abortion should be banned essay

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Why Abortion Should Be Banned Essay

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Introduction, the immorality of abortion, why abortion should be banned, the procedures and legalities of abortion, the right to choose: a woman's perspective, the historical context of abortion, life begins at conception: the biological argument.

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• Abolishing Abortion: The History of the Pro-Life Movement in America. (n.d.). Retrieved from https://www.oah.org/tah/issues/2016/november/abolishing-abortion-the-history-of-the-pro-life-movement-in-america/.
• Baird, R. M., & Rosenbaum, S. E. (2001). The ethics of abortion: pro-life vs. pro-choice. Amherst, NY: Prometheus Books.
• Beckwith, F. (2008). Defending life: a moral and legal case against abortion choice. Cambridge University Press.
• Higgins, M., & Dellapenna, J. W. (2013). Roe v. Wade: abortion and a woman’s right to privacy. Minneapolis, MN: ABDO Pub.
• OBOS Abortion Contributors. (n.d.). History of Abortion in the U.S. Retrieved from https://www.ourbodiesourselves.org/book-excerpts/health-article/u-s-abortion-history/.
• Shettles, L. B., & Rorvik, D. M. (1983). Rites of life: the scientific evidence for life before birth. Grand Rapids, MI: Zondervan Pub. House.
• Williams, D. K. (2019). Defenders of the unborn: the pro-life movement before Roe v. Wade. New York: Oxford University Press.
• Willke, J. C., & Willke, B. (1985). Handbook on abortion. Cincinnati, OH: Hayes Pub. Co.

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Pro and Con: Abortion

To access extended pro and con arguments, sources, and discussion questions about whether abortion should be legal, go to ProCon.org .

The debate over whether abortion should be a legal option has long divided people around the world. Split into two groups, pro-choice and pro-life, the two sides frequently clash in protests.

A June 2, 2022 Gallup poll , 55% of Americans identified as “pro-choice,” the highest percentage since 1995. 39% identified as “pro-life,” and 5% were neither or unsure. For the first time in the history of the poll question (since 2001), 52% of Americans believe abortion is morally acceptable. 38% believed the procedure to be morally wrong, and 10% answered that it depended on the situation or they were unsure.

Surgical abortion (aka suction curettage or vacuum curettage) is the most common type of abortion procedure. It involves using a suction device to remove the contents of a pregnant woman’s uterus. Surgical abortion performed later in pregnancy (after 12-16 weeks) is called D&E (dilation and evacuation). The second most common abortion procedure, a medical abortion (aka an “abortion pill”), involves taking medications, usually mifepristone and misoprostol (aka RU-486), within the first seven to nine weeks of pregnancy to induce an abortion. The Centers for Disease Control and Prevention (CDC) found that 67% of abortions performed in 2014 were performed at or less than eight weeks’ gestation, and 91.5% were performed at or less than 13 weeks’ gestation. 77.3% were performed by surgical procedure, while 22.6% were medical abortions. An abortion can cost from $500 to over $1,000 depending on where it is performed and how long into the pregnancy it is.

• Abortion is a safe medical procedure that protects lives.
• Abortion bans endangers healthcare for those not seeking abortions.
• Abortion bans deny bodily autonomy, creating wide-ranging repercussions.
• Life begins at conception, making abortion murder.
• Legal abortion promotes a culture in which life is disposable.
• Increased access to birth control, health insurance, and sexual education would make abortion unnecessary.

This article was published on June 24, 2022, at Britannica’s ProCon.org , a nonpartisan issue-information source.

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Key facts about the abortion debate in America

The U.S. Supreme Court’s June 2022 ruling to overturn Roe v. Wade – the decision that had guaranteed a constitutional right to an abortion for nearly 50 years – has shifted the legal battle over abortion to the states, with some prohibiting the procedure and others moving to safeguard it.

As the nation’s post-Roe chapter begins, here are key facts about Americans’ views on abortion, based on two Pew Research Center polls: one conducted from June 25-July 4 , just after this year’s high court ruling, and one conducted in March , before an earlier leaked draft of the opinion became public.

This analysis primarily draws from two Pew Research Center surveys, one surveying 10,441 U.S. adults conducted March 7-13, 2022, and another surveying 6,174 U.S. adults conducted June 27-July 4, 2022. Here are the questions used for the March survey , along with responses, and the questions used for the survey from June and July , along with responses.

Everyone who took part in these surveys is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories.  Read more about the ATP’s methodology .

A majority of the U.S. public disapproves of the Supreme Court’s decision to overturn Roe. About six-in-ten adults (57%) disapprove of the court’s decision that the U.S. Constitution does not guarantee a right to abortion and that abortion laws can be set by states, including 43% who strongly disapprove, according to the summer survey. About four-in-ten (41%) approve, including 25% who strongly approve.

About eight-in-ten Democrats and Democratic-leaning independents (82%) disapprove of the court’s decision, including nearly two-thirds (66%) who strongly disapprove. Most Republicans and GOP leaners (70%) approve , including 48% who strongly approve.

Most women (62%) disapprove of the decision to end the federal right to an abortion. More than twice as many women strongly disapprove of the court’s decision (47%) as strongly approve of it (21%). Opinion among men is more divided: 52% disapprove (37% strongly), while 47% approve (28% strongly).

About six-in-ten Americans (62%) say abortion should be legal in all or most cases, according to the summer survey – little changed since the March survey conducted just before the ruling. That includes 29% of Americans who say it should be legal in all cases and 33% who say it should be legal in most cases. About a third of U.S. adults (36%) say abortion should be illegal in all (8%) or most (28%) cases.

Generally, Americans’ views of whether abortion should be legal remained relatively unchanged in the past few years , though support fluctuated somewhat in previous decades.

Relatively few Americans take an absolutist view on the legality of abortion – either supporting or opposing it at all times, regardless of circumstances. The March survey found that support or opposition to abortion varies substantially depending on such circumstances as when an abortion takes place during a pregnancy, whether the pregnancy is life-threatening or whether a baby would have severe health problems.

While Republicans’ and Democrats’ views on the legality of abortion have long differed, the 46 percentage point partisan gap today is considerably larger than it was in the recent past, according to the survey conducted after the court’s ruling. The wider gap has been largely driven by Democrats: Today, 84% of Democrats say abortion should be legal in all or most cases, up from 72% in 2016 and 63% in 2007. Republicans’ views have shown far less change over time: Currently, 38% of Republicans say abortion should be legal in all or most cases, nearly identical to the 39% who said this in 2007.

However, the partisan divisions over whether abortion should generally be legal tell only part of the story. According to the March survey, sizable shares of Democrats favor restrictions on abortion under certain circumstances, while majorities of Republicans favor abortion being legal in some situations , such as in cases of rape or when the pregnancy is life-threatening.

There are wide religious divides in views of whether abortion should be legal , the summer survey found. An overwhelming share of religiously unaffiliated adults (83%) say abortion should be legal in all or most cases, as do six-in-ten Catholics. Protestants are divided in their views: 48% say it should be legal in all or most cases, while 50% say it should be illegal in all or most cases. Majorities of Black Protestants (71%) and White non-evangelical Protestants (61%) take the position that abortion should be legal in all or most cases, while about three-quarters of White evangelicals (73%) say it should be illegal in all (20%) or most cases (53%).

In the March survey, 72% of White evangelicals said that the statement “human life begins at conception, so a fetus is a person with rights” reflected their views extremely or very well . That’s much greater than the share of White non-evangelical Protestants (32%), Black Protestants (38%) and Catholics (44%) who said the same. Overall, 38% of Americans said that statement matched their views extremely or very well.

Catholics, meanwhile, are divided along religious and political lines in their attitudes about abortion, according to the same survey. Catholics who attend Mass regularly are among the country’s strongest opponents of abortion being legal, and they are also more likely than those who attend less frequently to believe that life begins at conception and that a fetus has rights. Catholic Republicans, meanwhile, are far more conservative on a range of abortion questions than are Catholic Democrats.

Women (66%) are more likely than men (57%) to say abortion should be legal in most or all cases, according to the survey conducted after the court’s ruling.

More than half of U.S. adults – including 60% of women and 51% of men – said in March that women should have a greater say than men in setting abortion policy . Just 3% of U.S. adults said men should have more influence over abortion policy than women, with the remainder (39%) saying women and men should have equal say.

The March survey also found that by some measures, women report being closer to the abortion issue than men . For example, women were more likely than men to say they had given “a lot” of thought to issues around abortion prior to taking the survey (40% vs. 30%). They were also considerably more likely than men to say they personally knew someone (such as a close friend, family member or themselves) who had had an abortion (66% vs. 51%) – a gender gap that was evident across age groups, political parties and religious groups.

Relatively few Americans view the morality of abortion in stark terms , the March survey found. Overall, just 7% of all U.S. adults say having an abortion is morally acceptable in all cases, and 13% say it is morally wrong in all cases. A third say that having an abortion is morally wrong in most cases, while about a quarter (24%) say it is morally acceptable in most cases. An additional 21% do not consider having an abortion a moral issue.

Among Republicans, most (68%) say that having an abortion is morally wrong either in most (48%) or all cases (20%). Only about three-in-ten Democrats (29%) hold a similar view. Instead, about four-in-ten Democrats say having an abortion is morally  acceptable  in most (32%) or all (11%) cases, while an additional 28% say it is not a moral issue. 

White evangelical Protestants overwhelmingly say having an abortion is morally wrong in most (51%) or all cases (30%). A slim majority of Catholics (53%) also view having an abortion as morally wrong, but many also say it is morally acceptable in most (24%) or all cases (4%), or that it is not a moral issue (17%). Among religiously unaffiliated Americans, about three-quarters see having an abortion as morally acceptable (45%) or not a moral issue (32%).

• Religion & Abortion

Carrie Blazina is a former digital producer at Pew Research Center .

Cultural Issues and the 2024 Election

Support for legal abortion is widespread in many places, especially in europe, public opinion on abortion, americans overwhelmingly say access to ivf is a good thing, broad public support for legal abortion persists 2 years after dobbs, most popular.

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The negative health implications of restricting abortion access

December 13, 2021— Ana Langer is professor of the practice of public health and coordinator of the Women and Health Initiative at Harvard T.H. Chan School of Public Health.

Q:  Roe v. Wade may soon be overturned by the Supreme Court, while at the same time other countries are loosening restrictions around abortion rights. What are your thoughts on the current climate around this issue?

A: The trend over the past several decades is clear: Safe and legal abortion has become more widely accessible to women globally, with nearly 50 countries including Mexico, Argentina, New Zealand, Thailand, and Ireland liberalizing their abortion laws. During the same period, however, a few countries have made abortion more restricted or totally illegal, including El Salvador, Nicaragua, and Poland.

In the U.S., legal frameworks are increasingly limiting access to abortion. Even while Roe is in place, many people are currently unable to receive abortion care.

If the Supreme Court were to limit or overturn Roe, abortion would remain legal in 21 states and could immediately be prohibited in 24 states and three territories. Millions of people would be forced to travel to receive legal abortion care, something that would be impossible for many due to a range of financial and logistical reasons.

This situation does not surprise me because of the deep polarization that characterizes public views on abortion, and the growing power and relentless efforts of anti-choice groups. Furthermore, it does not surprise me because of the important gender gap that exists in this country, which is to a great extent due to the lack of strong and consistent policies and legal frameworks to support women in their efforts to better integrate their reproductive and professional roles and responsibilities.

The U.S. legalized abortion nearly 50 years ago, at a time when it was legally restricted in many countries around the world, setting an important international precedent and example. It disappoints me to see that while important progress has been made towards equality in other culturally polarized areas such as same-sex marriage, women’s right to terminate an unwanted or mistimed pregnancy is now severely threatened.

Q:  How do laws that restrict abortion access impact women’s health? 

A: Restricting women’s access to safe and legal abortion services has important negative health implications. We’ve seen that these laws do not result in fewer abortions. Instead, they compel women to risk their lives and health by seeking out unsafe abortion care.

According to the World Health Organization, 23,000 women die from unsafe abortions each year and tens of thousands more experience significant health complications globally. A recent study estimated that banning abortion in the U.S. would lead to a 21% increase in the number of pregnancy-related deaths overall and a 33% increase among Black women, simply because staying pregnant is more dangerous than having an abortion. Increased deaths due to unsafe abortions or attempted abortions would be in addition to these estimates.

If the current trend in the U.S. persists, “back alley” abortions will be the last resource for women with no access to safe and legal services, and the horrific consequences of such abortions will become a major cause of death and severe health complications for some of the most vulnerable women in this country.

The legal status of abortion also defines whether girls will be able to complete their educations and whether women will be able to participate in the workforce, and in public and political life.

Improving social safety net programs for women reduces gender gaps and improves girls’ and women’s health and chances to fulfill their potential, and could help reduce the number of abortions over time. Women who are better educated, have better access to comprehensive reproductive health care , and are employed and fairly remunerated will be better positioned to avoid a mistimed and unwanted pregnancy, hence the need for termination will become less common.

Q: Should abortion be considered a human right?

A: Numerous international and regional human rights treaties and national-level constitutions around the world protect the right to safe and legal abortion as a fundamental human right. Access to safe abortion is included in a constellation of rights, including the rights to life, liberty, privacy, equality and non-discrimination, and freedom from cruel, inhuman, and degrading treatment. Human rights bodies have repeatedly condemned restrictive abortion laws as being incompatible with human rights norms.

While a supportive legal framework for abortion care is critical, it is not enough to ensure access for everyone who seeks the service. For universal access to become a reality, policies that cover the cost of abortion care and its integration into the health care system, in addition to societal measures that destigmatize the procedure, are needed.

— Amy Roeder

Should Abortion Be Banned?

Introduction, arguments for banning of abortion, counterarguments and refutation, works cited.

The issue of abortion has led to divergent opinions in the US with the pro-life activists advocating its illegalization and their pro-choice counterparts arguing in its favor. Pro-choice crusaders assert that a pregnant woman ought to be accorded the right to either sire the child or carry out an abortion before birth. One rationale behind their argument is that such a lady might have been a rape victim who is not prepared to get a baby (Sedgh et al. 224). In contrast, pro-life activists affirm that options should be established instead of abortion, for example, presenting the child for adoption. The reason they give for their position is that if all women were to undertake abortion and not get any child, the continuity of human life would be threatened. Abortion is a contentious and divisive topic in the community, civilization, and politics of the United States, and numerous anti-abortion rules have been in effect in all states from around 1900.

Pro-life activists assert that other options might be preferable in place of abortion. They state that only fewer than 20% of all cases of abortion are associated with rape or even minors (Thomas et al. 358). Therefore, they maintain that among the most effective solutions to the avoidance of abortion is engaging in protected sex when is not prepared to rear a baby. A different practice would be to get the baby and present it to be cared for by other willing individuals rather than termination of its life. One might contact organizations dedicated to nurturing babies who lack proper parents or allow adoption as some amicable solutions against abortion. Some women strongly desire to have a child, which does not happen attributable to infertility. The existence of options for abortion shows that the practice is needless and condemnable regardless of the reason provided.

Pro-life crusaders state that abortion should be banned because in nearly all occurrences it makes the patient develop health complications. For example, many females have experienced hemorrhage, infections, and sometimes death during or even after abortion. Breast cancer is one of the most widespread risks of undertaking abortion attributable to the altered or disrupted structure of the mammary glands (Thomas et al. 359). Carcinogenic practices are apparent in transitional cells of females who have had an abortion. Each time a woman carries out an abortion, she increases the possibility of developing breast cancer. Furthermore, more than a quarter of the females who get abortion-associated cancer lose their lives. Irrespective of the short-lived relief following an abortion, nearly all the women and girls who carry it out report related psychological problems. Some of the signs of abortion-associated psychological problems include flashbacks, guilt, substance use/abuse, anger, suicidal thoughts, hallucination, and sexual dysfunction. Ensuing problems after abortion establishes that it is an unsafe and risky practice that ought to be banned.

Abortion should be illegalized because it is tantamount to murder as it entails the termination of the life of an already living creature. After four weeks of pregnancy, the developing embryo already has a pumping heart, and the appearance of mouth, ears, nose, limbs, and brain follows closely. During that time, there is the possibility of recording brainwaves and perception of heartbeat (White et al. 190). Additionally, there is the emergence of bones, and the unborn child begins to reflectively respond to stimuli. Since these processes are already in existence before the period of any likely abortion, it is evident that undertaking the practices should be illegal because it subjects the unborn baby to agonizing pain and suffering.

