Dobbs, Gender Animus, and the Impact on Abortion Providers

ABSTRACT

In this article we engage in a critical legal analysis of the Supreme Court’s decision in (Dobbs v. Jackson Women’s Health Organization). We argue that by refusing to connect opposition to abortion with “invidiously discriminatory animus against women” (2246), the Court successfully insulated itself from having to consider the devastating impact overturning Roe v. Wade (Roe) and Planned Parenthood v. Casey (Casey) would have on women’s lives with a disparate impact on structurally marginalized communities. Through an examination of the opinion of the dissenting Justices, we highlight the operationalization of gender animus as the “curtailment of women’s rights, and of their status as free and equal citizens” (2318). Against this legal backdrop, we draw upon 22 semi-structured interviews to examine gender animus through the lived experiences of clinicians practicing in both abortion prohibitive and abortion protective states. Participants discuss how gender animus has manifested through their sense of professional and legal precarity and the impact of abortion restrictions and bans on their patients.

KEYWORDS:

• Abortion
• supreme court
• Dobbs
• Roe
• Casey
• gender animus
• abortion providers

Introduction

In gutting the federally protected right to abortion, in Dobbs v. Jackson Women’s Health Organization (2022), the Supreme Court rejected the argument that “the goal of preventing abortion” (2246), constitutes sex discrimination in contravention of the equal protection clause of the 14th Amendment. Despite the presentation of considerable evidence to the contrary, the Court insisted that abortion opponents are simply seeking to protect the fetus without any intention of controlling women’s reproduction through compelled motherhood. By refusing to connect opposition to abortion with an “‘invidiously discriminatory animus’ against women” (2246, quoting Bray v. Alexandria 1993, 273–74), the Dobbs majority successfully insulated itself from examining the devastating impact that overturning Roe and Casey would have on women’s lives, with a disparate impact on structurally marginalized communities.

In sharp contrast, the dissenting Justices reasoned about abortion in the register of gender equality. In a scathing rebuke of the majority’s gender-impervious reasoning, they underscored the inexorable connection between opposition to abortion and “‘invidiously discriminatory animus’ against women.” Recognizing the grim reality that lay ahead as a result of the Court’s decision, they forewarned that “[w]hatever the exact scope of the coming laws, one result of today’s decision is certain: the curtailment of women’s rights, and of their status as free and equal citizens” (2319). In short, they had no difficulty recognizing that the decision to wrest reproductive control from women and relocate it in the state means that “from the very moment of fertilization, a woman has no rights to speak of” (2317).

This article contributes to the existing scholarship on the Dobbs decision through our focused legal critique of the Court’s abject failure to recognize the connection between opposition to abortion and gender animus despite being presented with significant evidence to the contrary. Tracking the language of the dissenting Justices, we operationalize gender animus as the “curtailment of women’s rights, and of their status as free and equal citizens” (2318). Our article also contributes to the burgeoning post-Dobbs research examining the impact of criminalizing abortion on reproductive healthcare outcomes (Fuentes 2023; Guttmacher 2023a; Jones and Chiu 2023; Maddow-Zimet et al. 2023; Peachman 2022) by explicitly centering the experiences of abortion providers’ negotiation with the deeply gendered impact of criminalization in the period leading up to and immediately after the Dobbs’ decision.

We first provide a critical interrogation of the Court’s refusal to consider the argument that opposition to abortion is a form of sex discrimination in contravention of the equal protection clause. From here, we look back at the gender-aware reasoning of the Court’s decisions in both Roe and Casey, followed by an interrogation of Casey’s puzzling slide into pro-natalism through its abandonment of Roe’s trimester framework in favor of the undue burden standard. We then circle back to Dobbs to consider the dissenting Justices’ powerful critique that the majority has reinvested the state with the power to “control a woman’s body [and] the course of woman’s life” (2317).

Next, we analyze 22 semi-structured interviews with abortion providers conducted between February 2022 through March 2023. The interviews illuminate how gender animus has manifested in devastating, real-life impacts that have curtailed women’s reproductive rights, particularly for structurally marginalized communities, and curtailed providers’ ability to perform their work. Providers’ lived experiences stand in stark contrast to the gender-impervious reasoning employed by the Court in Dobbs and highlights the costs of the Court’s failure to reason about abortion restrictions in the register of gender equality.

Dobbs and the gender-impervious reasoning of the Supreme Court

On June 24, 2022, the Supreme Court announced its decision in the Dobbs case, which involved a constitutional challenge to Mississippi’s 15-week abortion ban. Infamously declaring that “the Constitution makes no reference to abortion, and no such right is implicitly protected by any constitutional provision,” it expressly overturned the longstanding precedent cases of Roe v. Wade (1973) and Planned Parenthood v. Casey (1992). In so doing, it renounced Roe’s legal holding that the right of privacy which is protected by the 14th Amendment’s due process clause “is broad enough to encompass a woman’s decision whether or not to terminate her pregnancy” – a result that was subsequently reaffirmed in Casey.

Before announcing the death knell of Roe and Casey, the Court cursorily considered the argument advanced in several of the feminist-oriented amicus curiae briefs filed in the case; namely, that the 14th Amendment’s equal protection clause offers an independent mooring for abortion rights given the inextricable connection between the ability to control one’s reproduction and gender equality.) as argued in the Brief for the Equal Protection Constitutional Law Scholars as Amici Curiae (2021e), this clause is a particularly suitable constitutional home because, like all restrictive measures, Mississippi’s 15-week abortion ban encoded a “sex-based and coercive classification that ‘perpetuate[s] the legal, social, and economic inferiority of women.’” A reality that, as underscored in the amicus brief filed by the Howard University School of Law Human and Civil Rights Clinic (2021f, 3-4, 18), is “uniquely severe and painful” for Black women in light of both their long being “subjected to invasive state regulation of their reproductive functions,” in tandem with, among other factors, “racial disparities in health care”.

The Court’s conservative super majority, however, flatly refused to take seriously the connection between restrictions on abortion and the legal subordination of women as a matter demanding attention under the equal protection clause, notwithstanding the fact that the nation’s criminal abortion laws were enacted in the 19th century when, according to leading anti-abortion physicians, women’s “holiest duty [was] to bring forth living children” (Storer 1866, 819). Instead, it relied upon the decision in Bray v. Alexandria (Bray), in which the Court held that the blockage of abortion clinics by Operation Rescue had nothing to do with “women seeking abortions,” but rather stemmed from activists’ “deep commitment to the goals of stopping the practice of abortion and ending its legalization” (246, quoting Bray v. Alexandria 1993, 273–74). Validating the animating assumption in Bray that “seeking to prevent women from making medical decisions [has] no social meaning for women’s equality” (Gans 1995, 1875), the Dobbs’ majority likewise divested abortion of its gendered social meaning, despite, as discussed below, the substantial body of evidence presented to it regarding the real-life harms of abortion restrictions.

