SR 09-14-2021 13G 13.G
September 14, 2021
Council Meeting: September 14, 2021 Santa Monica, California
1 of 1
CITY CLERK’S OFFICE - MEMORANDUM
To: Mayor and City Council
From: Denise Anderson-Warren, City Clerk, Records & Elections Services
Department
Date: September 14, 2021
13.G Request of Mayor Himmelrich and Councilmember Davis that Council
direct staff to take necessary steps to have the City join in the amicus brief
to be filed by the City of Columbus, Ohio, and joined by a large number of
local governments across the country (draft brief attached), to support the
plaintiffs in their challenge to Mississippi’s 15-week abortion ban, in Dobbs
v. Jackson Women’s Health Organization, United States Supreme Court,
Case No. 19-1392.
13.G
Packet Pg. 295
STATEMENT OF INTEREST
Amici are cities and counties from across the
country.1 Some Amici are in states with laws that
significantly restrict abortion access, while others are
in states with broader access.2 Some Amici deliver
health care services directly (including by performing
abortions in city or county facilities; others focus on
public health efforts. We file this brief to highlight the
shared interest of local governments in protecting the
health, safety, and general welfare of all our
constituents, which includes a particular focus on
eradicating racism and mitigating economic
inequality and their significant effects on health care
delivery and health outcomes. We all rely on the
existing viability standard guaranteeing a woman’s
right to an abortion under the Constitution.
Cities and counties stand on the frontlines of our
nation’s struggles with racial and income inequality.
Local governments provide essential services and
programs that are the building blocks of our
communities. We educate our children, care for our
sick, and protect the safety of our neighborhoods.
Throughout our nation’s history, some local
1 All parties have consented to the filing of this brief. No counsel
for a party authored this brief in whole or in part, and no party
or counsel for a party made a monetary contribution intended to
fund its preparation or submission. No person other than Amici
or Amici’s counsel made a monetary contribution to the
preparation or submission of this brief. A list of all Amici is
available at Appendix A.
2 Abortion access has been effectively eliminated for most women
in Texas, and several states have laws in place intended to
implement full or partial abortion bans should this Court
invalidate controlling precedent. See Part III, infra.
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governments have intentionally contributed to racial
discrimination, disparities in opportunity, and
systematic oppression. This history of action (and
inaction) has resulted in deep and extensive multi-
generational harm to people of color and other
historically underrepresented, marginalized, and
disenfranchised groups.
Despite having one of the best health care and
public health systems in the world, our country still
sees extensive differences when it comes to the
morbidity and mortality of patients based on race,
means, and social status. These factors impact
outcomes for all forms of care, including and especially
reproductive health. Women of color and their
children see relatively worse outcomes, including
mortality in childbirth.
In an effort to close this racial health gap, many
local governments have taken more intentional steps
to combat these endemic challenges, including by
naming racism itself as a public health crisis.3 Many
local governments have implemented programs
specifically focused on Black women, whose
experience of structural racism puts them at higher
risk for worse health outcomes, by providing, among
other things, prenatal and postnatal care. Amici know
from experience that their work requires purposeful
planning and strident efforts to make even small
3 At least 106 city councils, 78 county boards, and 16 mayors have
passed resolutions or declarations stating that racism is a public
health crisis. Cliff Despres, Update: 231 Cities, Counties,
Leaders Declare Racism a Public Health Crisis!, Salud America!
(Dec. 7, 2020) (last updated Aug. 6, 2021), https://salud-
america.org/rising-number-of-cities-counties-are-declaring-
racism-a-public-health-crisis/.
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differences. The arguments advanced by Petitioners in
this case threaten that crucial work and must be
viewed in that light. We write to ensure that the Court
accounts for all reliance interests when evaluating the
stare decisis factors, which clearly dictate affirmance
in this case.
SUMMARY OF ARGUMENT
For nearly 50 years, this Court’s precedent has
established a baseline guarantee of abortion access for
women nationally. The preservation of this right has
been crucially important to the economic well-being
and health of millions of women, their families and
their communities. The right to an abortion is likewise
essential to the legal equality of women in our nation.
The viability standard that this Court has maintained
from the time women of childbearing age were born
promotes equity by allowing sufficient time into
pregnancy for women to make choices and access care.
If this Court were to allow Mississippi’s pre-viability
ban to take effect, it would significantly curtail the
scope of the right and enable additional racial
discrimination and further health disparities.
Amici, as local governments, are at the forefront of
the fight to eliminate the racial and socioeconomic
health disparities that plague people of color and
lower-income people in our communities.
Reproductive health, an area where racial and
socioeconomic health disparities prove most stark,
encompasses a large part of Amici’s focus. A decision
upholding Mississippi’s pre-viability abortion ban,
Miss. Code Ann. § 41-41-191 (the “Mississippi Ban”),
would significantly set back Amici’s hard work to
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eradicate health disparities and promote well-being in
our communities.
The Mississippi Ban would exacerbate already
acute health disparities experienced by women of color
and low-income women. It would disproportionately
cause these women to lose access to abortions because
they, as a group, have abortions later than White and
higher-income women. And a decision upholding the
ban would create legal chaos not only in Mississippi,
but nationwide, because it could trigger similarly
restrictive, if not more restrictive, abortion bans in at
least 21 states. Our nation’s experience prior to Roe v.
Wade, 410 U.S. 113 (1973), as well as evidence from
the impact of other abortion restrictions, makes it
abundantly clear that women with means would
continue to have access to abortion while other women
(typically women of color and lower-income women)
would lose that access, thus disproportionately
experiencing negative health outcomes and economic
vulnerabilities. Such an outcome would work at cross-
purposes to crucial efforts undertaken by local
governments nationwide to combat endemic
disparities in our public health system.
ARGUMENT
I. Eradicating Racial and Economic Health
Disparities Is a Core Priority for Local
Governments.
Local governments are deeply committed to
addressing health disparities—inequities between
groups with respect to health (e.g., disease incidence),
health care (e.g., access to physicians), and health
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outcomes (e.g., mortality).4 Health disparities in
America are well documented and well recognized.5
As the National Institute on Minority Health and
Health Disparities (“NIMHHD”) observed, “[w]hile the
diversity of the American population is one of the
nation’s greatest assets, one of its greatest challenges
is reducing the profound disparity in health status of
its racial and ethnic minority, rural, low-income, and
other underserved populations.”6
Health disparities are particularly pronounced in
reproductive health. We will explain in this Section
how Amici have undertaken extensive programming,
especially in recent years, to address these disparities.
Then, we will explain in Section II how restrictive
abortion laws, such as Mississippi’s 15-week ban,
undermine efforts by Amici to overcome the impacts of
4 See Health Disparities Overview, Nat’l Conference of State
Legislatures (May 10, 2021), https://www.ncsl.org/research
/health/health-disparities-overview.aspx.
5 Zinzi D. Bailey et al., Structural Racism and Health Inequities
in the USA: Evidence and Interventions, Am: Equity & Equality
in Health (2017), available at https://med.emory.edu/
departments/human-genetics/dei/documents_images/documents/
lancet_2017_structural-racism-and-health-inequities.pdf
(“Racial and ethnic inequalities, including health inequities, are
well documented in the USA”); Wayne J. Riley, Health
Disparities: Gaps in Access, Quality and Affordability of Medical
Care, Trans. Am. Clinical & Climatological Assn (2012), available
at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540621/ (“As
a complex and multi-factorial construct, differential access to
medical care, treatment modalities, and disparate outcomes
among various racial and ethnic groups has been validated in
numerous studies.”).
6 Overview, Nat’l Inst. on Minority Health & Health Disparities,
https://www.nimhd.nih.gov/about/overview/ (last accessed Aug.
2, 2021).
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structural and interpersonal racism in the delivery
and outcomes of care.
A. Racial and Socioeconomic Disparities Are
Especially Pronounced in the Area of
Reproductive Health.
