More bans and creative clinics: the future of abortion access in a post-Roe US

The federal right to abortion ended in 2022 – where does that leave people seeking to terminate a pregnancy going forward?

It was a landmark year for abortion rights, for all the wrong reasons. In the summer, the US supreme court, with its new hard-right supermajority, dismantled the constitutional right to abortion secured almost 50 years ago through Roe v Wade. After that came a slew of laws passed in state legislatures, court battles and – indeed – some surprise victories for abortion rights advocates. All this has changed the way Americans can access pregnancy care and the way they think about women’s rights. Here are the key points from 2022.

New bans abound

For some it may have felt like abortion rights changed in the US overnight on 24 June 2022. But even before Roe fell, 22 states already had laws on the books that would make abortion bans likely if not inevitable once the supreme court ruled, after years of anti-abortion activism.

After Roe was overturned, things became complicated. Many bans written before the June decision bounced right into effect; others were held up in court – and continue to be – and in some places, such as Michigan, local activists and politicians found ways around them.

But the reality cannot be overstated: by October, 66 clinics across 15 US states were known to have closed, more than 80% of the total of 79 clinics open in June in those states. As of last summer, about 33 million women of child-bearing age lived in states that had or were poised to ban abortion, according to Bloomberg. Some states now ban all abortion without exception, while others allow abortion up to a certain time limit or in extreme exceptions, such as rape or incest, or to protect the life of the pregnant person. And an onslaught of new restrictions looms.

Legal crackdowns loom

In April 2022, 26-year-old Texan Lizelle Herrera was arrested on murder charges for allegedly self-inducing an abortion. The case was without legal basis, and was quickly dismissed, but it was a harbinger for more extreme measures since Roe was overturned.

Louisiana tried (and failed) to bring murder charges against people who obtained abortions. Missouri sought to ban out-of-state travel for abortions. South Carolina attempted to limit even basic information sharing about how to access abortions online.

None of these laws passed, but they highlight the measures that anti-abortion activists are willing to use.

Medication abortion proliferates

In 2021, the US Food and Drug Administration made abortion medication accessible by mail. That became a lifeline for many when many clinics closed their doors after June and organizations offering funding and travel assistance for abortion access went quiet while they worked out their options in the new legal landscape.

Use of these drugs has soared. One study suggested a threefold increase since the supreme court decision overturning Roe as part of a case out of Mississippi called Dobbs v Jackson Women’s Health Organization.

However, medication abortion is not a catch-allsome fear taking pills at home where an abusive partner might see, for example, or might be worried about not having a doctor physically present during an abortion. And there are safety risks with taking the pills too far along in a pregnancy, which is hard to regulate for. But using medication where feasible is a relatively affordable, convenient and discreet option.

Clinics get creative

Roving recreational vehicles with exam rooms and labs to provide more accessible abortion, and boats with surgical clinics sailing on international waters, are just some solutions emerging since the federal right to abortion ended.

Clinics on wheels allow doctors to meet patients on the borders of states with bans, closest to where they are traveling from. And plans for a so-called abortion boat in the Gulf of Mexico could give much-needed new access to patients in the south.

A surprise win, and a change in political tone

If anti-abortion advocates thought they could further restrict the procedure by harnessing the popular vote, they probably considered deeply red Kansas a sure bet. But those conservatives received a nasty shock in that state in August, when voters roundly rejected their proposal at the ballot box.

A hearty 59% of voters rejected the ballot proposal in the referendum, which had aimed to establish that there was no right to abortion in the state’s constitution. The pro-rights victory over that measure sent a resounding message to Republicans standing in the midterms, many of whom subsequently toned down their positions on abortion, or started avoiding the topic entirely.

Doctors’ licenses under threat

When the story emerged of a 10-year-old rape victim traveling out of state to access abortion because it was banned in her home state of Ohio, it made national news. While newspapers rushed to verify that story, however, statistics show that every year hundreds of children, in Ohio and the US generally, obtain abortions.

Dr Caitlin Bernard, who provided care to the 10-year-old in Indiana, was accused of fabricating the story and breaking patient confidentiality when the story leaked. Indiana’s attorney general opened multiple investigations into Bernard, and asked Indiana’s medical board, which has the power to revoke a doctor’s medical license, to punish her.

The case continues, but the implications for doctors everywhere are stark.

Abortion on the ballot

After the surprise win in Kansas, anti-abortion advocates and pro-choice activists across the country brought abortion ballots in the midterms, with yet more shocking results. Voters in all five states with abortion on the ballot chose to protect abortion, including in Kentucky, where campaigners hoped voters would be more anti-abortion than in Kansas.

As a result of the wins, abortion became explicitly protected within state constitutions in places such as Vermont, California and Michigan. And in Michigan, the referendum prevented a 1931 ban from bouncing back into action. In Montana, a bill that could have criminalized doctors for providing abortions was squarely defeated.

Those wins have been celebrated, although pro-choice activists are quick to point out that without federal legislation protecting abortion, access to the procedure will remain patchy at best, with a person’s right to abortion determined more by geography than by the care they need.


Poppy Noor in New York

The GuardianTramp

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