Tag Archives: abortion

What Dobbs Hath Wrought…

Lots of people cheered when our rogue Supreme Court overruled Roe v. Wade, and began what has turned out to be a flight from constitutional principles–especially the principle that government has an obligation to protect individual liberty and autonomy.

Faux Christians celebrated the obvious fact that the decision was a win for their particular religious beliefs. Those who’d piously pretended to care about religious liberty were delighted when the Court ignored the liberties of adherents of religions that differ on the issue. (It’s been clear for quite a while that the “liberty” these Christian warriors want to advance is the liberty to impose their own beliefs on others.)

Men (and some women) whose worldviews are paternalistic celebrated the Court’s declaration that women would no longer be permitted to govern themselves. After all, those sweet little females were never meant to have self-determination; pesonal autonomy is for men. (Mostly straight and White…)

Dobbs was also welcomed by the legions of authoritarians who believe–in contrast to the nation’s founders–that  government should make life decisions for its citizen/subjects, rather than protecting their right to believe and live as they see fit.

Dobbs was handed down in 2022, so enough time has passed to see whether all that celebrating was justified, or whether the desired results have failed to materialize. A recent essay in the Guardian assessed that “progress.”

Here’s the lede:

Dobbs v Jackson Women’s Health Organization, the US supreme court case that rescinded the constitutional right to abortion, is failing on its own terms. Since the ruling, in June 2022, the number of abortions in the US has risen. Support for reproductive rights is on the upswing. And the rate of voluntary sterilization among young women – a repudiation of Trumpian pronatalism, if a desperate one – jumped abruptly after Dobbs, and there’s no reason to believe it will drop off.

Also rising at an alarming clip are preventable maternal deaths and criminal prosecutions of pregnant people.

The Guttmacher Institute reports that abortions rose 1.5% between 2023 and 2024, on top of a 11.1% increase in the first year after Dobbs. That’s probably a significant undercount, since Guttmacher reports only “clinician-provided abortions”, either surgical or medical (using abortion pills), and doesn’t estimate how many abortions are happening outside the formal healthcare system. As we know, numerous women are obtaining abortion medications directly from suppliers or from the multiple feminist underground networks that have been organized in the wake of the decision.

The essay notes that the 21 state legislatures that, like my own state of Indiana, have imposed total or near-total bans have failed to do anything that might give doctors legal leeway to save the health and lives of pregnant women in medical distress. Indeed, rather than trying to save lives, several are prosecuting pregnant women who handle those emergencies on their own.

The fact that we have seen more abortions, not fewer ones (not to mention increases in pro-abortion public opinion and contraception) has infuriated the anti-abortion activists, who are searching for stronger disincentives. They seem to have settled on more punishment–and have no apparent problem with more deaths among the already born. (Evidently, the death of pregnant women is an unfortunate–but acceptable– consequence of saving the “pre-born.”)

The Trump administration and MAGA want to see more babies. (Fewer immigrants, more “real American” babies…). But if one goal of banning abortion was to produce more of those babies, that’s clearly not working.

Public health researchers saw “an abrupt increase in permanent contraception procedures” – sterilization – following Dobbs among adults in their prime reproductive years, ages 18 to 30. Unsurprisingly, the increase in procedures for women (tubal ligations) was twice that for men (vasectomies).

As the essayist notes, the carrots haven’t been appetizing enough, and the sticks not effective enough, so Red-state legislators “are bringing out the AR-15s.” Republican lawmakers in at least 10 states have introduced bills defining abortion as homicide, and criminalizing both the provider and the patient. The bills are based on “fetal personhood” – the strategy of conferring full legal rights to a fetus from conception. By 2024, 39 states had fetal homicide laws.

While they work toward criminalizing the ending of a pregnancy, anti-abortion lawmakers and prosecutors are making creative use of existing law to punish miscarriages.

A 31-year-old South Carolina woman who miscarried and disposed of the tissue in the trash was arrested for “desecration of human remains”, a crime carrying a 10-year sentence. In March, a woman found bleeding outside her Georgia apartment after a miscarriage was jailed for “concealing the death of another person” and “abandonment of a dead body” for placing the remains in the bin. 

