Undue Burden — the reality for women in post-Roe America

When the conservative majority on the US Supreme Court voided the constitutional guarantee of abortion rights in 2022, activists warned that American women were being plunged back into a world where their health and bodily autonomy would be at risk daily.

Within a year, 21 states had taken up the implicit invitation in the Dobbs vs Jackson Women’s Health decision to ban or significantly restrict access to the procedure, despite opinion polls showing broad majorities still favoured keeping the option available. Reproductive rights rose to the top of many voters’ agendas, helping to drive a series of unexpected Democratic victories at the polls in 2022 and 2023. The issue is likely to play an important role in determining the outcome of this November’s presidential election.

But, in the meantime, life has changed dramatically for millions of women who have found themselves carrying an unexpected pregnancy, a malformed foetus or a much-wanted baby that endangers their health. Undue Burden by Shefali Luthra delves into their stories and those of the doctors, nurses and activists who are striving to help them.

This is a harrowing book that sympathetically tracks individual women as they struggle through the decision to have an abortion and then come to grips with the reality that the Supreme Court has substantially foreclosed their options. Crossing the country, Luthra documents the human consequences of the 6-3 vote to scrap Roe vs Wade, the 1973 ruling that had previously guaranteed abortion rights. “The end of Roe is the first time we have seen a major civil rights protection taken away, but it is likely not the last,” she warns, with LGBT+ rights set to be next.

In the book, Angela, aged 21, was already struggling to care for her young son when she discovered that she was eight weeks pregnant. It was too late to do anything about it in Texas, where the state had pre-empted the Dobbs decision with a law that not only banned abortion after six weeks but also allowed private citizens to sue to enforce it. She started calling around to states where the procedure was still legal, desperately seeking an appointment.

Eventually, she and her boyfriend gathered all their savings, lied to her relatives and drove 11 hours to a New Mexico clinic where she was prescribed the two-part abortion pill. They shelled out more cash for extra nights in an Airbnb because she feared the legal repercussions of getting caught taking the second pill in Texas. She also skipped the recommended follow-up appointment after four weeks because they could not afford a second trek. “I just felt like my human right was taken away,” she told Luthra.

In Missouri, another anti-abortion state, Erika’s much-wanted pregnancy went horribly wrong at the 20-week scan, when damage was discovered to the baby’s internal organs. Her doctor, calling on a personal phone so that they could speak more freely, advised her that she could wait for the baby to die in utero, schedule high-risk foetal surgery that would address only some problem, or go to a state that allowed late-term abortion. She got on a plane to Washington, DC, where she was given an injection to stop the baby’s heart. She was home by the time she went into labour and did not dare tell the full story at the hospital, saying only, “We can’t find his heartbeat.”

Undue Burden also documents the impact of Dobbs on America’s network of abortion providers, such as Andrea Gallegos, whose family had been operating clinics since Roe made it legal. When Texas’s law put her San Antonio clinic out of business, she rushed to expand a sister operation in Oklahoma to serve women who came streaming across the border, only to have a new statute force her to up stakes and reopen in New Mexico.

Luthra, a Washington-based reporter who has covered health policy for a decade, also reveals how the poisonous fight to ban abortion in conservative parts of the US has infected broader reproductive healthcare nationwide. Clinics that once offered a full range of services were overwhelmed with out-of-state abortion patients who required additional intervention because their pregnancies were further along. Local women had to wait longer for their appointments and go elsewhere for birth control and other services.

Packed with recent on-the-ground reporting, the book weaves in the legal history of abortion rights and some politics, but can offer very little hope for the future. Doctors and political activists are fighting on, trying to maintain access and eventually restore legal protections through the ballot box. Yet, Luthra concludes, no one expects that to happen anytime soon.

“In this new world order, gender has become even more of a dividing line in American society, one that has amplified existing inequalities and created new ones,” she writes. “It shapes . . . people’s right to decide how and on what terms they wish to live.”

Undue Burden: Life and Death Decisions in Post-Roe America by Shefali Luthra Doubleday $29, 368 pages 

Brooke Masters is the FT’s US financial editor

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