When addressing issues of reproductive health,
this Court must confront the reality that race is among
the strongest predictors of outcomes.7 These
disparities are “persistent and difficult to address.”8
Similarly, and often relatedly, differences in
socioeconomic status—whether related to income,
education, or occupation—“persist[] across the life
cycle and across measures of health.”9 Simply put:
7 Baciu et al. ed., The State of Health Disparities in the United
States, Communities in Action: Pathways to Health Equity
(2017), available at https://www.ncbi.nlm.nih.gov/books
/NBK425844/ (“Racial and ethnic disparities are arguably the
most obstinate inequities in health over time, despite the many
strides that have been made to improve health in the United
States.”); Cristina Novoa & Jamila Taylor, Exploring African
Americans’ High Maternal and Infant Death Rates, Ctr. Am.
Progress (Feb. 1, 2018), https://www.americanprogress.org
/issues/early-childhood/reports/2018/02/01/445576/exploring-
african-americans-high-maternal-infant-death-rates/
(“Numerous studies show that after controlling for education and
socioeconomic status, African American women remain at higher
risk for maternal and infant mortality.”).
8 Baciu et al., supra, at
https://www.ncbi.nlm.nih.gov/books/NBK425845/.
9 Kevin Fiscella & David R. Williams, Health Disparities Based
on Socioeconomic Inequities: Implications for Urban Health
Care, Academic Medicine at 1139 (Dec. 2004), available at
https://scholar.harvard.edu/files/davidrwilliams/files/2004-
health_disparities_based-williams.pdf.
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“Those with higher incomes are more likely to live
longer, healthier lives.”10
The COVID-19 pandemic exemplifies the
health inequities suffered by diverse populations,
inequities that local governments strive to address.
The risk of being exposed to the COVID-19 virus and
the risk of becoming seriously ill or dying from
COVID-19 are higher among racial minorities than
among non-Hispanic White people. In Santa Clara
County, California, for example, although Latino
residents are only 25.8% of the population, they
account for 49.4% of COVID-19 cases.11 In the District
of Columbia, Black residents account for 71% of
coronavirus-related deaths despite representing only
37% of the population.12 Local governments recognize
10 Santa Clara County Public Health, Health and Social Inequity
in Santa Clara County, Santa Clara County at 7 (Jan. 2011),
available at https://publichealth.sccgov.org/sites/g/files/
exjcpb916/files/ship-exec-summary.pdf.
11 https://covid19.sccgov.org/dashboard-demographics-of-cases-
and-deaths.
12 https://www.kff.org/other/state-indicator/covid-19-deaths-by-
race-
ethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:
%22Location%22,%22sort%22:%22asc%22%7D. The higher
risks are a result of many factors, including that people from
racial minority groups (i) are more likely to work in essential
front-line settings, (ii) have less flexibility to work from home,
take time off or leave jobs that expose them to the COVID-19
virus, (iii) face barriers to accessing health care, including lack of
insurance, transportation and child care, (iv) live in more
crowded conditions, making separation difficult even when a
member of the household is sick, (v) are more likely to ride public
transportation, (vi) suffer from higher rates of obesity, high blood
pressure and other conditions that increase the risk of severe
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and struggle with these disparities when they take
steps to combat COVID-19. As one researcher
explained, “[p]ublic policies have the power to enhance
health and also exacerbate health disparities. Health
interventions that are adapted for local contexts and
community characteristics are more effective than
standard approaches.”13 The same holds true for
health disparities and interventions related to
reproductive care, including abortion.
Racial and economic health disparities are
particularly acute in the context of reproductive
health care, which includes, inter alia, prenatal and
postnatal care, contraceptive use and access, family
planning, treatment and testing for sexually
transmitted infections, and access to obstetrics and
gynecological services, including abortion.14 Yet, “in
almost every aspect of reproductive health, women of
color have poorer health outcomes than white
women.”15 Socioeconomic status also correlates to
illness from COVID-19, and (vii) have less access to coronavirus
testing.
13 Monica Webb Hooper et al., COVID-19 and Racial/Ethnic
Disparities, JAMA Network (May 11, 2020).
14 Reproductive Health, Centers for Disease Control &
Prevention (last updated Aug. 11, 2021), available at
https://www.cdc.gov/reproductivehealth/index.html; see also
Reproductive Health Strategy, World Health Organization at 21
(2004), available at https://apps.who.int/iris/bitstream/
handle/10665/68754/WHO_RHR_04.8.pdf.
15 Jamila Taylor, Women of Color Will Lose the Most if Roe v.
Wade Is Overturned, Ctr. Am. Progress (Aug. 23, 2019),
https://www.americanprogress.org/issues/women/news/2018/08/
23/455025/women-color-will-lose-roe-v-wade-overturned/
(emphasis added).
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reproductive health: “[a] mother’s low socioeconomic
status is associated with multiple risk factors for
adverse birth outcomes.”16 For example:
Contraceptives. “Cost is a known barrier to
contraceptive access and use for some women,”
particularly with respect to long-acting and the
most easily maintainable contraceptive devices.17
Fewer Black women use contraceptives than White
women.18
Preterm Births. Births before 37 weeks of gestation
are the leading cause of death in infants.19 In the
United States, low socioeconomic status is a risk
16 Fiscella & Williams, supra, at 10.
17 Madeline Y. Sutton, et al., Racial and Ethnic Disparities in
Reproductive Health Services and Outcomes, J. Obstetrics &
Gynecology (2021), available at https://journals.lww.com/
greenjournal/Fulltext/2021/02000/Racial_and_Ethnic_Disparitie
s_in_Reproductive.5.aspx.
18 Sutton, supra (”Awareness of historical and modern-day racial
injustices often contribute to the lower rate of contraceptive use
among Black and Hispanic women; there is a distrust by some
patients that has yet to be acknowledged by many clinicians.”).
19 UNC Dep’t of Obstetrics & Gynecology, Study Confirms
Socioeconomic Factors May Not Be the Only Cause of Higher
Preterm Birth Rates for Black Women and Women of Mixed
Black and White Race, UNC. Sch. Med. (Feb. 9, 2020), available
at https://www.med.unc.edu/obgyn/study-confirms-
socioeconomic-factors-may-not-be-the-only-cause-of-higher-
preterm-birth-rates-for-black-women-and-women-of-mixed-
black-and-white-race/; see also Premature Births in Mississippi,
Mississippi St. Dep’t of Health (May 24, 2021), available at
https://msdh.ms.gov/msdhsite/_static/44,0,381,658.html
(“Premature births are a major public health challenge in
Mississippi.”).
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factor for preterm birth.20 According to data
collected by King County, Washington, women
living in high-poverty areas have 33% more
preterm births than women in low-poverty areas.
Nationwide, Black women are twice as likely to
have preterm births than are White women.21
Similarly, from 2017-2019, Miami-Dade County,
Florida recorded a preterm birth rate of 7.2% for
White women and 14.1% for Black women.22
Prenatal Care. Women who do not receive proper
prenatal care are at higher risk for adverse
pregnancy outcomes.23 Nationwide, Black and
Hispanic women are less likely than White women
to receive prenatal care during their first
trimester.24 In King County, Washington, 8.3% of
20 Preterm Labor and Premature Birth: Are You at Risk?, March
of Dimes (Mar. 2018),
https://www.marchofdimes.org/complications/preterm-labor-
and-premature-birth-are-you-at-risk.aspx.
21 Tracy A. Manuck, Racial and ethnic differences in preterm
birth: A complex, multifactorial problem, Seminars in
Perinatology (Dec. 2017), available at
https://www.sciencedirect.com/science/article/abs/pii/S01460005
17300988?via%3Dihub.
22 Peristats, March of Dimes (last accessed Sept. 9, 2021),
https://www.marchofdimes.org/peristats/ViewSubtopic.aspx?reg
=12086&top=3&stop=63&lev=1&slev=6&obj=1.
23 Cristina Novoa, Ensuring Healthy Births Through Prenatal
Support, Center for American Progress (Jan. 31, 2020),
https://www.americanprogress.org/issues/early-
childhood/reports/2020/01/31/479930/ensuring-healthy-births-
prenatal-support/.
24 Births: Final data for 2010. Natl Vital Stat Rep 60:2. (Mar.
2009), https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-
508.pdf
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Black women and 6.0% of Hispanic women do not
receive adequate prenatal care, compared to only
3.5% of White women.