Rational people have always known this movement isn’t “pro-life.” It’s anti-woman.

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Puncturing The “Pro-Life” Myth

I assume there are sincere people (mostly, but not exclusively, male) who bought into the myth that prohibiting abortions was all about “saving babies.” In the wake of actual bans, the incredible dishonesty of that assertion has become harder to ignore. 

The avowed “pro life” activists have been conspicuously silent about the fact that– In the wake of the Dobbs decision–in states like Indiana that have stringent bans, women have died or suffered extreme medical consequences in greater numbers than before. While most women already knew that the purported “pro life” concerns about “life” didn’t extend to the lives of women, those activists have been equally silent about the sharp rise in infant mortality. As the linked report shows, in the year and a half following the Supreme Court Dobbs decision, hundreds more infants died than usual in the United States. The vast majority of those infants had congenital anomalies, or birth defects, and it is likely that a number of those babies experienced painful deaths.

The refusal of ideologues to understand that abortion availability is an essential part of healthcare has meant that women suffering miscarriages have been denied adequate and timely treatment, and that pregnant women who very much want to carry their babies to term are having difficulty finding an ob/gyn to provide prenatal care and deliver those infants. The state’s abortion ban has led to a decline in OBGYN residency applications–a decline likely to worsen the already alarming shortage of maternal care providers. A patient in Northern Indiana died last year from an ectopic pregnancy because there was no ob-gyn to treat her.

None of which seems to bother the “pro life” Micah Beckwiths of the world.

Now, it turns out that the medical consequences of these bans–their very negative effect on actual lives–extends far beyond reproductive medicine. According to the Indiana Capital Chronicle, the bans are also interfering with the diagnosis and treatment of breast cancer. In the wake of Dobbs and state bans, finding a local provider for breast screenings has become far more difficult. Planned Parenthood clinics that used to provide those screenings have closed and staff shortages at other sites have increased as medical personnel leave states with bans.  The remaining health care providers are overwhelmed.

One in 3 oncology fellows surveyed by the American Society of Clinical Oncology says abortion restrictions hurt cancer care, and more than half of fellows said they are likely to consider the impact of abortion restrictions on care when deciding where to practice. Although many states like Indiana allow exceptions when the termination of a pregnancy is necessary to protect the life of the pregnant patient, the rules on how to apply these exceptions are unclear. In Ohio, two cancer patients were denied treatment until terminating their pregnancies under the state’s 6-week ban, forcing them to seek care out of state. As these bans persist, more Hoosiers will face similar situations—many of which may go unseen.

Early detection through routine screenings plays a critical role in improving survival rates, as 1 in 8 women in the U.S. will develop breast cancer in their lifetime. But when health centers are forced to close, those lifesaving screenings disappear too.

How “pro life” are the pious ideologues who talk endlessly about the “pre-born” but refuse to acknowledge the profoundly negative outcomes of these bans for the lives of already-born women? 

Excuse my cynicism, but I remain convinced that the real motive for these bans is the patriarchal belief that women should be returned to a submissive social status. Increasing efforts by GOP politicians to restrict access to birth control give the game away.

With the advent of the pill, women were–for the first time– able to manage their fertility and plan their families. Women were able to enter the workforce, able to participate with men in the broader civic and political society. As Morton Marcus and I documented in From Property to Partner, reproductive choice has been far and away the most important element of women’s liberation. 

Initially, perhaps some people were convinced that the “pro life” movement really was about keeping wicked and “ungodly” women from “killing babies.” Now that we have irrefutable evidence that, thanks to these bans, more babies and more women are dying, it will be interesting to see how many of those people revise their opinions. 

I’m not holding my breath, because for the great majority of those “pro life” warriors, it was never about life. It was about male dominance and faux religion.

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Let’s Talk About Choice

A reader of this blog recently asked me why Americans seem so confused about whether individual “choice” is an essential element of freedom. Why, for example, do many Americans see reproductive choice as a critical human right, but oppose school choice, or the individual’s choice to own lethal weapons? Why did people during a pandemic oppose rules requiring them to wear masks, claiming their right to choose? Can we make sense of these differences?

