A BU School of Public Health professor says the end of Roe v. Wade amounts to ‘structural violence.’ Here’s what that means.

The Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which overruled Roe v. Wade (1973) and Planned Parenthood v. Casey (1992), invoked a landmark shift in women’s health that Boston University School of Public Health professor Julia Raifman calls “structural violence.” 

Structural violence is a form of violence in which people are unable to secure their basic needs due to social structures or institutions. When abortion is considered a human right, as Raifman thinks it is, the decision to restrict access to it — which is happening in at least 19 states in the wake of the decision — becomes a structurally violent one. 

“It’s a policy decision that brings population-wide harm and exacerbates disparities,” Raifman told Boston.com this week.

The U.S. already has higher maternal mortality and child poverty rates than many other countries, and she said the overturning of Roe would only make these existing issues worse. 

Raifman, who is an assistant professor in the department of Health Law, Policy & Management at the Boston University School of Public Health, researches how health and social policies drive population health and health disparities.

“[The overturn] threatens the bodily autonomy of every person who can give birth and the sense of safety of every person who cares about someone who can give birth, so I think that’s really substantial,” Raifman said. 

And there will be negative long-term effects to this policy, she said. Raifman referenced the Turnaway Study, led by University of California San Francisco professor Diana Greene Foster, which followed 1,000 women seeking abortions over 10 years. The women were split into two groups, with one group receiving their desired abortions and the other group getting turned away at abortion clinics. 

The study found that six months later, the women who had been denied abortions were three times more likely to be unemployed than the women who received abortions. A year later, they were less likely to have aspirational future plans, and five years later, they were four times more likely to live in poverty. Raifman noted that the pandemic has only exacerbated the poverty issue further. 

“Low-income people face repeated COVID infection, their kids face repeated COVID infection in schools; a single parent may have to miss multiple weeks of work due to COVID, and they might not be able to miss multiple weeks of work, they might be fired,” Raifman said. 

Raifman’s earlier work focused on how equal rights for LGBTQ+ people improve health and wellbeing, and how religious refusal policies that allow the denial of services to LGBTQ+ people harm their health. She equated this research to the overturning of Roe — a policy that’s taking away the rights of a subset of people in the population — and said even beyond losing the right to abortion, the overturn makes her nervous for the larger effects of not having this choice available. 

“It’s time to recognize that we’re in a crisis — when so much of the population is losing fundamental rights — and the crisis applies to everyone in our society and in our democracy,” Raifman said. “Many people who seek abortions have other children and are looking out not just for themselves but for their whole families.”

One of Raifman’s main concerns is that the overturn means women are no longer considered equal in the eyes of the law. 

“I think that is one of the most substantial parts of it, in addition to all the direct terms that it brings to people who live in states that have banned abortion,” Raifman said. 

Raifman warned of what could come next. She thinks that retaining a democracy that we all value and in which we are all valued requires substantive action. 

“This [policy] makes people who can give birth unequal; there are a lot of policies making LGBT people unequal,” Raifman said. “I think we’re only going to see more of these erosions of human rights and the foundations of our democracy unless there is decisive action to improve the legitimacy of our institutions and their ability to uphold human rights.”

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