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Will Warsaw, Alabama, Become Like Warsaw, Poland?

Yes, there is a Warsaw, AL. Also Warsaws in 16 other states. Curious? Good. This is important. Back in the Good Old Days of the Soviet Union and its very-low-orbit satellites, abortion was legal in Poland and most of Eastern Europe. It was seen as just another form of contraception, like going to a drugstore and buying a packet of condoms. No big deal. But the extreme right-wing Law and Justice Party, which now governs Poland, is wildly against abortion. And it means it.

To start with, doctors are required to register all pregnancies in a national database. The outcome—live birth, stillbirth, miscarriage, or abortion—is going to be recorded as well. Logging each pregnancy and how it ends is going to make it much easier to enforce the antiabortion laws. After all, if there is no birth recorded 9 months after conception, that is going to trigger an investigation about what happened.

And that is not all. A scientific paper published last year in the Journal Molecules describes a method for determining if a person has taken misoprostol by examining a biological specimen for misoprostolic acid, which is a byproduct of using misoprostol. It requires using a gas chromatography tandem mass spectrograph, a complex machine that can determine what molecules are present in a specimen bombarded with an electron beam. You can't pick up one of these things at your local Home Depot, but there are labs that have one. Labs attached to coroners' offices usually have one to determine what chemicals, if any, are present in the bodies of the deceased. Coroners need this information sometimes to see if someone was poisoned.

Now here's the connection between the journal paper and Poland. In an attempt to determine if a woman who didn't give birth when she was expected to had an abortion, a biological sample taken from her (possibly by court order) can be sent to a lab to see if she used misoprostol. There are labs in Poland running these tests now. Most likely there is no one in Warsaw, AL, who reads Molecules, but there might be some staffer to an Alabama state legislator who reads The New York Times or other publications that are carrying this story and then tells their boss about it. Boss then has a "Eureka!" moment and decides that what is good for Warsaw, Poland, is good for Warsaw, AL, and writes a bill mandating a lab test for misoprostol for all women once a month. After all, the Fourth Amendment (unreasonable searches and seizures) doesn't apply to misoprostol, which didn't exist when the Fourth Amendment was ratified.

We are not predicting that lab tests for misoprostol are the next big thing, but history shows that when a technology is developed that some folks really want, it is going to get used. One thing that is not known yet is how long misoprostolic acid remains detectable after it is taken. If it is metabolized or excreted within a few days, the window for getting the sample is quite small. If it lasts for weeks, the window is bigger. If you had asked us a year ago if the metabolism of misoprostolic acid was going to be a big deal, we would probably have said: "Nah." Silly us.

Right now, there is no lab test for mifepristone, but now that the cat is out of the bag, surely some red state can find the money to fund researchers at the local state university to see if they can find one and then publish a paper on how to do it, like the one cited above. Once it is technically possible, the law will surely take advantage of it. After all, in all states, police are allowed to ask drivers to take blood or breath tests for alcohol if they are suspected of drunken driving, so why not have a law allowing the police to take a blood sample to send to a lab if someone is suspected of violating the state's abortion law? If you refuse, there are severe penalties.

Just when technology (the development of RU-486, which became mifepristone) made it easy for women to get abortions, technology is making it easier to detect them. The next step in the abortion arms race is a new drug that masks the presence of misoprostolic acid, to foil the test. Of course getting it approved may be tricky if the only legitimate use is blocking the test, but if other medical uses can be found, then it could be approved. Let's just stop here. You probably get the idea by now.

This is not the only area where technology meets abortion. How could it be? Now AI is joining the mix. A pro-choice group called Plan C has created an AI-driven abortion bot that allows a woman seeking an abortion to fill in information about where she lives, how long she has been pregnant, and what kind of abortion she is seeking and presents her with a list of possible options. The bot is called Charley. This gives a whole new meaning to Travels with Charley. How long will it be before anti-choice organizations create bots that direct a woman to religious groups that try to talk her out of the abortion and if that fails, report her to the police. The next step will be a website that rates bots, telling which ones are run by pro-choice groups and which ones by anti-choice groups. Then there will be fake websites that lie about the bots. The battle continues. (V)

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