Reproductive rights in America and the road ahead for India

In 2022, the U.S. Supreme Court overturned Roe v. Wade through the Dobbs v. Jackson Women’s Health Organisation ruling. Roe had guaranteed abortion rights for half a century. Its reversal fractured the legal landscape: whether a woman can access care now depends less on medicine than her ZIP code.

The consequences have been disastrous. In Texas, Amanda Zurawski nearly died when doctors delayed treating her failing pregnancy until she developed sepsis. In Missouri, clinicians hesitated to treat miscarriages for fear of prosecution. ABC Reports show that women were denied timely care until their lives were endangered. Adriana’s ordeal sits within this continuum, proof that when law creates ambiguity, families pay the price.

India should take note. The Medical Termination of Pregnancy Act of 1971 is far more progressive than America’s patchwork. But rights on paper can be hollow if systems falter.

Fertility and Family Support
Supporters of abortion restrictions in the U.S. argue that they will raise birth rates. Yet evidence shows the opposite. The Lancet finds that fertility rises when states provide affordable childcare, reliable healthcare, and workplace support. The OECD echoes this: countries with strong social safety nets sustain higher birth rates, not those restricting rights.

This insight matters deeply for India. NFHS-5  data confirms that India’s fertility has already stabilised below replacement level. Yet some states continue to experiment with coercive population measures. Both the Lancet and OECD findings point to a clear lesson: India does not need restrictions; it needs support systems that lower the costs of raising children.

Health at Risk
The U.S. debate is not only about law, it is about survival. The CDC records rising maternal mortality, with Black and Indigenous women disproportionately at risk. The WHO warns that unsafe abortions surge wherever access is restricted.

The Turnaway Study found that women denied abortions faced worse health, financial, and family outcomes compared to those who received care. Coercive states weaken human capital, while supportive ones strengthen it.

India faces its own warnings. Unsafe abortions still account for 10% of maternal deaths. The risk is not prohibition, but poor access: rural clinics without doctors, underfunded public facilities, and stigma that silences women. On paper, India’s law is progressive, but in practice, these gaps drive women toward unsafe options.

India’s Crossroads
India’s fertility rate has fallen below replacement level, even as its population reaches 1.46 billion. This transition presents both opportunity and anxiety. States are experimenting with divergent approaches to increase population, though their motives are highly debated. Andhra Pradesh has explored incentives for larger families. Uttar Pradesh and Assam debate restrictive two-child rules. These reflect the tension between fears of overpopulation and concerns about demographic ageing.

History suggests caution. During the Emergency, coercive sterilisation drives left deep scars on public trust. But constructive paths exist. Tamil Nadu’s Muthulakshmi Reddy scheme, which combines maternity benefits with health and nutrition services, shows how supportive measures can ease demographic anxieties without coercion.

These choices are not abstract. Rekha Devi, a mother in Bihar, lost her newborn after being denied an ambulance and forced to deliver in an auto-rickshaw. Her tragedy mirrors the delay faced by women in Texas or Georgia: when systems collapse, law becomes irrelevant, and families pay the price.

Policy Pathways for India
The US case is a huge lesson to countries. If India aims to strengthen families, the way forward lies not in prohibition or compulsion but empowerment. Four priorities stand out. First, protect healthcare. The U.S. shows the dangers of legal ambiguity creeping into hospitals. India must ensure medical professionals are shielded from political interference so women and doctors can make decisions without fear. Second, reduce the cost of parenting. Schemes like the Pradhan Mantri Matru Vandana Yojana provide maternity benefits but remain limited, often excluding women in informal work. Tamil Nadu’s Muthulakshmi Reddy scheme offers a more holistic model, integrating financial, nutritional, and health support. Third, invest in social infrastructure. OECD data shows that fertility stabilises when childcare and workplace flexibility are guaranteed. India lags here, national schemes have shrunk, and workplace childcare remains rare outside the formal sector. Finally, equity must anchor reform. As The Hindu notes, poor rural women remain most vulnerable to unsafe abortions. Policies must prioritise those left behind by geography, caste, and class, not just the urban middle class.

In the end, it comes down to trust. If India follows harsh rules, families will feel punished and lose faith in the state. But if it walks the other path, which supports parents with care and respects people, they feel the government is on their side. We’ve seen in the U.S. how confusing, uneven laws can leave people feeling abandoned. India’s way forward is simpler: treat people with dignity, speak with clarity, and offer real support. That’s how families and the country grow strong together.

Control to Care
Adriana Smith’s story is unforgettable because it is unbearable: a woman reduced to a vessel by law, her family denied closure, her body kept alive for politics. It is also a warning. The U.S. shows how quickly reproductive rights unravel when law eclipses healthcare.
India is at a turning point. Its laws look progressive, but the systems that carry them are still unsteady. The real question is simple: will India try to control people, or will it choose to support them? Control only creates fear and mistrust. Support gives people dignity, trust, and stronger families. If we truly want to protect life, the answer isn’t to control it, it’s care.