Lilian Walker

Dr. Eberly
Public Policy 311
December 9, 2022
Policy Analysis Paper

As the United States political world is becoming more polarized, citizens are bearing the

brunt of new policies across the nation. Questions of healthcare, national security, and education

are being pushed into the hands of representatives who make decisions for everyone, leading

citizens to question the integrity of our elected voices, and the feasibility and legitimacy of the

policies that are presented and passed in government. As of June 24, 2022 the United States

endured a major transformation regarding the access of reproductive health for women across the

country. The overturning of Roe v. Wade, from a 6-3 majority vote, caused the supreme court

case that had been upheld for 50 years to fundamentally change the way women access

reproductive health care. It did not only alter the way abortions are accessed, but also

contraceptives, and it could potentially limit access to IVF practices. The demographic and

socioeconomic status of women must be taken into consideration when a shock to the legal

system comes so abruptly. Supporters and non-supporters of the overturning agree that women

still deserve the fundamental right to healthcare, but at what cost is the question. Considering

what is jeopardized and safeguarded from the overturning and how this will affect women

varying from their race, geographical location, economic status, is crucial when analyzing this

public problem and brainstorming alternatives.

Since the supreme court passed Roe v. Wade in January of 1973, generations of women

have not had to think twice about their bodily autonomy, but now current and future generations

have something to fight for. Almost immediately after the new ruling went into effect, allowing
state governors to make a final ruling on the continuation of reproductive health care, eight states

placed bans or serious restrictions on abortions. The states that have enacted new laws regarding

abortion thus far are Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Kentucky, Louisiana,

Mississippi, Missouri, North Carolina, South Dakota, Oklahoma, South Dakota, Tennessee, and

West Virginia (Sneed et al., 2022). While some states already had a trigger law in place, others

took a few days or weeks to make a final decision only causing more panic from anticipation

across the country. The feelings from anticipation are ongoing as states are able to make

revisions to reproductive healthcare anytime they feel necessary. This could be during a political

transition, where a democratic governor is being succeeded by a republican governor. Since

politics are a continuously uncertain game, women fear for bodily autonomy every day.

Abortion surveillance data reveals that women aged 15-44 underwent abortions in the

year 2020 and that 57.2% of abortions were conducted on women in their twenties. Of the

women the procedure was performed on, over 50% of terminations were early medical abortions

meaning the gestation period had not proceeded nine weeks (CDC, 2020). According to states

like Georgia, nine weeks would still be too late as the maximum gestation period to receive an

abortion is six weeks or else it would be considered illegal. States such as Alabama, Arkansas,

Kentucky, Texas, Missouri, Mississippi, Tennessee, Oklahoma, and more ban it at conception

(Washington Post, 2022), and only four states have an exception to termination other than a

pregnancy being a threat to the mothers life. In reality, this means that women who were raped

would not be allowed to terminate their assailants unwelcomed seed. This is where the

overturning becomes a greater troubling public concern as over 3 million women have

experienced pregnancy in the result of rape and of the women who were raped by an intmate

partner. Of the 3 million, about 20% reported that their partner had previously in the relationship
attempted to get them pregnant or prevent them from using birth control, and 23% reported their

partner refused to use a condom (CDC, 2022). This statistic should be more concerning than the

people receiving abortions.

The effects of the overturning were seen immediately especially in rural areas in which

women already had less access to healthcare in general. In definition, rural describes a remote,

countryside that is not a town. All states have pockets of rural areas, in Arizona for example,

women spoke to local newspapers to bring attention to the impacts of the overturning on women

in rural areas. Specifically the women mentioned how challenges in rural areas include traveling

to annual and obstetrician appointments, taking time off work for appointments, and arranging

child care services during their appointments (AZCentral, 2022). The overturning only

exacerbated these hurdles as women would be burdened with having to travel farther and thus

find a longer child care service, which would require more money. Not only does the overturning

impose negative effects of accessibility within the state, but also to neighboring states who will

receive the influx of women arriving at safe spaces to obtain reproductive healthcare. This

intensifies the public problem by either expecting other state healthcare providers to manage

more patients or expecting the hospitals located in rural areas to have larger, more equipped

maternity wards (Carey, 2022). The map below depicts how far women would have to travel in

order to reach a reproductive healthcare facility, and a lot of the same states that banned or

restricted reproductive healthcare have larger pockets of red indicating women must travel more

than 180 miles to reach one. The data comes from a 2014 study which found that 31% of women

living in rural areas had to travel at least 100 miles and a 2016 study which found that after

Texas initially implemented restrictions on abortions in 2011, the number of patients who

traveled more than 50 miles increased to 44% in 2014 from 10% in 2011 (Gerdts et al., 2016).
The connection between rural environments and access to reproductive healthcare clearly shows

the spatial inequalities of the United States.

