Dec. 10, 2021 -- In a highly anticipated decision, the U.S. Supreme Court ruled today that the controversial Texas abortion law that restricts the procedure to women pregnant for 6 weeks or less may continue to be enforced, but allowed for state and federal courts to hear challenges to whether it violates the Constitution.
As anti-abortion organizations celebrate and abortion rights groups confer on what the decision could mean for women not only in Texas but across the U.S., there is another, bigger implication as well.
The Texas law generated a lot of controversy, in part, because it took an unusual approach. In authorizing essentially anyone across the nation to file a lawsuit against a woman in the lone star state who seeks the procedure outside the law, or anyone who assists her -- including healthcare professionals, it opens up the potential for similar legal challenges to other Supreme Court rulings on marriage, guns and other rights.
The court refused efforts on behalf of abortion providers and the federal government to overturn the law, but said lower courts should determine the law’s ultimate fate.
The ruling allows abortion rights supporters to sue in state court, where a Texas judge on Thursday ruled the law unconstitutional. He stopped short, however, of issuing an injunction against. Abortion rights opponents have vowed to appeal District Judge David Peeples’ ruling.
A Timeline on the Case
The law took effect on Sept. 1, 2021. The day before, the Supreme Court did not act to put a hold on the law as requested by abortion rights organizations. As a result, many Texas women seeking the procedure after 6 weeks traveled to nearby states. On Oct. 25, the Court agreed to hear a challenge to the law by the Biden Administration.
Today's Supreme Court decision to uphold the Texas law contrasts with a general consensus among many legal observers that the justices were receptive to blocking the law, based on questions and issues the judges raised during oral arguments on Nov. 1, 2021.
A separate legal challenge to abortion rights involves a Mississippi law banning the procedure starting at 15 weeks of pregnancy. The Supreme Court justices scheduled oral arguments in that case for Dec. 1, and are expected to issue a ruling in that case in June 2022.
Abortion Numbers Continue to Decline
The number and rate of abortions increased after the Roe v. Wade decision in 1973, stayed relatively stable through the 1980s and then started declining. "This decline has been happening for a long time," Amanda Jean Stevenson, PhD, an assistant professor in sociology at the University of Colorado Boulder said during a recent media briefing sponsored by SciLine and the American Association for the Advancement of Science.
"One important thing is that these declines are probably not driven by abortion restrictions through 2017," she added.
Improvements in contraception options is one reason scholars believe the rate has been declining, Stevenson said. Also, rates have decreased the most among teenagers, reflecting an overall decrease in teenage pregnancies at the same time.
"There are a lot of myths about abortion and that's why we're here today," said Sarah Ward Prager, MD, professor of obstetrics and gynecology at the University of Washington in Seattle. For example, "the majority of people consider abortion to be pretty unsafe."
However, she emphasized, "There are no long-term health risks from abortion. It is not associated with the future risk of infertility or ectopic pregnancy, spontaneous abortion, birth defects or preterm delivery." Claims that link abortion to a higher risk for breast cancer, depression, anxiety or suicidality are untrue, Prager said.
Long-term mental health risks are no greater than for women carrying a pregnancy to term, she said.
A reporter asked about opponents claiming that science shows detrimental effects of the abortion, such as post-traumatic stress disorder or fetal pain.
"There are no scientific data that say that abortion causes PTSD," Diana Greene Foster, PhD, director of research for advancing new standards and reproductive health at the University of California at San Francisco. "You can claim that if you're politically motivated and don't care about the science."
"And, likewise, people who are knowledgeable about fetal brain development dispute the concept that of fetal pain happening before 24 weeks," Greene Foster added.
Another area of confusion is the difference between "the morning-after pill" and the medication abortion pill. The morning after pill is considered emergency contraception. "It is a medication designed to prevent ovulation and therefore to prevent a pregnancy from occurring," Greene Foster said.
In contrast, medication abortion – the combination of mifepristone and misoprostol, also known as "the abortion pill" – is designed to interrupt an existing pregnancy up to 10 weeks.
Carrying to Term and Maternal Risks
"Often what people think about abortion is not the true picture," Prager said. "Access to safe and legal abortion decreases maternal mortality."
The risk of mortality from abortion is 0.7 per 100,000 as compared to a risk of death from childbirth of 9 per 100,000 and risk of dying from a tonsillectomy is 3 to 6 per 100,000.
"Furthermore, we know that people who are disproportionately impacted by restrictions are also those who are facing higher rates of maternal mortality," Prager added. "That risk is higher for some populations. It is higher for black women in this country and American Indian and Alaska natives."