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

by Shefali Luthra

Overview

KIRKUS PRIZE FINALIST • A TIME BEST BOOK OF 2024 • An urgent investigation into the experience of seeking an abortion after the fall of Roe v. Wade, and the life-threatening consequences of being denied reproductive freedom • “Indispensable… Whatever your gender, race, religious background or political preferences, Luthra’s Undue Burden should be on your required reading list.”—San Francisco Chronicle

On June 24, 2022, Roe v. Wade was overturned, and the impact was immediate: by 2024, abortion was virtually unavailable or significantly restricted in 21 states. 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. A 21-year-old mother barely making ends meet has to travel hundreds of miles in secret for medical treatment 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 ban fails 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 Dobbs, it was a common misconception that abortion restrictions affected only people in certain states but left one's own life untouched. Since the fall of Roe, a domino effect has cascaded across the entire country. As the landscape of abortion rights continues to shift, the experiences of these patients—who crossed state lines to seek life-saving care, who risked everything in pursuit of their own bodily autonomy, and who were unable to plan their reproductive future in the way they deserved—illustrate how fragile the system is, and how devastating the consequences can be.

A revelatory portrait of inequality in America, Undue Burden examines abortion not as a footnote or a political pawn, but as a basic human right, something worthy of our collective attention and with immense power to transform our lives, families, and futures.

Product Details

ISBN-13:	9780385550086
Publisher:	Knopf Doubleday Publishing Group
Publication date:	05/21/2024
Pages:	368
Sales rank:	110,536
Product dimensions:	9.30(w) x 6.20(h) x 1.50(d)

About the Author

SHEFALI LUTHRA has covered national health policy for the past decade, most recently at The 19th. Her coverage of abortion rights has been cited in Congressional testimony and Supreme Court briefings and in 2023 received an Online Journalism Award. Luthra's writing has appeared in The New York Times, The Washington Post, NPR, and more. She lives in Washington, D.C.

Table of Contents

Contents

Introduction 

Part I: Tiffany
LOSING ROE
Chapter 1: Where It Started, Where It Ends — TEXAS
Chapter 2: “It Shouldn’t Be This Hard” — OKLAHOMA

Part II: Angela
ACROSS STATE LINES
Chapter 3: Not Strong Enough — NEW MEXICO AND ILLINOIS
Chapter 4: A Haven, for Now — KANSAS

Part III: Darlene
THE SAFE HAVEN MYTH
Chapter 5: The Promised Oasis — CALIFORNIA
Chapter 6: Just Because It’s Legal — COLORADO
Chapter 7: Even the Best-Laid Plans — NEW YORK

Part IV: Jasper
THE FIGHT FOR THE FUTURE
Chapter 8: The Center That Couldn’t Hold — FLORIDA
Chapter 9: Neither Living nor Dead — ARIZONA
Chapter 10: How Far Will This Go? — WASHINGTON, D.C.

Epilogue: The World After Dobbs — TEXAS

Afterword 
Sourcing Note 
Acknowledgments 
Notes 
Index

Editorial Reviews

★ 03/04/2024

Journalist Luthra debuts with an eye-opening and chilling look at the strain the U.S. reproductive healthcare system is undergoing in a “post-Roe” world. Tracking the circuitous, costly, and legally jeopardizing paths that patients seeking abortions who live in states that have imposed restrictions must take to access care across state lines, Luthra reveals that these cross-country journeys are having a “bottleneck” effect that is limiting healthcare access across America. The story of Angela, a 21-year-old San Antonio mother who can’t afford another child and makes an expensive trip to New Mexico for a dose of the abortifacient mifepristone, is juxtaposed with the plight of Jasper, a trans man who struggles to access abortion care because his local clinic in Orlando, Fla., has been overwhelmed by out-of-state patients. The healthcare providers themselves paint a dire portrait of a system in crisis (“It’s an unfolding national disaster,” says one). Luthra depicts them triaging patients (the staff at a Jacksonville, Fla., clinic routinely stays until midnight to help out-of-staters, but still has to limit services for locals), strategizing new ways of providing care (which include illegal mail-order mifepristone networks), and dealing with patients in mortal terror of jail time (one San Diego clinician describes patients anxiously discussing how best to hide where they’ve been from people back home). Luthra’s vivid and compassionate storytelling unveils an interconnected web of desperate individuals and heroic helpers who are only just barely within reach. It’s an urgent wake-up call. (May)Correction: An earlier version of this review incorrectly stated that Jasper’s local clinic is in Jacksonville, Fla. The review has also been updated with changes made prior to the book’s publication.

