The Supreme Court overturned Roe v. Wade on June 24, ending decades of federal legal precedent and thrusting the United States into a patchwork of state-level laws that ban or support abortion.
For many health care policy experts, the ruling in Dobbs v. Jackson has highlighted the importance of talking about abortion access—as well as preparing for the uncertain reproductive health care landscape ahead.
“Access to abortion care gives a person the ability to figure out for themselves the course of their health and their life,” said Lee Hasselbacher, a policy researcher and research assistant professor at the University of Chicago.
As the interim executive director for the Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health at UChicago, Hasselbacher is an expert on reproductive health policy. She has conducted research into abortion access and affordability in Illinois compared to other states, interviewing patients, health care providers and policymakers.
In the following Q&A, Hasselbacher discusses abortion access and the implications of state-level abortion bans—including possible impacts on fertility treatments and miscarriage care.
How does abortion access function as a part of reproductive services and health care?
There are so many reasons why a patient might consider abortion. It could be for health reasons. It could be because they have children in their life they’re already caring for. It could be because they have plans for their education, their future. Access to abortion care gives a person the ability to figure out for themselves the course of their health and their life.
Abortion is safe and generally carries much lower risks than childbirth. Some research has shown that abortion carries a lower risk of death than certain dental procedures and colonoscopies. And a person is at least 14 times more likely to die due to childbirth complications than after receiving early abortion care.
The full spectrum of reproductive health care includes contraception, family planning, fertility treatments, care for pregnancy and miscarriage management, as well as abortion. These are all common services that are integral to obstetrical and gynecological medicine.
Some states have instituted abortion bans that take effect after six weeks, or at some other stage of pregnancy. What does this mean for patients?
The dating of pregnancy begins even before you are actually pregnant. So, someone who’s six weeks pregnant is really only two weeks past their period. It’s often before people even realize they are pregnant, or have done enough testing or seen a provider to confirm that. That really doesn’t leave very much time at all for access to abortion care. Even some of the bans on later gestational periods overlook how often people don’t realize they are pregnant, or are facing access barriers such as cost or travel.
What do you think we will see next from policymakers, researchers or others?
There have been a lot of people who have been expecting this decision for a long time, and who have been planning for this at the national level and at the state level. Here in Illinois, there’s been a lot of legislation over the last several years to affirm the right to access reproductive health care—including things like requiring insurance coverage and Medicaid coverage for abortion. Research on the implementation of supportive policies as well as restrictive policies will help us understand the full impact of the Supreme Court decision.
From a research and policy perspective, financial assistance is probably the biggest thing that can be helpful to people seeking care. One of the biggest issues now is people thinking creatively about how to fund access. We’ve talked to patients who have used their Medicaid or private insurance coverage to access abortion care, and it’s been a great relief for them. It would be important for other states that are ensuring access to offer this kind of support. There are also organizations that provide financial assistance to help patients bridge those gaps. I think there will also be research to explore how health care providers and systems are responding as patients cross borders to seek care.
It’s also helpful for people to talk about the need for abortion and access to abortion. There’s been a lot of research on the importance of breaking through some of the stigma, and see abortion care as part of health care.
Illinois might soon be one of the few states in the Midwest that still has extensive legal protections for abortion. What does this mean for abortion access in the greater region?
We know from the state’s public health department numbers that more than 9,500 people traveled to Illinois in 2020 to seek abortion care. We could soon see anywhere from three to five times that number of out-of-state residents seeking services in Illinois.
Currently, there's no clear law against providing care for people in Illinois. But I think a lot of providers are thinking about this and might be worried about it. One of the consequences of this decision is that providers just don’t know what to expect. They don’t know what the law looks like. They don’t want to risk their careers or their licenses.
How might existing health care disparities affect the impacts of abortion bans?
We’ve seen that Black, Latinx and Indigenous individuals already receive the lowest-quality maternal health care in the United States. Young people also face some of the greatest obstacles to care, both in terms of cost and access. Difficulty paying for abortion care is a huge challenge. That results in particularly poor access for lower-income individuals, uninsured individuals and people who live in states where laws restrict insurance coverage. We expect all of these populations to face even greater access barriers given these laws against abortion.
What other aspects of reproductive health might be affected by court actions or state laws in the future?
The right to contraception is certainly something that people are also worried about. The legal underpinning is the same. But it’s equally important to pay attention to some of these other consequences that haven’t been fully explored.
There are potential consequences like access to fertility treatments and fertility care. If you have embryos that are being saved for use, what happens to those? Under laws in some states that view fertilization as the beginning of life, what happens then?
I'm also thinking about things like access to miscarriage care and treatment, and how that’s going to be affected. In states that restrict abortion care, the people who are most affected by criminalization of pregnancy will be the same people who face health care disparities. It’s going to be difficult both for patients and providers. For example, how do you demonstrate that a patient suffered a miscarriage? Compared to abortion care, the procedures are the same. The medications are the same. A lot of the symptoms and side effects are the same.
Again, contraception is important, but there are so many other implications for this ban on abortion care that are not fully realized yet.
What else is an area of focus for you moving forward?
There have been so many bigger questions surrounding abortion access, and this is an opportunity to think about those too. How do we view access to maternal and reproductive health care in a bigger, more holistic picture? If there are bans on abortion access, how are we going to think about supporting parents and young children?
There’s interest within both the research and policy communities to think about how we look at all these things together and as they're integrated together. How do we conduct research that can help us understand what maternal and child health can look like going forward—both for people who choose to have an abortion, but also for people who are choosing to have children? How can we create a better policy environment that supports access to care more broadly?
—Prof. Jacqueline Stewart