The pro-choice drive is established on the belief that no female should be compelled by the regulations in a country to have a baby contrary to her will whenever valid and substantial reasons are given. The argument provided is that siring a child should be a private familial affair, which should not be troubled. The pro-choice conviction is based on the notion that the life of a person begins after birth (Aiken et al. 396). Nevertheless, the American Life League marks a pro-life group that maintains that the right to life should be given to a human being from the fertilization phase hence the need to illegalize abortion.

Consistent with the affirmations of the pro-choice crusaders, bestowing on the embryo or fetus the sense of life infringes the rights of pregnant women for interfering with their independence. Additionally, banning abortion is a way of hindering girls from obtaining the help of health providers when they require tackling some medical concerns. Calling for the illegalization of abortion is being insensitive. For example, illegalization disregards how the education and later life of a teenager who becomes pregnant out of rape are irreparably damaged. This would lead to some female students becoming truants or school dropouts (Jones and Jerman 4). Another aspect that is ignored in the illegalization of abortion is the trauma that a family would suffer while nurturing an unwanted baby. Nonetheless, since there is only a small proportion of teenagers who become pregnant after incidences of rape, the illegalization of abortion would have an insignificant impact on adolescent girls.

The pro-choice movement is convinced that pro-life activists do not consider the fact that the law (such as the illegalization of abortion) will not prevent girls from becoming pregnant and clandestinely going for an abortion. Additionally, although most narcotic drugs are illegal, people are still using them secretly (Sedgh et al. 227). In the same way, enacting laws that illegalize abortion will result in many pregnant girls having abortions in unsafe settings that may leave them at the risk of death over and above the termination of the life of the embryo or fetus. The point is that if a pregnant woman or lady carries an unwanted pregnancy and has the determination of aborting it, they will still do it regardless of whether it is legal or banned. It is irrational for some people to put much significance on the need for an unborn child to live while overlooking the degree to which such a practice jeopardizes the mother’s life and welfare. However, it is imperative for laws to be enacted to control vices devoid of providing reasons for the irrelevance of such regulations.

Abortion leads to the intentional termination of a pregnancy prior to birth. It has elicited mixed feelings with one group establishing that pregnant girl should have the independence of either aborting or bearing the child. However, a different group asserts that options such as adoption should be practiced rather than abortion that denies the unborn child the right to life. Abortion is an argumentative and divisive subject in American civilization, community, and politics, and many anti-abortion guidelines have been in operation in all states since about 1900. Since the illegalization of abortion outshines the advocacy for its legalization, the practice should be banned.

Aiken, Abigail, et al. “Requests for Abortion in Latin America in the Wake of Zika Virus.” The New England Journal of Medicine, vol. 375, no. 4, 2016, pp. 396-400.

Jones, Rachel, and Jenna Jerman. “Abortion Incidence and Service Availability in the United States, 2011.” Perspectives on Sexual and Reproductive Health, vol. 46, no. 1, 2014, pp. 3-14.

Sedgh, Gilda, et al. “Adolescent Pregnancy, Birth, and Abortion Rates across Countries: Levels and Recent Trends.” Journal of Adolescent Health, vol. 56, no. 2, 2015, pp. 223-230.

Thomas, Rachel, et al. “Anti-Legal Attitude toward Abortion among Abortion Patients in the United States.” Contraception, vol. 96, no. 5, 2017, pp. 357-364.

White, Kari, et al. “Women’s Knowledge of and Support for Abortion Restrictions in Texas: Findings from a Statewide Representative Survey.” Perspectives on Sexual and Reproductive Health, vol. 48, no. 4, 2016, pp. 189-197.

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Following the leak of a draft decision by the Supreme Court that would overturn Roe v. Wade, the Medical School’s Louise King discusses how the potential ruling might affect providers.

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How a bioethicist and doctor sees abortion

Alvin Powell

Harvard Staff Writer

Her work touches questions we can answer and questions we can’t. But her main focus is elsewhere: ‘the patient in front of me.’

With the leak Monday of a draft decision by the Supreme Court that would overturn Roe v. Wade, the future of abortion in the U.S. has been a highly charged topic of conversation all week. Doctors are among those wondering what’s next. Louise King is an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School and a Brigham and Women’s Hospital physician whose practice includes abortion services. King, who is also the director of reproductive bioethics for the Center for Bioethics at the Medical School, spoke with the Gazette about ethical dimensions of abortion and how a ruling against Roe might affect providers.

Louise King

GAZETTE: In the U.S., abortion is framed in broad ethical terms: life versus death, privacy versus government intrusion, etc. From a medical ethics standpoint, what are the important concerns to be balanced on this issue?

KING: I frame the topic in the context of the patient in front of me. In other words, I look primarily to autonomy and beneficence in the context of doing good for the patient. That might mean upholding that person’s choice not to proceed with what is still a very dangerous proposition, namely carrying a pregnancy to term and delivering. If someone says to me, “I’m pregnant and do not wish to be pregnant,” for a multitude of reasons, I support that decision, because the alternative of carrying to term is risky. I want to protect that person’s bodily autonomy. From a reproductive justice standpoint, I want to support persons who have uteri in making decisions about when they wish to have a family, how they want that to look, whether they want to have a family at all, in expressing their sexuality, and in all kinds of different things.

I don’t believe that life begins at conception. Among the minority of people in this country who believe that’s the case, some are vocal and aggressive in imposing that belief on others, which may happen with this upcoming decision. But quite a number of students that I meet who believe life begins at conception still don’t believe that they have the right to impose that belief on others. To contextualize what we ask of persons with uteri when we make abortion illegal, it’s helpful to compare instances where we could ask people to undergo very risky procedures to help others. For example, we don’t demand that people give blood. It’s not a big deal and it could save lives every day, but we don’t demand that anybody donate blood or bone marrow. We don’t demand kidney donations, which are less risky than childbirth nowadays.

So we generally don’t ask one human being to give so completely of themselves to another, but we do so when it’s a pregnant person. That, I believe, does not comport with our ethics. But it also doesn’t fully address the concerns of persons who believe life begins at conception. They come to those beliefs honestly, but I think they have to explore them more deeply and figure out whether, even if true — do they hold up to the point where we require somebody to have a forced pregnancy to term? I would say, within my understanding of ethics, no.

“It’s not a big deal and it could save lives every day, but we don’t demand that anybody donate blood or bone marrow. We don’t demand kidney donations, which are less risky than childbirth nowadays.”

GAZETTE: Abortion is one of the most divisive issues in the country. Is the medical profession unified on it one way or another?

KING: That’s hard to say definitively. No study or survey exists to truly quantify this. The American Medical Association and the America College of Obstetricians and Gynecologists say that abortion is health care, and I agree. ACOG is very strong in their wording about supporting the right to access abortion. Unfortunately, only 14 percent of practicing OBGYNs provide abortion care. As a profession, our words and actions don’t match. I think there’s a multitude of reasons for that. One is the stigma associated with providing abortion care in some parts of the country.

I would guess that most providers feel similarly to the majority of Americans — that abortion is health care and should be available. While I’ve met some medical students and practicing physicians in all kinds of disciplines who feel strongly that abortion is unethical, the vast majority that I’ve spoken to feel as I feel: that it’s health care and should be provided.

GAZETTE: A big part of the debate over the decades has centered on viability. Is this an issue for science to determine? Is it an issue for society? Is it an issue for religion?

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KING: I don’t think that science can tell us definitively when life begins. Life is a broad term and includes a variety of living entities. I don’t think that religion can define it because we have freedom of religion and religions see this differently. Rabbis will explain that in the Torah, it’s very clear that an embryo is simply an extension of a woman’s body, like a limb, and should not be considered another person until birth. The leaked decision presumes that one version of Christianity’s assessment of this prevails, which seems to violate our understanding of freedom of religion in this country.

Ultimately, “when life begins” isn’t the right question because it’s unanswerable. The question then must be: How do we as a society come up with a compromise that upholds the autonomous rights of the persons in front of us who may become pregnant, who may have excessive risks associated with a pregnancy, or who may simply not wish to be pregnant, that also observes whatever our society’s agreed-upon understanding is of when a protected entity exists.

I think Massachusetts absolutely gets it right. If you read the Roe Act : Abortion is allowed for any reason in the first and second trimesters, and then abortion for medical reasons or lethal fetal anomalies can extend into the third trimester with careful consideration between patient and medical teams. To me, that is an exceptionally well-thought-out compromise. This is a societal decision. It shouldn’t be made by a minority of persons based on their narrow definition of “when life begins.”

GAZETTE: If something like the leaked draft decision emerges, is there a potential for medical providers to get caught in the middle?

KING: Overturning Roe would turn the question over to the states. That would mean that those providers who exist within the states that are clearly going to go forward with legislation to outlaw abortion would be in dire situations. In Massachusetts, we could provide the care we’re already providing and would expect people to travel from out of state to us. I don’t think that the long-arm statutes would reach a provider here, that somebody could come after me from Texas if somebody traveled from Texas to me and I provided care. But if I traveled to Texas, for a conference, it might. Legal experts aren’t sure.

GAZETTE: Have you ever been threatened because you’ve offered abortions?

KING: I haven’t, but many of my colleagues have. I did my training in Texas, so I lived a long time in the South. I’ve not been threatened directly, but spoken sternly to by many people who disagreed with me. I mentioned earlier that there are plenty of people who believe life begins at conception but who do not feel they should impose their viewpoints on others — those are people I met in Texas and Louisiana. There are a lot of people like that, but they can’t speak up for fear of being ostracized. The sense that I have through all the conversations I’ve had over many years is that we are all talking past each other. You started off by saying this is a topic that divides our country, but it doesn’t. The vast majority of people are settled on having abortion as an option, having contraception as an option, and having sex education available. There’s a group of politicians who make it appear that we’re divided and build their political careers off of that. It’s incredibly disheartening and unethical for them to do so.

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There’s a Better Way to Debate Abortion

Caution and epistemic humility can guide our approach.

If Justice Samuel Alito’s draft majority opinion in Dobbs v. Jackson Women’s Health Organization becomes law, we will enter a post– Roe v. Wade world in which the laws governing abortion will be legislatively decided in 50 states.

In the short term, at least, the abortion debate will become even more inflamed than it has been. Overturning Roe , after all, would be a profound change not just in the law but in many people’s lives, shattering the assumption of millions of Americans that they have a constitutional right to an abortion.

This doesn’t mean Roe was correct. For the reasons Alito lays out, I believe that Roe was a terribly misguided decision, and that a wiser course would have been for the issue of abortion to have been given a democratic outlet, allowing even the losers “the satisfaction of a fair hearing and an honest fight,” in the words of the late Justice Antonin Scalia. Instead, for nearly half a century, Roe has been the law of the land. But even those who would welcome its undoing should acknowledge that its reversal could convulse the nation.

From the December 2019 issue: The dishonesty of the abortion debate

If we are going to debate abortion in every state, given how fractured and angry America is today, we need caution and epistemic humility to guide our approach.

We can start by acknowledging the inescapable ambiguities in this staggeringly complicated moral question. No matter one’s position on abortion, each of us should recognize that those who hold views different from our own have some valid points, and that the positions we embrace raise complicated issues. That realization alone should lead us to engage in this debate with a little more tolerance and a bit less certitude.

Many of those on the pro-life side exhibit a gap between the rhetoric they employ and the conclusions they actually seem to draw. In the 1990s, I had an exchange, via fax, with a pro-life thinker. During our dialogue, I pressed him on what he believed, morally speaking , should be the legal penalty for a woman who has an abortion and a doctor who performs one.

My point was a simple one: If he believed, as he claimed, that an abortion even moments after conception is the killing of an innocent child—that the fetus, from the instant of conception, is a human being deserving of all the moral and political rights granted to your neighbor next door—then the act ought to be treated, if not as murder, at least as manslaughter. Surely, given what my interlocutor considered to be the gravity of the offense, fining the doctor and taking no action against the mother would be morally incongruent. He was understandably uncomfortable with this line of questioning, unwilling to go to the places his premises led. When it comes to abortion, few people are.

Humane pro-life advocates respond that while an abortion is the taking of a human life, the woman having the abortion has been misled by our degraded culture into denying the humanity of the child. She is a victim of misinformation; she can’t be held accountable for what she doesn’t know. I’m not unsympathetic to this argument, but I think it ultimately falls short. In other contexts, insisting that people who committed atrocities because they truly believed the people against whom they were committing atrocities were less than human should be let off the hook doesn’t carry the day. I’m struggling to understand why it would in this context.

There are other complicating matters. For example, about half of all fertilized eggs are aborted spontaneously —that is, result in miscarriage—usually before the woman knows she is pregnant. Focus on the Family, an influential Christian ministry, is emphatic : “Human life begins at fertilization.” Does this mean that when a fertilized egg is spontaneously aborted, it is comparable—biologically, morally, ethically, or in any other way—to when a 2-year-old child dies? If not, why not? There’s also the matter of those who are pro-life and contend that abortion is the killing of an innocent human being but allow for exceptions in the case of rape or incest. That is an understandable impulse but I don’t think it’s a logically sustainable one.

The pro-choice side, for its part, seldom focuses on late-term abortions. Let’s grant that late-term abortions are very rare. But the question remains: Is there any point during gestation when pro-choice advocates would say “slow down” or “stop”—and if so, on what grounds? Or do they believe, in principle, that aborting a child up to the point of delivery is a defensible and justifiable act; that an abortion procedure is, ethically speaking, the same as removing an appendix? If not, are those who are pro-choice willing to say, as do most Americans, that the procedure gets more ethically problematic the further along in a pregnancy?

Read: When a right becomes a privilege

Plenty of people who consider themselves pro-choice have over the years put on their refrigerator door sonograms of the baby they are expecting. That tells us something. So does biology. The human embryo is a human organism, with the genetic makeup of a human being. “The argument, in which thoughtful people differ, is about the moral significance and hence the proper legal status of life in its early stages,” as the columnist George Will put it.

These are not “gotcha questions”; they are ones I have struggled with for as long as I’ve thought through where I stand on abortion, and I’ve tried to remain open to corrections in my thinking. I’m not comfortable with those who are unwilling to grant any concessions to the other side or acknowledge difficulties inherent in their own position. But I’m not comfortable with my own position, either—thinking about abortion taking place on a continuum, and troubled by abortions, particularly later in pregnancy, as the child develops.

The question I can’t answer is where the moral inflection point is, when the fetus starts to have claims of its own, including the right to life. Does it depend on fetal development? If so, what aspect of fetal development? Brain waves? Feeling pain? Dreaming? The development of the spine? Viability outside the womb? Something else? Any line I might draw seems to me entirely arbitrary and capricious.

Because of that, I consider myself pro-life, but with caveats. My inability to identify a clear demarcation point—when a fetus becomes a person—argues for erring on the side of protecting the unborn. But it’s a prudential judgment, hardly a certain one.

At the same time, even if one believes that the moral needle ought to lean in the direction of protecting the unborn from abortion, that doesn’t mean one should be indifferent to the enormous burden on the woman who is carrying the child and seeks an abortion, including women who discover that their unborn child has severe birth defects. Nor does it mean that all of us who are disturbed by abortion believe it is the equivalent of killing a child after birth. In this respect, my view is similar to that of some Jewish authorities , who hold that until delivery, a fetus is considered a part of the mother’s body, although it does possess certain characteristics of a person and has value. But an early-term abortion is not equivalent to killing a young child. (Many of those who hold this position base their views in part on Exodus 21, in which a miscarriage that results from men fighting and pushing a pregnant woman is punished by a fine, but the person responsible for the miscarriage is not tried for murder.)

“There is not the slightest recognition on either side that abortion might be at the limits of our empirical and moral knowledge,” the columnist Charles Krauthammer wrote in 1985. “The problem starts with an awesome mystery: the transformation of two soulless cells into a living human being. That leads to an insoluble empirical question: How and exactly when does that occur? On that, in turn, hangs the moral issue: What are the claims of the entity undergoing that transformation?”

That strikes me as right; with abortion, we’re dealing with an awesome mystery and insoluble empirical questions. Which means that rather than hurling invective at one another and caricaturing those with whom we disagree, we should try to understand their views, acknowledge our limitations, and even show a touch of grace and empathy. In this nation, riven and pulsating with hate, that’s not the direction the debate is most likely to take. But that doesn’t excuse us from trying.

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Article Contents

I. the hope that abortion bans will deter abortion, ii. the hope that abortion bans will send a message, iii. the hope that abortion bans will be competently implemented and enforced, iv. conclusion, acknowledgements, ethics approval statement.

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What will and won’t happen when abortion is banned

Katharine & George Alexander Professor of Law, Santa Clara University School of Law.

