Barefoot And Pregnant

I am hopeful that women–and men who care about women– will save democracy in November. If so, it will be “thanks” to the ideologues on the Supreme Court, especially Justice Samuel Alito. His profoundly misogynistic and intellectually dishonest decision in Dobbs prompted a renewed national conversation over the consequences when judges and legislators presume to over-rule medical professionals.

In November, however, voters won’t just determine the fate of abortion restrictions. Unbelievable as it may seem, there are serious efforts underway to restrict access to birth control.

First, abortion.

Special elections in Red states have uniformly confirmed that–where reproductive rights are concerned–even political identities take a back seat. A large number of polls confirm that support for abortion bans has plummeted in the wake of Dobbs. Although I’d seen a number of polls showing substantial gains in support for reproductive rights, I was surprised to read that a recent Axios-Ipsos poll found 81% of Americans agreeing with the statement “abortion issues should be managed between a woman and her doctor, not the government.” That number included 65% of Republicans, 82% of Independents and 97% of Democrats.

The dilemma for Republicans is very real, because a substantial portion of their base remains extreme on the issue. A Republican candidate who tries to soften the party’s draconian stance on abortion in order to appeal to voters turned off by  intransigence on the issue will be vilified–and deserted–by the party’s zealots. And since those zealots are the voters most likely to turn out for primary elections, Republicans in Red states will run hard-Right culture warriors in November. Here in Indiana, Republican Senate candidate Jim Banks wants a national abortion ban with zero exceptions. (If the woman dies, well, them’s the breaks, baby…) Even in Indiana, that’s not a popular position.

In November, voters in a number of swing states will face referenda on abortion. Democrats promising to codify Roe and explicitly repeal the Comstock Act should get a boost.

Then there’s birth control.

American women should hope the federal government stays in Democratic hands, because forced birth Republicans aren’t going to be satisfied with banning abortion. They’re coming for birth control too.

It may surprise many people that there is a a concerted effort going on quite literally under their noses—on the screens of their smartphones, tablets, and laptops—to sow distrust, uncertainty, and fear of ordinary birth control among this country’s young people and particularly, young women.

In most instances the folks responsible for fostering this distrust are the same people vehemently opposed to abortion. Their failure to see any dissonance in advocating such contradictory positions might be perplexing—if you didn’t take their motivation into account. It’s the natural fulfillment of what they would consider an ideal society: one where men are in control, and women know their place.

Salon has recently tracked a sophisticated and well-financed Rightwing “information blitz” on social media, warning of the hazards of birth control.

Emboldened by the Supreme Court’s decision to overturn Roe v. Wade, they’ve now trained their focus on hormonal birth control, hysterically amplifying its alleged “hazards” to create a narrative of uncertainty ripe for what they see as the conservative-dominated highest court’s next logical step….

Physicians say they’re seeing an explosion of birth-control misinformation online targeting a vulnerable demographic: people in their teens and early 20s who are more likely to believe what they see on their phones because of algorithms that feed them a stream of videos reinforcing messages often divorced from scientific evidence.

One “influencer” candidly shared his motivations:

With fewer women on the pill, more women will become mothers, and some of them will drop out of the workforce and discover fulfillment and happiness as wives and homemakers. This is the real crisis that the Washington Post and the other Left wing rags are worried about. The last thing that the elites want to see is a movement of women fully embracing their own womanhood, and men fully embracing their manhood.

During the fifty years between Roe and Dobbs, most Americans shrugged off the efforts of “pro-life” activists, assuming that the Supreme Court would not overturn a settled constitutional right. Most reasonable people have a similar reaction to warnings that access to birth control will be next. (Those people haven’t read Justice Alito’s decision in the Hobby Lobby case.)

Fanatics who want to take this country back to a time before there were “uppity” women (and gays and Blacks) are a minority. But they are zealous and committed and a lot of them are running for office.

Women aren’t returning to “barefoot and pregnant” status. Voters–male and female– who understand what’s at stake will vote Blue in November. I hope there are enough of them.

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The Stakes II

A couple of days ago, I considered the stakes of this year’s election choices, and speculated about whether and to what extent the abortion issue will drive both turnout and results. What I failed to explain ( thanks to the word limit I have self-imposed for these daily rants) is why the debate about reproductive choice is in reality about far more than a woman’s right to control her own reproduction, important as that is.

The deeply dishonest Dobbs decision struck at a fundamental premise of America’s Constitution, as we have come to rely upon it– the belief in limited government.

When politicians talk about “limited government,” they generally focus on the size of government, but the U.S. Constitution defines those limits in terms of authority, not size. What is to be limited is the power of government to prescribe certain decisions that should be left to the individual. In the original Bill of Rights, the federal government was forbidden to censor speech, prescribe religious or political beliefs, and take other actions that were invasions of fundamental rights–rights for which early Americans demanded recognition.

