By Dr Sophie King-Hill
Senior Fellow, Health Services Managment Centre
Friday 24th June 2022 was a dark day for human rights.
Roe vs Wade was overturned by the USA Supreme Court, which will lead to abortion being heavily restricted or banned in approximately 26 states. When I read about this, the feeling of dread in the pit of my stomach was tangible and my reaction was visceral. Even back in May when it was leaked that this was going to happen, I did not believe that such a backward step would really materialise. The negative impact of this on so many lives, for so many reasons, will be immeasurable. The knowledge that so much unnecessary suffering and pain will result from this feels repulsive, as it could be so easily prevented.
What is Roe vs Wade?
In 1973, the US Supreme Court ruled that it was the right of a woman to decide to have an abortion and that this right would be protected by the US constitution. This stemmed from a challenge issued by a 25 year old woman, known as ‘Jane Roe’, against the Dallas district attorney Henry Wade. The challenge was based upon individual states banning abortion being unconstitutional.
This all changed on Friday 24th June 2022 when the constitutional right to abortion was revoked.
Five out of nine Supreme Court judges voted to overturn the ruling and give the decisions on abortion law back to individual states.
Roe vs Wade was a landmark step forward for the reproductive rights of those with a uterus, but now this lies in tatters and the impact of this will be profound. The basis for this being overturned was in another case, Dobbs vs Jackson Women’s Health Organisation, which challenged the Mississippi ban on abortion after 15 weeks. The court ruled in favour of the state, effectively leaving Roe vs Wade in pieces.
Of the 26 states that are likely to introduce severe abortion restrictions and bans, 13 of these have trigger laws which are designed to ban abortion in the event that Roe vs Wade being overturned, with immediate bans in place in these states the impact is already being seen.
A devastating impact
As a society it will be difficult to truly ascertain the long-term, and sometimes abstract, negative consequences of this ruling. However, there are some concrete examples of how this will affect people’s lives.
The main reality of this is that overturning Roe vs Wade will not stop abortion, history tells us this. What it will do is stop safe abortion and put a vast amount of people under a great deal of emotional and physical pressure. Some states are highly unlikely to ban abortions, and on face value it may look like people may be able to travel to access safe abortion. The reality, however, is much more complex. Many people who access abortion live in poverty and are from the BAME community. These are the people who stand to lose the most, with some estimates of a 550 mile round trip for an abortion and additional costs of accommodation, this will be unreachable for so many.
Then where does that leave them, what choices will they have? Unsafe abortion, getting into debt or keep the pregnancy that they don’t want. The impact upon both physical and mental health will be unsurmountable.
There is also the very real scenario of the abortion systems buckling over the sheer need from other states, abortion clinics in Illinois for example estimate an 8000% increase in patients.
Access to abortion pills that are effective up to 11 weeks may be a solution, but the effects of these are the same as a miscarriage and therefore run the risk of natural early pregnancy loss being party to a criminal investigation. There is also the impact upon staff in the abortion clinics that are set to close, and what bearing will there be on their livelihoods as a result of this. The physical, mental and economic shock waves that will result from this will be felt for many years to come and irreversibly change the life trajectories of so many.
Abortion and shame
Abortion, like many other medical procedures, carries a vast amount of stigma and shame. In my work in sexual health, I worked closely with abortion clinics and they were sombre places. Despite the caring, non-judgmental and pragmatic people who staffed them – the feeling of shame was palpable. But why is this?
Abortion carries a lot of stigma, secrecy, guilt and shame for many complex and interlinked reasons. Much of this links to the expectations of women in society being built for motherhood and childbearing. It is linked to sexuality, sex and the expectations of family. Abortion, quite rightly, gives women the right to opt out of this if they choose to do so.
These concepts of shame are underpinned by social and religious ideologies and perspectives on what constitutes life. A clear example of this has been seen with the pro-life protesters in the USA, who play into this guilt and shame. This again raises questions however, as those who want to ban abortion do not seem to have the same vigour for protest when it comes to welfare systems, healthcare and paid maternity leave.
There are ways to create a culture shift and start to dispel the shame attached to abortion. Much of this can be done in schools in Relationship and Sex Education through candid, transparent and realistic conversations about abortion – without judgement. But this will take time and, with the current climate, will be more difficult than before.
Reasons for an abortion
Many reasons have been given as key examples as to when an individual may want or need an abortion. These examples are hard hitting and real and relate to incest, child sexual abuse, rape and risk to a person’s life. These are all absolutely valid and having to fight for an abortion in these circumstances will be harrowing. There is already a large amount of shame attached to abortion and in these cases the decision to end a pregnancy is even more complex.
However, it is vitally important to highlight that people have the right to an abortion simply because they want one. It is their decision to make, and they should not have to justify this to anyone, for any reason.
Not just an issue for women
Whilst the ruling in the US screams of both openly hostile and benevolent misogyny and the imposition of rules on a person’s own body, there is a much wider impact. Firstly, it is useful to explore who can get pregnant. There are many trans and non-binary people that may want to access abortion and this may be even harder for them being from an already incredibly marginalised group. This issue compounds a definition of a woman and forces gender into a binary position that many cannot identify with.
There is also the issue of men. This has been framed about men controlling the body of a woman, when in reality it is much more nuanced. Whilst there is some truth in this in terms of toxic masculinity and patriarchal systems, many men stand to suffer because of this ruling and many more are strong allies of those with uteruses. Many men will feel the brunt of this when partners, children and friends cannot access safe abortion. The pressure on the males in these situations will no doubt increase – feeding into mental health issues that are so inextricably linked with the perception of masculinity.
Again, the impact of this will be immeasurable, but the suffering will be tangible.
The very real concern about what is next…
Related to this ruling, there have been three other cases from the Supreme Court that have been brought into question. These cases refer to the repeal of anti-sodomy laws in 2003. The right to contraception in 1965 and the relatively recent, and perhaps most fragile of these, the legislation that allows same-sex marriage in 2015.
The concerns that these basic human rights can be stripped back may have been unlikely a few years ago but the overturning of Roe vs Wade sets a dark precedent as to what is possible and what is coming next.
What this means for the UK
Abortion in Wales, Scotland and England has been legal since the 1967 Abortion Act. This is free and can be up to 24 weeks gestation if signed off by two doctors. In Northern Ireland abortion is permitted up to the first 12 weeks of pregnancy – this was only introduced in 2019.
Whilst the Supreme Court ruling may seem very unlikely to have an impact in the UK, once you scratch beneath the surface abortion rights appear to be more fragile than they look.
Under a 1861 Victorian Law, technically a person can be sentenced to life imprisonment if they have an abortion without the authorisation of two doctors. Whilst unlikely to be enforced, this demonstrates that the body with a uterus is still under some sort of governmental control.
The ruling in the US has also strengthened anti-abortion groups and there is a real risk of increased protests and victimisation of those accessing abortion services globally.
This instability is echoed with the presence of anti-termination MPs that could bring into question access to abortion. There are openly anti-abortion MPs such as Jacob Rees-Mogg who opposes abortion completely, Nadine Dorries who wants to cut down the maximum abortion time, and Jeremy Hunt, who in 2008 voted to cut abortion time down to 12 weeks.
Access to abortion does not feel like a sacred right any longer, and we should all be concerned.