Human Rights Crisis: Abortion in US Post-Dobbs

I. Executive Summary

II. Factual Background

A. Women's Lives and Health on the Line

B. Penalizing Healthcare: Criminalization, Civil Liability, and Involuntary Confinement

C. Threats to Privacy from Increased Digital Surveillance

D. Freedom of Thought, Conscience and Religion or Belief

E. Disproportionate Impact on Marginalized Populations

III. Anti-Abortion Legislation Violates International Law

IV. Conclusion and Calls to Action

I. Executive Summary

Following the United States (US) Supreme Court decision in Dobbs v. Jackson Women's Health Organization in June 2022, people in the US who can become pregnant[1] are facing an unprecedented human rights crisis. In Dobbs, the Supreme Court overturned the constitutionally protected right to access abortion, leaving the question of whether and how to regulate abortion to individual states. Approximately 22 million women and girls of reproductive age in the US now live in states where abortion access is heavily restricted, and often totally inaccessible. This briefing paper details the intensifying human rights emergency caused by the decision, and discusses the ways that Dobbs contravenes the US' international human rights obligations.

The consequences of the Dobbs decision are wide ranging. Restrictions on access to healthcare places women's lives and health at risk, leading to increased maternal mortality and morbidity, a climate of fear among healthcare providers, and reduced access to all forms of care. Dobbs also enables penalization and criminalization of healthcare, with providers, patients, and third parties at risk of prosecution or civil suit for their involvement in private healthcare decisions. Relatedly, the decision opens the door to widespread infringement of privacy rights as digital surveillance is expanded to detect violations of new regulations. New bans also infringe on freedom of thought, conscience and religion or belief, restricting the ability of physicians to counsel patients and clergy to provide pastoral care to their congregants. Finally, the harms of Dobbs violate principles of equality and non-discrimination; they fall disproportionately on marginalized populations including Black, indigenous, and people of color; people with disabilities; immigrants; and those living in poverty.

By overturning the established constitutional protection for access to abortion and through the passage of restrictive state laws, the US is in violation of its obligations under international law, codified in a number of human rights treaties to which it is a party or a signatory. These human rights obligations include, but are not limited to, the rights to: life; health; privacy; liberty and security of person; to be free from torture and other cruel, inhuman, or degrading treatment or punishment; freedom of thought, conscience, and religion or belief; equality and non-discrimination; and to seek, receive, and impart information.

A version of this briefing paper was submitted to UN special procedures mandate holders in March 2023. The submission, cosigned by nearly 200 human rights, reproductive justice, and other concerned groups and individuals, requested urgent action from the UN mandate holders to examine the situation, engage with civil society, and call on the US to uphold its international human rights obligations.

Less than a year on from this catastrophic legal decision, it is now apparent that the consequences are even worse than feared. Women and girls in need of reproductive healthcare are being met with systematic refusals, onerous financial burdens, stigma, fear of violence, and criminalization. Thousands are being forced to remain pregnant against their will.

Part II of this briefing paper outlines the consequences of Dobbs on the fundamental human rights of women and girls, as well as the disproportionate impact it has on certain demographics made vulnerable by systemic oppressions. This factual summary includes input from physicians in various states as part of fact-gathering efforts conducted by a number of organizations involved in this submission. Part III discusses the ways in which Dobbs contravenes the US' international obligations. Part IV sets forth our Conclusion and Calls to Action.

II. Factual Background

1. In June 2022, the US Supreme Court overturned the constitutionally protected right to access abortion,[2] leaving the question of whether and how to regulate abortion to individual states.[3] As of January 17, 2023, abortion is banned, with extremely limited exceptions, in thirteen states: Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, Wisconsin, and Oklahoma.[4] Georgia has banned abortion after six weeks of pregnancy (effectively outlawing access entirely).[5] Approximately 22 million women and girls of reproductive age (ages 15-49) in the US live in states where abortion access is heavily restricted, and often totally inaccessible.[6] Four states have begun restricting access to medication abortions, including by prohibiting the mailing of medication into their jurisdictions.[7] Meanwhile, at least three states (Texas, Oklahoma, and Idaho) enacted so-called "bounty" laws before the Dobbs decision, empowering private citizens to sue providers who carry out abortions.[8] In continuation of the country's devaluation of the lives of Black and Brown women, communities of color and of lower socio-economic status are bearing the brunt of these laws.[9] Dozens of clinics have closed across the country since Dobbs was decided,[10] increasing travel time and distance for women seeking care - and barring access for those women unable to travel.[11]

A. Women's Lives and Health on the Line

2. The onslaught of legislative abortion restrictions in the US denies women's decisional and bodily autonomy in a way that rejects the agency, dignity, and equality of people who can become pregnant.[12] This draconian attack on gender equality threatens women's lives and health on a massive scale.
3. In the months since Dobbs, two of the organizations involved in this submission have interviewed US healthcare practitioners about the impacts of anti-abortion legislation on women's healthcare.[13] The practitioners' responses describe far-reaching implications for women and girls seeking abortion and other reproductive healthcare, dramatically affecting their health, and resulting in serious - sometimes fatal - risks.
4. These interviews and documentation by women's rights groups describe difficulty, including:

• in accessing abortion in cases of miscarriage;
• forced travel across state lines in emergencies;
• denial of care in cases of ectopic pregnancy;
• hospitals delaying care until the woman's health has deteriorated to a level most certainly to fit within narrow and vague "risk to life of the mother" exceptions;
• professionals withholding information fearing that their advice could violate anti-abortion laws;
• reduced access to non-reproductive healthcare (e.g. chemotherapy);
• the infliction of serious psychological harm on women and girls forced to carry an unwanted pregnancy;
• complications for adolescents forced to give birth;
• reduced access to other forms of reproductive healthcare including contraception;
• heightened risk of violence faced by pregnant individuals in abusive relationships; and
• pregnant individuals forgoing prenatal care to avoid surveillance.

