tag:theconversation.com,2011:/fr/topics/abortion-1130/articlesAbortion – The Conversation2024-03-26T20:54:50Ztag:theconversation.com,2011:article/2266702024-03-26T20:54:50Z2024-03-26T20:54:50ZAbortion drug access could be limited by Supreme Court − if the court decides anti-abortion doctors can, in fact, challenge the FDA<figure><img src="https://images.theconversation.com/files/584450/original/file-20240326-30-a29mv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pro-abortion rights activists rally in front of the Supreme Court on March 26, 2024, the day justices heard oral arguments about the use of mifepristone.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/abortion-rights-activist-rally-in-front-of-the-us-supreme-news-photo/2107843451?adppopup=true">Drew Angerer/AFP via Getty Images </a></span></figcaption></figure><p><em>Who has the legal right to challenge decisions by the U.S. Food and Drug Administration? And should the moral umbrage of a group of anti-abortion rights doctors shift policy across the country, limiting women’s ability to get the widely used abortion drug mifepristone?</em></p>
<p><em>These are a few of the central questions that the <a href="https://www.cbsnews.com/news/supreme-court-abortion-pill-arguments-mifepristone/">Supreme Court fielded on March 26, 2024</a>, during the oral arguments in <a href="https://www.scotusblog.com/case-files/cases/food-and-drug-administration-v-alliance-for-hippocratic-medicine-2/">FDA v. Alliance for Hippocratic Medicine</a>. A group of doctors is challenging the FDA, saying that the federal agency’s decision allowing people to get mifepristone via telehealth, at up to 10 weeks of pregnancy, is causing some medical professionals harm.</em></p>
<p><em>Amy Lieberman, politics and society editor at The Conversation U.S., spoke with family law and reproductive justice scholars <a href="https://scholar.google.com/citations?user=gCJEShUAAAAJ&hl=en">Naomi Cahn</a> and <a href="https://www.law.gwu.edu/sonia-m-suter">Sonia Suter</a> to better understand what’s behind the oral arguments before the Supreme Court – and how the court’s eventual decision, expected in June, could affect people’s ability to get abortions by using mifepristone, one of two drugs used for medication abortion.</em> </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/584469/original/file-20240326-26-9qpi95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="White boxes of Mifepristone are seen stacked in a shelf." src="https://images.theconversation.com/files/584469/original/file-20240326-26-9qpi95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584469/original/file-20240326-26-9qpi95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584469/original/file-20240326-26-9qpi95.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584469/original/file-20240326-26-9qpi95.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584469/original/file-20240326-26-9qpi95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584469/original/file-20240326-26-9qpi95.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584469/original/file-20240326-26-9qpi95.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A cabinet holds mifepristone at a health clinic in Casper, Wyo., in June 2023.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/cabinet-containing-mifepristone-seen-in-wellspring-health-news-photo/1258730531?adppopup=true">Rachel Woolf for The Washington Post via Getty Images</a></span>
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<p><strong>What is this case about?</strong></p>
<p><strong>Sonia Suter:</strong> It’s about whether the FDA’s regulations for the use of <a href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifepristone-medical-termination-pregnancy-through-ten-weeks-gestation">mifepristone were appropriately loosened in 2016 and 2021</a>. These changes generally make mifepristone more accessible by allowing people to have the medication prescribed via a telehealth visit and then getting the pill in the mail.</p>
<p><strong>Naomi Cahn:</strong> That 2016 regulation also extended the time during which mifepristone could be prescribed, increasing it from seven to 10 weeks gestation. Medication abortions accounted for <a href="https://www.guttmacher.org/2024/03/medication-abortion-accounted-63-all-us-abortions-2023-increase-53-2020">63% of all abortions</a> that occurred in the U.S. in 2023. This percentage has increased since the Supreme Court overturned the constitutional right to an abortion in 2022.</p>
<p><strong>Why are these guidelines being challenged?</strong></p>
<p><strong>Suter:</strong> A group of doctors and medical associations that oppose abortion <a href="https://www.nytimes.com/2024/03/26/us/erin-hawley-abortion-pill-supreme-court.html">are challenging these guidelines</a> and using this court case as a way, we believe, to limit the ability to get an abortion by using medication. </p>
<p>They challenged the drug’s initial approval by the FDA and the relaxed restrictions on how it is used. They claimed that the FDA exceeded its authority, did not rely on proper data and did not have adequate support from scientific studies for its decision that mifepristone could be safely prescribed. Their initial arguments, which the lower court accepted, would have banned mifepristone. But that decision was not upheld by the <a href="https://www.ca5.uscourts.gov/opinions/pub/23/23-10362-CV1.pdf">5th Circuit Court</a>. </p>
<p>Instead, the issues before the Supreme Court focus on whether the FDA should have expanded the use of mifepristone. Virtually all studies have shown that <a href="https://www.nytimes.com/interactive/2023/04/01/health/abortion-pill-safety.html">mifepristone is not dangerous</a>, even with the relaxed conditions on its use. </p>
<p><strong>What is the federal government’s central argument against these claims?</strong></p>
<p><strong>Cahn:</strong> The government is stating that the FDA appropriately reviewed all of the evidence and its decision was appropriate. </p>
<p>Indeed, the attorney representing the mifepristone manufacturer, <a href="https://www.supremecourt.gov/oral_arguments/argument_transcripts/2023/23-235_p8k0.pdf">Jessica Ellsworth</a>, pointed out that <a href="https://apnews.com/article/abortion-pill-mifepristone-redacted-studies-supreme-court-ebd60519fd44dc69c5ac213580d1c1ba#:%7E:text=A%20medical%20journal%20has%20retracted,and%20flaws%20in%20their%20research.">the studies cited by the challengers have either been</a> discredited <a href="https://www.npr.org/sections/health-shots/2024/02/09/1230175305/abortion-pill-mifepristone-retraction-supreme-court">or withdrawn because they were unreliable</a>. </p>
<p>Another critical issue, as <a href="https://www.nytimes.com/live/2024/03/26/us/abortion-pill-supreme-court">U.S. Solicitor General Elizabeth Prelogar said to the justices today</a>, is whether the organization challenging this ruling actually has legal standing – the right to sue – to bring a lawsuit against the FDA. </p>
<p><strong>Why is the question of who can sue the FDA important here?</strong></p>
<p><strong>Suter:</strong> Under U.S. law, you cannot succeed in court every time you are unhappy. The Supreme Court has ruled that the Constitution requires parties who bring suit in federal court to <a href="https://www.law.cornell.edu/constitution-conan/article-3/section-2/clause-1/standing-requirement-overview">have “standing.”</a> This means parties have to show that they have been injured in some tangible way or threatened with such an injury by the acts that are the basis of the lawsuit. In this case, a group of doctors morally opposed to abortion are saying they have been injured. Their claim is that with the changes in the FDA’s regulation of mifepristone prescriptions, patients will come to them in the emergency room, requiring medical care that violates these religious beliefs and causes them stress. </p>
<p>The government’s response is that the FDA is not making them do anything, including prescribe these pills or treat these patients. And <a href="https://www.hhs.gov/conscience/conscience-protections/index.html">there are conscience laws</a> that say if the treatment is against a health care provider’s beliefs, they do not need to provide that care. So the government asks: How are the doctors harmed here?</p>
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<a href="https://images.theconversation.com/files/584543/original/file-20240326-18-ohf6hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A line of people in formal clothing are seen behind barricades outside the Supreme Court on a grey day." src="https://images.theconversation.com/files/584543/original/file-20240326-18-ohf6hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584543/original/file-20240326-18-ohf6hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584543/original/file-20240326-18-ohf6hs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584543/original/file-20240326-18-ohf6hs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584543/original/file-20240326-18-ohf6hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584543/original/file-20240326-18-ohf6hs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584543/original/file-20240326-18-ohf6hs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">People wait outside the Supreme Court to hear oral arguments on mifepristone on March 26, 2024.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-wait-in-line-outside-us-supreme-court-to-hear-oral-news-photo/2107843290?adppopup=true">Drew Angerer/AFP via Getty Images</a></span>
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<p><strong>What is your impression from the justices, listening to these arguments?</strong></p>
<p><strong>Cahn:</strong> I was surprised by how much time the justices spent asking about legal standing and whether there was a direct enough connection between the plaintiffs and the FDA’s guidance. </p>
<p><strong>What’s the potential impact of the court’s eventual ruling on this case?</strong></p>
<p><strong>Cahn:</strong> The court’s decision has implications for the whole FDA approval process as well as access to medication abortion, including through telehealth and the mail. If the court rules for the doctors challenging the FDA, mifepristone would still be available, but access to it would be severely limited because people would need an in-person visit before they could get it.</p><img src="https://counter.theconversation.com/content/226670/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Two legal scholars who study abortion-related laws explain what happened at the Supreme Court in a case that could make it harder to get an abortion.Naomi Cahn, Professor of Law, University of VirginiaSonia Suter, Professor of Law, George Washington UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2256192024-03-20T12:28:41Z2024-03-20T12:28:41ZBiden cannot easily make Roe v. Wade federal law, but he could still make it easier to get an abortion<figure><img src="https://images.theconversation.com/files/582808/original/file-20240319-20-n2gu76.jpg?ixlib=rb-1.1.0&rect=419%2C62%2C4759%2C3385&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A protester marks the Dobbs v. Jackson Women's Health Organization decision anniversary outside the Supreme Court building on June 23, 2023. </span> <span class="attribution"><a class="source" href="https://mapi.associatedpress.com/v2/items/39d8d89cb379472ea647b7756c313426/preview/AP23175098262311.jpg?wm=api&tag=app_id=1,user_id=904438,org_id=101781">Associated Press/Nathan Howard</a></span></figcaption></figure><p>President Joe Biden promised during his State of the Union address on March 7, 2024, that he would make the right to get an abortion a federal law. </p>
<p>“If you, the American people, send me a Congress that supports the right to choose, I promise you I will restore Roe v. Wade as the <a href="https://www.whitehouse.gov/briefing-room/speeches-remarks/2024/03/08/remarks-by-president-biden-in-state-of-the-union-address-3/">law of the land again</a>,” Biden said. </p>
<p>If Biden meant simply that he would sign a bill enshrining the right to an abortion, then he can keep his promise. But, as he noted, such a bill is unlikely to be enacted by this current Congress, <a href="https://pressgallery.house.gov/member-data/party-breakdown">in which the House majority is Republican</a>. Moreover, if Biden expected such a law to be upheld by this Supreme Court, or even a different set of justices, he could be seriously disappointed.</p>
<p>On the other hand, there is much that Biden’s administration and Congress can do to offset the impact of the Supreme Court’s 2022 <a href="https://www.oyez.org/cases/2021/19-1392">Dobbs v. Jackson Women’s Health Organization</a> ruling, which removed federal constitutional protection for the right to get an abortion and sent the regulation of abortion back to the states. </p>
<p><a href="https://www.law.virginia.edu/faculty/profile/nrc8g/2915359">As experts</a> on <a href="https://www.law.gwu.edu/alan-b-morrison">constitutional law</a> and <a href="https://www.law.gwu.edu/sonia-m-suter">reproductive health and justice</a>, we are sorting out just what the federal government can do to protect access to abortion.</p>
<p>Most Americans think of the federal government and the president as capable of doing anything that a majority of Congress thinks is appropriate. But that is not true. </p>
<p>The president has various powers under the Constitution, including the authority to issue <a href="https://constitutioncenter.org/blog/executive-orders-101-what-are-they-and-how-do-presidents-use-them">executive orders</a>. </p>
<p>That’s what <a href="https://www.whitehouse.gov/briefing-room/presidential-actions/2022/07/08/executive-order-on-protecting-access-to-reproductive-healthcare-services/">Biden did</a> shortly after the Dobbs decision when he issued an executive order that called on different government officials and agencies to promote access to reproductive care, including abortion. </p>
<p>Biden can also have government agencies craft rules that protect abortion rights. The Department of Health and Human Services, for example, has proposed <a href="https://www.hhs.gov/about/news/2023/04/12/hhs-proposes-measures-bolster-patient-provider-confidentiality-around-reproductive-health-care.html#:%7E:text=Today%2C%20the%20U.S.%20Department%20of,protected%20health%20information%20(PHI)%20to">a rule to increase privacy protections</a> for reproductive health information, including abortion information. </p>
<p>But Biden has only limited authority to do this: These efforts could be undone by <a href="https://constitutioncenter.org/blog/executive-orders-101-what-are-they-and-how-do-presidents-use-them">Congress overriding</a> executive orders – or his successors reversing them – and courts invalidating agency decisions. </p>
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<a href="https://images.theconversation.com/files/582806/original/file-20240319-26-k3xw86.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Joe Biden is seen standing at a podium, in front of a large American flag and several people around him, including Vice President Kamala Harris" src="https://images.theconversation.com/files/582806/original/file-20240319-26-k3xw86.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582806/original/file-20240319-26-k3xw86.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582806/original/file-20240319-26-k3xw86.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582806/original/file-20240319-26-k3xw86.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582806/original/file-20240319-26-k3xw86.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582806/original/file-20240319-26-k3xw86.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582806/original/file-20240319-26-k3xw86.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">President Joe Biden speaks during the State of the Union address on March 7, 2024.</span>
