Repercussions of overturning Roe v. Wade for women across systems and beyond borders

The impact of political power over abortion means greater biopolitical governmentality of women’s bodies and their daily lives in the way that the American state seeks to discipline women and teenage girls [7]. The collision between politics and reproductive health policy has led to a redefinition of women’s ‘personhood’ not only in terms of the ‘foetus’, over questions related to when exactly life begins, but also in terms of people questioning the limits imposed on their self-autonomy and agency over their own relationships and lives. Similarly, the collision between the Supreme Court’s legislative decisions and reproductive health policy has polarised debates in the popular press that may not align with the nuances and complexities about how and why women and their families make decisions about seeking a medical termination or having a surgical abortion. The realities are that abortion is gendered. Abortion impacts on the embodiment of women and girls, care for their physical and psychological wellbeing and involving mainly female healthcare providers and organizations. These realities are further impacted by the Supreme Court legislation and its implications in the 13 Republican-run US states with abortion trigger bans and the ways in which they interpret the law, some in highly restrictive terms that make abortion illegal even in cases of rape and incest [1, 2]. As stated earlier, biopolitics will impact the “North–South” divides, both nationally and internationally, to restrict access to surgical abortion and worsen already existing inequalities of health access. It is yet unclear how this will impact medical abortion (i.e., alternative services such as provision of contraception, the after-morning pill or self-management of abortions at home) [23].

Researchers including Lewandowska (2022) and Guillaume & Rossier (2018) note that in countries where abortions are illegal (Egypt and Jamaica) or permitted only to save a woman’s life (Nigeria and Mexico) and on the basis of health or therapeutic grounds (the Bahamas, Poland and Qatar), women resort to self-management of abortions at home [24, 25]. This raises further questions about how far the State will go in terms of surveillance of women’s bodies to access contraception, essential medicines or services and if or how surveillance technologies will be implemented to impact the services provided by governmental and non-governmental organizations nationally and internationally [25]. People have reported being warned about using social media and/or accessing apps for reproductive services akin to criminalization of abortion and incarceration of Black, Indigenous and racialized communities already affected by inequalities and high rates of deaths [25,26,27]. Women who cannot gain access to abortions or self-manage abortions at home, and are impacted by socio-economic and socio-cultural inequalities, will potentially give birth to children they do not want and/or cannot care for [28] just as periods of austerity and socio-economic difficulties tend to increase abortions.

The Supreme Court’s decision to overturn Roe v Wade will worsen people’s grappling with health-related needs whilst leaving them powerless to solve their reproductive health problems, especially where there is little attention to reproductive justice. People will not have access to abortions if they have ‘miscarriages, ectopic pregnancies, obstetric complications’ [25], if they need ‘lifesaving’ abortions or aftercare [28] and will not have choice over pregnancies (for example if they have cancer or during IVF) [29, 30] nor be able to prepare if their child has significant medical issues/disabilities or if they have a non-viable pregnancy. Taking away that choice to have children or not have children, when to have the children and the ability to nurture the children in a safe and healthy environment, is a clear injustice. Such lack of reproductive justice and choices will once again disproportionately impact Black, Indigenous and racialized women who already have worse maternity and neonatal health outcomes [31], struggle to access essential medical services and are impacted by structural racism across many systems (i.e., education, health, labour). In short, criminalizing abortions nurtures an environment of fear, while stigmatization makes them more deadly as women will pay the price with their lives.

Put differently, the social determinants of health lens [32] facilitates an understanding of how governmentality and lack of reproductive justice in the personal realm, can impact women’s education, employment, and housing and raises ethical quagmires about ensuring gender equity to combat those inequalities. For instance, will the state guarantee affordable nursery care or fund more disability services for those already facing inequalities? The impacts of such governmentality are likely to delay the achievement of many UN sustainable development goals (SDGs) which in the case of women include delaying: Goal 3 of ensuring healthy lives and improving well-being, Goal 4 of ensuring inclusive education and lifelong learning, Goal 5 of achieving gender equality, Goal 8 of promoting full and productive employment for all, and Goal 10 of reducing inequalities with and between countries.

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