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Abortion Bans Have Consequences

Yesterday, we had multiple items about the political wrangling that is currently taking place when it comes to abortion policy. Today, we follow that up with a rundown of some of the human consequences that are already showing themselves as a result of the Dobbs decision. Here are 10 of them:

  1. Cruel Prenatal "Care": This was one of the first issues that people began to talk about once the post-Dobbs laws kicked in. The line between "emergency prenatal care" and "abortion" is somewhat blurry, and if being on the wrong side of that line means losing your medical license and the career you spent a decade or more training for, then it leads to... extreme overcaution. Already women are being forced to carry non-viable or barely viable pregnancies to term, and to endure the agony of delivering a child that will not survive. To give one example, Samantha Casiano's daughter Halo had identifiable, unsurvivable deformities, including profound anencephaly. The problems were discovered well after the Texas cutoff for an abortion, so Casiano had to carry the pregnancy to term, and then watch Halo spend four hours gasping for air before dying. The family is unable to afford a funeral, incidentally.

  2. Maternal Mortality: Needless to say, if some women are compelled to carry non-healthy fetuses to term, then some women will suffer severe health consequences and, in turn, some of those women will die. In the former category, for example, is Amanda Zurawski, whose water broke too early, and who was denied an abortion. As a result of this, she developed a severe infection, went into septic shock, and spent three days in intensive care where her chances of survival were sometimes judged to be 50/50. She made it, but others will not. Amanda Stevenson, of the University of Colorado, has used statistical modeling to project a 14% increase in maternal deaths in states that adopt strict abortion restrictions. That works out to somewhere between 60 and 100 preventable deaths of women per year.

  3. Infant Mortality: Another predictable impact of carrying compromised fetuses to term is that some of them will make it, in the sense of surviving birth, but they won't make it long-term. Recall that Texas got a jump on the post-Dobbs world with its bounty-system workaround, which served to significantly curtail abortions in the state. The impact, in terms of infant mortality, is already manifesting itself roughly 2 years in. After 7 straight years of declines, the rate of infant death is up 21.6% this year in the Lone Star State. In total, the abortion restrictions appear to be responsible for about 230 dead children.

  4. Hair-Triggers: File this one under "the law of unintended consequences." As we have pointed out many times, the 6-week cutoff for abortions is designed to create a very short window, or no window, for women to decide whether to terminate. It takes time for the evidence of a pregnancy to show itself, more time to get a test, and more time to schedule a procedure.

    This is where the unintended consequences enter the picture. If a woman is left with mere days or hours to decide, and is not 100% sure about keeping the pregnancy, then the deadline might force a termination that might not otherwise have happened. For example, Angel (last name withheld) learned she was pregnant at the 5 week, 5 day mark. She had 24 hours to decide whether to keep the pregnancy or not and, not able to wrap her mind around such a life-changing possibility in that timeframe, concluded she had no choice but to terminate.

  5. Terrible Travel: As we noted yesterday, surgical abortions are still reasonably accessible for women, even in states with bans, if those women are willing and able to drive to a nearby state without a ban. Those trips can be and often are pretty miserable, however. Consider the story of Austin Dennard, who is herself an OB-GYN, and who learned 11 weeks into her pregnancy that her fetus had unsurvivable anencephaly. Since there was still a "heartbeat" (as we noted this weekend, that term is actually a misnomer), Dennard had to travel from her home state of Texas in order to secure an abortion. "I felt like my pregnancy was not my own, that it belonged to the state, because I no longer had a choice of what I could do. I felt abandoned. I couldn't believe that after spending my entire life in the state, being a sixth generation Texan, practicing medicine in the state, that the state had completely turned their back on me," she said in court testimony as part of a case challenging the Texas law.

  6. Back-Alley Abortions: When a country builds border walls, it leads to an uptick in ladder sales. When a country bans liquor, it leads to bootlegging. And when a country bans abortions, it leads to an increase in back-alley and/or self-induced abortions, which are obviously much less safe than the ones conducted by medical professionals. There hasn't been quite enough time for a statistical picture to become clear, but professional organizations for physicians are already publishing guidelines for how to treat the consequences of badly performed abortions.