• Article contents
• Figures & tables
• Supplementary Data

Michelle Oberman, What will and won’t happen when abortion is banned, Journal of Law and the Biosciences , Volume 9, Issue 1, January-June 2022, lsac011, https://doi.org/10.1093/jlb/lsac011

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For the past 50 years, abortion opponents have fought for the power to ban abortion without little attention to how things might change when they won. The battle to make abortion illegal has been predicated on three nebulous assumptions about how abortion bans work. First, supporters believe banning abortion will deter it. Second, they hope bans will send a message about abortion—specifically, that abortion is immoral. And third, they expect bans to be competently implemented and enforced. Drawing on empirical work from within and outside of the U.S., this Article offers an evidence-based assessment of each of these assumptions. Part One examines the question of deterrence by exploring findings from countries with relatively high and relatively low abortion rates. After explaining why restrictive abortion laws alone do not reduce aggregate abortion rates, I consider the matter of individual deterrence. By identifying those most likely to be deterred by U.S. abortion bans, I illustrate how abortion bans intersect with structural inequalities to disproportionately impact poor women of color and their children. Part Two tests the idea that abortion bans send a message. I consider the bans’ meaning in context with U.S. laws and policies affecting families, exposing the difference between laws discouraging abortion, and those encouraging childbirth. Then, drawing from literature on the expressive function of the law, I assess the limits on the message-sending capacity of abortion bans in a society divided over abortion and over its commitment to children living in poverty. Part Three turns to the expectation that abortion bans will be competently enforced, noting the legitimacy struggles arising from law enforcement patterns, along with the administrative challenges inherent in overseeing the various exceptions to abortion bans. This article concludes by considering why the consequences and limitations of abortion bans should matter to supporters and opponents, alike.

For the past 50 years, abortion opponents have fought for the power to ban abortion without paying much mind to the details of how things might change when they won. The battle to make abortion illegal has been waged over a surprisingly nebulous assumption that banning abortion would, in itself, lead to meaningful changes in the practice of abortion in America. It has been a policy based on hopes and prayers, rather than on actual evidence about how restrictive abortion laws work in practice.

When the law on the ‘books’ changes in the United States, what might the law on the ground look like? Drawing on empirical work from within and outside of the USA, this article offers an evidence-based answer to the question of what will and would not happen where abortion is banned.

In the spirit of full disclosure, like almost everyone who engages with the abortion war, I have a bias: I am an unambivalent supporter of abortion rights. Nonetheless, I strive in this article to maintain a tone that I hope will permit readers who disagree with me to hear my message. I do so because those on all sides of our abortion war should care about it. For 50 years, the USA abortion war has been fought almost exclusively around the issue of legalization. 1 Yet all evidence suggests the changes likely to be wrought by banning abortion should leave even ardent supporters of abortion bans not just disappointed, but profoundly disturbed by their downstream consequences.

The question of how abortion bans work in practice is a live one among abortion-rights advocates, with many, (including myself), working to identify what happens, and to whom, so as to permit advocates and policy makers to mitigate their harsh impact on the vulnerable. 2 By contrast, anti-abortion Americans who have spent decades working to enact such laws have paid relatively little attention to how things actually change when abortion is illegal. Instead, they have rested their support for outlawing abortion on three general assumptions about how abortion bans will work. First, they believe banning abortion will deter it. 3 Second, they hope the bans will send a message about abortion—specifically, that abortion is immoral. 4 And third, they expect the laws will be competently implemented and enforced. 5

This article interrogates each of these expectations. Part One begins its consideration of the question of deterrence by exploring research from countries with relatively high and relatively low abortion rates. This comparison offers powerful evidence that restrictive abortion laws alone do not reduce abortion rates. But while outlawing abortion is unlikely to cause an aggregate decline in abortion rates, bans will cause some to carry to term pregnancies they might otherwise have aborted. 6 This section concludes with an examination of how abortion bans intersect with structural inequalities to disproportionately impact poor women of color and their children–already the most vulnerable and marginalized Americans.

Part Two tests the assumption that outlawing abortion will send a message that abortion is morally wrong, thereby helping to foster a culture that rejects abortion as an option. This section considers the messages sent by US abortion bans by placing them in context with our laws and policies that inform when and whether people seek abortions. Then, drawing from literature on the expressive function of the law, this section explores the practical and symbolic limits on the message-sending capacity of abortion bans in a society divided over abortion and over its commitments to children living in poverty.

Part Three moves to the expectation that abortion bans will be competently enforced. Here, I examine the legitimacy struggles arising from law enforcement patterns, along with the administrative challenges inherent in overseeing the various exceptions to abortion bans.

This article concludes with a consideration of why the consequences and limitations of abortion bans should matter to supporters and opponents, alike.

Abortion opponents anticipate that banning abortion will deter it. That said, they are not overly sanguine about this hope; anti-abortion advocates acknowledge that abortions will continue to take place, even if illegal. 7 But their support for abortion bans rests firmly on the expectation that there will be fewer of them, once abortion is a crime. 8 In this section, I explore the question of deterrence, first considering the population-wide impact of bans on abortion rates, and then describing the Americans most likely to be deterred by abortion bans.

I.A. Deterrence, in the Aggregate

To think about whether abortion can be deterred by outlawing it, we must begin by reflecting on what leads people to have abortions. Abortion demand is driven by a host of factors—health status, relationship status, job status—but the most commonly cited concern is lack of money. 9 Half of all US abortions go to the 13 per cent of Americans living below the poverty line–which in 2022, means living on less than $13,590. 10 Those living in poverty or near poverty make up a full 76 per cent of abortions every year. 11 These are people whose abortion decisions are motivated, at least in part, because they cannot afford the costs of child rearing. 12

Rather than focusing on reducing abortion demand by offsetting the costs of having children, abortion bans aim to deter abortion solely by reducing access to legal abortion. Even a cursory glance at worldwide abortion rates suggests that strategy might not work. Abortion rates vary dramatically by region. In Latin America, (home to countries with the world’s strictest abortion bans), we find some of the highest abortion rates in the world: 32 abortions for every 1000 women. 13 At the other end of the spectrum, Western Europe, (with relatively liberal abortion laws), has the world’s lowest abortion rates: only 12 abortions per 1000 women. 14

The variation in abortion rates is best understood as an artifact of variation in rates of unintended pregnancy. 15 The single biggest predictor of abortion rates is not the legal status of abortion, but rather, the percentage of pregnancies that occur among those who were not looking to have a baby. In 2014, the most recent year for which data is available, 44 per cent of pregnancies globally were unintended. 53 per cent of those unintended pregnancies ended in abortion. 16 Rates of both unintended pregnancy and abortion vary by a country’s wealth status. In the world’s wealthier nations, over the past quarter century, rates of unintended pregnancies dropped by 30 per cent, triggering a decline in abortion rates from 46 abortions per 1000 women of reproductive age to an average of 27. 17 By contrast, over the same time frame in the developing world, unintended pregnancy rates fell by only 16 per cent, while abortion rates remained static. 18

Like other wealthy countries, U.S. abortion rates have dropped significantly in recent decades. 19 The decline is evident across almost every demographic in the country—younger, older, Northern, Southern. With one exception: abortion rates have remained constant among the poorest Americans. 20 This finding underscores the significance of unintended pregnancy in driving abortion rates: nearly half of all pregnancies in the United States are unintended—a higher rate than in many other developed countries. 21 These rates vary dramatically by class: a poor woman in the USA is more than five times as likely as an affluent woman to have an unintended pregnancy. 22

The single most effective way to help people avoid unwanted pregnancies, thereby deterring abortion, is by increasing contraception rates. When the Affordable Care Act mandated insurance coverage for contraception, the unintended pregnancy rate dropped from 44.7 to 37.9 per cent. 23 And yet, the anti-abortion movement has opted to oppose efforts to increase access to contraception. 24 Indeed, abortion opponents vigorously fought the Affordable Care Act’s birth control mandate, which the Supreme Court ultimately struck down in 2014. 25

If the goal of banning abortions is to deter them, a strategy that fails to focus on reducing unintended pregnancy seems limited, at best. But even if one accepts that abortion opponents are too ambivalent about promoting contraception to center the goal of deterring abortion by reducing unwanted pregnancy, the plan to deter abortion by banning it is flawed for a second reason. Specifically, owing to the ready availability of abortion medicines, abortion bans cannot effectively restrict access to a safe, effective, and affordable means to end a pregnancy.

The widespread availability of abortion medicines has completely transformed the world of illegal abortion. Unlike the pre-Roe era, medication abortion solves the problem of finding a doctor to perform an illegal abortion, while simultaneously reducing the health risks. 26 The most common and widely available abortion medicine is misoprostol. 27 Although less effective than the FDA-approved combination of mifepristone and misoprostol typically used in medical abortions in the USA, misoprostol alone causes an abortion in approximately 90 per cent of cases. 28 Efforts to restrict access to misoprostol are complicated for two reasons. It is both cheap and easy to manufacture, costing only pennies to make, and it also is an important life-saving medicine. 29 Indeed, the World Health Organization lists misoprostol as an ‘essential medicine,’ owing in part to its vital role in reducing deaths from postpartum hemorrhages, miscarriages, and illegal abortions. 30

There is a robust international market in misoprostol across the world today—particularly in countries where abortion is strictly banned. 31 Even in Central America, which boasts the world’s strictest abortion bans, one in three pregnancies ends in abortion, largely induced by medicines purchased online or on the street. 32 Americans familiar with the black market in opioids should have little trouble imagining how a market in abortion medicines will proliferate, where abortion is banned. As is all too evident from the scope of the opiate problem, it is unrealistic to think the government can prosecute away the expanding market in abortion medicines. 33

Outlawing abortion may lead to a short-term decline in US abortion rates, while people adjust to new market conditions. 34 But as we learn from the experiences of countries throughout the world, this decline is unlikely to be sustained. If anything, given the availability of reliable online information and buying options, it should take far less time for people to adapt to accessing illegal abortion than was true for alcohol access after Prohibition. 35

I.B. Deterrence, in the Specific

Even if abortion bans are unlikely to cause an aggregate decline in abortion rates–at least not independently of other trends 36 –we can predict that they will cause some to carry to term pregnancies they might otherwise have aborted. 37 In fact, we have a surprisingly clear picture of those who the bans are most likely to deter: they will be disproportionately young, poor, Black, and brown women. Abortion bans come as one in a long list of factors that circumscribe the reproductive lives and life options of these Americans. 38 They are more likely to experience unintended pregnancy, and where abortion is outlawed, they are more likely to struggle with accessing abortion, whether by traveling to a legal jurisdiction, or by identifying reliable information about how to safely end an unwanted pregnancy with abortion medications. 39

Those who support abortion bans on deterrence grounds have yet to fully grapple with what happens to those for whom abortion, legal or otherwise, is out of reach. The standard response is to promote the solution of placing newborn babies for adoption. Justice Amy Coney Barrett nodded to this viewpoint at oral argument in the Dobbs case, correcting the assertion that abortion bans amount to ‘forced motherhood’ by noting that safe haven laws permit them to surrender their newborns without legal consequences. 40 Adoption proponents point to the ways in which open adoptions have become the norm, hopeful that the prospect of staying involved in their baby’s life will encourage more people to place them for adoption. 41 Banning abortion, as they see it, can be a ‘win-win-win’ situation, in which the baby survives, the mother gets to go on with her life, and a married couple or family gets to raise the child. 42

Yet all available evidence suggests that banning abortion is unlikely to transform adoption from an outlier into a commonplace response to unwanted pregnancy. Even in the years prior to Roe, when the stigma of unwed motherhood led some facing pregnancy to place their babies, only 9 per cent of women chose adoption. 43 Much of that rate was driven by white women, because the two-parent family norm was less entrenched among Black and brown Americans. Today, the stigma is gone: 40 per cent of all children are born out of wedlock. 44 When faced with an unintended pregnancy, fewer than 5 per cent of people seriously consider adoption, and of those, fewer than 2 per cent ultimately place their children with adoptive families. 45

The best indication of what is likely to happen to those unable to access abortion is found in the Turnaway study, a 10-year longitudinal investigation of the impact of being denied an abortion. 46 That study followed hundreds of women who sought abortions, but were turned away because they were beyond the clinic’s gestational limits. 47 Fully 91 per cent of them opted to raise their child. 48

The Turnaway study also tells us about the consequent intensification of poverty for these families:

[C]hildren of women who are denied an abortion had greater odds (72 vs 55%) of living in poverty compared to children of women who received a wanted abortion. Similarly, existing children were more likely (87 vs 70%) to live in a household in which their mother is not able to afford necessary living expenses such as food, housing, and transportation compared to children of women who received a wanted abortion. 49

As we look to understand what happens when an abortion ban ‘works’ by deterring abortion, the only question is how broad a lens to use. More than one in three single-mother families lived in poverty in 2016. 50 Poverty is not color-blind. Instead, far more women of color live in poverty than do their white counterparts: close to 25 per cent of all American Indian or Alaskan native and 20 per cent of all Black and Hispanic women live in poverty, compared to only 9 per cent of their white counterparts. 51

So severe are the downstream consequences for children born into poverty that the American Academy of Pediatrics issued a statement decrying the short and long-term consequences of the ‘medicalization of poverty’:

Children who experience poverty, particularly during early life or for an extended period, are at risk of a host of adverse health and developmental outcomes through their life course. Poverty has a profound effect on specific circumstances, such as birth weight, infant mortality, language development, chronic illness, environmental exposure, nutrition, and injury. Child poverty also influences genomic function and brain development…. Children living in poverty are at increased risk of difficulties with self-regulation and executive function, such as inattention, impulsivity, defiance, and poor peer relationships. Poverty can make parenting difficult, especially in the context of concerns about inadequate food, energy, transportation, and housing. Child poverty is associated with lifelong hardship. Poor developmental and psychosocial outcomes are accompanied by a significant financial burden, not just for the children and families who experience them but also for the rest of society…. 52

We should read these statistics as a forecast. To the extent abortion bans deter abortion, we will likely see a disproportionate increase in the number of poor families of color experiencing the devastating consequences of living in poverty. Abortion bans work by leveraging existing inequalities. 53

Abortion opponents are of two minds about how to respond to the poor predicted outcomes for those who opt to raise children after being unable to access abortion. Small numbers of advocates–largely drawn from the volunteer ranks of pregnancy support or ‘crisis pregnancy’ centers–advocate helping women who are in desperate straits by offering housing, counseling, job training, and other support. 54 But the dominant voice of the anti-abortion movement–those advocates engaged in political activism and law reform, rather than direct service–focuses not on supporting poor mothers, but instead, on promoting adoption. 55

The suggestion that adoption is the optimal solution to a poorly timed pregnancy is as convenient as it is naïve. It allows abortion opponents to avoid a reckoning with consequences of having made the Republican party their political home. 56 The GOP’s historical and ongoing objection to family-friendly government policies 57 will make it hard, in the years to come, for abortion opponents to gain much traction for laws aimed at blunting the crushing impact of poverty on those whom the bans deter from having abortions.

Those who support abortion bans do not rest their support solely on the expectation that such laws will deter abortion. Instead, abortion opponents often invoke the belief that changing the law will send a message, thereby promoting culture change. 58 This section first considers the nature of that message, and then turns to whether it will be received.

It is helpful, when considering the message sent by outlawing abortion, to note the difference between an anti-abortion message (one that condemns abortion) and a pro-natal message (one that urges people to have babies). This distinction is easiest to observe when contrasting U.S. laws with those of countries that actively encourage childbearing.

Consider the case of Israel, which makes abortion a crime unless the person can prove to an official ‘pregnancy termination committee’ that they qualify for one of the statute’s exceptions. 59 This law would send a message that, outside of exceptional circumstances, abortion is wrong. 60 But it also exists alongside a host of laws and policies that encourage people to have children. 61 In Israel, there is guaranteed paid maternity leave—you can leave your job for 26 weeks, still get paid, and your employer cannot fire you. 62 Parents enjoy access to local neighborhood, government-subsidized day care. 63 In addition to tax deductions, the Israeli government pays everyone—rich and poor alike—a small monthly allowance for each child under eighteen. 64

In addition to the ways in which these policies help offset some of the most immediate costs associated with having a child, they send a message about how the government feels not just about abortion but also about babies. Israel’s laws send a message that the government wants people to have babies.