Over the years, those limitations on federal government power were imposed on state and local government units, and evolving cultural and social norms prompted a fuller understanding of what sorts of decisions individuals are entitled to make without government interference. I frequently cite what has been called the Libertarian Principle, because that principle undergirds America’s particular approach to government. The principle is simple: Individuals should be free to pursue their own ends–their own life goals–so long as they do not thereby harm the person or property of someone else, and so long as they are willing to accord an equal liberty to their fellow citizens.

The gender of your chosen mate, your adherence to a non-Christian religion (or your utter rejection of the notion of divinity), your choice to reproduce or not, and a number of other life choices are simply none of government’s business. (As Jefferson is often quoted, such decisions “neither break my leg nor pick my pocket.”)

The Libertarian Principle was central to the original Bill of Rights, and its application has  extended as “facts on the ground”–scientific and cultural–have changed. Ever since 1965, when the Supreme Court handed down its decision in Griswold v. Connecticut– informing the Connecticut legislature that a couple’s decision to use contraceptives was none of government’s business–the belief that there are areas of our lives where government simply doesn’t belong has been absolutely central to Americans’ understanding of liberty.

When I was much younger, the importance of limiting government to areas where collective action was appropriate and/or necessary—keeping the state out of the decisions that individuals and families have the right to make for themselves– was a Republican article of faith. It was basic conservative doctrine. Ironically, the MAGA folks who inaccurately call themselves conservative today insist that government has the right—indeed, the duty– to invade that zone of privacy in order to impose rules reflecting their own particular beliefs and prejudices.

It’s critically important to understand that what is really at stake in what we shorthand as the “abortion issue” is that fundamental Constitutional premise. Forcing women to give birth, denying medical care to defenseless trans children or forbidding school children to read certain books are not “stand-alone” positions. They are part and parcel of an entire worldview that is autocratic and profoundly anti-American.

I used to point out that a government with the power to prohibit abortion is a government with the power to require abortion. (As an ACLU friend used to say, poison gas is a great weapon until the wind shifts.)

The issue at the heart of the Bill of Rights–as I interminably repeated to my students–isn’t what decision is made. The issue is who gets to make it. In the government system devised by our Founders, certain decisions are simply off-limits to government. I may disagree with your religious beliefs or political opinions; I may disapprove of your choice of marriage partner or your selection of reading material–but I cannot use the government to countermand your choices and require behaviors more to my liking.

It is that fundamental premise that is at stake in this year’s elections, which will pit the MAGA theocrats and autocrats against those of us who want to preserve America’s hard-won civil liberties and individual rights.

The abortion issue is about so much more than abortion, and I have to believe that, at least at some level, most Americans realize that.

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The Stakes

Bret Stephens is a regular opinion writer for the New York Times. He is a self-described conservative who shares a Monday column with liberal Gail Collins. Stephens is a “never Trumper”–and very clear-eyed about the threat posed not just by Trump, but by the current GOP, and he has a wicked way with words. A few days ago, when Collins asked him what the remaining sane Republicans would do about the immigration bill, his response was dead-on perfect:

So-called sane House Republicans are basically passengers in a car being driven at high speed by a drunk. There’s no getting out of the car. And they don’t dare tell the driver to slow down because who knows what he’ll do then.

As Hoosiers are being inundated with advertisements from the candidates vying for the GOP nomination for Governor, the accuracy of Stephens’ description is evident. 

On the one hand, we have the MAGAs. Mike Braun is promising to fix problems that are matters of federal jurisdiction (why not stay in the Senate, Mike, if those are your issues?) and repeatedly reminding voters that he is Trump’s choice. Creepy Eric Doden is quoting the bible,  promising to “protect life” and “always back the Blue.” And we have Brad Chambers– the least scary of the lot (which isn’t saying much)–trying to avoid climbing into the drunk driver’s speeding car by focusing on job creation and his “outsider” claims.

I’ve missed ads from Lt. Governor Susanne Crouch and disgraced former Attorney General Curtis Hill–I assume we’ve been (mercifully) spared those due to the lack of zillionaire status that allows the others to spend lots of their own and their families’ money.

All of them support Indiana’s abortion ban. And that raises a question: how much weight will Hoosier voters place on the abortion issue when it is one issue among others on the candidates’ agendas?

Every state that has voted on the issue of reproductive rights in a stand-alone vote has upheld those rights, even deep-red states. Pundits argue, however, that voters will be less likely to vote against candidates whose anti-choice positions are only one position among many. When  the issue is separated from a campaign for public office, presumably, it is simpler for voters to understand what’s at stake and to register an “up or down” preference.

That belief may have been what  has convinced pro-Trump groups to formulate an “Anti-Abortion Plan for Day One.”