I think we can.

I have frequently alluded to the libertarian principle that underlies America’s constitutional system. Those who crafted America’s constituent documents were significantly influenced by the philosophy of the Enlightenment, and its then-new approach to the proper role of the state. They endorsed the principle that Individuals should be free to pursue their own ends–their own life goals–so long as they did not thereby harm the person or property of another, and so long as they were willing to accord an equal liberty to their fellow citizens.

The principle seems straightforward, but it requires a measure of consensus about the nature of harm to others.

To use a relatively recent example, lots of folks were enraged when local governments imposed smoking bans in public places. They insisted that the choice to smoke or not was an individual one. The bans, however, resulted from medical research documenting the harms done by passive smoke. The ordinances were based upon lawmakers’ agreement that individuals should retain the choice to smoke in their homes or cars or similar venues, but not where they would be polluting the air of non-consenting others.

Essentially, the libertarian premise asks: What is the nature of the “harm to others” that justifies government intervention? When may government disallow a seemingly personal choice? How certain does the harm have to be? Does harm to others include harms to non-persons (fetuses)?

Most sentient Americans understood that a rule requiring people to wear masks in public places during a pandemic was essential to preventing harm to unconsenting others, just as the ordinances against smoking in a local bar protected non-smokers from the hazards of passive smoke, and laws against speeding protect against potentially deadly accidents.

When we get to issues like gun ownership and educational vouchers, there is considerably less agreement–although survey research suggests that most Americans favor considerable tightening of the laws governing who can own weapons, given the daily evidence that lax regulation is responsible for considerable and often deadly harm to others.

What about allowing “parental choice” in the use of tax dollars to send one’s children to private and religious schools? Or, for that matter, “parental choice” to control what books the local library can include on its shelves?

The evidence strongly suggests that “educational choice” is harming both civic cohesion and the public school systems that serve some 90% of the nation’s children. (Given the large percentage of voucher users who choose religious schools, there is also a strong argument to be made that these programs violate the First Amendment’s Separation of Church and State.) There is also a significant difference between exercising choice with one’s own resources–which parents can absolutely do–and requiring taxpayers to fund those choices.

With respect to libraries, parents can certainly choose to prevent their own children from accessing books of which they disapprove, but efforts to keep libraries from offering those books to others is a clear violation of the portion of the libertarian principle that requires willingness to accord equal liberty to others.

Whether to impose on an individual’s right to choose a course of action will often depend upon a weighing of harms. With respect to a woman’s right to choose an abortion, even people who claim that a fertilized egg is a person should understand that an abortion ban demonstrably harms already-living women–physically, emotionally and economically. (It has become abundantly clear that very few of the “pro life” activists really believe that a fertilized egg is equivalent to a born child; they are far more likely to favor a return to a patriarchal time and a reversal of women’s rights. But even giving them the benefit of the doubt, a weighing of the harms clearly favors women’s autonomy.)

Bottom line: a free society will accord individuals the maximum degree of individual choice consistent with the prevention of harm to others. There will always be good-faith debates about the nature and extent of the harms justifying government prohibitions, but those debates should start with a decent respect for–and understanding of– the philosophical bases of our constitutional system and the relevant credible evidence.

A good society chooses wisely.

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Connecting The Dots

A few evenings ago, I introduced a Zoom meeting sponsored by ReCenter Indiana. It was focused upon the very negative effects of our legislative super-majority. Democrats have identified four districts in Indiana that–should they all go Blue in November–would reduce the current super-majority to a simple majority. My job was to begin the session with an explanation of how a legislative super-majority advances extremism and stifles democratic deliberation.

Here are those introductory remarks.

__________________

Let me begin this discussion by connecting some dots. Hoosier voters need to understand how partisan redistricting—usually referred to as gerrymandering–has given Indiana its legislative super-majority, and how that super-majority has given us increasingly extreme legislation: a virtually-complete abortion ban, education vouchers that are starving our public schools, gun laws that allow anyone who can fog a mirror to possess a lethal weapon– basically, a focus on culture war at the expense of attention to actual governance.

