This article was first published by Labor Notes.
The Supreme Court’s decision in Dobbs v. Jackson Women’s Health on June 24 overturned the Roe v. Wade precedent, erasing the constitutional right to an abortion.
Already for years, large parts of the U.S. have severely restricted abortion — especially hurting those least likely to have resources to travel for care, including poor, Black, indigenous, undocumented, and disabled people.
The U.S. has the highest maternal mortality rate of any wealthy country, and Black women are three times more likely to die from childbirth-related causes than white women.
Many unions issued public statements condemning the Dobbs decision. A few turned out to protest. And we can expect many to emphasize voting for Democrats this fall.
What more can unions do?
There is a no clear pathway to winning national abortion and reproductive health access. It will surely be a long struggle, involving many organizations and strategies.
But there are specific interventions the labor movement can make, beyond turning out voters and joining rallies.
Bargain Over Benefits
Here’s an immediate one: workers can demand to bargain over changes in benefits, which might now include abortion access.
A committee at the NewsGuild of New York has developed a bargaining framework for the questions this raises, including ensuring that your health insurance covers abortion, bargaining for travel funds to cover an abortion out of state if it is prohibited where you live, protecting your personal information, guaranteeing additional leave for travel, and securing non-discrimination language on the basis of gender and pregnancy.
The NewsGuild committee suggests that members look at current contract language where unions could demand to bargain over impacts, based on changes to their health coverage.
If your plan used to cover health care that is now prohibited in your state, that is a substantial change in your insurance, and your employer should have to work with the union to find alternatives. Perhaps employers could cover the difference in cost for an out-of-network, out-of-state provider, provide additional time off, and pay for the travel and associated costs.
Defend Members in Court
Unions can use their legal departments or hire lawyers to defend members who get sued or prosecuted for allegedly performing, getting, or helping someone get an abortion.
In the course of their jobs, this could involve health care workers, including mental health providers; people who deliver abortion medications, like postal workers or UPS drivers; and others. Unions should defend them just as they would defend members in other work-related disciplinary proceedings.
Last year Texas criminalized abortion after six weeks of pregnancy (about when fetal cardiac activity can be detected). The law allows private citizens to sue anyone they believe was involved in an abortion, including anyone who reimbursed travel or medical costs. Oklahoma has followed suit, and a similar law is pending in Idaho.
These laws will likely be argued in courts for months or years to determine exactly where and for what the states have jurisdiction to prosecute.
Some union contracts provide legal services to support members in housing, family, and civil courts. If a member were accused outside of work of obtaining or aiding and abetting an abortion, the member legal services could be expanded to cover this as well.
And unions should support workers in defying the laws. Abortion access was originally won through sustained, public civil disobedience.
“Most of the physicians I know and have been talking to are not interested in holding back,” says Paul Prater, chair of the Illinois Nurses Association political action committee. “They are going to provide the care people need and will deal with consequences after.”
Defend Medical Workers
The risk is particularly dire for health care workers. While they can only be privately sued in the states mentioned above, in other states workers can be criminally prosecuted for providing abortion care.
In these states, if a pregnant person comes into a hospital for care and the appropriate treatment is to terminate the pregnancy, that is now a crime if there is still fetal cardiac activity or the person’s life is not immediately endangered.
Health care workers will be facing this dilemma routinely. For instance, about 2 percent of pregnancies are ectopic, where the fertilized egg has implanted somewhere outside the uterus, dooming the pregnancy and endangering the pregnant person; termination is the treatment.
In order to avoid potential legal problems, health care facilities are now avoiding or delaying these treatments, sometimes waiting on clearance from hospital lawyers. A 2022 study of two Texas hospitals found at least two dozen cases where a procedure was delayed longer than doctors wanted to, in one case until the patient required a hysterectomy.
In some states, if a health care provider suspects the pregnant person had an abortion, they are expected to report it to law enforcement. This reporting has already led to the prosecution of many people suspected of intentionally harming their fetuses, sometimes despite little evidence.
Women of color are more likely to be charged for suspected abortions. Union-led education on racial disparities could help workers not to stereotype their patients.
Protect Medical Judgment
All these laws will have a profound impact on health care workers. Not coincidentally, the states with such laws are also the states with the lowest union density — though there are exceptions, like union-dense Ohio, where abortion is illegal after six weeks, and Montana, with little union presence but no abortion restrictions.