In emerging plans that involve everything from the EPA to the Federal Trade Commission to the Postal Service, nearly 100 anti-abortion and conservative groups are mapping out ways the next president can use the sprawling federal bureaucracy to curb abortion access.
 
Many of the policies they advocate are ones Trump implemented in his first term and President Joe Biden rescinded — rules that would have a far greater impact in a post-Roe landscape. Other items on the wish list are new, ranging from efforts to undo state and federal programs promoting access to abortion to a de facto national ban. But all have one thing in common: They don’t require congressional approval.

“The conversations we’re having with the presidential candidates and their campaigns have been very clear: We expect them to act swiftly,” Kristan Hawkins, the president of Students for Life, told POLITICO. “Due to not having 60 votes in the Senate and not having a firm pro-life majority in the House, I think administrative action is where we’re going to see the most action after 2024 if President Trump or another pro-life president is elected.”

The Heritage Foundation’s 2025 Presidential Transition Project — a coalition that includes Students for Life, Susan B. Anthony Pro-Life America and other anti-abortion organizations — is drafting executive orders to roll back Biden-era policies that have expanded abortion access, such as making abortions available in some circumstances at VA hospitals. They are also collecting resumes from conservative activists interested in becoming political appointees or career civil servants and training them to use overlooked levers of agency power to curb abortion access.

The linked article details the plans, and makes it very clear that the the right of a woman to choose to terminate a pregnancy will be at the very center of the 2024 federal election.  It will also be at the center of Indiana’s election for U.S. Senate–a contest that will likely pit “anti-woke” culture warrior Jim Banks, who supports a national ban with zero  exemptions, against Marc Carmichael, who wants to codify Roe v. Wade.

In November’s election, we’ll see whether voters understand that they are choosing between “forced birth” candidates and those who will protect women’s health and equality.

I’m pretty sure they will.

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When It REALLY Matters

A few days ago, in a column about Morton Marcus’ recommendations for changes to Indiana’s retrograde legislature, I alluded to a now-forgotten effort–bipartisan, even!–to reduce waste in Indiana’s government.

The Kernan-Shepard Commission, co-chaired by former Democratic Governor Joe Kernan and Republican then-Chief Justice of Indiana’s Supreme Court, Randy Shepard, had issued a report detailing the waste involved in maintaining 1008 townships in the state. The Commission recommended eliminating or consolidating a number of those townships, which–over the years–had been divested of most of the tasks they’d originally been created to perform.

Polling conducted by the Indiana Chamber of Commerce confirmed that a large majority of voters agreed that townships should go–that they wasted tax dollars better used elsewhere.  The problem was that it was a rare individual for whom this was salient–that is, a burning, issue.

It was a burning issue, however, for Township Trustees and the members of their Advisory Boards. Eliminating townships would eliminate the livelihoods of the Trustees (and the relatives too many of them employ). It would eliminate the inflated fees paid to many Advisory Board members for attending three or four meetings a year. The trustees and board members focused like lasers on Indiana’s legislators, bringing in people to testify, hiring lobbyists and calling in political favors.

For them, the issue was critically important–i.e., salient. And so Indiana still has 1008 townships.

In the Indiana Statehouse and in Washington, this same scenario plays out over and over. Most Americans disapprove of a number of decisions our lawmakers make or refuse to make–I consistently see comments disapproving of special tax breaks for the wealthy or fossil fuel companies, and Congressional refusal to even consider Medicare for All. How many of those who complain about the tax code and/or healthcare–or anything else– have written or called their lawmakers about these matters? Spent time or money lobbying for repeal or passage? Very few. On the other hand, the people who benefit from these policies–for whom they are salient– certainly have.

People rally to defend their interests, financial or cultural, and when those with lots of resources focus those resources on derailing or passing a proposed bill, the likely result is that the bill will be derailed or passed. So nothing changes.

On those rare occasions when a legislative issue becomes highly salient to a sizable number of voters, however, it’s possible for the “little guys”–the voters– to win these contests.

And that observation brings me to this year’s elections. For the first time in a long time, several partisan issues are highly salient to large numbers of voters. The most obvious of those is abortion. For many years, when Roe v. Wade protected women’s reproductive autonomy, all the passion–all the salience–was on the (misnamed) “pro-life” side. After Dobbs, that is no longer the case. Reproductive rights are suddenly very important, very salient, to huge numbers of voters, and not all of them are female.

It probably doesn’t rival abortion as a vote motivator, but thanks to the daily drumbeat of gun violence, gun safety is another issue that has become important/salient to large numbers of citizens. Several other issue speak forcefully to specific constituencies: the unremitting GOP attacks on trans children (one-half of one percent of American children, and thus a monumental threat) has raised the salience of those issues not just in the gay community but also among its numerous allies. Republican attacks on public schools and universities are deeply resented by educators and a considerable number of parents. Etc.

