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  • Dobbs’s Confounding Effect on Abortion Rates

    Dobbs’s Confounding Effect on Abortion Rates

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    When the Supreme Court overturned Roe v. Wade, Diana Greene Foster made a painful prediction: She estimated that one in four women who wanted an abortion wouldn’t be able to get one. Foster, a demographer at UC San Francisco, told me that she’d based her expectation on her knowledge of how abortion rates decline when women lose insurance coverage or have to travel long distances after clinics close.

    And she was well aware of what this statistic meant. She’d spent 10 years following 1,000 women recruited from clinic waiting rooms. Some got an abortion, but others were turned away. The “turnaways” were more likely to suffer serious health consequences, live in poverty, and stay in contact with violent partners. With nearly 1 million abortions performed in America each year, Foster worried that hundreds of thousands of women would be forced to continue unwanted pregnancies. “Having a baby before they’re ready kind of knocks people off their life course,” she told me.

    But now, more than a year removed from the Dobbs v. Jackson Women’s Health Organization decision, Foster has revised her estimate. After seeing early reports of women traveling across state lines and ordering pills online, she now estimates that about 5 percent of women who want an abortion cannot get one. Indeed, two recent reports show that although Dobbs upended abortion access in America, many women have nevertheless found ways to end their pregnancy. A study by the Guttmacher Institute, a research group that supports abortion rights, signals that national abortion rates have not meaningfully fallen since 2020. Instead, they seem to have gone up a bit. A report released this week by the Society of Family Planning, another pro-abortion-rights group, shows that an increase in abortions in states that allow the procedure more than offset the post-Dobbs drop-off in states that closed down clinics.

    Some of this increase may be a result of trends that predate Dobbs: Abortion rates in the U.S. have been going up since 2017. But the reports suggest that the increase may also be due to travel by women who live in red states and the expanded access to abortion that many blue states enacted after the ruling. Still, it is not yet clear exactly how much each of these factors is contributing to the observed increase—and how many women who want an abortion are still unable to get one.

    Alison Norris, a co-chair of the Society of Family Planning study, told me that she fears that the public will “become complacent” if they see the likely increase in abortion rates and believe that everyone has access. “Feeling like the problem isn’t really that big of a deal because the numbers seem to have returned to what they were pre-Dobbs is a misunderstanding of the data,” she said.


    It seems illogical that more than a dozen states would ban abortion and national rates would hardly change. But even as red states have choked off access, blue states have widened it. And the data show that women have flooded the remaining clinics and ordered abortion pills from pharmacies that ship across the country. More than half of all abortions are done using medication, a pattern that began even before the Dobbs decision.

    “It just doesn’t work to make abortion illegal,” Linda Prine, a doctor at Mount Sinai Hospital, told me. “There may be some people who are having babies that they didn’t want to have, but when you shift resources all over the place, and all kinds of other avenues open up, there’s also people who are getting abortions that might not have gotten them otherwise.”

    With mail-order abortion pills, “it’s this weird moment where abortion might, ironically, be more available than it’s ever been,” Rachel Rebouché, an expert in abortion law and the dean of the Temple University Beasley School of Law, told me.

    The Guttmacher Institute sampled abortion clinics to estimate the change in abortion counts between the first halves of 2020 and 2023. Areas surrounding states with post-Roe bans saw their abortion numbers surge over that period of time. In Colorado, which is near South Dakota, a state with a ban, abortions increased by about 89 percent, compared with an 8 percent rise in the prior three-year period. New Mexico saw abortions climb by 220 percent. (For comparison, before Dobbs, the state recorded a 27 percent hike from 2017 to 2020.) Even states in solidly blue regions saw their abortion rates grow over the three-year interval from 2020 to 2023: Guttmacher estimates that California’s abortion clinics provided 16 percent more abortions, and New York’s about 18 percent more.

    Some shifts predated the court’s intervention. After a decades-long decline, abortions began ticking upward around 2017. In 2020, they increased by 8 percent compared with 2017. The researchers I spoke with for this story told me that they couldn’t point to a decisive cause for the shift that started six years ago; they suggested rising child-care costs and Trump-era cuts to Medicaid coverage as possible factors. But the rise in abortion rates reflects a broader change: Women seem to want fewer children than they used to. Caitlin Myers, a professor at Middlebury College, told me that abortion rates might have increased even more if the Court hadn’t reversed Roe. “It looks like more people just want abortions than did a few years ago,” she said. “What we don’t know is, would they have gone up even more if there weren’t people trapped in Texas or Louisiana?”