Infant Mortality. Nationwide, Black mothers
experience twice the infant mortality rate (11.11
infant deaths per 1,000 live births)25 as the
national average (5.8).26 Similarly, “[f]etal deaths
are 2 times more likely among Pittsburgh’s Black
women compared to White women.”27 In some
areas, the disparity is even greater: in Ramsey
County, Minnesota, for example, Black babies have
an infant mortality rate of 12.4, as compared to 4.4
for White babies.28 The infant mortality disparity
also holds true based on socioeconomic status.29
Maternal Mortality. Nationally, “Black women are
dying at three to four times the rate of white
25 Baciu et al., supra.
26 Sofia Carratala & Connor Maxwell, Health Disparities by Race
and Ethnicity, Ctr. Am. Progress (May 7, 2020),
https://www.americanprogress.org/issues/race/reports/2020/05/0
7/484742/health-disparities-race-ethnicity/.
27 Junia Howell et al., Pittsburgh’s Inequality Across Gender and
Race, City of Pittsburgh’s Gender Equality Commission at 14
(2019), available at https://www.socialwork.pitt.edu/sites/
default/files/pittsburghs_inequality_across_gender_and_race_07
_19_20_compressed.pdf.
28 Health Equity Data Analysis Final Report, Saint Paul-Ramsey
County Public Health at 9 (2017), available at
https://www.ramseycounty.us/sites/default/files/Departments/Pu
blic%20Health/HEDA_10.12.17.pdf; Fiscella & Williams, supra,
at 1140.
29 Fiscella & Williams, supra, at 1140.
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women due to pregnancy-related issues,”30 a
disparity that has been directly linked to racism-
based delays in care.31 Additionally, between 2003
and 2007, women from counties with high poverty
rates were found to be 120% more likely to suffer
maternal mortality than were women in low-
poverty counties.32
These disparities demonstrate that reproductive
healthcare cannot be divorced from questions of race
and socioeconomic status; decisions regarding
reproductive care must be made with an
understanding and acceptance of how those decisions
will affect groups already struggling to find
reproductive health equity.
B. Local Governments Have Made Extensive
Commitments to Address Health
Disparities
Local governments recognize the crucial role they
play in eliminating racial and economic health
disparities.33 Local health departments “are at the
30 Sutton, supra; Taylor, supra.
31 Sutton, supra (“When individual recent cases were reviewed,
clinician-level biases and racism often contributed to delayed or
absent care that led to deaths.”).
32 Gopal K. Singh, Maternal Mortality in the United States,
1935-2007, Dept. Health & Human Servs. at 3 (2010), available
at
https://www.hrsa.gov/sites/default/files/ourstories/mchb75th/mc
hb75maternalmortality.pdf.
33 The National Association of County and City Health Officials
recognizes over 2,800 local health departments that are often the
only entities providing key health services. Nat’l Ass’n Cty. &
City Health Officials, 2019 National Profile of Local Health
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vanguard in the fight to eliminate disparities in the
population, and they are strategically positioned to
address this issue as they represent the frontline of
public health.”34 Because localities have intimate
knowledge of their communities, and routinely
partner with trusted community-based organizations,
“they are in a better position than other types of health
agencies to eliminate disparities specific to their
jurisdictions” and populations by structuring more
tailored programs.35 These collaborative partnerships
and outreach efforts have included particular focus on
reproductive health. For example, Columbus Public
Health runs a Women’s Health and Wellness Center,
which provides confidential reproductive health care,
annual exams, and contraceptive services.36
In order to address disparities in reproductive
health, localities have implemented programs focused
on low-income women and women of color. Clark
Departments 21 (2019), https://www.naccho.org/uploads/
downloadable-resources/Programs/Public-Health-Infrastructure/
NACCHO_2019_Profile_final.pdf.
34 Gulzar H. Shah & John P. Sheahan, Local Health
Departments’ Activities to Address Health Disparities and
Inequities: Are We Moving in the Right Direction?, Int’l J. Envtl.
Res. Pub. Health (2016), available at
https://www.mdpi.com/1660-4601/13/1/44/htm#B30-ijerph-13-
00044 (local health departments serve their populations “by
working with strategic partners in reducing the inequities
leading to disparities or assuring access to health care or by
directly providing primary care on a limited scale, particularly to
underserved and disenfranchised population subgroups.”).
35 Gulzar & Sheahan, supra.
36 Columbus Public Health, City of Columbus (June 2019),
available at https://www.columbus.gov/publichealth/About-
Columbus-Public-Health/.
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County, Nevada, for example, has developed an action
plan to increase community engagement in
reproductive services, focusing in part on increasing
access for low-income and underinsured residents.37
Los Angeles County recently enacted the African
American Infant and Maternal Mortality Prevention
Initiative, which provides a wide range of services that
work to reduce mortality rates among Black women
and their babies by addressing the perinatal health
impacts of racism and discrimination.38
Localities engage in health-related conversations
with their communities by partnering with
community organizations39 and seeking community
input.40 The City of Cincinnati, for example, partners
with multiple organizations to engage with the
community and provide care, including reproductive
37 Community Engagement in Reproductive Health Services:
Clark County, Nevada Community Action Plan at 13-15 (Dec.
2019), available at
https://dpbh.nv.gov/uploadedFiles/dpbhnvgov/content/Programs/
Community%20Action%20Plan%20%20%202%204%202020%20
(002).pdf.
38 Los Angeles County Department of Public Health, The Los
Angeles County African American Infant and Maternal Mortality
(AAIMM) Initiative, https://www.blackinfantsandfamilies.org
/about.
39 Baciu et al., supra, at https://www.ncbi.nlm.nih.gov/
books/NBK425845/ (“The health care system has an important
role to play in addressing the social determinants of health. At
the community level, it can partner with community-based
organizations and explore locally based interventions . . . .”).
40 Sarah Newman et al., 2015 Local Board of Health National
Profile, Nat’l Assn. Cnty. & City Health Officials (2016), available
at https://www.naccho.org/uploads/downloadable-resources/
Local-Board-of-Health-Profile.pdf.
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health care. Many of these community partnerships
focus on outreach to marginalized communities. King
County, Washington, for example, specifically
provides outreach to marginalized and underserved
populations that are disproportionately affected by
maternal and infant mortality, unintended and teen
pregnancy, STDs, and COVID-19. Similarly, San
Mateo County operates a Black Infant Health
program that partners with OB/GYN healthcare
partners and community organizations to reach Black
women and provide healthcare in a trusted way.
These and other community partnerships are
pivotal elements in creating sustained structural
interventions that can eliminate or reduce health
disparities.41 Community partnerships are also
significant generators of trust.42 Whether addressing
the effects of COVID-19 or confronting endemic
disparities in reproductive health, interventions that
are adapted for local contexts and community
characteristics are more effective than standardized
approaches.43
41 Arleen F. Brown et al., Structural Interventions to Reduce and
Eliminate Health Disparities, Am. J. Public Health at S73 (Jan.
30, 2019), available at https://ajph.aphapublications.org/
doi/pdf/10.2105/AJPH.2018.304844.
42 Irene Dankwa-Mullan et al., The Science of Eliminating Health
Disparities: Summary and Analysis of the NIH Summit
Recommendations, Am. J. Public Health (Sept. 20, 2011),
available at https://ajph.aphapublications.org/doi/full/10.2105/
AJPH.2010.191619 (“Community members bring an essential
understanding, expertise, and trust to the realm of research.”).
43 Monica Webb Hooper et al., COVID-19 and Racial/Ethnic
Disparities, JAMA Network (May 11, 2020).
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II. Abortion Bans Significantly Worsen Existing
Disparities in Health Outcomes
Women of color and women with less financial
means will be disproportionately affected if this Court
allows Mississippi’s 15-week ban and other similar
bans to go into effect. Denial of access to abortion in
and of itself causes health and economic consequences,
which further heightens already pervasive disparities.
Any infringement of the right to abortion, a right on
which Amici have relied for all segments of their
populations, negatively impacts Amici’s continued
efforts to combat health disparities.
A. Pre-Viability Abortion Bans
Disproportionately Affect Pregnant
Women of Color and Low-Income
Pregnant Women.
