Historically, the disability rights and pro-life movements have produced some strange bedfellows. Antiabortion advocates often appeal to the value of disabled lives when they promote legislation that prohibits abortion on the basis of fetal anomalies. And though what gets called “the disability community” is nothing if not heterogeneous, even disability advocates who support abortion rights often voice concerns about certain elements of reproductive choice, such as the dwindling of newborns with Down syndrome in countries with widespread prenatal genetic testing. It would be easy, then, to think there is a conflict between valuing disabled life and demanding full reproductive autonomy—but this would be a mistake.

As a disabled scholar who thinks a lot about disability ethics and health care, I’ve noticed that the debate over fetal anomalies doesn’t capture the full set of concerns that I share with disabled friends of so-called childbearing age. That’s because it only considers abortion through one limited, if still important, lens: prospective parents’ choice of whether or not to have children with disabilities. But given that people with disabilities make up more than a quarter of the US population and abortion is expected to be banned in about half the US states following the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, we are far past due for a reckoning with what reproductive justice requires for adults with disabilities. For many of us, it means affordable, accessible, and safe abortions, whether or not we want children.

Disability is as varied as the human condition, and many disabled people build thriving biological families that flout ableist assumptions about who can be a parent. At the same time, certain conditions can make pregnancy extremely high-risk and physically torturous in ways that restrictive state laws disregard. Doctors have already reported delaying medically necessary abortions out of fear of lawsuits or prosecution, and it is not hard to imagine how this hesitancy could harm people with chronic illnesses and disabilities. Some people with psychiatric disabilities might fear a relapse of crisis-causing symptoms as a result of the medication changes and hormonal fluctuations that accompany pregnancy. People with complications from diabetes might fear that being pregnant would exacerbate kidney disease or neuropathy. But the fact that the physical stress of a pregnancy could take years off a chronically ill person’s life would be of little to no consequence under Mississippi’s abortion law, for example, which contains a “life of the mother” exception only in the case of a “medical emergency” that “necessitate[s] the immediate performance or inducement of an abortion.”

Predictably, the number of people traveling out of state for abortions has skyrocketed since Dobbs. But this option exists only for those who are well enough to travel and who can afford the necessary transportation and time off work. Disabled people live in poverty at twice the rate of nondisabled people, and can’t accumulate savings under the punishing asset limits of Supplemental Security Income. Beyond the cost, travel also can be dangerous and inaccessible for people who rely on durable medical equipment. On average, airlines break or lose 29 wheelchairs a day, leaving the people who need them immobilized and at risk of injury or even death.

Even if a person surmounts those obstacles, finding an accessible medical facility is another challenge. Despite the Americans with Disabilities Act’s requirement that health facilities provide reasonable accommodations for disabled patients, many lack basic accessible equipment, and disabled people often encounter stigmatizing attitudes from medical professionals when it comes to sexual health. The continued shrinking of abortion provider networks will make it harder for pregnant people with disabilities to find providers who can meet their needs and treat them with respect.

Of course, abortion restrictions also endanger people who do wish to be pregnant. Many people who want biological children also have conditions that put them at higher risk of adverse outcomes and miscarriage, such as intellectual and developmental disabilities, thyroid disorders, hormonal conditions, and diabetes. Because the medications and surgeries used to end miscarriages are identical to those used in abortions, doctors are increasingly afraid to treat miscarriages, forcing pregnant people to carry an unviable or deceased fetus. This poses clear psychological risks as well as physical ones, as evidenced by the deaths of women in Ireland, Italy, and Poland who developed sepsis after being denied miscarriage treatment.

This lack of accessible gynecological care will disproportionately imperil those whose illnesses and disabilities put them at greater risk of miscarriage—especially if they are marginalized in other ways. Racialized health disparities mean that Black women have a higher likelihood of miscarriage than White women, while Black people in general are more likely to be disabled. Access to safe and timely miscarriage care is therefore a matter of intersectional disability justice.

An especially horrific outcome of the end of federal abortion protections is the fact that, in many states, people who miscarry or have stillbirths are vulnerable to prosecution. Even before Dobbs, law enforcement targeted people whose miscarriages they alleged were linked to drug use, overwhelmingly charging women of color. It is chilling to imagine how this practice might intersect with disabled people being forced to carry pregnancies while dependent on medications that pose risks to fetuses—such as methotrexate, a common arthritis medication that some doctors and pharmacists have refused to refill after Dobbs.

For the past thirty years, disability activism has been guided by the slogan, “Nothing about us without us.” When the conversation around disability and abortion is constrained to the interests of fetuses, that “us” is conveniently constrained to entities that can’t speak. And when antiabortion lawmakers cynically adopt disability critiques to restrict access to abortion, they neglect the diverse needs and desires of disabled people, many of whom object to yet another impingement on our bodily autonomy after decades of fighting for self-determination. It’s easy enough to profess to care about disabled lives in utero—but it’s time to start listening to us about what we need outside the womb.

An earlier version of this essay appeared in Hastings Bioethics Forum.