A woman speaks at a rally (copy)

Sue Birns speaks Sunday during a Berkshire Democratic Brigades Roe v. Wade 50th anniversary rally at Park Square in Pittsfield.

I was a college student in 1973 when Roe v. Wade first ensured that a back-alley abortion was not the only choice for an American woman who needed to terminate a pregnancy.

And I use the word needed very deliberately, because while I know many, many women who have had abortions in the ensuing 50 years, not a single one of them wanted an abortion. It was just the best option for them given their circumstances at the time.

I never imagined then that in 2023 my daughter and granddaughter would be denied a right that the U.S. Supreme Court had recognized as guaranteed by our Constitution for half a century. And yet that is precisely the situation we find ourselves in now and why we gathered in Park Square on Sunday as part of the National Women’s March 2023. Sunday was the 50th anniversary of the Roe v. Wade decision, and demonstrations were held across the country to call attention to the fact that the fight for reproductive rights and justice is far from over. The major change is that the struggle is now focused primarily on the state level because, with the Dobbs decision last June, the Supreme Court handed the decision about whether to limit or protect the legality of abortion back to the states.

We are among the lucky ones because we live in Massachusetts, one of the few states where abortion rights are decently protected at the state level.

Millions of other American women now live in states that do not offer this protection, and nine states outlaw abortion even in cases of rape and incest. Woe to the women of Alabama, Arkansas, Kentucky, Louisiana, Missouri, Oklahoma, South Dakota, Tennessee and Texas.

While Dobbs has a significant effect on all Americans, men as well as women, it has a particularly crushing impact on a very specific, but unfortunately large population: survivors of domestic violence and sexual assault.

Rape is one of the most traumatic events in the human experience. Imagine being forced to bear the child of the person who raped you. In the case of incest, imagine the horror and injustice of being forced to bear a child who is not only your offspring, but your sibling.

Consider these facts:

• Many battered women are raped by their husbands at least once, and many report being raped repeatedly.

• The National Domestic Violence Hotline reports that 25 percent of callers experience reproductive coercion including forced sex and sabotage of their birth control methods.

• 1 in 7 rape survivors becomes pregnant.

• Batterers’ violence often escalates when their partners are pregnant.

• The number-one cause of death of a pregnant or post-partum woman is not obstetric-related; it is homicide.

Sexual assault and domestic violence are efforts to dominate, humiliate and control another person. Survivors report feeling powerless as one of the most common outcomes. Denying women the right to make their own reproductive choices is a particularly powerful means of exerting control over them, and that is what this conservative Supreme Court has done. After a rapist or batterer victimizes them, the criminal legal system is now free to victimize them again.

Without the constitutionally protected right to choose an abortion, women will still have choices. And, yes, they will still have abortions. They will get to choose an unregulated, unsafe back-alley abortion; endure a forced pregnancy; stay in an abusive relationship that gets more violent due to the pregnancy; or risk jail time if they cross a state line to have an abortion.

The loss of a federally protected reproductive choice affects all women, but it is a particularly serious threat to the marginalized and most vulnerable who typically have the fewest resources. We must worry especially about women of color, undocumented immigrants, poor women. Wealthy women, who are most likely white women, will still have access to safe abortions regardless of where they reside.

The battle is far from over and we are angry, not depressed. There are many actions that states and the federal government can and must take, and we are going to hold them accountable to do so. These include:

1. Maintaining reproductive rights that are already enshrined in state laws.

2. Expanding access to these rights and abortion care.

3. Improving access to contraceptives.

4. Protecting funding for family planning services.

5. Limiting religious exemptions in order to protect patient rights.

6. Ensuring that health care providers can be honest with their patients concerning their full range of options.

7. Expanding access to reproductive health services through telemedicine.

8. Increasing availability of comprehensive sex and healthy relationship education.

The war against women, including our reproductive rights, is not over and it is not a war we intend to lose.

Dr. Susan Birns is a member of the Elizabeth Freeman Center board of directors and professor emerita at Massachusetts College of Liberal Arts.