Undue Burden: Life and Death Decisions in Post-Roe America

by Shefali Luthra

An urgent, intimate investigation into the experience of seeking an abortion after the fall of Roe v. Wade, and the economic, emotional, and life-threatening consequences of being denied reproductive freedom.On June 24, 2022, Roe v. Wade was overturned, and suddenly the right to an abortion in America was no longer guaranteed. The impact was by the beginning of 2023, the procedure was virtually unavailable or significantly restricted in 20 states. As other nations largely expand legal abortion access, the U.S. has gone backwards; the bans being enforced in many states are some of the most severe in the entire world.In Undue Burden, reporter Shefali Luthra traces the unforgettable stories of patients faced with one of the most personal decisions of their lives. Outside of Houston, there’s a 16-year-old girl who becomes pregnant well before she intends to, and is unable to get the abortion she so desperately wants. A 21-year-old mother barely making ends meet has to travel hundreds of miles in secret to access care in another state. A 42-year-old woman with a life-threatening condition wants nothing more than to safely carry her pregnancy to term, but her home state’s abortion bans fail to provide her with the options she needs to make an informed decision. And a 19-year-old trans man struggles to access care in Florida as abortion bans radiate across the American South.Before, it was a common misconception that abortion restrictions affected only people in certain states, but left one's own life untouched. Now, patients forced to travel to access care creates a domino effect across the entire country. As the landscape of abortion rights continues to shift, the experiences of these patients—those who had to cross state lines to seek life-saving care, who risked everything they had in pursuit of their own bodily autonomy, and who were unable to plan their reproductive future in the way that they deserved—illustrates how fragile the system is, and how devastating the consequences can be.Through the perspectives of patients, providers, activists, and lawmakers, Undue Burden is a revelatory portrait of human rights, healthcare, and economic and racial inequality in America.

Genres: Nonfiction, Feminism, Politics, Social Justice, Audiobook, Science, Social Issues

368 pages, Hardcover

First published May 21, 2024

Reviews

[Sharon Orlopp · Rating 4 out of 5]

Undue Burden: Life and Death Decisions in Post-Roe America is a comprehensive review of what life and reproductive health is like after the fall of Roe on June 24, 2022. The book starts with a quote from the dissenting Supreme Court Justices Breyer, Sotomayor, and Kagan, "Whatever the exact scope of the coming laws, one result of today's decision is certain: the curtailment of women's rights, and of their status as free and equal citizens."

The US was profoundly unprepared for the fall of Roe despite the early release of the Roe decision two months prior to the formal decision. Physicians, patients, attorneys, and lawmakers were often unclear and provided contradictory information about what could and could not be done.

Chapters provide true stories about patients and focus on specific states. Abortion access is a high stakes story. States with abortion bans have the highest rates of pregnancy related deaths. Childbirth is 14 times more likely to result in death than a legal abortion.

The Turnaway Study indicates that when abortion access is denied, patients are more likely to fall into poverty and stay there. Sixty percent of those who terminate a pregnancy in the US already have children.

Patients with high-risk pregnancies in states that don't allow abortions are often being told by their doctors to travel out of state in order to ensure that their high-risk pregnancy is handled well by a physician. Who has the resources to travel and/or live in another state while pregnant?

Nebraska prosecuted a mother and daughter because the daughter got an abortion after 20 weeks. This was before Roe fell. Prosecutors used Facebook messages to build their case.

Regardless of personal views about abortion, this book provides insights into the impact, including unintended consequences, of women's healthcare after the fall of Roe.

[Traci Thomas · Rating 3 out of 5]

I really appreciated the idea and effort behind this book. I’m glad there is writing about post Roe abortion care. UNDUE BURDEN is too long, though. It is extremely redundant. It is detailed in ways that do not add to the story/information being shared. The book is one note.

[Morgan · Rating 5 out of 5]

Undue Burden dives into the impact of the overturning of Roe v. Wade through the experiences of multiple people. Shefali Luthra makes it clear, the fall of Roe is a public health crisis and we (as a country) have not reckoned with the impact that it has had. Luthra follows people who were not able to obtain an abortion, the struggles of getting appointments out of state (and finding ways to pay for them), making life threatening time sensitive choices under 6 week abortion bans, and many more. I really appreciated the inclusion of trans men and nonbinary folks because it's something that a lot of books about this topic leave out. I highly recommend this to anyone wanting to learn more about the implications of abortion bans.

[Jillian B · Rating 4 out of 5]

This is an incredibly important book. It is so well-reported, and the author does such a good job of explaining the repercussions of overly punitive abortion laws. For instance, many readers may not be aware that more women are getting abortions later in their pregnancy than they’d prefer because there’s now such high demand, including from out-of-state patients, at an increasingly limited number of clinics that patients are being triaged and can face weeks-long waits. The author also introduces us to real people who put a face on the issue, including some less-commonly seen perspectives like a young trans man who needed an abortion. This book is well worth your time.