By contrast, US laws reflect little interest in encouraging people to have babies, particularly ones they cannot afford to raise. There is no paid parental leave, and no job security at all beyond the first 12 weeks of unpaid leave. 65 There is no child allowance. The Covid-related child income tax break, which reduced child poverty by 30 per cent, was permitted to lapse after a single year. 66 The goal of providing universal access to quality day care and preschool remains a pipedream. 67 The federal assistance program, Temporary Assistance to Needy Families, is so under-funded that no state’s subsidy amounts to more than 60 per cent of the federal poverty line, with the result that even in states with relatively generous monthly allocations, families cannot afford modest rent. 68

Those who believe abortion bans promote a culture of life might do well to recognize that any message sent by an abortion ban is necessarily entwined with the messages sent by government laws and policies that set the price of having a child. The message of an abortion ban on its own says little about embracing life, and instead merely suggests that abortion is wrong. 69

As to whether that message will be received, the answer is complicated. For all that, it is common to suggest the law can send messages, there is surprisingly little evidence for how it might do so. Professor Richard McAdams, one of the leading authorities on the ‘expressive function’ of the law, posits that an expressive law reveals the lawmakers’ beliefs, which in turn causes individuals to update their beliefs and ultimately to change their behaviors, usually in the direction of compliance. 70 He points to the example of indoor smoking bans by way of illustration. In the face of mounting evidence on the harmfulness of secondhand smoke, lawmakers enacted indoor smoking bans that served, in part, to send the message that tobacco was dangerous. In turn, these bans helped shift the culture away from smoking. 71

According to McAdams, smoking bans succeeded because lawmakers had a clear, credible message. But government credibility is not automatic; rather, it is earned. To send a message, government actors must offer some reason why the public should trust their conclusions. McAdams suggests the government earned credibility by persuading the public they were acting on data showing that the hazards of secondary smoke inhalation required nothing less. 72

Unlike smoking bans, abortion bans address themselves to a question of morality—one that cannot be settled by aggregated data or special expertise. A government hoping to persuade the public that abortion is immoral will struggle simply because it lacks the expertise needed to settle the question. 73

The challenge of sending a message by banning abortion is intensified by the impact of the ongoing battle over abortion’s legality. When it comes to the law’s ability to send a message, Professor McAdams notes, background noise can be fatal:

Individuals are constantly being bombarded by information from sources other than the law: the print media, Internet, social acquaintances, etc. For expression to change beliefs, there must be some factor that makes the legal signal strong enough to stand out against this background. 74

To send a message, abortion bans must compete for air time with a world of counter-messages. After all, the fight over abortion does not end with abortion bans. Together with the likelihood that abortion remains commonplace, even where banned, and remains legal in almost half the country, the message-sending capacity of abortion bans is more akin to that of marijuana bans than to indoor smoking bans. 75

At the end of the day, perhaps the most that can be said for the message-sending capacity of abortion bans is that, where popularly embraced by an anti-abortion electorate, the bans might contribute to a broader cultural message that abortion is wrong. As Katrina Kimport forcefully demonstrates in her book, No Real Choice , the ‘abortion as killing’ narrative can combine with structural constraints like legal barriers and cost to render abortion ‘unchoosable.’ 76

The final set of expectations harbored by those who support outlawing abortion involves tacit baseline assumptions about how the law will work, in practice. Specifically, supporters assume that abortion bans will be competently implemented and enforced—that the laws will have integrity. Competent implementation and enforcement are not abstract ideals, but rather, are necessary preconditions for a law to be considered a legitimate exercise of state authority. The failure to competently implement an abortion ban will undercut its legitimacy, thereby undermining both the law’s capacity to deter abortion and also its ability to send a message.

To understand the practical considerations relevant to enforcing abortion bans, begin by noting what is required in order to implement them. The standard form of US abortion bans includes a general prohibition, accompanied by a small number of exceptions. 77 This structure gives rise to two implementation and enforcement questions, both of which will determine whether the laws are ultimately seen as legitimate exercises of government authority. When and how will prosecutors endeavor to enforce the bans, and by what mechanisms will states evaluate cases involving exceptions to the bans?

Let us examine each of these in turn.

III.A. Enforcing Abortion Bans

Supporters of abortion bans have given relatively little thought to the question of how abortion laws will be enforced. In late 2021, movement leader Marjorie Dannenfelser, President of the Susan B. Anthony List (a nonprofit that supports pro-life politicians) explained how she views the question of enforcement:

[M]y view, and the view of the entire movement—without any exception that I’m aware of—is that the doctor, the one who has been planning to break the law, is the guilty party. The law is enforced against that person, not the woman. 78

But illegal abortion today need not involve a doctor or any third party besides an overseas pharmacy, outside the easy reach of US laws. 79 Given abortion medicines, the reality is that there are no doctors to prosecute.

When abortion becomes a crime, the question of who is the criminal will require an answer. And rather than being answered by movement leaders, the decision will rest in the hands of locally-elected prosecutors. No county can afford to prosecute every crime–far from it–so local District Attorneys set priorities when enforcing the law. 80 Their choices may be informed by many factors: staff resources, strength of evidence, heinousness of crime, perception of public will, or say, pro-choice or anti-abortion sentiment. As Judge Stephanos Bibas notes, there is no check on ‘idiosyncratic prosecutorial discretion.’ 81

A quick review of abortion prosecutions both historically and today helps us understand what idiosyncratic abortion prosecutions might look like. Historian Leslie Regan’s work documents the episodic nature of abortion prosecutions in the years prior to Roe , showing how they tended to be sporadic—an occasional crackdown, motivated by a zealous prosecutor, rather than a comprehensive effort at enforcement. 82

A similar pattern is seen today in places where abortion is outlawed. For example, consider El Salvador, which bans abortion without exception. In the 10 years from 2000–2010, there were 129 prosecutions. 83 This number suggests enforcement is relatively rare—just over 10 prosecutions per year—when, by the government’s own estimates, the country sees tens of thousands of abortions every year. 84 But there is a pattern to the prosecutions. Those charged with abortion crimes are drawn from the most vulnerable, marginalized sectors of society. 85 Almost half were illiterate; only a quarter had attended high school. 86

In the U.S. we already see a version of this pattern: abortion-related prosecutions are brought by zealous prosecutors 87 , and they disproportionately target Black and brown women. 88 The work of National Advocates for Pregnant Women helps us to understand the scope of abortion-related prosecutions in the years since Roe legalized abortion. They have tracked 1600 USA such cases since 1973. 89 These cases involve a range of allegations, linked by the common thread of alleged harm to a pregnancy. 90 The prosecutions overwhelmingly target poor people, and in particular, poor Black pregnant women. Of 413 cases arising from 1973 to 2005, 71 per cent involved low income women, of whom 59 per cent were women of color, with 52 per cent identifying as Black. 91

These patterns in abortion-related prosecutions tell us two important things. First, we can expect abortion bans to be enforced against those who end their own pregnancies. 92 And second, abortion prosecutions are likely to target the most marginalized, vulnerable members of society—those whom prosecutors view, or at least believe others will be willing to view, not as victims but rather, as villains. 93

Supporters of abortion should stop insisting that bans won’t be enforced against women, and should start figuring out what to do about the fact that, when abortion bans are enforced, the defendants will likely be Black and brown. It is, of course, unfair to make one subset of the population pay the price for acts that go unpunished when committed by others. Furthermore, as we learn from racial disparities in drug law enforcement, such patterns undermine the legitimacy of the law, and have downstream corrosive effects both on the people disproportionately targeted by the law and on society as a whole. 94

III.B. The Return of Conditional Abortion Access

Setting aside the question of prosecution, abortion laws also must be fully implemented in the regulatory sense of the word. A law that limits abortion access to patients with qualifying conditions presupposes an adjudicatory mechanism for determining eligibility. And barring a dramatic evisceration of the right to life for those who are pregnant, every state will have to make at least one exception to their abortion bans, for life-threatening pregnancies. 95

How will a patient establish their right to an abortion when they are experiencing a life-threatening pregnancy?

There are a variety of models by which states might screen such claims, ranging from relatively formal proceedings, such as those seen in cases involving termination of government benefits, to loosely structured processes like school disciplinary hearings. 96 Indeed, we already have a model for abortion-related adjudications in the judicial bypass system, by which minors can seek permission to end a pregnancy without parental involvement. 97

Each model is fraught, when it comes to screening for abortion eligibility. Formal judicial hearings pose challenges in terms of accuracy (there is surprisingly little agreement on what constitutes a life-threatening pregnancy) 98 and efficiency (given the urgent, technical nature of the inquiry). 99 A judge could not conceivably rule on such petitions without expert testimony, which raises numerous questions about process and evidence.

Prior to Roe , rather than ask judges to decide these cases, states delegated the determination to doctors, essentially leaving the medical profession to devise its own ways of complying with the law. 100 For reasons ranging from lack of consensus about qualifying conditions, 101 to concern over the legal implications of their decisions (which might trigger prosecution on the one hand, or a wrongful death suit if the pregnant patient dies, on the other), 102 doctors eschewed this responsibility. By the mid-20th century, hospitals around the country used so-called ‘therapeutic abortion committees’ to establish eligibility. 103 These committees were marked by inconsistent outcomes, stemming from a lack of consensus over what constituted a ‘valid’ reason for terminating a pregnancy, whether legally or morally. 104 Rather than standardizing the application of the law, the committee process facilitated ad hoc decision-making. 105

As states set about banning abortion, it is urgent that they erect a scientifically sound, impartial process by which to evaluate cases involving potentially life-saving abortions. Given that the vast majority of Americans support abortion in cases of life-threatening pregnancy, we can expect an enormous outcry from all quarters in the case of an incompetent oversight process, let alone a highly publicized death. 106

Yet the struggle to define what constitutes a life-threatening pregnancy, (or depending upon the law, a qualifying rape or fetal anomaly), is just the start. Which parties’ interests will be represented at these adjudicatory proceedings; however, they are configured? Will the pregnant patient be entitled to a lawyer? 107 Will the fetus? If unhappy with the outcome, can either side appeal? Will there be an expedited appeals process? By what criteria will adjudicators be chosen? Will these be adversarial proceedings, with experts from the state and from the pregnant patient’s medical team, or will the patient’s doctor’s testimony suffice? How will the government determine whose interests it represents: those of the patient in peril, or those of the fetus?

These are serious questions, made all the more so because they implicate vital interests and therefore trigger Constitutional due process rights. 108 Surely, there will be litigation over the answers in the years to come. But what is interesting about these questions is not so much their answers, but instead, the reality that they demand answers now. We are past the time when those who support banning abortion can respond to such questions about how the laws will be implemented with vague references to ‘traditional means of enforcement.’ 109 And the quality of those answers matters because inconsistent, incompetent or otherwise corrupt law enforcement cannot help but undermine the legitimacy of abortion bans.

We have spent half a century reckoning with abortion largely in abstractions, fighting over rights rather than focusing on the people whose lives are affected by those rights. If nothing else, the impact of abortion bans seems likely to put human faces on the abortion war. And if we stay true to the patterns laid out in this essay, those faces will be disproportionately poor, Black and brown women and children.

Abortion bans are not color blind.

It has become common for abortion opponents to invoke allegations of eugenics and racism when talking about abortion rates among Black Americans. 110 That rhetoric–already contested 111 –will become strained as the country witnesses the actual racist impact of abortion bans: their disparate impact on poor Black families, coupled with the disparate rates of prosecution of Black women for acts that go largely unpunished when committed by whites. 112

By bringing into focus the struggles facing the most vulnerable among us, abortion bans have the potential to transform the abortion war by forcing a direct engagement with the structural forces driving abortion, poverty, and racism. We are approaching a moment of truth for advocates on all sides of the abortion war.

For advocates of abortion rights, there will be a reckoning with the question of whether being pro-choice simply means supporting the right to abortion, rather than a commitment to working to offset the forces that constrain all reproductive options–including having a child. As Sister Song, a leading voice of the reproductive justice movement puts it, the commitment is to support, ‘the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.’ 113 As the impact of abortion bans brings structural inequality into sharp focus, will pro-choice movement leaders stay focused on legalizing abortion, or will the movement commit to this more robust understanding of reproductive autonomy?

For abortion opponents, the question is whether the term ‘pro-life’ has come to mean anything beyond one’s support for abortion bans. The years ahead likely will pose an existential challenge for people who have supported abortion bans, but who cannot help but be disturbed by the ways in which they fall short of expectations. Perhaps this result will embolden those who care deeply about deterring abortion, and find them laboring to craft policies that might actually help those contemplating abortion to continue their pregnancies. 114

Certainly, anti-abortion movement leaders are aware of the need to do something proactive in response to the impact of abortion bans on the poor. As Marjorie Dannenfelser, of the Susan B. Anthony Fund, put it: ‘Speaking for the pro-life movement, which is obviously attempting to lead Republicans, we absolutely, without question, have a responsibility to serve the needs of women and children as we pass ambitious laws. There’s no question about it.’ At the same time, Dannenfelser is aware that such policies are unlikely to fly, at least not in states dominated by a Republican party that has long opposed family-friendly government programs. 115

There’s a quote I keep on my desk these days: “How will we go when we’re faced with this? I don’t think it’s predetermined, and a great human moral drama is being played out in front of us.” 116 It is from a historian of pandemics, written in the early days of Covid-19. I keep it there because it speaks to me as we navigate the era of abortion bans. There is comfort in the invitation to step back and notice that we are in a time of high moral drama, in which things are in flux. But there is also, within it, a call to action. “How will we go when we’re faced with this?”

For helpful suggestions and conversation, I’m grateful to Diana Greene Foster, Julia Hejduk, Carole Joffe, Katrina Kimport, Larry Marshall, and my anonymous reviewers. I was particularly lucky to work with Jenai Howard (SCU Law, 2022), who provided outstanding research assistance. All errors are my own.

Human Subjects Research for this article was approved by Santa Clara University’s IRB, Protocol 17-03-950.

Research was funded in part by a Hackworth Grant (Santa Clara University, Markkula Ethics Center).

See Mary Ziegler, After Roe: The Lost History Of The Abortion Debate (2015), for a rich history of the anti-abortion movement in the early years after Roe v. Wade, illustrating among other things the way the anti-abortion movement shifted its focus from efforts to support pregnant women to the narrow issue of criminalization.

See generally Michelle Oberman, How Abortion Laws Do and Don’t Work , 36 Wis. J. L. Gender & Soc’y 163 (2022); see also Michelle Oberman, Her Body, Our Laws: On The Front Lines Of The Abortion War, From El Salvador To Oklahoma (2018); Diana Greene Foster, The Turnaway Study: Ten Years, A Thousand Women, And The Consequences Of Having Or Being Denied An Abortion (2020) [hereinafter, greene foster, the turnaway study]; Ushma Upadhyay, Alice F. Cartwright, and Daniel Grossman, Barriers to Abortion Care and Incidence of Attempted Self-Managed Abortion Among Individuals Searching Google for Abortion Care: A National Prospective Study , 106 Contraception 49 (2021); Lizzie Widdecombe, What Does an At-Home Abortion Look Like in 2021 , The New Yorker (Nov. 11, 2021), https://www.newyorker.com/news/news-desk/what-does-an-at-home-abortion-look-like-in-2021 (profiling self-managed abortion researcher, Abigail Aiken).

For example, see Ross Douthat, The Case Against Abortion , N.Y. Times (Nov. 30, 2021), https://www.nytimes.com/2021/11/30/opinion/abortion-dobbs-supreme-court.html (celebrating the impact of Texas’ S.B. 8, credited with causing a 93 per cent drop in the number of abortions taking place in the state).

See eg Richard Garnett, One Untrue Thing , Nat’l Rev. (Aug. 1, 2007), ( https://www.nationalreview.com/2007/08/one-untrue-thing-nro-symposium/ (‘The point of criminalization, after all, is not merely to put people in prison, or deter people from engaging in harmful behavior. It is, instead, to make a statement—a public statement, in the community’s voice—that certain actions, or certain harms caused, are morally blameworthy.’). See also Oberman, supra note 2, at 85–86 (quoting an anonymous Oklahoma state senator):

The purpose of the law is to stop abortion. To send a moral message. To get the message out via the law, to spark a debate in the population. The government’s responsibility is to give people education. It is up to the government to tell them that abortion is wrong. It’s not an acceptable solution.

This assumption is largely a tacit one, inherent in assertions about how abortion bans will be received by the public, and how they are likely to inspire others states to follow suit. See eg Issac Chotiner, The Pro-Life Movement Plans for a Future Without Roe , The New Yorker (Dec. 7, 2021), https://www.newyorker.com/news/q-and-a/the-pro-life-movement-plans-for-a-future-without-roe (interviewing Marjorie Dannenfelser, president of the Susan B. Anthony List, on her expectations for passing abortion bans in 30 states).

