Health Care/Joan Retsinas

Abortion Bans: Pandora’s Box

The Dobbs decision, outlawing Roe v. Wade, sent abortion to the states. And zealous state legislators, keen to protect zygotes at the expense of the women carrying them, opened Pandora’s box of idiocies.

First idiocy: abortion-travel, a modern variation on the Fugitive Slave Act. Women now face dilemmas: If I am diagnosed pregnant in one state that bans abortion, can I travel to a state that will allow it (assuming I can find a clinic, take the time, and muster the funds). Initially states tried to ban not just abortions, but travel out of state for an abortion; but both the Constitution and the Supreme Court have upheld interstate travel as a right. So states backed down, though a few states threaten anybody who aids in the travel with civil penalties. Women in Alabama, Missouri, Idaho, should tread cautiously. Forget the legalities though. Women often will need money to make this happen; and while Planned Parenthood used to subsidize medical care, they now are financial travel agents.

Next: obstetrician deserts. Some pregnancies can go awry, for instance, ectopic pregnancies, preeclampsia, potentially fatal fetal anomalies. An abortion can save the life of the mother. A physician, true to the Hippocratic oath, cannot cavalierly cite state law, and leave the patient to die. Then there is incest and rape. They happen; and whatever legislators proclaim about the impossibility of pregnancy from rape or the redemptive power of giving birth to the child of such a union, many victims desperately seek abortion; and their physicians, pledged to “do no harm,”face a dilemma when state strictures tell them to do grievous harm to these victims. The emergence of “obstetrician deserts” is understandable: why practice in a state that forces you to “do harm”?

Third idiocy: surgical procedures in lieu of abortion. Instead of a medication-induced abortion (the case with 63% of abortions in the United States today) or a minimally invasive procedure, why not a full Caesarean, or induce labor? The fetus might survive for a few hours, maybe, giving the parents time to grieve … but also making the woman undergo a major surgical procedure, with its complications, and prolonging the time when she might try to become pregnant. “Do no harm” morphs into “Do a lot of harm,” in the name of legislative legerdemain, when a cesarean becomes an end-run around a safer abortion. This idea, promulgated by the Charlotte Lozier Institute, is cruel.)

Fourth idiocy: the war on pills. The FDA has approved mifepristone and misoprostol as safe and effective. Since most abortions rely on pills, zealous legislators in 14 states have taken a new tack: ban the pills. Or reclassify the pills as a controlled substance, as Louisiana just did. Or prohibit a physician from treating a woman in an emergency room if she may have taken the pills. The Comstock Act bars distribution through the Postal Service of pornography. Why not add mifepristone and misoprostol to the list? A ban-the-abortion-pill campaign opens the door to ban-the-contraceptive pill, already hinted at in polemical tirades. The Heritage Foundation’s Project 2025 proposes forcing the FDA to rescind its approval of “chemical abortion drugs” and to put contraceptive pills under the Comstock umbrella. This attack on medication marks an attack on science. In effect, “government” is silencing the science-based pronouncements of physicians.

Fifth idiocy: banning in vitro fertilization. Ironically, the people intent on assisted reproduction desperately want families. A lot of babies (in 2021, 86,146 or 2.3% of all babies) are born through “ART.” Nationally, Senate Republicans blocked legislation that would make IVF a right for women. (Senators Lisa Murkowski and Susan Collins did not vote with their colleagues.) That bill did not pass. The IVF decision falls to states. But state legislators, true to their ban-abortion mindset, face a quandary. A lot of babies represent a lot of voters — parents, grandparents, aunts, uncles, siblings, friends. So a lot of anti-abortion legislators are standing back, even in Alabama, which In February outlawed IVF but in March passed a law to protect providers.

Final idiocy, one that is hard to squash: distrust of women, fearing that they are too stupid? Too narcissistic? Too immoral? Too whatever (fill in the misogynist blank) to decide, in consultation with their physicians, their partners, and their clergy their choices.

At election time this November, voters can put these idiocies back into Pandora’s box.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email joan.retsinas@gmail.com.

From The Progressive Populist, September 1, 2024

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