5. Anti-abortion legislation may also reduce access to reproductive healthcare in states where abortion is still legal, as patients are displaced from restrictive jurisdictions into already-overburdened clinics in jurisdictions where abortion remains legal.
6. The accounts provided by the interviewed professionals are shocking. Dr. Lisa Harris, Professor of Obstetrics and Gynecology at University of Michigan Medical School, described how a patient treated at her institution for ectopic pregnancy - a life-threatening condition in which an embryo implants outside of the uterus and therefore cannot result in a healthy pregnancy and requires an abortion - had to travel from her home state, Ohio, to Michigan because she could not find a doctor willing to treat her in Ohio after their six-week abortion ban came into effect in June 2022.[14] More broadly, Dr. Harris commented that, in the six months between the overturn of Roe v. Wade (Roe)[15] and the passage of Michigan's constitutional amendment protecting abortion access, some faculty and trainees with whom she works decided not to provide abortion care because of the potential risk of prosecution should Michigan's 1931 abortion ban come into effect.[16]
7. Dr. Elissa Serapio, an obstetrics and gynecology specialist (or OB-GYN, a doctor who specializes in pregnancy and female reproductive health), worked in Texas in the aftermath of the state's six-week abortion ban in 2021. Dr. Serapio explained that her colleagues were forced to watch their patients' health deteriorate before providing abortions due to the narrow exceptions for legal abortion where the "life of the mother" is at risk.[17] This challenge, Dr. Serapio noted, applied even when there was a zero percent chance that the pregnancy in question could result in a live birth.[18]
8. Dr. Eleanor Drey, Medical Director of the Women's Options Center and the Family Birth Center at San Francisco General Hospital, explained that physicians in states with abortion bans are now faced with two bad options: leave their patients to suffer harm or else risk prosecution.[19]
9. While the array of state level abortion bans ostensibly have "exceptions" to safeguard the life and/or health of the pregnant person, these exceptions are unworkable. Replete with vague and non-medical terminology, the "exceptions" to protect women's health and lives may be difficult to implement in practice, because their terms do not necessarily correspond with medical diagnoses and sometimes exclude health-threatening conditions.[20] Medical professionals report that the restrictive legal landscape means that they are generally unsure whether and when medically necessary, and even lifesaving, abortions are legal. They note that such uncertainty causes both healthcare providers and institutions to delay or deny abortion and other reproductive healthcare.[21] These dangerous chilling effects were foreseeable: research from other countries has long demonstrated the chronic unworkability, and concurrent danger, of general abortion prohibitions with exceptions to "save the life of the mother" or for "medical emergencies only."[22]
10. Several women who have been denied care in this way have bravely shared their experiences publicly. In July 2022, a woman had to travel hundreds of miles to a different state for a lifesaving abortion. Though she was experiencing an ectopic pregnancy (one of the leading causes of maternal mortality in the first 12 weeks of pregnancy)[23] her doctor would not end the pregnancy because he was "worried that the presence of a fetal heartbeat meant treating her might run afoul of new restrictions on abortion."[24]
11. In Wisconsin, hospital staff would not remove the fetal tissue for a patient with an incomplete miscarriage for fear that it would violate that state's abortion ban.[25] She was left to bleed at home for more than 10 days.[26] While the patient survived and expelled the tissue safely, delays in miscarriage care - now common in anti-abortion states - pose serious risks to women's health. Delays in expelling tissue following miscarriage can lead to hemorrhaging and life-threatening sepsis,[27] and can potentially impact future fertility.[28] Delayed care can also cause serious psychological suffering and trauma for women and families already dealing with pregnancy loss.[29]
12. Moreover, risk-averse hospitals often fail to give healthcare teams the information they need to feel comfortable making such a medical decision. In Dr. Serapio's experience, hospitals leave medical teams to make these decisions - and assume the risk that goes with them - alone.[32]
13. The chilling effect of anti-abortion legislation may also cause physicians to withhold information from patients for fear that their medical advice could violate their state's anti-abortion statutes.[33] Doctors report that the rapidly shifting landscape has impacted their ability to counsel patients, including full information on dealing with pregnancy complications and options for patients from across state lines: "We're trying to be very, very careful," said Dr. Katie McHugh, in an interview with National Public Radio (NPR), "And it is so scary to me to know that I'm not only worrying about my patients' medical safety, which I always worry about, but now I am worrying about their legal safety, my own legal safety. The criminalization of both patients and providers is incredibly disruptive to just normal patient care."[34]
14. Dr. Jennifer Griggs, a Professor in the University of Michigan's Department of Internal Medicine, Hematology & Oncology Division, also spoke to the impact of abortion restrictions on women's access to healthcare more broadly - even non-reproductive care.[35] She described how the legal landscape post-Dobbs leaves pregnant people and their clinicians in an untenable situation, risking the life of a pregnant patient by delaying treatment for a range of health conditions.[36] For example, she reported that anti-abortion laws challenge doctors' ability to provide cancer treatment in a timely manner. Because treatments such as chemotherapy and radiation can harm a fetus, particularly during early pregnancy, laws that restrict women's termination options can force them to delay cancer treatments until later in pregnancy when the risks are lowered or until they have given birth. Such delays, however, can put the patient's life at risk.[37] The uncertainty of the law under state abortion bans also has what Dr. Harris refers to as a "coercive negative impact on patients," in which concerns about restrictive or uncertain abortion regulations lead doctors or patients to make suboptimal decisions about a patient's course of treatment.[38]
15. Girls and adolescents are at increased risk of life-threatening consequences owing to delayed reproductive healthcare. Because girls and adolescents experience serious pregnancy-related complications at a higher rate than adults,[39] including, trauma to organs,[40] pregnant adolescents are particularly at risk when healthcare providers delay care. Despite this heightened vulnerability, none of the state abortion bans recognize an exception specifically for adolescent pregnancy.[41] Even before Dobbs, young people under 18 in at least 36 states faced "parental involvement" requirements forcing them to notify and/or seek permission from a parent to get an abortion. These restrictions remain in place in more than 20 states where abortion is still legal.[42] While most young people who have abortions voluntarily involve at least one parent in their decision, forced parental involvement laws put young people's health and safety at risk. Young people without a supportive parent to involve in their abortion decision - for example, those who "fear physical or emotional abuse, being kicked out of the home, alienation from their families or other deterioration of family relationships or being forced to continue a pregnancy against their will"[43] - generally have the option to go through a judicial bypass process to request permission from a judge to access abortion care. However, the process for securing a bypass is daunting and unworkable for many young people.[44] A recent study by Human Rights Watch revealed that Florida judges denied more than one in eight young people's petitions in 2020-2021.[45] These children and adolescents were then forced to continue a pregnancy against their wishes, travel outside the state, or seek a way to manage abortion outside the health system.
