Late last month, a series of developments related to abortion underscored the maddening state of access in the U.S. — and the urgent need for President Joe Biden to update the way he talks about the issue before November’s presidential election, when reproductive rights are again on the ballot. The president’s platform calls for “restoring reproductive freedom,” and he has often repeated the mantra that “If I’m elected, I’m going to restore Roe v. Wade.” But simply calling for a return to Roe is not nearly enough.
Early in the last week of June, new data published in the pediatric edition of the Journal of the American Medical association showed the toll an abortion ban takes on women and babies’ health. Two days later, Bloomberg reported that the U.S. Supreme Court would be delaying a decision that feels like the lowest-hanging fruit in reproductive freedom: guaranteeing women’s access to abortion care amid medical emergencies. The next day, an excruciating exchange on abortion during the debate between Biden and former President Donald Trump served to validate women’s panic over their eroding reproductive autonomy. And on the day after that, Iowa’s Supreme Court allowed a six-week abortion ban to go into effect, while Nevada became the latest state to add a question about abortion rights to its ballot.
Whew. That’s a lot.
Let’s start with that new data from JAMA. In the first year since Texas’s ban on abortions after six weeks, there was a 13% rise in infant deaths. In that time, infant deaths due to congenital anomalies rose by nearly 23% in the state, while falling by 3.1% in the rest of the country. To put it plainly, women are being forced to carry to term pregnancies that they know will end in heartbreak.
As for the Supreme Court, its ruling opened the door to emergency abortion access for women in Idaho whose pregnancy imperiled their own health, but it applies only to Idaho. It did nothing to address limits on care in other states, including Texas, where draconian bans have made doctors afraid to cross confusing legal lines.
“For the many more women that live in Texas than live in Idaho, they are not going to be able to get medically necessary, but not necessarily life-saving abortions,” says Greer Donley, an associate professor at the University of Pittsburgh School of Law and expert on abortion and the law.
Then there’s that unforgettable presidential debate. After first bizarrely asserting that some states allow “abortion after birth,” (they don’t), Trump launched into a false narrative around “late term” abortions.
Let’s inject some facts: “Late term” abortion is a political term, not a medical one. It’s a loaded phrase, rolled out with a contemptuous sneer that implies that women are, at the last minute, callously changing their minds. As Biden should have said in the moment, that’s pure malarkey. Instead, he at one point responded to Trump’s commentary with, “We are not for late-term abortion, period.”
“There isn’t actually a medical consensus about what makes an abortion later,” says Diane Horvath, who cofounded the Partners in Abortion Care clinic in College Park, Maryland. But by any definition, such terminations are rare. Nearly all abortions, 93.5%, took place in the first trimester in 2021.
More important are the people behind these numbers. “Every single later abortion I do is life-saving,” says Leilah Zahedi-Spung, a maternal fetal medicine provider in the Denver area.
Typically, that means something catastrophic has happened with the fetus, such as an anomaly that is not survivable, or with the mother, such as a chronic health condition that has worsened. Sometimes a new, serious condition that needs urgent attention, such as dangerously high blood pressure or a cancer diagnosis, emerges. Ending the pregnancy becomes the safer choice. “It is devastating for people,” Zahedi-Spung says. “They are grieving parents. They are losing a child.”
And then there are the other tragic, often-undiscussed reasons people seek later abortions — cases that are more common than we seem willing to acknowledge, says Horvath. These are the children who had no idea they were pregnant. It’s the women experiencing escalating intimate partner violence as their pregnancy progresses.
All these people deserve health care delivered with compassion and dignity, yet in post-Dobbs America, that care keeps moving further out of reach.
Ceding abortion laws to the states has made it harder to get timely care. Figuring out the logistics of traveling to an out-of-state clinic can take weeks, sometimes months. That’s meant an eightfold increase in later abortions at the hospital where Zahedi-Spung works, a situation echoed by doctors at clinics in other haven states. At that stage, the care is more complex, orders of magnitude more expensive and can require days of travel and recovery — and of course, exacts a steep emotional toll on the patient.
To be clear, a vote for Trump is a vote to go further down a road that many women reasonably fear ends in Gilead. But addressing the growing public health crisis caused by abortion bans requires more than Biden’s full-throated support of Roe v. Wade.
The problem is that Roe never granted women reproductive freedom. It never did enough to ensure equitable access to abortions in the U.S. Women in parts of the South and Midwest have spent years living under various versions of the harsh reality women in states with recent bans are now experiencing, being forced to cross state lines to get care.
Trump’s obsession with later abortions helps illustrate the ways Roe routinely failed women and their doctors. Under Roe, states were able to craft laws that imposed unnecessary boundaries around when and how care could be delivered.
Before moving to the Denver area, Zahedi-Spung spent years working at a hospital in Tennessee, where she had to navigate complex and inane laws that included a 22-week cutoff for abortion. When someone came in with a possible fetal anomaly or worsening health at 19 weeks, those laws meant rushing them into a deeply personal decision.
Now working in Colorado, a state with broad reproductive freedoms, Zahedi-Spung says she can tell her patients, “Why don’t you get more information?” She can give them time to do things like consult with a specialist and get additional tests so that they can better grasp what taking a pregnancy to term might mean for their child and their family.
In a sane world, the law would recognize a doctor’s expertise and give them the freedom to treat patients with dignity and respect — and, in turn, give patients the space to make the best, most informed decision rather than racing against the clock to make a choice at their most vulnerable moment.
That only comes from going further than Roe. Codifying reproductive freedom needs trusting women and doctors to make medical decisions on their own.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.
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