See Diane Greene Foster, Stop Saying That Making Abortion Illegal Won’t Stop People From Having Them , Rewire News Group (Oct. 4, 2018) [hereinafter Green Foster, Stop Saying ], https://rewirenewsgroup.com/article/2018/10/04/stop-saying-that-making-abortion-illegal-doesnt-stop-them/ ; see generally Greene Foster, The Turnaway Study, supra note 2.

See eg Stephanie Ranade Krider, Pro-life Advocates Focused on Legal Battles. They’re Not Enough to End Abortion , Wash. Post (Oct. 15, 2021), https://www.washingtonpost.com/outlook/pro-life-after-roe/2021/10/15/7e2a059e-2cf8-11ec-985d-3150f7e106b2_story.html (Krider, an abortion opponent, acknowledges that while ‘the end of Roe would be a victory and a cause for celebration for those…who oppose abortion, [it] would not end the practice nationwide.’).

See Douthat, supra note 3.

See Biggs, M. Antonia, Heather Gould & Diana Greene Foster, Understanding why Women Seek Abortions in the US , 13 BMC Women’s Health 1–13 (2013); see also Sophia Chae et al., Reasons Why Women Have Induced Abortions: A Synthesis of Findings From 14 Countries , 96 Contraception 233–41 (2017). (Analyzing data from 14 countries to identify the primary reasons given for seeking abortion, and finding that, although people often listed several reasons, the dominant reason involved socioeconomic concerns).

See Annual Update of the HHS Poverty Guideline, 87 Fed. Reg. 3315, 3316 (Jan. 21, 2021).

See Rachel K. Jones & Jenna Jerman, Population Group Abortion Rates and Lifetime Incidence of Abortion: United States, 2008–2014, 107 Am. J. Publ. Health 1904–909 (2017), https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.304042 ; see also Abortion Rates by Income Level , Infographic , Guttmacher Inst. (Oct. 19, 2017), https://www.guttmacher.org/infographic/2017/abortion-rates-income .

More accurately, because almost 60% of those having an abortion already have at least one child, they cannot afford the costs of another child. Jerman J, Jones RK & Onda T, Characteristics of U.S. Abortion Patients in 2014 and Changes Since 2008 , Guttmacher Inst. (2016), https://www.guttmacher.org/report/characteristics-us-abortion-patients-2014 .

Bearak J et al., Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019 , 8 lancet global health 9 (2020).

An unintended pregnancy is one that occurred when a woman wanted to become pregnant in the future but not at the time she became pregnant (‘wanted later’) or one that occurred when she did not want to become pregnant then or at any time in the future (‘unwanted’). See Unintended Pregnancy in the United States , Guttmacher Inst. (Jan. 2017), https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states . In recent years, this frame has been problematized by calling into view the reality that, for many people, pregnancies are not so much planned as they are responded to. That is to say, the relevant question is not whether it was intended, but whether it is wanted or unwanted. See Abigail R.A. Aiken, et al., Rethinking the Pregnancy Planning Paradigm: Unintended Conceptions or Unrepresentative Concepts? , 48 Perspect Sex Reprod Health 147–151 (2016).

See generally Unintended Pregnancy Rates Declined Globally from 1990 to 2014 , Guttmacher Inst. (Mar. 5, 2018), https://www.guttmacher.org/news-release/2018/unintended-pregnancy-rates-declined-globally-1990-2014 .

Between the 1990s and 2020, abortion rates declined by almost 40%. See Sabrina Tavernise, Why Women Getting Abortions Now Are More Likely to Be Poor , N.Y Times (July 9, 2019), https://www.nytimes.com/2019/07/09/us/abortion-access-inequality.html . In the years since 2010 alone, rates have declined by almost 20%. Elizabeth Nash & Joerg Dreweke, The U.S. Abortion Rate Continues to Drop: Once Again, State Abortion Restrictions Are Not the Main Driver , Guttmacher Inst. (Sept. 18, 2019), https://www.guttmacher.org/gpr/2019/09/us-abortion-rate-continues-drop-once-again-state-abortion-restrictions-are-not-main . Scholars are divided in their explanations for the decline, which vary from increasingly effective contraceptive practices to declines in rates of sexual activity. See Pam Belluck, America’s Abortion Rate Has Dropped to its Lowest Ever , N.Y. Times (Sept. 20, 2019), https://www.nytimes.com/2019/09/18/health/abortion-rate-dropped.html ; see also Diana Greene Foster, Dramatic Decreases in US Abortion Rates: Public Health Achievement or Failure? , 107 Am J. Public Health 1860 (2017); Alia E. Dastagir, Fewer Women are having abortions. Why? , USA Today (June 13, 2019), https://www.usatoday.com/story/news/nation/2019/06/13/abortion-law-fewer-women-having-abortions-why/1424236001/ ; Doug Stanglin, US Abortion Rate is at its Lowest, but Restrictive Laws aren’t the Likely Cause, Study Says , USA Today (Sept. 18, 2019), https://www.usatoday.com/story/news/nation/2019/09/18/number-of-abortions-us-drops-guttmacher-institute-study/2362316001/ .

See U.S. Abortion Rate Continues to Decline, Hits Historic Low, Guttmacher Inst. (Jan. 17, 2017), https://www.guttmacher.org/news-release/2017/us-abortion-rate-continues-decline-hits-historic-low .

See Guttmacher Inst., supra note 15. Although poor Americans have higher rates of unintended pregnancy for a range of reasons, central among them is that they struggle to access contraception. See Michele Troutman, Saima Rafique & Torie Comeaux Plowden, Are Higher Unintended Pregnancy Rates Among Minorities a Result of Disparate Access to Contraception? , Contracept Reprod Med 5, no. 16 (2020), https://doi.org/10.1186/s40834-020-00118-5 (describing the factors underlying the disparate rates of unintended pregnancy by race and class). One finds evidence of this struggle in the data on contraceptive use among sexually active women not seeking pregnancy. While 90% of those covered by private health insurance and 87% of those covered by Medicaid use contraception, that figure drops to 81% for those who have no insurance coverage. Megan L. Kavanaugh & Emma Pliskin, Use of Contraception Among Reproductive-aged Women in the United States , 2014 and 2016 , Guttmacher Inst. (July, 2020). On the cost of contraception, see Eliana Kosova, How Much Do Different Kinds of Birth Control Cost Without Insurance? , Nat’l Women’s Health Network (Nov. 17, 2017), https://nwhn.org/much-different-kinds-birth-control-cost-without-insurance/ (noting that the most effective methods, long-acting implants and devices, cost upwards of $800, and that oral contraceptives can cost up to $600 per year).

Cost is not the only barrier to contraception, ranging from cost to personal preferences. For example, Black women tend to report higher rates of dissatisfaction with existing contraceptive options, putting them at further disadvantage in terms of risk of unwanted pregnancy. Andrea V. Jackson, Deborah Karasek, Christine Dehlendorf, and Diana Greene Foster, Racial and Ethnic Differences in Women’s Preferences for Features of Contraceptive Methods , 93 Contraception 406–411 (2016).

See Colleen L. MacCallum-Bridges & Claire Margerison, The Affordable Care Act Contraception Mandate & Unintended Pregnancy in Women of Reproductive Age: An Analysis of the National Survey of Family Growth, 2008–2010 v. 2013–2015 , 101 Contraception 34–39 (2020) (Overall, the odds of experiencing unintended pregnancy decreased 15% from the pre-mandate to post-mandate period); See also Susan Christiansen, The Impact of the Affordable Care Act Contraceptive Mandate on Fertility and Abortion Rates (Dec. 2020) (Ph.D. dissertation, Johns Hopkins University), https://jscholarship.library.jhu.edu/handle/1774.2/63939 (last visited Jan. 28, 2022).

See Molly Jong-Fast, The Anti-Birth Control Movement Is the New Anti-Abortion Movement , Vogue (July 1, 2021), https://www.vogue.com/article/anti-birth-control-movement .

Burwell v. Hobby Lobby Stores, Inc., 573 U.S. 682 (2014) (striking down the ACA’s contraception mandate because it ‘created a substantial burden’ on Hobby Lobby’s religious freedom and it was not the ‘least restrictive means of satisfying the government’s interests.’) . See eg Tom Cohen, Hobby Lobby Ruling Much More Than Abortion , Cnn Politics (July 2, 2014), https://www.cnn.com/2014/07/02/politics/scotus-hobby-lobby-impacts/index.html (describing anti-abortion advocates opposition to contraception mandates).

See Carole Joffe, Failing to Embed Abortion Care in Mainstream Medicine Made it Politically Vulnerable , Wash. Post (Jan. 11, 2022), https://www.washingtonpost.com/outlook/2022/01/11/failing-embed-abortion-care-mainstream-medicine-made-it-politically-vulnerable/ (describing the range in quality of abortion providers when abortion was illegal).

See Elizabeth G. Raymond et al., Efficacy of Misoprostol Alone for First-Trimester Medical Abortion: A Systematic Review , 133 Obstet Gynecol 133–147 (2019).

Id. (This consolidated report of existing research finds that misoprostol alone successfully terminates a pregnancy in 93% of cases).

See How to Buy Abortion Pills That Are Safe and Effective , https://www.ipas.org/our-work/abortion-self-care/abortion-with-pills/how-to-buy-abortion-pills-that-are-safe-and-effective/ (Noting that manufacturers sell the pills to pharmacies for very little cost—less than $0.05 per pill—and that the highest sales price found in a recent study was $2 per pill).

See eg Celina Schocken, Business Case: Investing in Production of High Quality Misoprostol for Low-Resource Settings , Concept. Found. (Dec. 2014), https://www.conceptfoundation.org/wp-content/uploads/2015/06/BusinessCase_Misoprostol_web.pdf (describing misoprostol’s vital role in treating postpartum hemorrhage); see also Essential Medicines List includes Misoprostol tablets for use during pregnancy, childbirth and postpartum care , World Health Organization, https://www.who.int/data/gho/indicator-metadata-registry/imr-details/essential-medicines-list-includes-misoprostol-tablets-for-use-during-pregnancy-childbirth-and-postpartum-care .

Beverly Winikoff & Wendy Sheldon, Use of Medicines Changing the Face of Abortion , Guttmacher Inst. (Sept. 2012), https://www.guttmacher.org/journals/ipsrh/2012/09/use-medicines-changing-face-abortion . For a description of the misoprostol market in countries where abortion is illegal, see Michelle Oberman, What Happens When Abortion is Banned? , N.Y. Times (May 31, 2018), https://www.nytimes.com/2018/05/31/opinion/sunday/abortion-banned-latin-america.html .

See Gilda Sedgh et al., Induced Abortion: Incidence and Trends Worldwide from 1995 to 2008 , 379 The Lancet 625, 625 (2012) (comparing the one out of three pregnancies in Central America end in abortion with one out of five in the United States); see also Susheela Singh et al., Abortion Worldwide: A Decade of Uneven Progress , Guttmacher Inst. (Oct. 2009), http://www.guttmacher.org/pubs/Abortion-Worldwide.pdf .

There is evidence of an expanding market in misoprostol in the U.S. See Caroline Kitchener, Self-Managed Abortion Could be the Future—But it’s Very Hard to Talk About , The Lily (Dec. 20, 2021), https://www.thelily.com/self-managed-abortion-could-be-the-future-but-its-very-hard-to-talk-about/ . See also, Erica Hellerstein, The Rise of the DIY Abortion in Texas , The Atlantic (June 27, 2014), https://www.theatlantic.com/health/archive/2014/06/the-rise-of-the-diy-abortion-in-texas/373240/ .

Kari White et al., Initial Impacts of Texas’ Senate Bill 8 on Abortions in Texas and at Out-of State Facilities , Texas Policy Evaluation Project (Oct. 2021), http://sites.utexas.edu/txpep/files/2021/11/TxPEP-brief-SB8-inital-impact.pdf .

In the immediate aftermath of Prohibition–evidenced by mortality rates, mental health, and crime statistics–alcohol consumption fell to approximately 30% of its pre-Prohibition level. But this drop in alcohol consumption was short-lived. Within a few years after Prohibition, alcohol consumption had increased to 60–70% of its pre-Prohibition level. See Annika Nekalson, Prohibition was a Failed Experiment in Moral Governance, The Atlantic (Jan. 16, 2020), https://www.theatlantic.com/ideas/archive/2020/01/prohibition-was-failed-experiment-moral-governance/604972/ .

See Nash & Dreweke, supra note 19, regarding the various reasons behind declining abortion rates.

See Greene Foster, Stop Saying , supra note 6; see also Greene Foster, The Turnaway Study, supra note 2.

Hence the insistence of the reproductive justice movement that advocates center the goals of racial justice. RJ Squared. For a detailed description of the ways in which structural inequities circumscribe the reproductive choices of poor women and women of color, see Jamila K. Taylor, Structural Racism and Maternal Health Among Black Women , 48 Journal Of Law, Medicine & Ethics 506–517 (2020).

See generally, Katrina Kimport, No Real Choice: How Culture And Politics Matter For Reproductive Autonomy (2021) (positing that for the most marginalized Americans faced with an unwanted pregnancy, the question is not whether to have an abortion or have a baby, but rather, whether they can actually get an abortion or not).

At oral argument, Justice Barrett said, “Both Roe and Casey emphasized the burdens of parenting, and insofar as you and many of your amici focus on the ways in which the forced parenting, forced motherhood would hinder women’s access to the workplace and to equal opportunities, it’s also focused on the consequences of parenting and the obligations of motherhood that flow from pregnancy. Why don’t the safe haven laws take care of that problem?” Transcript of Oral Argument at 56, Dobbs v. Jackson Women’s Health, No. 19–1392. For a compelling analysis and indictment of safe haven laws, see Laury Oaks, Giving Up Baby: Safe Haven Laws, Motherhood, And Reproductive Justice (2015); see also Lizzie Widdicombe, The Baby-Box Lady of America , The New Yorker (Dec. 18, 2021) https://www.newyorker.com/news/news-desk/the-baby-box-lady-of-america .

See Mardie Caldwell, Open Adoption is a Win-Win Situation (Apr. 7, 2018), https://mardiecaldwell.com/open-adoption-is-a-win-win-situation/ ; see also Julia D. Hejduk, Gift Motherhood, the Prius, and the Peace Corps: Reducing Abortion by Incentivizing Adoption , The Public Discourse (Sept. 27, 2017), https://www.thepublicdiscourse.com/2017/09/20054/ .

Id . On the merits, what limited scholarly evidence there is on adoption runs counter to this rosy characterization of adoption’s outcomes, at least for birth mothers. See eg Are Birth Mothers Satisfied with Decisions to Place Children for Adoption? , Science Daily (June 8, 2018), https://www.sciencedaily.com/releases/2018/06/180608131605.htm (a longitudinal study of birth mothers that found women reported a mean satisfaction of 3.11 on a scale of 1–5). See also Gretchen Sisson, ‘Choosing Life’: Birth Mothers on Abortion and Reproductive Choice , 25 Women’s Health Issues 349–54 (2015) (a study involving in-depth interviews with 40 women who had placed infants for adoption from 1962 to 2009. The majority of the participants–many of whom placed their babies in closed adoptions, which are less typical today–described their adoption experiences as ‘predominantly negative,’ a response that Sisson attributes in part to the reality that adoption is not a preferred course of action, but rather, something chosen by those who feel they have no other options).

Olga Khazan, Why So Many Women Choose Abortion Over Adoption , The Atlantic (May 20, 2019). ( https://www.theatlantic.com/health/archive/2019/05/why-more-women-dont-choose-adoption/589759 ; S ee also Olga Khazan, The New Question Haunting Adoption , The Atlantic (Oct. 22, 2020), https://www.theatlantic.com/politics/archive/2021/10/adopt-baby-cost-process-hard/620258/ (‘Since the mid-1970s—the end of the so-called baby-scoop era, when large numbers of unmarried women placed their children for adoption—the percentage of never-married women who relinquish their infants has declined from nearly 9% to less than 1%.’).

See Elizabeth Wildsmith, Jennifer Manlove et al., Dramatic Increase in the Proportion of Births Outside of Marriage in the United States from 1990 to 2016 , Child Trends (Aug. 8, 2018), https://www.childtrends.org/publications/dramatic-increase-in-percentage-of-births-outside-marriage-among-whites-hispanics-and-women-with-higher-education-levels#:∼:text=Recent%20estimates%20show%20that%20about , worldwide%20(Chamie%2C%202017). The most rapid growth is among white women: as of 2016, 28% of all births to white women were non-marital. See also Khazan , supra note 43 (Starting in the 1970s, single white women became much less likely to relinquish their babies at birth: nearly a fifth of them did so before 1973; by 1988, just 3% did).

