At first the decision seemed in sync with our federalist system: let the states decide on abortion, as though the metrics — women and childbirth — varied by states. After Dobbs replaced Roe v. Wade, Minnesota’s legislature would decide for Minnesotans; Idaho’s for Idahoans, et al. The battles — pro and con (though the pro was not clear: pro-zygote? pro-fetus? pro-woman? pro-choice?) raged in America. A majority of our Supreme Court, buoyed by an ideo-religious frenzy to bar abortions as heinous, assumed that if right-thinking voters supported right-thinking politicos, abortion would segue from a crime to a statistical blip, state by litigious state.
Oh for a meld into the minds of Justices Samuel Alito (author), Amy Barrett, Neil Gorsuch, Brett Kavanaugh (concurrence), and Clarence Thomas (concurrence). Their vision was myopic.
The decision turned states into battlefields, eerily evocative of decisions about slavery. To date, 18 states bar abortion — some of them virtually all the time. If a Handmaid’s Tale instrument could pinpoint the moment of conception, some politicos might enshrine that in law. The dates go as low as six weeks — before some women know they are pregnant. You need a scorecard to consider the variations; the Guttmacher Institute has such a one; and a bot named Charley will help a user find a vetted clinic or telehealth provider anywhere in the country.
Dobbs did not end abortions; it moved them. Texas’s Health Department records only 17 abortions in the first four months of 2023, all for emergencies — clearly an undercount in a state with 7 million women of child-bearing age. (The Guardian: “Texas Records Just 17 Abortions In Four Months In Likely Vast Undercount.”)
Did the Justices foresee the abortion-travelers seeking the closest state for an abortion? South Carolina is out; North Carolina, possible. (Axios Raleigh: “North Carolina Remained A Southern Abortion Destination In Early 2023.”) Did they foresee the restrictions barring women from leaving one state for another? As for state officials keen on restricting travel, consider the eerie parallel to the current Alabama Attorney General’s zeal to prosecute people who facilitate travel to that state’s efforts a century ago to restrict the travel of Black people keen to escape servitude. And what would state officials do with a pregnant woman keen to leave Alabama? Restrain her until birth?
The justices obviously pored over tomes of judicial precedents, including Constitutional provisions, before ruling on Dobbs. They listened to legal arguments. They didn’t listen to obstetricians describe the messy mechanics of childbirth. The “abortion-as-heinous” mindset overlooked the biological mishaps: fetuses with fatal anomalies, ectopic pregnancies, pre-eclampsia, placental abruption, infections. Obstetricians know that childbirth is not always a wondrous easy process, but a nine-month ordeal that with the best of intentions can go awry. And sometimes abortion is the best recourse to save the life of the mother, or to safeguard her ability to have children in the future. Justices with no medical training might argue that the mother might still survive if a dead fetus led to infection, for instance, but that is a risk that doctors, and women, don’t want the government to make.
So it is not surprising — well, maybe surprising to the Justices — that women with “high risk” pregnancies are frantically seeking physicians in states that allow abortions. They must not only find the state, but find the hospital and/or physician, find the funds to pay, arrange for travel, arrange for childcare for the family left at home … Justice Kavanaugh had blithely opined that women could simply travel from one state to another in a post-Dobbs world, as though a poor pregnant woman could easily leave her family in Alabama to travel to California, Oregon or Massachusetts.
And it is not surprising that many obstetricians and specialists in maternal-fetal medicine are bowing out of those “no-abortion” states. The physician must juggle the needs of the patient against the state’s law and the possibility that a zealous attorney general will sue him or her. Idaho versus Oregon: one state loses physicians, the other gains. The March of Dimes publishes a state graphic showing the “maternity deserts.” A “medical desert” hurts all women. Many who begin a healthy pregnancy later become “high risk.” They need skilled medical oversight, but will be hard-pressed to find it.
Finally, some pregnancies stem from rape and incest. Would the Justices want women to continue with those pregnancies? What would the Justices want the women to do with those babies? Abandon them to the skinflint mercies of their state’s social welfare systems? And what of the women themselves, forced to carry reminders of a horrific act to term? The Justices might have paused from their tomes to talk to some victims. Bowing to the judicial ideologues, Iowa, which once upon a pre-Dobbs time routinely paid for “morning after” pills for victims of rape, is reconsidering that payment.
The Supremes live among people who share the same view of the world -- a cruelly myopic one to foist upon the country.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email joan.retsinas@gmail.com.
From The Progressive Populist, October 15, 2023
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