The Supreme Court’s decision in Dobbs v. Jackson Women’s HealthThe Constitution was overturned on June 24, Roe v. Wadeprecedent, erasing 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 one of the highest rates of maternal mortality in any country. Black women are three times more likely die from childbirth-related causes that white women.
Many unions condemned the actions of the government in public statements. Dobbs decision. A few protestors took to the streets. Many will be focusing their vote for Democrats in the fall.
What can unions do more?
There is no clear way to win national abortion and reproductive access. It will be a long battle that involves many organizations and strategies.
There are other interventions that the labor movement can make than turning out voters or 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 from the NewsGuild of New York developed a bargaining structure for these questions. This includes ensuring that your insurance covers abortion, negotiating for travel funds to cover abortions out of state if you live in a country that bans them, protecting your personal data, guaranteeing extra leave, and securing nondiscrimination language based on gender and pregnancy.
The NewsGuild committee suggests members review current contract language in which unions could seek to bargain over impacts based on changes to their healthcare coverage.
If your plan used health care coverage that is no longer available in your state, this is a significant change in your insurance. Your employer should work closely with the union in order to find alternatives. Employers may be able to pay the difference for an out of-network provider or out-of state provider, as well as provide additional time off and cover travel and associated costs.
Defend Members in Court
Unions have the option to use their legal departments to hire lawyers to defend members who are being sued or prosecuted.
They could be health care workers, including mental healthcare providers, or people who deliver abortion drugs like postal workers or UPS drivers. They should be protected by unions just like they would members in any other work-related disciplinary proceedings.
Texas last year made abortion illegal after six weeks of pregnancy. This is the time when fetal cardiac activity can usually be detected. Private citizens can sue anyone they believe is involved in an abortion, even those who have reimbursed travel and medical costs. Oklahoma has already followed suit, and Idaho is currently considering a similar law.
These laws will likely be argued in court for months or even years to determine where and for whom the states have jurisdiction.
Union contracts often provide legal services to members for support in family, housing, and civil court cases. The member’s legal services could also be extended to cover the possibility that a member is accused of aiding or abetting abortions.
Unions should help workers to defy laws. The original way to gain access to abortion was through 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
This is especially true for health care workers. They can only be sued privately in the states listed above, but workers in other states can be criminally charged with 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.
This problem is a common one for health care workers. This is a situation in which about 2 percent of pregnancies are considered ectopic. The fertilized egg has been implanted outside the uterus and is threatening the pregnancy. Termination is the best treatment.
Health care facilities are now trying to delay or avoid potential legal problems. Sometimes they wait for clearance from hospital attorneys. A 2022 Texas hospital study found that there were at least 22 cases in which a procedure was delayed more than doctors wanted. One case ended up requiring a hysterectomy.
In some states, if a doctor suspects that a pregnant woman had an abortion, they must report it to the authorities. Many people have been prosecuted for intentionally harming their fetuses by reporting this information, sometimes with little evidence.
Suspected abortions are more common in women of color. Union-led education on racial differences could help workers not stereotype their patients.
Protect Medical Judgment
All of these laws have a profound impact upon 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 lead to more nurses and doctors joining unions.
What other options should health care unions think about? 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. If possible, unions could negotiate for employers to provide civil liability coverage and to defend workers who are accused.
Unions should also negotiate clear policies regarding the treatment of pregnant women and who decides when it is medically necessary.
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 conduct their own legal research to inform members about what is clear and what remains 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 the call? On what grounds? How can they be protected?
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 are also at risk of being attacked by anti-abortion protestors.
Workers are facing uncertain futures as certain aspects of their jobs are being criminalized state-by-state. They are also unionizing partly to gain some control over budgets and layoffs.
Workers at the Guttmacher Institute won their July 14 election to unionize with OPEIU Local 533. One leader of the organizing committee was fired within an hour. The union continues to fight for reinstatement. The firing of active members from union organizing committees by Planned Motherhood affiliates in Austin, Miami has also been criticized.
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.”
Ohio now makes it illegal to have an abortion after six weeks. Preterm care is still available for some reproductive services, early abortions and counseling to other states. However, many workers have left due to lack of work or stress over the past few months.
Labor can recognize these workers and organize more of them. We can support their fight for strong contracts that will allow the workers to continue working in politically charged, shifting, and sometimes violent workplaces.
Catholic Hospitals Organized
The impact of the overturning of RoeCatholic hospital chains continue to take over health care facilities across the country, posing a risk to access to reproductive healthcare.
“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 legal reproductive care and contraceptives to trans people.
Four of the 10 largest hospital systems in the United States were owned by Catholic-affiliated companies in 2020. 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.
Prater’s punchline is that unions must organize health care workers to protect themselves and their patients.
The workloads will increase in areas where abortion access is not restricted. Illinois and other border states will see an influx of abortions coming from the surrounding states.
With staffing levels already at crisis levels, health care unions must fight to improve wages and conditions for these caregiving jobs.
Talk about It
All unions can do one more thing: break their silence on reproductive rights. Unions may be cautious when taking a stance in a divisive area, especially in open shop countries and sectors.
But is it really so divisive? We know that the majority support the right of individuals to make decisions about their 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.
