Dobbs

The stakes in the upcoming presidential race have never been higher for women and reproductive freedom and justice.

A report recently issued by 16 United States Senators, entitled Two Years Post-Dobbs: The Nationwide Impacts of Abortion Bans, sets forth the challenges and issues facing American women post-Dobbs. The report concluded that two years after Dobbs women are denied emergency care and life-saving treatments, hardship has been placed on women and families traveling long distances for care and the healthcare system is being strained. More than 23 million American women of childbearing age live in states with abortion bans. There is an unprecedented flow of pregnant patients across state borders risking at times their lives and financial security. It is stressing America’s reproductive healthcare system, like never before, including by impacting care in states that maintain access to abortion. It is driving healthcare providers out of states with abortion bans, creating a healthcare gap that would be difficult to fill since some medical residents are avoiding these states.

Women are being denied care in medical emergencies and doctors have to watch patients go into sepsis and watch their vital signs deteriorate because they are afraid the patient is not sick enough to qualify for a medical exemption, should there be one. For example, there were just 34 legal abortions recorded in Texas during a six-month period in 2023, but researchers estimate the number of women needing abortions in Texas is at least 400 a year for emergencies and 2,400 per year for physical health risks.

Miscarriage care and other emergency care for ectopic pregnancies for instance is the same procedure as an abortion, and this care is routinely being denied in states with abortion bans. Women with fetal anomalies are forced to seek care in states that permit abortion, as are rape and incest survivors.

Just some examples of the impact in states with legal abortion: there are three-week wait times at Kansas and Illinois clinics, wait time at clinics in Ohio forces patients to other states for care, and Wisconsin patients can get quicker care traveling to other states. The expense and difficulties of travel operate as a special hardship on low income patients.

When OB/GYN’s leave abortion ban states they lead to a lack of doctors trained to provide obstetric and gynecological care, including deliveries. A study has found that in Texas the infant death rate increased along the number of babies who died of birth defects. Between 2021 and 2022 there was a 12.9% increase in the deaths of children before their first birthday. Another study found that Texas had approximately 10,000 additional births between April and December 2022 which proportionally included pregnancies with increased risk of infant mortality.

In response to abortion bans, women are switching to long-acting methods of birth control, including IUDs and implants. Anecdotally, women are stocking up on the abortion pill just in case.

In the voting booth, women in at least six states, and probably more, will be able to vote on referenda to legalize abortion, including Florida and Colorado. No abortion rights referendum has lost since 2022.

Interestingly, when South Carolina ‘s legislature considered an abortion ban in 2023, three Republican female Senators bucked their party and voted against it. The party turned around and primaried them out of office.

In Poland last week, three members of the ruling coalition voted against a bill to slightly liberalize the strict Polish abortion ban. The bill lost by three votes. The Prime Minister retaliated and stripped two of the three members of their party coalition membership and stripped the third of his leadership position. Poland is hopefully moving towards decriminalizing abortion.

South Carolina doesn’t permit referenda. Poland does. Perhaps they should have a referendum.

Click to access 2024_dobbs_anniversary_national_report_final.pdf

Governments are at it again trying to increase birth rates. Recent stories out of Russia and China reveal that these government are doubling down on their policies to incentivize or force childbearing.

Xi Jinping, the Chinese leader (the Chinese leadership is all male – not a single woman on the 24 member Politburo) – at a meeting of the All-China Women’s Federation in November stated that “we should actively foster a new type of marriage and childbearing culture.” It is the role of party officials to influence young people’s views on “love and marriage, fertility and family.” China has over the past two generations gone beyond “influence” and had mandated family size through its One Child Policy. Are we to see a two or three child policy mandated? Whatever might happen, gender equality is not part of this culture. Currently some Chinese provinces offer cash bonuses for couples having two or three children.

Russian authorities are cracking down on abortion access, long a means of birth control in that nation, by cracking down on private clinics offering abortion. Russia reported about 500,000 abortions in 2022. The corresponding figure in the US for 2021 is over 600,000 (the CDC and Guttmacher differ in their estimates with Guttmacher reporting over 900,000). The US population is about 2.4 times larger than Russia, indicating a greater reliance on abortion in that country. Restricting legal abortion access puts women at risk when they resort to illegal ones – making them unable to have future children – a consequence it would seem the authorities would want to avoid.

At the same time, Russia is offering speedy citizenship to foreign fighters who immigrate to fight in the Ukraine, indicating the severity of their population decline and the attitude of the Russian males to being sent to certain death in a losing battle. It seems the authorities are desperate to preserve the Russian male to further and father their race.

Countries around the world have tried and mostly failed to influence birth rates with childcare incentives, cash bonuses, paid leave etc. These policies, at most, influence timing of births, not the number. Still, many couples say they are having fewer children than they want. Many social and economic factor come into play here, along with some basic biology.

In the US, the support for legal abortion has risen since the Dobbs decision, with 55% saying they support abortion for any reason. This is about the percent that supported abortion rights in the recent Ohio voting. This is a healthy response to the conservative attack on women’s rights.

One wonders also the connection to a recent study in the US indicating that millennial women are losing ground in health and safety, including rates of maternal mortality, suicide and homicide. But Millennial women have also seen improvement in education and earnings, with 44% completing a bachelor’s degree, up from 28% of Gen X women. Women now earn 89.7 cents per dollar as men, compared to 82.4 cents for Gen X women. No surprise that women on their own, making it on their own, with increased risk of maternal mortality and violence in their communities, support unfettered access to abortion, and that their families do too.

The US birthrate today has fallen to 1.6 (the white rate 1.6 and the African American is slightly higher at 1.67). If there is anything to be done about this (and there is scant evidence anything can or should be done), then maternal and child safety should be at the top of the list for policy makers, including the racial disparities in these statistics and including providing family planning and safe abortion services so that children are born when the parents deem it best and those giving birth aren’t put at increased risk.

https://www.france24.com/en/live-news/20231215-give-birth-to-more-soldiers-hardline-russia-turns-on-abortions

https://www.bbc.com/news/world-europe-67495969

https://www.aljazeera.com/features/2023/11/28/russia-limits-womens-access-to-abortion-citing-demographic-changes

https://www.wsj.com/articles/china-population-births-decline-womens-rights-5af9937b

https://www.economist.com/china/2023/11/09/china-wants-women-to-stay-home-and-bear-children

https://www.wsj.com/politics/policy/support-for-abortion-access-is-near-record-wsj-norc-poll-finds-6021c712