<span class="attribution"><a class="source" href="https://mapi.associatedpress.com/v2/items/8a914f2c68444fefb2f27f6cfa4ab597/preview/AP24068158996875.jpg?wm=api&tag=app_id=1,user_id=904438,org_id=101781">Associated Press/Andrew Harnik</a></span>
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<h2>Congress’ hands are partially tied</h2>
<p>Biden specifically said in February 2024 that he needs a Congress that will help him support a “woman’s right to choose.”</p>
<p>Two of us have written <a href="https://slate.com/news-and-politics/2022/01/congress-roe-law-abortion-alternative.html">about how Congress</a> does not have the authority to override a state’s decision to make abortions unlawful in most circumstances – although we <a href="https://twitter.com/jdmortenson/status/1521580604323737600">recognize that some</a> observers and experts would <a href="https://crsreports.congress.gov/product/pdf/LSB/LSB10787">question this conclusion</a>.</p>
<p>Congress has the power to pass laws, but only on a limited list of subjects. While the understanding of Congress’ power has expanded over time, there are still very real limits. </p>
<p>Congress is able to regulate commerce between states, but the Supreme Court has determined that its powers only reach activities that are <a href="https://crsreports.congress.gov/product/pdf/IF/IF11971">economic in nature</a>. So, the court ruled in 1994 that the federal government could not ban the possession of guns in a “<a href="https://www.oyez.org/cases/1994/93-1260">school zone</a>,” since there was no direct economic element involved. </p>
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<a href="https://images.theconversation.com/files/582919/original/file-20240319-30-7pp40o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two white boxes say the words 'Mifepristone tablets' and are on a black table." src="https://images.theconversation.com/files/582919/original/file-20240319-30-7pp40o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582919/original/file-20240319-30-7pp40o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582919/original/file-20240319-30-7pp40o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582919/original/file-20240319-30-7pp40o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582919/original/file-20240319-30-7pp40o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582919/original/file-20240319-30-7pp40o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582919/original/file-20240319-30-7pp40o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Packages of Mifepristone tablets are displayed in April 2023 at the family planning clinic in Rockville, Md.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/in-this-photo-illustration-packages-of-mifepristone-tablets-news-photo/1481950657?adppopup=true">Anna Moneymaker/Getty Images</a></span>
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<h2>Other options for protecting abortion rights</h2>
<p>The president and the federal government have other ways to make it easier and more affordable to get an abortion. Some of these methods might even be effective in states where there are partial or full bans.</p>
<p>First, Congress could amend existing federal laws to provide economic assistance for abortion. For example, it could repeal the <a href="https://crsreports.congress.gov/product/pdf/IF/IF12167#:%7E:text=The%20Hyde%20Amendment%2C%20according%20to,are%20not%20obligated%20to%20cover.">Hyde Amendment</a>, which is an annual restriction passed in 1976 that prohibits federal money from being used to fund abortions, except when necessary to save the life of a pregnant person or when a pregnancy is the result of rape or incest. </p>
<p>Biden promised to remove the Hyde Amendment in his 2020 campaign but has been unable to do so because of lack of congressional support. But eliminating the Hyde Amendment would have minimal impact in <a href="https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html">states with abortion bans</a>. </p>
<p>Second, some states with abortion bans, like Idaho and Alabama, <a href="https://apnews.com/article/abortion-texas-idaho-alabama-state-lines-trafficking-d314933f3f7db93858561a0c6ad0b188">are threatening to prosecute women</a> who travel to another state to get an abortion. Congress could enact legislation that protects the right to interstate travel for an abortion. Congress could also make it a federal offense for anyone, including state prosecutors, to interfere with that right. </p>
<p>Justice Brett Kavanaugh, <a href="https://www.supremecourt.gov/opinions/21pdf/19-1392_6j37.pdf">in his concurring opinion in Dobbs</a>, asserted that if states criminalized interstate travel for people to get an abortion, those laws would fail “based on the constitutional right to interstate travel.” </p>
<p>Since Dobbs, <a href="https://apnews.com/article/idaho-abortion-minors-criminalization-b8fb4b6feb9b520d63f75432a1219588">Idaho has passed a law</a> making it a felony for adults who are not the parent of a pregnant minor to help that minor cross state lines for an abortion. A <a href="https://apnews.com/article/idaho-abortion-trafficking-travel-ban-270a403d7b4a5e99e566433556614728">district court has temporarily stayed</a> this law as unconstitutional. In addition, <a href="https://www.texastribune.org/2024/02/09/texas-abortion-transgender-care-outside-state-borders/#:%7E:text=In%201974%2C%20just%20after%20Roe,they%20travel%20to%20that%20State.%E2%80%9D">four counties and a few cities in Texas</a> have passed so-called “abortion trafficking laws,” which allow individuals to sue people who travel to get abortions out of state and those who help them.</p>
<p>Third, the Food and Drug Administration has approved, and in 2016 and 2021 expanded, the <a href="https://theconversation.com/medication-abortion-could-get-harder-to-obtain-or-easier-theres-a-new-wave-of-post-dobbs-lawsuits-on-abortion-pills-198978">availability of mifepristone</a>, one of the two drugs used for medication abortions. The Supreme Court is <a href="https://www.scotusblog.com/2023/12/justices-will-review-lower-court-ruling-on-access-to-abortion-pill/">considering a challenge</a> to some of the FDA’s rules about access to mifepristone and will hear <a href="https://www.scotusblog.com/case-files/cases/food-and-drug-administration-v-alliance-for-hippocratic-medicine-2/">oral arguments in that case on March 26, 2024</a>. </p>
<p>But even if the FDA prevails, an anti-abortion president could replace the head of this federal agency. The FDA might then rescind the current rules that have <a href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifepristone-medical-termination-pregnancy-through-ten-weeks-gestation">expanded access</a> to mifepristone, including allowing the pill to be used later in pregnancy. </p>
<p>To prevent that from happening, Biden could ask <a href="https://crsreports.congress.gov/product/pdf/IF/IF12269">Congress to pass a law</a> that would guarantee the same kind of access to mifepristone that the FDA currently allows. </p>
<p>Congress could also ensure that <a href="https://theconversation.com/an-obscure-1800s-law-is-shaping-up-to-be-the-center-of-the-next-abortion-battle-legal-scholars-explain-whats-behind-the-victorian-era-comstock-act-204728">mailing abortion pills is legal</a>. It could do so by repealing a Victorian law called the Comstock Act, which <a href="https://www.nytimes.com/interactive/2023/04/08/us/court-decision-invalidating-approval-of-mifepristone.html">some judges</a> have interpreted as prohibiting the mailing of abortion pills, and directly declaring that such acts are legal. </p>
<p>The Department of Justice issued an <a href="https://theconversation.com/an-obscure-1800s-law-is-shaping-up-to-be-the-center-of-the-next-abortion-battle-legal-scholars-explain-whats-behind-the-victorian-era-comstock-act-204728">opinion in 2022</a> that the Comstock Act does not override the FDA rule allowing mifepristone to be delivered by mail. But legislation would make it impossible for a future president to reverse that opinion alone, or reverse that decision without congressional approval. </p>
<h2>Biden’s actions could still matter</h2>
<p>Biden’s attempt to explicitly codify Roe would probably not succeed. </p>
<p>But Biden can recommend that Congress undertake many other legal reforms that are not constitutionally barred, and he could also take some limited actions based on his own authority. These could remove some obstacles to getting an abortion.</p><img src="https://counter.theconversation.com/content/225619/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While both Congress and the president have extensive legal powers, they cannot easily change the law to protect abortions under federal law.Naomi Cahn, Professor of Law, University of VirginiaAlan Morrison, Professor of public interest and public service law, George Washington UniversitySonia Suter, Professor of law, George Washington UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2254182024-03-14T19:58:07Z2024-03-14T19:58:07ZIn France, abortion rights and hijab bans highlight a double standard on women’s rights<figure><img src="https://images.theconversation.com/files/581779/original/file-20240313-26-4feh20.jpg?ixlib=rb-1.1.0&rect=56%2C153%2C5348%2C3443&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even though laws on religious symbols are worded neutrally, in practice, they are mostly applied to Muslim women’s attire.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The French parliament recently voted in favour of enshrining the <a href="https://www.lemonde.fr/en/politics/article/2024/03/04/france-enshrines-freedom-to-abortion-in-constitution-in-world-first_6584252_5.html">right to abortion into the country’s constitution</a>. While crowds celebrated outside, the slogan “my body my choice” was projected onto the Eiffel Tower <a href="https://www.theguardian.com/commentisfree/2024/mar/06/france-abortion-rights-emmanuel-macron">in giant letters</a>.</p>
<p>Although concerns about <a href="https://www.hrw.org/news/2024/03/05/france-protects-abortion-guaranteed-freedom-constitution">barriers and access</a> still remain, women in France are now guaranteed the right to an abortion up to 14 weeks into their pregnancy, mirroring Spain but still <a href="https://www.hrw.org/news/2022/03/01/france-expands-abortion-access-two-key-moves">well behind</a> Sweden’s 18 weeks and the 24 weeks allowed in The Netherlands.</p>
<p>The decision comes at a time when women’s reproductive rights elsewhere are under threat. In contrast to the United States Supreme Court’s decision <a href="https://www.nytimes.com/2022/06/24/us/roe-wade-overturned-supreme-court.html">overturning abortion rights</a>, France’s vote to enshrine them into its constitution looks like a feminist dream. </p>
<p>In his triumphant speech, French Prime Minister Gabriel Attal said: <a href="https://www.nytimes.com/2024/03/04/world/europe/france-abortion-rights-constitution.html">“We are sending the message to all women: Your body belongs to you and no one has the right to control it in your stead.”</a> </p>
<p>Yet just last year, Attal, as education minister, banned Muslim girls from wearing <a href="https://www.politico.eu/article/french-education-minister-announces-ban-on-islamic-dress-in-schools/">abayas in schools</a>. His message — and France’s — to Muslim girls and women seems to be the opposite.</p>
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<h2>Hijab bans</h2>
<p>France’s double standard on women’s rights is most plainly seen in its treatment of Muslim women and girls. A week after its historic abortion vote, France marks 20 years since the adoption of the <a href="https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000000417977">March 2004 law</a> that bans students in public schools from wearing conspicuous symbols or clothing that manifest a religious affiliation.</p>
<p>In principle, the 2004 law applies to all students and prohibits them from wearing religious symbols like crosses, kippas (yarmulkes) and hijabs. But in practice, it is a sexist and racist law that <a href="https://www.amnesty.org/en/documents/eur21/7280/2023/en/">disproportionately targets Muslim girls</a>. </p>
<p><a href="https://yorkspace.library.yorku.ca/items/a9fd3c25-946c-4486-8dd5-5d9d13da4a34">My doctoral research</a> showed how Muslim girls are racially and religiously profiled by school administrators and have been suspended or expelled for wearing hoodies, hats, <a href="https://www.liberation.fr/societe/2013/04/04/la-jupe-et-le-bandeau-lettre-a-sirine_893735/">headbands</a> and <a href="https://www.cairn.info/islamophobie-comment-les-elites-francaises--9782707189462.htm">even long skirts</a>. Last year, they were also <a href="https://www.education.gouv.fr/bo/2023/Hebdo32/MENG2323654N">banned from wearing abayas</a>, which are long garments that are worn over clothing.</p>
<p>In my research, I refer to these bans as “anti-veiling laws” because, although they speak of religious symbols in general, the primary motivation behind these is always Muslim women’s dress. </p>
<p>France’s law led other jurisdictions across Europe and North America to ban Muslim women’s attire in various contexts. <a href="https://www.justiceinitiative.org/uploads/0b300685-1b89-46e2-bcf6-7ae5a77cb62c/policy-brief-restrictions-on-muslim-women%27s-dress-03252022.pdf">A 2022 report</a> from the Open Society Justice Initiative found that out of the 27 European Union member countries, only five have never enacted, or attempted to enact, bans on veiling. </p>
<p>Meanwhile, Québec holds the distinction of being the only province in Canada to implement a <a href="https://www.legisquebec.gouv.qc.ca/en/document/cs/l-0.3">ban on religious symbols</a>.</p>
<p>Former Québec Premier Pauline Marois cited the French law as being an <a href="https://www.ledevoir.com/politique/quebec/395252/pauline-marois-et-jean-marc-ayrault-sont-sur-la-meme-longueur-d-onde?">“inspiration”</a> for her government’s failed <a href="https://www.assnat.qc.ca/en/travaux-parlementaires/projets-loi/projet-loi-60-40-1.html?appelant=MC">Bill 60</a>, known as the Charter of Québec Values. That bill was a precursor to <a href="https://ccla.org/major-cases-and-reports/bill-21/">Québec’s Bill 21</a>, which bans teachers, judges, prosecutors, police officers and other officials in positions of authority from wearing religious symbols.</p>
<h2>Discrimination against Muslim women</h2>
<p>Even though the laws are worded neutrally, claiming to defend abstract principles like secularism, religious neutrality, gender equality or “<a href="https://hudoc.echr.coe.int/fre#%7B%22itemid%22:%5B%22001-145466%22%5D%7D">living together</a>,” in practice they are <a href="https://www.e-elgar.com/shop/gbp/behind-the-veil-9781788970846.html">mostly applied to Muslim women’s attire</a>.</p>
<p>Human rights groups like <a href="https://www.amnesty.org/en/documents/eur21/7280/2023/en/">Amnesty International</a> and the <a href="https://ccieurope.org/report2023/">Collective Against Islamophobia in Europe</a> have demonstrated that the surveillance, suspension and expulsion of Muslim girls at school have led to a decrease in their <a href="https://doi.org/10.1017/S0003055420000106">educational and employment outcomes</a>. </p>
<p>In addition to <a href="https://ccieurope.org/wp-content/uploads/2021/02/report-ccie-2023.pdf">increasing discrimination</a> against them, these bans also violate their right to education without discrimination, a right that is upheld in several international treaties, including the United Nations <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child">Convention on the Rights of the Child</a>.</p>
<p>However, the most insidious aspect of France’s 2004 law is how it has been used to justify even further restrictions on the rights of Muslim women and girls, such as women wearing <a href="https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000022911670">face veils or niqabs</a>, mothers wishing to accompany their children on <a href="https://www.education.gouv.fr/circulaire-preparation-rentree-2012?cid_bo=59726">school outings</a> and <a href="https://www.france24.com/en/europe/20230629-top-court-rules-in-favour-of-hijab-ban-in-french-women-s-football">women athletes</a> who <a href="https://www.amnesty.org/en/latest/news/2024/03/france-ensure-muslim-women-and-girls-can-play-sports/">wear hijab</a>. </p>
