at $508 for a first trimester abortion, and $1,195 for a second trimester abortion. A procedure performed in the third trimester can cost upwards of $3,000.1
Even with Roe in place, the economics of abortion are still a point of contention. At a campaign rally during her presidential candidacy in 2016, Hilary Clinton said: ‘Any right that requires you to take extraordinary measures to access it is no right at all,’ capturing the catch-22 of reproductive care in the US many decades after the apparent watershed of Roe v Wade.2 The leaked majority opinion suggests the case was not, in fact, the turning point in turbulent reproductive issues many hoped for.
According to the Guttmacher Institute, in 2014, 49% of abortion patients had a household income of less than 100% of the federal poverty level. Pew Research reports that in 2019, 59% of women who received an abortion were women of colour. Women in low-income households and women of colour have traditionally sought abortions, and been faced with difficulties acquiring them, at much higher rates than women of other backgrounds. This is often attributed to limited access to contraception, less than adequate sexual education and generally poor reproductive care. Women in these groups also find their ability to receive reproductive care impacted by cases of racism and sexism in healthcare, geographical limitations and financial barriers to funding procedures themselves, or travelling in order to procure one out-of-state.
The state of reproductive care in the US, as evidence suggests, is already fraught with economic disparity. Lack of sufficient healthcare or education services places those seeking abortions in a double bind; being unable to access affordable or safe abortions, many women are already forced to go ahead with unwanted pregnancies. These pregnancies, and the price of caregiving that follows, exacerbates already critical poverty rates in women seeking abortions. This will only worsen in the event of Roe’s overturn.
What will the ban mean?
If it matches the Supreme Court’s final decision, the leaked 98-page draft amendment is an omen of a bygone era, when individual states were given autonomy over highly sensitive and partisan issues, of which abortion is one of many. In a post-Roe America, it is predicted that 25 would ban abortion the moment legislation allows. As well as states with anti-abortion laws in place already, thirteen states have put ‘trigger bans’ in place, allowing them to bring abortion bans into effect immediately following the overturn of Roe.
The Turnaway study, led by demographer Diana Greene Foster, was a five-year longitudinal study which followed nearly 1000 women seeking abortions from over 30 US clinics from 2007-2012. The study was the first of its kind, tracking in depth the trajectories of women able to access abortions, compared to those unable to receive one due to state gestational limits; it sought to understand the effects of abortions on women who received them, versus the impact of carrying an unwanted pregnancy to term.
In interviews with participating women, the overwhelming reason given for seeking an abortion was financial inability to care for a child. The estimated median annual cost of raising a child in the US is currently around $12,000.
The study found, overwhelmingly, that women who were unable to access abortions were more likely to experience household poverty at least four years after being denied an abortion, and these women were three times more likely to be underemployed. Children born to women denied an abortion were disproportionately affected by household poverty, compared to the subsequent children of women who were able to access abortions.
The financial impact of limiting access to abortion is clear, and frightening. Abortion denials are also associated with poor mental health in the women following the pregnancy, increased rates of domestic violence and heightened instances of women being forced to raise their child alone, without financial or emotional support from a partner or family. These issues are experienced even more acutely by women of colour.
Though not conducted with the possibility of a post-Roe America expected in the near future, the study offers valuable, empirical evidence to suggest the catastrophic effect of reproductive restrictions, both on a personal and national level. Its findings are still relevant and, as Greene Foster herself has suggested:
‘We [the US] haven't become a more generous country that supports low-income mothers. And so those outcomes are still the outcomes that that people will experience when they are denied a wanted abortion.’
The macroeconomics of rights to abortion
Greene Foster saw an end to Roe only in her ‘worst nightmares’, but now that the end seems to be nigh, research like the Turnaway Study is invaluable for the protection of years of progress threatened by an abortion ban. Before Roe was passed, women’s labour force participation rates were at 40%; now it is 70%. Of course, female participation in the national workforce is subject to a number of factors, but there remains a strong correlation between rights to reproductive freedom and women’s ability and inclination to occupy traditionally male spaces in the labour force.
A 1996 study by Joshua Angrist and William Evans found that access to abortion results in increased education rates nationwide and stronger labour-market outcomes. The likelihood of young pregnant women being able to access an abortion increases their likelihood of completing college by 20%, according to American University economics professor Kelly Jones.
The freedom of choice for women brings net benefits for female income in the US, as increased rates of education completion are accompanied by heightened career aspirations and, fundamentally, help make valuable headway towards righting gender disparity. Being able to plan a life and career unburdened by the worries of financial, psychological and physical hardships associated with an unwanted pregnancy is essential to efforts towards economic gender equality.
The overturn of Roe v Wade imposes would change the landscape of reproductive health in the US for years to come. As activists point out, abortions will still be performed, illegal or not. Punitive measures against those seeking the procedure, and those performing it, will only give rise to unsafe, botched abortions.
Increasing the market for secretive, underground abortion services will exacerbate what is already clear: there is no level playing field, and the poorest women in America will be disproportionately affected. Even with a draft document, the SCOTUS has sent a clear message that a woman’s right to receive safe abortion services does not make constitutional sense; it has shaken the foundations of civil rights progress in the US, and the domino shockwaves of the decision will stretch across the political spectrum, into the minutiae of the lives of millions of women.