    One of the most significant factors in maintaining post-Roe abortion access dates from the latter half of 2021. As the coronavirus pandemic clobbered the health-care system, the FDA suspended its requirement that women pick up abortion medications in person. A few months later, it made the switch permanent. The timing was opportune: People became accustomed to receiving all of their medical care through virtual appointments at the same time that they could get abortion pills delivered to their doorstep, Rebouché told me. People no longer have to travel to a clinic and cross anti-abortion picket lines. But access to mifepristone, one of the most commonly used drugs for medication abortions, is under threat. After an anti-abortion group challenged the FDA’s approval of the drug, a federal court instated regulations that would require women to visit a doctor three times to get the pills, making access much more difficult. The Supreme Court is weighing whether to hear an appeal, and has frozen the 2021 rules in place while it decides.

    But paradoxically, several of the factors that may have contributed to the rise in abortion rates seem to have sprung directly from the Dobbs decision. In the year since the ruling, six blue states have enacted laws that allow practitioners to ship abortion pills anywhere, even to deep-red Texas. Although these laws haven’t yet been litigated to test whether they’re truly impenetrable, doctors have relied on them to mail medication across the country. Aid Access, an online service that operates outside the formal health-care system, receives requests for about 6,500 abortion pills a month. (The pills cost $150, but Aid Access sends them for free to people who can’t pay.) Demand for Aid Access pills in states that ban or restrict medication abortion has mushroomed since the Dobbs decision, rising from an average of about 82 requests per day before Dobbs to 214 after. The Guttmacher report doesn’t count abortions that take place in this legally fuzzy space, suggesting that actual abortion figures could be higher.

    As the Supreme Court revoked the constitutional right to an abortion and turned the issue back to the states, it also hardened the resolve of abortion-rights supporters. In the five months after Roe fell, the National Network of Abortion Funds received four times the money from donations than it got in all of 2020. People often donate as states encroach on abortion rights. In many cases, they bankrolled people’s travel out of ban states. Community networks also gained experience in shuttling people out of state to get abortions. “There’s definitely been innovation in the face of abortion bans,” Abigail Aiken, who documents abortions that occur outside of the formal health-care system, told me.

    Some researchers believe that the Dobbs decision has actually convinced more women to get abortions. Abortion-rights advocacy groups have erected highway billboards that promise Abortion is ok. Public opinion has tilted in favor of abortion rights. Ushma Upadhyay, a professor at UC San Francisco, told me that California’s rising abortion rates cannot all be due to people traveling from states that ban abortion. “It’s also got to be an increase among Californians,” she said. “It’s just a lot of attention, destigmatization, and funding that has been made available. Even before Dobbs, there was a lot of unmet need for abortion in this country.”

    Abortion used to be a topic that was “talked about in the shadows,” Greer Donley, an expert in abortion law and a professor at the University of Pittsburgh, told me. “Dobbs kind of blew that up.” Still, she believes that it’s unlikely that people are getting significantly more abortions simply because of changes within blue states. Just as obstacles don’t seem to have stopped people from seeking abortions, efforts that moderately expand access are unlikely to lead people to get an abortion, she said.

    The people I spoke with emphasized that even though overall abortion rates might be going up, not everyone who wants the procedure can get it. People who don’t speak English or Spanish, who don’t have internet access, or who are in jail still have trouble getting abortions. “What I foresee is a bunch of Black women being stuck pregnant who didn’t want to be pregnant, in a state where it’s incredibly dangerous to be Black and pregnant,” Laurie Bertram Roberts, a founder of the Mississippi Reproductive Freedom Fund, told me.

    Bertram Roberts’s fund used to provide travel stipends of up to $250. Now women need three times that. Most people travel from Mississippi to a clinic in Carbondale, Illinois. The trip takes two days—48 hours that women must take off work and find child care for. “If you are in the middle of Texas, and you have to travel to Illinois, even if funds covered all the costs, to say that abortion is more accessible for that person seems callous and wrong,” Donley told me.

    Many women spend weeks waiting for an abortion. “It is excruciating to be carrying a pregnancy that one knows they’re planning to end,” Upadhyay said. And although studies show that abortion pills are safe, women who take them can bleed for up to three weeks, and they may worry that they’ll be prosecuted if they seek help at a hospital. Only two states—Nevada and South Carolina—explicitly criminalize women who give themselves an abortion (and few women have been charged under the laws), but the legislation contributes to a climate of fear.

