Consequences of Roe v. Wade being overturned are infinite, says Michigan Public Health alumna

A wooden gavel is places on a white marble surface.

Q&A with Elizabeth Mosley, PhD ’18

Assistant professor of medicine at the University of Pittsburgh School of Medicine; affiliate faculty member with Emory University; researcher at the Center for Reproductive Health Research in the Southeast

The US Supreme Court overruled Roe v. Wade on June 24, eliminating the constitutional right to abortion. The decision turned back the clock on women’s reproductive rights by nearly a half-century.

Headshot of Elizabeth MoselyElizabeth Mosley, who earned a PhD from the University of Michigan School of Public Health in Health Behavior and Health Education, specializing in Gender and Population Studies, is an assistant professor of medicine at the University of Pittsburgh School of Medicine. She also is an affiliate faculty member with Emory University in Atlanta as well as a researcher at the Center for Reproductive Health Research in the Southeast (RISE) at Emory University Rollins School of Public Health.

Mosley spoke to Michigan Public Health about the repercussions this landmark decision will have on women in the United States.

Mosley started studying sexual and reproductive health inequities when she began pursuing her Master of Public Health at the University of North Carolina in 2008. Her master’s degree focused on gender-based violence prevention, intimate partner violence, sexual violence and family violence against children while working with a state-wide steering committee to prevent sexual and domestic violence in North Carolina. Ever since then, she has studied sexual and reproductive help with the focus on health equity and racial, ethnic and economic disparities.

After graduate school, she was called to global health work. Mosley took a job with FHI 360, an international non-governmental organization, or NGO, that dealt with research on family planning and HIV in South Africa, Uganda and Kenya. That led to her joining the Global Health Corps, where she worked in Uganda for a year as a Maternal and Child Health Fellow with the Elizabeth Glaser Pediatric AIDS Foundation.

After that life-changing experience, Mosley began her pursuit of a doctoral degree at Michigan Public Health, where she was the chair of Health Behavior Health Education PhD Student Organization and was heavily involved in the Health Behavior Health Education Doctoral Curriculum and Global Health Initiative Student Advisory committees as well as Women in Health Leadership.

The following is a Q&A with Mosley, edited for brevity and clarity.

Now that the Supreme Court has overruled Roe v. Wade, abortion will become illegal in most states. What does this mean for public health?

The public health consequences of Roe v. Wade being overruled are infinite, and they can’t be understated. We need to be clear about what the risks and the costs of this will be. A new study by Diana Greene Foster and her colleagues at the University of California, San Francisco, looks at what happens when people are turned away from having an abortion. We know in the US right now, if someone gets turned away from having an abortion, the chances of them self-managing that abortion at home are higher. We also know that self-managed abortions might not be as safe, especially in restricted settings. We know that getting turned away for abortions means that those patients and their children are more likely to be living in poverty longer—so outlawing abortion will increase the percentage of people and children in poverty. We know that turning people away from abortions means they're more likely to be stuck in domestic violence situations, and so overturning Roe and outlawing abortion will increase the incidence of domestic violence, the severity of domestic violence and increase the percentage of children who are experiencing child abuse. We also know that getting turned away increases mental health symptoms such as anxiety, depression and even substance abuse. Probably the most harrowing of all is that when we outlaw abortion, maternal mortality—or pregnancy-related death—increases.

Postpartum studies from the United States and from around the world are very clear that when you outlaw abortion, pregnancy-related deaths during childbirth or within the first six weeks will increase. That’s usually through two mechanisms: The first is that pregnancy is higher risk than abortion, especially in the United States; we have more than double the number of maternal or pregnancy-related deaths compared to any other wealthy country—and in states like Michigan and Georgia, it’s even worse. And then if you divide that by race and ethnicity, we know that Black people are 3-4 times more likely to die during pregnancy than white people.

We’re talking about life or death, we’re talking about people’s ability to get out of poverty or to live above the poverty level and we’re talking about increased violence for families because we know abortion is a very important part of people navigating their way out of domestic violence. We’re also talking about mental health effects that includes suicide. People who are pregnant and don’t want to be pregnant will find a way to get out of that, and unfortunately, sometimes that is self-harm. We know that suicide is one of the leading causes of maternal death in our country.