This was hardly the first time that the Supreme Court had been asked to recognize the inextricable link between restrictions on abortion and gender oppression. Notably, as Greenhouse (2008) explicates, feminists have been impressing this connection on the Court dating back to Roe arguing, for example, that “restrictions on the availability of abortion have crippled and even destroyed their own lives and lives of many other women” in contravention of their right to equal protection of the law (Brief for the New Women Lawyers, Women’s Health and Abortion Project 1973, 12-13). Although the Roe Court grounded the abortion right in privacy rather than equality, it nonetheless took the harms of compelled motherhood into account by expressly recognizing the “distress associated … with the unwanted child” and the “problem of bringing a child into a family already unable psychologically and otherwise, to care for it” (Roe 1973, 53).

Although stopping short of identifying the equal protection clause as an independent mooring for the abortion right, in its 1992 decision involving a challenge to a restrictive Pennsylvania law, the Casey Court engaged in what Siegel (2007, 836) identifies as a “sex equality analysis of reproductive rights,” which “views the social organization of reproduction as playing a key role in determining women’s status and welfare … .” (815). Echoing feminist arguments presented in an array of amicus briefs, such as that “Roe’s recognition of the centrality of choice to women’s lives reflects this simple truth: if women can be forced to endure unwanted pregnancies, they are not truly free,” (Brief for the 178 Organizations in Support of Planned Parenthood of Southeastern Pennsylvania as Amicus Curiae 1992) the Court underscored the dangers of allowing states to insist “upon its own vision of a woman’s role” (Planned Parenthood v. Casey 1992, 852). Recognizing that “[a]n entire generation has come of age free to assume Roe’s concept of liberty in defining the capacity of women to act in society,” which has facilitated their ability to “participate equally in the economic and social life of the Nation” (856), the Court affirmed what it referred to as the “essential holding” of Roe, namely the protected constitutional right of privacy to choose abortion prior to fetal viability.

However, Casey contains a major jurisprudential twist. Although, affirming the constitutional right to abortion with close attention to the gendered significance of doing so, the Court then declared that Roe had undervalued the state’s “profound interest” in protecting potential life “throughout pregnancy” by way of its trimester framework, which prohibited restrictions on abortion to protect potential life until the start of the third trimester, when the fetus becomes viable, unless necessary to save the life or health of the pregnant person.

Rejecting the trimester framework for hobbling the ability of states to promote life from the outset of pregnancy, Casey gave states the green light to enact laws designed to “persuade the woman to choose childbirth over abortion,” (878) by letting her know that “[e]ven in the earliest stages of pregnancy” there are “philosophic and social arguments of great weight that can be brought to bear in favor of continuing the pregnancy to full term” (872). The only limitation on these fetal-protective measures was that they could not impose an “undue burden” on the abortion right.

Deploying this newly minted standard, the Casey Court upheld the constitutionality of Pennsylvania’s state prescribed informed consent script and its 24-hour waiting period requirement – restrictions that would have been invalidated under Roe as impermissible encroachments on the abortion right. Signaling the deep pro-natalism of the undue burden test, the Court admitted to being troubled by the fact that the waiting period’s minimum two-visit requirement would have “the effect of increasing the cost and risk of delay” of abortion – consequences it recognized would likely be “particularly burdensome” for “women who have the fewest financial resources, those who must travel long distances, and those who have difficulty explaining their whereabouts to husbands, employers, or others” (Planned Parenthood v. Casey 1992, 886-87). However, its commitment to the protection of fetal life trumped these concerns.

In short, Casey is a paradoxical decision, which “reads like two parts not of the same whole” (Daly 1995, 151) in which (Gans 1995, 1896) the Court failed “to reconcile its focus on stereotyping and sex equality with its recognition of an interest in protecting fetal life” thus eliding “the ways in which the state’s interest in fetal life is inextricably linked to the interest in enforcing women’s roles as mothers.” We make no effort here to reconcile the irreconcilable; rather, we take from Casey both a deep clarity about the abiding connection between abortion rights and sex equality and the painful awareness that the decision also contained the seeds of its own demise in its atonal elevation of the state’s interest in fetal life over those of the pregnant person.

Responding to Casey’s new permissiveness, lawmakers in conservative states rushed to fill the void with restrictive measures, including waiting periods, state prescribed informed consent scripts, abortion procedure restrictions, and ultrasound mandates (Borgmann 2004a; Weber 2009; Wharton and Kolbert 2013; Wharton, Frietsche, and Kolbert 2006). Another incipient strategy was the enactment of Targeted Regulation of Abortion Provider (TRAP) laws, which subjected abortion providers to “unnecessary and burdensome regulations, not imposed on providers of comparable medical services” (Cavendish 2002, 311), thus amplifying the stigma many abortion care providers experience while trying to perform their job.

By 2013, 27 states had passed TRAP laws requiring extensive licensing requirements such as admitting privileges to a local hospital, specifications for the size of the procedure rooms and hallways and meeting the standards for ambulatory surgical centers (Brown 2015, 2019; Gold and Nash 2013; Nash and Joerg 2019). In 2016, in Whole Woman’s Health v. Hellerstedt, the Supreme Court struck down two provisions in Texas’ TRAP law – one requiring admitting privileges at a hospital and the other that abortion facilities adhere to ambulatory surgical center standards – for placing an undue burden on the abortion right. Although rejecting the most debilitating provisions of TRAP laws, other burdensome provisions have remained in effect, including those governing sites where only medication abortion is provided, complex licensing requirements, and size specification mandates for procedure rooms and corridors (Guttmacher Institute 2023b).

Further contributing to the deep erosion of Roe, the 2010 midterm elections netted major gains for the GOP at both national and state levels, resulting in an intensification of the anti-abortion agenda (Weeks 2010). In 2010, 950 anti-abortion provisions were introduced and 89 were enacted; by 2011, these numbers increased to 1,100 and 135, respectively, representing an historic high (Gold and Nash 2012). The accumulative impact of these attacks meant that well before Dobbs, access to abortion had been sharply curtailed in many states. Moreover, as Borgmann (2004b, 688) writes, while a “single provision may not place a substantial obstacle in a woman’s path to abortion” under Casey, “a state can, and many do, accomplish the same result, … by erecting separate hurdles that cumulatively amount to what is surely a ‘substantial’ obstacle for many women.” Accordingly, well before Dobbs, many pregnant persons, particularly if from a vulnerable or marginalized community, were forced to “delay or entirely forgo their abortions” (Wharton and Kolbert, 159; see also Borgmann 2004b, 716).

This also meant that by the time Dobbs reached the Supreme Court, a well-developed body of evidence existed documenting the gendered harms of restricting abortion access. Much of this research was provided to the Court in the rich array of amicus briefs filed in the case, but it was steadfastly ignored by the majority in its rush to deny the possibility of any plausible link between “the goal of preventing abortion” and “invidiously discriminatory animus’ against women.”