Not only do individuals in rural areas experience challenges accessing reproductive

health care, but also those in more condensed areas looking to start IVF or in vitro fertilization.

This type of fertilization of an embryo occurs outside of the womb. Activists and politicians in

favor of the overturning of Roe v. Wade argue that life starts at conception or fertilization rather

than when the embryo is inserted into the womb. With this ideology, concerns regarding the

rights of the embryo come to light since fertilization has technically occurred. This notion does

not have a solid foundation to become law, but there are fears it could in the future under a

personhood bill (Gordon, 2022). This threatens the practices of IVF as medical practitioners

would have to alter embryo storage, discarding, and even worry about legal fines.

It is not only access to abortions that was hindered but also to contraceptives and

education. The supreme court only legalized contraceptives for everyone in 1972, a year before

the supreme court case Roe v. Wade, so there is fear that this ruling will be next on the chopping

block. Providers practicing in rural areas are less educated in obstetrics and gynecology as they

are generally primary care physicians. Therefore, these providers are less confident in

recommending different forms of contraceptives such as the pill, IUDs, and implantations in
rural areas (Batstone, 2022). As less sex education, reproductive healthcare, and maternity and

family planning are available in rural areas, the pregnancy rate is higher compared to urban and

metropolitan areas. While the pregnancy rate is higher, the average age of becoming pregnant is

slightly lower in rural areas at age 24, rather than age 28 in metropolitan cities (Galvin, 2018).

The overturning seemed to have intensified the disparities and disproportionately affected those

in rural areas as a cut back of education and access will contribute to more unwanted pregnancy

and thus unfavorable outcomes for both mother and child.

Similarly to accessibility of contraceptives and education contributing to the disparities of

access to reproductive healthcare, is the socioeconomic status of women which play into the

ability to travel, provide childcare for existing children as over 60% of the women whom are

attempting to have an abortion are already a mother (Press, 2008), and being able afford health

care for themselves. Women of lower income simply do not have access to the same resources as

wealthy women in the United States. A report from 2014 discovered that over 75% of the women

receiving abortions were considered poor or low income. About 49% of the women lived below

the federal poverty line, and 26% lived at 100-199% of the poverty line (The Hill, 2022). This

annual income is not enough to support one person, much less two. Multiple studies reveal that

children who are born into poverty are more likely to be less prepared for school, take extra years

to complete their high school diploma or GED, experience increased risks around products that

cause health implications, have a higher chance of being an adult in poverty, and even affect

brain development due to high stress and neglect from guardians (PBS Frontline, 2017). Not only

does poverty affect the children born into it, but also the parents who must suddenly provide for

a child with food, clothes, school supplies, and more.

 The matter of children being born in poverty due to lack of reproductive healthcare is

concerning to the public because children raised in poverty are also 25% more likely to be raised

in fatherless households and currently, one in four children already live in fatherless households

(Brewer, 2022). This statistic further taints the roles of fathers in children's lives and worsens the

oppressive stereotype of single mothers who are expected to be the only or primary caregiver.

Contributing to the financial worries of single mothers’ are the minimum wages in the same

states which placed bans and restrictions on reproductive rights. The federal minimum wage is

$7.25 per hour which many of the states mentioned above have adopted as their minimum wage

as well. With minimum wages ranging from $7.25 per hour- $8.25 per hour in many red

Southern and Midwest states, there is added stress of accessing reproductive healthcare.

Questions with how to afford insurance to cover appointment costs and medicines are top

concerns in both new mothers and potential mothers. Economic concerns are tied to reproductive

healthcare and should be treated as such before access further oppresses people in poverty.

While income affects how everyone lives their life, so does race. Data from 2019

revealed that the number of Black women requesting and obtaining an abortion a year was higher

than those of White, LatinX, Indigenous, and Asian women. Black women made up 38% of the

women whom received an abortion, while White people made up 33%, LatinX at 21%, and other

racial and ethnic groups made up only 7% of the total percentage of women who received an

abortion (Artiga et al., 2022). These numbers reveal to policy makers that Black women are

receiving abortions more than any other race. To ban or restrict abortions then, can be seen as

persecution on the Black community. With previous and lingering civil rights obstacles the Black

community, and specifically women unfortunately deal with, the access to reproductive

healthcare adds another burden to be beared.