Khazan, Id .

The Turnaway Study is a longitudinal study examining the effects of unintended pregnancy on women’s lives. For the study and its findings, see Greene Foster, The Turnaway Study, supra note 2.

See id . See also Diana Greene Foster, What Happens When It’s Too Late to Get an Abortion , N.Y. Times (Nov. 22, 2021), https://www.nytimes.com/2021/11/22/opinion/abortion-supreme-court-women-law.html .

See Gretchen Sisson, Lauren Ralph, Heather Gould & Diana Greene Foster, Adoption Decision Making among Women Seeking Abortion, 27 Women’s Health Issues 136 (2017).

See Women’s Access to Abortion Improves Children’s Lives , Ansirh (Jan. 2019), https://www.ansirh.org/sites/default/files/publications/files/womens_access_to_abortion_improves_childrens_lives.pdf .

See generally Kayla Patrick, National Snapshot: Poverty Among Women & Families , National Women’s Law Center, https://nwlc.org/wp-content/uploads/2017/09/Poverty-Snapshot-Factsheet-2017.pdf . (The poverty rate for female-headed families with children was 36.5%, compared to 22.1% for male-headed families with children and 7.5% of families headed by married couples with children).

Robin Bleiweis, Diana Boesch & Alexandra C. Gaines, The Basic Facts About Women in Poverty , American Progress (Aug. 3, 2020), https://www.americanprogress.org/article/basic-facts-women-poverty/ .

See American Academy of Pediatrics, Council on Community Pediatrics, Poverty and Child Health in the United States , Pediatrics 137 no. 4 (2016): e20160339.

See kimport, supra note 39, at 37, and generally.

See Leah Outten, Birth Mothers and the Adoption Option , Focus On The Family (Nov. 9, 2021), https://www.focusonthefamily.com/pro-life/the-adoption-option-birth-mothers-need-your-support/ ; Stephanie McCrummen, A Maternity Ranch is Born: How Evangelical Women in Texas are Mobilizing for a Future Without Abortion , Wash. Post (Nov. 16, 2021), https://www.washingtonpost.com/nation/2021/11/16/evangelical-women-texas-abortion/?utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F354c967%2F6193e9909d2fdab56b8e7f16%2F5a1f90909bbc0f4d5203bb72%2F8%2F73%2F6193e9909d2fdab56b8e7f16 . see also Michelle Oberman, The Women the Abortion War Leaves Out , N.Y. Times (Jan. 11, 2018), https://www.nytimes.com/2018/01/11/opinion/sunday/abortion-crisis-pregnancy-centers.html (describing Oklahoma City’s Rose Home, a pro-life organization that houses up to five pregnant women and their children at any given time).

See Outten, supra note 54. See also Eleanor Bartow, 12 Pro-Life Truths to Counter Every Abortion Myth , The Federalist (Oct. 11, 2021) https://thefederalist.com/2021/10/11/12-pro-life-truths-to-counter-every-abortion-myth/ (where Bartow asserts adoption is ‘a better option than killing an unborn child’ because there are many ‘loving, screened, financially stable parents [who] are waiting to adopt babies.’).

See Sue Halpern, How Republicans Became Anti-Choice , The N.Y. Rev. (Nov. 8, 2018), https://www.nybooks.com/articles/2018/11/08/how-republicans-became-anti-choice/ (reviewing Reversing Roe , a documentary film directed and produced by Ricki Stern and Annie Sundberg).

See Robert Reich, Republicans, So Called party of Family Values, Do Not Support Needy Families , The Guardian (Jul. 18, 2021), https://www.theguardian.com/commentisfree/2021/jul/18/child-allowance-payments-american-rescue-plan-republicans

See eg Richard Garnett, supra note 4. See also Hadley Arkes, in One Untrue Thing , Nat’l Rev. (Aug. 1, 2007), https://www.nationalreview.com/2007/08/one-untrue-thing-nro-symposium/ , (‘[T]he law does not need to invoke the harshest penalties for the sake of teaching moral lessons.’).

§315, Penal Law, 5737–1977, LSI Special Volume (1977), as amended (Isr.),

https://knesset.gov.il/review/data/eng/law/kns8_penallaw_eng.pdf [ https://perma.cc/N9QZ-8JEV ].

Or at least it would do so if the law were interpreted in a way that strictly limited abortion access. Instead, as I explain elsewhere, the committees close to 100% of the requests they receive, making legal abortion readily available in the country. See Oberman, supra note 2, at 172.

And they do. Recall that Israel has the highest fertility rates of any country in the OECD. Families have an average of 3.1 children. See Family Database: Fertility Rates , Org. Econ. Coop. Dev., https://www.oecd.org/els/family/SF_2_1_Fertility_rates.pdf [ https://perma.cc/5J2Y-YGWG ] (last updated June 2021).

See Maternity Leave , Kol Zchut, https://www.kolzchut.org.il/en/Maternity_Leave [ https://perma.cc/Q29Q-T6Q6 ] (last visited June 19, 2021).

See Childcare in Israel , Expat.Com (Sept. 18, 2017) https://www.expat.com/en/guide/middle-east/israel/15420-childcare-in-israel.html [ https://perma.cc/2Z7S-SJCK ] (describing the relative level of state support that young Israeli families receive, compared to the U.S.). See also, Register to State Recognized Daycare and Afternoon Care, and Request State Participation in Tuition Fees , Gov. IL, https://www.gov.il/en/service/registration_for_day_care_centers_and_nurseries1 (last updated Feb. 7, 2020) (Israeli government website describing eligibility for state supported day care). Rates of enrollment in both day care and preschool are among the highest in the developed world. Indeed, preschool enrollment rates are double that of the OECD average. https://issuu.com/bernardvanleerfoundation/docs/publication_taub_center_early_childhood_education_ (at 27).

See, eg Children , Nat’l Ins. Inst. Of Isr., https://www.btl.gov.il/English%20Homepage/Benefits/Children/Pages/default.aspx [ https://perma.cc/8KE2-3K8L ] (last visited on Dec. 19, 2021). Although these policies may not significantly offset the costs of having a child, surely, they are a benefit to Israel’s poorest families.

The only government support for those who have babies lies in family medical leave, which promises twelve weeks of unpaid leave time after the birth of a child. See Family and Medical Leave Act (FMLA), 29 U.S.C. § 2612.

Ben Casselman, Child Tax Credit’s Extra Help Ends, Just as Covid Surges Anew , N.Y. Times (last updated Jan. 3, 2022), https://www.nytimes.com/2022/01/02/business/economy/child-tax-credit.html .

Ali Safawi & Cindy Reyes, States Must Continue Recent Momentum to Further Improve TANF Benefit Levels , Cntr on Budget & Pol’y Priorities (updated Dec. 2, 2021), https://www.cbpp.org/research/family-income-support/states-must-continue-recent-momentum-to-further-improve-tanf-benefit .

For signs that anti-abortion advocates are beginning to grapple with the need to take systemic realities into account, see Tish Harrison Warren, The Systemic Realities Created by Legal Abortion , N.Y. Times (Jan. 22, 2022), https://www.nytimes.com/2022/01/22/opinion/roe-legal-abortion.html .

See Richard H. McAdams , A Focal Point Theory of Expressive Law, 86 V.A. L. Rev.1649, 1713–28 (2000) (applying expressive law theory to smoking bans and landlord liability law). See generally Richard H. McAdams, The Expressive Powers Of Law: Theories And Limits (2015).

He offers little evidence, by way of proof. However, numerous studies both domestically and worldwide document an association between smoking bans and an overall decline in smoking rates, including a reduction in smoking by smokers. See eg Thomas W. Carton, Michael Dardon, et al., Comprehensive Indoor Smoking Bans and Smoking Prevalence: Evidence from the BRFSS , 2 J Health Econ. 535–56 (2016); see also Silke Anger, Michael Kvasnicka, Thomas Seidler, One Last Puff? Public Smoking Bans and Smoking Behavior , 30 J Health Econ. 591–601 (2011).

See McAdams, supra note 70, at 197.

These lawmakers also must contend with considerable public opposition to their position. As of 2020, 79% of Americans say that the decision to have an abortion is best left to women, not lawmakers, according to a Kaiser Family Foundation study from 2020. See Ariana Eunjung Cha & Emily Guskin, Most Americans Want Abortion to Remain Legal, but Back S ome State Restrictions , Wash. Post (Jan. 22, 2020), https://www.washingtonpost.com/health/2020/01/22/most-americans-want-abortion-remain-legal-back-some-state-restrictions/ .

See McAdams, supra note 70, at 180.

Recreational cannabis is legal in 18 states, while 11 states criminalize it. (See https://disa.com/map-of-marijuana-legality-by-state for a breakdown of the various jurisdictions’ laws). Experts estimate that at least 15 states will keep abortion legal, and perhaps even expand abortion rights, regardless of the absence of a Constitutional right. https://www.guttmacher.org/state-policy/explore/abortion-policy-absence-roe .

Kimport, supra note 37, at 28 and 62–69.

See eg Anna North, All the Near-Total Abortion Bans Passed This Year Have Now Been Blocked in Court, Vox (updated Oct. 29, 2019), https://www.vox.com/2019/10/2/20895034/alabama-abortion-ban-blocked-georgia-law ; see also Sean Murphy, Oklahoma Supreme Court Blocks 3 New Anti-Abortion Laws, ABC News (Oct. 25, 2021), https://abcnews.go.com/Health/wireStory/oklahoma-supreme-court-blocks-anti-abortion-laws-80779946 .

See Chotiner, supra note 5. See also O. Carter Snead, in One Untrue Thing , Nat’l Rev. (Aug. 1, 2007), https://www.nationalreview.com/2007/08/one-untrue-thing-nro-symposium/ (Offering a pragmatic justification for not punishing self-abortion: ‘[T]he public is more willing to accept a law that punishes doctors rather than mothers. Pro-lifers can thus achieve their goal of ending abortion without provoking a political backlash.’).

Although there are legal strategies a government might employ in response to overseas entities that sell abortion medicines to U.S. consumers (eg border patrol agents or diplomatic pressure), we learn from both the heroin and the fentanyl epidemics that the government’s options in the face of high demand are limited. See Claire Felter, Backgrounder: The U.S. Opioid Epidemic , The Council on Foreign Relations, (Sept. 8, 2021), https://www.cfr.org/backgrounder/us-opioid-epidemic .

Stephanos Bibas, Prosecutorial Regulation Versus Prosecutorial Accountability , 157 U. Pa. L. Rev. 959 (2009).

Stephanos Bibas, The Need for Prosecutorial Discretion , 19 Temp. Pol. & Civ. Rts. Rev. 369, 371 (2010).

See Leslie Reagan, When Abortion Was A Crime: Women, Medicine, And Law In The United States, 1867–1973 (1997), at 114, 164.

See From Hospital to Jail: The Impact on Women of El Salvador’s Total Criminalization of Abortion , 22 Repr. Health Matters 52–60 (2014); see also Oberman, supra note 2 , at 8–10 and 49–55 (describing similar patterns in Chile and El Salvador).

See Oberman , supra note 2, at 44.

See Repr. Health Matters, supra note 83.

See eg Chelsea Becker’s prosecution for murder, following stillbirth allegedly caused by methamphetamine use. Judge Dismisses Murder Charge Against Califronia Mother After Stillbirth , N.Y. Times (May 21, 2021), https://www.nytimes.com/2021/05/20/us/chelsea-becker-stillbirth-murder-charges-california.html .

They may also conscript doctors into law enforcement. See Michelle Oberman, Abortion Bans, Doctors, and the Criminalization of Patients ,48 Hastings Ctr. Rep.5 (2018); see also Oberman, Her Body Our Laws, supra note 2, at 43–67 for a discussion of how reports from doctors to police in El Salvador overwhelmingly involve poor, marginalized women.

Priscilla Thompson & Alexandra Turcios Cruz, How an Oklahoma Women’s Miscarriage Put a Spotlight on Racial Disparities in Prosecutions , Nbc News (Nov. 5, 2021), https://www.nbcnews.com/news/us-news/woman-prosecuted-miscarriage-highlights-racial-disparity-similar-cases-rcna4583 . For a detailed discussion of these cases, see Lynn M. Paltrow & Jeanne Flavin, Arrests of and Forced Interventions on Pregnant Women in the United States, 1973–2005: Implications for Women’s Legal Status and Public Health , 38 J. Health Pol., Pol’y And L. 299, 304–05 (2013) (discussing these findings and the limitations of the research which led the authors to conclude that their findings represent a substantial undercount of cases). See also Michele Goodwin, Policing The Womb: Invisible Women And The Criminalization Of Motherhood (2020).

See Arrests and Prosecutions of Pregnant Women, 1973–2020 , Napw (Sept.18, 2021), https://www.nationaladvocatesforpregnantwomen.org/arrests-and-prosecutions-of-pregnant-women-1973-2020/ (summarizing the range of cases). See also Lynn M. Paltrow, Constitutional Rights for the ‘Unborn’ Would Force Women to Forfeit Theirs , Ms. Magazine (Apr. 15, 2021), https://msmagazine.com/2021/04/15/abortion-constitutional-rights-unborn-fetus-14th-amendment-womens-rights-pregnant/ (The rate of arrests and prosecutions is increasing. ‘From 2006–2020, we have documented over 1000 such arrests—more than double in half as many years. Black, Brown and low-income, rural white women are the typical targets of these arrests.’).

Thompson & Turcios Cruz, supra note 85 (noting that the Black defendants were also significantly more likely to be charged with felonies than white women, with 85% of Black women receiving felony charges compared to 71% of white women); see also Lynn M. Paltrow, Roe v. Wade and the New Jane Crow: Reproductive Rights in the Age of Mass Incarceration , 103 Am. J. Pub. Health 17, 19 (2013). Note that healthcare experts object strenuously to these prosecutions on the grounds that they deter people from seeking treatment essential both to their own welfare and to that of the fetus. See eg Katherine C. Arnold, Viewpoint: Criminalizing Young Women is not the Way to Improve Birth Outcomes , The Oklahoman (Dec. 26, 2021, 5:00 AM), https://www.oklahoman.com/story/opinion/2021/12/26/viewpoint-prosecuting-oklahoma-women-who-miscarry-wrong/8930865002/ .

While beyond the scope of this Article, it bears noting the range of options that state lawmakers have given prosecutors, when it comes to abortion crimes, outlawing things like purchasing abortion medicine, or aiding and assisting an abortion. See eg Emily Bazelon, A Mother in Jail for Helping her Daughter Have an Abortion , N.Y. Times (Sept. 22, 2014), https://www.nytimes.com/2014/09/22/magazine/a-mother-in-jail-for-helping-her-daughter-have-an-abortion.html . See also Sabrina Tavernese, Citizens, not the State, Will Enforce New Abortion Law in Texas , N.Y. Times (Nov. 1, 2021), https://www.nytimes.com/2021/07/09/us/abortion-law-regulations-texas.html (Describing the ways that Texas S.B. Eight criminalizes all those who aid and assist abortion, and quoting Prof. Melissa Murray, ‘If the barista at Starbucks overhears you talking about your abortion, and it was performed after six weeks, that barista is authorized to sue the clinic where you obtained the abortion and to sue any other person who helped you, like the Uber driver who took you there.’).

See Paltrow , supra note 91. See generally Michele Bratcher Goodwin, Invisible Women: Mass Incarceration’s Forgotten Casualties , 94 Tex. L. Rev. (2015).

See Race & Justice News: Eliminating Crack/Cocaine Sentencing Disparity The Sentencing Project (July 27, 2021), https://www.sentencingproject.org/news/race-justice-news-senate-hearing-crack-cocaine-sentencing-disparity/ (summarizing the ongoing work toward sentencing equality in drug crimes, starting with the 2010 Fair Sentencing Act). On the negative downstream consequences of race bias in drug law enforcement, Republican Governor Asa Hutchinson noted that racial disparities, “undermined community confidence in the fairness of the criminal justice system. I talked with drug task force officers and front-line agents at the DEA who said this sense of injustice had a real impact in the fight against illegal drugs; it made it more difficult for agents to build trust and work with informants in the areas most impacted by the crack epidemic. The disparity in sentencing led to more harm than help in our federal anti-crime efforts.” ( Gov. Asa Hutchinson: It’s Time to Fix an Old Wrong and End the Disparity Between Crack and Cocaine Offenses , Fox News (June 8, 2021)), https://www.foxnews.com/opinion/end-crack-cocaine-offenses-gov-asa-hutchinson .