[Anne Jaconette · Rating 5 out of 5]

Phenomenally reported and still deeply personal.

[Jamie Park · Rating 5 out of 5]

I have been passionately prochoice since I was 13 years old. I also had fetal surgery to save my own unborn babies. Life is long and complicated and we need access to all our possible reproductive options. Had I been unable to obtain the fetal surgery I would have had to travel to Colorado for an abortion. I was 18 weeks along.
I have had friends who had to travel to abort for their own reasons. I have also had friends who needed fertility treatments. I have been sick over the overturning of Roe for nearly two years now.
It is hard to watch the OBGYNs leave Idaho. It has been hard to witness pregnant people suffer.
And it all feels hopeless.
I appreciate this book and how they humanized these cases. Not everyone will get it and not everyone will have compassion for the individuals in the story, but I do. I feel for them.
We need to fix this.

[Kristen C · Rating 2 out of 5]

DNF 42%

I struggled with this book for more than one reason. At first, it was because the subject matter is a tough one, but that’s not what stopped me. It was because of the subject matter that I gave this more of a chance than I normally give other books.

The reason I stopped was because the book felt very disorganized and it became hard to follow. It isn’t a particularly long book, but the way it is written made it feel interminable. The author cites real people’s stories to show how certain legislation has affected people, which is a great method to get her point across, except we receive many of these stories piece meal and mixed in with other stories before going back to the original story. It jumped around so much that I often struggled to keep people and stories straight. Since none of those people’s stories really felt complete to me, I can only assume (since this was a DNF for me) that the author does come back around to them eventually. If not, then that, too, is problematic.

One of the other reasons I struggled with this book was because it was very obviously biased. Don’t get me wrong, my politics fully align with the author’s here, but who was her audience exactly? Who is she writing to, trying to convince? I failed to find, in the 42% I read, anything new to add to the conversation outside of giving us real people’s stories. I’ll admit that the way some of those stories were written made it difficult to be sympathetic even, which if I struggled with that, someone of an opposing viewpoint would ignore completely. The bias of this book only seems to appeal to people already aligned with pro-choice politics, only succeeding to tell people who agree with them more of what they want to hear, just like social media algorithms. If the author wants to make a difference and change someone’s mind, this book isn’t going to do it. But maybe that’s not her intent. Again, I have to ask who her audience is.

Case studies of the impact of a post Dobbs world are necessary to the conversation if we hope to improve women’s healthcare, but unfortunately, I don’t see this book doing that. It was a good attempt but poorly executed.

[Brittney Bardin]

ABORTION IS HEALTHCARE

This is a tough book to rate. I’m so passionate about the subject but I feel like the book has some room for improvement.

The author includes personal testimony with abortion history and political climate. I think a better organization of all the elements would have made a bigger impact. The flow of the book felt stilted and repetitive.

Lots of good information and insights. Would definitely recommend.

[Caroline Traylor · Rating 4 out of 5]

Well-researched, data-driven reporting but still deeply personal and nuanced. A bit redundant and sometimes the stories were hard to follow because of the formatting but I loved all of the geographical case studies.

This book illuminated how bans in red states affect the infrastructure, wait times, and accessibility of care for patients in blue states. Abortion providers (doing the Lord’s work) in Colorado, New Mexico or California were already working around the clock to provide care to the patients in their state, and post-Roe, they’re caring for droves of new patients from states like Texas, Georgia and Oklahoma, whose cases might be more complicated because of the delay in care. I hadn’t realized how strained and interconnected this network of care was until reading this book.

I appreciated the author’s choice to include the story of Jasper, a 19 year-old trans man living in Florida, who struggled with the decision whether or not to have an abortion, but the ban in his state forced him to make a decision before he was ready. His story is not one often highlighted in this movement but it’s important and it should be. Reproductive justice and gender affirming care are both issues of bodily autonomy and HUMAN RIGHTS and Jasper’s story illustrated that intersection.

This book is really important. It’ll make you want to weep, scream, and donate to an abortion fund.

[Laura · Rating 5 out of 5]

An engaging and enraging book that combines medical and political reporting with the personal stories of many who found themselves in need of medical care that was denied to them by the Dobbs decision and its aftermath.

[spoko · Rating 5 out of 5]

A really spectacular book. I appreciate that Luthra begins from an understanding that access to abortion is access to basic healthcare, and she moves forward from there. I also appreciate her critique of abortion defenders, who were unnecessarily caught flatfooted by the Dobbs ruling, and still find themselves stumbling over apologetic bromides and stale rationalizations. The large majority of people support women’s right to determine their own healthcare options, but they find themselves disorganized and unnerved, accepting as a starting point the shame-based rhetoric of those who want to limit women’s agency. I hope that books like this can do something to counteract that mindset.

