7.6: Reproductive Freedom

Contraception and Abortion

Many cultures around the world still teach that the responsibilities of birth control lies with women. Even in contemporary Western ideology, women are still assigned the burden of birth control efforts. In the United States, this thinking led to social movements being led primarily by women for access to resources such as Planned Parenthood, contraception, and abortion services.

Abortion (and certain forms of contraception) remained illegal in the United States until the 1970s when the Supreme Court issued a series of rulings that made the decision to bear a child part of an individual’s constitutionally protected right to privacy. The most significant (and popular) of these rulings was Roe vs. Wade, which stated women have a constitutional right to choose abortion and that the state cannot unduly interfere with or prohibit that right. As a result of Roe, during the first trimester, the decision to abort was strictly private in all 50 states. Then states had varying legislation on the right to abortion in the second and third trimester. In the second trimester, some states imposed restrictions, but only to safeguard women’s health. And in the third trimester, some states prohibited abortions because of the viability of the fetus (the ability of the fetus to live outside the female’s body).

However, there have been recent efforts by some politicians to curtail or repeal rights which disproportionately affect women pertaining to access to reproductive health services. Some examples include attempts to defund Planned Parenthood, repeal women’s rights to choose abortion or criminalize abortion, and creating barriers to access to contraception. Some refer to this phenomenon as the War on Women. War on Women is a political catchphrase in United States politics used to describe certain policies and legislation as a wide-scale effort to restrict women's rights, especially reproductive rights.

A few examples of recent legislative efforts include: In March 2020, Arizona passed the “Tell Your Boss Why You’re on the Pill” bill. House Bill 2625 “permits employers to ask their employees for proof of medical prescription if they seek contraceptives for non-reproductive purposes, such as hormone control or acne treatment.”²¹² In 2020, the Supreme Court upheld a Trump Administration mandate allowing employers to opt out of the 2010 Affordable Care Act mandate guaranteeing no-cost contraceptive services for women.²¹³

Legislators in various states introduced a wide array of laws designed to either outlaw abortion or to discourage it by making sometimes humiliating or even painful requirements of women who might consider having a pregnancy terminated. As of October, 2021, 1,336 abortion restrictions had been enacted since Roe v. Wade went into effect and before it was overturned in June 2022.²¹⁴ Some states mandated ultrasounds for women seeking abortions. Since many women's pregnancies are not far enough along to get an image via a traditional ultrasound (a little jelly on the belly with a camera on the stomach), transvaginal ultrasounds, which involve the physician inserting a probe into the woman's vagina, may be required. Critics have questioned the value of having a medically unnecessary procedure, and characterized it as similar to some states' legal definition of rape. Several states have ultrasound laws on the books even though routine ultrasounds are not medically necessary in first-trimester abortions.

Today, the majority of Americans support allowing individuals to access evidence-based health care services and to make decisions about their own care in consultation with their medical team. According to a recent PEW research report, "about six-in-ten Americans (62%) say abortion should be legal in all (29%) or most (33%) cases. Around a third of the public (36%) says abortion should be illegal in all (8%) or most (28%) cases."215 It's important to mentioned here that one can be anti-abortion and pro-choice at the same time. Pro-choice ≠ pro-abortion.

However, even with more people identifying as pro-choice, laws and policies on abortion have been changing rapidly across the United States since the U.S. Supreme Court overturned the federal constitutional right to abortion (Roe v. Wade) in late June in Dobbs v. Jackson. But, as of August 2022:²¹⁶

• 27 states regulate the provision of ultrasound by abortion providers.
  • 6 states mandate that an abortion provider perform an ultrasound on each person seeking an abortion and require the provider to show and describe the image.
  • 10 states mandate that an abortion provider perform an ultrasound on each person seeking an abortion, and 8 of these require the provider to offer the patient the opportunity to view the image.
  • 8 states require that a patient be provided with the opportunity to view an ultrasound image if their provider performs the procedure as part of preparation for an abortion.
  • 6 states require that a patient be provided with the opportunity to view an ultrasound image.

Many argue body autonomy is a human right, and the right to choose when and with whom to have children is part of that fundamental right. Support for this right is found in a number of human rights instruments, which contain provisions that ensure freedom in decision-making about private matters. The rights to sex equality and gender equality are fundamental principles of human rights law.

