Jen Stark, Kavita Nandini Ramdas, Ann Warner

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Today marks four years since the U.S. Supreme Court Dobbs decision overturned Roe v. Wade, ending nearly 50 years of constitutional protection for abortion rights. Since then, states have set their own course to either banning or enshrining access to abortion with far-reaching consequences across society. Regardless of personal or political beliefs on the issue, there’s no denying that the rollback of abortion rights has had a profound impact not just on women and their families but also more broadly across sectors.

To better understand how the effects of the fall of Roe have played out across business, philanthropy and advocacy, I spoke with three leaders in these fields who are building cross-movement power to safeguard or expand access to reproductive care and freedom: Jen Stark, Director of Human Rights and Inclusive Business at BSR and co-founding member of Don’t Ban Equality (DBE); Ann Warner, Executive Director of the Collaborative for Gender + Reproductive Equity (CGRE); and Kavita Nandini Ramdas, philanthropic advisor to the International Planned Parenthood Federation (IPPF).

I asked them to reflect on the lessons they and their organizations have learned over the past four years, the implications for women, workplaces, the economy and democracy, and where they see opportunities for progress and the path forward.

Marianne Schnall: What has the fallout been from the fall of Roe from your perspective?

Jen Stark: In the post-Roe landscape, while many companies have retreated on DEI and sustainability pledges, they have not retreated from offering reproductive health benefits. Companies have had to become a firewall to enable access to abortion care, IVF and miscarriage management for workers who have employer-sponsored insurance. And while companies treat access like a benefit, workers experience it like infrastructure for family planning, pregnancy complications, labor force participation and more, which varies state to state.

In 2022, companies got credit for announcing abortion travel benefits. Today, the harder question is whether any workers, let alone hourly and part-time workers, can access care without fronting travel costs, risking privacy, losing wages or navigating HR bureaucracy to travel hundreds of miles for time-sensitive care across states, or even entire regions of the country.

Ann Warner: The fall of Roe has made it far less safe to be a woman in America. Incredibly, about 40% of women of reproductive age in the U.S. now live in a place where abortion is banned or severely restricted. Nobody should be denied essential health care because of where they live. The denial of reproductive health care is resulting in loss of life, wellbeing, safety and personal liberty for countless Americans. And unfortunately these attacks on reproductive freedom are happening alongside attacks on LGBTQ+ people, immigrants and our democratic institutions. These attacks are driven by a coordinated strategy in which diminishing the rights and autonomy of women and non-gender-confirming people has long been central. CGRE was established before Roe fell because we saw the writing on the wall, and we knew the states were going to be the frontline for protecting reproductive and gender equity. That’s why we take a holistic perspective to what is happening within each state where we fund.

Kavita Nandini Ramdas: Since the fall of Roe, we have seen a sharp rise in the restriction of abortion rights worldwide. But let’s be clear: without power, voice and agency over our own bodies, women cannot be fully engaged citizens. For 75 years, IPPF has provided care and defended rights in the face of authoritarian attempts to erode them. We are unwavering in our support of these rights alongside our partner Planned Parenthood Federation of America, which has faced a years-long campaign to dismantle its services to ban abortion nationwide. This is, without a doubt, a part of a global pattern of undermining reproductive freedom through defunding, criminalization and political attacks on care.

Schnall: What lessons have you and your organizations learned over the past four years?

Stark: The reality is that employers cannot solve this crisis alone, but they do have a choice. They can continue treating reproductive healthcare as an employee benefit, even if hidden in the fine print. However, to prepare for the years ahead, employers need to wrestle with going beyond off-the-shelf benefits by requiring their insurers, third-party administrators and benefits consultants to design coverage that reflects the reality employees now face.

Companies are not passive bystanders in the American healthcare system; they are powerful purchasers. Employer-sponsored insurance covers more than 165 million people under 65, and companies spend tens of thousands of dollars annually to insure a family. That gives employers leverage—and responsibility.

Nandini Ramdas: We are seeing a resurgence of a “neo-patriarchal and hyper-masculine” style of leadership in countries across the globe. Unfortunately, this includes many women who have aligned themselves with right-wing and authoritarian movements. These forces view the accomplishments of the last few decades of queer and feminist liberation movements as a direct threat to current systems and structures of social, political and economic control. In particular, the ability to bring new life into being and to determine when and if that should happen is seen by regressive regimes as potentially destabilizing. Their responses have sought to deny us the power over our own bodies, which in turn has the potential to silence our voices in the body politic.

Warner: One key lesson we have learned is the power of joining forces and collaborating as funders. Organizations doing the hard work on the ground have long been strong collaborators, and it’s critical that we do that as funders now as well. Collaborative funds like CGRE bring different types of donors together to put their resources behind a shared strategy. Together, we can direct more funds to grantee partners and allow them to focus on fulfilling their missions, rather than reporting to multiple funders.

Schnall: How should employers and business leaders be thinking about the impact of Dobbs on talent recruitment, retention and workplace equity? And what broader economic consequences concern you most going forward?

Stark: Privately, I hear about how the sharply fragmented landscape of abortion care across the states is a concerning trend for global companies operating in the U.S. marketplace—there are new risks, burdens and costs which affect where workers want to live, send their kids to college and get the healthcare they need.

