Last week (June 20-24, 2022) was a doozy in the U.S. Any other time the US House of Representatives’ January 6 hearings would have dominated the news cycle, but then you had a couple of Supreme Court rulings that rocked the country, the most “rocking” being the Roe v. Wade rollback that was released on Friday. Predictably, and understandably, that ruling led to protests across the country, and thousands, if not millions (billions?) of posts online.

I’m not a constitutional law expert, nor am I a women’s health expert, so I won’t offer any opinions on the merits of the ruling from a legal or medical standpoint. What I do know something about is working in the non-profit sector, with a particular focus on trade associations. That means I’ve spent a fair amount of time representing industries of one kind or another, and providing services to the member companies and their employees, in an effort to promote the growth of the people as individuals, the companies as businesses, and the industries as a body. That’s why, upon hearing the news from the Supreme Court my thinking went immediately to how I would approach the issue if I thought of those who provide women’s health/abortion services as an association (federation model) and women who could/would be patients as members of that association.
(Update: My daughter, who is much smarter than me, actually did a search and found just such an organization does exist. For those so inclined you can visit https://prochoice.org/ for more information).

First I’d do what every association does when confronted with a world-changing moment. That means we’d do an assessment of the situation and immediately begin defining what we need to do short term — think of these as tactical, “can’t wait” activities — then we figure out our medium- and long-term activities. It’s not that we only do the short-term activities from the start, it’s just that they take top priority at the time. Then we do an assessment of the resources needed to accomplish each activity, figure out which ones we can realistically tackle, focus on those and work our butts off to get the resources needed to accomplish them. Again, I’m no expert on the topic of abortion, but based on what I’ve been reading here’s what I see as some of the challenges and how they could be tackled. It’s not intended to be comprehensive – just a collection of thoughts I’ve had over the last few days.

Short Term (first 3-6 months)

Problem: Probably the most critical challenge is for women currently seeking service in states that have “trigger-laws” that immediately made abortions illegal upon the Supreme Court’s ruling, to get access to legal abortions. Some clinics in those states are already working to open operations in other states where it’s legal, but many women don’t have the resources required to travel to those states.
Solution: The association approach would be to fundraise to pay for travel for the women, and provide expertise and the required technology to affiliated local organizations to coordinate the travel of their “members” to clinics in legal states. This program would continue as long as abortion is illegal in any given state.
Problem: In states with trigger laws there could also be an initial fight in the courts about the legality of organizations aiding women seeking abortions in other states.
Solution: The association approach would be to provide on-demand legal services for local organizations or women who find themselves in a court fight. This could potentially be done in partnership with other organizations like the ACLU and Legal Aid.

Medium Term (next 5 years)

Problem: There are a huge number of passionate, energetic people ready to volunteer to fight for this cause. While there are numerous organizations out there that these folks are active through, there is a risk that they could go in multiple directions and not benefit from leveraging their collective resources.
Solution: Creating a federated organization that can pull these disparate groups together to leverage their resources, and organize them so that their work is optimized for maximum effect. It’s a delicate dance because you have to find a way to balance each organization’s unique identity and offerings, while getting them to line up behind a consistent message, political agenda, shared resources, etc. A good example of what I’m thinking is what Feeding America is to food banks, except that group doesn’t have the political challenge that a pro-choice group would have. You’d think this would be a short-term problem, but there’s no way something this complex gets done in a few months so I’d look at this as a medium-term issue.
Problem: States that ban abortions might also try to prevent women from having access to the “Morning After” pill or other therapeutic measures.
Solution: This is a legal and logistical problem. The legal issue could be addressed by an association’s legal operation; the logistical challenge of getting drugs into the hands of women in need could be addressed by teaming clinicians with Pharmacy Benefit Managers (PBMs) or even Mark Cuban’s new venture Cost Plus Drugs.
Problem: As far as I can tell there is not a strong legal framework that requires men to assume their share of the responsibility, financial and otherwise, for unintended pregnancies.
Solution 1: The association could create, and fundraise for, a cadre of lawyers to represent women in civil court, to require men to pay for pre-natal care, half (at least) of any of the mother’s related health care expenses, child support, etc. Those same lawyers can represent mother’s in any custody hearings. Again, this might be accomplished by partnering with ACLU, Legal Aid, etc.
Solution 1a: Before you beat me up about the atrocious history of men paying child support, another step the association should take is lobbying Congress and/or state legislatures to make sure these payments can be garnished from wages, that mother’s are first in line at any bankruptcy hearing, etc.

Long Term (foreseeable future)

Problem: With the Supreme Court’s ruling a woman’s access to abortions has become contingent on individual states’ laws. That means that women with limited resources living in states that ban abortions will not have equitable access to care that residents of other states, or women of more means in their own states, have.
Solution: This is a purely political challenge. The association will need to form and lead a long-term political operation that brings together stakeholders at all levels, local, state, and federal to effect the necessary changes to give women equal care no matter where they live. I’m not expert enough to say what the legal remedies are, but no matter what they are there will need to be a significant political shift to accomplish them. That will take long-term funding, coordination and will.

Obviously this outline is pretty simplistic, and unlike industry associations that have a relatively easy to define “membership”, the players in the pro-choice world are far more varied. Believe it or not, however, most industry associations have a fairly diverse constituency and often struggle to get members to agree to how to approach issues, what to prioritize with their political operations, where to concentrate their resources, etc. The same challenge will most definitely be faced by any pro-choice “association”, but the benefit that industry associations provide their members – political influence, shared knowledge base, leveraged legal representation, leveraged resources (particularly technology), a bigger messaging megaphone, volunteer recruitment and management – would be realized by women if a pro-choice association approach is taken.