    More than a year out from the Dobbs decision, the grainy picture of abortion access is coming into focus. With the benefit of distance, the story seems not to be solely one of diminished access, widespread surveillance, and forced births, as the ruling’s opponents had warned. For most Americans, abortion might be more accessible than it’s ever been. But for another, more vulnerable group, abortion is a far-off privilege. “If I lived in my birth state—I was born in Minnesota—my work would be one hundred times easier,” Bertram Roberts told me, later adding, “I think about that a lot, about how the two states that bookend my life are so different.”

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    Rose Horowitch

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  • The New Pro-life Movement Has a Plan to End Abortion

    The New Pro-life Movement Has a Plan to End Abortion

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    The unpleasant reality facing the anti-abortion movement is that most Americans don’t actually want to ban abortion.

    This explains why the pro-life summer of triumph, after the U.S. Supreme Court overturned Roe v. Wade, led to a season of such demoralizing political outcomes. Voters in Montana, Kansas, and Kentucky in November rejected ballot measures to make abortion illegal; just last month, in Wisconsin, voters elected an abortion-rights supporter to the state supreme court.

    Yet the movement’s activists don’t seem to care. Thirteen states automatically banned most abortions with trigger laws designed to go into effect when Roe fell; a Texas judge this month stayed the FDA approval of the abortion pill mifepristone, setting in motion what is sure to be a drawn-out legal battle; and some lawmakers are pursuing restrictions on traveling out of state for the procedure—what they call “abortion trafficking.”

    Even as the anti-abortion movement lacks a Next Big Objective, a new generation of anti-abortion leaders is ascendant—one that is arguably bolder and more uncompromising than its predecessors. This cohort, still high on the fumes of last summer’s victory, is determined to construct its ideal post-Roe America. And it’s forging ahead—come hell, high water, or public disgust.

    The groups this new generation leads “are not afraid to lose short term if they think the long-term gain will be eliminating abortion from the country,” Rachel Rebouché, a family-law professor at Temple University, told me.

    One such leader is Kristan Hawkins, the president of the anti-abortion group Students for Life. After Dobbs v. Jackson Women’s Health Organization, “some organizations had to go through this period where they had to reflect and figure out what they were going to do,” she told me. “But nothing changed in our organization—we’d already had that conversation years ago.” Students for Life participants have been calling themselves “the post-Roe generation” since 2019; that’s the year they launched a political-action committee to beef up their state-level presence and begin drafting legislation for a post-Roe society. In 2021, the organization started the Campaign for Abortion-Free Cities to promote what they call “alternatives to abortion” and neighborhood resources for pregnant women.

    “What the anti-abortion movement is, who’s leading it, and what it stands for are still being contested,” Mary Ziegler, a UC Davis law professor who has written about abortion for The Atlantic, told me. But organizations such as Students for Life will, in all likelihood, “be the ones running the movement going forward.” To understand the goals of people like Hawkins is, in other words, to peer into the future of America’s anti-abortion project.

    The thing about Hawkins is that she’s an optimist—and not a cautious one. So when the draft opinion suggesting that the Supreme Court was about to overrule Roe v. Wade leaked last May, she wasn’t particularly surprised, she told me—she felt vindicated. Other pro-lifers had refused “to let themselves even dare think that a post-Roe America was coming,” Hawkins said. “Of course it was.” She’d always assumed it would happen in her lifetime.

    As soon as the draft opinion came out, anti-abortion leaders began to consider their response. Some were worried that taking any kind of victory lap would be inappropriate—that it might scare the justices into moderating or reversing their ultimate decision. Hawkins didn’t care about any of that. “Why would we be guarded? It was important, good news!” she told me. “Folks across the country needed to see this generation celebrating.” Students for Life was one of the first anti-abortion organizations to release a statement praising the draft opinion—while being careful to condemn the leak itself.

    Hawkins, who is 37, styles herself as a straight shooter. She doesn’t dress up arguments with religious rhetoric—despite being Catholic herself—and she can be an effective, if sometimes abrasive, debater. Which makes sense, because she came to the pro-life movement through electoral politics. Hawkins knocked on doors for local and state Republican candidates; in college, she worked for the Republican National Committee to reelect President George W. Bush—and, for a year, she worked in his administration. Then, when Students for Life came looking for a new president in 2006, she eagerly accepted.

    Hawkins “saw the politics in this in ways a lot of people don’t,” Ziegler told me—and she brought that acumen to the movement. She knew how to lead a grassroots campaign, and how a state legislature functions. Then just 20, she was younger than other pro-life leaders, so she had a better idea of how to engage young people. Hawkins is trying, Ziegler said, “to grow the movement in a way that no one else really ever did.”

