U.S. Bucks Global Trend on Abortion Access

But new restrictions following the overturning of Roe v. Wade could reverberate in other countries, experts say.

Think Global panel on abortion access

By Alicia Banks

Published February 13, 2023 under Around DGHI

On a Thursday afternoon, Beverly Gray, M.D., told a room full of Duke students, faculty and staff about her grandmother’s decision to have an abortion.

During the 1970s, Gray’s grandmother was pregnant and diagnosed with cervical cancer. She chose to end the pregnancy to protect her health. But Gray worries a woman in similar circumstances today will not have that option.

“Pregnancy … is like running a marathon on your body. For most healthy people, it’s okay, but if you have any other medical comorbidities, it’s hard to run,” Gray said during a DGHI Think Global event on Feb. 9. “Having to wait until they’re really sick for care doesn’t help people.”

Gray, an OB/GYN and founder of the Duke Reproductive Health Equity and Advocacy Mobilization team, was part of a panel that discussed the current challenges to abortion care and its impact on reproductive and maternal health following the U.S. Supreme Court’s decision overturning Roe v. Wade. Many states have passed new restrictions on abortion following the ruling.

Those actions come as many other countries have expanded access to abortion, noted Jina Dhillon, J.D., M.P.H., associate director at Ipas North Carolina, an organization focused on global reproductive justice. But Dhillon said changes in the U.S. could re-energize movements in other countries to oppose abortion, as well as other reproductive rights.  

“What the Supreme Court’s decision did in other parts of the world was embolden their anti-rights opposition where there was already a lot of stigma, hostility and harassment of abortion providers and those seeking abortions,” she said. “It’s never been more apparent than now that not only are sexual and reproductive health rights under threat, but so are civil liberties and human rights of everyone. 

Watch the full discussion below, or scroll for highlights.


Megan Huchko, M.D., M.P.H, (moderator) has a dual appointment as an associate professor in the department of obstetrics & gynecology and DGHI. She practices as an OB/GYN generalist and serves as the director for the Duke Center for Global Reproductive Health.

Jina Dhillon has worked in the field of sexual and reproductive health rights for more than 16 years. She has strong experience developing strategies for reform of restrictive abortion laws and ensuring broad interpretation of abortion laws and policies to maximize access.

Beverly Gray is an associate professor of obstetrics and gynecology at the Duke School of Medicine and an OB/GYN for Duke Health. She serves as the division director for Women’s Community and Population Health. Her research interests include contraceptive planning and medical education.

Jonas Swartz, M.D., M.P.H., is an associate professor of obstetrics and gynecology at the Duke School of Medicine and a Duke Health OB/GYN. In his work, he seeks to build evidence that can help reduce health disparities with a focus on immigrants, Medicaid policy and access to abortion and contraception.


 The impact of abortion restrictions on health and safety:

 Beverly Gray

If we limit care at some arbitrary point, we can’t provide it at those points. Some of the sickest patients I’ve ever seen are those that break their water early and become septic and have an infection. We’re going to see this continue to happen in states that have bans as providers are fearful to care for them.”

 Jonas Swartz

 “I think it’s important to know that when we talk to our colleagues who practiced in a pre-Roe era, there used to be wards in the hospitals that cared for people who had illegal abortions and were having complications. They were caring for very sick patients. Abortion is really safe when you have access to a safe abortion. It’s one of the safer things we can do in medicine. We know the regulations people are proposing only make abortions more difficult to access, and it doesn’t make it safer.”

Jina Dhillon    

“Restricting abortions does not reduce the number of abortions. We know that and if abortion pills, information and support are not available or readily accessible, abortion care tends to be driven underground. It becomes less safe, dangerous and even deadly.” 

“Abortion too often gets thrown into the political machinery as a wedge issue and while it’s effective, we’re all impacted. It’s usually the most vulnerable and already disenfranchised groups that are most harmed by these kinds of restrictions.”


Global trends in abortion access:

Jina Dhillon

“Last week, France moved to add abortion access to their national constitution and the outcome is to be determined. The Mexican Supreme Court ruled it’s unconstitutional to criminalize abortion, and Nepal has included abortion care in its package of national health services that will be free. It demonstrates that there is a trend in the direction of progress. These are signals that this is about healthcare and saving lives and abortion is healthcare.” 

“When Roe was overturned, we asked [Ipas] country leaders what they were seeing. In Kenya in particular, US policies carry a lot of weight, and the progress that had been made was incredibly fragile… The effect was felt immediately Anti-rights actors were emboldened to hold this decision up as a victory.”

“In Latin America, our country leader in Bolivia talked about how it will have a reverberation on other rights and access to care for survivors of sexual violence and LGBTQ rights.” 

"Anti-rights actors are diverse, they’re well-connected, they work across religious denominations and political affiliation and geographies. It’s important to note there’s no single opposition movement and the threats come from a web of actors that are incredibly well-funded, highly motivated and very politically savvy. And the threats are intersectional. It’s about gender equality, civil rights, LGBTQ rights, voting rights and the list goes on.”


On requirements to provide counseling:

 Beverly Gray

 “I think it’s disrespectful, making this assumption that healthcare providers aren’t providing adequate counseling to our patients, which we absolutely are. And it’s disrespectful to the patient… When people make up their minds and call to make an appointment, they made up their minds. To say to them, ‘You know what, we really want you to rethink this for 72 hours and sit in a corner and think about it,’ that’s just ludicrous to me.”

Jonas Swartz

 “We provide comprehensive options, counseling and help them lay out what would lead them to not want to continue the pregnancy or continue it. We know the risk of regret after an abortion is low. The predominant emotion people feel after is relief.”


On public opinion supporting abortion access:

 Jina Dhillon

 “To face the people at the table who have power, you really need a strong social justice movement. It has to be more broad-based, and I think that’s starting to swell here. We can learn a lot from that and other parts in the world where there’s been success. Latin America has had some of the most restrictive abortion bans in the world, and that’s where we’re seeing movements that changing that.”

Beverly Gray

 “If you think about movements in our country in the past, they’ve been led by this energy of the more progressive generation. My husband, who is a geographer, likes to remind me this generation of students is more progressive than the past. We may go through a period of time where things are more restrictive, but I’m hopeful that the trajectory overall will lead toward better healthcare and abortion access for our patients.”

Jonas Swartz

 “An ABC News poll shows [many] believe in access to abortion, no legal limits on abortion care. I think that even though the majority appears to be on one side of this issue, it’s not necessarily an issue that’s salient for all people at all times. I agree with Beverly that there’s a bad period  coming, but the arch is positive.”

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