If the Mississippi Ban – or indeed, any pre-viability
gestational ban – goes into effect, women of color and
lower-income women would disproportionately lose
access to abortion services because these groups are
more likely to have abortions later than White and
higher socioeconomic status women. On average,
Black women have abortions significantly later than
White women.44 And lower-income women are more
44 Alexa L. Solazzo, Different and Not Equal: The Uneven
Association of Race, Poverty, and Abortion Laws on Abortion
Timing, Social Problems, (2019); Rachel K. Jones and Lawrence
B. Finer, Who Has Second-Trimester Abortions in the United
States?, Contraception, (June 2012) (“Black women were more
likely than white women to be obtaining a second-trimester
abortion by a factor of 1.50.”); Ted Joyce and Robert Kaestner,
The Impact of Mississippi’s Mandatory Delay Law on the Timing
of Abortion, Perspectives on Sexual and Reproductive Health,
(Jan./Feb. 2001), available at https://www.guttmacher.org/
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likely to have abortions later than women above 200%
of the federal poverty level.45 The results of these
studies and analyses are confirmed by Amici’s
experience. For example, two-thirds of the King
County’s marginalized and underserved populations
who are disproportionately affected by maternal and
infant mortality, unintended and teen pregnancy,
STDs and HIV, cervical cancer, and COVID-19 are
from communities of color, and members of these
communities are also more likely to access abortion
services later in their pregnancy.
Delay in accessing abortion typically results from
issues related to scheduling, cost, and distance.
Women most commonly cite the time needed to make
arrangements as the reason for delay, and more low-
income women cite this need relative to women above
200% of the federal poverty level.46 Relatedly, the most
common obstacle women cite as delaying their ability
to obtain an earlier abortion is the need to raise money
to pay for the abortion.47 Because Black and Hispanic
journals/psrh/2001/01/impact-mississippis-mandatory-delay-
law-timing-abortion (study finding that in Mississippi, nonwhite
women are more likely to delay getting an abortion than white
women.).
45 Eleanor A. Drey, et al., Risk Factors Associated With Presenting
for Abortion in the Second Trimester, Obstetrics & Gynecology,
(Jan. 2006) (study finding that trouble with Medi-Cal was
associated with a four-fold increased risk of second-trimester
abortion); Lawrence B. Finer, et al., Timing of Steps and Reasons
for Delays in Obtaining Abortions in the United States,
Contraception (Oct. 2006); Solazzo, supra (“[P]oorer women are
more likely to delay having an abortion than wealthier women.”).
46 Finer, supra.
47 Id.; Jessica W. Kiley, et al., Delays in Request for Pregnancy
Termination: Comparison of Patients in the First and Second
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women experience poverty at more than double the
rate of their White counterparts, a larger proportion of
Black and Hispanic women experience economic
barriers to earlier abortions than White women.48
Distance also plays a key role in the timing of
abortions, disproportionately affecting women of color.
Abortion clinics tend to be located farther away from
Black and Hispanic communities—six out of ten
abortion providers are located in communities where
more than half the residents are White.49 Being
required to travel even 25 miles for an abortion is
associated with later abortions among Black and
Hispanic women.50 Simply put, the Mississippi Ban
would cause women of color and low-income women to
disproportionately lose access to abortion services.
B. Pregnant Women Who Cannot Access
Abortion Care Face Increased Health
Risks and Economic Vulnerability,
Trimesters, Contraception (May 2010) (“Multivariate analyses
indicate that most significant obstacles associated with request
for abortion with late gestational age were (1) difficulties
financing the abortion and (2) needing to travel long distances to
the clinic.”).
48 Solazzo, supra; Marshall H. Medoff, Race, Restrictive Abortion
Laws and Abortion Demand, Rev. Black Polit. Econ. (2014) (“As
hypothesized, Medicaid funding restrictions have a greater
impact on black and Hispanic women who are relatively more
likely to be on Medicaid than white women.”).
49 Guttmacher Advisory, Claim That Most Abortion Clinics Are
Located in Black or Hispanic Neighborhoods Is False,
Guttmacher Institute (June 2014), available at
https://www.guttmacher.org/claim-most-abortion-clinics-are-
located-black-or-hispanic-neighborhoods-false.
50 Solazzo, supra.
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Exacerbating Existing Health
Disparities
Pregnant women who are denied access to abortion
face serious health and economic consequences. As
this Court has recognized, pregnancy and birth are in
and of themselves more dangerous than an abortion.
Whole Woman’s Health v. Hellerstedt, 136 S.Ct. 2292,
2135 (2016).51 In addition, the health risks of carrying
a pregnancy to term increase even further for the
population of women most likely to be denied
abortions. All told, the negative health and economic
impacts of abortion denial can create a vicious cycle,
with lack of money for health care and basic
necessities causing people to forgo health care, and the
health risks of pregnancy endangering pregnant
women’s job security. These risks are particularly
stark for women of color, given existing health
inequities.52 Taken together, the deep consequences of
abortion denial underscore the fact that abortion is
essential to maintaining public health and health
equity.
In addition to the danger of life-threatening
medical conditions, pregnant women who are denied
51 Numerous studies have shown that abortion is one of the safest
outpatient medical procedures performed in the United States.
Mortality from childbirth is fourteen times higher than that from
abortion. Caitlin Gerdts et al., Side Effects, Physical Health
Consequences, and Mortality Associated with Abortion and Birth
after an Unwanted Pregnancy, 26 Women’s Health Issues 55-59
(Jan. 2016).
52 Samantha Artiga et al., Racial Disparities in Maternal and
Infant Health: An Overview, Issue Brief. Kaiser Family
Foundation. Available online: https://www. kff. org/da8cdf8/j
(accessed on 28 December 2020) (2020); see also supra __.
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access to abortion care are substantially more likely to
face economic hardships. A study comparing women
who successfully obtained abortions with those who
were denied abortions found that the families of those
who were denied were four times more likely to be
living below the federal poverty line.53 They also had
77 percent more past due debt and 81 percent more
negative public records, such as bankruptcies and
evictions, than women who were not denied
abortions.54 These findings are consistent with other
studies that show the harsh financial consequences for
having a young child—consequences that are
particularly severe for parents of color.55 Having a
child under the age of five typically results in a 14 to
36 percent drop in income relative to households
without a child, depending on whether a household
has one or two parents.56 Thus, abortion bans would
53 Diana Greene Foster et al., Socioeconomic Outcomes of Women
Who Receive and Women Who Are Denied Wanted Abortions in
the United States, 108 Am. J. Pub. Health 407, 410-13 (2018).
54 Sarah Miller et al., The Economic Consequences of Being
Denied an Abortion 3 (National Bureau of Economic Research
2020).
55 See Amy Traub et al., The Parent Trap: The Economic
Insecurity of Families with Young Children, 2100 New York:
Demos 8,12, 14, 15 (2016) (explaining that for parents of color the
economic hardships associated with having a young child are
layered on racial disparities in pay and workplace flexibility,
making the overall economic impact of having a young child more
severe for families of color).
56 Id. at 1. Notably, states with restrictive abortion policies are
less likely to adopt policies that are supportive of women’s and
children’s wellbeing, such as expanding Medicaid coverage,
creating employment protections for parents and pregnant
workers, and providing childcare assistance. See Ibis
Reproductive Health and Center for Reproductive Rights,
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first force pregnant women to continue their
pregnancies and then force them to navigate the
economic demands of raising a child without a safety
net, a critical issue for Amici.
These economic hardships and health risks can
also exacerbate each other, with the economic stress
caused by abortion restrictions undercutting people’s
health and vice versa. People who cannot afford
adequate shelter or food struggle to prioritize
preventative health care.57 In states that have not
expanded Medicaid, low-income people sometimes
cannot access health care coverage, leaving them
functionally unable to obtain health care. Meanwhile,
pregnant women are routinely denied workplace
accommodations related to their health, denials that
can cost them their jobs.58 Taken together, the effects
of laws that deny women access to abortion can
“Evaluating Priorities: Measuring Women’s and Children’s
Health and Well-being against Abortion Restrictions in the
States.”
57 U. Ranji et al., Beyond the Numbers: Access to Reproductive
Health Care for Low-Income Women in Five Communities, KFF:
San Francisco, CA, USA (2019).
