When the Dobbs decision was announced, Shefali Luthra says the U.S. was “profoundly unprepared.” Her book Undue Burden digs into this unpreparedness, offering a dramatic look at the stakes of losing Roe.
Roe v. Wade, the 1973 decision that legalized abortion in the United States, was overturned on June 24, 2022—but according to Shefali Luthra, author of Undue Burden: Life and Death Decisions in Post-Roe America, “it had been on the verge of collapse for decades.”
After all, most Medicaid recipients had lost insurance coverage for the procedure in 1977 and a plethora of restrictions—from parental consent and notification requirements for minors, to mandated counseling sessions to dissuade people from ending their pregnancies—had long kept procedural abortion out of reach for large segments of the population.
Still, when the Dobbs decision was announced, Luthra writes that the country was “profoundly unprepared.”
Undue Burden digs into this lack of preparedness by introducing diverse people who have been directly impacted by the decision—people who have had to travel hundreds of miles to have an abortion, people whose highly-anticipated pregnancies became untenable, a trans man who became pregnant shortly after beginning his transition, and a young couple who lacked the emotional and financial resources to welcome a second child, among them. Their stories are juxtaposed with those of overwrought clinicians, as well as staff at abortion funds.
The result is a poignant and dramatic look at the stakes of losing Roe and a compassionate assessment of the human toll wrought by Dobbs.
Luthra spoke to Ms. reporter Eleanor J. Bader shortly before the book’s May 21 release.
Eleanor J. Bader: Let’s start with how the book evolved.
Shefali Luthra: The book builds on the work I do as a reporter at The 19th. I had been covering SB 8, the 2021 Texas law that banned abortion after six weeks of pregnancy, and saw firsthand what it means to ban abortion access. After the Dobbs decision was announced, providers in Texas told me that, for them, Roe had already fallen.
In addition to Texas, I’d been to Kansas and Oklahoma and had talked to people who knew that these states would be affected. These conversations helped me see an emerging pattern and gave me insight into what would happen when people had to travel for care.
It was actually in Oklahoma that the idea for a book came to me. It was a few weeks before the decision was leaked and I knew that writing news articles would not get at what it means for a once legally-protected right to be gone. I wanted to tell a story that placed impacted people at the center, but I also wanted the account to be comprehensive.
I started by listing the states where abortion would probably be banned, the states where abortion politics were up in the air, and the states that were likely to provide critical access to care. That’s how I came up with the states included in Undue Burden: Arizona, California, Colorado, Florida, Illinois, Kansas, New Mexico, New York, Oklahoma, Texas and the District of Columbia.
I knew that I wanted the experiences of different people to be included; I began with contacts I’d developed through The 19th. I started writing the book in September 2022 and finished it during the summer of 2023.
I wanted to tell a story that placed impacted people at the center, but I also wanted the account to be comprehensive.
Shefali Luthra
Bader: Prior to Dobbs, feminists and pro-choice activists often said that Roe was at risk, but on a deeper level I don’t think any of us believed it. Is that why folks were so unprepared?
Luthra: After the fact, many folks wondered why a law to codify Roe was never passed. I think people assumed that Roe was the law and abortion was taken care of. It wasn’t true.
Bader: Who is the intended audience for Undue Burden?
Luthra: There are quite a few.
There’s my mom and her friends, people who care about abortion intuitively, but don’t stay on top of the news surrounding it.
Another potential audience are men. I am part of a group chat with a few male friends. They care about politics and understand that abortion is a crucial issue, but like many men, they have not actually had to consider what losing abortion means. They don’t know why access matters.
Furthermore, I hope that the book will sensitize readers to the challenges facing people who want to end their pregnancies.
Finally, I hope it will open their eyes to how strapped abortion funds have become. Throughout the book, readers will see how fractured and frail these support systems are, how tenuous. In fact, people know that this level of support—financing travel, food, hotel rooms and providing childcare for kids left at home—is unsustainable long-term. Abortion funds are pushing themselves beyond the limit and despite this, people still can’t always get the abortions they want and need.
That’s why I told Tiff’s story. She is a Texas teenager who became pregnant and ended up having the baby because she could not get an abortion, despite weeks of effort.
Bader: One result of Dobbs is that surviving clinics in pro-choice states are now seeing significant bumps in the number of abortions they are providing. People routinely have to wait weeks for an appointment, which ups the cost.
Luthra: It is arguable that people should have foreseen that there would be more late-term abortions, but the truth is that many did not see this coming. Again, Texas’ SB 8 is instructive. Within six months of its taking effect, many people became unable to access abortion and, even if they managed to get to New Mexico or another state where abortion after six weeks was legal, the time lag meant that the procedure was more complex and more expensive. This has put great stress on the abortion infrastructure, an infrastructure that was vulnerable before Dobbs.
