Volume 36, Issue 4 p. 433-441
Original Article
Open Access

Society for Medical Anthropology Statement on Supreme Court Dobbs v. Jackson Women's Health Organization Decision

Mara Buchbinder

Mara Buchbinder

University of North Carolina at Chapel Hill, Department of Social Medicine

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Joanna Mishtal

Joanna Mishtal

University of Central Florida, Department of Anthropology

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Elyse O. Singer

Elyse O. Singer

University of Oklahoma, Department of Anthropology

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Claire L. Wendland

Corresponding Author

Claire L. Wendland

University of Wisconsin-Madison, Departments of Anthropology and Obstetrics and Gynecology

email: [email protected]

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First published: 26 November 2022
Citations: 2

Abstract

This statement summarizes key findings from anthropological and related scholarship on the harmful consequences of inadequate abortion access, leading the Society for Medical Anthropology to register profound concern about the recent Supreme Court decision in Dobbs v. Jackson. After circulation to SMA members for input, a finalized version passed a membership vote by an overwhelming margin. This statement complements one produced by the Council for Anthropology and Reproduction, available here.

The Society for Medical Anthropology registers its profound concern about the recent Supreme Court decision in Dobbs v. Jackson, which disregards evidence about the harmful consequences of inadequate abortion access. As researchers who study the ways that health and sociopolitical structures are connected in people's lives, we are attentive to the effects of laws that target reproduction.1 Even before Dobbs, opponents of abortion made it tremendously difficult to access abortion care by forcing through targeted regulation of abortion providers (TRAP) laws in many U.S. states. These laws exacerbated access barriers, imposed medically unnecessary delays and restrictions, and intensified harassment and intimidation of patients and clinic staff (Andaya and Mishtal 2016; Buchbinder 2016; Cohen and Joffe 2020). Anthropological research in U.S. states with TRAP laws and in nations with legal bans on abortion shows us what to anticipate from the Dobbs decision and the state restrictions that it unleashes (Arey et al. 2022). As we detail below, the ruling allows legislators to take actions that will worsen maternal health, increase preventable deaths, undermine women's autonomy and opportunities for equal participation in society, render families more precarious, constrain health care providers from providing ethical care, and exacerbate serious and longstanding health inequities that harm women living in poverty, women of color, and gender-nonconforming people.2

Worsened Maternal Health and Survival

Abortion Complications

The Dobbs v. Jackson decision will cause serious harms by pushing once-legal health care into the clandestine realm. Countries in which abortion is prohibited do not have lower abortion rates than those in which it is legal (Sedgh and Keogh 2019; Sedgh et al. 2012). Instead, illegality ensures that many more abortions are traumatic, delayed, stigmatized, and dangerous (De Zordo et al. 2016; De Zordo et al. 2020; Mishtal 2015; Suh 2021; Wendland 2022). Self-managed medication abortion can be safe and effective, especially in early pregnancy and when embedded in a strong referral system, should complications arise (Aiken et al. 2017; Moseson et al. 2019). However, many women induce abortions on their own with limited information on how to do so safely, using techniques that are unsafe or unproven (De Zordo et al. 2016; Suh 2021; Wendland 2022). These improvised abortions can result in sepsis, hemorrhage, poisoning or other kinds of bodily damage, infertility, and death—in addition to the danger, stigma, and emotional distress of seeking an illegal service (Suh 2021; Wendland 2022).

Maternal Death

The United States already has the highest rate of maternal mortality in the Global North; that rate is rising (Hoyert 2022; Villavicencio et al. 2020). Maternal mortality increases when pregnant people are forced to continue unwanted or medically dangerous pregnancies, when legal restrictions result in inappropriate or delayed care for miscarriage and other pregnancy complications, and when severely limited access to safe abortion methods results in improvised and sometimes dangerous practices (Morgan 2017; WHO 2011). Public health researchers estimate that a complete abortion ban would increase U.S. maternal mortality by 21%, with even larger death tolls among poor women and women of color (Harris 2022; Stevenson 2021). Anthropological research on practices of reporting and categorizing deaths shows that these figures are almost certainly substantial underestimates (Sedgh and Keogh 2019; Suh 2021).

