When a Right Becomes a Privilege

Melissa Jeltsen, The Atlantic, 5/15/22

When New York legalized abortion in 1970—three years before the Supreme Court decided Roe v. Wade—a shrewd entrepreneur named Martin Mitchell saw an opportunity. The 31-year-old Detroit-area man chartered a tiny private plane and began advertising frequent flights from Michigan, where elective abortion was illegal, to Niagara Falls, New York, where it was not. For $400, a woman got transportation, an abortion by a licensed doctor at a clinic near the airport, and lunch, before being flown home the same day.

One of Mitchell’s clients, a 22-year-old secretary with a steady job at a hospital, told a reporter at the time that she was too scared to seek out an illegal abortion in Michigan, and that if she hadn’t been able to get to New York, she would have been forced to continue her pregnancy. She was only able to afford the charter service—which, adjusting for inflation, would cost about $2,900 today—because her parents lent her the money. Before the flight home, she gushed with relief. “Gosh I feel great, fine, just great,” she said.

It is not far-fetched to imagine that this is the future we may soon face, in which the ability to terminate a pregnancy in the United States will largely depend on where you live and what kind of financial resources you have. If the leaked Supreme Court draft opinion to overturn Roe v. Wade is adopted, roughly half of U.S. states are expected to quickly ban or severely restrict abortion. No longer a protected constitutional right, abortion will become more akin to a privilege, reserved for those with the means necessary to obtain one.

To be clear, this is already the lived experience of poor and minority women in many parts of the country. In much of the South and Midwest, state legislatures have spent decades passing regulations on abortion with the express intent of suppressing access. Patients in these states are forced to spend more money, take more time off work, and travel farther distances to get to an abortion clinic. Given that nearly half of U.S. abortion patients live below the poverty line, and about another quarter are low-income, it follows that these obstacles have proved insurmountable for some.

To call an abortion a privilege is incompatible with what going through it feels like. For women fighting to maintain bodily autonomy, trying to avoid a forced birth, it ranks as a basic human necessity. But in a post-Roe world, the women who are and aren’t able to access this form of health care are likely to be starkly divided by race and class.

“Even though abortion is a right everywhere, for a lot of people around the country, it is difficult to access,” David Cohen, a professor at Drexel University’s law school told me. “But that’s a world different from saying it is illegal. If Roe is overturned, it will drastically change the circumstances for people in almost half the states in the country.” Some women will order abortion pills online, which may put them in a questionable legal situation, while others will cross state lines for care if they can afford it, he predicted. “Travel is a privilege, and privilege in this country is linked to people with money and people with white skin,” he said.

We already know the effect of making patients travel farther distances to terminate pregnancies: Some of them simply can’t make the journey. After Texas enacted H.B. 2 in 2013, a restrictive abortion law that was later gutted by the Supreme Court, the abortion rate plummeted in counties where the distance to the nearest facility increased by 100 miles or more.

That’s exactly what is expected to happen on a bigger scale if Roe is reversed. According to an estimate by Caitlin Knowles Myers, an economics professor at Middlebury College, about 54 percent of U.S. women of reproductive age would experience an increase in the distance to the nearest abortion provider. In counties whose nearest abortion provider is projected to close, the average distance would increase from 33 miles to 282 miles.

By Myers’s calculations, about three-quarters of the women seeking abortions in those counties would still make it to an abortion provider—overcoming the additional costs associated with traveling longer distances, such as gas, hotel stays, and child care. But about a quarter of the patients would not. In the first year post-Roe, she estimated, 100,000 women who want abortions would not be able to reach a clinic. Some would naturally have miscarriages, and others would seek out abortion pills to terminate their pregnancy at home. According to her model, about 75,000 women would end up giving birth against their will.

The main difference between the women who will make it to an abortion provider and those who won’t? Money. “Generally you’re looking at a situation in which the poorest, most financially constrained, and most economically fragile women are not able to navigate a long trip to obtain an abortion,” Myers told me. “It’s always been the case that the women with means will find a way to obtain an abortion. And that was true during the pre-Roe era.”

Abortion care has changed significantly since the 1970s, when Mitchell’s private plane whisked women to Niagara Falls for a quick day trip. Today, abortion pills account for more than half of abortions in the U.S. Medication abortion, as the two-pill regimen is called, can be done safely at home. Surely some women will fly to other states to access legal abortion at a clinic, but the more common scenario if Roe is reversed will likely involve a woman trying to get abortion pills through the mail or in a neighboring state. Anti-abortion lawmakers in some states are already trying to crack down on these avenues.

“Who will district attorneys and police test out arresting and criminalizing people for things like that?” said Liza Fuentes, a senior research scientist at the Guttmacher Institute, a research group that supports abortion rights. “The people who are most likely to be prosecuted are people who are already systemically seen as devalued, who experience systemic racism and discrimination.” Black and Hispanic women have higher rates of unintended pregnancy and abortion than their white counterparts.

This is not to say that privileged women have nothing to worry about. As Rebecca Traister forcefully argued in a recent essay, the eradication of abortion rights ultimately affects everyone. “The choices that people, even people of means, make about how to end pregnancies are going to require calculations they have rarely had to do before: about their own risks of criminal prosecution and about state-enforced systems that are there not to work on their behalf but to limit and punish their choices,” she writes.

But the hard truth of the matter is that without Roe, many poor women will be unable to obtain an abortion that they know is in their best interest. Their lives will be irrevocably changed as a result. The most common reason women give for wanting an abortion is that they are not financially prepared to raise the child. And they’re usually right.

Most of what we know about what happens to a woman who wants an abortion but can’t obtain one comes from the Turnaway Study, a longitudinal study that began in 2008 and followed more than 1,000 women who sought abortions in the U.S. Led by Diana Greene Foster, a UC San Francisco professor in the department of obstetrics, gynecology, and reproductive sciences, the study compared women who were able to obtain abortions with women who were denied abortions to see how their lives were affected over time.

The two groups were fairly similar in terms of financial well-being before they sought an abortion, Greene Foster told me. But for four years afterward, women who were turned away from a wanted abortion had a higher chance of living in poverty compared with those who received abortions. Those who were denied an abortion went on to have higher debt, an increased number of negative public financial records (such as bankruptcies and evictions), and a greater likelihood of a subprime credit score.

The financial consequences of being denied a wanted abortion are only part of the picture. Women who were unable to terminate a pregnancy in Greene Foster’s study also had reported worse health, were more likely to remain connected to an abusive partner, and raised children under less stable conditions than the women who obtained abortions. Being denied an abortion “changed key aspects of their lives, like their ability to take care of their existing kids, their chance at having wanted kids later, the quality of their relationships, and their achievement of aspirational plans,” Greene Foster said.

And for two women, it killed them. Two women in the Turnaway Study who were denied an abortion died shortly after childbirth. Pregnancy “is very risky, and it’s a risk we’re willing to take when we want to make a child,” Greene Foster said.

Without Roe, many women won’t be given the choice.