  7. Police State: There is much about the red-state abortion policies that is hard to enforce. One of those is limits on abortifacient pills via mail, which is a battle that's just getting underway. Another is drawing a line between miscarriages and induced abortions. That battle is already being waged. Most notably, at least in terms of press coverage, is the case of Celeste Burgess, who delivered a stillborn fetus, 28 weeks old, when she was 17 years old. The police in her home state of Nebraska investigated the matter in a manner commensurate with, oh, say, the case of the Zodiac killer. That meant, among other things, gaining access to text messages between Burgess and her mother. Ultimately, Burgess was found guilty at trial and sentenced to 90 days in jail.

  8. Disparate Impact, Race: Black and Latina women have less access to birth control and less access to prenatal care. That inevitably means that they will disproportionately suffer the consequences described above. To be more precise, Black and Latina women are about three times as likely to have an abortion as white women; that suggests that Black and Latina women are about three times as likely to feel the effects of abortion bans. Activists in those communities are already pointing this out, vocally.

  9. Disparate Impact, Social Class: This goes hand-in-hand with the previous item on the list, but poor women also have less access to birth control and to prenatal care, and so are more likely to suffer the consequences of abortion bans. Making things worse is that the abortion-banningest states tend to have the worst maternal support nets. NPR has some interesting visual journalism that puts this into perspective, with charts that show states by rate of uninsured women age 19-64, by child poverty rate, and by percentage of population that lives in a "maternity care desert" where such care is barely available or not available. To take one example, Mississippi has the tenth-most uninsured women (13%), the worst child poverty rate (28%), and the second-largest percentage of women in maternity care deserts (59.3%). Also worth noting is that if someone is already poor, having an infant child is not usually going to improve on that fact. The Turnaway Study, which is very well known among those who study these issues, reveals that half of women who seek abortions are below the poverty line, and that those who are denied treatment are 400% more likely to remain below the poverty line going forward.

  10. Disparate Impact, Age: Most adults know that when a woman reaches the age of 40, roughly speaking, the odds of fetal abnormalities go way up. Considerably less well known is that some of the most common abnormalities among such mothers do not reveal themselves until roughly the 15th week of pregnancy. Needless to say, that is well past the cutoff imposed by a 6-week ban and a 12-week ban. To be more precise, there are currently 17 states where week 15 would be too late for an abortion, and another 8 states where a sub-15 week ban is on the books but is currently on hold due to a court order. That's exactly half the states where 40+-year-old women are at risk, or potentially at risk.

It is abundantly clear that, barring some sort of black swan event (say, Russia nuking New York City), abortion is going to be THE issue of 2024, in races up and down the ballot. Joe Biden has set the tone for his party, taking every opportunity to bring up Dobbs and to talk about what he calls the "devastating consequences" of the ruling.

Meanwhile, even though the numbers argue very strongly that it's politically unwise, Republicans continue to press for more and more restrictions on abortion access. Yes, it might make sense for someone running for governor of Alabama or state senator in Wyoming to build their campaign around their strong opposition to abortion, but the math doesn't work so well in swingier states, cities and districts. In particular, the Freedom Caucusers in the House keep insisting on putting anti-abortion stuff in spending bills. Among other things, if the Paul Gosars and Lauren Boeberts of the world had their way, they would ban abortions in D.C., would prohibit any assistance on the part of the armed forces when it comes to service members who want or need abortions (even medically necessary ones), and would stop pharmacies from dispensing abortifacient medications.

Undoubtedly, swing-state GOP members of Congress will try to explain that they did not support [Extreme Measure X]. But it's going to be pretty easy for Democratic politicians, up and down the ticket, to run on the argument that voting Republican means voting for harsh anti-abortion policies. And as Democratic politicians make this point, they are going to have plenty of compelling, heart-wrenching material to work with, as outlined above. Some of the things we list are going to find their way into speeches, some will come up in debates, and some will become fodder for campaign ads. Meanwhile, the people on the front lines—the women and their doctors—are going to tell their stories, over and over—and, in fact, are already doing so (see here, here, here, here, and here for a few examples). We'll also point out that there are different exemplars available for different purposes. For example, talking about the impacts on 40-year-old mothers will likely resonate with suburban women; talking about the impacts on Black and Latina women will resonate with voters in those communities; talking about the aggression of law enforcement in places like Nebraska will connect with libertarian-minded voters, etc.

And that is why we present this rundown for your consideration. If the GOP gets crushed in 2024, and abortion policy is one of the main reasons (which it almost certainly would be, in the case of a blue wave), nobody can say they didn't see it coming. (Z)

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