16. Abortion bans also harm women's health in ways unrelated to pregnancy complications. Abortion restrictions can increase the risk of violence for pregnant individuals who are exposed to abusive relationships. Studies reveal that many victims of intimate partner or domestic violence seek abortions to prevent further abuse.[46] The inability to obtain an abortion can force victims to remain with their abusers.[47] These impacts are compounded for women from marginalized groups, who are more likely to experience domestic violence[48] and are less likely to have access to an abortion if the procedure has been banned in their state.
17. Abortion bans can also increase the risk of suicide. Medical exceptions to abortion bans in the US do not provide for psychological risks to life or health.[49] This limitation prevents physicians from providing abortion care even if they have a well-founded fear that their patient will attempt suicide if forced to continue their pregnancy.[50] Federal guidance regarding the provision of emergency medical care does not explicitly mention mental health under emergency medical conditions that may require abortion.[51] In Dr. Drey's experience, suicide risk is especially pronounced in some of her teenage patients who develop "post-traumatic stress disorder or suicidal ideation as a result of their pregnancies and make plans to commit suicide if they cannot obtain an abortion."[52] For individuals who have become pregnant as a result of rape, this risk can also be heightened, Dr. Drey explained.[53]
18. Even more starkly, pregnant people who attempt suicide can be charged with attempted feticide, manslaughter, or murder in some states.[54] For example, in 2011 in Indiana, Bei Bei Shuai, an immigrant woman from China, attempted suicide and was subsequently charged with murder and feticide for attempting suicide while pregnant, based on the prosecutor's interpretation of the murder code to include fetuses.[55] As the zeal for prosecuting pregnant individuals increases,[56] there is a significant risk that abortion bans with fetal personhood language can use a pregnant person's need for mental health support as a reason to funnel them into the criminal-legal system whilst simultaneously failing to address the underlying health issue.
19. Abortion bans also reduce the quality and availability of other forms of necessary reproductive healthcare, such as contraception, pre- and postnatal care, and preventative annual exams.[57] One reason for this is that the reproductive healthcare clinics that provide this treatment are often financially unable to stay open when abortion services become illegal.[58] Some communities are facing reductions in care because their obstetricians have moved or are considering moving to states where abortion is still legal.[59]
20. Even obstetric training is being impacted. Medical schools in anti-abortion states are limited in what they can teach about abortion, and young doctors are choosing to study - and eventually practice - elsewhere.[60] A research study mapping US residency programs predicted that almost 44% of OB-GYN residency programs are located in states that have already banned or are likely to ban abortions.[61] As more states ban or limit abortion, medical students may prefer to train in states where abortion is legal. Consequently, existing divides in healthcare access will deepen as many medical residents choose to practice where they trained.[62]
21. Anti-abortion legislation also has a chilling effect on patients' access to healthcare services more broadly. Access to healthcare in the US depends in part on access to insurance, and for many low-income individuals, the most available insurance provider is the federal government-run Medicaid system. Enrollment in Medicaid is limited by income level, but income caps for the program are higher for pregnant and postpartum individuals.[63] As a result, many low- and middle-income patients who have otherwise been excluded become eligible for the first time when they become pregnant.[64] This increased access to healthcare includes coverage for pre- and postnatal care, but also for non-pregnancy-specific care such as health screenings, hospital visits, and emergency care.[65] This window of increased access thus provides an opportunity for patients to be screened for a host of conditions.
22. But criminalization of certain pregnancy outcomes discourages engagement with the healthcare system, leading to reduced prenatal care and worse health outcomes for pregnant people and infants alike. For example, the number of women receiving any prenatal care markedly dropped in Tennessee while the state's law criminalizing any prenatal drug use was in effect, as pregnant people were threatened with criminal prosecution for a host of pregnancy outcomes and therefore avoided contact with formal healthcare.[66] The reduction in access was more pronounced for populations marginalized along class lines[67] and was associated with measurably worse health outcomes for mothers, fetuses, and newborns.[68] New abortion bans and criminalization can be expected to instill fear in pregnant patients[69] and create confusion over potential criminal liability, further reducing access to healthcare for vulnerable populations while increasing punitive surveillance of marginalized women.[70] Pregnant people - even those who wish to continue their pregnancies - may forgo prenatal care to which they are entitled altogether to avoid falling under surveillance.
23. Abortion access is also threatened in states where abortion is still legal. Due to the rapidly changing legal landscape and fears of future legal consequences, some providers feel forced to suspend services even where abortion has not yet been outlawed. For instance, in West Virginia, the only abortion clinic in the state stopped performing abortions shortly after Dobbs was decided, even though the state's pre-Roe abortion ban had not fully entered into force.[71] In Arizona, where a legislative attempt to ban abortion has been blocked by the courts, nine of the state's ten clinics have nevertheless stopped providing abortions.[72] A provider in Arizona reported that she had decided to suspend abortion services because, as a Black doctor, she felt particularly vulnerable to potential criminalization. She noted "abortion is still legal but that would not stop someone from causing a legal disaster that I would not be able to recover from."[73] Providers are hesitant to move to or continue practicing in states where restrictions are increasing or unstable, citing "an atmosphere … perceived as antagonistic to physicians."[74] This dynamic deepens existing shortages of physicians, nurses, and other skilled providers.
24. The chaos has spilled over to states where abortion is expected to remain legal. As patients are displaced from their home states by abortion prohibitions, providers in states where abortion remains legal are seeing an influx of patients, placing a large strain on already overtaxed clinics.[75] Clinics in less restrictive states often do not have enough staff. As Dr. Serapio explained, it can be difficult to find qualified staff because of the need for specialized training and experience.[76] Given the legal landscape over the past few years, obtaining the requisite formal and practical experience is difficult, so qualified staff was already in short supply.[77]
25. Abortion providers also suffer risk to their physical safety and lives in the US. Both in their clinics and in their homes, many providers and other staff report being in near constant fear of attack from extremists within the anti-abortion movement.[78] Extremist anti-abortion vigilantes have kidnapped, attacked, bombed, and even murdered abortion providers.[79] In 2021 alone, the National Abortion Federation reported 1,465 incidents of violence against providers across the US.[80] The widespread organized campaigns of harassment and violence appear to have been emboldened in recent years by the movement's broader success in restricting abortion.[81] Notably, those who target providers and clinic workers and harass abortion seekers often have ties to violent extremist movements. For instance, a number of violent anti-abortion extremists were documented at the January 6, 2021 coup attempt at the US Capitol.[82] As recently as January 15, 2023, an anti-abortion group carried out an arson attack on a clinic in Illinois.[83]