These issues aren’t just important to lots of people–they have the added benefit of being clear-cut. Tax policy, energy policy, healthcare–these areas give rise to complex and often arcane arguments. A debate about who should get to make reproductive decisions for an individual woman– the government or the woman whose life will be affected–is  far clearer. Whether a man who has been convicted of spousal abuse should be entitled to buy an assault rifle is equally clear.

Call me a Pollyanna, but I am convinced that the dramatically increased salience of these and other issues–together with widespread loathing of  Donald J.Trump and his lunatic cult– will help activists motivate an unprecedented and necessary turnout in November.

I sure hope I’m right….

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Chasing Those ‘Elitists” Away

Even policies that are adopted after extensive research and thoughtful debate often generate unanticipated consequences, so it shouldn’t be a surprise that a policy based on rejection of relevant evidence and refusal to engage in debate is rapidly degrading access to medical care in Red states.

I’m referring, obviously, to the abortion bans that were enacted (or triggered) immediately after the Dobbs decision overturned Roe v. Wade.

In November, Timothy Noah reported that warnings of an eventual “brain drain” caused by those bans had the timing wrong: it wasn’t “eventual”–it was already occurring. Red state culture wars aren’t only creating medical care “deserts,” they’re driving other college-educated workers— teachers, professors, and more—out as well.

Noah began his article by telling the story of a married same-sex couple, both Ob-Gyns practicing in Oklahoma. They now live in Washington, D.C.–a move that doubled their housing costs and reduced their pay. (It turns out that Red states, which have fewer Ob-Gyns, pay doctors significantly higher wages than states where there are ample practitioners.)

Kate Arnold and Caroline Flint are two bright, energetic, professionally trained, and public-spirited women whom Washington is happy to welcome—they both quickly found jobs—even though it doesn’t particularly need them. The places that need Kate and Caroline are Oklahoma and Mississippi and Idaho and various other conservative states where similar stories are playing out daily. These two fortyish doctors have joined an out-migration of young professionals—accelerated by the culture wars of recent years and pushed to warp speed by Dobbs—that’s known as the Red State Brain Drain.

Abortion restrictions have turbocharged that brain drain, but state laws restricting “everything from academic tenure to transgender health care to the teaching of ‘divisive concepts’ about race” are making these states uncongenial to other knowledge workers.

The number of applications for OB-GYN residencies is down more than 10 percent in states that have banned abortion since Dobbs. Forty-eight teachers in Hernando County, Florida, fed up with “Don’t Say Gay” and other new laws restricting what they can teach, resigned or retired at the end of the last school year. A North Carolina law confining transgender people to bathrooms in accordance with what it said on their birth certificate was projected, before it was repealed, to cost that state $3.76 billion in business investment, including the loss of a planned global operations center for PayPal in Charlotte. A survey of college faculty in four red states (Texas, Florida, Georgia, and North Carolina) about political interference in higher education found a falloff in the number of job candidates for faculty positions, and 67 percent of the respondents said they would not recommend their state to colleagues as a place to work. Indeed, nearly one-third said they were actively considering employment elsewhere.

Here in Indiana, school corporations are experiencing dramatically higher teacher vacancies, and like other Red states, Hoosier rural residents struggle to find medical care–and not just prenatal care. It seems it isn’t just Ob-Gyn practitioners who are abandoning Red states.

Family doctors are also “reassessing” their options–and training availability.

Researchers from the Person-Centered Reproductive Health Program at the University of California San Francisco have found there is reason to be concerned about training for family physicians in ban states as well.

A study published in the November-December issue of the Annals of Family Medicine found that 29% or 201 of 693 accredited family medicine residency programs in the U.S., are in states with abortion bans or significant restrictions on abortion access. The study used publicly available data from the American Medical Association to conduct the analysis, and found 3,930 residents out of 13,541 were in states where abortion is banned or heavily restricted.

For practitioners who remain in those states, the training they are now able to receive deprives them of the skills they need to deal with miscarriages and various problems in pregnancy. Residents in those states no longer have access to comprehensive reproductive health training because they’re not experiencing it within their state context. As the lead researcher explains, “they cannot see abortions, cannot perform them, cannot learn how to care for patients after abortions in the same way they would be able to if they were working in a state where abortion was unrestricted.” As she points out, early pregnancy loss is very common, and the skill set for caring for that and first trimester abortion are very similar.

It bears repeating that the exodus of educated citizens isn’t limited to medical professionals. (MAGA Republicans are actually applauding the exit of the teachers and professors they distrust.) Ironically, the rural folks these MAGA lawmakers disproportionately represent are the ones first experiencing the “unintended consequences” of their misogyny–the absence of teachers and doctors.

It will only get worse…..

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