It’s a vicious circle, because in Indiana, the GOP’s legislative super-majority also allows the party to continue the extreme gerrymandering that has made Indiana one of the five most gerrymandered states in the country.

Gerrymandering has all sorts of undemocratic consequences, one of which is voter suppression. In districts perceived as “safe,” people who favor the “loser” party tend to stay home. That’s one reason why Indiana ranks 50th among the states in turnout. (Interestingly, due to Indiana’s population shifts, a number of those theoretically “safe” districts wouldn’t currently be safe if discouraged folks came out and voted. Those demographic shifts are one of the reasons there’s a chance this year to break the current GOP supermajority.)

Indiana is an excellent example of how the gerrymandering that leads to legislative super-majorities has a profound and very negative impact on policy.

We know that primaries attract the most ideologically extreme voters in either party. When the primary is, in effect, the general election, Republican incumbents protect their right flank, Democrats their left. In Indiana, which has been gerrymandered to produce more Republican districts, that reality has steadily moved us farther and farther Right. Today’s “culture warriors” win office in order to focus on issues like banning abortion, waging war on trans children, and removing common-sense restrictions on gun ownership. And it’s getting worse–there are indications that during the next session we’ll see the introduction of anti-vaccine measures that—if passed–would threaten public health. (For reasons I fail to understand, opposition to vaccination has become a preoccupation of what I’ll call the “Micah Beckwith wing” of the GOP.)

These are the pet issues of extremists, rather than the issues that most Hoosiers care about and that we traditionally consider governmental: roads and bridges and other infrastructure, crime and punishment, economic development.

Thanks to the gerrymandering that has given Republicans a super-majority, these extremist legislators face virtually no barriers to enacting measures that research tells us are deeply unpopular with most Hoosiers. Members of a super-majority don’t face pressure to negotiate, or to moderate the most extreme versions of their extreme positions.

A party with a super-majority also faces no obstacles to rewarding its donors and supporters; in Indiana, that has given us policies that almost uniformly favor the well-to-do. It has defeated even the most minimal efforts to protect renters. It has given us privatization programs like vouchers, in which our tax dollars are used almost exclusively by the well-to-do while impoverishing the public schools that serve poorer children, and it has given us what is arguably an unconstitutional effort to protect gun manufacturers from litigation.

That super-majority has also blocked more stringent ethics measures.

Any super-majority—Republican or Democrat—gives those in power the ability to ignore contending arguments, unpalatable data and the needs of Hoosiers likely to vote for the opposing party. They don’t need to negotiate or compromise. They don’t even need to look like they’re negotiating or compromising.

Indiana can’t get rid of the gerrymandering that makes our legislature’s extremism possible—we lack a referendum or initiative, mechanisms that have been used by other states to institute nonpartisan redistricting. In this state, only the legislature itself—only the people who benefit from the system—can change it. The only way Indiana will get rid of the gerrymandering that allows legislators to choose their voters rather than the other way around would be Congress passing the John Lewis act, which (among other very positive things) would make gerrymandering illegal nationally.

Since the GOP benefits from America’s gerrymandering far more than the Democrats do, passing the John Lewis Act would probably require a Democratic trifecta: a Democratic House and Senate to pass it and a Democratic President to sign it.
Until that happens, if it ever does, Indiana’s Republican gerrymandering is likely to continue giving Hoosiers a Republican legislative majority. But we do have a chance this year to defeat the super-majority, and to slow down our state’s march toward culture-war extremism. One reason is the shifting demography that I previously mentioned. Another is that the GOP has moved so far toward a very unconservative extremism that its candidates are turning off voters who previously voted Republican.

Those realities give four candidates in particular a better-than-usual chance to win their districts:
• Josh Lowry, District 24;
• Tiffany Stoner, District 25;
• Victoria Garcia Wilburn, District 32 (incumbent); and
• Matt McNally, District 39.

We’ll now hear from each of them.