B. Penalizing Healthcare: Criminalization, Civil Liability, and Involuntary Confinement

27. Following Dobbs, 13 states' statutes now criminalize healthcare providers who perform abortions.[84] Penalties include up to life in prison (Texas)[85] and fines as much as $100,000 (Oklahoma).[86] Some states also impose criminal liability for "aiding or abetting" abortion, making it a crime for any individual, whether a healthcare provider or not, to assist a pregnant person in obtaining an abortion.[87] This can apply to hospital administrative staff, therapists, and other medical professionals who have discussed or provided information about obtaining an abortion; family, friends, or religious leaders; or even rideshare or cab drivers who transport patients to abortion clinics.[88] Employers, family members or friends who contribute financially or provide other forms of support can also be criminalized.[89]
28. Individuals can also face civil penalties for "aiding and abetting" abortion in some states. Texas, for example, provides for privately enforced civil liability,[90] in addition to its criminal ban.[91] This threat of private suits places further pressure on providers to cease providing any abortion care whatsoever - even for patients who experience complications making abortion medically necessary and permitted under the state's criminal restrictions - because they may have to defend themselves from a costly lawsuit brought by a bystander.[92] As Dr. Serapio explained, the law has left providers in Texas feeling potentially surveilled by everyone around them and questioning whether private discussions with their patients could land them in front of a judge.[93]
29. Some states are attempting to enforce their bans across state lines. Although the legality of this strategy is uncertain,[94] lawmakers in several states that have banned abortion have proposed legislation to "allow private citizens to sue anyone who helps a resident of that state… terminate a pregnancy outside the state," from an out-of-state physician who performs a procedure to a driver who conveys a patient across state lines.[95] For example, Missouri lawmakers introduced a bill in 2021 that claimed jurisdiction over any pregnancy conceived within the state or where the parents were Missouri residents.[96] While the law was not adopted, another bill introduced last year is intended to allow private enforcement across state lines.[97] These cross-border efforts expand the threat of prosecution beyond providers practicing in restrictive states, creating uncertainty for providers[98] even in states where abortions remain legal, and infringing on women's freedom of movement.
30. Pregnant individuals themselves are also at risk of criminalization.[99] In some states, officials have indicated a willingness to arrest those who self-induce abortion.[100] In Idaho, a statute from 1973 remains a potential threat: a woman "who purposely terminates her own pregnancy otherwise than by a live birth" can be found guilty of a felony.[101] Similarly, some states have begun to explore criminalization approaches based on "fetal personhood,"[102] a concept which attributes legal rights to a fetus.[103] If adopted, these provisions will increase prosecutions targeting pregnant people by classifying abortion as homicide and permitting prosecution of those who receive such treatment for murder or manslaughter.[104] A Louisiana House of Representatives committee voted in May 2022 to amend criminal laws to make abortion qualify as a homicide.[105] While the bill was subsequently withdrawn, other states are exploring fetal personhood approaches to criminalizing a range of pregnancy outcomes.[106]
31. Even prior to Dobbs, prosecutors charged pregnant women and girls in situations where they suspected that the woman's actions during pregnancy harmed the fetus.[107] Alleged conduct deemed worthy of prosecution went beyond suspected abortions to include using drugs (even where prescribed by a doctor), drinking alcohol, and falling down stairs.[108] For example, in 2020, a pregnant woman from Alabama was prosecuted for using pain medication prescribed by her doctor, even though it was established after the baby was born that the child suffered no adverse consequences.[109] In 2014, a pregnant woman who took just half a Valium pill and whose child was born healthy was charged with "chemical endangerment of a child."[110] Pregnancy Justice, one of the organizations involved in preparing this submission, has documented more than 1700 instances of arrests, forced medical interventions, and other deprivations of liberty of pregnant people since 1973, with 1331 of these cases occurring between 2006-2020.[111] This sharp escalation in arrests engenders significant concern given that states now have no restrictions on their ability to criminalize women for their reproductive outcomes.
32. Some jurisdictions also have policies of civil or administrative detention to hold pregnant girls and women in custody - even without criminal charges - if they are suspected of using controlled substances during pregnancy.[112] Thus even in states that do not explicitly criminalize women who seek abortions, authorities have used civil commitment and involuntary substance abuse treatment to detain individuals for allegedly endangering their fetuses.[113] Following their 2016 country visit to the US, the UN Working Group on arbitrary detention observed, "The civil proceedings to commit pregnant women are often in closed hearings, lack meaningful standards and provide few procedural protections. In some states, important early hearings may take place without the mother having legal representation, as the pregnant woman does not have the right to appointed counsel although the fetus has a court-appointed guardian ad litem."[114] Pregnant individuals have been arbitrarily detained under these policies for months at a time. Because spontaneous miscarriage and self-managed abortion are medically indistinguishable in most cases,[115] prohibitions on abortion will predictably lead to the investigation and detention of many women experiencing miscarriages as well as those self-managing abortions.
33. Those targeted for detention and criminalization are more likely to be Black, Indigenous, and people of color (BIPOC) individuals,[116] contributing to the already disproportionately high level of incarceration of BIPOC persons in the US.[117] For example, out of 413 cases of arrest or forced intervention of pregnant persons documented between 1973 and 2005, 71% were economically disadvantaged women, 59% were women of color, and 52% were Black.[118] Communities of color, especially Black communities, are disproportionately impacted by pregnancy criminalization due in part to the heightened policing of these communities under the auspices of the "war on drugs."[119] As the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health has already described, "given that the country's criminal legal system already disproportionately polices women and girls of African descent, [this] is the population group that suffers the most from increased surveillance and criminalization."[120]
34. Finally, the criminalization of abortion threatens to further affect the relationship between patients and their healthcare providers. Providers fear that their actions, or even their words, could be used against them in court. Patients may be afraid to seek care[121] and worry that providers will act as an arm of the police by collecting evidence and reporting them to the authorities if they suspect an abortion has been induced.[122] Since BIPOC individuals already face well-documented barriers to obtaining proper medical treatment and are subject to over-policing,[123] they are put at particular risk.[124]
35. The ultimate impacts of abortion criminalization have not yet been fully realized, but it is reasonable to expect this criminalization to have a chilling effect on women's health generally, to increase risks to women's lives, and to lead to further arbitrary detention of women and girls.