    The organization’s 14,000 participants campaign for state-level anti-abortion candidates and legislation in their local legislatures. Hawkins, who oversees a staff of 100 paid employees, spends her days traveling to meet with chapter leaders, organizing demonstrations, delivering speeches, and generally doing her best, as she put it to me, “to stir up discussion.” In March, during a visit to Virginia Commonwealth University, protesters shouted over Hawkins when she tried to speak. Demonstrators called her a Nazi and a fascist. Eventually, campus security shut down the event, and police arrested two protesters (who weren’t actually VCU students). Hawkins, who livestreamed the drama, later went on Fox News to offer a full account.

    The Students for Life YouTube channel has a 22-minute highlight reel called “Greatest Pro-Choice Takedowns,” in which Hawkins responds to questions from young, often-emotional abortion-rights advocates. As you might expect, the videos feel mean. In each clip showing Hawkins facing off against a different student with a shaky voice, she makes them look silly and ill-informed, a relatively easy thing to do when your opponent is not being paid to perfect her talking points. But these exchanges don’t seem intended to change minds; they’re meant instead to humiliate—and thereby reveal the purported weaknesses in abortion-rights arguments.

    Doggedness and moral conviction have always characterized the anti-abortion movement. Activists have sustained their energy for 50 years “by believing that success was possible, even in the absence of clear victories,” Daniel K. Williams, a history professor at the University of West Georgia, told me. Dobbs gave this new generation a taste of victory. Activists like Hawkins are bolder now. Without Roe, they reason, anything is possible.

    Students for Life, in particular, is “more abolitionist than prior generations of similar groups,” Rebouché told me. In contrast to other organizations that have pursued incremental progress, the group adopts strategies that are “totalizing and absolute.” Throwing out the rule book, they operate as though they’ve got nothing to lose.

    “I admire their persistence; I admire their sacrifices,” Lila Rose, the president of the anti-abortion nonprofit Live Action, says of previous generations of anti-abortion activists. “But we’re playing to win. This isn’t just some nonprofit job.” Rose, who is 34, achieved early prominence in the movement back in 2006 for partnering with the conservative activist James O’Keefe to film undercover exposés at abortion clinics. Live Action doesn’t have the kind of nationwide membership that Students for Life has, but its email list contains more than 1 million contacts, Rose told me, and its social-media following runs into the millions.

    Students for Life and Live Action frame their anti-abortion efforts as not just saving babies but empowering women—enabling them to avoid the depression and regret the organizations say can be caused by having an abortion. These aren’t new ideas in themselves, but they’ve been repackaged in a way that mimics the language of a modern social-justice movement appealing to young people. “They’re using phrases like born privilege,” Jennifer Holland, a gender-and-sexuality professor at the University of Oklahoma, told me. “Language that’s hip—in the culture—but that still leads back to this one point of view that maybe you thought was old or conservative.”

    Historically, there’s been “a lack of vision” in the movement, Rose said. It was great, she allowed, that the National Right to Life Committee fought so hard in the 2000s to ban what they called “partial-birth abortion” (using a pro-life term not recognized by medical professionals). But, to Rose, pill-induced abortion is just as “anti-human and anti-woman”; a 15-week abortion limit is nothing to celebrate. “I don’t think that we do ourselves any favors as a movement by, like, walking over to the opponent’s side of the field and saying that that’s a victory.”

    Hawkins’s master plan to completely eradicate abortion in America begins with passing as many state controls as possible. She calculates that 26 state legislatures contain enough anti-abortion Republicans to be amenable to a strict ban of some sort, and her organization is pushing an “early abortion” model, which means that it drafts and supports legislation restricting abortion either entirely or after six weeks. Hawkins claims credit for pressuring reluctant Republican state leaders in Florida to take up the six-week abortion ban that Governor Ron DeSantis signed late Friday night. Gone are the days of small-ball second-trimester limits, Hawkins says, because most abortions happen before then. “We’re not going to spend a significant amount of resources to pass legislation that’s going to save only 6 percent of children.”

    Right now the centerpiece of Students for Life’s campaigning is the effort to ban medication abortion—what Hawkins and her allies call “chemical abortion.” For two years, the group lobbied Republicans in Wyoming to prohibit mifepristone from being sold in pharmacies; the governor signed that measure into law last month. Now it’s setting its sights on the pharmacy chains Walgreens, Rite Aid, and CVS—which Hawkins singles out as “the nation’s largest abortion vendor.”