<p>In fact, Muslim women are routinely told to take off their clothes or to wear less clothing, even in places or contexts where they legally have the right to wear whatever they want, including at <a href="https://doi.org/10.13169/islastudj.4.1.0101">public beaches</a> and <a href="https://www.bbc.com/news/world-europe-61883529">swimming pools</a>.</p>
<h2>Body sovereignty</h2>
<p>This brings us back to the issue of a woman’s right to make decisions about her own body. Access to abortion is an important right for women everywhere, but women’s rights extend beyond abortion.</p>
<p>The concept of body sovereignty was developed by Indigenous feminists and activists, and refers to a person’s autonomy over their own body as well as to their <a href="https://doi.org/10.1080/10130950.2017.1366179">relationship to land</a>, <a href="https://www.adiosbarbie.com/2016/01/a-critical-conversation-with-sheena-roetman-on-body-sovereignty-and-justice/">belief systems</a> and ways of being that are <a href="https://www.journal.mai.ac.nz/system/files/MAI_Jrnl_2020_V9_2_Gillon_FINAL.pdf">intersectional</a>, <a href="https://ro.uow.edu.au/jgi/vol1/iss1/4">sexually diverse</a>, non-Eurocentric, non-ableist and <a href="https://doi.org/10.1177/1440783319893506">non-fatist</a>. It includes everything from diet, clothing, sexual activity and beauty ideals to reproductive health and freedom from violence.</p>
<p>Anti-veiling laws discriminate against Muslim women and girls, <a href="https://doi.org/10.3138/cjwl.32.1.05">encourage violence against them</a> and undermine the principle of body sovereignty.</p>
<p>Feminists and pro-choice activists everywhere should pause and think about what it means for governments to guarantee abortion rights to women while denying them the more expansive concept of body sovereignty. If feminists and their allies are outraged when theocratic regimes impose religious dress on women, they should be similarly outraged when democratic governments also restrict what women can wear: these are two sides of the same coin. </p>
<p>Both undermine women’s freedom, body sovereignty and self-determination. It is time for feminists everywhere to demand an end to laws that force women to dress one way or another, regardless of where in the world they are enacted.</p><img src="https://counter.theconversation.com/content/225418/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roshan Arah Jahangeer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As France enshrines abortion rights in its constitution, the country’s ban on wearing religious symbols in schools turns 20 years old.Roshan Arah Jahangeer, Postdoctoral Researcher, Memorial University of NewfoundlandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2257142024-03-13T14:57:43Z2024-03-13T14:57:43ZAbortion rights are featuring in this year’s European election campaign in a way we’ve not seen before<p>The recent landmark decision in France to inscribe the right to abortion in the constitution serves to protect the law that first legalised abortion in the country in 1975. This law – the so-called Veil law – was championed by Simone Veil, one of France’s most admired and respected political figures, and an icon of the women’s rights movement.</p>
<p>In 1974, Veil, a magistrate who had been asked by French President Valéry Giscard d’Estaing to serve as health minister in his government, delivered a momentous <a href="https://www.youtube.com/watch?v=45MOc6PYoY8">speech</a>. She presented the public health case for the decriminalisation of abortion to the National Assembly, which at the time was composed almost entirely of men. </p>
<p>The speech was met by fierce opposition and hostility, especially by those on the political right. Veil nevertheless managed to convince a majority of the deputies to vote in favour of her proposal. Once approved by the Senate, the law entered into force in 1975. Veil thereby became a symbol of women’s empowerment and emancipation.</p>
<p>Following her political success at national level, Veil stood in the first direct elections to the European Parliament in 1979. Once elected, the parliament chose her as its president, and she became the first woman to head any of the European institutions.</p>
<h2>An election ahead</h2>
<p>Political parties are now gearing up for the latest round of elections to the European Parliament in June, more than 40 years after Veil first entered the institution. And issues of reproductive rights are on the agenda once again. </p>
<figure class="align-right ">
<img alt="A black and white portrait photo of Simone Veil." src="https://images.theconversation.com/files/581645/original/file-20240313-16-e73bjq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/581645/original/file-20240313-16-e73bjq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=905&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581645/original/file-20240313-16-e73bjq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=905&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581645/original/file-20240313-16-e73bjq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=905&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581645/original/file-20240313-16-e73bjq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1138&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581645/original/file-20240313-16-e73bjq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1138&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581645/original/file-20240313-16-e73bjq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1138&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Simone Veil, legend of the women’s rights movement and European politics.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Simone_Veil#/media/File:Simone_Veil_bij_uitreiking_Four_Freedoms_Awards_in_Middelburg,_Bestanddeelnr_933-0124_-_Restoration.jpg">Wikipedia/Anefo photo collection</a></span>
</figcaption>
</figure>
<p>In 2022, the European parliament felt the need to issue a <a href="https://www.europarl.europa.eu/doceo/document/TA-9-2022-0243_EN.html">resolution</a> strongly condemning backsliding in women’s rights and sexual and reproductive health rights. </p>
<p>This came in response to the US Supreme Court’s decision to overturn Roe v Wade, which had guaranteed the constitutional right to abortion for 50 years. But it was also a response to <a href="https://www.politico.eu/article/abortion-right-europe-vary-widely-getting-squeezed/">developments</a> in some EU member states. </p>
<p>The resolution highlighted in particular the de facto ban on abortion that has come into force in Poland in recent years but also mentioned Malta, where abortion is illegal, Slovakia, where access is restricted, Hungary, where procedures are “not available” and Italy, where rights are being threatened. </p>
<p>Importantly, the resolution also calls for the right to abortion to be included in the EU Charter of Fundamental Rights, which would mean all women in the European Union would have the right to access reproductive healthcare of this kind, thereby offering them some protection from restrictions in their home nations. </p>
<p>This call was echoed by French president <a href="https://www.france24.com/en/live-news/20240308-france-s-macron-to-seal-abortion-becoming-constitutional-right">Emmanuel Macron</a> during the ceremony marking the new constitutional right to abortion in France.</p>
<p>Yet, the parliamentary resolution masks internal divisions between, and sometimes within, the political groups of the European parliament. As these political groups are launching their campaigns and election manifestos, it is clear that the issue of abortion has become part of the wider political polarisation seen across Europe.</p>
<p>Many far-right parties, which are predicted to <a href="https://ecfr.eu/publication/a-sharp-right-turn-a-forecast-for-the-2024-european-parliament-elections/">make significant gains</a> in the upcoming elections, call for restrictions on abortion rights. The European Conservatives and Reformists, a right-wing group that brings together parties such as Brothers of Italy and Spain’s Vox, says it wants to “<a href="https://ecrgroup.eu/campaign/family_and_life">defend life, from its conception until its natural end.</a>”. </p>
<p>The political parties within the Identity & Democracy group do not share a common position on the issue, but several adopt a restrictive approach. For example, the Alternative for Germany recently <a href="https://www.politico.eu/article/germany-parliament-bundestagvotes-to-remove-ban-on-abortion-advertising/">voted against</a> a proposal to ban a law preventing doctors from providing information on abortion procedures in Germany.</p>
<p>The centre-right European People’s Party, the biggest political group in the Parliament, remains <a href="https://www.politico.eu/article/abortion-debate-european-parliament-division-hatred/">divided</a> on the issue, but most of its MEPs agree that abortion should remain a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jcms.13378">matter of national competence</a>. </p>
<p>Groups on the other side of the political spectrum, meanwhile, are making explicit reference to the need to safeguard and expand reproductive health and rights in their European election manifestos. They include <a href="https://left.eu/mon-corps-mon-choix/">the Left</a> group, <a href="https://www.datocms-assets.com/87481/1708539548-egp_manifesto-2024_courage-to-change.pdf">the Greens</a> and the <a href="https://pes.eu/wp-content/uploads/2024/03/2024_PES_Manifesto_EN.pdf">Socialist & Democrats</a>. </p>
<p>Similarly, the liberal group Renew Europe is pushing for greater alignment on abortion rights across the EU. It it is behind the recently launched <a href="https://www.simoneveilpact.eu/">Simone Veil Pact</a>, which calls for greater pan-European effort on gender equality.</p>
<h2>A new parliamentary term</h2>
<p>Veil considered the European parliament a key institution in the democratic development of the European Community. She saw the right given to Europeans to vote for the parliament as a <a href="https://www.cvce.eu/content/publication/1999/1/1/174d384d-d5c7-4c02-ad78-b1f6efc9740a/publishable_en.pdf">milestone</a> and a springboard for increased parliamentary involvement in European integration and decision-making. Under her leadership, the European parliament gained greater recognition and transformed into a real political actor.</p>
<p>Veil held the post of president for three years, and she remained a member of the European parliament until 1993. During her three terms as an MEP, she continued to support issues relating to women’s rights.</p>
<p>The arguments once made by Simone Veil, who in 2018 was honoured with a <a href="https://www.france24.com/en/20180629-liveblog-france-women-rights-abortion-simone-veil-holocaust-pantheon">burial in the Panthéon</a> (the Parisian mausoleum reserved exclusively for France’s most eminent citizens), are surfacing once again ahead of the hotly contested European parliament elections. </p>
<p>When the 720 newly elected MEPs meet for the next parliamentary term, discussions and debates around abortion and women’s rights are bound to continue. They may well take a different tone and occupy a higher position depending on the outcome of the elections.</p><img src="https://counter.theconversation.com/content/225714/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Magdalena Frennhoff Larsén does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Legendary European parliament president Simone Veil fought for women’s reproductive rights in France and in Brussels. Is her legacy about to be re-opened?Magdalena Frennhoff Larsén, Associate Professor in Politics and International Relations, University of WestminsterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2226652024-03-07T15:00:05Z2024-03-07T15:00:05ZFemicide in Italy: A modern phenomenon deeply rooted in country’s cultural past<p>“Femicide is not a crime of passion, it is a crime of power,” wrote Elena Cecchettin <a href="https://www.theguardian.com/world/2023/nov/25/anger-across-italy-as-killing-of-student-highlights-countrys-femicide-rate">after her sister</a> was killed in November 2023.</p>
<p>Italian student Giulia Cecchettin, 22, was killed allegedly by her controlling ex-boyfriend, Filippo Turetta, a fellow student at a university in Padua. Not being able to handle the breakup, Turetta <a href="https://www.bbc.com/news/world-europe-67530529">lured Giulia into one last shopping trip together</a> before killing her, prosecutors claim. Her body, <a href="https://www.ilmessaggero.it/en/life_behind_bars_filippo_turetta_s_new_routine-7910899.html">with more than 20 stab wounds</a>, was found at the bottom of a ditch. Turetta fled to Germany, was caught <a href="https://www.ilmessaggero.it/en/life_behind_bars_filippo_turetta_s_new_routine-7910899.html">and is now behind bars awaiting trial in Italy</a>, according to the latest reports from Italy. </p>
<p>Cecchettin’s case has grabbed headlines in Italy <a href="https://nypost.com/2024/01/06/opinion/stop-ignoring-violence-against-women-in-italy/">and worldwide</a>. But it is not unique. Femicide – <a href="https://www.oxfordlearnersdictionaries.com/us/definition/english/femicide#:%7E:text=%2F%CB%88fem%C9%AAsa%C9%AAd%2F-,%2F%CB%88fem%C9%AAsa%C9%AAd%2F,girl%20because%20she%20is%20female">the act of killing women on account of their gender</a> – is worryingly common in Italy. At least <a href="https://www.ansa.it/english/news/2023/12/11/109-women-murdered-in-italy-so-far-in-2023-study_b1b82904-4d40-47e6-8758-ed3450567548.html#:%7E:text=As%20of%20December%203%2C%20109,criminal%20police%20presented%20on%20Monday">109 women were killed in Italy in 2023</a>; more than half were murdered by a partner or an ex-partner.</p>
<p>International <a href="https://www.europeandatajournalism.eu/cp_data_news/in-italy-femicides-are-not-decreasing-like-homicides/">comparisons on femicide rates can be difficult</a>, but those who do track such numbers suggest that Italy’s femicide problem has been persistent. So much so that cultural organization <a href="https://inarea.com/en/case-study/treccani/">the Institute of the Italian Encyclopedia Treccani</a> chose “femicide” as <a href="https://www.unionesarda.it/en/the-word-of-the-year-for-2023-treccani-chooses-quot-femicidequot-ozm95r5j">2023’s word of the year</a>.</p>
<p>In an attempt to address the high rates of femicide, on Dec. 12, 2023, a new law went into effect in Italy titled <a href="https://www.loc.gov/item/global-legal-monitor/2023-12-27/italy-new-law-to-combat-violence-against-women-and-domestic-violence-enters-into-effect">Provisions for Combating Violence Against Women and Domestic Violence</a>. Although the law strengthens protection for women by broadening the definition of unlawful conduct related to domestic violence and by increasing penalties for offenders, the legislation has its limits.</p>
<p>One of the ministers who proposed that law, Eugenia Maria Roccella, <a href="https://www.nytimes.com/2023/11/22/world/europe/italy-giulia-cecchettin-violence-against-women.html">emphasized how laws had failed to protect Giulia Cecchettin</a>, or “any other women who did not suspect the violence brooding in the heart of the man who claimed to love them.” </p>
<p>Indeed, Elena Cecchettin pointed at a cultural factor in the killing of her sister and other women in Italy: a patriarchal society in which male violence and control has long been accepted. “<a href="https://www.bbc.com/news/world-europe-67514334">Monsters are healthy sons of the patriarchy and rape culture</a>,” she said.</p>
<h2>The Roman rule</h2>
<p>Femicide is a cultural phenomenon with deep roots that go back millennia.</p>
<p>Many premodern societies were patriarchal and violent, but Italy is in many ways unique. The legacies of the Roman Empire, Italian Fascism and Roman Catholicism still loom large. Each, I would argue, has contributed to a modern Italy in which male violence has been normalized. </p>
