In the year that followed the Arab Spring and Occupy Wall Street, Stephanie Nakajima decided she wanted to be part of a movement, too.
It was 2012, and after graduating from college five years earlier, Nakajima had bounced around working as a waitress and writer. But it was her experience with the health care system that motivated the 26-year-old to act. She relocated from Denmark with her husband to take an unpaid summer internship at a Boston nonprofit that was pushing for what’s now known as Medicare for All.
The path forward seemed clear until two weeks before her start date. That’s when Nakajima learned she was pregnant.
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Having a baby was not in the plan, so Nakajima opted for an abortion. She continued with the internship at the organization, Mass-Care, which allowed her to build a résumé and a professional network. Last fall, with the benefit of more experience in the nonprofit sector, she returned as Mass-Care’s executive director.
With the Supreme Court expected to overturn Roe v. Wade, Nakajima, now 37, can’t help but think about how different things would have been if she had gone through with the pregnancy. Plenty of working mothers have successful careers, but that ability to control when — or whether — to have children matters.
“I would have not lived a life that was as true to myself,” she said. “I didn’t want to have kids then, and to this day I’m unsure if I ever will.”
“That,” she added, “is a choice every person should make for themselves. It’s inconceivable that someone can’t make that choice.”
What’s also inconceivable: the argument against Roe that is partly built on how there’s little evidence showing that legalized abortion has helped women. The leaked draft opinion by Justice Samuel Alito asserted that the effect of abortion rights on women and society ”is hard for anyone — and in particular, for a court — to assess.”
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That line confounded Middlebury College economist Caitlin Myers, who organized 154 economists to file an amicus brief last year to the Supreme Court case to show how striking down Roe would have a negative impact on women’s lives. The 73-page document compiled studies, including her own research, that exhaustively detailed how the legalization of abortion in 1973 has transformed women’s lives in various ways, from reducing teen pregnancy to increasing wages.
It “dramatically reshaped the ages and circumstances under which American women became mothers,” Myers said in an interview. “It has a spillover effect on their lives that let them finish their education . . . let them earn more to escape poverty.”
If Roe is overturned, abortion will still be allowed in Massachusetts because the Legislature passed a law in 2020 to protect a woman’s right to choose. But at least 26 other states are expected to ban or severely restrict abortions.
Nearly one out of four women in the United States will have an abortion by the age of 45, according to the Guttmacher Institute, with many taking place when the women are in their 20s. Myers’s research indicates that in the first year post-Roe, about 100,000 women won’t be able to travel out of state for an abortion because of barriers such as cost and the ability to take time off from work.
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Based on historical trends, she estimates that a quarter of those pregnancies will end in miscarriages or from self-managed terminations. That means there could be roughly 75,000 unplanned births every year, primarily in the Deep South and Midwest. But those figures and other fallout from the upending of Roe are unlikely to pose a shock to the economy, Myers said, because abortion is expected to remain legal in half the country and most women will find a way to reach providers that remain open. But it will exacerbate inequality, she added, because those who can’t travel will overwhelmingly be the poorest.
Reflecting on the impact an abortion has had on Nakajima’s life, Myers said stories like hers are not “singular or unique. This is just a really important component of women’s health care that has tremendous effects on their lives.”
Sally Alves was unemployed in 2010 when she found out she was six weeks pregnant. Her husband at the time was in the military and about to be sent to Iraq. At 24, Alves had been struggling with alcohol addiction and her mental health. For her, an abortion was the only good option.
“It was not the right time to expand my family,” she said. “It would have been hard on so many different levels.”
Today, Alves credits the abortion with turning her life around. Instead of taking care of a baby, she was able to take care of herself. Six months after terminating the pregnancy, she sought treatment for her addiction.
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She also got a job at a cemetery, helping families make interment arrangements. In 2017, she decided she wanted to help women who could not afford an abortion and began working for the National Network of Abortion Funds, an organization that reduces financial and logistical obstacles to abortion.
“I am 11 years sober . . . that is a testament to how the abortion saved my life,” said Alves, 36, who lives in Boston. “It allowed me to really focus on other parts of my life.”
In 1993, Trish Karter was already the mother of a toddler and expecting twins. Twenty-three weeks into the pregnancy, doctors told Karter that her unborn son was healthy but his twin sister had a rare chromosomal disorder. If her daughter didn’t perish before birth, she would suffer from devastating disabilities and health complications, and probably die young. But there was another risk that weighed on Karter: The condition could cause her to spontaneously lose both babies.
Karter made an agonizing decision to abort the baby girl that she and her husband desperately wanted. “There were no good answers,” she wrote in a 2015 Globe opinion piece.
I reached out to Karter last week to ask her how that choice might have changed her career over the ensuing decades. She gave birth to a healthy boy in 1993, cofounded Dancing Deer Baking Co. the following year, and ended up running the company for nearly two decades.
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“This is not a decision I have lived easily with,” said Karter, now 65, of her abortion.
Karter said that at the time, she was not thinking about her career. Looking back, though, it’s hard for her to imagine balancing the grueling schedule of an entrepreneur with being the mother of a gravely ill child.
“I don’t think my life would have been the same,” said Karter. “I probably wouldn’t have been racing off and working at Dancing Deer through the night or holiday. . . . It just wouldn’t have been the top priority.”
Karter named her unborn daughter Dora, the Greek word for gift. Her twin brother, Dimitri, is 28.
“I can’t be anything but grateful for the gift of my wonderful child who was given a better chance to live by the impossible decision which we had the ability to make,” added Karter. “I nestle Dora in my heart. Never forgetting.”
For Nakajima, the choice to have an abortion a decade ago eventually led her to a leadership role. Nakajima, who did not have health insurance at the time, underwent her procedure at Women’s Health Services in Brookline, which primarily serves uninsured, poorly insured, and low-income women. It cost her $600.
When her three-month internship at Mass-Care ended, she moved back to Denmark with her husband and took a job at a human rights organization.
In 2015, Benjamin Day, her former boss at Mass-Care, reached out to see if she would return to Boston to work at the organization he was running called Health Care-Now.
Nakajima had been a standout intern, and he needed a communications director. She was the first person he thought of. It seemed like a long shot, but Nakajima was intrigued and ended up taking the job. After six years, she felt prepared to lead her own organization and she sought to be the executive director of Mass-Care.
I asked Day about what might have happened if Nakajima had no choice but to keep the baby.
“It would have dramatically changed the course of not only her life but our organization. She’s really becoming a national leader in this movement,” he said. ”Not a lot of people are directing the place where they started as an intern.”
Shirley Leung is a Business columnist. She can be reached at shirley.leung@globe.com.