C. Threats to Privacy from Increased Digital Surveillance

36. The proliferation of abortion bans in the US has decimated reproductive autonomy - the power to control all aspects of one's reproductive health - which is "at the very core of [individuals'] fundamental right[s] to equality and privacy."[125] The right to privacy of individuals (irrespective of whether or not they are pregnant) and the rights of medical professionals are also threatened by states' use of digital surveillance to track the identities of people who seek or provide reproductive healthcare.
37. Because many states now criminalize abortion, law enforcement officials in these states are using electronic data to prosecute patients or those who help them access abortion.[126] This personal information is wide in scope and may include:

• location data to show if someone visited an abortion clinic, substance use disorder treatment center, or other health facility;
• search histories on medication abortion, clinics, and general information on abortion;
• menstrual cycle tracking applications; and
• communications data such as text messages about pregnancy and abortion.[127]

38. The pre-Dobbs case of Latice Fisher, who was charged with second-degree murder after a stillbirth when investigators found the words "mifepristone" and "misoprostol" in her phone's search history, shows how these tactics were used even while Roe was still in force.[128] Now that abortion is explicitly criminalized in many states, law enforcement's use of digital surveillance to track abortions is likely to increase.
39. Notably, law enforcement can access many of these sensitive personal records without a warrant. The legal standards for accessing novel digital evidence like location data vary depending on whether the data are obtained directly from the suspect (as in a search of a person's cell phone), via an order issued to a third party (e.g. warrants issued to Google or Meta), or through purchases from data brokers[129] (i.e. individuals or companies that collect and aggregate many types of personal information usually from online sources).[130] This means that many of the usual limitations on police searches designed to protect defendants and prevent overbroad surveillance do not apply to all law enforcement access to personal information.[131]
40. Purchasing data from brokers provides particularly easy and so-far unregulated law enforcement access to an unprecedented volume of sensitive personal information for use in prosecuting individuals seeking abortions - or even reviewing their options for reproductive care - often without any oversight by courts.[132]
41. As with most aspects of abortion bans, these surveillance tactics will disproportionately affect marginalized individuals. BIPOC women, particularly Black women, are more likely to suffer miscarriages,[133] which are generally indistinguishable from medically induced abortions.[134] Combined with existing higher law enforcement surveillance rates of these communities,[135] these factors mean that BIPOC women will face higher rates of privacy infringement. Additionally, low-income women face surveillance and privacy intrusions not only from the government as a result of receiving government benefits, but also from employers monitoring workplace conduct and performance.[136] They also face financial barriers to protecting their privacy.[137] As a result, the privacy of BIPOC, low-income, and otherwise marginalized women will be violated disproportionately.
42. Private parties including anti-abortion activists also use technology to gather data on both providers and pregnant people. For instance, anti-abortion groups have used mobile geo-fencing technology to target patients at abortion clinics with anti-abortion advertisements.[138] Anti-abortion centers known as "crisis pregnancy centers" and "abortion alternatives" hotlines also collect data on pregnant individuals.[139] In states such as Texas, which offer a bounty for citizens to bring civil lawsuits against anyone aiding and abetting an abortion, private parties may have a particular incentive to purchase abortion-related data. In May 2022, journalists revealed that they were able to purchase location data of individuals who visited Planned Parenthood centers for just $160 from a data broker - in the context of possible $10,000 bounties under the Texas law.[140] The purchased data are purportedly "anonymized," but due to the small number of devices visiting these locations, it is often possible to de-anonymize the data (i.e. link to specific individuals).[141] These practices are emerging and evolving in a landscape without protections, as "the U.S. lack[s] a comprehensive set of federal digital privacy laws."[142]

D. Freedom of Thought, Conscience and Religion or Belief

43. Some forms of anti-abortion legislation in the US infringe upon the right to freedom of thought, conscience, and religion or belief under international human rights law. First, anti-abortion laws that prevent providers and/or clinic staff from providing abortions to pregnant persons may infringe upon the provider's freedom to manifest their freedom of conscience and religion or belief. For some healthcare providers, their religion or beliefs (including non-theistic beliefs) mandate that they provide healthcare (including abortion) when a person's life, health, or well-being is at risk. For example, Jewish physicians in Florida have explained in a lawsuit that their faith compels them to provide abortion to patients where the patient's life, health or well-being is at risk.[143] For these and other healthcare workers, criminal abortion laws eviscerate their freedom to manifest a key aspect of their faith.[144]
44. Even religious leaders and clergy members risk falling afoul of abortion laws in the US for providing pastoral care, guidance, and religious teaching. For faith leaders whose belief system affirms the right to abortion, counseling on reproductive healthcare in accordance with their faith could fall within the aforementioned broad crime of "aiding or abetting" an abortion. Members of the Unitarian Universalist Church in Florida have been forced to turn to the courts to seek injunctive relief against the law's attempt to punish them for providing ministry and serving their congregants in this way.[145] Specifically, these clergy members underscore that counseling in line with their faith involves explaining the tenet of the "God-given right to self-determination over their own bodies and reproductive lives."[146] But if a pregnant person has an abortion following a conversation on this area of the church's doctrine, the clergy members could face prosecution for aiding, abetting, or encouraging abortion.
45. Crucially, laws that criminally prosecute or otherwise punish people of faith who feel obligated by their religion or belief to help others access abortion, or to counsel congregants on abortion care, do not meet the thresholds set by international law that would permit the State to limit their freedom to practice their religion or belief. The right to manifest one's religion or belief may be subject only to such "limitations as are prescribed by law and are necessary to protect public safety, order, health, or morals or the fundamental rights and freedoms of others."[147]