<p>The history of Rome is <a href="https://www.thefrenchhistorypodcast.com/metoo-and-roman-rape-culture-with-darah-vann-orr/">inseparable from misogyny and rape</a>; it is present in the city-state’s origin story. When Romulus found his newly born city bereft of women, he trapped unmarried girls and women from the neighboring Sabine tribe and kept them as Roman concubines. By the time the Sabines sought revenge, many of the tribe’s daughters and sisters were either carrying or had given birth to Romans. <a href="https://www.britannica.com/topic/Sabine">The women</a>, so the story goes, ran onto the battlefield as live shields to <a href="https://www.metmuseum.org/art/collection/search/359809">secure peace between their fathers and Roman captors</a>.</p>
<figure class="align-center ">
<img alt="A painting depicts women being abducted by Romen men." src="https://images.theconversation.com/files/580308/original/file-20240306-18-2g9zim.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580308/original/file-20240306-18-2g9zim.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580308/original/file-20240306-18-2g9zim.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580308/original/file-20240306-18-2g9zim.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580308/original/file-20240306-18-2g9zim.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580308/original/file-20240306-18-2g9zim.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580308/original/file-20240306-18-2g9zim.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pietro da Cortona’s painting ‘Rape of the Sabine Women.’</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/d/d8/Cortona_Rape_of_the_Sabine_Women_01.jpg">Wikmedia Commons</a></span>
</figcaption>
</figure>
<p>Roman women were treated as second-class citizens. During <a href="https://www.britannica.com/topic/Colosseum">gladiator fights</a>, women were allowed to <a href="https://www.smithsonianmag.com/smart-news/please-find-your-seats-evidence-seating-plan-discovered-colosseum-180954023/">sit only in the worst seats</a>, next to the slaves. Women’s disobedience resulted in severe physical punishment, with instances of Roman women being <a href="https://blogs.unimelb.edu.au/shaps-research/2022/06/01/domestic-violence-and-the-law-in-ancient-rome/">kicked to death, drowned and thrown from windows</a>. </p>
<p>Higher social status did not protect women. Emperor <a href="https://blogs.unimelb.edu.au/shaps-research/2022/06/01/domestic-violence-and-the-law-in-ancient-rome/">Nero’s first wife and his mother were murdered on his orders</a>; Nero’s second wife was kicked to death while pregnant. Even <a href="https://www.britannica.com/topic/Vestal-Virgins">Vestal Virgins</a>, holy Roman priestesses, <a href="https://www.britannica.com/topic/Vestal-Virgins">were buried alive</a> if they violated their vow of chastity or let the eternal flame die. </p>
<p>While prostitutes and actresses <a href="https://www.focus.it/cultura/curiosita/che-cose-la-suburra">were traded</a>, <a href="https://www.focus.it/cultura/storia/diritto-di-bacio-antica-roma">raped and killed</a>, noble women were subject to “<a href="https://historicaleve.com/right-to-kiss-in-ancient-rome/">the right to kiss</a>.” Through that law, male relatives were allowed to “test” women to make sure they had not drunk wine. Violating that “right to kiss” and the no-alcohol policy <a href="https://www.focus.it/cultura/storia/diritto-di-bacio-antica-roma">was punishable by death</a>.</p>
<p>Misogyny was so endemic that Roman law <a href="https://theconversation.com/ancient-rome-didnt-have-specific-domestic-violence-legislation-but-the-laws-they-had-give-us-a-window-into-a-world-of-abuse-179460">focused on preserving a woman’s chastity</a> rather than on punishing the perpetrator in the case of rape. Roman centurion <a href="https://artuk.org/discover/artworks/libertatis-virginia-killed-by-her-father-to-protect-her-from-appius-claudius-221779">Lucius Verginius killed his daughter</a> to protect her chastity from an abuser, Appius Claudius. </p>
<p>This misogynist culture has been celebrated through art, education and cinematography. For example, works by Giambolognia, Rubens, Poussin and Picasso all depict the rape of Sabines, with pieces <a href="https://www.metmuseum.org/art/collection/search/359809">on display in New York’s Metropolitan Museum of Art</a> and in <a href="https://www.theflorentine.net/2022/06/14/new-summer-opening-hours-at-the-accademia-gallery/">Florence’s Accademia Gallery</a>. </p>
<p>Roman patriarchal legacy is prevalent in pop culture, too. From “<a href="https://www.imdb.com/title/tt0043949/">Quo Vadis</a>” to “<a href="https://www.imdb.com/title/tt0052618/">Ben-Hur</a>” and “<a href="https://www.imdb.com/title/tt0172495/">Gladiator</a>,” movies have glorified a violent time in which strong men were venerated. </p>
<p>Meanwhile, many contemporary men are – as it has been recently claimed – <a href="https://www.nytimes.com/2023/09/15/style/roman-empire-men-tiktok-instagram.html">obsessed with the Roman Empire</a>. </p>
<p>So too are cultural industries. Cinecittà film studios’ gladiator series “<a href="https://www.theguardian.com/film/2023/jul/14/hollywood-on-the-tiber-cinecitta-stars-return-to-rome-studios-heston-fellini">Those About to Die</a>” has become <a href="https://variety.com/2023/film/global/roland-emmerich-those-about-to-die-prime-video-1235684470/">an international hit</a>.</p>
<p>For a certain type of modern man, Rome represents an escape from <a href="https://www.genderspecialist.com/blog/whymenareobsessedwithrome">egalitarian norms</a>, allowing them to reclaim a perceived loss of male power. </p>
<h2>The Fascist touch</h2>
<p>Italian society also continues to be influenced by fascism, an ideology <a href="https://phillipian.net/2023/12/15/hypermasculinity-and-the-rise-of-fascism/">steeped in male violence</a>.</p>
<p>Fascism, introduced to Italy by Benito Mussolini in the 1930s, held <a href="https://www.jstor.org/stable/1394751">procreation as the main woman’s duty</a>. Women were defined in terms of their full subordination to men and in regards to <a href="https://doi.org/10.1177/026569149302300103">their role in the family and in motherhood</a>. </p>
<p>Nearly 100 years later, the legacy of fascism is alive in Italy. Italian Prime Minister Giorgia Meloni praised Mussolini in her youth, and her own right-wing political party, Fratelli d’Italia, is a <a href="https://theconversation.com/giorgia-meloni-the-political-provocateur-set-to-become-italys-first-far-right-leader-since-mussolini-190116">descendant of the Italian Social Movement party</a> that was <a href="https://www.politico.eu/article/italy-mussolini-denies-rehabbing-fascism-after-army-calendar-outcry/">founded by former fascists</a>. </p>
<p>And as a new TV show about Mussolini’s rise, “<a href="https://www.lemonde.fr/en/m-le-mag/article/2023/12/21/in-rome-cinecitta-studios-embraces-new-golden-age_6365899_117.html">M: Son of the Century</a>,” shows, the fascist leader remains in the national consciousness. So too does the <a href="https://www.theguardian.com/commentisfree/2018/may/04/what-do-incels-fascists-and-terrorists-have-in-common-violent-misogyny">toxic “masculinism</a>” that became associated with fascism, finding a new audience among incels as a <a href="https://doi.org/10.1177/08912432221128545">rationale to legitimize anti-woman violence</a>. </p>
<h2>The Catholic grip</h2>
<p>Catholicism has also, I believe, helped <a href="https://www.scirp.org/journal/paperinformation?paperid=71987">normalize patriarchy and misogyny</a> in Italy. </p>
<p>Catholicism is at the core of the so-called “<a href="https://www.modernintimacy.com/the-psychology-of-the-madonna-whore-complex/">Madonna-whore complex</a>,” in which women are seen as being either chaste and virtuous or promiscuous and immoral. Theorists have long explored how that dichotomy is <a href="https://doi.org/10.1002/aps.1831">steeped in misogyny</a>. Stereotypes based on <a href="https://doi.org/10.1080/07491409.2013.832088">that dichotomy</a> have been used to justify perpetrators’ violence against women.</p>
<p>Take the example of Roman baroque painter Artemisia Gentileschi, who <a href="https://www.nationalgallery.org.uk/exhibitions/past/artemisia/artemisias-rape-trial">was raped by her painter-mentor</a>, Agostino Tassi, in 1611 at the age of 17. She gave testimony in court, was physically tortured during the trial and treated as a promiscuous seductress. </p>
<p>Tassi was protected by the pope and set free; Gentileschi, despite being <a href="https://www.theguardian.com/artanddesign/2016/oct/05/artemisia-gentileshi-painter-beyond-caravaggio">a brilliant artist</a>, was shamed and erased from public memory for centuries.</p>
<p>The influence of Catholicism has also contributed to customs and a legal system that can make women more vulnerable. Italy’s abortion laws allow Catholic doctors to “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106580/#:%7E:text=Data%20from%20the%20Italian%20Ministry,increased%20over%20the%20last%20decade.">conscientiously object</a>” to performing a termination, forcing women seeking the procedure to <a href="https://www.economist.com/graphic-detail/2022/09/23/the-difficulties-of-getting-an-abortion-in-italy">travel across the country or abroad</a>.</p>
<p>Meanwhile, Catholic <a href="https://www.ncronline.org/opinion/grace-margins/church-must-face-its-own-role-violence-against-women">doctrine on contraception and abortion</a> has forced women – even those made pregnant through rape or facing high-risk pregnancies – to give birth.</p>
<p>Research also suggests the Catholic Church’s teachings on divorce may <a href="https://doi.org//10.4236/psych.2016.713155">cut off a route of escape</a> for women trapped in violent relationships. </p>
<h2>The deadly passion</h2>
<p>Meanwhile, Italy’s patriarchal traditions have bled into law and society in other ways.</p>
<p>The mandating of extreme leniency to those implicated in <a href="https://www.politico.eu/article/italy-giulia-cecchettin-confronts-its-toxic-culture-of-violence-against-women/">the killing of “spouses, daughters and sisters caught in illicit sex</a>” was written into the country’s penal code until 1981. And even today, public figures refer to “<a href="https://www.politico.eu/article/italy-giulia-cecchettin-confronts-its-toxic-culture-of-violence-against-women/">crimes of passion</a>” and “<a href="https://www.washingtonpost.com/world/europe/how-italy-has-changed-its-view-on-murdering-women/2016/11/02/8f22d42a-930b-11e6-bc00-1a9756d4111b_story.html">honor killings</a>” in reference to the killing of women involved in “illicit” sexual relations. </p>
<p>Femicides do not occur in a vacuum; they are the outcome of a society that legitimizes violence against women. And while I believe changes to the law to better protect Italy’s women are welcome, looking at the country’s culture – both past and present – may also be a necessary step. Until then, Italy’s daughters will not be safe, or fully free.</p><img src="https://counter.theconversation.com/content/222665/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julia Khrebtan-Hörhager does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A spate of recent high-profile murders has put focus on the role of patriarchy and misogyny in persistent rates of anti-woman violence in Italy.Julia Khrebtan-Hörhager, Associate Professor of Critical Cultural & International Studies, Colorado State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2243652024-02-27T04:06:50Z2024-02-27T04:06:50ZAlabama ruling frozen embryos are equivalent to living children has worrying implications for IVF<figure><img src="https://images.theconversation.com/files/578118/original/file-20240227-28-8t4spu.jpg?ixlib=rb-1.1.0&rect=49%2C0%2C5472%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dewar-liquid-nitrogen-straws-frozenn-embryos-1225485064">Ekaterina Georgievskaia/Shutterstock</a></span></figcaption></figure><p>In <a href="https://static01.nyt.com/newsgraphics/documenttools/4b56014daa6dda84/a039b1d9-full.pdf">December 2020 in Alabama</a>, a hospital patient gained unauthorised access to an adjoining IVF storage facility, which was not adequately secured. The patient is said to have removed several frozen embryos, which they then dropped on the floor, owing to a freeze-burn to their hand. The embryos were destroyed.</p>
<p>In Alabama, the <a href="https://casetext.com/statute/code-of-alabama/title-6-civil-practice/chapter-5-actions/article-22-injury-and-death-of-minor/section-6-5-391-wrongful-death-of-minor">Wrongful Death of a Minor Act</a> allows parents of a deceased child to recover punitive damages for their child’s death, and <a href="https://www.abc.net.au/news/2024-02-25/ivf-frozen-embryo-alabama-supreme-court-ruling/103501872">three couples affected</a> by the incident subsequently brought lawsuits against the clinic under this legislation.</p>
<p>When this case was heard recently in the Supreme Court of Alabama, the majority of justices opined this statute <a href="https://static01.nyt.com/newsgraphics/documenttools/4b56014daa6dda84/a039b1d9-full.pdf">applies to frozen embryos</a> because:</p>
<blockquote>
<p>an unborn child is a genetically unique human being whose life begins at fertilization and ends at death.</p>
</blockquote>
<p>This essentially means frozen embryos are protected under Alabama law to the same extent as any living child. While this was a civil matter, it’s not inconceivable that, based on this interpretation, anyone who destroys a frozen embryo in Alabama – accidentally or on purpose – could face criminal penalties, such as manslaughter or even murder charges. </p>
<p>Likely for fear it’s too risky, clinics in the state are now limiting their IVF services, leaving patients having to <a href="https://www.today.com/video/more-clinics-in-alabama-stop-ivf-treatments-after-court-ruling-204773957818">seek treatment elsewhere</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/considering-using-ivf-to-have-a-baby-heres-what-you-need-to-know-108910">Considering using IVF to have a baby? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<p>Ascribing personhood to frozen embryos is not a novel idea, but such a conviction is held only by the very fringes of the religious and conservative spectrum. There are clear political dimensions to this ruling, which appears to be an extension of a radical agenda on the altar of which the <a href="https://www.supremecourt.gov/opinions/21pdf/19-1392_6j37.pdf">Supreme Court of the United States</a> recently sacrificed the right to abortion. </p>
<p>This ruling from the Supreme Court of Alabama reflects a profound ignorance about how the process of IVF works.</p>
<h2>Creating multiple embryos is essential for overall IVF success</h2>
<p>The process of in vitro fertilisation, or IVF, begins with a “stimulated” cycle, where hormones are injected into a woman to stimulate an ovary to produce multiple eggs. These eggs are then collected and combined with sperm, forming embryos that are placed in an incubator to grow. </p>
<p>Five days later, the embryos are assessed. Some develop into “good quality” embryos suitable for transfer into a woman’s uterus. The hope is that following the transfer, the embryo will implant and result in a viable pregnancy, ultimately leading to the birth of a healthy child. Any good-quality embryos not used in a stimulated cycle are usually frozen for future attempts.</p>
<p>Unfortunately, IVF is somewhat inefficient, with attrition a prominent feature at every stage. Not all collected eggs are suitable for fertilisation, not all fertilise, not all embryos fertilise normally, and not all normally-fertilised embryos are of good quality. Poor-quality eggs, abnormally-fertilised embryos and poor-quality embryos are routinely discarded.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1760408483688534266"}"></div></p>
<p>The practical implications of this process and the heartbreaking reality for individuals and couples undergoing IVF is that it takes, on average, three to five eggs to produce <a href="https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20Reproductive%20Technology%20in%20Australia%20and%20New%20Zealand%202021.pdf">one good-quality embryo</a>. However, this number is age-dependent and significantly higher for older women. </p>
<p>The chance of achieving pregnancy from one embryo transfer is also significantly influenced by <a href="https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20Reproductive%20Technology%20in%20Australia%20and%20New%20Zealand%202021.pdf">the woman’s age</a>, being as high as 50% in younger women but decreasing exponentially as a woman gets older. At the age of 46, it can be as low as 1-2%. </p>
<p>So it’s vital to be able to safely produce as many good-quality embryos as possible from one stimulated IVF cycle in case multiple sequential embryo transfers are needed to achieve a healthy pregnancy. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-business-of-ivf-how-human-eggs-went-from-simple-cells-to-a-valuable-commodity-119168">The business of IVF: how human eggs went from simple cells to a valuable commodity</a>
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</em>
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<p>Should the initial embryo transfer fail to produce a viable pregnancy, and frozen embryos are available, those can be thawed and transferred into a woman’s uterus in a “thaw” cycle. These cycles usually don’t require the use of injectable hormones or an egg collection and, in most instances, require only monitoring (including ultrasounds and blood tests), and timed embryo transfer.</p>
<p>The risks associated with IVF, such as bleeding and infections, are mostly confined to the stimulated cycles, while thaw cycles <a href="https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20Reproductive%20Technology%20in%20Australia%20and%20New%20Zealand%202021.pdf">pose minimal risk</a>. Notably, the most labour-intensive, and, therefore, costly portion is the stimulated cycle, while a thaw cycle can be around three to four times cheaper. </p>
<p>Should embryo freezing become unavailable, all people undergoing IVF would have to rely solely on stimulated cycles to achieve pregnancy, significantly increasing the risks and radically escalating the costs.</p>
<h2>The judge’s error in interpreting Australian practice</h2>
<p>Tom Parker, the Chief Justice of the Supreme Court of Alabama, made the following statement in his judgement:</p>
<blockquote>
<p>in Australia and New Zealand, prevailing ethical standards dictate that physicians usually create only one embryo at a time.</p>
</blockquote>
<p>He implied that in Australia, the only IVF cycles ethically permitted are stimulated cycles, where just one embryo is created and transferred, with no embryos being frozen. </p>
<figure class="align-center ">
<img alt="A pregnant woman holding her stomach." src="https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578120/original/file-20240227-24-koxpao.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many women need the help of IVF to become pregnant.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/image-pregnant-woman-touching-her-belly-147978782">10 FACE/Shutterstock</a></span>
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<p>However, this assertion is demonstrably false. There are no guidelines or regulations in Australia that discourage the creation of multiple embryos, as this practice enhances overall pregnancy rates, while making IVF safer and more cost-effective. </p>
<p>What is discouraged is the <em>transfer</em> of multiple embryos at one time, as this increases the likelihood of multiple births, which carry <a href="https://www.fertilitysociety.com.au/wp-content/uploads/20211124-RTAC-ANZ-COP.pdf">heightened medical risks</a> for both mothers and babies.</p>
<p>It seems the Chief Justice has fundamentally misunderstood the Australian regulatory framework. Ironically, the <a href="https://www.varta.org.au/sites/default/files/2023-11/VARTA_AR2023.pdf">excellent IVF outcomes</a> and very low rates of multiple births in Australia are largely attributable to the widespread use of frozen embryo transfer cycles – a practice now <a href="https://www.today.com/video/more-clinics-in-alabama-stop-ivf-treatments-after-court-ruling-204773957818">under threat</a> in Alabama.</p><img src="https://counter.theconversation.com/content/224365/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I am a fertility specialist and a Medical Director of Genea Fertility Melbourne, a private IVF unit.</span></em></p>A recent ruling from the Supreme Court of Alabama implies frozen embryos are legally equivalent to living children. This creates risks for IVF providers, and therefore problems for patients.Alex Polyakov, Medical Director, Genea Fertility Melbourne; Clinical Associate Professor, Faculty of Medicine, Dentistry & Health Sciences, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2231372024-02-20T16:52:16Z2024-02-20T16:52:16ZThe Virgin Mary features heavily in anti-abortion activism – and many Catholics are worried<p>If you’ve ever come across an anti-abortion protest, particularly outside of a clinic, you may have been struck by the use of the Virgin Mary. Images of Mary and other religious signs and symbols are frequently used in anti-abortion activism in Britain, as in other countries*.</p>
<p>At one level this is understandable because, as <a href="https://books.emeraldinsight.com/page/detail/anti-abortion-activism-in-the-uk/?k=9781839093999">our research has shown</a>, anti-abortion activists in the UK are overwhelmingly highly religious, with most aligned with conservative forms of Catholicism and a smaller number of evangelicals. Yet the use of these images also reveals important information about the activists’ motivations and understandings, such as ideas about the nature of women. And many Catholics are concerned about the way their religion is being portrayed.</p>
<p>The Catholic image of <a href="https://www.bbc.co.uk/news/world-latin-america-67690996">Our Lady of Guadalupe</a> appears on everything from clothing to jewellery to shopping bags. Our Lady of Guadalupe is a specific, Mexican variation of the Virgin Mary. She depicts Mary as pregnant and has been given the title of “the protectress of the unborn”. </p>
<p>Catholic activists we spoke to said that Mary was important in their campaign as someone who proceeded with an unplanned pregnancy. So Our Lady of Guadalupe is a good representation of their cause. </p>
<p>There was also a particular colonial understanding of Our Lady of Guadalupe’s role in converting Mexico to Christianity, linked to the activists’ ideas about child sacrifice. They mentioned how Our Lady of Guadalupe’s apparition was central to Christianity displacing the “pagan” Aztecs, who they believed <a href="https://www.mexicolore.co.uk/aztecs/home/nearly-everything-you-were-taught-about-aztec-sacrifice-is-wrong">sacrificed children</a>. </p>
<p>One participant went as far as to say that Mary enabled Mexicans to convert to the “true religion”. This position is in line with the <a href="https://www.nationalgeographic.com/culture/article/colonialism">colonial mentality</a> at the time, which <a href="https://eprints.whiterose.ac.uk/98075/3/Pennock%20-%20Insights%20from%20the%20Ancient%20Word.pdf">exaggerated and distorted indigenous practices</a> to justify subjugating whole populations.</p>
<p>Activists we spoke to linked child sacrifice and abortion and believe these to be the same thing. For these activists, Our Lady of Guadalupe visually represents opposition to abortion and is therefore really significant to their campaign.</p>
<p>But despite the beliefs of anti-abortion activists, there is no singular meaning of Our Lady of Guadalupe. All religious interpretations are disputed, and images can be used for many different reasons. </p>
<p>Our Lady of Guadalupe is often used to represent Mexican identity. <a href="https://www.police1.com/gangs/articles/understanding-east-coast-mexican-gangs-part-2-PJzWfEWCxb7QP21r/">Mexican prisoners</a> are known to deploy her image in tattoos. And she has also been an <a href="https://qspirit.net/queer-lady-guadalupe/">icon for the queer community</a>. </p>
<p>In these instances, her connection to abortion is absent, and we think that this is a surprise to many of the anti-abortion activists who promote her image.</p>
<h2>Misuse of religious symbols</h2>
<p>British Catholics are often unhappy with the ways anti-abortion activists use Catholic imagery. The majority of British Catholics <a href="https://www.independent.co.uk/news/uk/home-news/most-uk-catholics-support-abortion-and-use-of-contraception-2083291.html">support abortion</a> in at least some circumstances. Only a minority follow the strict Vatican teaching which is against abortion in all circumstances, including rape. </p>
<p><a href="https://link.springer.com/book/9783031546914">Our latest research</a> with Catholic parishioners reveals that they are particularly unhappy about anti-abortion activism at clinic sites. This is because they see this as harassment of service users and staff, as well as a public nuisance to the local people who live around abortion clinics. </p>
<p>Like most people in Britain, they think that “<a href="https://www.rcog.org.uk/media/iouempf3/fsrh-rcog-safe-access-zones-around-abortion-clinics-report.pdf">safe access zones</a>” are needed to prevent any form of abortion protest in the vicinity of clinics.</p>
<p>Some Catholic parishioners told us that anti-abortion activism at clinics involving prayer like the Rosary was a “misuse of prayer” and preyed on women who might be vulnerable. They are concerned about the overall image that this gave to Catholicism, especially when objects connected to Catholicism – such as rosary beads – are used. </p>
<p>Rather than following the teaching of the church – that abortion is always wrong – these Catholics felt individual conscience was key to abortion decisions. They also often emphasised the importance of recognising that reproductive decisions are made within the broader context of people’s lives. </p>
<p>Of those who were against abortion, many still did not think it was the right of anti-abortion activists to display their theological viewpoint outside of clinic sites. Instead, parishioners felt that people needed to determine what their moral stance on abortion was through their relationship with God.</p>
<p>Overall, rather than adopting a secular interpretation of abortion, Catholic parishioners used Catholic theology to interpret their perspective on abortion. This often led to a negative perception of anti-abortion activists.</p>
<p>The <a href="https://theconversation.com/there-is-no-one-religious-view-on-abortion-a-scholar-of-religion-gender-and-sexuality-explains-184532">multiple Catholic viewpoints</a> on abortion mean that an image such as the Virgin Mary does not have the same meaning to all those who display and see it. Even the same images of the Virgin Mary can have many different, and contrasting, interpretations. </p>
<p>It is important to recognise that, while religiously motivated anti-abortion activists often dominate the abortion discourse, they represent only a small minority of viewpoints within the broader Christian church.</p>
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<p class="fine-print"><em><span>Sarah-Jane Page has received funding from The British Academy for research related to abortion. </span></em></p><p class="fine-print"><em><span>Pam Lowe has received funding from The British Academy for research related to abortion. She is a member of Abortion Rights and has previoulsy undertaken a secondment at BPAS. </span></em></p>There is no singular meaning behind the Mary imagery used by anti-abortion activists.Sarah-Jane Page, Associate Professor, Faculty of Social Sciences, University of NottinghamPam Lowe, Senior Lecturer in Sociology, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2194952024-01-31T19:09:33Z2024-01-31T19:09:33ZWill abortion be the issue that swings the 2024 US presidential election?<p>Abortion is shaping up to be a central issue for both parties in the 2024 US presidential and Congressional elections.</p>
<p>Nearly two years ago, the US Supreme Court overturned the landmark Roe v. Wade decision, finding there was no constitutional right to abortion and returning regulation to the states.</p>
<p>Since that decision (a case known as Dobbs v. Jackson), <a href="https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html">14 states</a> now ban abortion in almost all circumstances and ten have imposed restrictions, some of which have been blocked by the courts. <a href="https://apnews.com/article/abortion-dobbs-anniversary-state-laws-51c2a83899f133556e715342abfcface">One in three</a> women of reproductive age now live in states that have either banned or restricted abortion.</p>
<p>Abortion remains legal and protected in 26 states, plus the District of Columbia. </p>
<p>For decades, abortion has been central to partisan politics in the United States. Republicans made opposition to abortion a core part of their identity and voter mobilisation strategies. They pumped out so-called “<a href="https://www.nytimes.com/2024/01/12/us/politics/house-republicans-abortion-ban.html">messaging bills</a>” (dramatic legislation with little chance of passing or being upheld, such as the <a href="https://www.paul.senate.gov/news-sen-rand-paul-introduces-life-conception-act/">Life At Conception bill</a>), while <a href="https://link.springer.com/content/pdf/10.1007/978-3-030-01707-1.pdf">pledging</a> to end Roe v Wade.</p>
<p>Yet, abortion was not a make-or-break electoral cause. In 2018, sociologist <a href="https://www.wiley.com/en-au/Abortion+Politics-p-9780745688787">Ziad Munson</a> concluded</p>
<blockquote>
<p>[…] for the vast majority of the public, abortion is simply not a key issue they consider when deciding their vote.</p>
</blockquote>
<h2>Most Americans still support abortion rights</h2>
<p>Dobbs v. Jackson, however, transformed the political landscape. Support for abortion is now at a <a href="https://news.gallup.com/poll/506759/broader-support-abortion-rights-continues-post-dobbs.aspx">record high</a> among Americans, with 69% believing abortion should be legal in the first three months of pregnancy and 61% believing that overturning Roe v. Wade was a “bad thing”. </p>
<p>Women and young people have <a href="https://www.vox.com/policy-and-politics/2022/9/4/23333329/roe-voter-registration-dobbs-midterms-democrats">rushed</a> to register as new voters. And 21% of registered voters describe abortion as the issue they would be <a href="https://fivethirtyeight.com/features/abortion-was-always-going-to-impact-the-midterms/">unwilling to compromise on</a>, a sentiment most pronounced among Democrats and independents. </p>
<p>In the 2022 midterm elections in the US, voter anger over Dobbs v. Jackson was <a href="https://www.npr.org/2022/11/25/1139040227/abortion-midterm-elections-2022-republicans-democrats-roe-dobbs">widely</a> <a href="https://fivethirtyeight.com/features/abortion-was-always-going-to-impact-the-midterms/">credited</a> with stopping the expected “<a href="https://www.politico.com/news/2022/11/09/abortion-votes-2022-election-results-00065983">red wave</a>” in Congress and state races, even as President Joe Biden’s <a href="https://www.pewresearch.org/politics/2023/12/14/assessments-of-joe-biden/pp_2023-12-14_gop_2-01/">approval rating</a> hovered around 40%. </p>
<p>Abortion was also central to Democrats <a href="https://www.theguardian.com/us-news/2023/dec/20/democrats-virginia-abortion-strategy-roe-v-wade-2024-election">gaining control</a> of the Virginia state legislature in 2023.</p>
