EMILY KWONG, HOST:
You're listening to SHORT WAVE...
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KWONG: ...From NPR.
Earlier this month, a draft majority opinion for a pending Supreme Court case was leaked by Politico.
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AYESHA RASCOE, BYLINE: The case the court is considering is Dobbs vs. Jackson Women's Health Organization. It deals with a Mississippi law that shortened the window for abortion from 20 weeks to 15.
RACHEL MARTIN, BYLINE: In other words, this would end Roe v. Wade and federal abortion protection as we've known it for nearly 50 years.
KWONG: If Roe is overturned, decisions about regulating abortions would fall to individual states, including states with so-called trigger laws - laws that would go into effect soon after the Supreme Court decision and would severely restrict most abortions, establishing near-total bans or bans after six weeks of gestation. And the earliest a lot of people know they're pregnant is around four weeks.
LIZA FUENTES: You can ban abortion. People still get abortions. That is important to know - that people will be denied care and that that will put their health at risk.
KWONG: Liza Fuentes is a senior research scientist at the Guttmacher Institute, a research organization that focuses on sexual and reproductive health and supports abortion rights. As a researcher, Liza says access to a safe abortion is health care, and protecting that access is protecting public health.
FUENTES: Public health is a broader practice that ensures the health of communities. So what goes into public health isn't just collecting data and looking at risk factors, but partnering with communities and looking at broader priorities in communities to promote health.
KWONG: Within any community in the U.S., a lot of different types of people seek abortion care.
FUENTES: Sixty percent of people obtaining abortion care are already mothers. Three-quarters of people obtaining abortion live with low incomes or below the poverty line. Sixty-one percent of people obtaining abortion care are women of color. One in four abortion patients identify as Catholic.
KWONG: About half of people who get an abortion are in their 20s. And in the U.S., according to the Guttmacher Institute, about 1 in 4 women will obtain an abortion by the time they're 45.
FUENTES: That number changes by country, for sure. But certainly, there's no country on this planet where people who are pregnant do not require the ability to terminate a pregnancy when they no longer want to be pregnant.
KWONG: Given how common abortion is worldwide, it's striking how seldom our society talks about it when, statistically speaking, everyone knows someone who has had one. To lose access to this procedure not only impacts an individual, but their family and community too.
FUENTES: If a person is forced to take on the risks of pregnancy when they didn't want to, and they become sick or even die, that affects their children's health and well-being. It affects their partner's health and well-being. And, frankly, it affects the whole community when a person dies before their time because they couldn't get the care that they needed.
KWONG: Today on the show, the intersection of abortion and public health - how abortion fits into health care and the safety of pregnant people. This is part one of our discussion with Liza. In part two, we'll talk about what it looks like in practice for health agencies to treat abortion as a matter of public health. I'm Emily Kwong. Thanks for listening to SHORT WAVE, the daily science podcast from NPR.
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KWONG: Public health is the practice of ensuring the health and well-being of communities. That's done through data collection, but also a lot of on-the-ground work, partnering with community groups and really thinking about what policies lead to the best health outcomes for the population you're trying to serve. So in the case of abortion, the question becomes - how do we protect the health of a pregnant person? For Liza, it means looking at abortion as part of family planning.
FUENTES: Family planning is the ability to decide if, when and how to become pregnant - to parent. More specifically, more traditionally, family planning refers to contraceptive services - so ensuring that anyone who can become pregnant is able to use contraceptives that meet their needs so that they can delay or plan for pregnancy when the timing is right for them. And abortion fits into family planning because it's an essential component of being able to decide if someone wants to continue to be pregnant, and abortion is also critical for ensuring that people can avoid the adverse health effects of an unintended pregnancy or, in some cases, pregnancies where people develop conditions that threaten their life or health.
KWONG: Mmm hmm. From where you sit, why is abortion access a public health issue, Dr. Fuentes?
FUENTES: Abortion is a public health issue for a few reasons. First, like I said, abortion's just a central and essential component of the full range of sexual and reproductive health care that everybody needs to be able to live a healthy life at every phase in their life. And then if someone does become pregnant, they need to be able to decide if they want to continue that pregnancy. People may think that contraceptives that are used before someone becomes pregnant could be a solution, for example, to abortion, but they're not. Half of people seeking abortion care report using a contraceptive the month they became pregnant.