The same, however, cannot be said for the dissenting Justices who, in their fierce negation of the conservative supermajority’s gender-impervious reasoning, drew upon the expertise of the amici and the wealth of supporting data contained in their briefs. In so doing, they carefully documented the full cascade of intersectional harms that flow from restrictions on the abortion right, thus documenting the connection between opposition to abortion and gender animus.

In support of their conviction that “taking away the right to abortion. … diminishes women’s opportunities to participate fully and equally in the Nation’s political, social, and economic life,” they turned to the evidence-based finding in the Brief for Economists “showing that abortion availability has ‘large effects on women’s education, labor force participation, occupations, and earnings’” (2344, Kagan, Breyer, and Sotomayor, JJ., dissenting, quoting Brief for Economists 2021a, 13, internal citations omitted). Similarly, they relied upon the brief filed by the Howard University School of Law Human and Civil Rights Clinic to underscore the racialized impact of abortion bans, writing that “[e]xperts estimate … [will] increase maternal mortality by 21%, with white women facing a 13% increase in maternal mortality while black women face a 33% increase,” as they are “three to four times more likely to die during or after childbirth than white women, often from preventable causes” (2238; Brief for the Howard University School of Law Human and Civil Rights Clini 2021f).

Further expounding on the intersectional harms of overturning Roe and Casey, the dissenting Justices stressed that “those without money” will be the hardest hit, as “women of means will still be able to travel to obtain the services they need” (2344–2345). Drawing upon the amicus briefs filed by 547 Deans and the Abortion Funds and Practical Support Organizations they stressed that “[w]omen living below the federal poverty line experience unintended pregnancies at rates five times higher than higher income women do, and nearly half of women who seek abortion care live in households below the poverty line” (2345; Brief for the 547 Deans, Chairs, Scholars and Public Health Professionals 2021c; Brief for the Abortion Funds and Practical Support Orgnaizations 2021d). Grounded in this recognition, they highlighted the grim reality that low-income women “will lose any ability to obtain safe, legal abortion care” and are thus at risk of losing “not just their freedom, but their lives” (2345).

The erosion of women’s status as, in the words of the dissent, “free and equal citizens” stemming from the loss of “control over their lives,” (2319), reinstates what Nossiff (2007) identifies as a regime of gendered citizenship. Asserting that citizenship requires having the “political, civil and social rights necessary to fully participate in the polity … free of domination and discrimination,” she argues that it cannot be achieved if one “loses control over their reproductive function,” thereby losing “rights to privacy and equality” (Nossiff 2007, 76–77). This is the precise result that Dobbs has ushered in as a result of its treating abortion restrictions as gender-neutral measures aimed at the preservation of fetal life, rather than, as Goodwin (2022, 13) writes, an expression of “[m]ale authority, power, and dominion over women’s reproduction … that framed women’s capacities and the span of their rights almost exclusively as service to men: as a good wife to a husband, as mother and caregiver to a man’s children, as a conduit to male reproduction, as a whipping post, and as sexual chattel.”

In a stinging rejoinder to the majority’s assertion that the “most striking feature of the dissent is the absence of any serious discussion of the legitimacy of the States’ interest in protecting life” (2261), rather than addressing this contention head-on, the dissenting Justices instead respond that the “most striking feature of the [majority] is the absence of any serious discussion of how its ruling will affect women” (2344). As they proclaim, this absence “reveals how little it knows or cares about women’s lives or about the suffering its decision will cause” and how far removed they are “from the reality American women actually live” (2344).

One year after the Dobbs decision, the legal and political topography of the country has become increasingly dire and complex for abortion care providers and patients. Among the numerous losses, 13 states have completely banned abortion, while 10 other states have enacted strict gestational bans (Guttmacher Institute 2023a). Compounding the difficulties of navigating this reality, the law in many states has been in flux in the wake of court challenges, often resulting in considerable confusion over their scope and enforceability. Standing as a stark testament to the devastating impact of Dobbs, since the decision, 66 clinics have stopped offering abortion care services; half of those clinics have focused their clinical practices on other reproductive health services, others have closed, or been sold, or reopened in abortion protective states (Fuentes 2023; McCann and Walker 2023).

The impact of Dobbs has and will not fall equally on all sectors of the population. Notably, well prior to the decision, patients living in states where access to abortion was already highly restricted experienced steeper financial and contextual barriers compared to patients in other states (Jones and Chiu 2023), with a greater impact on communities of color and economically vulnerable patients. Augmenting the health risks and inequities in these regions, abortion restrictive states are less likely to have access to maternity care, and less likely to have even minimal social family policies that improve health and well-being outcomes for women and children (Badger et al. 2022). In short, the post-Dobbs criminalization of abortion will profoundly increase “inequities in abortion access at the intersection of race and geography because the South and Midwest have the largest proportions of Black people and also the most states that have banned abortion or are expected to do so” (Fuentes 2023, 1).

As a result of the state bans and closure of abortion clinics across these states, abortion rates in protective states, particularly those bordering states that have banned or significantly restricted access to abortions, had a pronounced increase in abortion rates between 2020 to 2023 (Guttmacher Institute 2023a). During this three-year period, the number of abortions in states such as Colorado increased by 89%, 69% in Illinois, 220% in New Mexico, and 36% in Washington (Maddow-Zimet et al. 2023). At the same time, however, it is important to recognize that vulnerable communities are likely to have the greatest difficulty surmounting the challenges of cross-border abortion care. For example, one study found that Indigenous, Black, and Latinx persons who “have historically worse pregnancy-related outcomes than non-minority populations” face “large absolute increases in travel time to abortion facilities” (Rader et al. 2022, 2046; see also; Society of Family Planning 2022).

Of critical concern, the cumulative impact of abortion bans and restrictions will fall most heavily on marginalized communities, thus making the “cost of being denied abortion care very, very high” (Fuentes 2023, 1). This concern is well-borne out by ANSIRH’s landmark longitudinal Turnaway Study which documents the sweeping adverse impacts on women being denied a wanted abortion as compared to the trajectories of those able to access a wanted abortion (see generally, Foster 2020). Those denied a wanted abortion are more likely to experience greater economic precariousness (Foster et al. 2018); poorer maternal bonding (Foster et al. 2018); a dampening of future aspirational plans (Upadhyay, Biggs, and Foster 2015); continued violence from the man involved in the pregnancy (Roberts et al. 1997); and a “persistent worsening” in self-reported health problems (Ralph et al. 2019, 245–46).

Grounded in this legal framework, we now turn to the interviews with abortion care providers. Taken as a whole, they reverberate with the dissenting Justices’ powerful refrain that “[w]hatever the exact scope of the coming laws, one result of today’s decision is certain: the curtailment of women’s rights, and of their status as free and equal citizens” (2318).

