Last week on national television, the former president of the United States repeatedly decried the practice of “post-birth abortion”. I laughed aloud at the absurdity of this statement—an abortion is a termination of pregnancy, and of course, no one can terminate a pregnancy after birth. Later that night, the NAACP official account on X posted, “For the record: You cannot have an abortion in the 9th month.” I paused and thought of the parents I have sat with through devastating moments in the later weeks of their pregnancy, contemplating the heartbreaking reality of needing an abortion for a multitude of reasons (none of which I will list here, as none should impede their ability to access necessary healthcare). In response, the vice president shared moving stories of people whose lives have been impacted by restrictions on abortion, then proclaimed she would restore the protections brought by Roe v. Wade — which is, in effect, a restriction on abortion.

To clarify, although it’s not physically possible to have an abortion after birth nor is anyone lobbying to legalize infanticide, about 1% of people having abortions in the United States are doing so after 21 weeks of pregnancy—yes, even in the 9th month of gestation. It is rare, but genetic counselors of all people should know that in these instances, it is necessary care. We should be mindful not to aggrandize these stories or perpetuate a hierarchical framework of abortion, which my colleague Phil Connors spoke to beautifully last year. But we must not invisibilize or stigmatize them, either. All abortion is necessary abortion. Restoring Roe is the beginning, not the end. Can the US move beyond Roe and into a world where all our patients have unrestricted access to the care they need?

Let’s reflect on Roe v. Wade. This US Supreme Court decision, made in 1973, hinged on an “arbitrary” (as proclaimed by Justice Blackmun, author of the court’s opinion in the landmark case) trimester framework meant to position early abortion as less morally consequential than later abortion. More than 50 years later, this framework is still used to perpetuate a false divide between abortions we should fight to protect and abortions we should condemn. Roe offered some people protections while handing a pregnant person’s rights to the state after fetal “viability”. However, “fetal viability”, upon which so much restrictive abortion legislation hinges, is not a fixed point in time but rather a window determined by a multitude of factors, of which gestational age is only one. In fact, ACOG published a statement strongly opposing the use of viability in determining access to evidence-based abortion care.

The framework Roe put forth denounced any reason one might seek an abortion after a viability limit, a standard that is subject to vastly different interpretations across states and institutions. This policy does not reflect the medical or social complexities of reality; our bodies do not conform to legal frameworks. Abandoning some of our patients does not further the success of the broader movement for reproductive rights and justice.

Many reproductive justice advocates rally around the call: Roe was the floor. Although Roe brought some protections to some people seeking abortion, it left much to be desired and never catered to the entirety of our population. We should absolutely strive to restore reproductive rights to all people, but a 22-, 23-, or 24-week abortion ban is still an abortion ban. Roe also left open the opportunity to erode abortion rights: states enacted restriction upon restriction; politicians implemented waiting periods, parental involvement, and mandatory counseling after the 1992 Planned Parenthood v. Casey ruling; and the ​​Hyde Amendment prohibited the use of Medicaid benefits to cover abortion, making it infinitely more difficult for low-income people to access care. Why should we settle for the bare minimum of protections?

In my role as a clinical GC, I have counseled people seeking abortions at all gestational ages, and I recognize the despair of our post-Roe world. I have met with individuals and families who have traveled hundreds or even thousands of miles to seek abortion care in my state. I’ve tried to steady the hands and voices and minds of people who won’t even say “abortion” out loud, for fear of treading into dangerous (punitive) waters. I’ve helped book flights and called abortion funds for patients who are actively grieving beside me but don’t have a single day to waste. I will carry these stories and experiences with me forever.

I know we need that ground back beneath our feet; simultaneously, I know it was not enough. I need only to think about every patient who was forced to decide between waiting for genetic testing to return—information that, no matter the result, would ensure a truly informed decision—or pursuing a legal abortion to see the gaps in what Roe gave us. I dare us to advocate for a world where pregnant people are empowered socially and legally to leverage their own expertise and make decisions about their body without any restrictions. I encourage us to embody the principle that nothing should come between a person, their body, and the clinician they entrust it with. I urge us to conceptualize a world where all our needs are truly met, and then move toward it.

Who is better equipped to advocate for this world than us? Genetic counselors cannot separate the personal, “professional”, and political. Neutrality is simply not an option when abortion legislation impacts how we can show up for patients. The misinformation that is perpetuated by our elected officials translates directly into harmful policies, rhetoric, and attitudes which harm our patients and disrupt our work. So, I ask us to move into action with this in mind: if Roe was the floor, what is the ceiling? How can we meet this moment, and where can we go?

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