Publishers Weekly

Finalist for the 2024 Kirkus Prize for Nonfiction • A TIME Best Book of 2024

“Indispensable… An impeccably researched, clearheaded and frankly terrifying assessment of just how grave the situation in post-Roe America is… Whatever your gender, race, religious background or political preferences, Luthra’s Undue Burden should be on your required reading list.”
—San Francisco Chronicle

“A superbly reported account… Undue Burden focuses on the stories of those who are attempting to navigate an unraveling healthcare system while pregnant. Luthra brings their voices to life, and she locates her subjects in their larger contexts—socioeconomic, political, religious, historical—thereby exposing how abortion bans disproportionately harm the most vulnerable…The stakes could not be higher… Undue Burden provide[s] a preview of a nationwide catastrophe that we still have the opportunity, one can hope, to prevent.”
—Washington Post

“Luthra calls the end of Roe a ‘public health crisis,’ and it is one… She also effectively uses public health data to highlight disproportionate racial impacts of abortion bans… But it is when discussing abortion as a human right that Luthra makes her most powerful points: about the limitations of Roe, which was ‘never enough to ensure that everyone could easily, safely access legal abortions’; the injustices of legislation like the 1977 Hyde Amendment, under which no federal health insurance dollars can be used to pay for abortions; and the vulnerable and marginalized individuals in this country who have always been left behind, or left out entirely, in conversations about ‘choice...’ Luthra rightly criticizes a tendency in the national debate ‘to speak about abortion in only the starkest terms...’ In Undue Burden, she resists such simplistic storytelling.”
—New York Review of Books

"Shefali Luthra places at the center of this urgent volume the people whose lives, bodies, families, and ability to provide care have been wholly remade by Dobbs, insisting that the stories of human suffering cannot be sidelined as some niche politicized concern. An absolute must-read—tell your friends; buy it for your family; sit with it on your own. This is storytelling we need."
—Rebecca Traister, New York Times bestselling author of Good and Mad and All the Single Ladies

“Moving and deeply informative in highlighting the ways in which access to abortion is a basic human right, Undue Burden focuses on the consequences of limiting access to reproductive justice. The fall of Roe is a public health crisis with an impact we are still struggling to grasp.  Shefali Luthra humanizes those burdened by the changes in the law while making excellent points about the shortsightedness of lawmakers pandering to the mob who want to control instead of serve their constituents who actually need access to reproductive care. As an indictment of our societal failure to protect the lives and liberty of those with uteruses, Undue Burden does the heavy lifting of research so that even the most apolitical reader can understand the risks to us all.” 
—Mikki Kendall, New York Times bestselling author of Hood Feminism

"Undue Burden reframes the battle over abortion to a national human rights crisis that threatens everyone’s welfare and freedom instead of a niche cultural issue. By telling the gripping stories of pregnant people desperately seeking abortions across the country and the advocates who courageously fight for expanded access to care, Shefali Luthra makes plain Dobbs’s devastating repercussions for our health, autonomy, and equality—and highlights the potential for change. Undue Burden is a compelling, urgent call for reproductive justice."
—Dorothy Roberts, author of Killing the Black Body

"For decades, access to abortion has been our nation's most vigorously attacked human right—a battle that Shefali Luthra has chroncled with a rigor and an empathy matched by few others. In the pages of Undue Burden, Luthra explores the war on abortion rights through the stories of the real people whose rights are threatened and lives forever altered by the powerful political movement that has spent decades working to overturn the right to terminate a pregnancy. The history told within these pages is sweeping, the characters moving, and the message urgent. This is a book that meets our moment, painting a portrait that vividly underscores the stakes of our times."
—Wesley Lowery, Pulitzer Prize-winning journalist and author of American Whitelash

"Undue Burden reveals the deeply human and devastating reality of the post-Roe world—it is the urgent reminder we all need that abortion is a human right."
—Anne Helen Petersen, author of Out of Office and Too Fat, Too Slutty, Too Loud

“Shefali Luthra has told the story of post-Roe America in the way it needs to be told—with a compelling, unflinching and deeply human look at the lives it has turned upside down. This gripping portrait is a must-read for anybody who wants to understand how much reproductive rights matter—and what happens to everyday Americans when those rights go away.”
—Jonathan Cohn, author of Sick and The Ten Year War

"This is a very important book and should be required reading for everyone interested in civil rights and gender equality in the health sector and beyond."
—New York Journal of Books

"Packed with recent on-the-ground reporting… Shefali Luthra sympathetically documents the harrowing human consequences of curtailing the right to abortion."
—Financial Times

"A poignant and dramatic look at the stakes of losing Roe and a compassionate assessment of the human toll wrought by Dobbs."
—Ms. Magazine

“An eye-opening and chilling look at the strain the U.S. reproductive healthcare system is undergoing in a post-Roe world… The story of Angela, a 21-year-old San Antonio mother who can’t afford another child and makes an expensive trip to New Mexico for a dose of the abortifacient mifepristone, is juxtaposed with the plight of Jasper, a trans man who struggles to access abortion care because his local clinic in Orlando, Fla., has been overwhelmed by out-of-state patients. The healthcare providers themselves paint a dire portrait of a system in crisis (“It’s an unfolding national disaster,” says one)…Luthra’s vivid and compassionate storytelling unveils an interconnected web of desperate individuals and heroic helpers who are only just barely within reach. It’s an urgent wake-up call.”
—Publishers Weekly (starred)

“Vivid portrayals of lives disrupted and freedom denied.”
—Kirkus Reviews (starred)

"In her empathetic book, Luthra capably zooms in on private stories and zooms out on the laws that have irrevocably changed lives, proving the feminist adage: The personal is political. Undue Burden is a rigorous and compelling condemnation of the unnecessary pain and sorrow Dobbs left in its wake."
—BookPage (starred)

"Luthra’s well-researched, compelling book will appeal to anyone who is interested in the human cost of reproductive rights in America."
—Booklist

From the Publisher