Suicide and Homicide

The anticipated increases in maternal death do not include deaths by suicide or homicide. Suicides were so numerous among young women with unwanted pregnancies in El Salvador that they became a leading cause of maternal mortality after a total abortion ban there (Moloney 2014; Teter 2020). Deaths by homicide nearly double during pregnancy and the postpartum period in the United States (Margerison et al. 2022; Subbaraman 2021). We anticipate that the Dobbs decision will increase risks of both suicide and homicide for pregnant people.

Exacerbation of Inequities

Reproductive Injustice

Black women developed the framework of reproductive justice in 1994, rooted in longstanding activism and theory-building, and based on the Universal Declaration of Human Rights (Morgan 2015; Price 2010; Zavella 2020). Many anthropologists use reproductive justice to analyze intersecting forms of violence, oppression, and marginalization (Davis 2019a; Morgan 2015; Valdez and Deomampo 2019). Core tenets are the right of bodily autonomy, the right to have children, the right not to have children, and the right to parent in dignity. The Dobbs decision threatens these tenets in ways that further entrench interlocking inequalities based on racism, sexism, ableism, and other forms of marginalization. States that now have abortion bans already had some of the nation's highest rates of maternal mortality, infant deaths, and other poor neonatal outcomes (Ely and Driscoll 2021; Everett et al. 2021; United Health Foundation 2022). Abortion bans will amplify these disparities, especially for low-income and historically marginalized people (Watson 2022).

Women of Color and Women Living in Poverty

Extensive international research shows that pregnant people who have the social and economic means to do so will travel to seek abortion care across regional and international borders (Mishtal 2015; Ostrach and Cheyney 2014; Sethna and Davis 2019; Singer 2020). The situation is not benign even for them: The need to travel can increase risks by delaying access to time-sensitive care, and it exposes them to financial, emotional, and logistical hardships (Arey et al. 2022; Cano and Foster 2016). Many women, however, will not be able to secure the funds, time off work, or childcare necessary to arrange abortion care across borders (Aragon Martin 2017). Women living in poverty and Black and Native women will be disproportionately affected by the inability to access abortion care (Ostrach and Cheyney 2014; Watson 2022).

Other People with Limited Access to Health Care

Gestational age limits on abortion care disproportionally hurt women living in remote areas, people in abusive relationships, minors, those living in contexts with marked abortion stigma, and those with cognitive impairments (De Zordo et al. 2020). Legal webs of restrictions and regulations that hinder abortion access cause particular harm to people who already face difficulty accessing or trusting health care due to racism, disability, homophobia, or transphobia (Moseson et al. 2021). Limited social welfare and mental health services compound the problem: these supports are often inaccessible to the very communities at highest risk for experiencing the negative consequences of state abortion bans.

Constraints on the Practice of Health Care

Legal Repercussions for Clinicians

Criminalization of reproductive health care across various states now includes potential felony charges, imprisonment, fines, and suspension of professional licensure (New York Times 2022). Criminalization places moral, legal, and emotional burdens on health care providers, many of whom feel forced to choose between breaking their oaths or breaking the law (Arey et al. 2022; Buchbinder et al. 2016; Levine 2022). It also creates fear of legal repercussions among health care providers—including pharmacists, midwives, genetic counselors, physicians, and others—that can further limit the reproductive care that is still lawful and can create distrust between providers and patients (Erdman and Cook 2020; Harris 2022; Hercher 2022; Suh 2021; Weiss 2022).

Unintended Consequences beyond Abortion Care

Policies inevitably have unintended consequences. This ruling is already affecting women's health care in many ways that extend beyond undesired pregnancy (Paltrow et al. 2022; Premkumar and Wendland 2022). Standard medical practices such as superovulation for infertility treatment, IUD placement, storage and selection of frozen embryos, or use of medication to treat ectopic pregnancy are curtailed or under question (Arey et al. 2022; Cromer 2019; Harris 2022). Non-pregnant women have reported being denied teratogenic drugs such as methotrexate for chronic illness management (Sharp 2022; Weiss 2022).

Impact on Training

Obstetrics and gynecology residents who train in states where abortion is banned or severely restricted will either not be trained in this basic medical procedure or will need to go to great lengths to secure necessary training. This de-skilling is likely to exacerbate longstanding inequities in reproductive health care caused by the maldistribution of providers. It will have a lasting generational effect on the number of trained abortion providers and on the number of physicians available to perform complex miscarriage management and other essential reproductive health services (Montoya and Gray 2022; Polic and Rapkin 2020).

