The End of Roe

And where we go from here

Friday’s ruling from the Supreme Court was a destructive step backwards for healthcare in the United States. The impact was immediate. Clinics across the country were forced to turn people away in some cases, including people who were already in the waiting room. The ensuing days have been chaotic. Color-coded maps of the country continue to change in real time as “trigger” and “zombie” laws go into effect, and as people scramble to understand what exactly is legal where. 

The Court’s decision was swiftly condemned by over 100 global medical organizations, by the leaders of peer nations and by the UN’s High Commissioner for Human Rights. As states begin implementing abortion bans, it is galling to see the degree to which U.S. lawmakers fail to understand “the scientific realities of human reproduction,” as NEJM puts it. 

It is impossible to care for any population of people without encountering many who are pregnant and do not want to be, people whose pregnancies are medically dangerous, people whose pregnancies are psychologically excruciating. In my own practice as an OB-GYN this was a daily occurrence. My job was to center and affirm the needs of my patients — and to support their choice. Forcing pregnancy upon them would have been unimaginably cruel and inhumane. 

I am devastated by the idea that the law of the land in many parts of our country may be at odds with the moral duties of healthcare providers, who hold personal autonomy and justice as sacrosanct. I am heartbroken that those who were already made most vulnerable will suffer most — particularly Black women in the South who already face the highest rates of maternal mortality, who live in reproductive healthcare “deserts,” and endure well-documented racism. 

Still, we are not powerless. There are many ways to help — you can vote, you can donate, you can organize. 

At Maven, in anticipation of this outcome, we asked our providers for their support to ensure we could deliver factual, evidence-based pregnancy options counseling to those in need as part of a broader effort to improve our full-spectrum reproductive health offering. The overwhelming majority responded right away. 

I feel fortunate to work with colleagues who are trained and willing to provide this service on our platform. Following their lead, teams from across Maven pitched in to make sure this care will be easy to access and integrated into our product experience in the most seamless way possible. Just about every team touched this effort in some way — from our product leaders and engineers to our legal, data, communications, and operations teams. Along with fact-based educational resources, this new offering will help ensure that our platform is able to meet people where they are and help them make the right decision for themselves.

In addition, our founder and CEO Kate Ryder announced on Friday that we will be supporting employers and health plans who wish to reimburse out-of-state travel costs through Maven Wallet.

There is much work yet to do but this is a start.

What my team is reading, considering, and building against

• This month in 1994, a group of Black women coined the term “reproductive justice,” which SisterSong defines 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.” This concept extends the historically narrow understanding of “pro-choice/pro-life” reproductive rights to the ongoing struggle for social justice, and calls for a deeper examination of race, gender and class politics in the United States.
  

• Diana Greene Foster’s ‘Turnaway Study,’ is canonical research to understand the impact of widespread abortion bans. Based on a sample of almost 1,000 women seeking abortions from 30 different clinics, the study found that women who were turned away from abortion clinics were nearly 4 times as likely as women who were able to have an abortion to live below the federal poverty line. They were more likely to stay with violent partners or to be single parents. They were at greater risk of adverse health outcomes from carrying their pregnancy to term than from receiving an abortion. And the existing children of women denied abortions were more likely to miss developmental milestones and to live in poverty.
  

• This excellent New Yorker article authored by Jill Lepore in 2015 explains why abortion rights are tethered to a web of privacy rights, with broad implications for future judgements on everything from contraception to in vitro fertilization and other reproductive health services to gay marriage. 
  

• This amicus brief filed by 154 distinguished economists and researchers, highlights the myriad ways that women’s economic wellbeing has advanced since the Roe decision nearly 50 years ago (a less wonky, slightly more digestible read from Brookings is here). Most essentially, the authors note that women being able to decide when, how, and if they wish to start a family has profound implications on their ability to pursue additional education and training, find the right partner, and participate in the economy to their fullest potential. The impacts on wages and educational attainment have been broadly felt, but most acute for Black women.