A shock wave went through the U.S. on Monday evening when Politico published what appeared to be a legitimate first draft of a Supreme Court ruling written by Justice Samuel Alito that would overturn Roe v. Wade entirely. It was a huge breach at the Supreme Court and a political earthquake as well. But for many women across America, it was a blow that hit much closer to home.
If Justice Alito’s draft is adopted by a majority on the court, it would return the issue of abortion to the states; half of them would be expected to try to ban or severely restrict the procedure. Bloomberg Opinion columnist Sarah Green Carmichael spoke with Bloomberg News reporters Kelsey Butler and Ella Ceron and Harvard Medical School physician Aditi Nerurkar on Twitter Spaces to consider what this means for women and abortion rights. The conversation has been edited for length and clarity. Sarah Green Carmichael: Were you surprised by the release of the opinion or anything in it?
Ella Ceron: My family is from Mexico, and so seeing the way Mexico has decriminalized abortion last year and seeing the contrast with what’s happening here in the United States did strike me personally. I’m still trying to process that.
Aditi Nerurkar: I am just so heavy-hearted about this news. It’s devastating because abortions are often medically necessary. There are 32 million American women who will no longer have access to safe abortion. We know that the [World Health Organization] has said that around the world, a woman dies about every eight minutes because of an unsafe abortion. I’m an internal medicine physician, and as someone who has seen the medical complications that can happen with unsafe abortion, what a blow [this is] for medical care for human rights and for women.
Green Carmichael: Ella, some of the work that you have done for Bloomberg has been about abortion deserts across the U.S. What is an abortion desert, and how much bigger are they likely to get if this draft ruling does become law?
Ceron: An abortion desert is, in very loose terms, if somebody has to travel a hundred miles or more to receive abortion care. Obviously the distance is a very basic way to look at this, because there are so many other factors, whether it’s taking time off work, paying for child care for the children that they already have while they travel, whether they have a car. For some people, 10 miles is really impossible, whereas for other people, a hundred miles, 300 miles is less of a burden.
Green Carmichael: How much does abortion typically cost now? And what do you think is likely to change as a result of a ruling like this?
Kelsey Butler: Research that came out last month showed that the [cost of the] two most common abortion procedures — medication abortion, and a first trimester [procedure] — has jumped in the last few years. As of the latest data for medication abortion, it was $560. That’s up from $495 in 2017. And for first trimester abortion, it’s $575, up from $475. That’s just the cost of the procedure itself. We’re not talking about the time that you have to take off work, or child care or travel.
Green Carmichael: Sometimes abortion restrictions depend on whether a woman’s “life” is in danger. What does it mean in practical terms to decide that a woman’s life is in danger, versus her health? Do you think that an exception for the life of the mother is sufficient?
Nerurkar: Absolutely not. This is such a slippery slope because even that wording, what does it mean? Who makes that decision? It should be a woman’s right to choose, right?
Green Carmichael: Some large companies have said that they will cover the cost of travel expenses so that women who are in states where abortion will be banned can afford to get the health care they need by traveling. This is something that, Kelsey, you have written about for Bloomberg quite extensively. Can you talk a little bit about how this works? Would you have to tell your boss about it?
Butler: Some bigger companies like Apple and Levi Strauss are [handling] it through their insurance program, just like any other benefit. Let’s say you had an ACL that needed to get repaired, and there was a specialist in another state who was the only person that could really help you. It would be a similar process.
Then there are companies that do it in different ways. I spoke with a small startup based in New York called Alloy that was [handling] it out of their HR department. They were small enough that it made sense for them, but it wouldn’t necessarily be scalable at a bigger company.
And then there’s a different approach. Match, the dating app, has set up a partnership with a third party, Planned Parenthood Los Angeles. They have a toll-free number where employees can call and Planned Parenthood will then arrange the travel and lodging. In all these circumstances, the companies are really focused on making sure that privacy is of the utmost importance.
Green Carmichael: Dr. Aditi, would this ruling affect miscarriage care? When I had a miscarriage, I needed the same [D&C] procedure that someone has when they have an abortion. And I don’t know how that procedure will be restricted now, or if it will make miscarriage care more difficult to get.
Nerurkar: It’s really unclear what this means and what the ripple effects will be in the immediate term. I’m thinking about ectopic pregnancies and also complications from unsafe abortions, such as uterine ruptures or septic shock. There are so many unknowns here, but I anticipate that those complications will rise from unsafe abortions simply because there will be more of them.
A D&C procedure, which is something that is routinely done for miscarriages and for many of other reasons, what will that be considered? There are tens of thousands of those done in the U.S. every day for medically necessary reasons.
Green Carmichael: I’m curious to know what you think about abortion pills as a solution. I know the pills are only really functional until you are 10 weeks along. So they’re clearly not a solution for everybody. But is there a way in which they could maintain some level of access?
Nerurkar: I don’t know if solution is the right word. I don’t consider oral pills necessarily a workaround for safe abortion. They can be a corollary or an adjunct in a case-by-case basis, but we need to make abortion available to all women who choose it.
Green Carmichael: When it was my own choice about how to deal with the miscarriage, they gave me the options of pills or the procedure. I looked into the risks and the side effects of both, and I chose the procedure because it was the best choice for me. Hopefully that is something that women will continue to be able to do.
The United States has one of the highest maternal mortality rates of any developed nation. We have no paid maternity leave mandated at the federal level. We have no universal child care, and child care is very unaffordable. And now this. How did we get here? How do we become a hostile environment for parents — a country hostile toward women? What would you like to see happen now, and what are you watching next?
Butler: What I’ll be really watching are the people who fall through the cracks. In this country, where your employer is located or the state that you live in determines whether you have access. And in doing that, there are a bunch of people who get left behind at this really crucial moment in their lives.
Ceron: We know that there are going to be a lot of protests because Roe v. Wade is really popular. There are so many polls that show that people want it to be upheld. They don’t want abortion rights rolled back.
Nerurkar: What I’ve been reflecting on is that the pandemic showcased this idea of bodily autonomy and personal freedom. Wearing a mask or not wearing a mask, getting vaccinated or not getting vaccinated. Why is this any different? Women should have that bodily autonomy. There should be a sense of personal freedom to make a choice. That is what enrages me.
Green Carmichael: I will say that having recently been pregnant, I can’t imagine what it would be like to have to go through an experience like that when I didn’t want to. Giving birth is a complete full-body, full-mind, full-soul experience. I don’t think that the sort of cavalier way in which adoption is sometimes mentioned as a solution is realistic or sensitive to what the reality of giving birth is. So yes, there is much more work to be done here. The fight now goes to the 50 states, and people who believe that women should have control of their bodies will continue to carry that fight forward.
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