Katherine Kraschel. Photo by Matthew Modoono/Northeastern University.

How do you teach using a social justice lens? We grapple with this question at Northeastern University School of Law regularly. Explicitly including social justice in our mission statement—“to fuse theory and practice with ethical and social justice ideas”—distinguishes us from most law schools. Specifically, I grapple with how to best teach my “Reproductive Rights, Justice and Health” course using a reproductive justice frame. Among other things, a reproductive justice–informed lens asks us to center the lived experience and stories of those on the margins and to account for intersectional harms. Shefali Luthra’s work in Undue Burden does just that. Her work provides an incredibly helpful pedagogical tool to complement and humanize legal readings and strengthen the reproductive justice ethos I aspire bring to my course and that I hope other law professors might rely on as well. 

When I call upon students to present cases in my course, I often ask that they tell me the story of who is involved in the case. As they may have become accustomed to through their other legal training, they often respond with “[Person X] is the plaintiff suing [state Y] for their [law restricting reproductive rights].” They aren’t incorrect about the parties to the lawsuit, but this common scenario illustrates the insufficiency of teaching reproductive rights from an exclusively case-based or doctrinal focus. Health care organizations are often the plaintiffs in cases involving abortion, rather than patients seeking abortion care. In addition, the vast majority of cases that aid in teaching students the legal standards that courts adopt and the types of laws that restrict reproductive autonomy are appellate decisions that focus on legal, not factual, issues and so often tell us nothing or very little about what the law at issue actually means for those whom it governs. It’s difficult to bring the people impacted to the fore.  

I often assign reading from Melissa Murray, Kate Shaw, and Reva Siegel’s 2019 book Reproductive Rights and Justice Stories; their work carefully unpacks the litigation and movement stories behind many landmark cases in reproductive rights. Undue Burden provides an additional text that will help my students understand the broader social context and impact of laws affecting reproductive autonomy.  Luthra’s work follows the stories of pregnant people seeking abortion care after Roe v. Wade was gutted by Texas Senate Bill 8 and then overruled entirely in Dobbs v. Jackson Women’s Health Organization. It includes the stories of those who may not be part of the movement or who may not be selected as the most sympathetic plaintiffs in impact litigation. Part of what makes Luthra’s book exceptional is that it not only humanizes the avoidable public health crisis ushered in by Dobbs but also tells the story of how we got here. Luthra masterfully illustrates how the antiabortion movement’s legal victories throughout the past fifty years persist and exacerbate the crisis in abortion-restrictive states as well as abortion-protective states.  

The stories illustrate how laws requiring parental consent, like the one upheld in Planned Parenthood v. Casey, are as effective as they ever have been in creating barriers to care. Stories remind us how the Hyde Amendment, upheld in Harris v. McRae, means that Medicaid patients have always had to rely on abortion funds to access care—funds that are now unsustainably stretched covering travel expenses for those who have to go out of state or for those who have to travel within a state due to abortion deserts resulting from the TRAP (targeted restrictions on abortion providers) laws at issue in Whole Woman’s Health v. Hellerstedt.  

Perhaps most importantly, Luthra captures the indelible harms abortion restriction laws cause and how Dobbs’s damage goes far beyond what empirical evidence tells us about mortality, other health outcomes, or financial impacts. It describes the weighty loneliness Dobbs demands of those seeking abortion care—by transforming a discreet trip to a clinic into an elaborate scheme of deception or a clandestine and uncertain procurement of medication. Undue Burden lays bare the dignitary harms abortion restrictive laws create. No reader with any semblance of empathy could come away from Luthra’s book with an honest belief that reproductive justice advocates’ responses to Dobbs are mere political posturing. 

Luthra’s work helps readers (including students) understand the reality of the post-Dobbs public health emergency and the importance of learning from the paths that led us here. It compellingly depicts the urgency of the moment while disabusing readers of any notion that Roe was ever enough. In so doing, her work will aid in students’ understanding of the law’s ability to reshape lives and of the necessity of adopting a reproductive justice approach moving forward. 

Pamela Merritt

As a Black midwestern feminist who spent the bulk of my career organizing in Missouri, I saw the fall of Roe v. Wade as the expansion of the “Show-Me” state’s reproductive hellscape. Access to reproductive health care has been a privilege in many states for many years, and legal abortion care had all but disappeared in Missouri before the Dobbs ruling. From folk having to drive hundreds of miles to find a birthing center to indefensible maternal morbidity and mortality rates to the loss of access to in-clinic abortion care in thousands of zip codes, people who can get pregnant have long been suffering or just barely surviving in whole regions of the US. Far too many Americans believed the myths that Roe was great, that access to abortion was the sole reproductive right under attack, and that Supreme Court justices can be held accountable for lying during confirmation hearings or ignoring settled law whenever it suits them. So here we are. We lost. And many of us are exhausted and disgusted and struggling to keep our heads above water while those newly awakened to the reality of reproductive oppression don their pussy hats to chants of “Roe, Roe, Roe the vote!” 