58 See Carly McCann & Donald Tomaskovic-Devey, Pregnancy
Discrimination at Work 8–9 (2021) (“Based on these survey
results, an estimated 250,000 women are denied accommodations
related to their pregnancies each year. This is likely a
conservative estimate of unmet need, given that around 36% of
women who reported needing an accommodation did not ask their
employer.”); Young v. United Parcel Service, 575 U.S. 206 (2015)
(finding that UPS violated the Pregnancy Discrimination Act
when they refused to give a pregnant driver an accommodation,
recommended by her doctor, allowing her to lift no more than 20
pounds, and then placed her on unpaid leave).
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destabilize their entire lives, creating a cycle of
struggle that extends far beyond pregnancy.
The physical and economic toll of abortion bans is
not limited to pregnant women, but ripples out to their
families and their broader communities. Children
born as a result of their mother being denied an
abortion are more likely to grow up in a household
without enough money to pay for basic living expenses
than subsequent children born to the same woman.59
Additionally, the stress of trying to navigate
restrictive abortion laws may itself worsen the health
of the pregnant woman and in turn the later health of
her child.60 Sixty percent of people who obtain
abortions already have at least one child.61 Relative
to the children of people who obtain an abortion, the
children of pregnant women who seek but are denied
abortions have lower child development scores and are
more likely to live in poverty.62 Like the harms
abortion denial imposes on pregnant women, these
harms disproportionately affect children of color, who
59 Diana Greene Foster et al., Comparison of Health,
Development, Maternal Bonding, and Poverty among Children
Born after Denial of Abortion vs after Pregnancies Subsequent to
an Abortion, 172 J. Am. Med. Ass’n Pediatrics 1053–60, 1057
(American Medical Association 2018).
60 Anusha Ravi, Limiting Abortion Access Contributes to Poor
Maternal Health Outcomes, Washington DC: Center for
American Progress (2018).
61 Guttmacher Institute, Induced Abortion in the United States,
Guttmacher Institute (Sept. 2019).
62 Diana Greene Foster et al., Effects of Carrying an Unwanted
Pregnancy to Term on Women’s Existing Children, 205 J.
Pediatrics 183–89, 185–87 (2019).
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already contend with the deep health and economic
inequities caused by racism.63
Amici recognize that well-being and resilience are
communal attributes, determined not just by people’s
individual circumstances but by the health of
communities as a whole. Pregnant women who are
denied abortions are integral parts of our
communities, part of the “public” that our public
health efforts operate in service of.64 Given the deep
connection between abortion access and physical and
socioeconomic wellbeing, achieving these goals is
impossible without continued access to legal
abortion—access that localities have depended on to
protect their residents’ health and alleviate deep
racial and economic health disparities since Roe was
decided nearly fifty years ago.65 Abortion is essential
63 See Maria Trent et al., The Impact of Racism on Child and
Adolescent Health, 144 Pediatrics __ (2019) (explaining that
“[r]acism is a social determinant of health that has a profound
impact on the health status of children, adolescents, emerging
adults, and their families,” and explaining the many ways that
racism harms the health of children and adolescents of color);
Neil Bhutta et al., Disparities in Wealth by Race and Ethnicity in
the 2019 Survey of Consumer Finances, Feds Notes 28–2 (2020)
(“[T]he typical White family has eight times the wealth of the
typical Black family and five times the wealth of the typical
Hispanic family.”).
64 Amici strive to bridge these gaps through regular
programmatic efforts. For example, Columbus is committed to
“addressing minority health inequities, including a systematic,
data-driven focus on poverty, economic mobility, and other
factors that impact the social determinants of health.” [CITE].
65 See American Public Health Association, Restricted Access to
Abortion Violates Human Rights, Precludes Reproductive Justice,
and Demands Public Health Intervention, Policy (2015) (“A public
health strategy to achieve health in all policies, economic
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health care, and localities have a duty to guard their
residents’ health.
C. Pre-Viability Abortion Bans Would
Destroy the Community Trust That
Is Fundamental to Local Efforts to
Reduce Health Disparities.
As explained above, pregnant women who cannot
access needed care suffer increased health risks and
negative economic consequences, which in turn ripple
to disrupt and burden families, communities, and local
governments. This not only leads to strains on local
health care systems, but also erodes the individual
and community trust that is essential to bridge health
disparities because needed care is unavailable.
Further undermining this crucial trust is the common
linkage between abortion restrictions and mandated
disclosures or procedures that are not scientifically, or
evidence based. Criminalization of most abortions
exacerbates disparities due to uneven enforcement
against Black and brown communities.
Pre-viability abortion bans fundamentally
interfere with the doctor-patient relationship by
preventing doctors from providing medical care that is
medically necessary, ultimately eroding pregnant
women’s trust in the medical system because care they
are seeking is not available or hard to access. Many
states poised to impose stricter bans also have enacted
regulations intended to deter patients and damage the
credibility of reproductive health providers. For
example, state laws that require doctors to
equality, social justice, and human rights should protect and
advance women’s access to abortions and reproductive justice.”).
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communicate medically false information directly
undermine the doctor-patient relationship. Thirty-
eight states require physicians to provide disclosures
to pregnant patients considering an abortion that are
mandated by legislatures rather than the medical
community.66 Eleven states require physicians to
provide brochures with government-mandated
information about risks associated with abortions.67 If
Mississippi’s ban is upheld, other states will likely
impose additional disclosure and counseling
requirements on their providers. When doctors are
required to communicate false information to patients,
patients do not know whether they can trust their
doctors, and pregnant women report finding
counseling less helpful.68
State laws mandating medically unnecessary
procedures as preconditions to seeking an abortion
also undermine trust in the medical profession. Ten
states require doctors to administer an ultrasound to
66 Callie Beusman, A State-by-State List of the Lies Abortion
Doctors Are Forced to Tell Women (Aug. 18, 2016),
https://www.vice.com/en/article/nz88gx/a-state-by-state-list-of-
the-lies-abortion-doctors-are-forced-to-tell-women.
67 Id. These disclosures often have no basis in medical evidence
or are outright contradicted by medical evidence. For example,
five states require doctors to state that abortion is linked to
breast cancer, an assertion discredited by multiple scientific
studies.
68 Heather Gould, MPH, et al., Predictors of Abortion Counseling
Receipt and Helpfulness in the United States, Women’s Health
Issues (July 1, 2013), https://www.whijournal.com/article/S1049-
3867(13)00039-X/fulltext.
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patients seeking an abortion,69 even though
ultrasounds generally are not medically necessary for
the safe provision of an abortion.70 Women forced to
undergo medically unnecessary procedures report
trauma; doctors administering them report feeling
conflicted as well.71
Criminalizing most abortion care creates another
level of strain. The enforcement of abortion bans can
be uneven, typically targeting women of color and thus
negatively affecting trust in local government and
Amici’s efforts with respect to health equity. In 2015,
Purvi Patel became a highly visible example of a
woman of color sentenced to 20 years in prison for
feticide after an allegedly induced miscarriage—a
sentence later modified to felony neglect.72 Although
Patel’s case was often framed as an outlier, pregnant
women have increasingly faced charges of homicide,
child abuse, or neglect when a fetus has been affected
by conditions of the pregnant woman, such as
addiction to controlled substances.73 A survey of 400
69 Guttmacher Institute, Requirements for Ultrasounds,
https://www.guttmacher.org/state-policy/explore/
requirements-ultrasound
70 National Partnership for Women and Families, Bad Medicine:
How a Political Agenda Is Undermining Abortion Care and
Access, https://www.nationalpartnership.org/our-work/
resources/repro/bad-medicine-third-edition.pdf
71 Id.
72 Emily Bazelon, N.Y. Times Magazine (April 1, 2015),
https://www.nytimes.com/2015/04/01/magazine/purvi-patel-
could-be-just-the-beginning.html.
73 Mary Ziegler, Some Form of Punishment: Penalizing Women
for Abortion, 26 Wm. & Mary Bill Rts. J. 735 (2018),
https://scholarship.law.wm.edu/wmborj/vol26/iss3/6.
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cases of arrests, convictions, and detentions of
pregnant women found that 84% of cases related to the
pregnant woman’s use of controlled substances,
charges that are disproportionately brought against
women of color. One study found that Black women
are ten times likelier than White women to be
prosecuted for controlled substance use despite
similar rates of addiction.74 These trends are only
likely to accelerate with stricter abortion bans in
place.