The new risks could inspire more doctors and nurses to unionize.
What else should health care unions consider doing? They can demand to bargain, since the scope of work has changed for health care workers—they could face liability for using their medical judgment. Unions could bargain for employers to provide liability coverage against civil litigation, if possible, and to defend accused workers.
Unions should also bargain for clear policies about the treatment of pregnant people and who determines what is medically necessary when.
The laws are largely untested and have huge amounts of gray area, and health care professionals get little say in their employers’ interpretation. One Missouri hospital administration denied patients the contraceptive “morning-after pill” after the Dobbs decision, then reversed its decision within a day.
Union legal teams can do their own legal research, to educate members on what is clear and what is still contested. For instance, what would be the process for determining that a pregnant person’s life is at risk if a termination is not performed? Who would make that call, on what grounds, and how can they be protected in that decision?
Health care unions have fought hard to protect nurses’ and physicians’ judgment in patient care, and unions should bargain to push for the broadest possible reading of these policies.
Embrace Abortion Workers
There has been a recent flood of unionizations in the “repro” movement, including at Planned Parenthood North Central States region (the Dakotas, Nebraska, Iowa, and Minnesota) and other states (SEIU); Preterm Clinic, the independent abortion provider in Ohio (SEIU); Feminist Majority Foundation (Nonprofit Professional Employees Union); and about two dozen others, according to Reprojobs.
Reprojobs, a website that began as a jobs posting site for repro workers, now features articles and networks to support repro workers unionizing, including a column called “Ask a Union Organizer.”
For abortion providers, many of their organizing issues echo those of other health care workers: low pay, critical staffing shortages, and frustration over management’s handling of Covid. They also face threats of violence from anti-abortion protestors.
Facing an uncertain future as parts of their jobs are criminalized state by state, workers are unionizing also partly to win some level of control in budgets and layoffs.
Workers at the at the Guttmacher Institute, a reproductive health research center, won their election to unionize with OPEIU Local 153 on July 14. Less than an hour after the results were announced, one organizing committee leader was fired without cause; the union continues to fight for reinstatement. Planned Parenthood affiliates in Austin and Miami have also come under fire for laying off active members of union organizing committees.
Thishi Gangoda, on the organizing committee at the Preterm Union in Cleveland, Ohio, says workers there unionized because “abortion is health care and abortion workers are health care workers. We deserve power to decide our workplace conditions.”
Abortion after six weeks of pregnancy is now illegal in Ohio. Preterm is still open for some reproductive care, early abortions, and counseling to other states, but many workers have left for lack of work, or burned out by the stress of the last several months.
Labor can recognize these workers as siblings in our movement, and organize more of them. We can back their fights for strong contracts that will allow them to continue working in politically charged, changing, and occasionally violent workplaces.
Organize Catholic Hospitals
Compounding the impact of the overturn of Roe, Catholic hospital chains are continuing to gobble up health care facilities around the country, posing a particular risk to access to reproductive care.
“Catholic hospitals in Illinois have never provided this care,” said Prater. “Companies like Ascension and Aurora Advocate have bought up several facilities and imposed their values on hospitals, sometimes the only ones available in a community.”
These institutions may refuse to provide even legal reproductive care, along with contraceptives and gender-affirming health care for trans people.
In 2020, four of the largest 10 hospital systems were owned by Catholic-affiliated corporations. These institutions already control 40 percent of hospital beds in some parts of the U.S., and they’ve been growing rapidly through mergers and acquisitions.
For Prater, the punchline is: unions must organize these health care workers, to defend themselves and their patients.
Meanwhile, where abortion access remains, workloads will snowball. Border states like Illinois will see a huge influx of abortions from surrounding states.
With staffing levels at a crisis point already, health care unions must fight for wages and conditions that can make these nursing and caregiving jobs sustainable and attractive, and union protections for workers to provide appropriate health care.
Talk About It
One more thing that all unions can do is break their silence on reproductive rights. Unions may be cautious about taking a stance on a divisive issue, especially in open shop states and sectors.
But how divisive is it, really? We know the majority of the country supports the right for people to make decisions about their own bodies.
Members can engage in these conversations in good faith — particularly around issues of health, autonomy, and the ability to use your professional judgment at work.