See Caroline Kitchener, The Texas Abortion ban has a Medical Exception. But some Doctors Worry it’s too Narrow to use, The Lily, Oct. 22, 2021 (describing existing legal protections and the limitations of Texas S.B. 8’s ‘medical emergency’ exception to its abortion ban), https://www.thelily.com/the-texas-abortion-ban-has-a-medical-exception-but-some-doctors-worry-its-too-narrow-to-use/ .

See Michael Asimow, Federal, Administrative Adjudication Outside The Administrative Procedure Act 3–4 (2019) (classifying these hearings into three categories, according to level of formal process).

See Kari White, Subasri Narasimhan, Sophie A. Hartwig, Erin Carroll, Alexandra McBrayer, Samantha Hubbard, Rachel Rebouché, Melissa Kottke & Kelli Stidham Hall, Parental Involvement Policies for Minors Seeking Abortion in the Southeast and Quality of Care , Sexuality Rsch. & Soc. Pol’y (Jan. 18, 2021), https://link.springer.com/content/pdf/10.1007/s13178-021-00539-0.pdf .

See David S. Cohen & Carole Joffe, Obstacle Course: The Everyday Struggle To Get An Abortion In America 209 (2020) (quoting Ohio doctor Chrisse France, decrying this standard in U.S. practice today; ‘She cannot be seen at our public hospital unless pretty much she’s going to die today or maybe tomorrow’).

See Kari White, Subasri Narasimhan, Sophie A. Hartwig, Erin Carroll, Alexandra McBrayer, Samantha Hubbard, Rachel Rebouché, Melissa Kottke & Kelli Stidham Hall, Parental Involvement Policies for Minors Seeking Abortion in the Southeast and Quality of Care , Sexuality Rsch. & Soc. Pol’y (Feb., 2021) (noting the impact of these policies in delaying access to early abortion among those ultimately deemed eligible to end their pregnancies).

See Herbert L. Packer & Ralph J. Gampell, Therapeutic Abortion: A Problem in Law and Medicine , 11 Stan. L. Rev. 417, 418, 421 (1959). (Explaining that hospitals developed protocols at least in part as a defensive measure: to protect themselves from potential downstream criminal or civil liability). See also, Carole Joffe, Doctors Of Conscience 31 (1995) (describing how doctors who performed abortions illegally would do so outside of the hospital setting, but legal abortions that met the test of necessary to save life would necessarily have been performed in a hospital, thereby implicating both medical and hospital oversight).

See generally Packer & Gampell, id . at 418 . (Noting these questions, among others: Is the procedure limited to cases where its purpose is to avoid shortening the pregnant woman’s life? If so, how do we determine whether carrying the child to term will shorten life? If not, what other considerations are relevant? Is a threat to health necessarily a threat to life? Must the threat to life (or health) be on account of a somatic illness? Or is the woman’s mental condition also to be considered? If so, is a probability that suicide will ensue a justification for therapeutic abortion?). For a searing indictment of U.S. therapeutic abortion committee practices in the mid-twentieth century, see Rickie Solinger, ‘A Complete Disaster:’ Abortion and the Politics of Hospital Abortion Committees, 1950–1970 , 19 Feminist Stud. 241 (1993).

See Packer & Gampell, supra note 100, at 449. (‘[R]eputable members of the medical profession may well find it galling that their freedom from criminal and civil liability turns merely on the nonenforcement of provisions of the law which, on their face, appear to embrace the conduct in question.’). Texas’s S.B. 8 law employs such a threat by way of subjecting doctors who provide abortions after six weeks to civil suit. See Sabrina Tavernese, supra note 75.

Id. at 421 (citing Alan F. Guttmacher, The Shrinking Non-Psychiatric Indications for Therapeutic Abortion , in Therapeutic Abortion 12 (Rosen, ed. 1954)).

Id . at 430. Their study concluded with a call for law reform—a call that was echoed by their Canadian counterparts in the 1977 Badgley report, which found “gross inequities existed in the availability of therapeutic abortion to the women of Canada.” W.D.S. Thomas, The Badgley Report on the Abortion Law, 116 Can. Med. Ass’n. J. 966, 966 (1977).

See Carole Joffe and Jody Steinauer, Evan Texas Allows Abortions to Protect a Woman’s Life. Or Does It? , N.Y. Times (Sept. 12, 2021), https://www.nytimes.com/2021/09/12/opinion/abortion-texas-roe.html (describing how contemporary abortion bans will likewise challenge medical integrity).

See Oberman, supra note 2, at 13–42 (describing the highly public Salvadoran case of Beatriz, a woman forced to continue a life-threatening pregnancy until her doctors agreed that death was imminent, which then triggered her right to self-defense, permitting doctors to end her pregnancy).

For a thoughtful consideration of the constitutional protections owed to one who is pregnant, when abortion is illegal, see Meghan Boone, Reproductive Due Process , 88 Geo. Wash. L. Rev. 511, 526 (2020) (‘Beyond its flexibility and ability to evolve, a third feature of due process is simply its function as a catchall constitutional backstop for determining the fairness of government action’).

See Matthews v. Eldridge, 424 U.S. 319, 335 (1976) (“Identification of the specific dictates of due process generally requires consideration of three distinct factors: first, the private interest that will be affected by the official action; second, the risk of erroneous deprivation of such interest through the procedures used, and probable value, if any, of additional or substitute procedural safeguards; and, finally, the Government’s interest, including the function involved and the fiscal and administrative burdens that the additional or substitute procedural requirements would entail.”). See also Simona Grossi, Procedural Due Process , 13 Seton Hall Cir. Rev. 155, 158 (2017) (‘[A]…procedural law that is not supported by logic, fairness, and efficiency considerations,…violates due process.’).

See Chotiner, supra note 5, (citing Marjorie Dannenfelser).

See eg Box v. Planned Parenthood, 139 S. Ct. 1780 at 1783 (Thomas, J., concurring) (supporting an Indiana law banning abortion on grounds of fetal anomaly by invoking the state’s ‘compelling interest in preventing abortion from becoming a tool of modern-day eugenics.’).

See eg Eli Rosenberg, Clarence Thomas Tried to Link Abortion to Eugenics. Seven Historians Told the Post He’s Wrong , Wash. Post (May 30, 2019, 9:50 PM), https://www.washingtonpost.com/history/2019/05/31/clarence-thomas-tried-link-abortion-eugenics-sevenhistorians-told-post-hes-wrong [ https://perma.cc/5DNR-PJT5 ]; Imani Gandy, When It Comes to Birth Control and Eugenics, Clarence Thomas Gets It All Wrong , Rewire (May 29, 2019, 5:11 PM), https://rewire.news/ablc/2019/05/29/when-it-comes-to-birth-control-and-eugenics-clarencethomas-gets-it-all-wrong [ https://perma.cc/3HZ3-689B ]; Lydia O’Connor, What Justice Clarence Thomas Gets Wrong About Eugenics and Abortion , Huff. Post (May 29, 2019, 5:50 PM), https://www.huffpost.com/entry/clarence-thomas-eugenics-abortion_n_5ced6c87e4b0356205a07182 [ https://perma.cc/6AHJ-MS5U ].

See Melissa Murray, Race-ing Roe: Reproductive Justice, Racial Justice, and the Battle for Roe v. Wade , 134 Harv. L. Rev. 2025 (2021) (providing a compelling response to the eugenics charge); see also Jennifer L. Holland, Tiny You: A Western History Of The Anti-Abortion Movement (2020) (arguing that the goals of the anti-abortion movement are deeply entwined with those of the white supremacy movement). Indeed, one might find evidence of racism in the suggestion that adoption is the best solution for poor Black and brown babies, which echoes the U.S. Indian Adoption Project of 1958–1967, under which as many as one-third of indigenous children were separated from their families. 85% of those children were placed in non-native homes or institutions. See Stephanie Woodward, Native Americans Expose The Adoption Era and Repair Its Devastation , Indian Country Today (updated Sept. 13, 2018), https://indiancountrytoday.com/archive/native-americans-expose-the-adoption-era-and-repair-its-devastation .

Reproductive Justice–Sister Song   https://www.sistersong.net/reproductive-justice . See also, Mission and Vision , If, When, How, https://www.ifwhenhow.org/about/mission-vision/ [ https://perma.cc/3RRJ-LKT5 ] (last visited Dec. 21, 2021) (A leading reproductive justice organization, their vision statement reads: ‘We envision a transformation of the legal systems and institutions that perpetuate oppression into structures that realize justice, and a future when all people can self-determine their reproductive lives free from discrimination, coercion, or violence.’).

They might begin by looking to Germany. Not, as Chief Justice Roberts suggested in the Dobbs oral argument, because its law restricting abortion to 12 weeks’ gestation is a good compromise. (Transcript of Oral Argument at 53–55, Dobbs v. Jackson Women’s Health, No. 19-1392). Rather, because of the story of how anti-abortion German lawmakers concluded that the best way to deter abortion was to enact, along with a partial ban, “a suite of services that had to be made available to women and families as part of any law regulating abortion: financial assistance for stay-at-home parents; a guaranteed return to a parent’s prior job if he or she took off up to three years to care for a child; extended day care and extensive tax credits for day care costs; increases for child support payments; extended paid leave to care for sick children; reemployment guarantees for empty nesters; sex education services; and a host of other measures relating to adoption, housing and taxation.” Jamal Greene, How Rights Went Wrong: Why Our Obsession With Rights Is Tearing America Apart 130 (2021).

See Chotiner interview, supra note 5. (“We make sure there’s child care in the first few years of that child’s life that’s cheap or free. That’s going to look very different in Minnesota than it does in Georgia. In Minnesota, there very well may be a political appetite for passing more state-supported aid…. There is not a one-size-fits-all when it comes to…how the needs of women will be met. That is vital work for the pro-life movement, and the Republican Party.”).

See Isaac Chotiner, How Pandemics Change History , The New Yorker (Mar. 3, 2020), https://www.newyorker.com/news/q-and-a/how-pandemics-change-history (quoting Frank M. Snowden).

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Reproductive rights in America

7 persistent claims about abortion, fact-checked.

Jaclyn Diaz

Koko Nakajima

Nick Underwood

Anti-abortion demonstrators watch as abortion rights protestors chant in front of the U.S. Supreme Court in Washington, D.C., on May 5. Jim Watson/AFP via Getty Images hide caption

Anti-abortion demonstrators watch as abortion rights protestors chant in front of the U.S. Supreme Court in Washington, D.C., on May 5.

Since the Supreme Court's 1973 Roe v. Wade decision ruled that women have a constitutional right to end their pregnancies, proponents and opponents of abortion rights have worked to own the conversation over the issue.

In 2019, the Centers for Disease Control and Prevention reported that 629,898 legal induced abortions were reported across the United States.

Lingering claims circulate about abortion, including about the safety of it, who gets abortions and even who supports or opposes access to abortion.

Below, seven popular claims surrounding abortion get fact-checked.

According to the Pew Research Center's polls , 37% of Americans want abortion illegal in all or most cases.

But an even bigger fraction — around 6 in 10 Americans — think abortion should be legal in all or most cases.

Current abortion rates are lower than what they were in 1973 and are now less than half what they were at their peak in the early 1980s, according to the Guttmacher Institute , a reproductive health research organization that supports abortion rights.

In 2017, pregnancy rates for females age 24 or below hit their lowest recorded levels, reflecting a long-term decline in pregnancy rates among females 24 or below.

Overall, in 2017, pregnancy rates for females of reproductive age hit their lowest recorded levels, with 87 pregnancies per 1,000 females ages 15 to 44, according to the Guttmacher Institute.

The annual number of deaths related to legal induced abortion has fluctuated from year to year since 1973, according to the CDC.

An analysis of data from 2013 to 2018 showed the national case-fatality rate for legal induced abortion was 0.41 deaths per 100,000 legal induced abortions, lower than in the previous five years.

The World Health Organization said people obtaining unsafe abortions are at a higher risk of death. Annually, 4.7% to 13.2% "of maternal deaths can be attributed to unsafe abortion," the WHO said. In developing regions of the world, there are 220 deaths per 100,000 unsafe abortions.

Trans and nonbinary people have undergone abortions as well.

The Guttmacher Institute estimates in 2017 an estimated 462 to 530 transgender or nonbinary individuals in the U.S. had abortions. That same year, the CDC said, 609,095 total abortions were carried out in the country.

The Abortion Out Loud campaign has collected stories from thousands of people who have had an abortion. Included are stories from trans and nonbinary people who have had an abortion — such as Jae, who spoke their experience.

"Most abortions in 2019 took place early in gestation," according to the CDC . Nearly 93% of abortions were performed at less than 13 weeks' gestation.

Abortion pills, which can typically be used up to 10 weeks into a pregnancy, made up 54% of abortions in 2020. These pills were the primary choice in the U.S. for the first time since the Food and Drug Administration approved the abortion drug mifepristone more than 20 years ago.

State legislatures have been moving to adopt 20-week abortion bans, with abortion opponents claiming fetuses can feel pain at that point. Roughly a third of states have implemented an abortion ban around 20 weeks .

But this contradicts widely accepted medical research from 2005. This study , published in the Journal of the American Medical Association , concluded that a fetus is not capable of experiencing pain until somewhere between 29 or 30 weeks.

Researchers wrote that fetal awareness of pain requires "functional thalamocortical connections." Those thalamocortical fibers begin appearing between 23 and 30 weeks' gestational age, but the capacity for pain perception comes later.

The argument against abortion has frequently been based on religion.

Data shows that the majority of people who get an abortion have some sort of religious affiliation, according to the most recent Guttmacher Institute data , from 2014.

The Pew Research Center also shows that attitudes on whether abortion should be legal vary among evangelical Protestants, mainline Protestants and Catholics.

Roe v. Wade and the future of reproductive rights in America

Here's what could happen now that roe v. wade is overturned.

• Supreme Court
• Roe v. Wade

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Comparison/Contrast Essays: Two Patterns

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First Pattern: Block-by-Block

By Rory H. Osbrink

Abortion is an example of a very controversial issue. The two opposing viewpoints surrounding abortion are like two sides of a coin. On one side, there is the pro-choice activist and on the other is the pro-life activist.

The argument is a balanced one; for every point supporting abortion there is a counter-point condemning abortion. This essay will delineate the controversy in one type of comparison/contrast essay form: the “”Argument versus Argument,”” or, “”Block-by-Block”” format. In this style of writing, first you present all the arguments surrounding one side of the issue, then you present all the arguments surrounding the other side of the issue. You are generally not expected to reach a conclusion, but simply to present the opposing sides of the argument.

Introduction: (the thesis is underlined) Explains the argument

The Abortion Issue: Compare and Contrast Block-by-Block Format

One of the most divisive issues in America is the controversy surrounding abortion. Currently, abortion is legal in America, and many people believe that it should remain legal. These people, pro-choice activists, believe that it is the women’s right to chose whether or not to give birth. However, there are many groups who are lobbying Congress to pass laws that would make abortion illegal. These people are called the pro-life activists.

Explains pro-choice

Abortion is a choice that should be decided by each individual, argues the pro-choice activist. Abortion is not murder since the fetus is not yet fully human, therefore, it is not in defiance against God. Regardless of the reason for the abortion, it should be the woman’s choice because it is her body. While adoption is an option some women chose, many women do not want to suffer the physical and emotional trauma of pregnancy and labor only to give up a child. Therefore, laws should remain in effect that protect a woman’s right to chose.

Explains pro-life

Abortion is an abomination, argues the pro-life activist. It makes no sense for a woman to murder a human being not even born. The bible says, “”Thou shalt not kill,”” and it does not discriminate between different stages of life. A fetus is the beginning of life. Therefore, abortion is murder, and is in direct defiance of God’s will. Regardless of the mother’s life situation (many women who abort are poor, young, or drug users), the value of a human life cannot be measured. Therefore, laws should be passed to outlaw abortion. After all, there are plenty of couples who are willing to adopt an unwanted child.

If we take away the woman’s right to chose, will we begin limiting her other rights also? Or, if we keep abortion legal, are we devaluing human life? There is no easy answer to these questions. Both sides present strong, logical arguments. Though it is a very personal decision, t he fate of abortion rights will have to be left for the Supreme Court to decide.

Second Pattern: Point-by-Point

This second example is also an essay about abortion. We have used the same information and line of reasoning in this essay, however, this one will be presented in the “”Point-by-Point”” style argument. The Point-by-Point style argument presents both sides of the argument at the same time. First, you would present one point on a specific topic, then you would follow that up with the opposing point on the same topic. Again, you are generally not expected to draw any conclusions, simply to fairly present both sides of the argument.

