Warning: This article contains content some readers may find distressing.
If you are a person in the UK who wishes to terminate a pregnancy the process is relatively straightforward: within two weeks you can usually obtain an abortion at a National Health Service hospital or licensed clinic free of charge. If you are a person in the US who wishes to terminate a pregnancy, your ability to access abortion health care will depend on two key variables: the state in which you live, and your access to financial resources or health insurance.
In the US, health care is not considered a human right and abortion health care is not a guaranteed right. Health care is regulated by each state, and states have the ability to limit access to abortion health care. The 1973 Roe v Wade US Supreme Court decision made clear that each state can regulate abortion but cannot create complete bans prior to viability. Since that decision, various US states have made it increasingly difficult to access abortion health care by passing laws that force pregnant people to delay essential abortion care. Included among these many laws are: waiting periods, state-mandated counselling that often includes false medical information (e.g. that there are possible links between abortion and breast cancer), physician and hospital requirements, limits to public funding and insurance coverage, telemedicine restrictions and medication restrictions.
Particularly grievous legislation exists in almost a quarter of US states requiring a person seeking an abortion be subjected to an ultrasound against their will, and six states force women to view the ultrasound images even if they do not want to. Almost 90 percent of abortions occur during the first ten weeks of pregnancy, when abortions can be provided using very safe oral medications. Routine ultrasounds are not considered medically necessary nor are they recommended for abortions during this first-trimester period. At this early stage of gestation, internal transvaginal ultrasounds are utilized to view the embryo because they are usually too small to be viewed with an external abdominal ultrasound. This means that women in states with these laws are subjected to vaginal penetration (with a twelve-inch plastic wand called a transducer) against their will in order to receive abortion health care. This forced penetration is nothing less than sexual violence, abuse and trauma. And, it is particularly unconscionable that poor and minority communities are disproportionately subjected to it.
A woman’s ability to access abortion health care in the US also depends on her financial resources and access to health insurance. In 2021, approximately 31 million people in the US had no health insurance. A person with adequate financial resources or with health insurance that includes abortion coverage can usually obtain an abortion from a hospital, clinic or physician’s office privately and discreetly. A person without financial resources or health insurance will most likely have to use one of the few abortion clinics in their state, or travel out of state. In 2017, almost 90 percent of counties in the US did not have a known abortion clinic, and almost 40 percent of women aged 15-44 lived in a county without one. Stand-alone abortion clinics have been the target of violence for decades, creating additional burdens for women to seek care. Between 1993 and 2016, anti-abortion terrorists murdered 11 people and attempted to murder an additional 26 people. And, between 1977 and 2015 more than 7,200 reported acts of violence and terror have been directed at abortion providers, including “42 bombings, 185 arson attacks, and thousands of death threats, bioterrorism threats and assaults.”
On May 2, 2022 in a leaked draft opinion, the US Supreme Court signaled that it might actually overturn the previous Roe v Wade decision and, in so doing, allow states to pass legislation that limits abortion access prior to viability or even outlaws and/or criminalizes abortion entirely. The results for people who need access to abortion health care will be devastating and will predominantly affect people who are poor, Black, Indigenous, persons of color, LGBTQI, immigrants, disabled or unhoused.
In many states, the change in access will be swift. Indeed, there are abortion-access trigger laws already in place in 13 states, including Texas. What this means, practically speaking, is that if the US Supreme Court guts or completely overturns Roe, abortion-limiting legislation will automatically become law. To travel out of state to access abortion care, which is prohibitive for many if they cannot find child care (the majority of people seeking abortions in the US already have children), transportation or funding, will add to women’s burden. The longer it takes a person to make these arrangements, the further along the pregnancy continues. Most people who have abortions later in pregnancy lack the financial resources to overcome barriers to care, or are people who receive devastating news that a very much wanted pregnancy is no longer viable or is detrimental to their health.
Social contexts that devalue and desecrate women’s personhood, spirit, lives and bodies have profound impacts on reproductive health, freedom and choice. The social context women in the US face is one of deprivation and discrimination – particularly for low income and minority women. Unlike in many other OECD countries, women in the US do not have access to free, accessible and universal: health care (including prenatal and postnatal care), child care, pre-kindergarten, paid maternity leave, paid family and medical leave, free public transportation, free higher education, guaranteed living wages, and unions – all of which make childbirth and child-rearing easier.
All of the above should force us to reconsider how we define a “pro-life” position. We do not have to accept that “pro-life” simply means anti-abortion. We can and should redefine and reframe “pro-life” to mean policies and positions that support human dignity, human flourishing and solidarity. When taken together, the UK’s basket of institutions and services are more “pro-life” and more humane than those in the US. Women who choose abortion are dealt with as autonomous and agentic human beings and receive far more access to the health care they need. Women in the UK are also in a better position to choose to continue pregnancies and build families because the state provides far more services for children once they are born, and the economic burden of raising a child is shouldered far more substantially by the state than in the US. The challenge, then, in the US, is to demand more “pro-life” state policies that value women and children, including policies that provide free, easily accessible health care to all. And that means access to abortion.
Tamara Kay is a Professor of Global Affairs and Sociology at University of Notre Dame. Susan L Ostermann is an Assistant Professor of Global Affairs and Political Science at University of Notre Dame. The views expressed do not reflect those of the authors’ employer.