Data and methods

The findings presented below are based on 22 semi-structured interviews, lasting 60–80 minutes, with abortion care professionals. The interviews were conducted between February 2022 through March 2023, which captured a unique period after the Supreme Court heard arguments in the Dobbs case on December 1, 2021, leading up to the leaked Dobbs decision on May 2, 2022 (“pre-Dobbs”) and eight months following the issuance of its final decision on June 24, 2022 (“post-Dobbs”).

When the interviews began in February 2022, Roe and Casey were clearly on shaky ground. President Trump’s third appointment to the Supreme Court, Amy Coney Barrett, filled the seat left vacant by the death of Justice Ruth Bader Ginsberg in 2020, which gave the Court a definitive anti-abortion majority. Oral arguments before the Court in Dobbs thus took place during a liminal period when abortion was legal but recriminalization was on the horizon.

Eleven of the interviews were initially conducted during this liminal period to explore providers’ views on opposition to abortion and gender equality, their experiences with the impact of anti-abortion restrictions, stigma, and harassment on their patients and their professional identity given the anti-abortion majority composition of the Court. After June 24, 2022, we conducted five additional interviews and re-interviewed six original participants, for a total of 22 interviews with 17 participants. We modified the post-Dobbs interview questions to more prominently focus on the gender-impervious reasoning of the Court’s decision, and the projected or realized impact of it on providers and their patients.

Pseudonyms are used for all participants, and human subjects’ approval was granted by the University of Kansas Institutional Review Board (#00148005) for this research. Participants were given a verbal and written description of the project, and each participant was required to read and sign a consent form. They were provided with a copy of the consent form that appraised them of their rights and contained contact information for the researchers and for the human subjects’ committee that approved the research. Prior to the interviews, participants were also provided with an optional demographic survey containing 19 questions. Thirteen out of the 17 participants opted to complete the survey.

Participants were recruited using a convenience sample originating from a private, professional listserv comprised of medical doctors, public health professionals, academic scholars and other medical health providers working in abortion care facilities. Listserv members were vetted by the professional association, which is not open to the public. We placed a recruitment call on the listserv that provided a brief description of the project, selection criteria for participants (abortion care professionals), and a contact e-mail address.

The sample was predominately white, heterosexual, identified as politically liberal, and did not attend monthly religious services. Based on participants’ self-disclosure during the interview or on the survey, 15 interviewees identified themselves as female, one as non-binary, and one as male. One participant racially identified as Black, two participants identified their ethnicity as Ashkenazi Jewish women, and two ethnically as Latinas. Twelve interviewees identified as heterosexual, two as bisexual, two as gay, and one as queer. All but two participants were married or partnered, and seven had children. Participants were between the ages of 29 to 60, with the median age being 41.

Four abortion care professionals were employed by large nonprofit organizations, 12 were employed by independent clinics, hospitals, or both, and one was employed in a mobile clinic. The sample was highly educated; 12 participants have a medical degree and six have other advanced degrees in addition to their medical degrees, most commonly a master’s degree in public health. The other five interviewees have master’s in public health degrees, PhDs, or varying levels of nursing degrees. Fifteen participants have been providing abortion care for more than 15 years, therefore they often discussed their lived experiences of providing abortion care in the increasingly hostile political and policy environment that they had been working in for more than a decade. Participants work in Alabama, Alaska, Arizona, Colorado, Georgia, Hawaii, Illinois, Indiana, Kentucky, Massachusetts, Minnesota, Mississippi, New York, Ohio, Oregon, Pennsylvania, and Texas. Those working in Alabama, Kentucky, and Texas stopped providing abortion care services after it was criminalized following Dobbs.

Interviews were conducted over Zoom, audio recorded and transcribed verbatim. Data were analyzed based on repeated close readings of the transcripts. To facilitate this analysis, we used a grounded theoretical inductive approach (Maxwell 2012; Thomas 2006), using an open coding format to catalog dominant and frequent themes that emerged from the data. These themes were then used to continually compare across participants to support, refine, and identify additional themes that materialized over the course of the interviews (Maxwell 2012; Thomas 2006).

The findings below are organized around three salient interview topics. Section one explores abortion providers’ views on opposition to abortion and gender equality. Section two examines the manifestation of gender animus through the projected or realized impact of anti-abortion restrictions on providers’ ability to care for their patients. Within this topic, three themes emerged: compounding pre–Dobbs inequities, post–Dobbs inequities, and care for people left behind. Section three examines another significant manifestation of gender animus, namely, the impact of the rapidly evolving, and often legally ambiguous, patchwork of state abortion policy on the ability of providers to perform their work. Within this topic, two themes emerged: pre-Dobbs precarity and post-Dobbs precarity.

Findings

Gender Animus: Opposition to abortion and gender equality

Across all interviews, participants were unable to disentangle opposition to abortion from gender animus. Rather, they embraced an understanding of abortion that aligned with Casey’s “sex equality analysis of reproductive rights,” thus repudiating the Court’s conclusion in Dobbs that opposition to abortion is devoid of gendered significance. Encapsulating this understanding in a pre-Dobbs interview, Gianna, a physician providing abortion care in the Northeast, commented on a recently introduced 15-week abortion ban in another state:

It’s more than just preventing abortions, I feel. It is about controlling women’s bodies. I don’t think they’ll stop there…this is their means to an end, which is to ban abortions altogether, but also, restrict birth control and women’s ability to work in the workplace.¹

(February 10, 2022)

Although the Court in Dobbs erased women’s lived experiences by denying that restrictions on abortion have any discernible impact on their lives, during the oral arguments in 2021, in a rare moment where women’s interests were briefly considered alongside the fetuses’, Justice Kavanaugh stated, “And the problem, I think the other side would say and the reason this issue is hard, is you can’t accommodate both interests. You have to pick. That’s the fundamental problem. And one interest has to prevail over the other at any given point in time, and that’s why this is so challenging, I think,”² thus implying at a minimum, an equivalency between a person’s right to bodily autonomy, agency, health, and life, and those of a fetus. Justice Kavanaugh’s position, however, is highly contested and based on an assumption that a woman and a fetus are separable and equal. Yet, as Roberts (1997, 2014) contends, the separability of a woman and fetus was socially constructed during slavery and facilitated an intersectional gender animus that slave owners violently practiced against enslaved Black women to physically punish them while “protecting” the “property” growing inside them. Other legal scholars also take umbrage with equating women’s rights to fetal rights (Dadlez and Andrews 2012; Goodwin 2022; Gvozden 2022). As Goodwin (2017, 224) persuasively argues, “only in contexts that involve punishing women and regulating their bodies have legislatures sought to create a new, narrow legal standard that transforms the identities of embryos and fetuses and grants them legal rights.”

Justice Kavanaugh’s problematic implied separability and equivalency, and the scant regard given to women by the other conservative Justices in the case, devastated and angered all interviewees. Michelle, a physician with a master’s degree in public health, and the medical director of an abortion clinic in the Midwest, was baffled by Justice Kavanaugh’s line of questions:

This is like 50% of the US population. How can you possibly take their rights away? It does make me very pissed off and disappointed. The fact that this is something that affects women or people that were born women…It’s hard to help people understand that it just affects every aspect of equality in our live. You know, when Roe gets overturned, women are just going to be back to second-class citizens without control over whether or not we can reproduce.