Yeah, no thanks. We got here through the imperfect framework built on the foundation of Roe v. Wade, and I sure as hell don’t want to resurrect it so future generations can do this over and over again. Now more than ever, we need books like Undue Burden by Shefali Luthra to document the realities of life under Roe and the horrors of post-Roe health care before all of this gets normalized. We also need to document who Roe left behind and why. We need to capture the voices of those most impacted by reproductive oppression for organizers and policy makers so that organizing strategies will focus on what people need rather than what those with proximity to power are willing to settle for. 

Undue Burden isn’t an easy read, but it’s worth it. The book documents the consequences of failed policy, flawed strategy, and a movement that enjoys talking about trusting Black women in leadership more than it is interested in actually doing that work. I imagine that the book wasn’t easy to write either. Luthra acknowledges that the book captures a moment in time and that the abortion access landscape will continue to evolve for many years to come. But I applaud the effort and finished product, knowing that it covers the lead-up to conflict and how we lost a brutal battle at the Supreme Court, all while acknowledging that the war for bodily autonomy in the US is far from over. 

The current work of organizations and activists takes place following the world Luthra explores in Undue Burden. After several months of strategic triage where we leapt from ban to ban and closure to closure, the movement for reproductive health, rights, and justice now finds itself in uncharted waters. Some of us want to build back better, to seize this opportunity while the harm of abortion restrictions is crystal clear and painfully understood across a variety of voting blocks. We want to go beyond the limitations of Roe v. Wade and liberate abortion from the tyranny of gerrymandered statehouses and risk-averse politicians. Others just want to build back. With alarming speed, they seek to reinstate the legal foundation that gave birth to two-parent-notification laws, the criminalization of drug use during pregnancy, thousands of clinic closures due to TRAP (targeted restrictions on abortion providers) laws, physicians forced to lie to patients, and indefensible increases in maternal mortality rates. 

They want to recreate a habitat hospitable to undue burdens just as an undeniable majority is eager to establish the human right to abortion without restriction because they believe the myth that Roe was as good as it gets.  

They have money, proximity to power, and talented communicators who can easily convince folk that Spam is filet mignon, at least until they actually need an abortion. 

We who believe in freedom have history as our justification, the voices of providers and patients chronicled in books like Undue Burden that demand audacity not caution. We have our well-honed organizing skills, the ability to build strategy without the limitations of Roe (finally), and the reproductive justice framework.  

When they go low, we organize, and I wouldn’t bet against us. Onward. 

Lina-Maria Murillo

June 24, 2024, marks the second anniversary of the fall of Roe v. Wade, the 1973 Supreme Court case granting constitutional rights to access abortion in the United States. Scholars of abortion have been ringing alarm bells about this moment for decades. Conservative legislators had put the landmark decision on the chopping block since its inception. First came the Hyde Amendment introduced by Republican congressman Henry Hyde of Illinois in 1976. Critics rightly concluded it was an attack on poor pregnant people as the law denied the use of public monies for abortion to anyone enrolled in public health assistance. In the years that followed, antiabortion activists found novel ways of reshaping American politics to center the loss of abortion rights, including coopting an entire political party to its ranks and helping elect the first “pro-life” president, Ronald Reagan, in 1981. 

By the time the next major abortion case came before the Supreme Court, abortion providers and clinics had experienced over a decade’s worth of antiabortion violence, including arson, assault and battery, death threats, and kidnappings—not to mention the rash of clinic bombings and murder of abortion providers that would dominate news cycles the following years. In 1992, the Supreme Court affirmed the rights guaranteed under Roe but in Planned Parenthood of Southeastern Pennsylvania v. Casey  introduced new language that would allow states to legislate the procedure before “fetal viability” and cautioned that new legislation restricting abortion should not cause an “undue burden” on those seeking the procedure. This ruling opened the flood gates to thousands of pieces of antiabortion legislation across the country, tying up already strapped abortion seekers and providers in a dizzying panoply of legal constraints for decades into the future. 

Shefali Luthra’s new book, Undue Burden: Life and Death Decisions in Post-Roe America, brilliantly interrogates the idea of “undue burden” in the past and present of abortion politics and provision. Interviewing dozens of abortion seekers, providers, physicians, clinic staff, attorneys, and activists in the months leading up to and after the fall of Roe, Luthra brings to life the multidimensional aftermath of a post-Roe America that existed in bits and pieces even when Roe was still law. 

As she travels across the country—from Texas (the epicenter of much abortion-rights history in the last half century) at one extreme of the abortion legal system to states like California and New York (known to some as sanctuary states protecting physicians and abortion seekers from repercussions if they need to travel out of state for care) at the other—Luthra reveals a new reproductive health geography I’ve named borderlands of abortion care. Losing our constitutional right to abortion has produced a new underclass of people—we might call them reproductive health migrants—who uproot their lives to travel hundreds or thousands of miles for access to care. As abortion seekers flee abortion restrictions in their home states, abortion providers in states such as Illinois, Colorado, and Minnesota brave the onslaught of abortion migrants from these more restrictive zones. Abortion providers have seen need skyrocket, pushing their sparsely resourced clinics to the breaking point. Even in states where abortion is “safe for now,” abortion providers and activists spend their days scurrying to expand their resources to offer care to a growing number of out-of-state abortion seekers. 

