Abortion: An Important Part of Reproductive Justice and a Public Health Issue of Our Times

Definition of reproductive justice

The organization SisterSong defines reproductive justice (RJ) as the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities. The concept of RJ is squarely derived from the Universal Declaration of Human Rights by the United Nations. RJ is about access, not simply choice. While preserving the right to an abortion is important, because of limited access in the United States, many people functionally cannot get an abortion anyway, because they do not have a place to go nearby, time off work, childcare for other children, or other issues. This particularly affects people of color and poor people, and especially people in rural communities in the US. In addition to abortion, in order to achieve RJ, people also need access to contraception, education, healthy environments, an equitable medical and healthcare system, domestic violence resources, adequate wages, safe neighborhoods and homes, and others. 

Human rights

The International Conference on Population and Development was held in Cairo in 1994, where it was decided that the right to plan your own family is a basic human right and at the center of developing the world. The right to family planning includes a variety of legal rights that must be guaranteed. Some of these are placed within the medical system, some in the educational system, and others should be societal. The ability to plan a family includes education attainment for women, comprehensive sex education, access to effective forms of birth control including long-acting reversible contraception, access to abortion, and various social determinants of health that can help people have healthy pregnancies, childbirth experiences, and child rearing. That means all people should get equal access to prenatal care and good nutrition – in the United States this is hindered by the 14% of reproductive-age adults not having any health insurance. Additionally, large numbers of people cannot afford the out-of-pocket payments of the health insurance they do have. This leads to many people delaying prenatal care or not getting the kind of care they want and need. 

Other barriers in the United States include many states not providing comprehensive sex education in schools, the many bans or restrictions placed on abortion in states across the nation, and the fact that these restrictions have led to fewer or no clinics that are able to provide abortions in certain states. We also have some of the worst maternal health outcomes among high-income countries, particularly in Black and other women of color, which means that they are not guaranteed the same right to a healthy childbirth experience as White women. People of color are much more likely to live in environments where children and pregnant people are exposed to dangerous conditions – housing with peeling paint, rodents and other pests, unsafe water, air pollution, near Superfund sites that need remediation. This places people at risk for exposure with allergens and asthma triggers, lead which can create developmental delays in children, arsenic in drinking water, pathogens, and many other toxins. 

Abortion is a public health issue

The term abortion is defined as any procedure done to end a pregnancy, and a miscarriage is called a spontaneous abortion. There are two main ways to perform abortions – medical and surgery. The medications necessary for a medical abortion (mifepristone and misoprostol) are prescribed by a healthcare professional and then people can take the medication at home. The surgical abortion, typically by dialation and curretage must happen in a healthcare provider’s office or clinic, but is considered an outpatient procedure (people go home after it is done). While pregnancy has many possible complications, like ectopic pregnancy, hypertension, depression during and after pregnancy, gestational diabetes,  preeclampsia, and many others, there are very few negative health outcomes reported after an abortion – pregnant people are 14 times more likely to die compared to those who receive an abortion. Additionally, having an abortion does not interfere with a person’s ability to get pregnant again if they so choose.

The most common reason people give for seeking an abortion is that the pregnancy was unintended – thus, better access to contraception has been very important in reducing the rates of abortion. Also, some conditions, like ectopic pregnancy, can only be treated with an abortion. For many years, abortion rates have been decreasing in the US because of better access to contraception and sex education, but also partially because access to abortion has been decreasing. The vast majority of abortions, 93% in 2019, occur in the first trimester of pregnancy. When people seek an abortion later in the pregnancy, often it is because there are concerns for the health and life of the pregnant person or because the fetus will not survive the pregnancy or has already died.  

After Roe v. Wade was overturned in June 2022, within a month, 11 states either banned abortion completely or instituted a 6-week abortion ban. Many people may not even know they are pregnant at 6 weeks of gestation. The length of gestation or pregnancy is counted from the first day of the last menstrual cycle a pregnant person had. This most often means that when fertilization occurs, people are already “2 weeks pregnant” since ovulation occurs around 14 days into a menstrual cycle. Thus, if people have a fairly regular cycle of about 28 days, then on the first day of their missed period, they are considered 4 weeks pregnant, and only have 2 weeks to confirm that, find a clinic that performs abortions, coordinate a visit to a healthcare provider, take time off work or school, and get the procedure. In the states where 6-week abortion bans took place, within one month of Roe v. Wade being overturned, only 11 clinics are still performing abortions as of July 2022, which means access has severely dropped, even for those people who know they are pregnant early enough to begin the process of getting an abortion. For those people who do not have a regular menstrual cycle, who cannot easily get time off work, or who do not have access to a clinic nearby, abortion access may have all but disappeared. 

There have been many stories coming out of the states with the most restrictive laws prohibiting or limiting abortions already – pregnant people having to travel out of the state to get abortion care, doctors uncertain how to treat people suffering from complications of pregnancy, pharmacies refusing to fill prescriptions that may harm a fetus even if a person is not pregnant. Many organizations have stated that this ban will have a negative impact on pregnant people, for example the about 1 in 1,000 pregnant people who may be diagnosed with cancer and then have fewer options for treatment and worse outcomes. Access to abortion is a public health issue. Studies show that when people are unable to receive a wanted abortion, that can lead to stress and anxiety, higher rates of poverty, debt and eviction, and that health outcomes for existing children are worse. Additionally, criminalizing abortion often leads to worse penalties for pregnant people who are Black and brown, as well as prosecution of miscarriages and other routine medical issues.  While the Biden administration has been seeking to preserve some rights and help with access, including to emergency contraception options and medical abortions, ultimately the only way to guarantee safety and health is to have national legislation that protects reproductive rights.  
If you want to learn more about Roe v. Wade, abortions, and and other reproductive justice topics, BMCC will be holding a year-long series on Reproductive Justice. The first event will be on October 20th and is titled The Fall of Roe: The Enduring Legacy of Reproductive Violence. Another event on October 26th is on Demistifying Abortion and the final event for the Fall semester will be held on November 9th and is titled Overturn of Roe v Wade: Consequences and Impact. Additionally, an alliance of CUNY students, faculty and staff named CUNY for Abortion Rights is active and will be supporting a student day of action on October 6th. To learn more, look for @cunyforabortionrights on Instagram and join to learn about that and other events and actions being planned.

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