Dr. Kathy Simmonds says an increase in women having to travel long distances to end an unwanted pregnancy and a higher rate of maternal mortality will be among the unintended repercussions if the Supreme Court strikes down the 50-year-old landmark law.

If the landmark Roe vs. Wade decision legalizing abortion is overturned by the Supreme Court, as a draft ruling leaked to Politico indicates, the consequences will be devastating for those without means and burdensome for states where abortion remains legal. That’s according to Katherine Simmonds, PhD, MPH, RN, WHNP-BC, an Associate Professor in the School of Nursing at the MGH Institute of Health Professions and abortion clinician for the past 30 years. 

If the power to legislate abortion remains with the states, she believes, abortion likely would be banned in conservative states and remain legal in liberal-leaning states like Massachusetts. Dr. Simmonds expects a domino effect in ways few are thinking about. 

“Massachusetts will be a magnet for people from other states because we have a lot of healthcare facilities, and that’s going to be burdensome on the abortion workforce,” says Simmonds. “People who work in the abortion field are already feeling it and already planning, but it's sort of like planning for a pandemic, right? You don’t really know what you need until you need it.” 

Simmonds, who has taught at the IHP since 2000 and is Coordinator of the Women's Health/Gender-Related track in the school’s nurse practitioner program, says women living in states where abortion becomes illegal will flood into states where abortion remains legal.  “People who have a car and means to travel will be able to get an abortion, but the more vulnerable people - the ones who probably need the abortion the most because they're really struggling with life issues, or age, or rape and incest, things like that – they’re going to be the ones really hard hit.”

Simmonds is a Women’s Health Nurse Practitioner and certified sexual assault nurse forensic examiner who has expertise in prenatal care, contraception, postpartum, and family planning. Additionally, her scholarship includes 20 peer-reviewed articles on topics such as abortion, unintended pregnancies, and medication abortion. Her research interests include reproductive health including abortion, unwanted/mistimed pregnancies, and access to services. 

Simmonds expects abortion clinics and women’s health centers to be overtaxed, particularly with women who are later in their pregnancies. Currently in the U.S., most abortions happen at less than 10 weeks of pregnancy, but Simmonds says if a pregnant woman needs to travel, she may also have to arrange for childcare, transportation, and time off from work. That all takes time. 

“So, when they arrive, they will be further along,” says Simmonds. “That’s more taxing for everybody – for the healthcare providers, for the people having the abortion, and for the wraparound services that they need, and there’s a psychological toll of that. It's going to be quite impactful for the health system in terms of absorbing these people.”

Anticipating a future need, the Commonwealth of Massachusetts recently passed a law allowing Advanced Practice Nurses and Midwives to provide abortions, which has widened the workforce net.  “Advanced Practice Nurses can do the earlier, less medically complex abortions, which will free up the physicians to be able to do the later gestations or medically complex abortions, so it's a win in terms of abortion workforce support.”

Even without the ruling from the Supreme Court, there are already restrictive measures in place from states that are making it tougher for women to have abortions. The state of Texas instituted a law that makes abortions illegal six weeks after conception. Additionally, the Lone Star state has introduced the so-called “bounty law” that allows for citizens to report to police fellow citizens who cross state lines to receive the procedure. Other states are instituting copycat laws. Several other states, most of which have political Republican super majorities, have “trigger laws” that will make abortion illegal if the Supreme Court upholds the Mississippi law that is at the center of the issue.

“In the Midwest and the South, it's becoming increasingly restrictive,” said Simmons. “So, even though abortion remains legal, for all intents and purposes it is not legal. As a result, we’re seeing a considerable influx of people from those restrictive states and that’s very burdensome to the existing abortion workforce.”

Simmonds says a second consequence will be a sharp rise in unwanted pregnancies. “People are not likely to relinquish children for adoption. They will raise them, but in sub optimal conditions, so without enough resources to be able to parent healthily and that might be because they're struggling with substance use or domestic violence,” she notes. “So, the children who are born because somebody can't get an abortion are not facing a bright future as a result, and the social services are not there to support those parents.”

Lastly, if Roe vs. Wade is struck down, an increase in mothers dying because they cannot get an abortion will be unavoidable, says Simmonds. 

“We are going to see some increase in maternal mortality because there are some people who will never have the means to travel, and they will be desperate to end a pregnancy,” she says. “We know from history they will do all kinds of things that are very harmful to their bodies to be able to try to end a pregnancy. We're going to see some uptick in that and we’re already seeing it in the states where restrictions have been applied.”