This dangerous legal situation is compounded by social and economic constraints that have thwarted reproductive health access for poor and racialized pregnant people in the US for centuries. Undocumented people can’t even avail themselves of travel, lest they put themselves and their families in the crosshairs of the federal government. These restrictions have formed a new underclass within the underclass—one that mirrors and exacerbates existing racial, gender, and class inequities. 

Luthra’s meticulously researched Undue Burden is not only about exposing the perniciousness of government-mandated pregnancy in the present; it also lays bare how this burden was constructed and deployed methodically over time. The exclusionary conditions produced under Roe have been weaponized and ramped up after the Dobbs v. Jackson Women’s Health Organization decision ended federal protections for abortion in 2022. If conservatives secure the White House and Congress in the fall, this is just the beginning.  

Katha Pollitt

Tiffany was 16, a “typical teenager” with an on-again-off-again boyfriend and a pregnancy five weeks along. Angela was a young mother with plans for her future, from a strongly antiabortion family. Darlene was thrilled to be pregnant again—she wanted her small daughter to have a sibling—until it turned out that her uterus was so fragile after recent major surgery it could break and kill her. Jasper was a 19-year-old trans man, still in college, astonished to find himself pregnant despite testosterone.  Like Melissa, Anna, and the other abortion seekers whose stories Shefali Luthra tells, all found themselves desperately trying to navigate red-state restrictions and bans post-Dobbs (or in Tiffany’s case, pre-Dobbs, because Texas’s HR8, passed in 2021, already banned abortion after six weeks). Their stories—and those of the harried clinic directors and advocates trying to help them but too often unable to do so—are the framework on which Luthra, a first-rate health-care reporter (most recently for The 19th), hangs the larger story of abortion rights and access in present-day America.     

I thought I knew a lot about what’s happening now, but I was wrong.  The situation is so much worse than I imagined.  

You might think, for example, that all a red-stater needs to do is get to a state where abortion is legal, as in a game where you just need to touch home base and you’re safe. It’s not so simple.  In the first place, getting there is a huge challenge for many—transportation, lodging, food, childcare (more than half of women who have abortions are already mothers), taking time off work—it adds up quickly, and the majority of abortion seekers are low income and disproportionately Black or Hispanic. For some it’s impossible—minors with antiabortion parents, undocumented immigrants (Texas has lots of checkpoints where ID is demanded), women with controlling partners, people with no way to connect to networks that can help them.  But an even bigger problem is the fact that there are simply not enough clinics in blue states to accommodate the post-Dobbs surge of people from the seventeen states where abortion is completely banned or banned after six weeks, when many women don’t even know they are pregnant. The result is a cascade in which laws are constantly changing, inflation drives up costs, clinics have to book patients later and later in their pregnancies, and clinics must balance both the needs of travelers against those of their customary in-state patients and the needs of abortion seekers against those who come to the clinic for other kinds of care.  Moreover, abortion funds, which raise money to help low-income people arrange and pay for their procedures, are stretched to the limit and are having to cut back on how much help they can give. No wonder clinics close and some abortion seekers give up.  

What about abortion pills? Ordering them through the post can make ending a pregnancy in the first trimester much easier and cheaper than traveling hundreds and even thousands of miles.  But they are not a magic bullet. You need a computer, a credit card, and an address to have them sent (maybe not to your home, if you live with nosy antiabortion relatives?), and you need to be early enough in pregnancy for the pills to reach you in time to be effective. Pills are banned or tightly regulated in over a third of the states (fortunately, the Supreme Court just rejected an attempt to ban Mifepristone, one of the two components of the pill regimen, but the issue will probably come before the Court again.).  As Luthra makes clear, there is no universal workaround for the loss of Roe—which, as she also makes clear, was never enough to ensure abortion care for all who needed it. Before Dobbs, there was exactly one clinic standing in Texas’s Rio Grande Valley, an area of 43,000 square miles. Now even that one is gone. 

Against this background, the travails of the abortion seekers Luthra writes about stand out as profiles in courage, not the least because in addition to practical obstacles (one woman and her partner had to spend the money they were saving to buy a house), the whole process is as if designed to fill them with guilt and fear, “that strange sense of illicitness.” Were they breaking the law by leaving the state? Could they pick up pills in a safe state and take them at home where they were banned? What were their doctors, barred by law from so much as mentioning abortion, not telling them?  

Blue staters like to comfort themselves that they’re safe. This is doubtful—anti-choicers are keen to pass federal bans, and Donald Trump would like to help them. Meanwhile, at least by some measures, the pro-choice movement seems to have trouble maintaining a sense of urgency.  After Dobbs, abortion funds were showered with “rage donations.” But those have tapered off. Rage, it turns out, is hard to sustain—at least when it involves opening your checkbook.   

I don’t know if even a book as clear, as well written, as fact filled, and as moving as Undue Burden can change that. But if you only read one book about abortion this year, Undue Burden should be that one.