Disabled People Face Renewed Threats to Autonomy After Dobbs Decision

by | Jul 18, 2023 | Reproductive Rights

It has been over a year since the Supreme Court of the United States stripped those who can give birth of the guaranteed, constitutional right to abortions and to choose whether, if and when to have a child. Dobbs v. Jackson Women’s Health Organization was an attack on bodily autonomy – particularly on women, disabled people, people of color, the LGBTQIA+ community, and other marginalized communities. However, discussions about abortion access and the impact of Dobbs on disabled people are often overlooked. While we view this Disability Pride Month as an opportunity to highlight this important intersection, it should not, and cannot, be the only time of year we seek to include or consider disabled people in conversations about abortion and reproductive justice.

Reproductive freedom and access to abortion care are critical to the economic security, health, well-being, dignity, and autonomy of disabled people and their families, particularly disabled women of color. Disabled people – particularly disabled women – face regular attacks on their reproductive freedom and decisions on whether, if and when to parent. Attacks on the right to abortion disproportionately impact disabled people and women. Norma McCorvey, also known as “Jane Roe” and the litigant at the center of Roe v. Wade, herself was at one point a ward of the state who had experienced significant trauma and substance use. While the disability and reproductive rights and justice movements have historically struggled to interact around issues like abortion, these movements are aligned in their goals to ensure bodily autonomy for all people – including disabled women and pregnant people.

Abortion restrictions, along with other attacks on reproductive autonomy, are steeped in a history of sexism, racism, ableism, and eugenics. In a case from 1927, Buck v. Bell, the Supreme Court upheld Virginia’s forced sterilization laws and procedures. Plaintiff Carrie Buck’s mother was determined to be “feeble minded” based on her sexual behavior. Carrie Buck was taken out of her mother’s custody. Eventually, she met the same fate as her mother after being impregnated as a result of a rape committed by her foster family’s nephew. In the ruling, Justice Oliver Wendell Holmes wrote, “It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. . . . Three generations of imbeciles are enough.” This ruling has never been expressly overturned.

As this case shows, blatant attacks on the bodily autonomy of disabled people to make their own choices about their bodies are not new and have been happening throughout our history to the present day. Decisions about disabled people’s bodies are often made based on what is easy, convenient and comfortable for others, leaving disabled people with little to no autonomy. People of color and disabled people, particularly women of color and disabled women, have long been subjected to attacks on their bodily autonomy. The roots of gynecological practice in the United States were based on inhumane experimentation of enslaved Black women, and the first birth control pill was tested on women in Puerto Rico without their consent. Disabled women, women of color, and multi-marginalized women have faced, and continue to face, coerced sterilization. Over 30 states still have laws that allow for the forced sterilization of disabled people.

Moreover, disabled people are often presumed to not have or want sexual experiences. At the same time, disabled people are often viewed as “sexually deviant” or promiscuous. While these assumptions are completely contradictory, they come from the same damaging line of thinking: disabled people are viewed as objects. This eugenic reasoning leads to discriminatory assumptions about the ability of disabled women to make decisions about their own reproductive health and bodies.

Disabled people have been hit especially hard by the effects of Dobbs. In 2021, the South had the highest rates of disability in the country at 13.8 percent. An estimated 2.9 million women with disabilities live in states that have banned or are soon to ban abortions post-Dobbs. On top of that, the Hyde Amendment is still in effect. The Hyde Amendment bars the use of federal funds to cover abortions, except under certain limited circumstances. The Hyde Amendment and other similar policies impact abortion coverage under Medicaid, the Indian Health Service, Medicare, and the Children’s Health Insurance Program (CHIP). Disabled people disproportionately rely on Medicaid and Medicare. American Indians and Alaska Natives are also about 50 percent more likely to have a disability compared to the national average. When disabled people cannot afford to receive abortion care due to lack of coverage, they are effectively denied autonomy.

Pregnancy, delivery and raising a child can have a financial impact, particularly on disabled women. Disabled people are more likely to live in poverty and more likely to work in low-wage, part-time or service positions. Disabled people may also be subject to strict asset and/or income limits if they receive Supplemental Security Income (SSI), Home- and Community-Based Services (HCBS) and/or Medicaid to live and work in their communities. SSI payments in particular may not be enough to cover all living expenses. As of January 1, 2023, the maximum SSI benefit was only $943 per month for a disabled individual and $1,371 for a couple. Not only does this make it difficult to afford the medical cost of pregnancy, childbirth and raising children – it also means lost wages (due to the lack of paid family and medical or paid sick leave in these jobs) and travel costs for out of state care. Additionally, an estimated 13.4 million disabled Americans between ages 16 and 64 experience difficulty traveling, meaning that receiving abortion care in or outside of a state with abortion restrictions may be extremely hard, if not impossible.

Dobbs has put disabled people at risk of harm, and even death. Disabled people are more likely to experience complications during pregnancy. Disabled women are at 11 times greater risk of maternal mortality. Some disabilities and underlying conditions make childbirth dangerous or potentially life threatening. In Time, Keeley Knight shared that pregnancy could place fatal levels of strain on her under-developed heart. Flora Ellis shared concerns about her connective-tissue disorder leading to potential complications. Disabled people, in particular those with intellectual/developmental disabilities, are also at greater risk for maternal morbidity. Non-disabled pregnant people may also become disabled as a result of pregnancy, especially when adequate care is not provided. Birthing people with disabilities often deal with health care practitioners who lack knowledge or comfort in managing their pregnancies, which also puts them at heightened risk for pregnancy-related health complications. The lack of disabled medical professionals with diverse lived experiences contributes to this concern. Abortion bans following Dobbs are leaving disabled people, and pregnant people more broadly, with medical care providers who are unable to provide an adequate or appropriate standard of care.

Given the eugenic myth that disabled people are unable to make their own decisions and direct their own lives, disabled adults may be placed under overly restrictive guardianships. These guardianships are also a threat to disabled people’s autonomy, preventing them from making their own reproductive, health care, economic and other choices. A guardian is someone who is appointed by a court to make some or all decisions on behalf of an adult the court finds to have a diminished decision-making ability. A guardianship may be granted to make all decisions or limited to make only certain types of decisions. As the nation watched Britney Spears’ conservatorship case, we heard her testify about how she was not allowed to have more children and was forced to keep an intrauterine device (IUD) inserted. For disabled adults, this story is all too familiar. When under guardianship, the right to procreate, the right to an abortion, the right to make medical decisions and to refuse treatment are all in limbo, regardless of whether the state has maintained abortion protections post-Dobbs. Less restrictive alternatives to guardianship, like supported decision-making, can help to ensure disabled people retain the right to make their own reproductive and health care choices.

With these disproportionate impacts post-Dobbs on disabled people, and disabled women of color in particular, in mind, the National Partnership has continued to advocate for important legislation and administrative efforts to advance access to reproductive health care and abortion. Disabled people must be included in all conversations about abortion and reproductive justice. Without including disabled people, particularly disabled women of color and multi-marginalized disabled people, we cannot create sustainable solutions that work for everyone.

This post is part of our blog series examining what has happened in the year since the Dobbs decision. Read more: