CIVICUS speaks about struggles to access abortion services in the USA with Sheena Dooley, Gabriela Fuentes and Mazie Stilwell of Planned Parenthood Advocates of Iowa (PPAI).
PPAI is an independent, nonpartisan civil society organisation with the mission of fostering and preserving a social and political climate favourable to reproductive health.
How has access to abortion evolved in the wake of the reversal of Roe v. Wade?
In June 2022 the Supreme Court overturned Roe v. Wade, the 1973 ruling that guaranteed a federal constitutional right to abortion. Since then, numerous US states have banned or heavily restricted abortion, and people have been forced to travel long distances to access abortion care or otherwise carry pregnancies against their will. This has increased the importance of medication abortion, a safe and effective option for ending pregnancies at home.
Medication abortion has become a crucial way to ensure people get the care they need when they need it. As such, it has been at the centre of struggles between those trying to restrict access to abortion and those fighting to improve it.
During the pandemic, the Food and Drug Administration (FDA) allowed medication, including mifepristone, a drug used in medication abortions, to be sent through the mail. New changes in FDA rules in early 2023 allowed pharmacies to dispense abortion drugs, and in March 2024 it was announced that they would soon be available in major chain pharmacies. This is a very positive step, as it will help break down barriers and improve abortion access nationwide.
What are the main inequalities in access to reproductive health services in the USA?
Excluded communities face disproportionate barriers against reproductive healthcare access. Systemic disparities and inequities are highly intersectional. In Iowa, for example, communities of colour and rural communities experience rising maternal mortality rates, with Black Iowans six times more likely to die from pregnancy-related causes than their white counterparts.
The closure of Planned Parenthood health centres and the defunding of family planning programmes further limit access to essential services, particularly for communities with few alternative options. These restrictions disproportionately affect communities of colour, with Black women accounting for about 40 per cent of abortions in the USA. Abortion bans pose significant risks to health and financial wellbeing, particularly for Black, Indigenous and Latine people with low incomes, and those living in rural areas.
Abortion access is also an issue for LGBTQI+ people, including lesbians, bisexual, queer, non-binary, intersex people and transgender men who may seek abortion services.
The effects of abortion bans extend beyond the present generation, with long-term impacts disproportionately affecting people of colour and working class people. As we navigate these challenges, it’s essential to centre the voices and experiences of excluded communities in advocating for equitable access to reproductive healthcare.
Will the new rules for dispensing abortion drugs help address inequalities in access to abortion care?
The expansion of abortion access through pharmacies has the potential to address systemic inequalities in healthcare access faced by marginalised communities. Allowing pharmacies to dispense abortion medication opens access to those who struggle to find care or who would otherwise be forced into pregnancy. Medication abortion doesn’t require anaesthesia or sedation, is less invasive and more private, and allows patients to control their own bodies and healthcare safely. It offers the flexibility to complete an abortion in the comfort of one’s own home, with a chosen support person.
However, it’s essential to acknowledge that access to abortion medication through pharmacies is directly tied to the laws of the state where you live. This means that people in states where abortion is banned will still face barriers to access, as pharmacies in those states won’t offer the service.
What’s the process for obtaining medication abortion?
The logistics of obtaining medication abortion vary from state to state. In Iowa, for instance, patients are required to undergo an ultrasound and meet a medically unnecessary 24-hour waiting period, which means they must make two separate visits to a health provider. They must also undergo state-mandated counselling. Despite the safety and efficacy of mifepristone, which has been used in over five million abortions in the USA, patients must be prescribed the medication and receive the first pill on site. They can then take the second dose at home.
Over half of US states have laws that impose medically unnecessary barriers that restrict access to medication abortion. Some states, however, are working to protect abortion access by allowing people to obtain abortion medication without physically visiting a health centre. For example, in Minnesota, Planned Parenthood provides it via telemedicine appointments to patients with a Minnesota address, but not to those who live across state lines. Additionally, some states, including Iowa, don’t allow mifepristone to be sent by mail.
How do you expect abortion to affect the upcoming election?
The issue of abortion is expected to significantly shape political discourse in this crucial election. The current landscape of deliberate, manufactured chaos, driven by politicians who want to ban all abortions, is contributing to voter confusion. The stark reality that one’s ability to control one’s own body is determined by one’s ZIP code is widely recognised as unjust.
Recent events, such as Alabama’s ban on in vitro fertilisation, have demonstrated the urgent need for proactive strategies to protect reproductive freedoms nationwide. In Iowa, for instance, successful efforts to obstruct legislation granting personhood to embryos and foetuses were partly driven by the fear of following in Alabama’s footsteps.
As attacks on reproductive healthcare, including abortion access, increase, people are also mobilising to protect their right to make decisions about their bodies and futures. We are heartened by the growing support for safe and legal abortion, both nationally and in our region. The key to overcoming these challenges is to engage directly with voters and communities on the ground. Abortion has consistently proven to be a winning issue when brought to the forefront of public discourse, even in solidly conservative states that have passed ballot measures supporting reproductive rights.
We therefore expect abortion and reproductive rights to be key motivating factors for many voters in the upcoming election. As the election approaches, the discourse around abortion will vary depending on the laws in each state. Abortion rights and the ability to control one’s own body will be more prominent as campaign issues in some areas than others, depending on the laws in place. We expect abortion to continue to be a significant factor in elections, with extreme bans causing outrage and mobilisation among communities affected by restricted access to healthcare.
Civic space in the USA is rated ‘narrowed’ by the CIVICUS Monitor.
Get in touch with Planned Parenthood Advocates of Iowa through its website or Instagram page, and follow @ppadvocatesia on Twitter.