E. Disproportionate Impact on Marginalized Populations

46. Dobbs is devastating for all people who can become pregnant, but it has had and will have an outsized impact on certain marginalized groups who already face documented discrimination within and outside the healthcare system. This includes BIPOC women, people of diverse gender identities and sexual orientations, migrants, persons with disabilities, people who are low-income or living in poverty, children, and rural residents.[148] These groups often have poorer health outcomes compared to other populations,[149] and Dobbs will worsen these disparities, since individuals who belong to these groups have fewer resources and face discrimination from the healthcare community.[150]
47. For people with disabilities, "[c]onstitutional protection for bodily autonomy is of vital importance… because that protection has far too often been denied to them in both reproductive and non-reproductive contexts."[151] The Autistic Self Advocacy Network and the Disability Rights Education and Defense Fund note in their Dobbs amicus curiae brief that the US has a history of engaging in the forced sterilization of persons with disabilities, particularly targeting people of color with disabilities.[152] Individuals with disabilities have been continuously denied reproductive autonomy, and many fear the Dobbs decision will further entrench these policies and erode what progress they have achieved toward the protection of their bodily autonomy.[153]
48. Communities marginalized by racial discrimination and oppression also face barriers in accessing healthcare, which severely and negatively impacts these communities. Indigenous Americans experience statistically worse healthcare outcomes than other populations in the US[154] and already had difficulty accessing abortion long before Dobbs.[155] The same is true for Black Americans, who have always faced high barriers to accessing healthcare.[156] Hence, individuals who belong to more than one marginalized group, such as rural Black Americans, face especially high barriers.[157] Access to abortion - and indeed to quality healthcare - has never been equitable for persons from marginalized communities in the US. Dobbs exacerbates many of these inequities by, for example, requiring individuals to travel farther for care and often out of state. Women of color are more likely to fall below the poverty line than white women and therefore feel the costs of interstate travel for healthcare particularly acutely. They are also less likely to have paid time off or paid sick leave to allow for travel, and face additional discrimination to obtain necessary healthcare.[158]
49. Migrants and asylum seekers face further barriers in accessing reproductive healthcare.[159] Irregular immigration status prevents millions of individuals from qualifying for health insurance programs in general, and creates particular barriers to accessing insurance that covers reproductive healthcare services.[160] Immigrants also face mobility restrictions. Many US states require documentation of immigration status in order to receive a driver's license, and some of the most restrictive bans on abortion are in states (such as Texas) that host a network of Border Patrol checkpoints.[161] Undocumented immigrants who seek to cross state lines to access abortion care are at risk of arrest, detention, and deportation. As Dr. Serapio explained, for individuals who are undocumented and/or unauthorized, or who have undocumented and/or unauthorized family members, travel out of state is therefore not an option due to the possible legal ramifications, even where resources are available.[162]
50. Youth with migrant status or with families that have mixed migration or documentation statuses face particular barriers in states where parental consent is required for abortion. For example, immigrant youth may lack access to a qualifying parent living in the country; immigrant parents may not be able to provide legally valid consent if they lack documentation of their legal status; and younger people with migrant status may be deterred from seeking healthcare or involving a parent by a general fear of immigration consequences for themselves or their families.[163] In these cases, immigrant youth may be forced to seek a judicial bypass or remain pregnant involuntarily.[164]
51. State abortion bans have also led to the closure of reproductive health clinics that, in addition to abortion, provide non-abortion-related medical care upon which many individuals from vulnerable groups rely.[165] In general, the states enacting bans have some of the worst healthcare systems in the country and have historically dedicated few resources for low-income residents.[166] Lawmakers passing abortion bans have for years refused to address these problems.
52. Rates of sexual violence against individuals in marginalized communities are also significantly higher than for the rest of the population.[167] Since many state laws prevent pregnant persons from obtaining an abortion even in circumstances of rape or incest,[168] these groups face an increased risk of being forced to continue a pregnancy that is the result of sexual violence. Even where a state has a legal exception allowing for abortions in cases of rape, these exceptions are extremely difficult for survivors to access in practice because they generally require filing an official police report before a provider can perform an abortion.[169] Given low rates of reporting of sexual violence, especially among marginalized communities including BIPOC and individuals of diverse gender identities and sexual orientations, these requirements effectively bar survivors from accessing abortion care.[170]
53. Finally, Dobbs obliges many women to travel farther distances to obtain an abortion, due to state bans and clinic closures.[171] This means taking time off work, arranging childcare, and obtaining the funds to pay for travel expenses and accommodations.[172] Such laws have a disparate effect on persons of lower socio-economic status including those living in poverty. A pre-Dobbs study "found that the average travel distance to an abortion clinic [would] increase threefold - from nearly 40 to more than 113 miles - if the U.S. Supreme Court overturn[ed] Roe and restrictive state legislation kick[ed] in."[173] This prediction has been borne out: early post-Dobbs analysis shows that travel time to clinics has increased significantly for people across the country.[174] Since individuals in marginalized groups are more likely to be low-income, this travel, and thus access to reproductive services, is often beyond their means.[175] A higher percentage of individuals from these marginalized communities will be unable to travel out of state for abortion and thus will be forced to bear a child for which they likely have fewer resources to provide.
54. These barriers to access create a vicious cycle of poverty and marginalization, reinforcing existing inequalities. A study on abortion access - conducted before Dobbs was decided[176] - illustrates how abortion denial can reinforce economic and social marginalization. Based on thousands of interviews with women who sought, but were denied, an abortion, the study found that such patients are more likely to: (1) be exposed to significant health risks from delivery; (2) experience negative health outcomes over the next five years; (3) scale back their aspirations and career plans; (4) face long-term economic hardship; and (5) raise their children in poverty. In short, as the author of the study explained in a recent article, "we are about to see a deepening of existing inequalities…Being denied an abortion [will] lead[] to . . . greater poverty and health risks."[177]

III. Anti-Abortion Legislation Violates International Law

IV. Conclusions and Calls to Action

The US has violated its human rights commitments by removing constitutional protection for reproductive healthcare. The Dobbs decision subjects all those who can become pregnant to barriers to medical care, criminalization and penalization, infringements on privacy and on freedom of conscience, with disproportionate impact on already-marginalized populations. Similarly, the multiplying restrictions on abortion expose healthcare practitioners, clergy, and others to criminalization, professional sanction, and infringements on privacy and on free exercise of thought, conscience and religious belief. These impacts contravene the US's international treaty obligations to protect the rights to: life; health; privacy; liberty and security; freedom from torture or CIDT; freedom of thought, conscience, and religion or belief; equality and non-discrimination; and to seek, receive, and impart information.

In light of these violations, the US must take immediate steps to undo the grave harms caused by the Dobbs decision. The US should:

