Photo: Frederic J. Brown/AFP/Getty Images
If the right wanted to bring more babies into the world by banning abortion, the plan is backfiring.
In fact, abortions have increased since June 2022, when the Supreme Court overturned Roe v. Wade. Every state without a ban — especially those adjacent to red states — saw a rise in abortions from 2020 through 2023.
But even women facing severe restrictions have managed to end their pregnancies. In 2023, abortion in the U.S. reached its highest level in over a decade, according to the Guttmacher Institute — and that’s counting only terminations recorded by the formal health care system.
While surgical abortions are harder to get, the word is out about self-managed abortions using pills. Online services like PlanC, Aid Access, and Abuzz disseminate the information; shield laws protect blue-state providers from red-state prosecution if they prescribe pills via telehealth and mail them to patients living under the bans. Abortion funds are in overdrive helping abortion-seekers with travel, child care, and medical costs.
The right is actively seeking to ban every one of these tools: telehealth prescription, self-management, out-of-state travel, and funds that “aid and abet” abortion-seekers. At the same time, a U.S. feminist underground with links to overseas suppliers is outrunning the posse, sending out pills without professional intervention and at low cost, even gratis.
Ironically, now that abortion is gone or all but gone in 21 states, feminists have realized the dream of over half-century of activism: free abortion on demand without apology.
But abortion isn’t the only thing impeding births in the U.S. Since Dobbs v. Jackson Women’s Health Organization, the ruling that nullified Roe, a growing number of people still young enough to have children are getting sterilized. Tubal ligations and vasectomies among adults ages 18 to 30 were creeping up before the ruling. But following it, “we observed an abrupt increase,” report the authors of a research letter published last month in JAMA Health Forum.
The researchers couldn’t break the data out by state or race. But unsurprisingly, the trend is gendered. As with birth control, unwanted pregnancy, and parenthood, the greater burden of “permanent contraception” is falling on women: “The increase in procedures for female patients was double that for male patients,” write the authors, three Pennsylvania public health policy experts.
The U.S. could see more people choosing voluntary sterilization in the future. Birth control is still legal and constitutionally protected — and 9 in 10 American women have used it. But the religious right is chipping away at that too.
In 2014, in Burwell v. Hobby Lobby Stores, Inc., a split Supreme Court ruled that certain private companies can cite religious objections to get out of covering the cost of contraception for their employees under the Affordable Care Act. A few days later, the same slim majority decided that Wheaton College, a Christian school already exempt from using its insurance policy to pay for birth control, was unduly burdened by having to fill out a form so that a third party could cover the cost.
A 2020 lawsuit by a Christian father challenging his daughter’s right to get birth control without parental consent is a piece of the anti-contraception long game, modeled on the strategy that slowly killed abortion rights. Just three years after Roe, in 1976, a Missouri requirement that minors get written parental consent for abortion was the first restriction upheld by the Supreme Court. And Donald Trump, who likes to take credit for delivering Dobbs to the right, hinted that he’d be OK with state crackdowns on contraception. (Then he walked it back. As usual with Trump, who knows what’s true.)
Emotionally, early sterilization is not simple. The right has long claimed that women who terminate pregnancies suffer “post-abortion syndrome,” a lifelong residue of depression and regret. PAS does not exist. In fact, the most common post-abortion emotion is relief. But post-sterilization regret is real, and a 2005 study found that the younger a woman is when she has her tubes tied, the more likely she is to wish she hadn’t, request a reversal, or seek in vitro fertilization to have a baby.
The authors of the post-Dobbs sterilization study surmise that some of these procedures were contemplated before Roe was overturned, but felt suddenly urgent when the bans came down. If oral contraceptives, IUDs, or morning-after pills (all of which the antis have incorrectly called abortifacients) become unavailable, permanent contraception will be the last reliable option.
If sterilization with regrets can be sad, some other effects of the bans are tragic.