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Let’s Send A Message

I have occasionally quoted my cousin Mort, a noted cardiologist, on issues involving medical care. He recently shared with me his concerns over the challenge of providing appropriate–or even barely adequate–medical care to women in the wake of the Dobbs decision. In Indiana, this is a huge problem, because–unlike other states– We the People lack any effective electoral mechanism to reverse our GOP-dominated legislature’s assaults on reproductive liberties.

As I was reading my cousin’s email, it occurred to me that while Indiana voters might not be able to mount a referendum, we do have a way to send a message to the pious, self-important legislators who think that occupying a gerrymandered seat in the General Assembly entitles them to overrule people with specialized expertise who actually know what they’re doing.

That message is our vote.

Here’s my proposal: Every pro-choice voter in Indiana should go to the polls and vote Blue “all the way down.” In addition, they should make sure their state senators and representatives know that their vote is tied to reproductive choice–by posting on social networks, writing their legislators, or by carrying a sign or wearing a t-shirt saying “pro-choice voter” when they go to the polls.

As my cousin knows–and Indiana’s Republican legislators evidently don’t– reproductive autonomy isn’t just about being forced to give birth; it is often a matter of life and death.

The U.S. House of Representatives Energy and Commerce Committee’s Ranking Member, Frank Pallone, Jr. (D-NJ), has recently released a 40-page report detailing the findings of a 10-month-long investigation into the impact of the Supreme Court’s Dobbs vs. Jackson ruling on the practice of obstetrics and gynecology. This was the court’s decision on June 24, 2022, that took away a woman’s previously recognized constitutional right to abortion and gave states the right to limit or outlaw abortions.

In September 2023, Pallone launched the investigation to examine how providers and, by extension, their patients, are impacted by the Dobbs decision. In conducting the investigation to determine the effects on medical practice, the Democratic Committee staff interviewed OB–GYN educators and resident physicians. The investigation disclosed alarming effects that included the following:

  • Providers are seeing sicker patients suffering from greater complications due to delayed care caused as a result of the Dobbs decision.
  • The Dobbs decision has harmed the training of OB–GYN residents in restrictive states.
  • Residency applicants are increasingly concerned about the quality of abortion training programs offered in restrictive states.
  • Residency directors are finding restrictions on clinical communication are degrading trust between providers and patients and are robbing patients of the ability to make informed decisions about their health.
  • The training of OB–GYN residents in abortion-protective states has been harmed as programs in those states strain their capacity and resources to help train out-of-state residents from restrictive states.
  • Restrictive state laws are already leading us to a future with a provider workforce less prepared to provide comprehensive reproductive health care.
  • OB–GYN residents and program directors are increasingly frustrated, discouraged, and experiencing negative mental health effects in the aftermath of the Dobbs decision.
  • Residency program leaders who participated in the report universally agreed that abortion care is integral to other components of reproductive health care and should not be eliminated or isolated from residency training.
  • After Dobbs, OB–GYN residency applicants more strongly preferred programs in states that permit abortion access.
  • A patchwork of state restrictions is leading to disparate systems of reproductive health care, worsening reproductive and maternal health care shortages, and fracturing the OB–GYN workforce.

As my cousin concluded (I could almost see the smoke coming out of his ears!), Dobbs was yet another example of the naivete and hubris of a politicized Supreme Court. The Court flouted scientific evidence, overruling knowledgeable and skilled medical practitioners in a field in which they were totally unqualified.

I will readily admit that my recommendation–vote Blue to send a message–might require a few Hoosiers to be single-issue voters this November. Those of us who have already surveyed the caliber of candidates being offered by Indiana’s GOP and the issues they are peddling will have no problem voting Blue from top to bottom, but pro-choice Republicans may find it more difficult (although really, Republicans–have you looked at your statewide ticket? Those MAGA theocrats sure don’t resemble the Republicans I used to know…)

Trump keeps saying that abortion/reproductive liberty is no longer a “big deal” electorally. He’s so wrong.

Even one election cycle that turned Indiana Blue–or even purple–would send a much-needed message to our legislative overlords. And we might even elect competent and thoughtful public servants for a change!

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