55. By overturning the established constitutional protection for access to abortion, and through the passage of the state laws discussed above, the US is in violation of its obligations under international human rights law, codified in a number of human rights treaties to which it is a party or a signatory.
56. Specifically, the US has ratified the International Covenant on Civil and Political Rights (ICCPR),[178] the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD),[179] and the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT).[180]
57. The US also signed, but has not yet ratified, the International Covenant on Economic, Social and Cultural Rights (ICESCR),[181] the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW),[182] the Convention on the Rights of the Child (CRC),[183] and the Convention on the Rights of Persons with Disabilities (CRPD).[184] As a signatory to these treaties, the US must refrain from acts that would defeat their object and purpose.[185]
58. These treaties enshrine in law numerous complementary human rights. The US has committed to respect and protect these rights; instead, it is infringing them through restrictions on abortion access. As eight Special Procedures mandate holders recently reaffirmed: "Over time, States and human rights bodies clarified that human rights treaty obligations encompass the reproductive rights of women and girls, including safe and legal abortion access."[186] These human rights obligations include, but are not limited to, the rights to: life; health; privacy; liberty and security of person; to be free from torture and other cruel, inhuman, or degrading treatment or punishment (CIDT); freedom of thought, conscience, and religion or belief; equality and non-discrimination; and to seek, receive, and impart information.[187]
59. First, abortion laws and policies in the US endanger the life and health of persons seeking abortions and people in need of emergency reproductive healthcare. These policies contravene the US' human rights obligations to respect the right to life[188] and the right to health.[189] As the Human Rights Committee (HRC) has confirmed, States parties to the ICCPR must not adopt anti-abortion measures that "result in violation of the right to life of a pregnant woman or girl" and must "provide safe, legal and effective access to abortion where the life and health of the pregnant woman or girl is at risk, or where carrying a pregnancy to term would cause the pregnant woman or girl substantial pain or suffering…"[190] States parties should also "remove existing barriers to effective access by women and girls to safe and legal abortion…and should not introduce new barriers."[191] Other treaty bodies - including the Committee on Social, Economic and Cultural Rights (CESCR), the Committee on the Elimination of Discrimination against Women (CEDAW Committee), the Committee on the Rights of the Child (CRC Committee), the Committee on the Elimination of Racial Discrimination (CERD Committee), and the Committee on the Rights of Persons with Disabilities (CRPD Committee) - have unanimously and unambiguously recognized that access to abortion, and the ability to make free decisions regarding abortion, are indispensable to the fulfillment of the right to health.[192]
60. In addition to the rights to life and health, abortion restrictions in the US also infringe the right to privacy[193] by allowing states to restrict reproductive choices and thereby to interfere with a pregnant individual's physical and psychological integrity. HRC jurisprudence has firmly established that an individual's decision to seek an abortion falls under the scope of the right to privacy.[194] The HRC has also found that some abortion bans, similar to those being enacted in the US, constitute impermissible interference with the ability to decide whether and how to proceed with a pregnancy, contrary to the right to privacy protected by Article 17 of the ICCPR.[195] Some US laws, particularly those imposing broad accessory liability on anyone who "advise[s] or encourage[s]"[196] a woman to get an abortion also infringe the freedom of a pregnant person to seek, receive, and impart information and ideas, guaranteed by Article 19 of the ICCPR.[197]
61. Further, certain state laws, particularly those that criminalize abortion and/or provide no exception in the event of rape, incest, threat to the life or health of the pregnant person, or fatal fetal anomaly,[198] violate the right to be free from torture and other CIDT.[199] The Committee against Torture (CAT Committee) has acknowledged that abortion laws and denial of abortion can result in "physical and mental suffering so severe in pain and intensity as to amount to torture,"[200] a view echoed by the former Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment.[201]
62. The CAT Committee has also affirmed that narrow exceptions only to save the life of the pregnant person, but not permitting abortions to preserve their health, are not sufficient to satisfy the requirement that States parties refrain from adopting policies amounting to torture or CIDT.[202] The HRC has likewise found that restrictions on access to abortion in cases of rape, incest, fetal anomaly, or to protect the life or health of the pregnant person violate the right to be free from torture and other CIDT under Article 7 of the ICCPR.[203] Notably, the HRC explicitly acknowledged that the right protected by Article 7 "relates not only to acts that cause physical pain but also to acts that cause mental suffering."[204] The CEDAW Committee has also found that "criminalization of abortion, denial or delay of safe abortion and/or post-abortion care, [and] forced continuation of pregnancy... are forms of gender-based violence that... may amount to torture or cruel, inhuman or degrading treatment."[205]
63. The arrest and imprisonment of individuals on abortion-related charges - including those experiencing miscarriage or stillbirth - infringes upon the right to liberty and security of the person protected by Article 9 of the ICCPR.[206] The Special Rapporteur on health has explained the link between abortion restrictions and deprivations of the right to liberty: "Where abortion is illegal, women may face imprisonment for seeking an abortion and emergency services for pregnancy-related complications, including those due to miscarriages."[207] In 2018, when reviewing El Salvador's compliance with the ICCPR, the HRC specifically urged the State party to "suspend immediately the criminalization of women for the offence of abortion." The HRC also urged the State party to "review all cases of women who have been imprisoned for abortion-related offences, with the aim of ensuring their release…."[208]
64. Expanding the grounds for civil or administrative detention of pregnant individuals for the "protection" of the fetus[209] also violates the right to be free from arbitrary arrest or detention.[210] Observing the trend of civil confinement of pregnant individuals for suspected use of drugs following a country visit in 2016, the Working Group on arbitrary detention concluded that such civil confinement "lacks due process…" and concluded "[t]his form of deprivation of liberty is gendered and discriminatory in its reach and application, as pregnancy, combined with the presumption of drug or other substance abuse, is the determining factor for involuntary treatment."[211]
65. Abortion bans also infringe upon the right to freedom of thought, conscience, and religion or belief, specifically the freedom to manifest religion or belief.[212] Manifestation of religion or belief includes "worship, observance, practice and teaching."[213] As the mandate of the UN Special Rapporteur on freedom of religion or belief has outlined, the right involves "not only the "believing," but also the "belonging" and the "behaving" in line with one's religion or belief.[214] This manifestation component of the right, also known as the forum externum, is not, however, unlimited. Article 18(3) of the ICCPR sets out the parameters of the State's authority to limit the freedom to manifest a religion or belief, providing that the right "may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health, or morals[215] or the fundamental rights and freedoms of others." Governments can apply these limits to freedom of religion or belief only for those purposes for which they were prescribed and the limits must be directly related and proportionate to the specific need on which they are predicated.[216] The HRC and the mandate of the UN Special Rapporteur on freedom of religion or belief have also clarified that restrictions may not be imposed for discriminatory purposes or applied in a discriminatory manner.[217]
66. Restrictions on a rights-holder's ability to behave in accordance with their religion or beliefs by providing abortion care do not conform to the limits set out in Article 18(3). First, these laws do not fall within the permitted exceptions because they are indeterminate. The HRC has explained that under the first criterion for limiting freedom of religion or belief, "law" must be "formulated with sufficient precision to enable an individual to regulate his or her conduct accordingly and it must be made accessible to the public."[218] As described above, the myriad state laws that criminalize abortion provision and, in some states, "aiding or abetting" an abortion, are plagued by legal ambiguity.[219] As such, for the healthcare provider who is compelled to provide abortions because of their beliefs, the state's efforts to limit their manifestation of their religion or belief is legally indeterminate, and therefore incompatible with Article 18(3).