Introduction: (the thesis is underlined)

Explains the argument

The Abortion Issue: Compare and Contrast Point-by-Point Format

Point One: Pro-life and Pro-choice

Supporters of both pro-life and pro-choice refer to religion as support for their side of the argument. Pro-life supporters claim that abortion is murder, and is therefore against God’s will. However, pro-choice defenders argue that abortion is not murder since the fetus is not yet a fully formed human. Therefore, abortion would not be a defiance against God.

Point Two: Pro-life and Pro-choice

Another main point of the argument is over the woman’s personal rights, versus the rights of the unborn child. Pro-choice activists maintain that regardless of the individual circumstances, women should have the right to chose whether or not to abort. The pregnancy and labor will affect only the woman’s body, therefore it should be the woman’s decision. Pro-life supporters, on the other hand, believe that the unborn child has the right to life, and that abortion unlawfully takes away that right.

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Abortion: What it is and why people disagree whether it should be legal

And why you’re hearing so much about it right now.

⭐️HERE’S WHAT YOU NEED TO KNOW⭐️

• A U.S. Supreme Court ruling has determined that states will get to decide how abortions are regulated.
• An abortion is a medical procedure that ends a pregnancy.
• This means in some American states, abortions will become illegal.
• Abortion is legal in Canada and not affected by the U.S. decision.
• Some people agree with this decision, but others say abortion should be a universal right for all who want it.
• Keep reading to understand the anti-abortion/pro-choice debate. ⬇️ ⬇️ ⬇️

On June 24, the U.S. Supreme Court overturned a historic decision called Roe v. Wade.

The court’s new ruling limits a person’s right to have an abortion in the United States.

It’s expected to lead to abortion restrictions or outright bans in at least 13 U.S. states.

If you want to know more about the decision, read this article:

• Roe v. Wade was overturned. What does that mean?

If you want to know what an abortion is and why people disagree whether or not it should be allowed, keep reading.

Why are there different views on abortion?

Abortion can be controversial because not everyone agrees who should decide whether or not to end a pregnancy: the individual who is pregnant or the government.

Bernard Dickens, professor emeritus of health law and policy at the University of Toronto, has been studying the history of abortion and the laws relating to it for 50 years.

He says for some people who are pro-choice and support the right to abortion, the fact that the fetus is inside the individual's body means that they get to decide what happens to it.

Those who are anti-abortion oppose the decision to end a pregnancy with abortion and believe that the fetus is considered a person long before birth.

“From a religious or moral perspective, some people say that life begins earlier than birth, life begins at conception, when a woman becomes pregnant,” Dickens said.

Because those who are anti-abortion see the fetus as a living being, they believe that abortion is ending a life, and that the government should intervene to protect that life.

When do abortions happen?

In the U.S., federal statistics suggest that 94 per cent of abortions are performed at or before 13 weeks of pregnancy, which lasts about 40 weeks, or nine months.

Roughly 99 per cent of abortions are performed before 21 weeks of pregnancy (about four and a half months).

In Canada, the statistics are very similar.

Few health care providers in Canada or the U.S. perform abortions after 24 weeks (about five and a half months), unless the life of the person who is pregnant is at risk, if the fetus has serious complications, or in cases where a person has become pregnant as a result of a sexual assault.

Why do people have abortions?

According to Dickens, numerous factors can influence a person’s decision to have an abortion in the United States, including financial, medical and personal.

One of the common reasons is socioeconomic. In other words, some of the people who have had abortions said they couldn't afford to raise a child or add another child to their family.

According to a study done in 2014 by the Guttmacher Institute, a not-for-profit research organization that studies reproductive health:

• 59 per cent of people in the U.S. who chose abortions already have kids.
• 75 per cent of people who had had abortions lived below the poverty line of $15,730 US for a family of two. 

OK, now that you understand the background and you want to learn more about what led to the decision in the United States, read this article .

Have more questions? Want to tell us how we’re doing? Use the “send us feedback” link below. ⬇️⬇️⬇️

With files from The Associated Press

Was this story worth reading?

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What is the federal law at the center of the Supreme Court’s latest abortion case?

Abortion rights activists and Women’s March leaders protest as part of a national day of strike actions outside the Supreme Court, Monday, June 24, 2024, in Washington. (AP Photo/Alex Brandon)

Left to right; Dr. Sara Thompson, an OBGYN provider in ldaho, Jillaine St. Michel, a patient who had to travel out of state to access abortive services, U.S. Health Secretary Xavier Becerra, Lauren McLean, Mayor, City of Boise, Dr. Julie Lyons, LY- UHNZ, St Luke’s, Blaine County women’s health initiative and Family Physician and Dr. Loren Colson, Cofounder, Idaho Coalition for Safe Healthcare participate in a conversation with local patients and providers who have been impacted by Idaho’s abortion restrictions held at the Linen Building in Boise, Idaho, Wednesday, June 26, 2024. (AP Photo/Kyle Green)

• Copy Link copied

WASHINGTON (AP) — The Supreme Court appears ready to rule that hospitals in Idaho may provide medically necessary abortions to stabilize patients at least for now, despite the state’s strict abortion law, according to a copy of the opinion that was briefly posted on Wednesday to the court’s website and obtained by Bloomberg News .

The document suggests that a 6-3 ruling from the court will reinstate a lower court’s order to allow Idaho emergency rooms to provide abortions that save a woman’s health as the broader legal case plays out.

The Justice Department had sued Idaho over its abortion law, which allows a woman to get an abortion only when her life — not her health — is at risk. Idaho doctors say they were unable to provide the stabilizing treatment the federal law requires and that is typically standard of care, prompting them to airlift at least a half-dozen pregnant patients to other states since Idaho’s law took effect in January.

But attorneys for Idaho have said their state law allows for women in dire circumstances to get an abortion and is not in conflict with the federal law.

The federal law, called the Emergency Medical Treatment and Active Labor Act , or EMTALA, requires doctors to stabilize or treat any patient who shows up at an emergency room.

Here’s a look at the history of EMTALA, what rights it provides patients and how a Supreme Court ruling might change that.

What protections does EMTALA provide patients at an ER?

The law requires emergency rooms to offer a medical exam if you turn up at their facility. The law applies to nearly all emergency rooms — any that accept Medicare funding.

Those emergency rooms are required to stabilize patients if they do have a medical emergency before discharging or transferring them. And if the ER doesn’t have the resources or staff to properly treat that patient, staff members are required to arrange a medical transfer to another hospital, after they’ve confirmed the facility can accept the patient.

So, for example, if a pregnant woman shows up at an emergency room concerned that she is in labor but there is not an OB-GYN on staff who could deliver her baby, hospital staff cannot simply direct the woman to go elsewhere.

Why was this law created?

Look to Chicago in the early 1980s.

Doctors at the city’s public hospital were confronting a huge problem: Thousands of patients, many of them Black or Latino, were arriving in very bad condition — and they were sent there by private hospitals in the city that refused to treat them. Some were gunshot victims who hadn’t been stabilized. Most of them did not have health insurance.

Chicago wasn’t alone. Doctors working in public hospitals around the country reported similar issues. Media reports, including one of a pregnant woman who delivered a stillborn baby after being turned away by two hospitals because she didn’t have insurance, intensified public pressure on politicians to act.

Congress drafted legislation with Republican Sen. David Durenberger of Minnesota saying at the time , “Americans, rich or poor, deserve access to quality health care. This question of access should be the government’s responsibility at the federal, state, and local levels.”

Then-President Ronald Reagan, a Republican, signed the bill into law in 1986.

What happens if a hospital turns away a patient?

The hospital is investigated by the Centers for Medicare and Medicaid Services. If they find the hospital violated a patient’s right to care, they can lose their Medicare funding, a vital source of revenue needed for most hospitals to keep their doors open.

Usually, however, the federal government issues fines when a hospital violates EMTALA. They can add up to hundreds of thousands of dollars.

Why did the Supreme Court look at the law?

Since the Supreme Court overturned the constitutional right to an abortion, President Joe Biden, a Democrat, has repeatedly reminded hospitals that his administration considers an abortion part of the stabilizing care that EMTALA requires facilities to provide.

The Biden administration argues that Idaho’s law prevents ER doctors from offering an abortion if a woman needs one in a medical emergency.

But Idaho’s attorney general has pointed out that EMTALA also requires hospitals to consider the health of the “unborn child” in its treatment, too. Attorneys for Idaho have also said that there’s no conflict between the state and federal law since Idaho allows doctors to perform an abortion if the woman’s life is at stake.

What are the advocates saying?

Anti-abortion advocates argue that state laws banning abortion can coexist with the federal law that requires hospitals to stabilize pregnant patients in an emergency.

The prominent anti-abortion group Susan B. Anthony Pro-Life America has called the lawsuit in Idaho a “PR stunt.”

“The EMTALA case is based on the false premise that pregnant women cannot receive emergency care under pro-life laws,” said Kelsey Pritchard, the group’s state public affairs director after the case was heard earlier this year. “It is a clear fact that pregnant women can receive miscarriage care, ectopic pregnancy care and treatment in a medical emergency in all 50 states.”

But many doctors say it’s not as clear cut as anti-abortion advocates claim.

In rare cases, a woman may risk sepsis, hemorrhaging or reproductive organ loss if a troubled pregnancy is not terminated. But Idaho’s state law forces a doctor to wait until the patient is close enough to death to end a pregnancy, doctors argue.

Doctors risk a minimum two-year imprisonment for providing an abortion if the woman’s life is not at risk.

“There’s nothing worse than feeling as a physician that you know what the patient needs and you can’t get it for them,” Dr. Jessica Kroll, the president of the Idaho American College of Emergency Physicians told reporters during a press conference early this month.

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• Copy URL https://www.pbs.org/newshour/politics/read-the-supreme-court-ruling-on-emergency-abortions-in-idaho

Read the Supreme Court ruling on emergency abortions in Idaho

A 6-3 Supreme Court decision released Thursday allows Idaho doctors discretion to perform emergency abortions while the current law says it is only permissible to save the life of a pregnant patient. A draft of the largely procedural ruling was briefly posted to the court’s website a day before the decision was released.

Read the full decision by clicking the image below.

The decision, which reinstated a lower court ruling, did not weigh in on whether doctors should be allowed to perform emergency abortions, meaning that question may come before the court again. The case aimed at resolving the conflict between Idaho’s state law that bans abortion in almost all cases and the federal Emergency Medical Treatment and Active Labor Act , which requires that hospitals that receive Medicaid and Medicare funds take measures to preserve the life and health of patients in the emergency department.

WATCH: How a draft opinion on Idaho’s abortion ban was mistakenly posted by the Supreme Court

In a concurring opinion, Justice Elena Kagan noted the gulf between the Idaho law and federal law. “What falls in the gap between them are cases in which continuing a pregnancy does not put a woman’s life in danger, but still places her at risk of grave health consequences, including loss of fertility,” Kagan wrote. “In that situation, federal law requires a hospital to offer an abortion, whereas Idaho law prohibits that emergency care. And the record shows that, as a matter of medical reality, such cases exist.”

“This months-long catastrophe was completely unnecessary. More to the point, it directly violated federal law,” wrote Justice Ketanji Brown Jackson in a separate opinion.

LISTEN: Supreme Court hears arguments on Idaho abortion ban

Justice Samuel Alito’s dissent criticized the majority for changing course from a few months ago . “Apparently, the Court has simply lost the will to decide the easy but emotional and highly politicized question that the case presents. That is regrettable,” he wrote.

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In Texas, Infant Mortality Rose After Abortion Ban

Deaths of infants in the state increased by 13 percent in 2022, a study found, driven by fatal birth defects.

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By Claire Cain Miller

New data from Texas shows a possible consequence of abortion bans: a rise in infant mortality.

In 2022, the year after the state’s six-week abortion ban took effect, deaths of infants before their first birthdays increased 13 percent, an analysis published Monday in JAMA Pediatrics showed.

The increase was driven by congenital defects or chromosomal abnormalities, it found. The number of babies with such conditions who died rose 23 percent in that period, compared with a 3 percent decrease in the rest of the country.

Fatal fetal anomalies include trisomy 18 or conditions in which fetuses are missing kidneys or parts of the brain. Many are not discovered until the anatomy ultrasound at roughly 20 weeks of pregnancy, well after the gestational age limit in Texas’ abortion ban.

The results “suggest that additional live births occurring in Texas in 2022 disproportionately included pregnancies at increased risk of infant mortality, particularly those involving congenital anomalies,” the study’s authors wrote.

The period of the study did not include most babies born after Dobbs, the Supreme Court decision in June 2022 that ended the constitutional right to abortion. Seventeen states now have total bans or six-week bans, and most do not have exceptions for fatal fetal anomalies.

It takes a long time for complete data on births and deaths to be released, so it is too early to know much about the effect of these bans on infant mortality. But the new study adds to research on earlier bans showing a link to increases in infant deaths , births with chromosomal abnormalities , and maternal health complications.

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Argumentative Essay

Jazatte Dalisay is a ninth-grade student at the Manhattan Center for Science and Mathematics. This essay was composed in a class tutored by James Traub, a long-time PEN Member and coordinator of PEN’s Writers in the Schools program.

Women’s rights have greatly evolved throughout the centuries. As of 2014, women in the U.S. are entitled to their right to decide when to have a child. But there is a constant debate on whether or not abortion should remain legal in the United States. The legalization of abortion has not only kept women from danger, but has provided women with a concrete solution to unplanned pregnancies and protects their civil rights. Taking abortion off the shelf of opportunity for women will only make them seek illicit and dangerous methods to abort an unwanted child and takes away the ability of women to decide what to do with their own bodies.

It is understandable why some might think abortion is an inhumane act that is unnecessary and unlawful, especially since there are alternatives. Adoption has been seen as the perfect solution to unplanned pregnancies; women can simply give their unwanted child away to someone who wants it. With adoption, infertile couples get another chance at making a family, and the child still has a chance at life. This would seem to be the most logical, and humane thing to do. So why does abortion exist?

What people who are pro-life fail to see is the psychological and emotional damage that is inflicted on the woman during the pregnancy. If abortion were to be banned, women who have gotten pregnant through rape and/or incest would have to withstand the shame and pain of knowing that an unwanted child is growing inside them. Victims would be forced to have a constant reminder of their rape. A recent study shows that rape victims are 13 times more likely to attempt suicide, and 26 times more likely to abuse substances such as alcohol and drugs (mscu.edu). Banning abortion would mean destroying the chances of women who are victims of rape to get closure. The psychological and emotional stress can fuel their desperation to rid themselves of the fetus and make them go to great lengths to do that. According to Daniel R. Mishell, Jr., MD, Chair of the Department of Obstetrics and Gynecology at the Keck School of Medicine, University of Southern California, “before abortion was legalized women would frequently try to induce abortions by using coat hangers, knitting needles, or radiator flush, or by going to unsafe “back-alley” abortionists.” In the end, banning abortion will not stop women from trying to rid themselves of the fetus, but just put their own well-being in jeopardy.

Abortion is also a concrete solution to unplanned pregnancies. Though the use of contraceptions, such as the morning-after pill, have been proven to work, it is not always as effective. “Fifty-one percent of women who have abortions had used a contraceptive method in the month they got pregnant, most commonly condoms (27 percent) or a hormonal method (17 percent)” (guttmacher.org). Often, women and teenage girls are too afraid to speak up or don’t even know that they are pregnant, and once they realize they are, it’s already too late—contraceptions are not effective after a certain amount of time. Abortion is their last chance of terminating the pregnancy in a safe and legal way.

Lastly, keeping abortion legal protects women’s rights. Women have full control over their bodies, meaning what they do with them is their decision. If abortion were illegal, women would be stripped of this right. According to Supreme Court Justice Sandra Day O’Conner, “The ability of women to participate equally in the economic and social life of the Nation has been facilitated by their ability to control their reproductive lives” (procon.org). Abortion is also viewed as a fundamental right under law. The Constitution gives “a guarantee of certain areas or zones of privacy,” and that “This right of privacy…is broad enough to encompass a woman’s decision whether or not to terminate her pregnancy” (procon.org). Making abortion illegal means robbing women of their rights.

Keeping abortion legal ensures a woman’s safety when faced with unplanned pregnancies, provides hope for rape victims and helps them in moving on with their lives, and protects women’s rights. Making abortion illegal does not stop women from trying to terminate a pregnancy, nor does it save lives. Rather, it does the opposite — illegalizing abortion puts women in danger and prevents them from having control over their own bodies.

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