(February 28, 2022)

In the post-Dobbs interviews, when interviewees were asked to respond directly to the majority’s claim that “opposition to abortion” does not “evince a discriminatory animus towards women,” they found the claim “absurd,” “laughable,” “ridiculous,” “absolutely hysterical, honestly,” and were frequently at a loss of how to appropriately respond to a claim that was incredulously false. Emily, an East Coast abortion care physician with a master’s degree in public health, was angered by the fact that Justice Alito, author of the majority opinion, reasoned about abortion in a gender-impervious manner given that his prior support in Casey for the spousal consent provision invoked a deeply gendered understanding of women as lacking decisional capacity:

Alito was the one person who went to the mat for spousal consent in 1992 in Casey. Like he clearly feels that women should not be allowed to make that decision. I mean, it’s clearly because he doesn’t believe that the person who’s pregnant should be allowed to make the decision, and that has to be rooted in gender.

(February 27, 2023)

Reflecting a typical response to Justice Alito’s claim that the Dobbs decision does not “evince a discriminatory animus towards women,” Kayla, a physician providing abortion care in the South, remarked, “No one can hear that with a straight face. What does he think? He thinks we’re idiots” (March 7, 2023). Similarly, Evelyn, an abortion care physician in New York noted, “If it’s not impacting the XY, it’s only impacting the XX, [then] it’s clearly about gender and it’s also clearly about control” (February 13, 2023). Echoing the same point, Rebecca said, “you can pretend what you want and believe that you’re not intending to make it about gender, but intent doesn’t really matter; effect does” (February 24, 2023).

Gianna astutely identified the structural role of the decision in maintaining and reinscribing gender animus:

If the federal government thinks that state governments can outlaw [abortion], and that’s okay, then of course it is [discrimination]. There is no other way to describe it. How could telling women what to do with their body not be that? I mean, it’s as simple as that. That’s really the end of the story.

(February 20, 2023)

Madison, the executive director of a feminist women’s health care center that provides abortion care in the South, also took a larger systemic view. She discussed the ways in which the Dobbs decision is connected to larger systems of power that work in conjunction with each other and adversely impact women:

I believe that a lot of what is happening is more than just a patriarchal decision. I think it is a capitalist decision. I think that there are ways that the maintenance of white supremacy and capitalist and imperialist structures depend upon the ability to control people’s reproductive decisions… [There is] a sort of fundamental distrust and neglect of the needs, rights and humanity of people who identify as women that is clear and apparent.

(February 24, 2023)

Across all post-Dobbs interviews, participants firmly rejected the mendacious claim by the Court that “preventing abortion” is not connected to “discriminatory animus.” Instead, the decision served to reinforce the reality of their lived experiences of the deep and abiding connection between opposition to abortion and the deprivation of women’s right to bodily autonomy and decisional dignity.

Gender Animus: Impact on abortion care patients

Compounding pre-Dobbs inequities

The most palpable and salient manifestation of gender animus discussed in the interviews was the impact of anti-abortion restrictions on patients. All the interviewees discussed their grave concerns about the numerous ways that the Dobbs decision has magnified the risks for patients who already faced significant obstacles accessing healthcare. Madison, for instance, talked about the stress her patients dealt with accessing health care in Georgia pre-Dobbs, where Medicaid expansion is not available. She described navigating the system as “incredibly difficult” and “riddled with obstacles,” and discussed the ways that “poverty and housing insecurity and access to education…and general stability” affected patients’ ability to access healthcare in general let alone reproductive healthcare (February 24, 2023).

Gianna’s patients also experienced barriers accessing reproductive healthcare pre-Dobbs. Driven by her deepening commitment to providing abortion care to underserved communities, Gianna had been traveling to Mississippi from the Northeast since 2016 to deliver services. She was struck by the overall absence of general healthcare available to people:

I mean, even if you’re ambivalent about the abortion issue - forget the whole abortion thing. The state of healthcare in Mississippi is really terrible. They don’t really have access to high-quality medical care, especially in mid-central Mississippi. They get no support. Hospitals are closing, providers are leaving. They did not expand Medicaid - one of the few states that didn’t expand Medicaid. So, patients really don’t have insurance. People are so poor that just providing appropriate care is a challenge.

(February 10, 2022)

Madison and Gianna’s individual experiences working with patients in the South reflect larger patterns of healthcare inequity that, as discussed above, predate Dobbs, and as Madison succinctly states, impacts “the needs, rights and humanity of people who identify as women, [and] the dangers of pregnancy, particularly in poorer parts of the country” (February 24, 2023). Rebecca views Dobbs as another institutionalized decision that will continue to make healthcare “more fragmented. In the places where it’s accessible, it will continue to be accessible. And then the places where it’s always been hostile, it will continue to get more hostile” (February 24, 2023).

Post-Dobbs inequities

When Madison’s state enacted a six-week abortion ban after Dobbs, she was extremely concerned about the number of people who would be unable to access abortion care within the state’s new legal timeframe. “I don’t know where all of these people are going to go who need abortions. [They] can’t all just go to California” (February 24, 2023). Like Madison, all interviewees witnessed the added hardships their patients were experiencing on multiple logistical fronts primarily resulting from the greater distance they were traveling for services. Many of the providers in abortion-protective states, like Rebecca, reported an increase in “referrals from out of state” that required “coordinating transportation and housing and logistics.” Although her staff had dealt with these issues previously, post-Dobbs they have become more frequent and “feel more urgent and a little bit more pressured” because “patients are probably getting to us a little bit later” (February 25, 2023).

Madison explained the “profound” ways that the Dobbs decision has created logistical complications for patients and erected additional barriers that make it impossible for some to travel out of state for care:

Most of the people that we serve are Black. Most of the people we serve are low-income. A good portion of the people we serve are from Spanish-speaking communities or from other immigrant and refugee communities. People who are already working to survive these intersecting systems of oppression – people who are simultaneously Black and poor and uninsured or non-English-speaking and you know, differently able[d] … .People who do not have the means to travel four states [away] and take time off work and find somebody to care for their existing children and are coming back home to a violent situation.

(February 24, 2023)

Knowing that the increased volume of patients was driven by people traveling from abortion restrictive states, providers felt an intense obligation and responsibility to treat everyone, even when it created chaotic schedules. Kayla explained, “We have had more of these patients where we have to see them that day no matter what has happened, because they’re flying in or they’ve driven in, so we’re trying to take care of them as much as possible” (February 25, 2023).

