What Should Public Health and Health Department Professionals Do in Preparation for Roe v. Wade Falling?

In the same way that health departments respond to other threats to public health, they should prepare to mitigate the public health harms we expect to be caused by these policy changes.

In November 2021, along with colleagues, we authored a report (ahead of print) in the Journal of Public Health Management and Practice (see the full article now available in the July issue) on our experience convening a group of public health professionals to discuss appropriate activities related to abortion for health departments. At the time of the convening (in May 2020), we had yet to witness many of the recent and unprecedented threats to abortion legality, including SB 8 in Texas that has, in effect, banned abortion after 6 weeks gestation in Texas.

More recently, the leaked draft of the Supreme Court majority decision in Dobbs v. Jackson Women’s Health Organization has indicated that Roe v. Wade, the Supreme Court decision that legalized abortion nationwide, will almost certainly be overturned. This decision will drastically change the landscape of abortion legality in the United States, as 26 states are certain or likely to ban and recriminalize abortion.

What does this mean for public health professionals, especially those working in state and local health departments? In the same way that health departments respond to other threats to public health, they should prepare to mitigate the public health harms we expect to be caused by these policy changes. The activities list identified as part of the convening includes steps health departments can take. For those operating in states where abortion will become criminalized, this might look like:

  1. Estimating how many additional people will be forced to continue their pregnancies, who these people are likely to be, and building up the health department capacity to serve and care for them for example: increasing the capacity of local prenatal care facilities, home-visiting programs, and WIC;
  2. Anticipating that more people may attempt to self-manage their abortions. Many people will be able to self-manage their abortion safely with abortion pills. Regardless of how people attempt to self-manage their own abortions, health departments should take steps to prevent people from being criminalized for self-managing their own abortions;
  3. Providing information to residents on where they may be able to obtain an abortion in another state and connecting them possible resources for doing so.

Health departments in states where abortion will remain legal should partner with abortion care facilities to identify what supports they may need to care for additional pregnant people from other states seeking abortion care while also maintaining services for current residents. This might look like identifying funding to pay for services for people traveling from out of state and improving Medicaid reimbursement for telehealth.

The evidence is clear that abortion is safe, and that denying people abortion harms the health and socio-economic wellbeing of women, children, and families. At the same time, the realities of obtaining a safe abortion have changed since the pre-Roe era. Public health professionals should refrain from propagating the “coat hanger” and “back-alley” imagery often associated with illegal abortions.

Instead, as more people will attempt to self-manage their own abortion, particularly with abortion pills, we must prepare to minimize the harm caused by the criminalization of abortion. If people who need care after self-managing their abortion avoid it out of concern for legal consequences, it could endanger their health.

Participants in our May 2020 convening came to consensus on a menu of activities related to abortion that are appropriate for health departments. This list of activities is even more relevant today as the future of abortion legality is threatened. We hope that this resource can both provide guidance on what health departments can do and foster discussion on the unique role of public health in this moment.


About the Authors

Claudia Zaugg, MPH, is a Project Manager at Advancing New Standards in Reproductive Health (ANSIRH), based at the University of California, San Francisco. She oversees Dr. Sarah Roberts’ portfolio of research that seeks to evaluate state-level policies targeting alcohol and drug use during pregnancy. Claudia is passionate about translating research into practice and building the capacity of public health practitioners to advance health equity. Prior to ANSIRH, she worked at the Best Babies Zone Initiative where she supported organizations in advancing a community-driven, multi-sector model to reducing racial inequities in birth outcomes. Claudia received her MPH from UC Berkeley and her BA from Pomona College.

Sarah CM Roberts, DrPH, is a Professor and Legal Epidemiologist at ANSIRH, at the University of California, San Francisco. She studies the ways that policies and the health care system punish, rather than support, structurally vulnerable pregnant people, including pregnant people who use alcohol and drugs and pregnant people seeking abortion. Dr. Roberts’ current research focuses on evaluating impacts of state-level pregnancy-specific alcohol and drug policies and understanding health care provider reporting practices in the contexts of self-managed abortion and of birthing people’s use of alcohol and drugs. Previously, Dr. Roberts has led research about public health approaches to abortion, the impacts of state-level restrictive abortion policies, COVID-related impacts on abortion providers and patients, and changes in alcohol and drug use subsequent to receiving versus being denied an abortion. Dr. Roberts has published more than 90-peer reviewed manuscripts and has received grant funding from multiple private foundations as well as the National Institutes of Health and other government agencies. Dr. Roberts co-led the Social Scientists’ Amicus Brief for the Supreme Court Case June v. Russo. Dr. Roberts received her undergraduate degree in history from Columbia University, her MPH and a Graduate Certificate in Women’s Studies from the University of Michigan, and her DrPH from the University of California, Berkeley. She also completed a postdoctoral fellowship in Alcohol Epidemiology at the Alcohol Research Group.