 Problems with the overturning do not just affect the woman, but also the doctors and

physicians performing or providing reproductive health care. Since the federal government is no

longer regulating reproductive healthcare, states have taken matters into their own hands to

create legal penalties for doctors who perform or provide abortions. In Texas, for example, the

law forbids any abortions unless it’s a medical emergency, and if doctors were to perform an

abortion, they could face life in prison, a $100,000 civil penalty, and lose their license to practice

(Scott, 2022). Any of these penalties would result in detrimental consequences to the doctor's

life. Even the recommendation of birth control has become risky as doctors fear legal penalties

for hindering a pregnancy. Therefore, not only are the doctors at risk for trying to help women

but also the women themselves.

The original ruling of Roe v. Wade under the 14th amendment to prevent states from

depriving people of life, could become a constitutional right, but even under the most favorable

circumstances it is said to be impossible. Amending the Constitution is possibly the most

difficult goal to achieve as the last time this was done was in 1992. Since a constitutional

amendment proposal would not pass, an alternative is to acquire two thirds of the states to

request that the United States conduct an Article V convention to amend the Constitution. Even

if this were to happen, three fourths of the states would then need to endorse any amendments

proposed (Levinthal, 2022). Considering the many states above that were eager to limit

reproductive rights, this proves to be another unlikely possibility to guarantee women's rights

and therefore needs to be considered part of public policy, because it is a public problem

affecting many.

The problem is not as simple as political figures sometimes argue it to be. As outlined

above, there are many changes that resulted from the overturning, and none in the favor of bodily
autonomy. To address this public concern, policy makers will need a substantial, almost

unfathomable, amount of support from the citizens and governmental public leaders, such as the

President, state governors, and Senate members in the United States to create change.

Unfortunately in today's day and age, coming to agreements or even compromises over policy is

more and more difficult. Both parties are stubborn in their ways and this is amplified when there

is a divided government which we see today. With the House of Representatives currently

controlled by Republicans and the President of the United States being affiliated with the

democratic party, there are many questions as to how legislation, if any, will be passed regarding

the overturning.

There are no easy answers to constructing alternatives when it comes to the rights of

someone's life. Market incentives, taxes, subsidies, or privatization are far reaching, too broad,

and don’t consider people’s choices in a solution. Some approaches to begin dealing with this

public problem must be done at local and state levels as the federal government has put it in their

hands. This includes electing governors and politicians in favor of reproductive healthcare, male

or female. During the year 2023, the United States will see 12 female governors, the greatest

number since 2009 (Fitzgerald, 2022). This statistic has some potential to help women in the

United States as most incoming female governors are in favor of protecting women's rights.

Though this will not solve the problem immediately, it would be beneficial to have leaders who

understand what women endure. Women fortunately still have the right to cross state lines to

receive reproductive healthcare, but an alternative that is feasible would be state governors

providing compensation for the travel. Primary care physicians, not specifically obstetricians,

could also offer free or reduced birth control if it were not covered by insurance. The

compensation and provision of birth controls could come from the federal or state governments,
but be included in the budget for healthcare. This alternative would also cause a lesser amount of

ethical dilemmas from voters.

Some other alternatives to the complete banishment of abortions would be to back track,

and set a gestational limit as other states have done. Setting the limit at six weeks, as it is in some

states, does not allow some women enough time to even realize they have missed a period, much

less come to the conclusion they’re pregnant. A more appropriate gestational limit would be

12-20 weeks, translating to about three to five months, when women would experience clear

signs they are pregnant. Policy makers can argue that at 20 weeks gestation, the latest gestational

limit allowed, a baby is simply not viable and cannot breath on its own. Studies have reported

that babies born at 20 weeks gestation have a median survival time of 80 minutes, less than one

hour and a half (Macfarlane et al., 2003). Thus, the baby is not developed and naturally would

not be able to survive without the mother, and since the mother is an established breathing

human, she overrules the child in what she decides happens in and to her body. This would not

be taken well as policy makers on the opposing side would argue it’s “murder” and unethical and

therefore would not be likely to pass at a federal level, but some states and voters may favor

having the option to set the limit between 12-20 weeks.