I have to add how impressed I was simply by the organization of the book. There are myriad approaches one might take—broad-view vs. case study, state-by-state contrast & comparison, contraception vs. early-term vs. late-term, a chronological approach, etc. To be honest, Luthra manages to straddle all these possibilities, and has put together a cohesive narrative that not only leaves you well informed as to the current state of things, but encouraged to do something about it.

[Fiona Maloney · Rating 5 out of 5]

I really enjoyed this book, I learned so much about abortion law in the US and enjoyed the personal stories and testimonies about the great lengths people have to go to in order to have a safe abortion. Because of the high costs associated with having to travel to a state where abortion is legal, people needing to take time off work, people being unable to tell their families because of differing opinions on abortions, the time crunch associated with needing an abortion, there are so many layers to having a safe abortion and this is just basic healthcare that all people should be granted!

Abortion is healthcare and by limiting people's access to get one safely, people die. And finally fuck Trump and certain slimy members of SCOTUS who I wish all the bad karma in the world!

Sometimes it did feel a little repetitive, I listened to this on audiobook but if I had read the physical book I know it would have taken me longer to finish it. Overall 4.5 stars!

[Bbecca_marie]

Undue Burden by Shefali Luthra

Thank you PRH Audio + Doubleday for the free audiobook and gifted copy.

My thoughts:
I’m glad I listened to this entirely as an audiobook because I’m not sure I could have gotten through it as a physical book. Although, I appreciated the information it just felt really long winded… it definitely could have been shorter. I didn’t feel right leaving a starred review because I can’t say it was enjoyable, however it was informative. There’s a true audience for it, unfortunately I’m not it.

Happy reading 📖

[Veronica Jacobson · Rating 4 out of 5]

I could not have picked a worse time to read this book LOL! A very well researched book about abortion access post-Roe. I'm taking a point off because it was a bit repetitive and I didn't love how the patient's stories were formatted. It is nice to know that some of the situations in this book will improve based on the passed amendments in several states (uncommon Missouri W).

[Ashley · Rating 5 out of 5]

Full RTC!

[Kimberly · Rating 5 out of 5]

In the words of Taylor Swift, I hate it here.

Excellent writing and nuanced discussion. This book follows the stories of different pregnant people as they try to receive abortion counseling and services post Roe overturn, including social and economic barriers they each face.

[Ann · Rating 3 out of 5]

Makes some good points, but gets redundant.

[Kate (kate_reads_) · Rating 4 out of 5]

Undue Burden is an important read. I hate that this book needs to exist and we are talking about a post Roe world - but this is what we are living in. And this book helped me see some of the implications I hadn’t thought about - from states where abortion is still legal but are too overwhelmed by the increased demand coming from other states to impacts on doctors learning about abortion care in states where it is now illegal.

This was a tough read because it’s so frustrating but I think it’s important for all of us to hear these personal stories and know these impacts. Parts felt a little long and could have been tightened up but overall I would definitely recommend. Thank you to the publisher and Netgalley for the free ebook to review.

[Grace · Rating 5 out of 5]

I was lucky enough to read a galley copy of this book. It is an extraordinary piece of reporting on abortion access in the United States, grounding a serious policy analysis with the stories of people around the country who struggled to obtain reproductive care. A vital read for anyone who wishes to understand the politics of abortion in the U.S., particularly in the post-Dobbs era.

[Christina · Rating 4 out of 5]

If you liked You’re the only one I’ve told by Meera Shah, this book is a natural sequel. The author lays out the aftermath of roe v wade being overturned and provides a timeline of each state and the personal stories of women affected by these abortion restrictions. The book read like a journalistic update and was dry at times but very informative.

[Rachel · Rating 4 out of 5]

An impressive, exhaustive book about the undoing of Roe v Wade in the United States. I think this might be the most straightforward piece of investigative journalism on my BookTube Prize ballot, without much concession given to creative writing. Perhaps this aids Luthra’s argument in taking a scalpel to the consequences for countless people who no longer have easy access to care. But it can also be a little bit dry.

Luthra divides her book into four parts where she tracks four different pregnant people. Interspersed with that and often taking over the narrative entirely, she goes from state to state (usually red states but also some blue states that are affected by these changes), interviewing care providers struggling under new and changing laws, and also some smaller examples of pregnant people seeking abortions. This new political reality, it should be noted, has far-reaching consequences for Americans.

Most of these people are 'cis" women, and there is one transgender man. All of the main case studies involve consensual sex, and most people seek to end their pregnancies due to emotional or financial needs rather than medical ones. For some anti-abortionists this is a red line in the sand, and their beliefs skew more towards carrying a pregnancy to term due to “personal responsibility.” But Luthra doesn’t shy away from telling the case studies from their own perspectives. At the very least, hopefully readers will consider the factual realities of these peoples’ lives, laid out in nuance by the author.