KWONG: Half?
FUENTES: Half. Yes.
KWONG: Wow.
FUENTES: Yeah. And that doesn't mean...
KWONG: I didn't realize that.
FUENTES: ...That contraceptives don't work. We're talking about people seeking abortion care. The vast majority of people using contraceptive care are not seeking abortions in the next month, but contraceptives are not 100% foolproof - not even sterilization, right?
KWONG: And sterilization - what do you mean by that?
FUENTES: Somebody could have a tubal ligation or a vasectomy, and it can fail. Even that can fail, right? It's not common, but if it does, abortion needs to be part of the options for somebody. In public health, we want to make sure people have the resources to make the best choices where they're at.
KWONG: This is public health thinking in action. It's this move where individual health is woven into the tapestry of the broader community. And in thinking on the community level, Liza considers abortion an issue of racial and economic justice, too. That's because most people who seek an abortion are low income - almost half live below the poverty line. So any policies designed to deny, delay or impede abortion access will affect those groups disproportionately.
FUENTES: Because why? Attempts to restrict or deny abortion care can often be overcome by people if they simply have the money and the means to do so. So people can travel out of state to avoid an abortion restriction. But for people who are struggling to make ends meet, who are disproportionately likely to be low income or uninsured - which are Black and brown women in this country - they're more likely to experience the delays, the denial of abortion care and the harms that go along with it. States that seek to restrict and ban abortion are the least likely to offer the social supports that people need to be able to raise children. They rank among the highest states for maternal mortality and infant mortality. And finally, abortion is a public health issue because it's a human right, and human rights frameworks and social justice frameworks really undergird the scientific practice of public health because our goal is not simply to observe and produce knowledge, but channel it towards eliminating health inequities and ensuring that everyone has the chance to be healthy in the community where they live.
KWONG: Since this leak, a lot of people - for maybe the first time in their lives because of how long Roe v. Wade has been around - are wondering what its removal would mean for pregnant people in the U.S. If that were to happen, how do you think it would affect those who become pregnant in the U.S.?
FUENTES: First of all, clearly, even in places where abortion is highly restricted or illegal, people still seek and obtain abortion care...
KWONG: Right.
FUENTES: But many people will be denied abortion care as well.
KWONG: Yeah.
FUENTES: And we can't ignore that, right? People who need abortion care will go to great lengths - and I know this personally, for keeping abortion funds - to be able to ensure that they can get the care they need. But it's not possible for everyone to overcome those tremendous costs, so people will be forced to continue a pregnancy and take on the risks of doing so. For some of those people, it will be at the detriment of their health or potentially even their life. Other people will be delayed in their care. Abortion is extremely safe, but the further along it is, the risks uptick slightly - still safer than continuing a pregnancy and then giving birth, still safer than getting a wisdom tooth out. But forcing people to take on any risk when they've done everything they can to take care of themselves contravenes, certainly, public health values in practice. But secondly, all pregnant people will be put at risk if Roe falls because people will be monitored, surveilled and harassed for the outcomes of their pregnancy, potentially. We already saw that with a young woman in Texas recently - like, last month - who went to seek care for a miscarriage during pregnancy, and her clinician called the police on her. And it went to a grand jury, and she was charged with murder, even though self-managing an abortion is not illegal and it certainly is not considered murder, but the political climate made it possible for somebody to even think that that was OK. So people even seeking health care for bleeding during pregnancy for potential miscarriage may be put under scrutiny. And finally, if Roe is overturned or severely gutted, that also impedes the ability of health care providers to be trained to take care of pregnant people. The fall of Roe really has the potential to deny anyone who's pregnant or is thinking about becoming pregnant the ability to get the highest-quality, timely care when they need it throughout their pregnancy.
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KWONG: This is part one of our conversation with Liza Fuentes. Listen for part two, where we'll talk about what it looks like in practice for health agencies to treat abortion as a matter of public health.
This episode was produced by Berly McCoy. It was edited by Rebecca Ramirez and fact-checked by Margaret Cirino. The audio engineers for this episode were Josh Newell and Gilly Moon. Gisele Grayson is our senior supervising editor. Beth Donovan is our senior director, and Anya Grundmann is our senior vice president of programming. I'm Emily Kwong. Thank you for listening to SHORT WAVE, the daily science podcast from NPR.
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