The Economist April 16th 2022 UnitedStates 27Likelihood* of banning abortion following an
overturning of Roe v WadeStates of termination*Basedonstate-levelregulationsandotherindicators at Oct 2021
Source:GuttmacherInstituteME
VT NH
WA ID MT ND IL MI NY MA
OR NV WY SD IAMN
OH PA CT RI
CA UT CO MO KY WV MD DE
NM KS TN NC SC DC
AL GA
HI FLAKIN
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TXARNJWIAZ
LA MSCertain Likely Not likelyabortion refugees from nearby states.
Planned Parenthood has also built clinics
on the Illinois borders of Indiana and Wis
consin, two of five neighbouring states
that are likely to ban abortion if Roegoes.
In January the Fairview Heights clinic
and an operation nearby, the Hope Clinic,
opened a regional logistics centre to deal
with the expected surge in nonclinical
workload: arranging transport, hotels and
funding for the many more women who
were expected to arrive. Colleen McNicho
las, Planned Parenthood’s chief medical of
ficer in the region, says staff are preparing
to put in longer days and work seven days a
week instead of six.
Where pregnant women go, antiabor
tionists follow. Local armies have moved
their campaigns from states like Missouri,
where the battle has been largely won, into
Illinois. As patients drive into the Fairview
Heights clinic they pass a large gallows
from which the image of a fetus is hanging.
Parked trucks, operated by an antiabor
tion group, try to entice pregnant women
into conversation by offering “free on
board” ultrasounds and pregnancy testing;
posters advertise “abortion pill reversal”.
At Planned Parenthood’s clinic in Missou
ri, by contrast, it is quiet: a couple of softly
spoken protesters wait with leaflets en
couraging women to have their babies; the
only ones they saw, one recent morning,
were there for contraception.
Only in America
Elsewhere, smaller abortion providers are
weighing their options. Tammi Kromenak
er, director of the Red River abortion clinic
in Fargo, North Dakota, the only one in that
state, says she is often asked why she
doesn’t move a few miles east into Minne
sota, where abortion will remain legal if
Roeis overturned. She is torn, she says, be
tween practicality and principle (“our
community needs us to be here”), adding
that in no other field of health care would
providers face such uncertainty.
This points to another example of
American exceptionalism. In other coun
tries abortion tends to be embedded in
broader healthcare systems. In the United
States it is practised almost exclusively in
standalone clinics, largely so that provid
ers can avoid the costly billing systems
found in hospitals. Yet this has made the
job of antiabortion campaigners easier, al
lowing them to find the right women to
shout at and enabling them to portray
abortion as being separate and different.
Partly as a result, clinics have become
powerful defenders of abortion rights, in
cluding in the courts. When these places
close, says Carole Joffe, a professor at the
Bixby Centre for Global Reproductive
Health at the University of California, San
Francisco (uscf), “huge political clout and
grassroots support for the rights of women
is lost”. Several clinics in Texas, she says,
are close to shuttering.
As great as the postRoe upheaval is
likely to be, it would be greater still but for
three mitigating factors. First, it is not just
the likes of Planned Parenthood that have
been making preparations. A handful of
states have scrapped all regulations on
when or for what reason a woman may ter
minate a pregnancy. In California, law
makers are expected to consider a plan to
make the state a “sanctuary” for anyone
seeking an abortion.
Second, the abortion rate today is half
what it was in 1980. That is mostly down to
improved access to more effective meth
ods of contraception. It may also be linked
to better sex education, especially in states
that used to teach only abstinence (al
though in Jackson, Mississippi, Shannon
Brewer, the director of the state’s last abor
tion clinic, which is at the heart of the case
the Supreme Court will soon rule on, raises
her eyebrows exaggeratedly when asked
whether many young patients lack basic
knowledge about reproduction).
A third element is the increasing use of
abortion medication, which has trans
formed abortion care globally (because
tracking it is hard it may also make Ameri
ca’s abortion rate look lower than it really
is). By taking two drugs several hours
apart, women are able to abort at home
without a clinic appointment. The pills
can be posted after an online consultation.
Several telemedicine startups now offer
the pills more cheaply than clinics do. The
drugs are also available illegally from Aid
Access, a charity in Europe, and from on
line pharmacies overseas. Their efficacy
and safety up until 11 weeks of pregnancy
mean America should not return to an era
of backstreet abortions.
Antiabortion lawmakers are onto that.
Last year, 15 states introduced bills restrict
ing medication abortion. If Roeis over
turned, more will surely follow. Even if
women can get hold of the pills, they couldstill be in trouble. The cramping and heavy
bleeding that these pills cause prompt
some women to seek medical help. A num
ber of abortion providers suggest they tell
doctors they are having a miscarriage if
necessary. They worry that such women—
or doctors who have helped them—may be
charged with a crime. Such fears have in
tensified since several states have said they
plan to copy Texas’s law. It enables private
citizens to sue anyone who “aids or abets”
an illegal abortion, and for every case that
is successful it authorises “damages” (in
effect a bounty) of $10,000.How much will voters care?
Some women—those who wish to keep
their abortion secret from their parents or
partner, say, or those whose pregnancy has
passed 11 weeks—will continue to need
care in an abortion clinic. And the number
of those needing abortions later in preg
nancy will grow if women have to travel
farther, with the timeconsuming burdens
that entails. Thus the number who fail to
have an abortion altogether will also in
crease, with woeful consequences.
Using data from a nationwide longitu
dinal study that investigated the effects of
either having an abortion or being turned
away, researchers found that women who
were denied abortions experienced a sharp
spike in financial hardship. Their children
suffered. Some obstetricians worry that
overturning Roe could push up America’s
maternal and infant mortality rates.
Democrats are ready to use such fears to
try to boost turnout in the midterms in
November. This may work among some
educated women in suburbs where many
of the competitive Senate races will be de
cided. But whether it would prevent Re
publicans from taking the House and Sen
ate is far from clear. In Virginia’s guberna
torial race last year, Terry McAuliffe, a
Democrat, repeatedly castigated Texas’s
new law. But he lost to Glenn Youngkin, his
Republican rival, who has supported abor
tion restrictions. Exit polls revealed, as
they have done before, that abortion is a
bigger voting issue for Republicans than it
is for Democrats.
Overall, however, abortion is some way
behind a lot of other issues in voters’
minds. The end of Roemay not necessarily
prompt huge protests. After Texas banned
most abortions some businesses in the
state offered to relocate employees; other
wise their response was subdued. Termi
nating Roewould undoubtedly cause a big
ger stir, but it is unclear how the effects
would really be felt beyond the lives of
women and the abortion providers who
serve them. And on that, “The only thing
we know for sure is that it will be a mess,“
says Dr Joffe of the uscfBixby Centre,“and
that rich women will do better thanpoor
women. What else is new in America?”n