Sociologists often focus on the systems or institutions that hold power and/or control and how those systems or institutions exercise, propagate, maintain, and enforce that power. While research will be conducted for years to come on the social consequences of overturning Roe v. Wade, many are predicting this legislation will disproportionately affect already vulnerable or marginalized groups: women & gender minorities, low-income communities, survivors of domestic & sexual violence, refugees & asylum seekers, communities of color, and many others who are affected by systemic oppression and who rely upon rights not explicitly granted in the Constitution.²¹⁷ Some have already pointed to the access to contraception, marriage equality, and gay and trans rights as being vulnerable to reconsideration for legal protection, as these are also not as not explicitly guaranteed in the Constitution.²¹⁸

Others argue the lack of access to safe abortions in the U.S. will have a range of health and financial ramifications, compounding factors like poverty and systemic racism.²¹⁹ While the actual figure on how many abortions are performed each year in the United States vary, it is well established that the majority of people seeking a legal abortion are low-income and the rate of abortion for people of color is significantly higher than for white people.²²⁰ Poverty, access to healthcare, and education are disproportionately racialized. In some circumstances, carrying a pregnancy to term can endanger the pregnant person’s life, disrupt educational plans, and change someone’s career trajectory, compounding disadvantages for already marginalized groups.

Sociologists can evaluate likely consequences of social policies.²²¹ On abortion, for example, they can estimate how a policy might affect the birthrate, population growth, expenditures for welfare and education, the disparate impacts on various groups, or impacts on family structure in the U.S. Access to contraception and abortion opened doors to changes in trends in the family structure. "The gradual control over reproduction liberated time for further female education, more female tertiary sector employment, etc."²²² This, in turn, resulted in other societal shifts away from the traditional nuclear family: cohabitation and (optional) marriage at later ages, legal divorce with less stigma, childbearing without marriage, and substantial movement toward gender equality in families. Sociologist Philip Cohen writes, "Reproductive rights are a prerequisite for the changes in family life that underlie all progress toward gender equality."²²³

²¹² House Bill 2635. State of Arizona. http://www.azleg.gov/legtext/50leg/2...ls/hb2625c.pdf
²¹³ Supreme Court Ruling. (2019). Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania.
https://www.supremecourt.gov/opinion...9-431_5i36.pdf
²¹⁴ Guttmacher Institute. (2021). U.S. states have enacted 1,336 abortion restrictions since Roe v. Wade was decided in 1973. https://www.guttmacher.org/infograph...1336-abortion- restrictions-roe-v-wade-was-decided-1973
²¹⁵ “Majority of Public Disapproves of Supreme Court’s Decision To Overturn Roe v. Wade.” Pew Research Center, Washington, D.C. (2022). https://www.pewresearch.org/politics...isapproves-of- supreme-courts-decision-to-overturn-roe-v-wade/
²¹⁶ Guttmacher Institute. (2022). Requirements for Ultrasound. https://www.guttmacher.org/state- policy/explore/requirements-ultrasound#
²¹⁷ Pan, D. (May 4, 2022). 'Everyone who is vulnerable in some way' will bear the brunt if court overturns Roe, specialists say. Boston Globe.
²¹⁸ Cohen, P. (2022). Overturning Roe is an attack on the modern family. The New Republic. https://newrepublic.com/article/1662...-modern-family
²¹⁹ Dehlendorf C, Harris LH, Weitz TA. Disparities in abortion rates: a public health approach. Am J Public Health. 2013 Oct;103(10):1772-9.
²²⁰ Kortsmit K, Mandel MG, Reeves JA, et al. Abortion Surveillance — United States, 2019. MMWR Surveill Summ 2021;70(No. SS-9):1–29. DOI: http://dx.doi.org/10.15585/mmwr.ss7009a1
²²¹ Becker, H. (1996). Outsiders: Studies in the Sociology of Deviance. New York : The Free Press.
²²² Lesthaeghe, R. (2014). The second demographic transition: A concise overview of its development. Proceedings of the National Academy of Sciences. Vol. 111, No. 51.
²²³ Cohen, P. (2022). Overturning Roe is an attack on the modern family. The New Republic. https://newrepublic.com/article/1662...-modern-family