67. Second, the state's limit on the manifestation of freedom of religion or belief is not sanctioned by international human rights law because it does not serve a legitimate aim under international human rights law. Rather than serve safety, order, health, morals, or the fundamental rights and freedoms of others, the abundance of criminal abortion laws that restrict rights-holders' freedom of religion or belief endanger people's lives and violate numerous fundamental human rights.[220] Thirdly, even if such limits on the right could be said to pursue a legitimate aim under Article 18(3), (which, we argue, they cannot) the extreme punitive measures for providing care could not be construed as proportionate. The HRC has clarified that governmental restrictions on a right must be the least restrictive among all the adequate measures that could be applied.[221]
68. Restricting access to abortion discriminates against women and girls, breaching the right to equality and freedom from discrimination on the basis of gender.[222] In its communications to the State party in Mellet v. Ireland and Whelan v. Ireland, the HRC outlined the gender discriminatory nature of abortion criminalization, noting that Ireland's criminal abortion law subjected women "to a gender-based stereotype of the reproductive role of women primarily as mothers" and that "stereotyping [a woman] as a reproductive instrument subjected her to discrimination."[223]
69. The CEDAW Committee has explicitly recognized the gender-discriminatory nature of abortion restrictions: "It is discriminatory for a State party to refuse to provide legally for the performance of certain reproductive health services for women."[224] Elaborating on the discriminatory nature of the restrictive legal landscape for abortion in Northern Ireland in 2018, the CEDAW Committee further found, "that the failure to combat stereotypes depicting women primarily as mothers exacerbates discrimination against women and violates article 5, read with articles 1 and 2, of the Convention."[225] Similarly, the UN Working Group on discrimination against women and girls (WGDAW) has emphasized that "the right to safe termination of pregnancy is an equality right for women."[226]
70. Restrictions on abortion can also violate the right to be free from racial discrimination. The CERD Committee has explicitly indicated that restrictions on abortion that disproportionately impact racial and ethnic minorities[227] run afoul of international obligations to eliminate racial discrimination.[228] In its 2022 review of the US, the CERD Committee expressed "deep[] concern[] at the Supreme Court's ruling in Dobbs v. Jackson Women's Health Organization, of 24 June 2022, which overturned nearly 50 years of protection of women's access to safe and legal abortion in the State party; at the consequent profound disparate impact on the sexual and reproductive health and rights of racial and ethnic minorities, in particular, those with low incomes; and at the disparate impact of legislation and other measures at the state level restricting access to safe and legal abortion or criminalizing abortion."[229] The Committee recommended that the US "take all measures necessary…to provide safe, legal and effective access to abortion in accordance with the State party's international human rights obligations."[230]
71. Abortion restrictions can violate the right to be free from discrimination on the basis of socio-economic status or age as well. In Mellet v. Ireland, the HRC found that "the differential treatment to which [the woman seeking an abortion] was subjected in relation to other similarly situated women failed to adequately take into account her medical needs and socio-economic circumstances and did not meet the requirements of reasonableness, objectivity and legitimacy of purpose."[231] Accordingly, the HRC concluded that the failure of Ireland "to provide services to [the woman] that she required constituted discrimination and violated her rights under article 26 of the Covenant."[232] Similarly, the WGDAW observes, "in countries where induced termination of pregnancy is restricted by law and/or otherwise unavailable, safe termination of pregnancy is a privilege of the rich, while women with limited resources have little choice but to resort to unsafe providers and practices."[233] The Working Group observed that abortion restrictions do not decrease overall abortion rates, but only rates of safe abortions, and concluded: "This results in severe discrimination against economically disadvantaged women."[234]
72. The CRC Committee has highlighted the discrimination faced by youth seeking abortions, finding that "particular efforts need to be made to overcome barriers of stigma and fear experienced by, for example, adolescent girls, girls with disabilities and lesbian, gay, bisexual, transgender and intersex adolescents, in gaining access to such services."[235] The Committee also urged states to eliminate barriers, such as third-party consent or authorization requirements, that block adolescents and children from accessing abortion care, and recommended that states "decriminalize abortion to ensure that girls have access to safe abortion and post-abortion services, review legislation with a view to guaranteeing the best interests of pregnant adolescents and ensure that their views are always heard and respected in abortion-related decisions."[236]
73. Finally, some restrictions on abortion implicate the human rights obligations of private companies. Corporations have obligations to respect human rights, safeguard users' rights to privacy, and ensure their services are not used in ways that cause or contribute to human rights violations.[237] This includes adopting policies that protect users from unwarranted government surveillance and harassment.[238]
74. Against this backdrop, it is no surprise that the Dobbs decision was greeted with international condemnation. Then-UN High Commissioner for Human Rights Michelle Bachelet Jeria described the decision as a "setback after five decades of protection for sexual and reproductive health and rights…"[239] UN human rights experts representing diverse mandates concluded that Dobbs is "a shocking and dangerous rollback of human rights that will jeopardize women's health and lives… [and it is] a monumental setback for the rule of law and for gender equality. With the stroke of a pen and without sound legal reasoning, the US Supreme Court has stripped women and girls in the United States of legal protections necessary to ensure their ability to live with dignity."[240
75. Enact a federal law that enshrines the right to abortion access as a human right in accordance with the 2022 World Health Organization Abortion Care Guidelines[241] and that preempts state laws restricting abortion.
76. Take measures at the state and federal level to:
    1. Ensure the right to safe and legal abortion and reproductive healthcare;
    2. Ensure the right to seek information and consultation regarding birth control and pregnancy options;
    3. Require all health services to be provided in compliance with human rights standards;
    4. Ensure access to a full range of modern contraception, without discrimination or coercion;
    5. Remove all legal obstacles, including parental involvement laws, to accessing affordable, non-discriminatory, and quality comprehensive sexual and reproductive healthcare, including safe abortion;
    6. Protect the confidentiality of persons who can become pregnant and medical professionals by: (1) limiting the collection of patient data; (2) prohibiting the disclosure of confidential information to any third parties, including law enforcement, without consent; and (3) informing patients of their right to privacy and the confidentiality of their visit and queries;
    7. Protect medical professionals who provide abortion and other reproductive healthcare by prohibiting their prosecution, disbarment, loss of license, or other retribution or reprimanding measures;
    8. Fund medical facilities that provide access to abortion care and evidence-based, non-biased pregnancy and abortion-related information and counseling, especially in areas where minority and marginalized populations reside;
    9. Adopt a federal law that prohibits the criminalization of interstate travel for medical care, and assistance thereof;
    10. Address discrimination on the basis of disability throughout all aspects of reproductive healthcare;
    11. Address racial and ethnic origin discrimination in healthcare and health outcomes directly, through measures that: (1) remedy structural racism and intersectional discrimination; (2) make resources available to communities of color affected by reproductive health inequities; and (3) prioritize the meaningful participation and leadership of BIPOC people in all systems and at all points of decision-making processes that impact their reproductive health and rights.

As previously noted, a version of this briefing paper was submitted to UN special procedures mandate holders in March 2023. The submission requested urgent action from the UN mandate holders to examine the situation, engage with civil society, and call on the US to uphold its international human rights obligations.

The US has taken a dramatic step backwards in the protection of human rights by removing national safeguards for people who can become pregnant's health, liberty, autonomy, privacy, and equality. The harms documented in the foregoing pages will only multiply as restrictions on essential healthcare increase.