In one arena, however, progress seems to be actively backsliding: reproductive freedom, or the right of every person to make their own decisions regarding their bodies and their reproductive health. Forty-eight years after Roe v. Wade established abortion as a constitutionally-protected right, the battle over how women choose to use and take care of their bodies rages on. In 2019, dozens of states, including Alabama and Georgia, passed laws seeking to effectively ban abortion outright (or make it nearly impossible to access). Several states, including Iowa and Alabama, used the early days of the COVID-19 pandemic as a pretext to temporarily ban abortion. Most recently, Louisiana's draconian abortion law was narrowly overturned by the Supreme Court in June with a 5-4 vote (and conservative Chief Justice John Roberts casting the unlikely tie-breaking vote). On the heels of this announcement, Iowa's governor signed into law a bill requiring a 24-hour mandatory waiting period before getting an abortion.
The battle over reproductive rights is not limited to abortion, either. Current Trump administration policies aim to restrict insurance coverage for birth control while funding non-evidence-based abstinence education over contraceptives—despite the fact that 99 percent of women in the U.S. aged 15-44 have used birth control in some form at some point in their lives.
To understand why we're (still) here and what we can do to give women autonomy over their own bodies in 2020, it's important to first look back at the storied history of this fight.
The history of the fight for reproductive rights
According to historian Leslie Reagan, up until around the mid 1860s, abortion was a routine part of American life, banned only after a woman could feel her baby move (something that usually doesn't happen until well into the second trimester, according to the Mayo Clinic). Within a short span, this flipped; by 1880, the practice was largely illegal. Many abortion practitioners (which were mostly midwives and homeopaths, not doctors) were shut down by medical professionals who wanted to standardize medical care. Additionally, many of those seeking abortions prior to 1880 were married white women, and some lawmakers worried that with the influx of immigration into the United States, birth rates in white communities could decrease while those in other communities increased. So, lawmakers moved to prevent white women from terminating pregnancies.
None of this stopped people from getting abortions. According to Reagan, practitioners simply stopped advertising and began performing abortions in secret. In many cases, women were also forced to resort to dangerous measures to end their pregnancies on their own. This continued to be the case all the way up until the 1960s, when backlash against anti-abortion laws began to swell as a part of the fight for civil rights.
Interestingly, pro- and anti-abortion rights groups were not always split along party lines. "The early [anti-abortion rights] movement before 1973 thought of itself as a human rights movement," says Daniel K. Williams, author of Defenders of the Unborn: The Pro-Life Movement Prior to Roe v. Wade. "During the late 1960s and early 1970s, probably the majority of [anti-abortion activists] were Democrats in the United States, and many of them identified with a number of causes that we would associate with the political left." Some women involved with the early anti-abortion rights movement, for example, felt that restricting abortion was empowering for women. "They tended to view abortion as detrimental to women's interests because they thought it encouraged disrespect for women's bodies, that it encouraged men not to take responsibility for their pregnancies," Williams says.
Those who supported abortion, meanwhile, were likewise a mixed bag of folks who didn't necessarily affiliate with one political party or the other: feminists like Gloria Steinem, environmental organizations, Republicans such as Barry Goldwater and Nelson Rockefeller, and liberal Democrats.
One thing both movements had in common in those days, however, was that they were run by men. "Initially, in the early 1960s, the debate tended to be not so much about women's rights but about medical procedures and doctors' rights. And so on both sides, it tended to be dominated by a lot of doctors and lawyers, who were, at the time, overwhelmingly male," Williams says.
"Opposition to [abortion rights] came partly from a reaction to the increased equality of women and the way in which access to abortion care as well as access to contraception allowed women to participate more equally in our society." —Andrea Miller, president of the National Institute for Reproductive Health
By the 1970s, however, the debate began to look more like it does today. Prior to Roe v. Wade in 1972, neither political party had an official stance on abortion. After the ruling, however, the Democratic party felt it had to take a stand. "There were pressures from both sides—from the [anti-abortion rights] side to to endorse a constitutional amendment banning abortion and stronger pressures from the [pro-abortion rights] feminist wing of the party to make abortion a women's rights issue and to champion the cause," Williams says. "In 1976, the party attempted to split the difference by essentially endorsing the status quo—that Roe v. Wade has been decided and the party did not support constitutional amendments to overturn Roe."
This alienated some demographics, and the Republican party seized the opportunity to shore up its ranks by taking the stance against abortion. "The Republican party platform in 1976 endorsed a constitutional amendment to overturn the Supreme Court decision, and in their words, 'protect human life,'" says Williams.
The polarity of the two parties' stances quickly made abortion into a hot-button issue. "Immediately after Roe, you had elected officials—both in Congress and in state legislatures—who were fundamentally opposed to abortion rights," says Andrea Miller, president of the National Institute for Reproductive Health. "That opposition came partly from a reaction to the increased equality of women and the way in which access to abortion care as well as access to contraception allowed women to participate more equally in our society."
