Overturning Roe v. Wade: Concerns for Accessing Sexual and Reproductive Health Services, Including Safe Abortion

One-third of Respondents Believe Access to Sexual and Reproductive Health Services is Reduced Following U.S. Supreme Court Decision

A new survey from PMNCH, the world’s largest alliance for women’s, children’s, and adolescents’ health, reveals that more than one third (35%) of respondents primarily active in Africa, South Asia, and the Americas believe there may be reduced access to sexual and reproductive health and rights (SRHR) after the overturn of Roe v. Wade, the landmark ruling that legalized abortion in the United States in 1973.

A PMNCH Special Report “Overturning Roe v. Wade: Concerns for Accessing Sexual and Reproductive Health Services, Including Safe Abortion” has been produced by PMNCH in collaboration with Fòs Feminista, AMREF, and Aga Khan University to assess if and how the US decision is being felt around the world. It also aims to help partners strengthen advocacy and accountability for SRHR in this global context.

Key Findings

• One-third of respondent organizations (52 in total) believe there is less access to SRH services including abortion and post-abortion care, and family planning in their countries following the June 2022 U.S. Supreme Court decision.
• One-quarter of respondents perceive negative changes in domestic funding and international funding for SRH services including family planning, abortion care, and post-abortion care.
• More than half of respondents think that overturning Roe v. Wade has emboldened anti-abortion movements in their countries.
• More than one-third of respondents believe the overturning of Roe v. Wade is limiting opportunities among key stakeholders and decision makers to discuss and support abortion, post-abortion care, and SRHR policies, including family planning laws and policy frameworks.
• Advocates are countering these effects by supporting increased public education on the benefits of SRH services, as well as on the harmful effects of the U.S. Supreme Court ruling.

Broader Implications

The US Supreme Court’s decision on 24 June 2022 in Dobbs v. Jackson Women’s Health Organization (Dobbs) ended the federal constitutional right to abortion in the United States, previously established by the Supreme Court in 1973’s landmark ruling, Roe v. Wade. As of September 2023, abortion has been banned or heavily restricted in 22 U.S. states, with more expected to ban or restrict access to the service.

Beyond its direct impact on abortion services, respondents believe the overturning of Roe v. Wade has cast a shadow over access to a broader range of SRH services including family planning, affecting policies, service delivery, and financing.

Survey results revealed deep concern about perceived local effects of the U.S. decision in some countries.

“Most likely, abortion advocacy in the country will be impacted, especially for us at the forefront,” reported one Ugandan NGO. “We also anticipate that women will go into hiding and procure unsafe abortions rather than having the courage to go to (health) facilities.”

“Funding for abortion advocacy has been a challenge for the most part, but with the Roe v. Wade repeal, it has doubled the constraints and challenges around access to funding,” reported another organization from Sierra Leone focused on adolescents and youth.

“India has for the first time seen an anti-choice/abortion protest across the country, along with judicial appeals to ban abortion and restrict access within the Indian courts system by faith-based opposition groups,” a donor foundation based in India reported. “This has never been an issue for India but is emerging/growing into one post Roe.”

In other countries, however, the Roe v. Wade decision served as a significant wake-up call for the feminist movement, underlining the imperative of sustained abortion advocacy efforts and showing that progress is possible even within more challenging global contexts. Exemplar countries showcased in the report – including Colombia – can provide insights globally, fostering changes in SRHR policy dynamics and funding flows.

For PMNCH, the survey results confirm widely held fears of potential impact. The need for intensified advocacy is clear, especially at a time when SRH services and rights have been assaulted by the impact of COVID-19, as well as other factors, such as the expanding number of humanitarian conflicts in the world today, where women are often highly affected. The findings highlight the realities faced by some PMNCH members – in particular, the need for practical tools and mitigation strategies that partners can use to strengthen accountability for SRHR within their respective domains.

“The effects of the overturn of Roe v. Wade extend far beyond US borders,” said Rt. Hon. Helen Clark, PMNCH Board Chair and former Prime Minister of New Zealand. “As is often said, ‘When America sneezes, the world catches cold’. The PMNCH survey results show that what we most feared: that there could be a potential reduction in access to sexual and reproductive health services for women, following the overturn of Roe v. Wade. This may pose serious risk to the health and well-being of millions of women worldwide, who rely upon access to family planning and abortion services.

“The ruling also lends spurious legitimacy to those who seek to restrict the rights of women and may also encourage some countries to move towards their own regressive and restrictive abortion laws. This cannot be accepted. Now more than ever, we must invest in protecting sexual and reproductive health services, increasing public education on the value of these services, and upholding human rights.

Ahead of the UN General Assembly in New York this month, this report supports countries in making the case for SRH and rights to be prioritized and recognized with urgency within global agreements. Advocates and partners supporting health service provision must re-double their efforts to scale up access to comprehensive and accessible reproductive healthcare services to safeguard the well-being of individuals seeking the full range of SRH services, including safe abortion.

Survey Methodology and Contributors

The questions were developed by PMNCH, and responses were solicited through PMNCH networks in early 2023 via PMNCH’s newsletter, social media channels (Twitter, LinkedIn), the PMNCH membership engagement platform (Digital Advocacy Hubs), and through direct outreach to PMNCH’s constituencies. These efforts gathered 52 voluntary responses between March and July 2023 among local, regional, and global organizations involved in women’s, children’s, and adolescent’s health advocacy. Respondents’ primary country or territory of work was described as “global” (13.4%), with the highest number of survey responses received from India (15.4%) followed by Malawi, Nigeria, and the United States of America (11

SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being
• SDG 5: Gender Equality
• SDG 10: Reduced Inequalities
• SDG 16: Peace, Justice, and Strong Institutions

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs.
• SDG 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Program of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.
• SDG 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies, and practices and promoting appropriate legislation, policies, and action in this regard.
• SDG 16.6: Develop effective, accountable, and transparent institutions at all levels.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicator for SDG 3.7: Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods.
• Indicator for SDG 5.6: Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use, and reproductive health care.
• Indicator for SDG 10.3: Existence of laws, policies, or practices that discriminate against women and girls.
• Indicator for SDG 16.6: Proportion of population satisfied with their last experience of public services.

Table: SDGs, Targets, and Indicators

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Source: pmnch.who.int

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