Worsening of Structural Sexism and Erosion of Women's Autonomy

Criminalization of Pregnancy

Criminalization affects those who are pregnant, and not only their clinicians (Kublik and Sufrin 2020; Paltrow and Flavin 2013). Already, zealous officials have arrested, prosecuted, and jailed women for actions deemed likely to cause a pregnancy loss. These actions have overwhelmingly targeted low-income women of color (Goodwin 2017, 2020; Kublik and Sufrin 2020; Paltrow and Flavin 2013). The Dobbs decision opens the door for much more reproductive surveillance, and much more criminalization in communities that are already marginalized (Goodwin 2020).

Impacts on Women and Families

The inability to access an abortion has many adverse consequences for people who can get pregnant and for their families. It decreases likelihood of employment, worsens poverty for mothers and the other children in a family, and keeps women in violent relationships (Foster 2020). Being forced to continue a pregnancy can lead to anguish and violates human rights (Erdman and Cook 2020). As abortion for serious congenital problems disappears in many places, the gendered burdens of care will increase (Gammeltoft 2014; Rapp 1999; Williamson 2018). Some state laws further isolate pregnant people by threatening—or incentivizing—civil action against any support people who help them access abortion (Picchi 2021). In others, the loss of women's rights to abortion has been accompanied by increases in legal rights, and incentives to civil action, for rapists’ family members (CBS News 2022). All of these ramifications undermine women's opportunities for equal participation in society.

Subjugation on the Basis of Sex

The Dobbs decision legitimizes an inequitable distribution of power and resources based on sex. When abortion is prohibited, any person capable of pregnancy occupies a subjugated status. They exist under a regime that requires them—without choice or consent—to put the full materiality and physiology of their body in service of the state's interest in the fetus (Bridges 2013; Paltrow and Flavin 2013; Sufrin 2017). They become legally and socially less than fully sovereign human persons (Kligman 1998; Singer 2020).

In sum, the Dobbs v. Jackson decision will have far-reaching ramifications, threatening all three core tenets of reproductive justice: the right to have children, the right not to have children, and the right to parent children in safe and sustainable environments.

Anthropological research shows that state regulation of abortion and contraception typically reinforces narrow models of “appropriate” reproduction (Kligman 1998; Morgan and Roberts 2012; Unnithan and de Zordo 2018). In the United States, the values reinforced include white supremacy and patriarchy: The Dobbs majority decision valorizes a historical time in which Black people, Native people, and women were not full citizens and had little if any say in legislation that affected their lives in profound ways (Alito 2022; Davis 2019b; Howard University School of Law 2022). Across a variety of cultural contexts, assaults on abortion access are frequently tethered to xenophobia, racism, backlash against gender equity, and anxieties about social and demographic change (De Zordo et al. 2016; Faúndes and Defago 2016; Millar 2015). They reflect ideals that leave little room for alternative family structures or for gender pluralism. Such regulations are often justified with language of “moral renewal” that designates certain people as unworthy, putting them in danger of harassment and violence (Maffi 2018; Millar 2015). We anticipate that women, trans men, and other people seeking abortions will now be among those targets.

The dissent in Dobbs v. Jackson notes that the majority opinion “reveals how little it knows or cares about women's lives or about the suffering its decisions will cause” (Breyer et al. 2022: 48). We concur. The Society for Medical Anthropology condemns this decision. It endangers women and others who can become pregnant, worsens health inequalities, interferes inappropriately with the practice of medicine, and violates human rights.

Acknowledgments

The authors are grateful to the anonymous peer reviewers who drew our attention to additional research and helped clarify ambiguous areas. We also thank the many other people who wrote to share suggestions, and especially Emma Varley for helpful insights.

    Notes

  1. 1 The four authors are listed in alphabetical order of surnames. We contributed equally to the statement and share responsibility for its content.
  2. 2 This statement blends gendered language (women, maternal) with language that recognizes that people capable of pregnancy are not all women: Trans men and non-binary people also seek abortion care. Anthropological scholarship has shown how often women are rendered invisible in reproductive health policy and practice. In using both inclusive and gendered language, we refuse to pretend that transgender people do not matter and refuse to make women disappear from a set of decisions that enforce patriarchy and codify sexism.