New research that monetizes abortion restrictions calculates they cost state economies an estimated $140 billion annually, which is $7 billion more than last year’s estimate. From a workforce perspective, doctors don’t want to be in states that keep trying to introduce new laws that penalize them for offering comprehensive reproductive healthcare—and it sends a chilling message beyond just OB/GYNs. This is a problem bigger than any one company or benefits program can solve for when there’s a healthcare desert in a state or region of the country.

From an economic perspective, the U.S. economy is already facing headwinds and women’s labor force participation remains below pre-pandemic levels, so the post-Roe landscape isn’t helping the economy—it is actually limiting women’s economic and reproductive freedom.

Schnall: What connections do you see between reproductive freedom, economic opportunity and women's ability to participate fully in civic and public life?

Warner: Reproductive freedom is not only a health issue—it is foundational to economic mobility and to the ability to participate fully in our democracy. When women have the ability to make decisions about their own bodies and families, they are better able to pursue education, participate in the workforce, build financial security and engage as leaders in their communities. A woman’s ability to have wealth, wellbeing and freedom in civic life should not be controversial, and her gender, location or race shouldn’t determine her access to healthcare and opportunity—yet here we are. This is a moment in time where we have to ask ourselves: are women truly free if they can’t determine what happens with their own bodies? That’s why CGRE invests in state-based organizations that protect access to care and build the infrastructure to power this movement, not just because it’s the right thing to do, but because it’s essential for a thriving economy and democracy. Most Americans get this, and that’s why reproductive freedom is broadly supported by the majority of the American people.

Schnall: Why do you believe bodily autonomy is foundational not only to women's health but also to economic opportunity, citizenship and democracy?

Nandini Ramdas: The struggle for freedom and liberation begins with our own bodies. If our bodies are the site of violence, control and oppression then the struggle for our freedom in the body politic is fundamentally altered, constrained and distorted. We may legally have the right to vote, but the laws used to define our very being and our bodies render us unfree even within societies claiming to be democratic. It also severely impacts our abilities to play "productive" not just "reproductive" roles in our societies. Women’s labor and ability to make economic contributions to societies is severely affected by the ability to make choices about bearing, raising and educating children. Women disproportionately bear the responsibility of care and this, in turn, affects their ability to provide economically for the children for whom they are responsible. Until such time as “carework” is considered work and is compensated accordingly, the "reproductive" labor of women will never ensure their "productive" labor can be acknowledged and valued.

Our bodies remain a central battleground in the struggle for truly open and free societies, not only in the U.S. but around the world. However, such an idea of society depends on all people having voice, agency and power. The notion that women are equal beings capable of making decisions about their own bodies should simply not be a radical notion in a representative democracy. This is why sexual and reproductive rights and freedoms are human rights and should be protected and defended for all people of all genders, abilities, ethnicities, religions and ages.

Schnall: Where do you see opportunities for progress, and what do you believe needs to happen next?

Stark: While abortion access continues to shift in states and depends on court rulings, workplace benefits have largely held up. That matters to women and their families, and to employers. Women make up half the workforce and need access to reproductive healthcare over the course of their careers, including abortion, miscarriage management and pregnancy care.

Citigroup, Inc. quietly led the way months before Roe fell, announcing in March 2022 that it would provide benefits for employee travel to access reproductive healthcare. Anti-abortion members of Congress sent cease-and-desist letters, and state officials threatened to cut Citi from government contracts. It didn’t work. In fact, Citi's stock recently hit multi-year highs, and CEO Jane Fraser is Fortune's Most Powerful Woman of the year. There is no going back to the world before Roe fell. But there should also be no going back on the commitments made in its wake. Now companies have to decide whether they will accept the harmful and complicated status quo or keep pushing ahead to meet the scale of this generational challenge.

Nandini Ramdas: Sexual and reproductive health, rights and justice continue to be under profound pressure in the U.S. and around the world. However, as Maria Antonieta Alcalde Castro, IPPF’s Director General, recently reminded us at the Annual Consultative Meeting in Dublin, “Rights are rarely given. They are won. And once won, they must be defended, renewed and expanded for each generation.” We can’t be the land of the free and brave while simultaneously chipping away at sexual and reproductive rights. This moment demands us to resist authoritarianism, seek out truth and fight for the rights and justice for all because history has shown us what’s at stake if good-hearted people stand by in silence.

Warner: Right now we’re on a real backslide in terms of having a representative democracy in this country, and that has direct impacts for the fight for reproductive equity because these attacks are not happening in isolation; they are coordinated. That’s why this moment demands a collaborative response. We diminish our power when we work in isolation, but when we build coalitions across issues, we go further, faster. We need to be re-doubling our efforts to ensure that those who represent us know what we care about and why attacks on one set of freedoms impact us all. We cannot look away; we need to fight for our future as a representative democracy by supporting local organizations to ensure that our government reflects the neighborhoods and communities that make up this country.

For more information about these organizations, visit Don’t Ban Equality (DBE), Collaborative for Gender + Reproductive Equity (CGRE), and International Planned Parenthood Federation (IPPF).