Providers also discussed the challenges of treating out-of-state patients given the logistical challenges of, for example, scheduling follow-up appointments that they are accustomed to providing. As Gianna points out, “for patients you would say, ‘Oh, come back in a week.’ Well, they can’t come back in a week” (February 20, 2023). Emily explained some of the compromises she must live with in a post-Dobbs reality:

People who do travel, I worry about them because, well first of all, often they can’t stay very long so they’re often traveling back like immediately after their procedure. So that means sometimes providing them one day of cervical ripening, maybe even when it’s kind of on the edge of my comfort zone, or again, kind of like at the end of the day where we maybe have to wait around just to accommodate them which, you know, is fine. We will do that. Or, if they didn’t have a procedure, if they had a medication abortion, they could be bleeding and cramping along the way. So, I just feel like, it’s not ideal for them to have a procedure and then get on a plane, but we see this and so we just have to deal with it.

(February 27, 2023)

Providers, like Michelle, working in abortion protective states have been experiencing an overwhelming sense of responsibility to accommodate all out-of-state patients seeking care. “I felt this intangible thing that’s weighing on me. I feel like being in a safe state, I feel this incredible sense of responsibility. Like we have to take care of everybody who shows up” (March 6, 2023). At the same time, all interviewees knew that access to abortion care largely hinges on what Sienna summarized as “a question of whether you have the money. That’s probably the biggest barrier for people is financial.” (February 27, 2023)

Care for people left behind

The biggest concern for interviewees was the countless numbers of people who were unable to make it to an abortion protective state to receive care. Their worries are well founded. As noted above, people unable to travel for abortion care are those with the fewest socioeconomic resources, and the consequences for being unable to obtain a desired abortion include long-term economic hardship and insecurity, more serious health problems, and prolonged exposure to violent partners (Foster 2020).

Encapsulating interviewees’ feelings, Michelle observed that people who will be harmed the most by the Dobbs decision are “expendable” to the Court, the “throw away” people who “don’t have people speaking for them” (February 24, 2023). Thus, as Aaliyah explained, she was acutely aware that although “the people who find their way to our doorstep have some of the most devastating stories to share, it’s a drop in the bucket of what’s happening in terms of the real harm across the country that we’re seeing” (March 2, 2023).

Their collective unease for people living in abortion restrictive states spanned beyond the narrower confines of elective abortion care, but rather encompassed the inevitable decline in reproductive health care due to the substandard training medical students will be receiving in these locations. As Hannah explained:

When we create environments where medical trainees, regardless of whether it’s physicians, APPs, nurses, cannot get accurate training on essential healthcare services, again we’re impacting safety. You know, the care for a miscarriage is the same as the care for an elective abortion.

(February 1, 2022)

Likewise, others noted the “exodus of residents” and “downward spiral” occurring in abortion restrictive states. Emily noted:

I think the training is going to suffer and a whole generation of OB-GYNs who train in certain places are not going to have the same skills or the same quality of training as people who train in other places. And then if those doctors are more likely to then stay in the areas in which they do residency, which we know is true, it becomes this kind of downward spiral in the skill of the providers. It makes me very scared and sad.

(February 27, 2023)

The downward spiral that Emily describes is rational. Approximately 45% of accredited US obstetrics and gynecology residency programs are in states that have banned or severely curtailed abortion following Dobbs (Peachman 2022). The consequence will amount to a “loss of a critical skill” for residents, which means a loss of reproductive care for people living in abortion prohibitive states (Peachman 2022, 1668).

While this gendered health crisis continues to unfold and becomes worse throughout the 21st century, Kayla and Madison try to draw comfort and hope from taking an historical view:

It’s just a blip in time and what will happen is we will need to be the historians and mark this time and mark what happens and mark what happens to all of our patients, so that we can really make everyone aware of the damage that it’s doing, so that people figure out sooner rather than later that something needs to be done in terms of policy.

(February 25, 2023)

Similarly, Madison believes:

I think things will have to get extremely dire before we’ll see substantial sustainable change. But I think that’s the short part of the story. I think that abortion absolutely will come back around again. I think it will be reestablished and expanded in the United States. It’s inevitable that abortions will continue to happen. Where and how they happen, I think will continue to change. But they will continue to happen, and I think that there is a reality for them to be legal and safe in the future. It’s going to take a lot of work and a lot of time, and I think, again, a lot of the people who are currently holding positions of power will have to no longer hold those positions.

(February 24, 2023)

Gender Animus: Legal and Professional Precarity

Abortion has been politically bifurcated from other routine medical care, framed as a moral rather than a medical issue (Borgmann 2014; Doan 2007). This framing has facilitated the ability of “legislatures and courts to subject abortion to unique, and uniquely burdensome, rules” that have created regressive state policies on abortion (Borgmann 2014, 1048; Millar 2023; Joffe and Schroeder 2021). Thus, interviewees discussed at length the ways in which gender animus manifests in the legal and professional precarity they have been, and continue to be, subjected to by the state’s insistence on treating abortion as an exceptional medical procedure in law and practice.

By way of background, 15 out of the 17 interviewees had been providing abortion care for more than a decade prior to the decision in Dobbs. Having already become accustomed to working in what some scholars characterize as a gendered regime of reproductive surveillance and social control (Brown, Ehrlich, and Guidotti-Hernández 2023; Doan and Schwarz 2020; Ehrlich and Doan 2019) interviewees were already trepidatious about the future of reproductive health care. Accordingly, they nested their post-Dobbs experiences within the larger political and policy environment that they had been contending with, which, to varying degrees contributed to a preexisting sense of legal and professional precarity.

Pre-Dobbs precarity

The above-discussed pre-Dobbs restrictions on abortion rights inspired Carmen to “feel more defiant” and “passionate about making things easier” for patients. Undeterred, she was emphatic that she and her staff were “going to do everything we can to just make it less of a burden for [patients] and easier for them to get. You require us to go to absurd lengths, and we’ll do it if that’s what’s needed” (July 15, 2022).

Hazel, a provider who worked in Alabama, Georgia, and Ohio detailed the additional time and burden these restrictions created:

In Georgia nurse practitioners can’t provide medication abortion and that is extremely silly, so that’s a major access problem. We have a 24-hour waiting period so we don’t have availability for appointments shorter than 24 hours’ notice…Alabama is a bit of a different beast where they have a two-day situation, and that can be really burdensome. And just the staff time that it takes to consent these people in person is just ridiculous, and the amount that it costs for them to pay me to read someone a piece of paper is just insane. It’s just ridiculous and stigmatizing for the patients.

(February 16, 2022)

In similar fashion, Carmen zeroed in on the cumulative strains of having to comply with existing TRAP laws that treat abortion care as an exceptional medical procedure – which she referred to as “stupid hoops.” Noting “the absurdity of the regulations,” such as requiring “changing areas for volunteers [that are] separate from staff” and “faucets that have the right wrist turn-ons.” She emphasized that the constant vigilance needed to stay compliant with state law to avoid any misstep that might close the clinic exacted a heavy toll from clinic staff.

