Understanding the real impact of abortion bans, one woman at a time

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Undue Burden: Life and Death Decisions in Post-Roe America, Author: Shefali Luthra. Doubleday. 348 pp. $29

Here’s a confession: I’ve been trying to follow the story of reproductive rights since the fall of Roe in 2022, and I’ve been struggling. At the time of this writing, nearly two dozen states have passed abortion bans or placed new limits on the procedure. It’s hard to keep up, much less grasp the bigger picture. How’s our fragile system of reproductive health care faring? What’s happening with the tens of millions of people – women, transgender men and nonbinary people – who need reproductive health care in states where abortion is banned?

For those brave enough to delve into this maelstrom, first-time author and veteran journalist Shefali Luthra’s “Undue Burden: Life and Death Decisions in Post-Roe America” provides a superbly reported account of the past two years. Grounded in conversations with a diverse range of people across the United States, “Undue Burden” showcases Luthra’s expertise in covering health-care policy and abortion rights. But the politics and policies that have created what she calls a “public health crisis” are not her primary topic. “Undue Burden” focuses on the stories of those who are attempting to navigate an unraveling health-care system while pregnant. Luthra brings their voices to life, and she locates her subjects in their larger contexts – socioeconomic, political, religious, historical – thereby exposing how abortion bans disproportionately harm the most vulnerable, including women of color and undocumented women and girls.

Luthra divides her book into four parts, each named after a main character seeking an abortion. She weaves these parallel stories together through the perspectives of a wider cast: patients, doctors, nurses and advocates, as well as owners and workers at reproductive health clinics. The braided structure enables her to follow the challenges faced by those who need abortion care as well as those who provide it. Her extensive reportage reveals the multiple unintended consequences, for patients as well as providers, that occur when abortion is taken out of a state’s medical system, as well as the ways that the laws in one state affect the choices and resources available to people who live in another. She wants her reader to understand that people “get abortions for all sorts of reasons” and that each reason is “equally valid and deserving of our attention.” It’s a worthy goal, though the massive cast sometimes left me looking back to remember who was who.

“Undue Burden” begins with Tiffany, a 16-year-old high school student who lives outside Houston and discovers that she’s five weeks pregnant in early 2022. Tiffany struggles to find information and support; there is no one to help her, she has a history of severe mental illness and self-harm, and she must contend with Texas’s six-week abortion ban. Roe v. Wade was functionally overturned in Texas the prior year, when the state passed Senate Bill 8, a ban following decades of restrictions made possible by Planned Parenthood v. Casey, the 1992 Supreme Court decision that allowed states to place limits on abortion if they didn’t impose an “undue burden” on women seeking the procedure.

Luthra’s book is filled with people facing undue burdens. She charts the journeys of those who cross state lines for surgical abortions and abortion pills, often spending hours trying to find a clinic and funds to help pay for their trips. The time limits set by restrictions force decisions, as they do for Jasper, an 18-year-old transgender man who has only one week to decide whether to keep or end his pregnancy before he comes up against Florida’s 15-week ban. Others, like Darlene, a mother healing from fibroid surgery, must leave their state to receive basic medical care. Texas law prevents Darlene’s doctor from having an honest conversation about whether she can safely carry an unexpected pregnancy to term. She flies to San Francisco, where routine testing helps her decide to keep her pregnancy. But women like Tiffany, the character who starts the book, will never make it to a clinic or encounter a health-care provider who asks whether she wants to have a child.

Some of the book’s richest insights come from the doctors, nurses and clinic owners who care for patients under exceedingly challenging circumstances. Providers struggle with the task of scheduling abortions in states where legal uncertainty looms. Meanwhile, in states where abortion remains legal, clinics see dramatic increases in out-of-state patients, restricting their ability to care for in-state residents. After Dobbs, the ruling that struck down Roe, the staff members at an Illinois clinic began working 10-to-12-hour days, six days a week, even though they knew that “it was never going to be enough.” While “Undue Burden” is by no means an uplifting book, the deep commitment and care expressed by these providers left me with hope.

“Undue Burden” paints a distressing picture. The stakes could not be higher, Luthra writes: The coming years are “pivotal” not just for abortion rights but also for “shaping our understanding of gender equality in America.” Throughout, Luthra strives to present abortion as an essential medical procedure – and to show that the current situation is a “serious health crisis worthy of our collective attention.” Is there any chance in this divided moment that Americans might come to collectively share that understanding with her? It’s clear that any possible alternative future starts with confronting and understanding what’s happening now. “Undue Burden” may not offer comfort, but it does provide a preview of a nationwide catastrophe that we still have the opportunity, one can hope, to prevent.

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Heather Hewett is an associate professor of women’s, gender and sexuality studies and an affiliate of the department of English at the State University of New York at New Paltz.

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