Bader: Do you think medication abortion offers a way out of this situation?
Luthra: Clinicians are still figuring that out. We have to see what happens with the Supreme Court, which will rule on the efficacy of mifepristone, one of two drugs that are typically used in medication abortion. We also need to see how the law handles telemedicine and if practitioners will continue to be able to prescribe abortion medications without an in-person meeting. But abortion pills are not recommended in all circumstances. Right now we are in uncharted territory. Dobbs feels like it was decided a long time ago, but in terms of history, it is a recent decision. There are still a lot of unknowns.
(Editor’s note: The World Health Organization has authorized use of abortion pills to end a pregnancy up to 12 weeks.)
Bader: I’ve been heartened to learn that new abortion clinics have opened in Wyoming and Illinois. How likely is it that providers will open more facilities in states where abortion is legal?
Luthra: Opening an abortion clinic takes a high level of tenacity. You have to hire staff, find a space, secure insurance, and then market the clinic so people know it exists. It’s quite difficult to start a new practice.
Bader: Has Dobbs had an impact on anti-abortion crisis pregnancy centers (CPCs)?
Luthra: This is really important. We are seeing states with abortion restrictions or bans putting money into CPCs. This year’s March for Life in January put crisis pregnancy centers in the center of the narrative about anti-abortion efforts. We also hear from many people that if they want to confirm a pregnancy, and don’t have much money, the local CPC is their only option.
Bader: In some states that have banned abortion, some clinics have pivoted to offer pre-and-postnatal care, gynecological exams, STI screening and treatment, birth control, and gender-affirming care. Other clinics have closed. Can you explain this?
Luthra: Some clinics are pivoting but there are challenges.
First, we know that gender-affirming care will be the anti-abortion movement’s next target. Clinics are attuned to the fact that their state legislatures may make this care illegal.
In addition, for a lot of clinics, finances were fraught before Dobbs and abortion provision helped them subsidize other services.
Anti-abortion stigma is pretty entrenched in the U.S., but attitudes do change.
Shefali Luthra
Bader: Since Dobbs was issued, we’re hearing the word abortion spoken aloud more frequently. Has the decision spearheaded more openness in discussing abortion as necessary health care?
Luthra: I live in Washington, D.C., and have seen conversions with lawmakers shift. Even the 2024 State of the Union speech by President Biden zeroed in on abortion and the complex reasons people have for ending pregnancies. People have been really brave in sharing their stories and the issue is now a more acceptable part of political discourse.
Bader: Has this lessened the long-standing stigma surrounding it?
Luthra: So often when I interviewed people for the book, they told me that they had not discussed their abortion with anyone but me. I don’t know the answer to ending the stigma but I do know that when people feel unable to share their experience with the people they love, it is painful. Anti-abortion stigma is pretty entrenched in the U.S., but attitudes do change. That said, real social change typically takes a very long time.
(Editor’s note: The Ms. series Our Abortion Stories chronicles readers’ experiences of abortion pre- and post-Roe. Share your abortion story by emailing myabortionstory@msmagazine.com.)
Bader: Voter referenda in support of the right to abortion have passed in Kansas, Kentucky, Michigan, Vermont and California. Is this strategy likely to spread to other states?
Luthra: This is being discussed throughout the movement, but referenda are expensive and time-consuming. Some states don’t allow ballot measures.
What we do know is that before Dobbs the people who made abortion their number one concern were anti-abortion. Now, post-Dobbs, the people who’ve made abortion an electoral priority are solidly pro-choice.
Bader: Dobbs has had a considerable impact on medical students. If they happen to be studying in a locale where abortion is banned, they need to go out of state to be trained. Is this happening?
Luthra: We’re in a legal quagmire. Aspiring OB-GYN physicians need to learn to provide abortions and manage miscarriages, but they can’t get training in states with bans. In a real sense, doctors fear being unable to provide the care their patients need. Most family physicians and OB-GYN specialists are women and they also have to consider where they want to practice, especially if they want to have children. Many doctors and medical students I’ve interviewed have told me that they do not want to live or work in a state without a full range of reproductive options.
Bader: Abortion bans often have exceptions for rape, incest or life endangerment—as if these are the only legitimate reasons to have an abortion. Is there any effort to change the discourse so that all abortions are seen as equally legitimate?
Luthra: People are typically horrified by the lack of rape, incest, and life endangerment exceptions. But we know that most abortions are not sought for these reasons. Undue Burden is an attempt to introduce the varied Americans who seek abortions. It is also an attempt to put abortion into a wider context. We’re still in the early days of collecting and assessing the data, but already, we’ve seen a post-SB 8 spike in infant mortality in Texas.
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