<p>Seven states have voted on abortion referendums since the Dobbs v. Jackson decision. All were <a href="https://www.politico.com/news/2023/11/09/abortion-rights-elections-red-states-00126225">decisive victories for reproductive rights</a>, including in <a href="https://www.washingtonpost.com/politics/2023/11/07/ohio-issue-1-election-results/">traditionally red</a> states such as Kansas, Kentucky and Ohio. In Ohio, one in five Republicans voted to constitutionally <a href="https://www.theguardian.com/us-news/2023/nov/17/ohio-abortion-rights-republicans-overturn">protect</a> abortion access in the state.</p>
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<h2>Democrats have an issue to rally support</h2>
<p>All of this points to abortion being a major issue in the presidential election later this year.</p>
<p>Biden, a practising Catholic, is an unlikely pro-choice ally. In 1973, he believed the Supreme Court went “<a href="https://www.nytimes.com/2019/03/29/us/politics/biden-abortion-rights.html">too far</a>” in the Roe v. Wade decision. During his decades in the Senate, his views <a href="https://www.nbcnews.com/politics/2020-election/biden-s-long-evolution-abortion-rights-still-holds-surprises-n1013846">evolved</a> and he now believes Roe v. Wade “<a href="https://www.cbsnews.com/news/joe-biden-abortion-catholic-faith-roe-v-wade-got-it-right/">got it right</a>.”</p>
<p>Initially, the Biden administration was slow to respond to the <a href="https://theconversation.com/what-would-amy-coney-barrett-trumps-pick-for-the-supreme-court-mean-for-abortion-rights-in-the-us-146931">palpable threat</a> to reproductive rights in the lead-up to Dobbs v. Jackson. It took Biden <a href="https://didbidensayabortionyet.org/">468 days</a> to publicly say the word abortion as president, and he still <a href="https://www.politico.com/news/2023/06/22/biden-abortion-2024-campaign-reelection-00103158">rarely</a> uses the term. </p>
<p>After Dobbs v. Jackson, however, both Biden and Vice President Kamala Harris became assertive in defence of abortion rights. Legislatively hamstrung, the administration used the <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2023/01/22/fact-sheet-president-biden-to-sign-presidential-memorandum-on-ensuring-safe-access-to-medication-abortion/">Food and Drug Administration</a>, the <a href="https://www.justice.gov/opa/pr/attorney-general-merrick-b-garland-statement-supreme-court-ruling-dobbs-v-jackson-women-s">Justice Department</a>, and <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2023/06/23/fact-sheet-biden-harris-administration-highlights-commitment-to-defending-reproductive-rights-and-actions-to-protect-access-to-reproductive-health-care-one-year-after-overturning-of-roe-v-wade/">executive orders</a> to try to protect and expand access to abortion and contraception across the country.</p>
<p>And abortion will be “<a href="https://www.politico.com/news/2023/06/22/biden-abortion-2024-campaign-reelection-00103158">front and centre</a>” for Democrats in the 2024 elections.</p>
<p>In <a href="https://www.nytimes.com/2023/11/08/us/politics/abortion-ads-democrats-election.html">advertisements</a>, <a href="https://www.youtube.com/watch?v=yGnc8JkaUII">Senate briefings</a>, <a href="https://www.whitehouse.gov/briefing-room/speeches-remarks/2023/04/25/remarks-by-vice-president-harris-at-a-political-event-on-reproductive-rights/">campaign events</a>, and <a href="https://www.reuters.com/world/us/biden-harris-begin-abortion-rights-campaign-roe-v-wade-anniversary-2024-01-18/">television appearances</a>, Democrats emphasise the suffering caused by what they call “<a href="https://abcnews.go.com/Health/wireStory/bidens-campaign-pushes-abortion-rights-2024-battle-republicans-106483145">draconian</a>” Republican abortion bans and the advocacy work of doctors and reproductive rights groups.</p>
<p>To drive home the point, the Biden-Harris team made their first joint campaign appearance of the year in late January at a <a href="https://edition.cnn.com/2024/01/23/politics/biden-harris-abortion-rights/index.html">reproductive rights rally</a> in Virginia, a day after what would have been the 51st anniversary of the Roe v. Wade decision. </p>
<h2>For Republicans, it’s complicated</h2>
<p>Dobbs v. Jackson was the fulfilment of a Republican promise decades in the making. Publicly, Republicans celebrated. Privately, some believed the party was “<a href="https://www.politico.com/news/2022/06/25/the-dog-that-caught-the-car-republicans-brace-for-the-impact-of-reversing-roe-00042387">the dog that caught the car</a>”.</p>
<p>Anti-abortionists have always viewed overturning Roe v. Wade as merely a first step, with the ultimate goal being an end to legal abortion nationwide. Since Dobbs v. Jackson, anti-abortion groups have pushed for: </p>
<ul>
<li><p>a <a href="https://www.nytimes.com/2023/04/20/us/politics/trump-abortion-susan-b-anthony.html">federal abortion ban at 15 weeks and beyond</a> </p></li>
<li><p>state bills to outlaw <a href="https://www.washingtonpost.com/politics/2022/08/14/medicated-abortions-drugs-students-for-life/">abortion-inducing drugs</a> (now the most common type of abortion method) </p></li>
<li><p>“<a href="https://time.com/6191886/fetal-personhood-laws-roe-abortion/">foetal personhood</a>” laws that would extend legal rights to foetuses or embryos from the <a href="https://www.nytimes.com/2022/08/21/us/abortion-anti-fetus-person.html">moment of fertilisation</a>, with likely consequences for in vitro fertilisation and some forms of contraception.</p></li>
</ul>
<p>Since the Republican primary campaigns began last year, however, <a href="https://apnews.com/article/iowa-republicans-presidential-candidates-abortion-55dd7067d626c4add1f1270c03e33655">the silence among prospective candidates</a> has been striking. </p>
<p>Most presidential aspirants have preferred to talk generically about “<a href="https://www.npr.org/2023/11/16/1213006071/republican-candidates-abortion-rights">protecting life</a>.” Nikki Haley, the only candidate remaining to challenge frontrunner Donald Trump, has spoken vaguely of the need for “<a href="https://www.washingtonpost.com/politics/2024/01/23/haley-abortion-new-hampshire/">consensus</a>” on abortion at the federal level.</p>
<p>As for Trump, he ran <a href="https://democrats.org/news/donald-trump-brags-about-his-role-in-overturning-roe-in-new-ads/">Facebook advertisements</a> before the Iowa caucuses last month calling himself “THE MOST Pro-Life President in history.” Yet, simultaneously, Trump is positioning himself as an abortion <a href="https://www.rollingstone.com/politics/politics-features/donald-trump-abortion-moderate-run-2024-election-1234893936/">moderate</a>. </p>
<p>Trump’s cynical about-face should come as no surprise. In 1999, Trump claimed to be “<a href="https://www.nbcnews.com/meet-the-press/video/trump-in-1999-i-am-very-pro-choice-480297539914">very pro-choice</a>.” By the 2016 Republican primaries, he had become much more <a href="https://www.washingtonpost.com/news/wonk/wp/2016/10/20/rip-the-baby-out-of-the-womb-what-donald-trump-got-wrong-about-abortion-in-america/">extreme</a> and <a href="https://edition.cnn.com/2016/03/30/politics/donald-trump-abortion-town-hall/index.html">controversial</a> in his rhetorical opposition to abortion.</p>
<p>Trump has repeatedly dodged questions about whether he supports a federal law, refusing to support the idea of a 15-week ban <a href="https://www.bbc.com/news/world-us-canada-66003915">championed</a> by his former vice president, Mike Pence. </p>
<p>In September, he described Florida Governor Ron DeSantis’ signing of a six-week abortion ban in his state as “<a href="https://www.pbs.org/newshour/politics/trump-labels-desantis-abortion-ban-a-terrible-mistake-riling-some-republicans">a terrible thing and a terrible mistake</a>.” Then, in January, Trump told a Fox News town hall audience that on abortion, “there has to be a little bit of a <a href="https://slate.com/news-and-politics/2024/01/donald-trump-abortion-bans-fox-news-town-hall.html">concession</a>.”</p>
<p>Initially, anti-abortion activists condemned Trump, even picketing one of his Miami rallies with signs declaring “<a href="https://www.rollingstone.com/politics/politics-features/anti-abortion-activists-protest-donald-trump-rally-florida-1234873608/">Make Trump Pro-Life Again</a>”. However, with Trump widely expected to be the Republican candidate, these groups are now <a href="https://www.washingtonpost.com/politics/2024/01/05/trump-abortion/">falling in line</a>. Ultimately, they need him far more than he needs them.</p>
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<p>The new Republican timidity about abortion does not mean that conservatives have had a fundamental change of heart. As Trump put it, “<a href="https://abcnews.go.com/Politics/trump-boasts-role-ending-roe-wade-abortion-regulations/story?id=106280890">you got to win elections</a>.” If they win the presidency and majorities in both houses of Congress in November, Republicans will most likely continue their assault on abortion and reproductive rights.</p>
<p>In January, Biden’s job approval rating hit <a href="https://abcnews.go.com/Politics/trump-tops-opponents-biden-hits-new-low-approval/story?id=106335244">record lows</a> at a time of historic inflation levels. Even though abortion has been political poison for Republicans, it <a href="https://time.com/6561898/donald-trump-voters-2024/">may not be enough</a> to help Democrats hold onto the White House.</p><img src="https://counter.theconversation.com/content/219495/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Prudence Flowers has received funding from the South Australian Department of Human Services. She is a member of the South Australian Abortion Action Coalition. </span></em></p>Democrats now have an issue to mobilise voters. For Republicans, however, it’s more complicated.Prudence Flowers, Senior Lecturer in US History, College of Humanities, Arts, and Social Sciences, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2190762024-01-30T13:35:16Z2024-01-30T13:35:16ZTelehealth makes timely abortions possible for many, research shows<figure><img src="https://images.theconversation.com/files/570966/original/file-20240123-19-9zfcc4.jpg?ixlib=rb-1.1.0&rect=60%2C0%2C6649%2C4466&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The COVID-19 pandemic brought telehealth into the mainstream. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/telemedicine-royalty-free-image/1390865559?phrase=telehealth+abortion+care&adppopup=true">Sladic/E+ via Getty Images</a></span></figcaption></figure><p>Access to telehealth abortion care can determine whether a person can obtain an abortion in the United States. For young people and those living on low incomes, telehealth makes a critical difference in getting timely abortion care. </p>
<p>These are the key findings from our recent studies published in the <a href="https://doi.org/10.2105/AJPH.2023.307437">American Journal of Public Health</a> and the <a href="https://doi.org/10.2196/45671">Journal of Medical Internet Research</a>.</p>
<p>We surveyed 1,600 people across the country who accessed telehealth abortion in 2021 and 2022, prior to the <a href="https://www.nytimes.com/interactive/2022/06/24/us/politics/supreme-court-dobbs-jackson-analysis-roe-wade.html">Dobbs v. Jackson Supreme Court decision</a> in June 2022 that led to <a href="https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html">abortion bans in much of the U.S. South and Midwest</a>.</p>
<p><a href="https://theconversation.com/abortion-pills-are-safe-to-prescribe-without-in-person-exams-new-research-finds-179622">Telehealth abortion</a>, which has been widely available in the U.S. only since 2021, allows patients to be evaluated remotely by a licensed provider and, if medically eligible, receive abortion medications in the mail. Our research has shown that this <a href="https://doi.org/10.1001%2Fjamanetworkopen.2021.22320">type of abortion care is extremely safe</a>.</p>
<p>Nearly all the patients we surveyed had positive experiences with telehealth abortion: They were satisfied, trusted their telehealth provider, felt cared for and felt telehealth was the right decision. Our research shows that for many patients, telehealth offers important benefits over abortion care from a clinic. </p>
<h2>Why it matters</h2>
<p>Since 14 states have banned abortion as of January 2024 following the Dobbs decision, patients have been <a href="https://doi.org/doi:10.1001/jama.2022.20424">traveling long distances to access care</a>. This puts increased pressure on clinics in states where abortion remains legal. </p>
<p>Research has shown that the consequences of abortion bans are highly unequal. People of color, young people and those living on lower incomes are <a href="https://www.guttmacher.org/node/300256/printable/print">disproportionately affected by abortion restrictions</a>. These are the same people who stand to benefit the most from access to telehealth abortion. </p>
<p>Nearly 1 in 10 abortions in the U.S. <a href="https://doi.org/10.46621/218569qkgmbl">are now done via telehealth</a>. At the same time, access to telehealth abortion is under threat. The Supreme Court will decide on the <a href="https://www.scotusblog.com/case-files/cases/food-and-drug-administration-v-alliance-for-hippocratic-medicine-2/">Alliance for Hippocratic Medicine v. FDA case</a> in 2024, which could limit access to telehealth abortion across the country.</p>
<p>While there will always be a need for in-person abortion care, and many patients prefer it, our research shows that telehealth can make a critical difference for many. Telehealth can bring an otherwise impossible abortion within reach, especially for people who have been underserved in health care. Restrictions on telehealth abortion threaten equitable abortion access.</p>
<p>Telehealth allows patients to avoid a significant amount of travel to an abortion clinic, which has become prohibitively difficult as abortion clinics <a href="https://www.guttmacher.org/2022/10/100-days-post-roe-least-66-clinics-across-15-us-states-have-stopped-offering-abortion-care">have closed in record numbers</a>. Avoiding travel can make abortion care much more accessible without the need to arrange for transport, time off from work and child care. Telehealth abortion appointments are usually available sooner, and in many cases they are more affordable than abortion care from a clinic. Telehealth also allows patients to tell fewer people about their abortion decision.</p>
<p>When we asked people what would have happened if they had not been able to have a telehealth abortion, 43% of those we surveyed said they would not have been able to get a timely abortion without telehealth. </p>
<p>This was more likely to be true for young people, those living on lower incomes, those living in rural areas and those who lived far from an abortion clinic. While only 2% of patients said they would have continued the pregnancy if they had not had access to telehealth abortion, we expect that this proportion would have been substantially higher if we replicated this study after Dobbs.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/pUjiu_AcehE?wmode=transparent&start=15" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">New York City’s public health system offers telehealth visits to pregnant patients, who then can receive abortion pills by mail.</span></figcaption>
</figure>
<h2>What’s next</h2>
<p>Our future research will look at the structural changes necessary to ensure that the benefits of telehealth abortion are available equitably. We will also test how to tailor telehealth abortion so that it reaches people historically excluded from health care. </p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/219076/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leah Koenig receives funding from the National Institute of Child Health and Human Development and the Society of Family Planning.</span></em></p><p class="fine-print"><em><span>Ushma Upadhyay receives funding from the BaSe Family Fund, Erik E. and Edith H. Bergstrom Foundation, Isabel Allende Foundation, Lisa and Douglas Goldman Fund, Preston-Werner Ventures, and the National Institute of Child Health and Human Development under Award Number 1R01HD110659-01A1.