In the wake of Roe, Miller says conservative lawmakers tried to pass as many laws as they could to restrict abortion. "They started by attacking the most vulnerable in our society: low-income women who didn't have access to resources," she says. This took specific shape as the 1976 Hyde Amendment, a 40-year-old ban on federal funding for abortion services named after former Illinois representative Henry Hyde, who is quoted as having said at the time: "I certainly would like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle-class woman, or a poor woman. Unfortunately, the only vehicle available is the…Medicaid bill.”
Then in the 1980s, the anti-abortion rights movement embraced a new strategy of appointing conservative justices. "They largely abandoned the quest for a constitutional amendment and instead decided that it would be faster to overturn Roe v. Wade through the Supreme Court," says Williams. It's an easier, shorter process to get a Supreme Court justice on the bench than it is to amend the Constitution. With this strategy, anti-abortion advocates could work to pass local or state laws attempting to chip away at abortion rights, in the hopes that they'll make their way through the court system up to a sympathetic Supreme Court for ratification.
"That position practically necessitated an alliance with the Republican party," says Williams, "because Democratic presidents would never give [anti-abortion rights advocates] the sort of Supreme Court justices who would overturn Roe."
Why the present still feels like the past when it comes to abortion
Fast-forward to the present and the battle over abortion rights continues. Since 1970, the Supreme Court has had a consistent majority of justices appointed by Republican presidents, which has paid off for anti-abortion rights advocates. While Roe v. Wade is still the law of the land, over the past few decades, Supreme Court rulings that helped erode abortion rights have outnumbered those that supported them. (One example being 1992's Planned Parenthood v. Casey, which ruled that it was constitutional for states to put some restrictions on abortion access and funding.)
And anti-abortion activists are now gearing up for a new round of court cases. "We have a real race to the bottom, where a number of conservative states over the last year have really doubled down, including passing absolute bans on abortion," says Miller. In 2019 alone, nine states enacted gestational bans (meaning they outlawed abortion at various points in pregnancy), two states banned specific methods of abortion, four states enacted bans on specific reasons for abortion, and four states adopted "trigger laws" that would outlaw abortion entirely if Roe v. Wade were overturned by the Supreme Court. These laws are essentially designed to be challenged by the Supreme Court, which currently has a conservative majority.
Plus, President Trump is stacking lower federal courts with conservative appointments, too. These largely anti-abortion newbies could decide the fate of the hundreds of bills filed in 45 states over the course of the last year. Ohio currently has a bill that would require doctors to attempt to "re-implant" ectopic pregnancies (which is not possible) or face prison time and even the death penalty for "abortion murder."
Despite the prevalence of anti-abortion laws throughout the country, public sentiment does not seem to align with restrictive political action. “Support for keeping abortion safe and legal has never been higher, and that’s not just a hunch," says Samuel Lau, director of federal advocacy communications for Planned Parenthood Votes. "Nearly eight in 10 people do not want to see Roe v. Wade overturned—including a majority of Trump voters and Republican men—and there is no state in the country where making abortion illegal is popular."
The problem isn't that the tide is turning against reproductive freedom, therefore, but rather that the small group of people who oppose it has gotten louder. "Opponents of abortion rights have been really successful in creating and advancing stigma around people who access abortion care, people who provide abortion, and, most insidiously, around even talking about support for abortion rights and access," says Elisabeth Smith, chief counsel for state policy and advocacy at the Center for Reproductive Rights. "When people start having conversations, they begin to realize just how widespread support [for abortion rights] is and how opposition is much smaller—it's just very vocal and very aggressive."
Contraceptive access matters, too
Though abortion is the shiniest object in this battle, it's not the only reproductive right at risk. "Abortion is a canary in the coal mine," says Smith. While abortion access has been the main focus of coordinated conservative attacks over the past 40-plus years, she says that other aspects of reproductive health, such as contraception, have also been under threat. "That [anti-abortion rights] opposition is not just about abortion—it's really about comprehensive reproductive health services."
This includes access to contraceptives. "The reality is that we have more methods of contraception than ever before, and the Affordable Care Act presented a huge step forward in terms of providing coverage for the full range of contraceptive methods with no co-payment, because the cost of contraception historically had been a real barrier for a lot of women," Miller says. "The bad news is that the Trump administration has been attacking the Affordable Care Act, trying to give employers carte blanche to decide contraceptive access for their employees," she says, along with attempting to repeal the bill outright.
Title X funding is the best case study of the current administration's hostile attitude towards contraception and reproductive health. Title X is another policy from the 1970s—it's a grant program created by the federal government designed to help increase access to family planning and reproductive health services for low-income people. Title X-funded clinics prescribe contraception, perform breast exams, pap smears, and other critical preventative health services, and test and treat for sexually transmitted infections. (Due to the aforementioned Hyde Amendment, these providers can't use Title X funds to perform abortions.)