The unequal targeting of certain communities will
further erode trust in the local government, as it has
in other contexts, such as immigration enforcement.75
This is among the reasons that major medical
institutions, from the American Medical Association
to the American Academy of Pediatrics to the
American Public Health Association, have all
discouraged prosecution of women whose pregnancies
are terminated.76
III. A Decision That Upholds Mississippi’s Ban
Could Trigger Abortion Bans In At Least
Twenty-One States, Leading to Chaos and
74 Deborah L. Rhode, The Terrible War on Pregnant Drug Users,
The New Republic (July 17, 2014), https://newrepublic.com/
article/118681/law-protect-fetuses-actually-punishes-minority-
women.
75 Karen Hacker, M.D., M.P.H, et al, The Impact of Immigration
and Customs Enforcement on Immigrant Health: Perceptions of
Immigrants in Everett, Massachusetts, USA, Soc. Sci. Med. 2011
Aug; 73(4): 586-594.
76 Id.
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Confusion at the Expense of Low-Income
Women and Women of Color.
Although the Mississippi Ban restricts
abortions after fifteen weeks, a reversal of the decision
below could lead to the immediate imposition of
abortion bans well before fifteen weeks, and thus even
further before viability, in at least twenty-one states.
Those bans could come in the form of (i) post-Roe
abortion bans that are currently enjoined, (ii) pre-Roe
laws that have never been repealed, and (iii) so-called
“trigger bans.”
Petitioners maintain that overruling Roe would
simplify the prevailing abortion jurisprudence by
undoing an “unworkable” standard and replacing it
with rational basis review. That is not correct.77
Instead, potentially within hours of an opinion by this
Court that even theoretically compromises Roe, legal
chaos will ensue as providers, patients, and Amici try
to determine which laws apply to abortion access in
their states. As the dust settles, women of means
will—as they always have—travel and leverage
relationships with private physicians to access
abortion care, while women of color and low-income
women are left behind.
A. Twenty-One States—Including
Mississippi—Have Even More
77 Richard H. Fallon, If Roe Were Overruled: Abortion and the
Constitution in a Post-Roe World, 51 St. Louis L.J. 611, 648
(2007) (“The notion that by overruling Roe the Supreme Court
could extract itself from controversial assessments of the
constitutionality of state anti-abortion legislation is not just a
fallacy. It is a delusion.”).
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Extreme Abortion Bans Poised to
Go into Effect if Roe Is
Overturned.
The implications of upholding the Mississippi
Ban extend well beyond the state of Mississippi and a
fifteen-week cut-off for abortion access. At least
twenty-one states already have laws on the books that
could be used in an attempt to ban abortion access
beyond Mississippi.78
Although the Mississippi Ban prohibits
abortion after fifteen weeks, Mississippi is one of at
least nine states with even more severe abortion bans
that were passed after Roe but that are currently
enjoined on the basis of Roe. Those enjoined
restrictions could go into effect if a constitutional right
to abortion were overruled.79 Seven of the nine states
passed restrictive abortion bans based on gestation in
the first half of 2019 alone—Missouri at eight weeks;
Georgia, Kentucky, Louisiana, Mississippi, and Ohio
at six weeks; Alabama would restrict abortion
78 Guttmacher Inst., Abortion Policy in the Absence of Roe (as of
August 1, 2021), https://bit.ly/2W1saSn. Indeed, Mississippi itself
has a pre-Roe ban on abortions at any gestational age, a post-Roe
six-week ban, and a “trigger law” that is intended to ban virtually
all abortion upon a determination by the State Attorney General
that the Supreme Court has overturned Roe v. Wade. Miss. Code
Ann. § 41-41-45.
79 Guttmacher Inst., Abortion Policy in the Absence of Roe (Sept.
1, 2021), https://www.guttmacher.org/state-
policy/explore/abortion-policy-absence-roe# (listing Alabama,
Arkansas, Georgia, Kentucky, Mississippi, Missouri, Ohio, South
Carolina, and Tennessee as states with “post-Roe restrictions
that could take effect if Roe [is] overturned.”).
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altogether.80 These bans have been temporarily or
permanently enjoined, but the injunctions were all
expressly based on a fundamental right to abortion as
recognized by prior Supreme Court precedent.81
Seven states (Alabama, Arizona, Arkansas,
Michigan, Mississippi, West Virginia, and Wisconsin)
retain abortion bans that pre-date Roe v. Wade and
that could go into effect if the Mississippi Ban is
upheld. These pre-Roe statutes carry harsh criminal
penalties for violation and ban abortion without
regard to viability or gestational age, with only
extremely limited exceptions.82
80 K.K. Rebecca Lai, Abortion Bans: 9 States Have Passed Bills
to Limit the Procedure This Year, N.Y. Times (May 19, 2019),
https://nyti.ms/3syk2o1. (Arkansas and Iowa also have post-Roe
bans.)
81 See, e.g., SisterSong Women of Color Reproductive Justice
Collective v. Kemp, 472 F. Supp. 3d 1297, 1302 (N.D. Ga. 2020)
(striking down Georgia’s Living Infants Fairness and Equality
Act) (“The hallmark of the Supreme Court’s abortion
jurisprudence is Roe v. Wade[,] wherein the Court held that the
Due Process Clause of the Fourteenth Amendment provides a
fundamental constitutional right of access to abortions.”). In
Ohio, there could be an attempt to revive a “heartbeat bill” that
bans abortion at six weeks—a point at which most women do not
even know they are pregnant—if an injunction premised on Roe’s
fundamental right is lifted. Ohio S.B. 23, 123rd Gen. Ass. (2019);
Pre-Term Cleveland v. Yost, 394 F. Supp. 3d 796, 800 (S.D. Ohio
2019) (“The Court concludes, based on current United States
Supreme Court precedent, that Plaintiffs are certain to succeed
on the merits of their claim that S.B. 23 is unconstitutional on its
face. The law is well-settled that women possess a fundamental
constitutional right of access to abortions”) (citing Roe v. Wade,
410 U.S. 113, 153-54 (1973)).
82 See, e.g., Wis. Stats. Ann. 940.04(2), which states that any
person who “[i]ntentionally destroys the life of an unborn quick
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In addition to these restrictions, twelve
states(Arkansas, Idaho, Kentucky, Louisiana,
Mississippi, Missouri, North Dakota, Oklahoma,
Tennessee, Texas, South Dakota, Utah) have so-called
“trigger laws” or “trigger bans,” the purpose of which
is to totally ban abortion in the event that Roe v. Wade
is overruled or modified.83 All of these trigger laws
purport to enact a total ban if the Court no longer
recognizes a fundamental right to abortion. Although
the constitutionality of these trigger bills is
questionable,84 any decision that could be interpreted
as making it “reasonably probable” that a criminal ban
on abortion is constitutionally sound will trigger the
substantive provisions of the bills, leading to
child” is guilty of a Class E Felony, which provides for up to 15
years in prison and up to $50,000 in fines. Wisconsin’s pre-Roe
statute allows abortion only if two physicians deem the abortion
necessary to save the life of the mother. Wis. Stats. Ann.
940.04(5)(a)-(b). Mississippi’s statute allows abortions only
where necessary “for preservation of the mother’s life” or where
the pregnancy was caused by rape. Miss. Code Ann. § 97-3-
3(1)(a)-(b).
83 Guttmacher Inst., Abortion Policy in the Absence of Roe, supra
note [XX]. Two additional trigger bans—in Texas and
Oklahoma—were passed in 2021. Tex. H.B. No. 1280; Okla. S.B.
918 § 18.
84 See, e.g., Heidi S. Alexander, The Theoretic and Democratic
Implications of Anti-Abortion Trigger Laws, 61 Rutgers L. Rev.
381 (2009) (arguing that trigger laws are unconstitutional
legislative entrenchment); Matthew Berns, Trigger Laws, 97
Geo. L.J. 1639 (2009) (arguing that trigger laws constitute
“extrajudicial constitutionalism” that will inevitably lead to
“conflicting constitutional interpretations from the courts and
high-ranking non-judicial officers [and] leave lower-ranking
officials with poor guidance as to what the Constitution requires
and result in those officials’ inconsistent enforcement of
constitutional norms.”).