She is a member of the Society of Family Planning, the Population Association of America, and the South Asian Public Health Association. </span></em></p>People of color, young people and those with low incomes tend to benefit most from telehealth abortion.Leah Koenig, PhD Candidate in Public Health, University of California, San FranciscoUshma Upadhyay, Professor of Obstetrics, Gynecology & Reproductive Science, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2213892024-01-26T13:21:52Z2024-01-26T13:21:52ZMost state abortion bans have limited exceptions − but it’s hard to understand what they mean<figure><img src="https://images.theconversation.com/files/571261/original/file-20240124-27-dzfjqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women who were denied abortions, despite serious pregnancy complications, appear outside the Texas Supreme Court in November 2023, following arguments in a lawsuit they brought against the state. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/plaintiffs-including-amanda-zurowski-speaks-at-a-press-news-photo/1807598346?adppopup=true">Suzanne Cordeiro/AFP via Getty Images </a></span></figcaption></figure><p>More than a year after the Supreme Court found there is no <a href="https://www.oyez.org/cases/2021/19-1392">fundamental right to get an abortion</a>, <a href="https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html">21 states have laws in effect</a> that ban abortion well before fetal viability, generally allowing it only in the first trimester. </p>
<p>Fourteen of these 21 states have also issued near-total bans on abortion from the point of conception. But it’s not clear when, if ever, an abortion would be permissible under these near-total bans.</p>
<p>Virtually all states, including Arkansas, North Dakota and Oklahoma, for example, allow an <a href="https://www.kff.org/womens-health-policy/state-indicator/gestational-limit-abortions/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D">abortion when necessary</a> to save the life of the pregnant person. But the laws don’t explain just how close to death the person must be before the abortion can be performed. </p>
<p><a href="https://www.kff.org/womens-health-policy/issue-brief/a-review-of-exceptions-in-state-abortions-bans-implications-for-the-provision-of-abortion-services">Some states</a>, such as Georgia, Indiana and West Virginia, also include exceptions for health concerns, rape, incest or lethal fetal anomalies. </p>
<p>Most of these exceptions are <a href="https://www.nytimes.com/2023/12/17/opinion/kate-cox-abortion-texas-exceptions.html">vaguely worded</a>, leaving physicians and pregnant patients to navigate <a href="https://www.nashvillescene.com/news/citylimits/sarah-needed-an-abortion-her-doctors-needed-lawyers/article_472a621e-7fdb-11ed-bf8d-0797b6012be2.html">whether a particular abortion</a> <a href="https://www.washingtonpost.com/health/2022/07/16/abortion-miscarriage-ectopic-pregnancy-care/">would be legal</a>. </p>
<p><a href="https://www.law.virginia.edu/faculty/profile/nrc8g/2915359">As experts</a> on <a href="https://www.law.gwu.edu/sonia-m-suter">reproductive health and justice</a>, we are trying to untangle just what these different medical exceptions mean. This is an important question for legal experts, but also for doctors and caregivers, as well as people who are pregnant and their families – all trying to make sense of the various bans in effect. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/571258/original/file-20240124-17-qkkg3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="People, some holding posters, march outside of a grey building that says 'Bans off our bodies' in white writing, against a hot pink backdrop." src="https://images.theconversation.com/files/571258/original/file-20240124-17-qkkg3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571258/original/file-20240124-17-qkkg3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571258/original/file-20240124-17-qkkg3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571258/original/file-20240124-17-qkkg3o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571258/original/file-20240124-17-qkkg3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571258/original/file-20240124-17-qkkg3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571258/original/file-20240124-17-qkkg3o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Anti-abortion activists protest outside a Planned Parenthood clinic in Washington, D.C., on Jan 18, 2024.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/pro-and-anti-abortion-protesters-are-facing-off-in-front-of-news-photo/1935914291?adppopup=true">Aaron Schwartz/NurPhoto via Getty Images</a></span>
</figcaption>
</figure>
<h2>Steep penalties, murky legal language</h2>
<p>Because these different state laws use nonmedical language and threaten steep penalties – such as <a href="https://www.americanprogress.org/article/a-year-after-the-supreme-court-overturned-roe-v-wade-trends-in-state-abortion-laws-have-emerged/">life imprisonment</a> – for performing an abortion that violates the statute, some <a href="https://www.nbcnews.com/health/health-news/risky-pregnancy-abortion-doctors-consult-lawyers-rcna37651">physicians have been turning to lawyers for guidance</a>. </p>
<p>For example, Tennessee <a href="https://law.justia.com/codes/tennessee/2021/title-39/chapter-15/part-2/section-39-15-213/">has an exception</a> that allows abortions “necessary to prevent the death of the pregnant woman or to prevent serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman.” And West Virginia allows abortions for “nonviable” fetuses, <a href="https://code.wvlegislature.gov/16-2R-2/">defined as those with a “lethal anomaly</a> … incompatible with life outside of the uterus.”</p>
<p>These exceptions are confusing to health care providers, in part because the laws <a href="https://scholarship.shu.edu/shlr/vol53/iss5/2">assume a certainty in medicine that may not exist</a>. The laws also <a href="https://www.cnn.com/2023/12/15/us/texas-abortion-ban-emergency-medical-exception/index.html">do not rely on medical terms</a>. </p>
<p>This means that health care providers in states where abortion is banned – apart from these limited exceptions – are reluctant to provide abortions under any circumstances, <a href="https://www.latimes.com/world-nation/story/2022-07-29/fearful-of-prosecution-doctors-debate-how-to-treat-pregnant-patients">even in the face of life-threatening conditions</a> or severe <a href="https://jessica.substack.com/p/abortion-exceptions-dont-exist">fetal anomalies</a>. </p>
<p>The rate of abortions in the states where there is a near-total or total ban <a href="https://www.axios.com/2023/10/24/abortion-increase-roe-wade-state-ban">decreased by 100%</a> from April 2022, just before the <a href="https://www.oyez.org/cases/2021/19-1392">Supreme Court overturned</a> the right to an abortion, through June 2023.</p>
<h2>Legal action for answers</h2>
<p>Some health care providers and their patients have sued to find out just when abortions might be permitted. </p>
<p>Courts in different states, from the trial court to the supreme court level, are now being forced to consider these questions and have begun to weigh in with opinions that lead to even more uncertainty. At the heart of this litigation is <a href="https://scholarship.shu.edu/cgi/viewcontent.cgi?article=3550&context=shlr">how to balance doctors’ conflicting obligations</a>
to provide the best medical care, which could include offering an abortion that they fear state bans may prohibit. </p>
<p>And because each state uses its own language to define a ban and its exceptions, one court’s opinion regarding its ban does not dictate how another state’s ban should be interpreted. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/571484/original/file-20240125-21-169abh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman in a black outfit stands at a podium in front of a long row of women who stand looking forward." src="https://images.theconversation.com/files/571484/original/file-20240125-21-169abh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571484/original/file-20240125-21-169abh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571484/original/file-20240125-21-169abh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571484/original/file-20240125-21-169abh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571484/original/file-20240125-21-169abh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571484/original/file-20240125-21-169abh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571484/original/file-20240125-21-169abh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Center for Reproductive Rights attorney Molly Duane speaks outside the Texas Supreme Court in Austin, joined by the plaintiffs in the organization’s abortion clarification suit against the state.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/center-for-reproductive-rights-attorney-molly-duane-news-photo/1807623427?adppopup=true">Suzanne Cordeiro/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>Texas’ abortion ban</h2>
<p>Texas is one of the states that banned nearly all abortions in 2022. Texas law allows an abortion only when there is a “medical emergency” for the pregnant person, defined as a “life-threatening physical condition” related to the pregnancy that “poses a serious risk of substantial impairment of a <a href="https://statutes.capitol.texas.gov/Docs/HS/htm/HS.170A.htm#:%7E:text=Sec.-,170A.,induce%2C%20or%20attempt%20an%20abortion.">major bodily function</a>.”</p>
<p>In March 2023, the advocacy group Center for Reproductive Rights filed a lawsuit on behalf of a group of Texas women and two obstetricians-gynecologists, seeking clarification over when Texas’ ban allows an abortion. </p>
<p><a href="https://reproductiverights.org/zurawski-v-texas-plaintiffs-stories-remarks/">The Texas women</a>, who faced serious pregnancy-related health risks or very low odds of their baby’s survival outside the womb, were denied abortions or told to wait until death was more imminent. Some of the women got abortions outside of Texas, and others gave birth to babies who lived only briefly because of serious fetal health problems.</p>
<p><a href="https://reproductiverights.org/case/zurawski-v-texas-abortion-emergency-exceptions/zurawski-v-texas/">The plaintiffs argued</a> that the law’s confusing language – as well as the <a href="https://www.nytimes.com/2023/12/14/podcasts/the-daily/texas-abortion-ban.html?showTranscript=1">threat to physicians</a> of 99 years in jail, $100,000 in fines and a loss of their medical license – led to delays or denials of medical treatment they needed. </p>
<p>In August 2023, a Texas trial court judge blocked enforcement of the state’s abortion ban when “in a physician’s good faith judgment and in consultation with the pregnant person, the pregnant person has an emergent medical <a href="https://statecourtreport.org/sites/default/files/fastcase/additionalPdfs/processed/District%20Court%20-Order%20Granting%20Injunction%20-08.04.2023.pdf">condition requiring abortion care</a>.” This could include medical conditions that make it unsafe to continue the pregnancy or diagnosis of a fetal abnormality that would not allow it to survive after birth. </p>
<p>Texas appealed this decision to the state Supreme Court. The lower court decision is on hold until the Supreme Court issues its final decision; the court has not <a href="https://www.texastribune.org/2023/11/28/texas-supreme-court-abortion/">said when it would rule</a>.</p>
<p>Because there is still no definitive decision on how to interpret the Texas law, pregnant patients have been left in limbo. </p>
<p>Katie Cox, for example, is a Texas woman who was diagnosed when she was 20 weeks pregnant with a <a href="https://msmagazine.com/2023/12/13/welcome-to-the-pro-life-dystopia/">severe fetal anomaly</a> called trisomy 18. Carrying the pregnancy to term would have threatened her fertility, potentially preventing the mother of two from birthing more children in the future. </p>
<p>After <a href="https://www.nytimes.com/2023/12/14/podcasts/the-daily/texas-abortion-ban.html?showTranscript=1">Cox’s doctor</a> explained it was not an option in Texas to terminate the pregnancy, Cox and her doctor went to court seeking judicial approval for <a href="https://www.texastribune.org/2023/12/07/texas-emergency-abortion-lawsuit/">an abortion</a>. </p>
<p>Travis County District Judge Maya Guerra Gamble granted permission in December 2023, finding that it would be a “miscarriage of justice” to prohibit <a href="https://abc13.com/texas-abortion-ban-attorney-general-ken-paxton-katie-cox-block-ruling/14155514/">Cox from ending her pregnancy</a>. </p>
<p>But days later, the Texas Supreme Court blocked the district court ruling. It <a href="https://www.txcourts.gov/media/1457645/230994pc.pdf">conceded that Cox’s pregnancy was “extremely complicated</a>,” but refused to find that state law permitted the abortion. Cox left the state to get an abortion. </p>
<p>The Texas Supreme Court opinion in December still left many questions unanswered. The court stated that a judicial order was not required to permit a doctor to perform an abortion in the case of a medical emergency. <a href="https://www.txcourts.gov/media/1457645/230994pc.pdf">But it also interpreted the law as setting an objective standard as to whether the exception applied</a>. </p>
<p>That left open the possibility that the state could find an expert witness to challenge the physician’s judgment. </p>
<h2>A thread of uncertainty</h2>
<p>Since 2022, the Center for Reproductive Rights has also brought <a href="https://apnews.com/article/supreme-court-abortion-medical-emergencies-idaho-8ca89d7de0c1fa9256dcd27d1847e144#:%7E:text=The%20Supreme%20Court%20is%20allowing,ban%2C%20even%20in%20medical%20emergencies&text=WASHINGTON%20(AP)%20%E2%80%94%20The%20Supreme,while%20a%20legal%20fight%20continues">lawsuits in Idaho</a>, <a href="https://apnews.com/article/abortion-tennessee-lawsuit-fd630c5f55f605597d8eaa2800abbcfd#:%7E:text=WHAT%20THE%20LAWSUIT%20SEEKS%20TO,to%20legally%20receive%20an%20abortion">Tennessee</a> <a href="https://www.reuters.com/world/us/women-denied-abortions-file-lawsuits-idaho-tennessee-oklahoma-over-bans-2023-09-12/">and Oklahoma</a>, <a href="https://reproductiverights.org/exceptions-complaints-idaho-tennessee-oklahoma/">seeking clarity</a> on medical emergency exceptions in the states’ abortion bans.</p>
<p>The lawsuit’s underlying claim is that uncertainty about the scope of the exceptions has, according to the Idaho complaint, “sown confusion, fear and chaos among the medical community, resulting in grave harms to pregnant patients whose health and safety hang in the <a href="https://reproductiverights.org/wp-content/uploads/2023/09/ID-Complaint-Final-9-12.pdf">balance across the state</a>.” </p>
<p>What all of these cases and stories show is that even when abortion bans claim to allow exceptions based on medical judgment, physicians – and their patients – <a href="https://scholarship.shu.edu/cgi/viewcontent.cgi?article=3550&context=shlr">know their decisions</a> can be second-guessed and challenged in court.</p><img src="https://counter.theconversation.com/content/221389/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Women in Texas and in other states with abortion bans are suing, asking for clarification on when medical exceptions could actually be granted.Naomi Cahn, Professor of Law, University of VirginiaSonia Suter, Professor of law, George Washington UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2216892024-01-22T17:13:25Z2024-01-22T17:13:25ZShould a health professional be disciplined for reporting an illegal abortion?<figure><img src="https://images.theconversation.com/files/570679/original/file-20240122-22-wbx4er.jpg?ixlib=rb-1.1.0&rect=19%2C9%2C6395%2C4260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/infertility-concept-depressed-unrecognizable-lady-showing-2396733297">Prostock-studio/Shutterstock</a></span></figcaption></figure><p>There have been <a href="https://www.theguardian.com/world/2023/nov/10/the-women-being-prosecuted-in-great-britain-for-abortions-her-confidentiality-was-completely-destroyed">several high-profile cases</a> in the last year of women in the UK being prosecuted for allegedly obtaining abortions illegally. In 2022, there were 29 cases of suspected unlawful abortions that were reported to police – almost a twofold rise on the number reported four years earlier.</p>
<p>In response to this, the Royal College of Obstetrics and Gynaecologists (RCOG) has <a href="https://www.rcog.org.uk/news/rcog-issues-guidance-for-healthcare-professionals-on-involving-the-police-following-abortion-and-pregnancy-loss/">issued guidance</a> that seeks to clarify the legal obligations of healthcare professionals. The full guideline has not yet been released, but the RCOG insists that professionals “are under no legal obligation to contact the police following an abortion, pregnancy loss or unattended delivery”.</p>
<p>There are different ethical questions that we might ask concerning abortion and the law in the UK. For example, we might ask what the law should be. That is, at what stage of pregnancy and in which circumstances abortion should be legally permitted?</p>
<p>A more radical question would be whether abortion is properly a question for the law. </p>
<p><a href="https://www.rcog.org.uk/about-us/campaigning-and-opinions/position-statements/reforming-abortion-law/">RCOG</a> and the <a href="https://www.bma.org.uk/media/1142/bma-paper-on-the-decriminalisation-of-abortion-february-2017.pdf">British Medical Association</a> (the trade union for UK doctors) have long called for reform and decriminalisation of abortion, arguing that – where it is provided by a health professional with the woman’s consent – it should be managed and regulated as other forms of healthcare.</p>
<p>But a different question relates to how health professionals should respond in a situation where abortion is sometimes unlawful and they become aware that a woman has sought an abortion outside the current legal framework. Must they report to the police? May they report to the police (for example, if they have a personal view that abortion is seriously wrong)? Or, if they do report to the police, might the health professional be the one who ends up in trouble?</p>
<figure class="align-center ">
<img alt="A police car with blue lights flashing." src="https://images.theconversation.com/files/570690/original/file-20240122-25-h2bmgy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570690/original/file-20240122-25-h2bmgy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=331&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570690/original/file-20240122-25-h2bmgy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=331&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570690/original/file-20240122-25-h2bmgy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=331&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570690/original/file-20240122-25-h2bmgy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=416&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570690/original/file-20240122-25-h2bmgy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=416&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570690/original/file-20240122-25-h2bmgy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=416&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Is it really a question for the police?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/burnopfield-england-uk-september-10-2021-2044855232">Duncan Andison/Shutterstock</a></span>
</figcaption>
</figure>
<h2>A question of confidentiality</h2>
<p>The central ethical issue at stake here is not, in fact, the morality of abortion. Rather, the key issue is about medical confidentiality and when health professionals are justified in violating their strong obligations to safeguard the patient’s medical details.</p>