However, 2019 updates to Title X funding requirements explicitly forbid clinics that receive this grant money from referring patients to get abortions elsewhere, or even to discuss it as an option. These updates have forced Planned Parenthood out of the Title X program, while allowing many pregnancy "crisis centers"—which are anti-abortion and are often not run by legitimate health professionals—to receive millions in federal funding for the first time. "Grants are being directed to anti-abortion pregnancy centers that are also often talked about as fake clinics and similar organizations that do not provide the full range of reproductive health services that likely engage in biased information and misleading practices," says Miller.
These policies disproportionately affect young people. "It's really important for young people to have information, to have skills, to understand their bodies, to be able to negotiate and understand what a healthy relationship is, and to be able to have both the knowledge and access to services to keep themselves safe and healthy," Miller says. "People are surprised to learn that most of the time, in most places, we're not giving young people that—there is either nothing or worse. And the 'worse' is curricula that focus solely on abstinence, that demonize and stigmatize sex and sexuality and abortion and contraception. So it's really important to be advocating at the local level in particular for comprehensive sexuality education that is age appropriate, medically accurate, and really does serve young people well."
Fortunately, some states are stepping in to fill holes left by the withdrawal of federal funding for family planning providers while also enshrining coverage protections of the Affordable Care Act. "So if the Affordable Care Act were to be overturned, or if they were to further gut the contraceptive coverage in it, there's at least some protections in place in a number of states," says Miller.
What you can do to support reproductive rights in 2020
A lot is at stake this year, starting with the latest Supreme Court ruling on a blocked Louisiana law that would require all abortion providers to have admitting privileges to a nearby hospital. The court overturned this law, so anti-abortion rights advocates will likely try to find other ways to bring the abortion question back to the Supreme Court in the future. "The Supreme Court sets the floor," says Miller, meaning that they can tell states what kinds of actions they can and cannot take.
"Abortion rights and abortion access really begin and end at the state level, so that's where people need to be paying attention," Miller says. This is why, Smith says, advocating for the cause with your state representative is an extremely effective way to protect access in your state. So, too, is contributing to state abortion funds, whether they're in your state or a state in which access is decreasing.
You can also make noise in your city or county, says Miller. "People don't realize that local governments have budgets they can use to ensure access to reproductive health care, and we've seen a number of localities start to look at providing direct funding for abortion care for people who can't afford it or don't have coverage," she says. "That's just one example, but they can do things around ensuring that public clinics provide affordable contraceptive care and make those services available." Miller recommends following your elected officials on social media, as well as the types of organizations in these fights, such as The Guttmacher Institute, for updates and alerts.
"We are facing unprecedented attack...It's our duty to fight for all of us to have access to the care we need, and there's truly no time like the present." —Kelsey Ryland, director of federal strategies at All* Above All
It's also worth paying attention to 2020 presidential and congressional candidates' stance on the Hyde Amendment. "The biggest impact of [the Hyde Amendment] is on folks who get their insurance through Medicaid, who are low income, and we know are disproportionately folks of color, LGBTQ people, and young folks," says Kelsey Ryland, director of federal strategies at All* Above All, a women-of-color-led coalition of organizations committed to ending the Hyde Amendment. Without insurance access, an abortion can cost thousands of dollars—more than what most people can afford to pay out of pocket, Ryland says. Women denied abortions are also four times more likely to end up in poverty and stay with violent partners, among other serious consequences.
Miller adds that people should petition their lawmakers to pledge support of Title X. "Title X was one of the most effective programs in terms of providing quality, basic reproductive health care services for people who didn't have other access to care," she says. "It had direct impact, it made a real difference. People should ask their elected officials what they're going to do decide to bring the program back to its previous medically appropriate, medically accurate standard of care." She says this likely will be decided by the executive branch, since that's how changes to the program have been handled in the past—so it's down to ensuring that our next president supports a Title X that allows for providers to discuss all medically safe family planning options with their patients—including, yes, abortion.
If you support reproductive rights, it's also important to be vocal about that. "People need to talk forthrightly and honestly about their opinions on abortion and their experience with abortion and change the the cultural narrative and the climate around us," says National Abortion Federation president and CEO Katherine Ragsdale. Opposition is loud, in other words, but support is in the majority and can be louder. "The attacks on abortion and contraception and reproductive freedom have happened in part because there's been a vacuum, and our opposition has been able to fill that vacuum," agrees Miller. "So it's really important to break down the stigma, because it's a lot easier for them to attack when people are silent about their support."
2020 is shaping up to be a pivotal year for abortion rights in the United States, and it's on all of us to ensure that our freedoms are protected. "Now's the time [to get involved]," Ryland says. "We are facing unprecedented attack, and the threats are real for people in our communities... It's our duty to fight for all of us to have access to the care we need, and there's truly no time like the present." My body, my choice, has never mattered more.
This story was originally published on March 24, 2020. It was updated on June 30, 2020.
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