Rebecca, a complex family planning specialist, had also been dealing with the legal frustration of trying to comply with her state’s TRAP law as it cycled through fluctuating periods of being in effect and then subjected to a court injunction. However, the aspect of the law that “infuriates” Rebecca the most is “the stigma and interference” which “makes providing care more challenging:”

It creates this idea that what I’m doing is special and an exception. Instead of it being treated as routine healthcare…it creates this whole environment of challenge and difficulty where, myself and my patients, and the way that the system kind of interacts with us is, you know – we don’t get treated the same way.

(June 10, 2022)

Notably, as reflected in some of the interviews, the escalation of legislative attacks on abortion following the 2010 elections further stigmatized providers and discredited their medical expertise (Doan and Schwarz 2020; Doan, Candal, and Sylvester 2018). Kayla noted how the credibility of abortion providers had been undermined by anti-abortion elected officials. “They already don’t consider our expertise when they’re making these laws. And when we go to provide testimony at hearings, they already tell us we’re lying” (March 7, 2022). Likewise, Hannah recounted that abortion providers’ medical expertise had been thwarted in state politics, “No one’s going to listen to our medical judgment. They’re going to tell us we’re liars and they’re going to discount it just like they have for so long, just like they’ve discounted women and their health for so long” (April 1, 2022).

Post-Dobbs precarity

Despite interviewees’ experiences with legal and professional precarity, even among those working in highly restrictive states, most were unprepared for Dobbs. Capturing the general sentiment, Rebecca remarked, “As soon as the Supreme Court agreed to take up this case last fall, we kind of knew [it] would happen,” but emotionally “it still feels kind of surreal. It brings a level of uncertainty to my future” (February 24, 2023). For Emily, the decision was jarring. “When Dobbs first hit, I had that realization, like I could be a felon in some of these places” (February 27, 2023). Echoing her colleagues’ sentiments, Rebecca struggled to simultaneously contend with her disbelief over the decision and the criminalization of her profession in the emerging post-Dobbs landscape:

It feels a little surreal…I never thought that I would think so frequently about how my practice might need to shift or change in response to the law, that I could be, you know, an outlaw in certain states or, there could one day be certain states where it is not safe for me to travel to because of legal work I do in other places.

(February 24, 2023)

All interviewees discussed being in legal limbo following Dobbs. Capturing this sentiment, one physician said, “this work was always chaotic, and I just feel like it’s gotten even more chaotic, honestly. It’s hard to believe that can happen, but it’s been just a lot of uncertainty and a lot of fear and sadness” (February 24, 2023).

For interviewees working in abortion prohibitive states, the stress of adjusting their practices to the dizzying number of abortion related lawsuits, the constantly shifting legal status of abortion, the contradictory directives being issued by hospitals, the vague policy guidelines governing patient care, and their vulnerability to running afoul of hastily passed anti-abortion policies, has been intense. According to Rebecca, the labyrinth of laws, regulations, and legal challenges created “confusion about whether or not abortion is still an option, and under what circumstances, especially with the ban and injunction” (February 24, 2023). Physicians, such as Sienna, working in these states were “guessing and preparing for worst case scenarios since that seems to be the trend amongst the highly conservative state legislatures” (February 27, 2023).

Madison described the legal precarity she and her colleagues were experiencing working in states where abortion is now banned or heavily restricted:

There’s an additional fear of prosecution or investigation. Not knowing whether or not people in your community or people in your family or people in your healthcare center might turn you in…it could be banned totally tomorrow. Who knows what will happen? The State could shut us down.

(February 24, 2023)

Working in this liminal space also left the interviewees deeply troubled by the prospect that their respective state legislatures will enact a law “that will require us to criminalize our patients if they present for self-managed abortion” (January 19, 2023).

Abortion care providers working in states where abortion remains legal, also experienced distress trying to navigate the legalities of assisting patients living in states with criminal bans. Sierra asked:

How do you manage patients calling from a state where abortion is illegal? I remember talking to one nurse. She’s been covering calls for a long time and is pretty well informed about how to manage most situations. And she said, “I don’t know what to do about this.” And I’m like, “I don’t either.”

(February 27, 2023)

Nine interviewees practicing in states where abortion remained legal, discussed the ramped up anti-abortion activism in this new environment, which, as reported by the National Abortion Federation, increased significantly in abortion protective states post-Dobbs, including incidents of arson, burglary, stalking, obstructions, and death threats, thus adding to the instability of their legal footing. According to Rebecca, “we have also seen, since the overturning [of abortion] in Dobbs, a reinvigorated cohort of anti-abortion activists who are filing an increasing number of complaints against our abortion providers,” which “definitely fuels a lot of the stress and the fear of losing our medical license” (February 24, 2023). Another interviewee observed that since Dobbs, anti-abortion activists “have been energized by a political system in this state that has publicly demonstrated their willingness to harass providers and interfere with medical care without valid reasons” (February 25, 2023).

Abortion care providers, like Madison, working in abortion restrictive states, worry that “the threat of prosecution, the threat of fines, the threat of losing your job, the threat of legal recourse” are going to push physicians out of the profession when they are needed the most (February 24, 2023). The intense legal precarity for these interviewees forced them to reflect on their professional identity and future career trajectory. For some providers, that meant, doing “a little soul searching” and deciding “how close to the edge” of newly defined illegal healthcare procedures they were willing to perform (March 2, 2023). Aaliyah’s self-reflection became a path to finding courage – the ability to act despite their fear. “We step in and assume some level of risk in this field” (March 2, 2023).

Remarkably, although all interviewees went through a process of reflecting on their professional identity and trying to reconcile it with their moral, ethical, and personal identity, they all came through it with a more fused intersectional identity that cemented their commitment to providing abortion care. The overt and aggressive gender animus radiating from the Dobbs ruling galvanized interviewees to be more public facing about their professional identity. As Evelyn noted, “I feel more convicted in my identity as an abortion provider. I feel less apologetic. I’m as proud as I was before. I’m just more vocal about it now” (February 13, 2023). Gianna also felt that the Court’s reversal of Roe was a “battle cry” for abortion care providers who had wanted to “stay anonymous” because for so long “they were afraid.” She decided it was her job “to do abortions because that’s what I can do that not everybody can do,” and she was going to use her skills in “whatever states I can to improve access,” while being “emboldened to be more outspoken” to combat stigma.

For Emily and Kayla, their reflection process included a reaffirmation and strengthening of their identities, which unfolded in the months after Dobbs. For Emily, this meant centering her identity as an abortion care provider:

Initially I thought of myself as an OB-GYN who provides abortions. Over time I have much more become an abortion provider. Like it’s become a stronger part of my identity. I felt so strongly that I had an obligation to incorporate it into my practice, especially in light of what was going on. It’s about justice. It’s about autonomy. It’s about, you know, treating women as decision-capable humans, and providing good care. My identity as an abortion provider has become stronger and stronger.