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additional litigation and widespread confusion about
abortion access. Indeed, any decision that upholds the
Mississippi Ban will likely be perceived by some as
triggering the substantive provisions of these laws,
leading to constitutional chaos and a wave of litigation
about how to interpret the new post-Roe standard for
abortion.
Previous state abortion bans are instructive
regarding the confusion that will ensue. For example,
after Ohio’s so-called ‘heartbeat bill” was passed, a
study found that nearly 40% of the women studied
thought that abortion was totally illegal (or were
unsure) in the state.85 After Alabama passed a total
abortion ban, Alabama abortion providers described a
deluge of calls from women desperately seeking
information about whether abortion was illegal in
their state.86 This panic was despite the fact that the
Alabama law never went into effect. Similar confusion
will proliferate nationwide and make it difficult, if not
impossible, for public health officials and providers to
share accurate information and provide the full
spectrum of care to their patients.
B. As in the Era Before Roe, Abortion Bans
Will Leave Low-income Women and
Women of Color Closed Off from Abortion
85 Maria F. Gallo et al., Passage of Abortion Ban and Women’s
Accurate Understanding of Abortion Legality, Am. J. Obstetrics
& Gynecology 63 (2021).
86 Kim Chandler & Sudhin Thanawala, At Abortion Clinics, New
Laws Sow Confusion, Uncertainty, AP News (May 21, 2019),
https://apnews.com/article/us-news-ap-top-news-laws-
huntsville-ms-state-wire-aad4cc8b68b7400aac27e5c1abc7b1be.
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Access Relative to White Women with
Means.
Although the delivery of abortion care and
safety of self-managed abortion has changed
drastically in the half-century since Roe was decided,
many of the disparities in reproductive healthcare for
women of color and low-income women persist. Before
Roe v. Wade was decided, lower-income (and typically
nonwhite) women died at alarming rates in
dangerous, illegal procedures while their wealthier
counterparts were more likely to travel to places
where abortion was legal or to influence private
physicians to perform abortions for them. These
disparities would be exacerbated by a decision that
drastically changes abortion access. Because low-
income women and women of color often get pushed
into later abortions, any compromise to pre-viability
standards will cause health disparities to become only
more stark.
Roe v. Wade ensured that doctors and patients
would not be subject to criminal penalties for
providing or having an abortion, but the decision did
not invent legal abortion or create demand for
abortion. Nonetheless, by standardizing the
patchwork quilt of state criminal abortion bans in the
United States, Roe expanded abortion access that was
previously available only to those with the means to
travel or influence their physicians.
Before abortion was widely available in the
United States, those with means traveled abroad to
procure abortions at a cost well beyond what the
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average woman could afford.87 For those hoping to
stay closer to home, the cost of getting a “safe,
competently performed abortion in a local hospital”
was prohibitive for all but the very wealthiest. As the
Washington Post reported in 1966, a woman seeking a
hospital abortion needed $600 (nearly $5,000 in
today’s dollars) to get “two psychiatrists” to attest that
the woman was suicidal because of her pregnancy and
a gynecologist to perform the “therapeutic abortion for
depression.”88
After New York legalized abortion in 1970,
hundreds of thousands of women traveled to New York
City to access abortion. In Planned Parenthood of
Southeast Pennsylvania v. Casey, the City of New
York filed an amicus brief detailing the influx of out-
of-state women desperately seeking an abortion in
NYC.89 The numbers revealed a stark reality: over
ninety percent of those who traveled to New York City
for an abortion between 1970 and 1973 were white.
Wealth and race created a two-tiered system of
abortion access in the decades before Roe: one for
87 See, e.g., Linda Greenhouse & Reva Siegel, Before Roe v. Wade:
Voices That Shaped the Abortion Debate at 8 (2012) (reproducing
instructions written by the Society for Humane Abortion for
procuring an abortion in Japan, including that plane tickets
would cost around $8,000 in today’s dollars). See U.S. Bur. Lab.
Stats., Consumer Price Index Inflation Calculator,
https://www.bls.gov/data/inflation_calculator.htm.
88 Elisabeth Stevens, When Abortion Was Illegal: A 1966 Post
Series Revealed How Women Got Them Anyway, Wash. Post
(June 9, 2019), https://wapo.st/3tngYf0.
89 Brief of the City of New York, et al., as Amici Curiae in
Support of Petitioners and Cross-Respondents, Planned
Parenthood of Se. Pa. v. Casey, 1992 WL 12006404.
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white women of means who could travel and influence
their physicians to sign off on otherwise illegal
abortions, and a much more dangerous tier for non-
white, non-wealthy women.
If Roe is overruled or compromised, the demand
for abortion will not disappear, and women of color
and low-income women will be disproportionately
impacted. The Iowa Supreme Court recently
recognized this fact when it struck down a 72-hour
waiting period for abortion:
Abortion regulations impact
different women in many different
ways. Womanhood is not a
monolith. There are few hurdles
that are of level height for women
of different races, classes, and
abilities. There are few
impositions that cannot be solved
by wealth. Women of means are
surely better positioned to
weather the consequences . . . .”90
Studies of abortion access following restrictive state
abortion regulations foreshadow what a post-Roe
landscape could look like for low-income women and
women of color. For example, the effects of Texas’s
H.B. 291—including decreased abortion access and an
90 Planned Parenthood of the Heartland v. Reynolds, No. 17–
1579 (Iowa 2018).
91 Texas’s H.B. 2, the subject of Whole Woman’s Health v.
Hellerstedt, 136 S.Ct. 2292 (2016), (i) required individual
abortion providers to have admitting privileges at a hospital
within thirty miles of their abortion facility, and (ii) required
abortion facilities to conform to requirements for ambulatory
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increase in travel distance of over 100 miles to get an
abortion—affected Hispanic women significantly more
than white women.92 More recently, the fallout from
Texas’s S.B. 8, which bans all abortion after six weeks,
demonstrates the chaos and difficulty in accessing
abortion that could await women well beyond Texas.
As S.B. 8’s effective date loomed, pregnant women
sought information and care from clinics in Oklahoma,
Colorado, Kansas, New Mexico, and Minnesota.93
When S.B. 8 went into effect, the average one-way
driving distance to the nearest abortion clinic
increased twenty-fold. And, because the states
nearest to most Texans (Oklahoma and Louisiana)
also restrict abortion access, many pregnant women
will need to travel even farther.94 Moreover, although
surgical centers. When the law was in effect, half of Texas’s
abortion providers were forced to shut down. Id. at 2313.
92 Vinita Goyal, Isabel H. McLoughlin Brooks, Daniel A. Powers,
Differences in Abortion Rates by Race–Ethnicity After
Implementation of a Restrictive Texas Law, Contraception (2020)
(“The abortion rate also decreased more among those living in a
county with an HB2-related clinic closure, especially for Hispanic
women (41% Hispanic vs. 29% White vs. 30% Black vs. 3%
Other). Hispanic women whose travel distance increased 100+
miles had the greatest reduction in the abortion rate (43%)”).
93 Neela Bohrum, Abortion Providers and Distraught Patients
Confront Stark Realities of Texas’ New Law, Tex. Tribune (Sept.
1, 2021), https://www.texastribune.org/2021/09/01/texas-
abortion-law-clinics-patients/; Shefali Luthra, After the Texas
Abortion Ban, Clinics in Nearby States Brace for Demand, The
Guardian (Sept. 2, 2021), https://www.theguardian.com/us-
news/2021/sep/02/as-texas-patients-prepare-to-travel-hundreds-
of-miles-for-abortion-access-out-of-state-clinics-brace-for-surge.
94 Elizabeth Nash et al., Guttmacher Inst., Impact of Texas’
Abortion Ban: A 20-Fold Increase in Driving Distance to Get an
Abortion (Aug. 2021),
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there will be abortion “hubs” in places like New York
City and California, there will likely be huge swaths
of the country where abortion access by anything other
than air travel is impossible.
In sum, upholding the Mississippi Ban—
whether by overruling Roe or by otherwise
compromising the fundamental abortion right it
promised—will inevitably lead to legal and logistical
chaos surrounding abortion and any attempt to access
care. Amici’s roles as caretakers of the public health
and overall well-being will be fundamentally
disrupted.
