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Monday, July 15, 2024

Roe Stood for 49 Years. It Revolutionized Life for Women

The Supreme Court today overturned the legal right to abortion in the United States, returning the ability to regulate the procedure to the states, more than half of which have promised to ban it. The decision in Dobbs v. Jackson Women’s Health Organization explicitly overturns the landmark 1973 case Roe v. Wade, which guaranteed the right to abortion, prior to fetal viability, across the country.

“Held: The Constitution does not confer a right to abortion; Roe and Casey are overruled; and the authority to regulate abortion is returned to the people and their elected representatives,” Justice Samuel Alito wrote for a majority. The decision was 6–3, with the court’s three liberal justices in dissent.

The decision—which will launch the advent of “trigger laws” in 13 states—had been anticipated since a draft version was leaked in May. As it takes effect, it promises to roll back 50 years of profound changes in the lives of women in the United States, and in the structures and well-being of families, created by Roe.

Since the early 1970s, American women’s rate of marriage has halved and their college degree attainment has quadrupled. The number of women who do not bear children has more than doubled, and the number of women who forgo jobs because they are raising children is half of what it was.

Put more simply: Over the past 50 years, because of access to legal, safe abortion, women have been able to make choices that reshaped their lives. Now that Roe is overturned, some of those choices, and some of those life paths, might not be available any more.

“The ability to determine the timing of your childbearing is a pillar of the modern family,” says Philip N. Cohen, a professor of sociology at the University of Maryland, who argued in The New Republic in May that abortion rights are a fundamental component of democracy. “Abortion rights are central to women’s progress, and are part of a package of self-determination and autonomy that are foundational to women’s lives.”

It’s important to state up front that the Roe decision in January 1973 doesn’t represent a single moment when all abortion access in the US changed, as though a switch had been flipped. Before Roe, the decision had been up to state legislatures, as it will be again. In the late 1960s, 11 states loosened what had been total bans on abortion to allow occasional exceptions, after scrutiny by some sort of medical committee, for rape or incest or to preserve women’s lives. More significantly, by 1970 Washington, DC, and five states—Alaska, California, Hawaii, New York, and Washington—legalized abortion, both for their own residents and for any women affluent enough to get there.

What happened in those states over the three years before the Roe decision provides economists and social scientists with a natural experiment in the effects of legal access to safe abortion. Alaska, Hawaii, and Washington state were self-evidently difficult to get to; for the most part, only their residents benefited from legalization there. But California, New York, and Washington, DC, were population centers served by many transportation routes. National data from the time is incomplete; the Centers for Disease Control and Prevention began counting abortions in 1969, but only about half the states participated. This state data shows that abortions rose after local legalization and fell after Roe legalized them nationwide. The natural conclusion is that women initially flocked to states where abortions were available, but no longer needed to do so after Roe.

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In 1970, according to CDC data, New York and California accounted for 80.7 percent of all legal abortions reported in the US—but that proportion dropped to 54.5 percent in 1973, after the Roe decision was handed down in January. In an analysis of New York State data published in the Journal of Health Economics in 2013, economists estimated that New York accounted for 84 percent of all abortions performed outside a woman’s home state. In 1971, for instance, 97 percent of abortions received by Maine residents, 96 percent for Florida residents, and 92 percent for Texas residents took place in New York. But the researchers also found that the likelihood that women could access legal abortions before Roe was clearly linked to their distance from New York (or another state where anti-abortion laws had been repealed or reformed). With every 100 miles from New York’s borders, the occurrence of abortion diminished by 12 percent.

That history demonstrates what might happen now that Roe has been overturned and abortion is once again under the control of individual states. “When Dobbs overturns Roe, it's not going to be a return to the 1960s,” says Caitlin Knowles Myers, an economist and professor at Middlebury College whose work focuses on reproductive policy data. “It's going to be a return to that narrow period of 1970 to 1972. That’s what we’re talking about: a return to this inequality in access for women in half the country.”

Myers has estimated that, in this scenario, every year about 100,000 women who live in states that plan to institute new bans or limitations will not be able to reach an abortion provider. About 75,000 of them, she estimates, will carry their pregnancies to term. (The rest will lose them to miscarriage, or possibly undergo a medication abortion.) “This group of women are disproportionately the poorest of a very poor and already vulnerable group,” Myers says. “Many of them are already mothers. They’re experiencing disruptive life circumstances. They’re so credit-constrained and poor that they can’t figure out how to travel to get an abortion. And many of them give birth as a result.”