(February 27, 2023)

Kayla more firmly integrated her feminist identity into her professional one, and a year later, she struck a more defiant tone:

They haven’t taken away my expertise and my experience and my skill level. No one can tell me what I can and can’t do, not some stupid law. And they have not taken away my identity. I wanted my work to reflect my feminist values. That was very important to me. I felt very passionate about that, and I had the opportunity to work at an abortion clinic.

(February 25, 2023)

Although interviewees were uniform in their commitment to providing reproductive health care for patients, most felt professionally precarious, uncertain about their future or their colleagues’ future.

Like abortion providers living in restrictive states writ large, interviewees practicing or planning on practicing in these states had to reevaluate the trajectory of their careers (McCann and Walker 2023). Stella grew up and attended medical school in Texas. She was finishing up a prestigious fellowship in the Northeast and had been planning on returning to Texas to begin her career as a complex family planning specialist. Dobbs has disrupted her plans:

SB8 and then Dobbs. It really changed my plans because my plan was to go back to Texas and provide care there. So, I feel like at this point I have nothing to lose. It’s like everything has already happened so I might as well just find the best fit for me where I can still serve patients in the way that I want.

(January 19, 2023)

Aaliyah was also hoping to return to her home state of Ohio, where she has family and friends. However, like Stella, after dedicating years to acquiring specialty training, she is coming to terms with the new political reality that is limiting where she can legally practice medicine. “If I were to ever move back, I would not be able to practice medicine certainly in the way that I would like to.” Aaliyah noted she was not alone in struggling to adjust:

We have fellows and residents who are in the process of becoming subspecialists or experts on abortion or have the aspiration to pursue this as a career. Everybody’s struggling to figure out, what does all this mean? How do I fit in? Is this something that I can practically integrate into my future?

(March 2, 2023)

Sienna, who also has a faculty position and trains medical residents, discussed the professional precarity her early career and senior career colleagues have been experiencing:

We all have been just sideswiped by the reality of this and I think everybody is dealing with this in their own way. We have faculty who have dedicated their entire careers to this focus. It’s hard to see a dismantling of so much of the work that [they’ve] done in this moment. We have young junior faculty who are like, “What the fuck? I just completed all this extra special training and I’ve got this faculty position and there’s so much uncertainty and instability in this career field right now.”

(February 27, 2023)

Madison, however, did not have any intention of relocating to another state, despite the legal and professional precarity she faces in Georgia. She was dedicated to “supporting the needs, the immediate critical needs of communities of color, Black people in particular” and employing a “black feminist understanding” of the world in her career. Since oral arguments in Dobbs, Madison has been “working through multiple scenarios to anticipate how we would need to adjust based on lost revenue and how I could maintain my staff without layoffs or downsizing.” She has collaborated with other local and regional coalitions to “better understand the regional and national landscape … to strategize about how we move through and move towards something that is better for all of us” (February 24, 2023).

Conclusion

The interviews we conducted with abortion providers buttress the claim of the dissenting Justices in Dobbs that the Court’s conservative supermajority knows or cares little “about women’s lives or about the suffering its decision will cause.” In contrast to the distance these anti-abortion Justices are “from the reality American women actually live,” the participants in our study are deeply enmeshed in this reality based on their professional identities and associated intimate knowledge of the first-hand challenges faced by those seeking abortion care in this ever increasingly hostile environment. Unfortunately, we are still bearing witness to the unfolding and devastating gendered impacts of the Court’s decision in Dobbs as legal controversies continue to swirl around various issues, such as travel restrictions and the FDA’s approval of mifepristone, leaving no doubt that the “the goal of preventing abortion” constitutes “‘invidiously discriminatory animus’ against women.”

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Lori Brown

Lori Brown’s creative research practice focuses on the relationships between architecture and social justice issues with particular emphasis on gender and its impact upon spatial relationships. She is the co-founder and leads ArchiteXX, www.architexx.org, a gender equity in architecture organization transforming the profession by bridging the academy and practice in New York City. Her two books include Feminist Practices: Interdisciplinary Approaches to Women in Architecture (2011), an edited collection of a group of international women designers and architects employing feminist methodologies in their creative practices, and Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitals (2013), exploring highly securitized spaces and the impact of legislation and the First Amendment’s affect upon such places. Her two current book projects include Birthing Centers, Borders and Bodies and co-editing The Bloomsbury Global Encyclopedia of Women in Architecture 1960-2020 with Dr. Karen Burns (2024). She is 2021 Architectural League of New York Emerging Voices recipient and a Fellow of the American Institute of Architects. She is a Distinguished Professor at the School of Architecture Syracuse University and a registered architect in New York state.

Alesha E. Doan

Alesha E. Doan is Associate Dean in the College of Liberal Arts & Sciences at the University of Kansas. She also holds a joint appointment in the School of Public Affairs & Administration and the Women, Gender & Sexuality Studies Department. Professor Doan’s interdisciplinary research program is situated at the intersections between gender, public policy, and organizations, with a substantive focus on reproductive health, sexual violence, and gender and the military. She has been awarded more than $7 million in external funding, and her publications include articles in a variety of journals. She is the co-editor of Managing Sex in the U.S. Military: Gender, Identity, and Behavior (2022), as well the author or co-author of Abortion Regret: The New Attack on Reproductive Freedom (2019), Organizational Obliviousness: Entrenched Resistance to Gender Integration in the Military (2019), Opposition and Intimidation: The Abortion Wars and Strategies of Political Harassment (2007), and The Politics of Virginity: Abstinence in Sex Education (2008).

Shoshanna Ehrlich

J. Shoshanna Ehrlich is a professor emerita of Women’s, Gender, and Sexuality Studies at UMass Boston. Her interdisciplinary scholarship and activism focus on the legal regulation of reproduction and sexuality. Recent publications include “The Abortion Rights of Teens in the Post-Dobbs Era” (Cardozo Journal of Equal Rights and Social Justice, forthcoming), “Why the Dobbs Court Got It Wrong: Connecting the Dots Between Opposition to Abortion and Gender Animus” (Seattle Journal for Social Justice, forthcoming), “Too Young for Marriage but Not for Abortion” (Harvard Journal Gender and Law, 2022), “The Body as Borderland: The Abortion (Non) Rights of Unaccompanied Minors in Federal Immigration Custody” (UCLA Women’s Law Journal, 2021), and Abortion Regret: The New Attack on Women’s Reproductive Freedom (co-authored, 2019). Shoshanna also is a regular contributor to Ms. Magazine and is currently collaborating with the Planned Parenthood League of Massachusetts’ ASPIRE Center Sexual and Reproductive Health on a research and advocacy project focusing on the abortion rights of minors.

Notes

1. Quotes have been edited for clarity.

2. The full transcript of the oral arguments in Dobbs v. Jackson Women’s Health are available at: https://www.supremecourt.gov/oral_arguments/argument_transcripts/2021/19-1392_bq7d.pdf.