Another policy alternative would be granting pregnant women extensive insurance

coverage provided by the workplace. This would make women feel more secure if they were to

become pregnant and decide to keep the child. Paid maternity leave and paid time off guaranteed

for women would allow them time at home to prepare for a child and then rest after having the

child. Single mothers especially take on all the responsibilities of buying, putting together

newborn necessities, and working all while dealing with physical ailments and financial stress

that come from pregnancy. Smaller businesses with less revenue would likely snub this initiative,
whereas larger corporations would already be providing insurance and thus only have to make

small amends to current plan coverages. Policy makers may argue this initiative would be

discriminatory against men, but so is forcing a woman, because she has a uterus, to have a child

she does not want nor have the means to take care of.

A common alternative already in use before the overturning, is two types of orally

administered pills approved by the FDA, which block progesterone and cause uterine

contractions to shed the uterine lining. The results occur within 24-48 hours after administration

and work effectively on pregnancies up to 11 weeks. This alternative to abolishing abortions

would at least give women a little more time to recognize they are pregnant, and present in a

non-invasive manner. The same pill which causes uterine cramping is also used in cases of

miscarriages when the fetus cannot naturally be expelled (Redford, 2022). Even though the pill

has been approved since 2000, states like Indiana and Texas placed bans on using the pill at

seven and ten weeks (Guttmacher In, 2022). Policy makers could start by arguing that the pill

should be accessible to all pregnant women until 11 weeks of gestation. This policy would grant

women equal opportunities across the country and be the least invasive way to access healthcare,

as the pill can be shipped and delivered via postal services. This alternative, in theory, seems to

have the most potential in passing as it wouldn’t cost much money at state or federal level and

would appease both parties. Voting citizens may also favor this policy change since the

termination is less invasive and occurs naturally within the body, so it is much safer for the

woman and shortens the gestation limit to 11 weeks, rather than 20. Considering over 50% of the

abortions that took place in 2020 were before nine weeks, this method could be used in over 50%

of the unwanted pregnancies.

 An alternative that could prevent unwanted pregnancies would be providing in depth sex

education in schools starting at the end of middle school and continuing throughout high school.

This isn’t to deter or scare kids about having sexual intercourse, but to share with them the

realities of pregnancy and the consequences of unprotected, but even safe intercourse because

things happen. The Department of Education would have to agree with the curriculum presented

in schools, but a compromise could easily come to fruition as it’s not likely instructors are in

favor of students missing class due to pregnancy. It could also be favorable to provide free

condoms in health class, campus wellness centers, and doctors offices.

Though none of the alternatives are without drawbacks, some are more favorable than

others. Since setting a federal gestational limit at 20 weeks would likely not be achievable due to

voters' ideas of when life starts, this bill would probably not make it on an institutional or

governmental agenda. The alternative of providing compensation for travel or free birth control

would be more reasonable to see from state governments, but less likely for the federal

government to consider since the national debt is only growing larger with no end in sight.

Providing more coverage to pregnant women in the workplace sounds like a wonderful idea, but

the men in government would likely not allow this to happen in any place of work, at any level,

due to fear of discrimination lawsuits. Though it is very practical and logical for women to have

more time off when they are pregnant, in terms of equal rights in the workplace, the federal

government would never go for it. Implementing this extra coverage could also create negative

stigmas around women getting pregnant if people begin to believe that women are becoming

pregnant on purpose for more time off. The most feasible, applicable, and passable policy

alternative in response to the overturning would be to provide equal access to the medication

used to terminate pregnancies before 11 weeks and equal access to education on the subject of
pregnancy. Neither of these alternatives are invasive and are actually quite safe. The drawback

comes from parents who may not want their children to learn about pregnancy in schools and

from voters who believe 11 weeks is still too late to terminate. Many of the counterarguments for

all of the suggested alternatives would likely come from the same states that placed restrictions

or bans on abortions in June.

Since the overturning of Roe v. Wade in the United States more than just women have

been affected. The overturning created a ripple effect, not only altering the way thousands of

women access reproductive health care, but the way doctors practice, the financial security felt

among women, and the frequency at which state lines are being crossed. The overturning has

created a fight for current and future generations; the fight to regain bodily autonomy for women

across the country. Many women must cope with the dismantling of reproductive healthcare

while public outcry reaches local, state, and federal levels to create change. In hopes, the change

women of the United States are looking forward to is the abolishment of systemic oppression

against bodily autonomy. In order for this to happen, the political figures will need to set aside

personal differences to have successful cooperation.

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