Almost immediately after the June 2022 ruling, stories started emerging of pregnant people forced to drive hours out of state while miscarrying, carrying dead fetuses, feverish and in pain; of women going into sepsis or losing their fertility — all because doctors feared breaking the law by practicing good medicine. While emergency rooms around the country turn away pregnant patients in distress — one Oregon OB-GYN called the situation “absolutely shocking,” “appalling,” and “inconceivable” —providers and advocates are holding their breaths for the first preventable death due to compulsory medical malpractice.
But, new research shows, the deaths are already happening — caused not inadvertently by doctors but intentionally by pregnant people’s partners or pregnant people themselves.
For women in abusive relationships, to get pregnant is to risk your life. The narrative is well documented: A violent intimate partner, sensing the impending loss of control over his wife’s or girlfriend’s body and the arrival of a competitor for her time and attention — even if he wanted the baby at first — grows increasingly possessive, volatile, and assaultive. His menacing behavior erodes not just her freedom but also her will to take care of herself. She grows depressed, skips prenatal clinic visits, eats poorly and smokes, drinks, and uses drugs more, all to the detriment of her own and her fetus’s health.
Sometimes the partner’s violence turns murderous. “Women who are pregnant or recently gave birth are significantly more likely to be killed by an intimate partner” than women of the same age who are neither pregnant nor postpartum, write the authors of a new study from Tulane University.
The harder it is to end a pregnancy, the more danger women are in. Looking at states with multiple abortion restrictions alongside their rates of intimate partner homicide committed against women and girls ages 10 to 44, the researchers found a 3.4 percent rise in the state homicide rate with each restriction enforced between 2014 and 2020. The authors acknowledge the limits of their methodology but extrapolate that nearly a quarter of those murders were associated with the statutes.
Some abusive men prefer to exert control by keeping their partners pregnant, and Republican legislators are helping them with legal threats and reprisals. In at least 15 states, the father of an aborted fetus can sue for the “wrongful death” of his child.
Ask the staff at any abortion clinic or hotline: These laws are causing terror and desperation among abortion-seekers in ban states, and that desperation boils hotter with each passing day. Ohio providers have issued a report showing how required 24-hour waiting periods between an initial visit and an abortion stretch to an average of over a week, complicating the procedure and in some cases pushing it past the legal limit.
The more desperate the pregnant person’s situation — no money, abusive partner, insecure housing, addiction or other psychological ills — the more desperate is the “solution,” until the solution may become final. An analysis by researchers at several Philadelphia medical institutions and published in JAMA Psychiatry in 2022 compared suicide data from 1974, just after Roe, through 2016, by which time restrictions in some states had created what were, for some, insurmountable obstacles to ending a pregnancy. During the period, suicide rates increased among reproductive-age women but not women of post-reproductive age. Each new statute “was associated with a 5.81 percent higher annual rate of suicide than in pre-enforcement years,” the authors wrote.
Since Dobbs, the antis have been flummoxed by the surge — and then the endurance — of support for legal abortion across party lines, religion, geography, race, and age.
In response, they’ve flogged old, conservative arguments (“Mothers need husbands, not abortion”) or, rarely, progressive ones. The anti-abortion Charlotte Lozier Institute, for instance, supports a strong federal social safety net. Some far-right Christian evangelicals are calling for eugenic programs of white hyper-reproduction — which Andrew Torba, the Christian nationalist CEO of Gab, calls “babymaxxing” — to combat the abortion “holocaust.” Where honey doesn’t work, they pour on the boiling oil, enacting more intrusive surveillance and harsher penalties.
But try as they might, the anti-abortion movement is unable to force people to want babies they don’t want. The World Health Organization has repeatedly shown that prohibition does not reduce rates of abortion. Where it is illegal, pregnant patients turn to untrained and criminal providers, and as many as 13 percent of them don’t survive.
A person will do everything in their power to end an unwanted or untenable pregnancy. They will grasp at social equality and bodily freedom — even if they have to die trying.
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