Luthra’s argument, which she saves until the end, is that abortion is a matter of human rights because of equality. Biology means only about half of the population will ever have to worry about carrying a pregnancy to term. But if society doesn't honor modern medicine when it can super cede biology and provide the option of ending an unwanted pregnancy, do we espouse inequality? It's a very loaded question, especially when stats show that already marginalized people often have the most difficulty in finding care.

“People of all circumstances get abortions for all sorts of reasons,” Luthra asserts here. And through her reporting, it’s pretty rare that her subjects lament that choice later. She says it’s a mistake when conservatives “characterize[e] every abortion as a mistake people regret forever.”

“Simply having the option of abortion—whether or not a woman takes that option—allows health care providers to offer patients truly informed consent, meaning a full discussion of the risks and benefits of a medical intervention as well as its alternatives,” Christine Henneberg writes in her review of this book in the New York Review. But she also criticizes Luthra for glossing over some details regarding her one case study who did have the rare medical reason for wanting to abort her pregnancy. “Here Luthra falls into exactly the trap she aims to avoid, of speaking about abortion ‘in only the starkest terms’—as though she feels the need to explain or justify something to us,” Henneberg says. Even when the medical reason for abortion doesn’t go as far as endangering the mother’s life, there’s still an argument for it.

The idea of any “case study” can feel performative. But I’m not sure how else to get the point across that lack of access to healthcare—or fine, if you prefer, abortion care—is a very human issue. I also think that the personal resistance I felt to some of their stories is part of a cultural narrative where we judge people for their choices. But should I be judging people for choices that don’t directly affect me? Some people—those who claim God sides with them—would say yes. For me, witnessing the human lives of these people was a stark reminder that the rest of us don’t belong in the doctor’s office. In some utopia, maybe peoples’ personal lives won’t be turned into political spectacle.

[Monty · Rating 5 out of 5]

Compelling and urgent, this book deftly unpacks the confusion and cruelty of the post-Dobbs patchwork of state laws and abortion bans, the monumental strain that care providers now operate under, and the devastating difficulties that many patients now face in accessing abortion - or even learning what their options are. Extremely well-written and accessible even to readers not familiar with the history of abortion access in the US or the legal landscape post-Dobbs.

[Ellen · Rating 4 out of 5]

A very timely and rage-inducing book about restrictions on abortion access in post-Roe America. I appreciated that the author combined interviews and personal stories alongside an analysis of the legal framework being used to restrict and outright ban abortion care in certain states. The book does a great job of highlighting the countless barriers pregnant people face in trying to access abortion care in some states, as well as the legal ramifications medical professionals face in trying to provide access to this type of essential healthcare.

[Sierra Morales · Rating 1 out of 5]

When I read a book I want it to tell me something I don't know. Thank you for the never ending examples of overburdened clinics, doctors who have to choose whether to face jail time or provide medical care, and people who are forced to become mothers or carry at risk of their own lives - but tell me something I don't know. Wouldn't recommend.

[Paige · Rating 4 out of 5]

Heartbreaking and infuriating. The stories in this book remind us that just because something is legal doesn’t mean it’s accessible. And in our post-Roe reality, nothing is guaranteed. I have taken for granted the privilege and comfort I have always taken in the ability to protect my right to plan my own future family, but that is mostly gone in my current location. The end could be imminent if we don’t listen to women and vote for those who are willing to protect our most personal and consequential decisions.👂🏻

[Ellie · Rating 3 out of 5]

I wanted so badly to like this book, but it’s incredibly redundant. I felt like I was reading the same chapter over and over again. When this book provides new & thoughtful analysis, it’s interesting, but it could’ve been shorter.

[Britta Böhler]

Read for the BTP. Rating to come after the winner has been announced (4 October)

[Janet Hutchinson · Rating 4 out of 5]

A well-written timeline of the falling of the Roe vs Wade decision, and the subsequent tightening, or removal, of access to abortion in the US. Starting with Texas, the author moves through the timeline, but intersperses the personal stories of women seeking an abortion, and the action of abortion providers.
Reading this, I feel like it's folly to at this could never happen in Canada - but the strengthening of the conservative movement, and the growing number of right-wing/Christian organizations lobbying for the abolishment of codes, and the coverage through healthcare is worrisome.

[alexis berry · Rating 4 out of 5]

exceptionally thorough, human-focused reporting!! Totally recommend

[Steph | bookedinsaigon · Rating 5 out of 5]

This book was perfectly executed, with a balanced and moving blend of human narratives and macro reporting. I just HATE that this book has to exist.

Full review to come.