The fall of Roe v Wade: the fight for abortion rights is universal

On the 24 June 2022, the Supreme Court of the United States overturned Roe v Wade, the landmark 1973 decision to legalise abortion in the US, which for half a century has guaranteed that women had the fundamental right to choose whether to have an abortion. The ruling had ensured that states could not implement laws banning abortion before fetal viability. Its recent annulation means that states will be able to decide their abortion laws. Thirteen states have since decreed so-called trigger laws banning abortion; 13 more are likely to follow suit, ensuring that abortion will become illegal or highly restricted in more than half of all states. At least 300 000 pregnant women across the US will be affected by the bans, with no exception made even for terminations of pregnancies resulting from rape or incest.1

The US Supreme Court’s decision has been condemned by political and public health leaders around the globe. The United Nations Population Fund has warned that restricting access to abortion makes it more deadly. That was certainly true before Roe v Wade was first ruled in the 1970s, when the alternatives to lawful abortion were unsafe, backstreet surgical terminations. Yet medical abortion has transformed that reality, making the placard slogan of “you can only ban safe abortion” more relevant then than it is today. Self-management of medical abortion with the use of mifepristone and misoprostol is effective, safe, and recommended by the World Health Organization. It is often the only method available in settings where abortion is illegal, facilitated outside the system by pro-abortion collectives—as is the case in Poland, Brazil, and Nigeria.234 The availability of medical abortion will undoubtedly mitigate some of the worst effects of the draconian laws in the US, allowing at least some women to carry out their own abortion at home. But the lack of choice of method will remain a problem for those for whom medical abortion is unsuitable. Of the nearly one million abortions done in the US in 2019, fewer than half were performed with the use of medication.5 The lack of systemic support will be a barrier and a cause of distress for many.4 Even in the well regulated UK context, women described the need for more assistance in the course of their self-administered medical abortions.6

Yet many others will suffer even more devastating consequences of this ruling. Pregnant women will die because of the chilling effect the law will have on healthcare practitioners in management of miscarriages, ectopic pregnancies, and other obstetric complications, as was the case with Savita Halappanava in Ireland, with Izabela Sajbor in Poland, and thousands of others who have lost their lives because of oppressive abortion regulations. This law will hit those of lower socioeconomic status disproportionately severely. They are less likely to have the means to order abortion medications in advance, the means to travel across states, or the capacity to advocate for themselves in a medical setting. The financial impact on individuals will be even more drastic in states like Arkansas and Louisiana, where the perverse law threatens not only imprisonment, but also extortionate fines for conducting or aiding an abortion. The threat of surveillance of internet searches and period tracking apps, the monetary incentives to report on those “committing a crime,” and the harsh prosecutions will destroy the lives of pregnant women and their families, and of the medical practitioners willing to help them.

But the consequences of the decision of six judges of the Supreme Court will go far beyond the residents of the US. The US has long had a substantial influence on abortion policies worldwide. Among the most important examples of this were the Helmes Amendment and the Global Gag Rule, which banned federal funds from being used for abortion organisations and prevented foreign organisations receiving donations from the US from providing any sort of abortion aid, even using their own funds. The crisis in the US should ring alarm bells even in the UK. We must not forget that England, Scotland, and Wales have still not decriminalised abortion, and even though it is legalised under certain conditions, it still requires the signature of two doctors to be lawful. Britain remains one of the few European countries where a woman can be prosecuted for carrying out her own abortion outside the health system. Northern Ireland is the only nation that has repealed the 1861 law that had placed abortion in the criminal code, yet still there is no commissioning for abortion services, and many women are left without care or forced to travel to England to receive it. The fight for abortion rights is universal. We must stand in solidarity with those affected by the brutal legislations in the US, and we must strive to improve abortion legislation and access in the UK. The fall of Roe v Wade is an assault of human rights, and it is a public health crisis.