When people can’t control their bodies, they can’t control their lives and overturning abortion means that people who can become pregnant no longer have control over their bodies and therefore won’t have control over their lives.

What is the potential impact of a domino effect about women’s rights and reproductive rights?

The Dobbs v. Jackson decision is a testing ground to see how far federal protections of all kinds of rights can be pushed back. I could see this causing a domino effect, going after things like contraception. We’re already seeing in several very conservative states the outlawing of IUDs, because an IUD, which is a contraceptive device, also can be used as emergency contraception; to be clear, emergency contraception is not an abortion. Emergency contraception helps you prevent the pregnancy after you’ve already had sex. We see these states going after IUD and emergency contraception such as Plan B. We see things like just rolling back entire protections for contraception. The Affordable Care Act made it law of the land: access to different types of birth control for free, if needed. We will definitely see that kind of protection rolled back.

But I don’t think it stops there. It’s very clear to me that going after state-level abortion rights or going after Federal protection of abortion rights is very closely related to going after federal protection for marriage equality. And we know that things like LGBTQ rights and reproductive rights are all connected and they’re part of the larger vision of reproductive justice because queer families can’t have reproductive justice unless there are also things like marriage equality. There are dominoes that are already falling for reproductive rights and reproductive justice, but, again, it’s bigger than just abortion and contraception. We were also seeing domino effects likely for civil rights, as well as LGBTQ rights.

What is it about the Dobbs v. Jackson case that brings us to where we are today?

There were immediate push-backs and restrictions enacted against abortion as soon as Roe v. Wade was passed in 1973. Many states enacted “trigger bans,” meaning that as soon as Roe v. Wade falls, their trigger-ban laws will go into effect. Most of those outlaw abortion almost under any circumstances. Abortion opponents weren’t having success outlying at the federal level, but states were able to enact everything from gestational age limits to targeted regulation of abortion providers, mandatory waiting periods and mandated counseling. Those requirements are really inaccurate and misleading and have been mounting over the last couple of decades with dozens and dozens of bills being passed by states over the last few years; examples being Georgia’s six-week limit and others like it.

The difference with Dobbs v. Jackson is, there have been many Supreme Court cases where the strength of review weight has been tested, and essentially a lot of the federal court cases have landed on states cannot regulate abortion before viability, which is around 20 to 22 weeks. Up until now, when states tried to outlaw abortion before viability, they were met with federal resistance. At this point, with the Supreme Court composed as it is of conservative justices, which has been a long strategy, they’re now poised to undo that viability rule. The Dobbs case will essentially allow the court to say, we no longer federally protect abortion before viability, and the states will now have the obligation and the power to regulate abortion as it sees fit. What this essentially does is get rid of things like Plessy v. Ferguson and Casey v. Planned Parenthood and other federal cases that have kind of regulated abortion at the national level, and says the state is now good to choose, which is very unfortunate.

If you’re someone living in a state controlled by conservative politicians who use abortion as a leverage point for votes, these states now can regulate abortion and outlaw abortion as they see fit. And since 1973, that had just not been possible.

What would you say to people who advocate for abortion rights and women’s reproductive rights?

The main thing is to stay active. Don’t let your anger dissipate and then disengage. This is a marathon. We’re in it for the long haul. Find an organization in your area that does reproductive justice work and get involved with them, become a volunteer—don’t just stop at the protest in the marches. Donate your money, figure out a way to get involved and find your lane. As public health practitioners and researchers, like myself, we have a lot of skills and a lot of power that can be put to use. An example of that is, I've been testifying at the state capital ever since the Georgia six-week ban came into our legislative assembly back in 2019. I go to every session and testify as a public health expert against these abortion restrictions, and with your MPH or your PhD, or even your BS in public health, that matters. And your voice matters. You can write letters and emails. You can call. You can testify. There are a lot of ways to get involved. And so think about it, what is your role? How can you help? And just stay committed.