CONCLUSION
The judgment below should be affirmed.
Respectfully submitted,
[COUNSEL SIGNATURE BLOCKS]
https://www.guttmacher.org/article/2021/08/impact-texas-
abortion-ban-20-fold-increase-driving-distance-get-abortion.
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APPENDIX A
(List of Amici Curiae)
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Vernice Hankins
From:Sylvia Ghazarian <sylvia@wrrap.org>
Sent:Sunday, September 12, 2021 5:08 PM
To:Sue Himmelrich; Gleam Davis
Cc:councilmtgitems
Subject:Fwd: Item 13G - Amicus Brief: Dobbs v JWHO
EXTERNAL
As the largest and only independent national abortion fund supporting folks in all 50 states, we hear every single day
about the impact of state bans, and Texas is by far the most alarming. As more and more people will now be forced to
leave their communities and get care at clinics in other states, we reaffirm our commitment to supporting folks who
need abortions and the providers that are able to see them, no matter where folks seek care. Abortion care can’t wait
and WRRAP is ready to help.” said Sylvia Ghazarian, Executive Director/WRRAP ‐‐Ms. Magazine, Health, Justice &
Law, 09/1/2021
Mayor and City Council Members,
I’m Sylvia Ghazarian, Chair of the Commission on the Status of Women in Santa Monica. I write today in my personal
capacity of what I am observing and experiencing regarding the current abortion restrictions and bans enacted in many
states.
As Executive Director of the Women’s Reproductive Rights Assistance Project (WRRAP) I hear first hand the impact
Texas’s SB8 has had on not just individuals seeking abortion care, but providers, abortion funds and the countless
advocates and volunteers that stand with us each day.
WRRAP, the Women’s Reproductive Rights Assistance Project, established in 1991 and headquartered in Los Angeles, is
the only independent 501 (c) 3 abortion fund that provides urgently needed financial assistance, on a national level, to
those seeking abortion or emergency contraception. Since June of this year, over 90+ abortion restrictions have been
enacted triggering more insurmountable financial barriers for countless individuals needing abortion services. This is
exacerbated by the ongoing COVID pandemic and Delta variants which understandably has required clinics and doctors
to restrict the number of patients on a given day but furthering delays of patient care.
WRAAP’s mission: To ensure that financially needy individuals of all ages, ethnicities, cultural backgrounds, gender
identities, and sexual orientations can access abortion care and emergency contraception.
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What WRRAP does: WRAAP evaluates each individual solely on the basis of need. Once approved, WRRAP sends funds
earmarked for the individual to the WRRAP‐affiliate health clinic or doctor of the patient's choice. Those clinics and
doctors are members of Planned Parenthood Federation of America, National Abortion Federation, the Abortion Care
Network and/or independent health clinics. And, we have over 700 clinics, doctors, and hospitals that we work with
across the United States.
Significance of WRAAP’s national presence: WRRAP’s national presence uniquely positions it to alleviate potentially
devastating geographic‐based hardships for its patients. Because so many reproductive health centers have closed and,
thus, many states have very few remaining (Kentucky, Mississippi, and Alabama have just one), the clinics located closest
to patients may be in neighboring, rather than in patients’ home, states. State‐based financial assistance requires aid
recipients to use in‐state services. Therefore, people located far from in‐state clinics are forced to incur increased travel,
child care, lodging and missed work related expenses to receive care out of state ‐ not to mention mandated waiting
periods in certain states and the on‐going COVID‐19 dangers. WRRAP enables its patients to receive care at WRRAP
approved clinics of their choosing, regardless of location. Right now, much of our funding is given to patients living in
hostile or very hostile states. In addition, WRRAP works with doctors and clinics (including virtual clinics) that provide
telemedicine which was highly restricted until the pandemic and we must now fight to make this change permanent to
further lift restrictions and provide better access for individuals with little to no access to a clinic or doctor.
WRRAP understands the harm of all barriers fall hardest on those who already face oppression in various and
overlapping ways – whether because of their lack of financial resources, young age, disability, immigration status or
because they are Black, Indigenous or other people of color.
This often results in an impossible cycle of raising the funds needed for the procedure, only to still fall short on the total
cost by the time they get to their appointment. This is only made harder when they must travel to another state for their
procedure, only to encounter 24‐48‐hour forced waiting periods and other obstacles. These postponements carry higher
health risks for the patient with each week and also higher costs. The legal right to have an abortion does not guarantee
that an individual will have access to it.
We should all be able to make our own decisions about our health and future and that includes the right to decide
whether and when to become a parent.
I leave with you with a few testimonials, one from an OB/GYN doctor and from a few patients – stories I too hear every
day working with our dedicated volunteers who handle our hotline:
“I have been an ob/gyn for almost 17 years. And I would like to invite you to come into my exam room just for a
moment, to listen to the stories I have heard from women. Listen carefully to what is said to me behind closed
doors. And then get the f*ck out, you and your decisions about her life don’t belong there…I can’t afford to feed my
children I have now. I fear for my life. I went into heart failure with my last pregnancy. My tubes were tied, I never
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intended to have more kids. I’m starting grad school in a week. I had an affair and made a mistake and I don’t want to
break up my family. I am alone. I had a one night stand and don’t know who the father is. I was raped. I am 13 years
old. I’m 48 years old. I have breast cancer and am getting chemotherapy. My uterus ruptured during my last
pregnancy. My diabetes is completely uncontrolled. This pregnancy put me in kidney failure. I have malignant
melanoma. My baby has multiple anomalies. I’m worried I will kill myself if I keep this pregnancy. I don’t want a baby
right now. I don’t want to be pregnant.
Here’s the thing. Even with all those statements, the truth is, it should not matter. You don’t need a reason other than,
this is your choice.
My body. My choice.
And if I get sent to prison for 99 years for taking care of my patient during such a personal and difficult decision, we have
gone too far!” ‐‐OB/GYN
“I am having this abortion because I am homeless at the moment and this pregnancy is unplanned of course. I am
addicted to drugs and I am not stable myself to take care of another child. I have no source of income or any support
to help me with this baby.” ‐ Patient
“The doctors said that the baby might not make it to full term and would die shortly after birth. This was the hardest
decision I ever had to make. I am currently going into my senior year at the University of Cincinnati. I am working
hard to prepare for my senior year so I am not working. Without funding, I would not have been able to pay for the
procedure and would have had to continue to carry the baby.” Patient
“I opted for the abortion pill since I don't have a driver to get back home after the procedure. I'm in the military and
my insurance doesn't cover abortions, and I can't get extra pay to cover the cost. I found out that the price out of
pocket is $2009. I cannot come close to affording this, and I cannot afford a child either. I can pay up to $300
because that is what I have set aside. I'm in a bad situation and my family cannot and will not help me." ‐ Patient
“I lost my job for 3 months due to COVID‐19 and also have a 4 year old son that I care for on my own. This funding will
tremendously help me because I am not in a good place financially and could not afford another baby at all. The
father of this pregnancy is very toxic and not understanding of my circumstances. I can’t say enough how much this
helps me.” ‐ Patient
WRRAP’s values affirm the following: 1) The right to choose abortion is meaningless without access to abortion services;
2) Restrictions on abortion access and funding are discriminatory because they especially burden poor women, young
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women, military women, women of color and rural women; and 3) Abortion is a component of basic healthcare, a right
that should be guaranteed to all.
We must continue to stand ready to support people’s human rights – to advance gender equality, leaders must ensure
sexual and reproductive rights for all. If the Court weakens or eliminates abortion protections, the effects would be felt
the most by people already marginalized and oppressed by structural inequities and lack of abortion access, including
people with low incomes, people of color, young people and LGBTQ people.
In solidarity,
Sylvia Ghazarian
Executive Director
Women's* Reproductive Rights Assistance Project
To help protect your privacy, Microsoft Office prevented automatic download of this picture from the Internet.
wrrap.org
@wrrap or @wrrapreprojustice
*Definition of “women” includes transgender, genderqueer and non-binary people.
Please donate at: www.wrrap.org/donate. WRRAP is a 501 (c) 3 non‐profit organization. Our Federal Tax ID is: 95‐
4522977
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