Abortion care is already changing dramatically after the U.S. Supreme Court weighed in with the precedent-shattering Dobbs decision in June.

More than half the states now are moving to ban or severely limit abortion. Dozens of reproductive health care clinics have recently closed. And many women – but particularly those of color – will have fewer options while navigating a chaotic landscape that’s likely to produce worse health outcomes overall, according to a panel of experts convened by the Leonard Davis Institute of Health Economics, the health policy hub at the University of Pennsylvania.

The ruling will cause many women to lose control over their lives and their care and may lead to less access to contraception. “At its core, abortion is health care,” noted moderator Courtney Schreiber, MD, MPH, an LDI Senior Fellow and Founding Director of PEACE, the Pregnancy Early Access Center at Penn Medicine, a national model for family planning and early pregnancy care. “And access to abortion and its related health care arguably has unparalleled ripple effects on sex disparities in our country and globally, on equality and honestly, on our social fabric.”

The decision also will likely worsen maternal mortality among minority women – widely identified as one of health care’s greatest problems, the speakers said.

“All of these changes will disproportionately impact people of color, particularly black women and people with lower incomes, thus exacerbating health inequities that have plagued our nation for decades,” said panel member Raegan McDonald-Mosley, MD, MPH, and CEO of Power to Decide, which works to improve reproductive well-being for people throughout our nation. Also joining the panel on September 16 were Heather Shumaker, LMM, MA, Director of State Abortion Access at the National Women’s Law Center, and Aletha Y. Akers, MD, MPH, Vice President for Research at the Guttmacher Institute.

Here are 10 points you need to know from the discussion. See a full recording here.

1. Since June, 60 reproductive health clinics have closed or paused in the U.S. These closures affect access to all reproductive health care, including contraception, and they are occurring, for the most part, in communities with poor maternal health care outcomes. 

2. Twenty-six states are expected to ban or severely limit access to abortion. At the same time, five states protect providers, and in some cases individuals that support patients, from the reach of out-of-state abortion restrictions and bans, according to a post on the Guttmacher Institute’s site, dated August 1, 2022. Dobbs doesn’t mean abortion is banned across the country, but the legal chaos that has ensued will likely continue for decades.  

3. Where people live will determine their access to abortion and many forms of reproductive health care. The Guttmacher Institute website hosts an interactive map showing how much geography has come to define abortion care in just a few months.  

4. The decline in the number of health care providers who can perform abortions, a trend that started before Dobbs, will continue and may accelerate. The number of abortion providers has fallen by half since 1981. 

5. The biggest difference between pre-Roe and now is the frequency of medication abortions, which now account for over half of all abortions performed. However, this option won’t be a solution for everyone because of state bans and rules regarding the administration of those drugs. The FDA’s removal of in-person administration requirements is helpful, opening the possibility of increased access through telehealth. Yet, some states ban the use of telehealth in abortions, and over half of the states require in-person visits for medication abortion. 

6. Abortion restrictions in states where Black women need this health care are not accidental. It’s the latest development in a long history of structural racism that includes redlining and a lack of access to education and jobs. 

7. Adolescents are uniquely affected by new abortion restrictions. While adolescents are less likely to become pregnant, when they do, they are more likely to characterize their pregnancy as unintended. Moreover, adolescents tend to show up later in pregnancy for care. Young people may have difficulty traveling, making access to care in other states more challenging. In addition, laws requiring parental involvement put reproductive care out of reach for many. 

8. Individuals with chronic medical problems and disabilities are also vulnerable in states with abortion bans. Those for whom pregnancy is unsafe will be impacted by a one-size-fits-all restriction on abortions.  

9. Immigrant populations without documentation will also be disproportionately affected, as they may not be able to travel to get the care they need. 

10. Abortion restrictions do nothing to reduce the number of abortions, according to global research the panel cited. But they do increase health consequences for pregnant women.

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