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Overturning Harm Reduction: HR's Role in a Post-Roe World

A fair skinned arm holds up a white sign against a blue sky and the Supreme Court building which reads "Bodily autonomy for all"

On May 2, a leaked draft of the forthcoming Supreme Court decision pointed to what many feared was imminent - the overturning of Roe v. Wade. The 1972 SCOTUS decision has long stood as the legal backbone for the right to access abortion care in the United States, and its overturning looks to criminalize the practice in states across the country. (See: 26 States Are Certain or Likely to Ban Abortion Without Roe: Here’s Which Ones and Why, from the Guttemacher Institute) The decision is another step in the long process that many have already been experiencing - the slow erosion of legal protections that support the health, wellbeing and safety of marginalized people, especially women/femmes, communities of color, and people experiencing economic hardship.

While some harm reductionists have long called to recognize the intersection of abortion access and harm reduction, the movement as a whole has lagged behind these voices. There is no more ripe a time to recognize the ways in which allyship is mutually supportive and integral to the full realization of both forms of social justice.

Both are Community-led, Criminalized Approaches to Health

Access to abortion and access to harm reduction share similar roots as criminalized forms of health support rooted in community-based knowledge and sharing. Harm reduction information has always operated as outside the system care, facing institutional barriers of criminalization and barriers to accessing sustainable, state-based funding. Over the last few years, harm reduction has begun to push back on the increasing penalties for paraphernalia and distribution, showing how these compromise health outcomes for people who use substances, and access to information, support, and tools make life possible for people who use substances. As abortion access has seen increases in criminalization and other penalties over the last few years, we will need to apply the same values, and push for the use of evidence-based approaches in support of health, and not punishment.

And both of these efforts of criminalization have a racialized history, disproportionately impacting people, families and communities of color Just as we can trace the drug war back to the moralizing and stereotyping of Latine, Asian and Black communities as substance users and traffickers, pregnant people of color have already been targeted for criminalization for termination of pregnancy. In April, a woman in Texas who self-induced her abortion was arrested, with advocates calling it a scare tactic for pregnant people in the state. Of the women who have been arrested and charged for miscarriages, substance using people and women of the global majority are disproportionately represented.

Just as the drug war was meant to destroy racialized families, criminalization of abortion has squarely targeted women of color’s ability to make decisions for their own reproductive health and autonomy.

Connections in Advocacy

There are clear, tangible ways in which harm reduction advocacy can move to become a strong voice in the need for evidence and science-based efforts to expand care. As proponents of anti-criminalization efforts, more space must be given to the weaponization of the legal system to cause harm, instead of bring justice, to marginalized people and families. As advocates of thoughtful amoral drug scheduling, the pills which offer medication-based abortion, as opposed to clinic-based, aspiration abortion, are unnecesarily restricted by the FDA, despite being safer than Advil. As a community who knows the impact of letting moral determinations overrule the need for health and safety, access to abortion care is an integral part of these dialogues.

But harm reduction can also offer a great deal more to the pregnant and parenting, substance using people who come to the drop-ins, those who are stigmatized out, or those with access needs such as childcare to come. While abortion access is a clear need which is best served with more locations, information and offerings, many substance users want to maintain pregnancies, and fight hard to be great parents. More accessibility options should be made available, including offering child-care at drop-ins and exchanges or creating drug user spaces which are friendly to children. Information for safer substance use should include information on what that means for pregnant and chest-feeding parents. Anti-stigma work can mean more people to speak to and places to share the challenges of using while being a caregiver. Fighting mandatory reporting laws which consider these behaviors abuse or neglect can create safer support networks and health care options for people who fear losing custody.

The more we can integrate conversations of harm reduction and reproductive justice, the more we can serve both movements. Then, people who are pregnant and substance users will find only more opportunities to show up and be seen as whole, multi-faceted people.

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