The Post-Roe World

Harvard experts on what's next for abortion access, laws, and politics

Supreme CourtPhotograph by Unsplash

“Clarity is power,” said Harvard T.H. Chan School of Public Health (HSPH) dean Michelle Williams, at the school’s panel last week on the post-Roe United States. “American people need a clear understanding of the science and consequences of depriving girls and women of this essential component of healthcare.”

The panel, a collaboration between HSPH and Reuters, featured Harvard experts weighing in on what the overturning of Roe means for the future—and what policymakers and citizens who seek to retain women's abortion access can do now.

 •Uncertainties for medical practitioners. The overturning of Roe has created widespread “uncertainty,” according to visiting professor of constitutional law Mary Ziegler. There is uncertainty about how states will legislate and what the ruling will mean for abortion-limiting laws currently on the books. But most urgently, medical professionals “are uncertain about whether, in some cases, they’re violating the law” by providing an abortion. Ziegler says the penalties cropping up now are unprecedented. “The prototypical criminal enforcement of the pre-Roe abortion ban would be about five years in prison,” Ziegler said. “We’re seeing trigger bans now with penalties of 99 years in prison or life in prison.” She added, “Those penalties are creating a great hesitancy on the part of the providers to do anything, because if you get it wrong, you not only lose your license—you lose your liberty for an extended period of time.”

Medical necessity. A leading concern is that, without Roe, states will limit access to medically necessary abortions—those that save the life of the mother. According to Elizabeth Janiak, assistant professor at Harvard Medical School and HSPH and research investigator at Brigham and Women’s Hospital, events in Texas hint at things to come. After September 2021 legislation banned abortions beyond six weeks of gestation, one study found that women who went to Texas hospitals for non-viable pregnancies waited an average of nine days to receive treatment. She said, “That can be that they’re waiting for the person to lose the pregnancy spontaneously, but it’s also often that they’re waiting for the person to get sick enough that they think it’s permissible to intervene under the law.” And 57 percent of women in Texas did get sick enough–experiencing “severe maternal morbidity,” which includes events like hemorrhages and transfusion. Delaying care runs counter to a physician’s duty. Said Janiak, “What we want is for healthcare providers to be able to do what they think is best for their patient’s health.”

Adoption, missing maternal support, and out-of-state abortion services. Some predict that as abortion ebbs, the number of children put up for adoption will rise. The experts disagree. A study at the University of California San Francisco found that, of a group of women denied wanted abortions, 90 percent chose to raise the child and only 10 percent chose to give the child up for adoption. More mothers, many of them in poverty, will be raising children after Roe, and Janiak said the government must support them accordingly. Affordable housing, closing the wage gap, legislating a living wage—“those are the interventions we need to address poverty,” she said. “Adoption is not the solution to poverty.”

“The state governments in the non-ban states have a major role to play in protecting their providers who want to help women in the abortion-ban states,” and in providing transportation for women in ban states, she continued. Experts say non-ban states should prepare for an influx of abortion requests for out-of-state women.. To keep wait times at abortion clinics down, Janiak suggested that general practitioners and OB-GYN generalists in non-ban states “start providing abortions for their own patients, rather than referring them to the clinic down the street.”

The federal government has a role to play as well, panelists suggested. It could bypass state abortion bans by building clinics on federal land. That is theoretically a feasible path, but Ziegler said she fears states would arrest people at those clinics and set up clashes that would end up in the Supreme Court. “I think any time the federal government is doing something that looks like financially supporting or subsidizing abortions,” she explained, “there’s going to be questions about whether that’s barred by the Hyde Amendment and various other policies that prevent direct federal support for abortion.” 

An outright national prohibition. If anti-abortion lawmakers gain control of the U.S. House, Senate, and presidency, said Jane Mansbridge, Adams professor of political leadership and democratic values emerita at Harvard Kennedy School, they could enact a federal ban on abortion.

Supporting the poor. Whatever legislation may ensue, it’s most important to help those most affected by the ruling. It’s the poor women who are going to suffer here,” said Evelynn Hammonds, Rosenkrantz professor of the history of science and of African and African American studies. She noted that about half the women who get abortions live below the poverty line, and 60 percent of them are already mothers. Abortion bans do not affect everyone equally, she said. They put undue stress on “the people with the least number of resources, the least amount of vacation time” to travel out of state for an abortion. 

Electoral leverage. Given the Supreme Court’s ruling, state and local elections will play a key role in determining the future of abortion access, Ziegler said, so it’s important for proponents to vote. “It’s not ‘other people’s problem,’” she said. “What happens to pregnant people in general affects everyone. So I would change even how you think about this so that you’re not inadvertently shirking responsibility.”

Dean Williams said those who wish to preserve access to abortions have strength in numbers. A majority of Americans disagreed with the Court’s decision, and she predicts that—in the days, weeks, and months ahead—“that strong majority will become an overwhelming majority.”

Read more articles by Nancy Walecki

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