There’s abundant data, gathered immediately before and after the Roe decision and also in the decades since, that tells us what’s likely to happen next. Before Roe, more women died from hemorrhage or infection as a result of unsafe abortions, and some from the inherent risks of pregnancy. (Maternal mortality in Black women improved by 40 percent after legalization, according to research done last year.) Research published by the Guttmacher Institute almost 20 years ago found that the primary impact of Roe was on public health, not demographics—that is, there was a moderate dip in the birth rate, but a striking decrease in illness and deaths.

About that dip. Economists have found that if you isolate the availability of legal abortion from other simultaneous events, such as the availability of oral contraceptives, the Roe decision accounts for an 11 percent drop in the US birth rate. That might seem like a small number, but it’s huge in the context of who would have experienced those births: Myers found that after the Roe decision the number of teen mothers dropped by 34 percent. And the number of teen marriages—“shotgun marriages,” a thing that in the ensuing decades mostly passed out of US culture—dropped by 20 percent.

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But what happens after that birth—especially to young women and women of color—best demonstrates the world that Roe remade. The ability to choose whether and when to have children or to marry made a profound difference in women’s economic futures. Multiple studies show that women who could time their pregnancies were more likely to finish high school and attend college, more likely to earn higher wages, and more likely to enter professions. While other changes sparked in the 1970s improved women’s economic and work prospects, including attention to diversity in education and the rise of tech work, economists are confident the Roe decision played a role.

Which is why they were so troubled about the likelihood of Roe being overturned. Last September, 154 economists and researchers filed a lengthy amicus brief in the Dobbs case, intended to walk the court through the evidence that access to legal abortion is critical for women’s economic health. (In oral arguments, Chief Justice John Roberts appeared to disregard the brief, saying to the attorney presenting it: “Well, putting that data aside …”)

Jason Lindo, a professor of economics at Texas A&M University who signed the brief (as Myers did) points out that it isn’t only women who will suffer from this economic derailment. “The large majority of people seeking abortions already have at least one kid, and many will have kids at a later point in their life,” he says. “As a result of their mothers not being able to have an abortion, these children are going to grow up in more disadvantaged households. And there is a very large literature showing that growing up in a more disadvantaged household leads to worse economic outcomes, worse educational outcomes, higher rates of incarceration, greater reliance on social support programs.”

This isn’t merely supposition. A groundbreaking research project known as the Turnaway Study, which began in 2008, followed 1,000 women for five years. All of them had sought abortions and either received them or were “turned away” because they were past their state’s gestational limit and subsequently gave birth. Compared to the women who received abortions, the women who could not obtain one were four times more likely to have a household income below the federal poverty limit, three times more likely to be unemployed, more likely to file for bankruptcy or be evicted and more likely to have lower credit scores and higher debt and be unable to afford necessities such as transportation and food.

They also were more likely to be with unstable or violent partners and more likely to be living as single mothers. And their children—both those from the unwanted pregnancy and others born before or after—were three times more likely to be living below the federal poverty line. “The outcomes for children who are unwanted have a generational impact,” says Naomi R. Cahn, a professor and codirector of the Family Law Center at the University of Virginia School of Law.

The potential harm reaches beyond childbearing and child-rearing. The clinic system that grew in the aftermath of Roe, made up of both stand-alone offices and outposts of national organizations such as Planned Parenthood, does more than just provide abortions. In many locations, those clinics also ensure that women receive low-cost health care: family planning advice, breast and cervical cancer screenings, physical exams. As restrictions have tightened and family-planning funding has been cut, those clinics have been closing. In 2016, economists found that when 100 miles are added to the trip to the nearest clinic, women are 14 percent less likely to receive Pap smears and 18 percent less likely to get mammograms.

“Lots of places that do abortion care do a full range of services,” says Karen Benjamin Guzzo, a sociologist and director of the Center for Family and Demographic Research at Bowling Green State University. “Some women will just simply not be able to get the reproductive care they need.”

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