    On campuses, Students for Life leaders are trying to mobilize young people who might otherwise be ambivalent about the abortion pill; Hawkins says they’ve had luck with the message that mifepristone, when flushed, enters the water system and threatens the health of humans and wildlife. “Young people are aghast to find out that something they care deeply about—the environment—is now conflicting with their views on abortion,” Hawkins told me. Never mind that there is no evidence for these claims. According to Tracey Woodruff, the director of the Program on Reproductive Health and the Environment at UC San Francisco, the amount of mifepristone found in drinking water is so small that it might not even be measurable.

    “Of all the things we have to worry about with our drinking water,” she told me, “this is not one of them.” Students for Life’s messaging on this, she added, is “a perverse use of science.” The organization is nonetheless backing new laws in several states that would require women prescribed abortion pills to use medical-waste “catch kits” and return them to a health-care provider.

    Hawkins is realistic about the fact that her movement’s progress has a ceiling. Some states, especially the liberal strongholds of Illinois and New York, are never going to go for the kinds of laws that she’s pushing for. This is when, she says, her organization will shift its emphasis to the federal government—pushing for a constitutional amendment that would recognize fetal personhood, or for a ruling from the Supreme Court to affirm that the Fourteenth Amendment already does.

    Abortion should become “both illegal and unthinkable” in America, Hawkins said. But even when the anti-abortion movement can no longer change hearts and minds, it plans to find a way to change the law anyway. She favors using the law as a tool because, in her view, people tend to derive morality from legality: “Nothing’s going to change their minds until the law changes their minds.” Hawkins envisions a future, 20 years from now, in which university students will discover with abject horror that other states allow the murder of babies in the womb—culturally, she believes, “that’s gonna be massive.” The idea that young people in college would be shocked to learn that different states have different laws on abortion may seem implausible now, but Hawkins is articulating her larger goal—of making abortion unconscionable.

    Yet American culture seems to be moving in the opposite direction. The Dobbs ruling, though exciting for anti-abortion activists, was so enraging for abortion-rights supporters that, in some places, they responded by enshrining the right to abortion into state law. These and other political losses suggest that the pro-life movement is already overreaching—and generating a backlash. “It’s breathtaking to see people so motivated and so well funded to push an agenda that is so incredibly unpopular,” Jamie Manson, the president of the abortion-rights organization Catholics for Choice, told me. The months since Dobbs have exposed a fundamental tension between the outcome that abortion-rights opponents want and the one democracy supports.

    As it becomes clear that abortion is not always an election winner—that, on occasion, it is even a predictable loser—some Republican legislators have broken from the movement in order to support rape and incest exceptions; others have simply avoided the issue. “Most of the members of my conference prefer that this be dealt with at the state level,” Senate Minority Leader Mitch McConnell told reporters last fall. Hawkins and Rose are happy to criticize those Republicans they see as wishy-washy on abortion. When former President Donald Trump blamed Republicans’ 2022 midterm losses on the extremism of the anti-abortion movement, Rose called it “sniveling cowardice.” But Hawkins and Rose may be underestimating how much more challenging and complex the post-Roe environment is.

    “This is much more expensive politics around abortion,” Holland said. “It used to be cheap: You could promise all sorts of things” without penalty, because with Roe intact, such radical measures would never pass.

    Does this give Hawkins any pause—the idea that her movement’s aims are so antithetical to what most Americans want? Hawkins said that public opinion doesn’t concern her. The fact that most Americans support abortion access doesn’t make them morally correct, she argued, and neither does it make her own efforts undemocratic. “Do I look upon abolitionists in pre–Civil War America as undemocratic for trying to change people’s minds and prevent the proliferation of owning another human being for your own financial gain? No,” she said.

    Hawkins has spent a lot of time thinking about this question. Consider the civil-rights era, she went on. “We had states that stubbornly refused to integrate.” In the end, federal legislation forced them to comply. The implication is that the same sort of national ban should eventually happen for abortion.

    Given this goal, we can expect that abortion will be an issue in almost every single election, in almost every single state, for the next many cycles. In some parts of the country, the anti-abortion-rights movement will fail. In others, it will skate along with utter success. Lawmakers will tighten laws, ban pills, and restrict travel. They may even feel audacious enough to venture into the broader realm of reproductive tools—outlawing or restricting IUDs, the morning-after pill, and even in vitro fertilization.

    Post-Roe, we can expect these hungry, mobilized activists to seek new conquests. But even as they do, pro-life leaders will have to wonder whether they are guiding their movement toward righteous victory—or humiliating defeat.

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    Elaine Godfrey

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