<p>Confidentiality has been thought to be vital to the doctor-patient relationship <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2280818/pdf/canfamphys00158-0229.pdf">for centuries</a>. For doctors to be able to help patients, they need the patient to provide full details of their symptoms and how they have arisen. That will sometimes include very private details – say, of sexual relationships and function – which the patient will only divulge if they can be assured the doctor will keep them strictly secret. </p>
<p>In more recent decades, confidentiality has also been justified in terms of a more fundamental right of the patient to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2280818/pdf/canfamphys00158-0229.pdf">privacy and autonomy</a>. That right seems particularly vital when it comes to reproductive healthcare.</p>
<p>Because it is so important, modern <a href="https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/confidentiality/disclosures-for-the-protection-of-patients-and-others">codes of practice</a> for health professionals allow confidentiality to be breached only in truly exceptional circumstances. That could include notification of a serious infectious disease or prevention of terrorism. But it does not, in most circumstances, include reporting that a patient has committed a crime. </p>
<p>For example, imagine a doctor who discovers that their patient suffered an injury while burgling a house, has suffered an overdose from taking class A drugs, or has acquired a sexually transmitted disease while engaging in street prostitution. General Medical Council (GMC) guidance suggests that in such circumstances it would not be appropriate (unless the patient consents) for the doctor to report that information to the police. </p>
<p>The GMC – the body responsible for medical licensing – indicates that breaching confidentiality would only be <a href="https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/confidentiality/disclosures-for-the-protection-of-patients-and-others">justified</a> for a “serious crime”, and that it would only be in the public interest to disclose if “failure to do so may expose others to a risk of death or serious harm”.</p>
<p>Of course, one key ambiguity in the GMC guidance is what counts as a “serious crime”. The guidance notes this and mentions <a href="https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/confidentiality/disclosures-for-the-protection-of-patients-and-others">examples of</a> “murder, manslaughter, rape and child abuse”. However, some members of the community – including potentially some health professionals – regard abortion as a serious crime, just as bad as those listed. That may lead them to feel a responsibility to report.</p>
<p>The latest RCOG guideline seeks to address that ambiguity, indicating a <a href="https://www.rcog.org.uk/news/rcog-issues-guidance-for-healthcare-professionals-on-involving-the-police-following-abortion-and-pregnancy-loss/">view</a> that “it is never in the public interest to investigate and prosecute women who have sought to end their own pregnancy”. </p>
<h2>Reassuringly strong statements</h2>
<p>It indicates that health professionals must not provide information to the police without a woman’s consent unless “concerned for her safety or the safety of others”. Such strong statements will hopefully reassure health professionals of the scope of their legal duty to report and reduce the number of women who are reported to the police.</p>
<p>But we might wonder what would happen if, despite this guidance, a doctor were to report to the police. The <a href="https://www.rcog.org.uk/news/rcog-issues-guidance-for-healthcare-professionals-on-involving-the-police-following-abortion-and-pregnancy-loss/">college guideline</a> refers, elliptically, to “potential consequences of breaching patient confidentiality”. </p>
<p>That might be intended to remind professionals of the <a href="https://www.theguardian.com/world/2023/nov/10/the-women-being-prosecuted-in-great-britain-for-abortions-her-confidentiality-was-completely-destroyed">profound, distressing negative consequences</a> for patients if they were to report to the police. But it should also prompt professionals to consider whether they might find themselves having to answer awkward questions in front of their regulatory body. </p>
<p>Providing information, without her permission, about a woman’s pregnancy and reproductive choices is a grave threat to patient trust and risks serious harm to vulnerable patients. The GMC has suspended doctors for <a href="https://www.bmj.com/content/380/bmj.p707">much less</a>.</p><img src="https://counter.theconversation.com/content/221689/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dominic Wilkinson receives funding from the Wellcome Trust and the Arts and Humanities Council. He is a member of the British Medical Association Medical Ethics Committee. This article is written in a personal capacity and not on behalf of the British Medical Association. </span></em></p>New guidance indicates health professionals must not provide information to the police without a woman’s consent unless “concerned for her safety or the safety of others”.Dominic Wilkinson, Consultant Neonatologist and Professor of Ethics, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2207612024-01-10T13:30:13Z2024-01-10T13:30:13ZPope Francis called surrogacy ‘deplorable’ – but the reasons why women and parents choose surrogacy are complex and defy simple labels<figure><img src="https://images.theconversation.com/files/568467/original/file-20240109-17-1nw9j8.jpg?ixlib=rb-1.1.0&rect=137%2C31%2C6938%2C4678&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pope Francis baptizes 16 infants in the Sistine Chapel on Jan. 7, 2024, in Vatican City.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/pope-francis-baptises-16-infants-in-the-sistine-chapel-on-news-photo/1914446578?adppopup=true">Vatican Media via Vatican Pool/Getty Images</a></span></figcaption></figure><p>Pope Francis made headlines on Jan. 8, 2024, when he called for a global surrogacy ban, <a href="https://www.nytimes.com/2024/01/08/world/europe/pope-francis-surrogacy-ban.html">stating</a>, “I deem deplorable the practice of so-called surrogate motherhood, which represents a grave violation of the dignity of the woman and the child, based on the exploitation of situations of the mother’s material needs.”</p>
<p>The use of surrogacy, in which a woman carries and delivers a child for someone else, has grown exponentially in <a href="https://doi.org/10.1016/j.fertnstert.2016.03.050">recent years</a> and is expected to <a href="https://www.gminsights.com/industry-analysis/surrogacy-market">continue to do so</a>. While headlines often surface when celebrities like <a href="https://www.vanityfair.com/style/paris-hilton-on-why-she-chose-surrogacy-for-her-children">Paris Hilton</a> grow their family using the technology, it also gets attention on the rare occasion a surrogate <a href="https://www.dailymail.co.uk/news/article-1356176/Surrogate-mother-wins-case-baby-giving-birth.html">refuses to relinquish the child they carried</a>, or when <a href="https://www.harpercollins.com/products/the-red-market-scott-carney?variant=32123686453282">surrogates experience exploitation</a>.</p>
<p>Such human rights violations appear to be the reason that Francis condemned the practice. But in so doing, I argue, the pope is failing to recognize how varied and nuanced the experiences of intended parents, surrogates and children are.</p>
<p><a href="https://www.baylorpress.com/9781481310567/conceiving-family/">I have researched surrogacy</a> <a href="https://candler.emory.edu/faculty-profiles/danielle-tumminio-hansen/">for over a decade</a> and have learned many things: Some women indeed become surrogates out of desperation and <a href="https://cup.columbia.edu/book/wombs-in-labor/9780231169905">are abused in the process</a>, as the pope says. But others, like the Christian ethicist <a href="https://www.sup.org/books/title/?id=31699">Grace Kao</a>, are thriving professionals who make the choice for altruistic reasons and never accept remuneration.</p>
<p>The complex reasons why women become surrogates and why parents choose to create families in this way <a href="https://oneill.law.georgetown.edu/a-lack-of-consensus-around-surrogacy-regulation-at-the-national-level/">make it nearly impossible</a> to issue a universal conclusion about it. Instead, like many technologies, surrogacy’s ethical value is dependent upon the people and systems who use it. </p>
<h2>Catholicism and surrogacy</h2>
<p>While the pope framed his condemnation of surrogacy as a human rights abuse, the Catholic tradition has <a href="https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html">consistently opposed</a> <a href="https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20081208_dignitas-personae_en.html">surrogacy, in vitro fertilization</a> and <a href="https://www.usccb.org/issues-and-action/human-life-and-dignity/abortion/respect-for-unborn-human-life">abortion</a> on the grounds that they violate natural law. </p>
<p>Natural law is a philosophy that states there are certain unchangeable parts of human nature that God endows. Catholic theologians who support this basic view extrapolate that intercourse within heterosexual marriage is the only acceptable way to reproduce, that life begins at conception, and that an embryo has a right to life from conception until natural death.</p>
<p>Hence, the Roman Catholic Church only encourages reproduction within the confines of heterosexual marriage, and when a heterosexual couple cannot conceive via intercourse, they are encouraged to adopt or remain childless.</p>
<p>The church has consistently condemned IVF because conception takes place outside of heterosexual intercourse. IVF results in the destruction of embryos and involves conception via a test tube. The church likewise has never supported surrogacy, so the pope’s recent assessment of surrogacy as “despicable” is consistent with the church’s overall views of reproduction.</p>
<p>Nonetheless, surrogacy is the only form of assisted reproduction documented in the Bible, unless one considers Mary’s conception of Jesus to be a form of assisted reproduction. In the <a href="https://www.biblegateway.com/passage/?search=Genesis%2016-18&version=NRSVUE">Book of Genesis</a>, the wife of Abraham begs her husband to have sex with <a href="https://www.researchgate.net/publication/301577539_Hagar_the_Egyptian_Wife_Handmaid_and_Concubine">her slave Hagar</a> in order to procreate. Sarah abuses the slave and orchestrates both sex and procreation without Hagar’s consent. </p>
<p>Hagar eventually bears a son <a href="https://www.usnews.com/news/religion/articles/2008/01/25/why-scholars-just-cant-stop-talking-about-sarah-and-hagar">named Ishmael</a>. Later, Sarah demands that both Hagar and Ishmael be cast out into the wilderness. Muslims regard Ishmael as a prophet and believe he and Abraham built <a href="https://www.khanacademy.org/humanities/ap-art-history/introduction-cultures-religions-apah/islam-apah/a/the-kaaba">the Kaaba</a> in Mecca, Saudi Arabia.</p>
<h2>Myths and fears</h2>
<figure class="align-center ">
<img alt="Four women standing together wearing masks, with two of them holding new-born babies." src="https://images.theconversation.com/files/424528/original/file-20211004-13-1ggnsgp.jpg?ixlib=rb-1.1.0&rect=47%2C31%2C5176%2C3554&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/424528/original/file-20211004-13-1ggnsgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424528/original/file-20211004-13-1ggnsgp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424528/original/file-20211004-13-1ggnsgp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424528/original/file-20211004-13-1ggnsgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=516&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424528/original/file-20211004-13-1ggnsgp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=516&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424528/original/file-20211004-13-1ggnsgp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=516&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nurses with babies born to Ukrainian surrogate mothers in Kyiv.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/nurses-hold-babies-as-foreign-couples-gather-to-collect-news-photo/1219071333?adppopup=true">Sergei Supinsky/AFP via Getty Images</a></span>
</figcaption>
</figure>
<p>Fast forward to modern times, and surrogacy is now performed predominantly in high-priced in vitro fertilization centers in one of two ways. In “traditional surrogacy,” the fertilized egg belongs to the surrogate. In “gestational surrogacy,” which is <a href="https://surrogate.com/about-surrogacy/types-of-surrogacy/what-is-traditional-surrogacy/">more common today</a>, the fertilized egg comes from either the intended mother or a donor.</p>
<p>In both cases, that egg combines with a sperm to become an embryo that grows in the surrogate’s womb and not the intended mother’s.</p>
<p>Gestational surrogacy may be preferable because it allows intended mothers to maintain a genetic connection with their child. Others may prefer it because of fears that a surrogate could lay claim to the child with whom <a href="https://www.americansurrogacy.com/blog/the-legal-and-emotional-risks-of-traditional-surrogacy/">she had a biological connection</a>.</p>
<p>The concern that a surrogate will try to steal or adopt a child is one of many legal and ethical fears surrounding surrogacy. In the 1980s, the <a href="https://law.justia.com/cases/new-jersey/supreme-court/1988/109-n-j-396-1.html">Baby M Case</a> in the United States attracted much media attention because it tapped into these fears. In this situation, the surrogate, named Mary Beth Whitehead, attempted to retain custody of the baby she birthed. </p>
<p>The case <a href="https://doi.org/10.1093/humrep/deu339">fueled a stereotype</a> of surrogates as emotionally unstable, defying the reality that surrogates undergo psychological testing before participating in a procedure.</p>
<p>Documented instances of surrogates retaining children are also rare. Research shows that surrogates often experience pregnancy and birth differently than they did with their <a href="https://academic.oup.com/humrep/article/33/4/646/4941810">own children</a>. They also often see themselves as <a href="https://academic.oup.com/california-scholarship-online/book/17848">heroes or gift givers</a> instead of mothers. </p>
<p>If the public perceives surrogates negatively, intended parents often fare no better. They are often categorized as selfish, desperate and rich, especially when they choose surrogacy <a href="https://www.theguardian.com/lifeandstyle/2019/may/25/having-a-child-doesnt-fit-womens-schedule-the-future-of-surrogacy">without a medical reason</a>. </p>
<p>Those popular images of intended parents fail to account for the <a href="https://www.apa.org/pubs/books/reproductive-trauma-second-edition">reproductive trauma</a> many of them experience prior to turning to surrogacy. The decision to hire a surrogate is <a href="https://syndicate.network/symposia/theology/conceiving-family/#:%7E:text=In%20Conceiving%20Family%3A%20A%20Practical,class%20and%20are%20often%20white">often the last option</a> for parents who have tried everything else and are, as <a href="https://www.baylorpress.com/9781481310567/conceiving-family/">I’ve proposed in my own research</a>, attempting to write a happy ending to the story of their reproductive lives.</p>
<p><a href="https://www.filia.org.uk/latest-news/2023/4/19/dont-buy-adopt-stop-surrogacy-now">Critics</a> counter that individuals who use surrogates should be turning to adoption instead. However, this logic fails to recognize that adoption can be traumatic <a href="https://doi.org/10.1016/j.chiabu.2021.105309">for the child</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/2276293/">the birth mother</a>. Adoption, therefore, isn’t a cure-all for individuals who can’t conceive via heterosexual intercourse.</p>
<h2>Ethical concerns about surrogacy</h2>
<p>It is true that surrogacy is expensive, at least in the U.S., where use of the technology routinely costs over <a href="https://money.usnews.com/money/personal-finance/family-finance/articles/how-much-surrogacy-costs-and-how-to-pay-for-it">US$100,000</a>. The cost is so extreme because intended parents pay health care fees for both themselves and the surrogate, many of which aren’t covered by insurance. </p>
<p>They also have to pay legal and agency fees and compensate the surrogate, which alone can range from <a href="https://www.westcoastsurrogacy.com/become-a-surrogate-mother/surrogate-mother-compensation">$45,000 to $75,000</a>. Contrast that price tag to the one in India prior to its ban on international surrogacy in 2015: Couples who traveled there could expect to spend <a href="https://www.motherjones.com/politics/2010/04/surrogacy-tourism-india-nayna-patel/">$15,000 to $20,000</a> in total for their surrogacy journey. The extreme costs of surrogacy in the U.S. also limit its availability to the wealthy. </p>
<p>In addition, feminists are divided on how surrogacy affects women. Some feminists feel that surrogates have a right to <a href="https://www.jstor.org/stable/3174860">choose what to do with their bodies</a>. Others object to surrogacy on the grounds that systemic oppression drives women into surrogacy, or that it’s unethical for people to <a href="https://cup.columbia.edu/book/wombs-in-labor/9780231169905">buy women’s bodies</a>. </p>
<p><a href="https://www.motherjones.com/politics/2010/04/surrogacy-tourism-india-nayna-patel/">Cases documented in India</a> support these concerns. Investigative journalist <a href="https://www.harpercollins.com/products/the-red-market-scott-carney?variant=32123686453282">Scott Carney</a> found one prominent Indian surrogacy clinic where surrogates were kept in crowded bedrooms on restricted diets and forced to have Cesarean sections in order to streamline the labor and delivery process. </p>
<p>Scholars also worry about surrogacy’s <a href="https://cbc-network.org/issues/making-life/surrogacy/?fbclid=IwAR13wlHiYvqQ_crLOiatzk6XpkFvp0WKXBWOYfi4BURgMLm00aY4EZDC9Sk">impact on children</a>.
Extensive research hasn’t been conducted with children of surrogates, but research by social scientists studying children born via egg and sperm donation largely mirrors the findings of adoption research: Children have questions about their identity, and they find answers from individuals who are <a href="https://academic.oup.com/humrep/article/15/9/2041/2915461">part of their birth story</a>.</p>
<p>Yet agencies and governments rarely regulate how surrogates, intended parents and children interact following the baby’s birth. </p>
<h2>The case for surrogacy</h2>
<figure class="align-center ">
<img alt="A woman in a green shirt stands in front of colorful red and orange flowers." src="https://images.theconversation.com/files/424575/original/file-20211004-12705-rfkwei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/424575/original/file-20211004-12705-rfkwei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424575/original/file-20211004-12705-rfkwei.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424575/original/file-20211004-12705-rfkwei.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424575/original/file-20211004-12705-rfkwei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424575/original/file-20211004-12705-rfkwei.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424575/original/file-20211004-12705-rfkwei.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Actress Gabrielle Union has talked openly about her surrogacy journey.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/gabrielle-union-attends-the-veuve-clicquot-polo-classic-at-news-photo/1344504189?adppopup=true">Frazer Harrison/Getty Images</a></span>
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</figure>
<p>Such objections might lead to the conclusion that there is never a reason to hire a surrogate. But this might be too simplistic. Even with the documented struggles on the parts of both intended parents and surrogates, many are profoundly grateful for the technology.</p>
<p>Intended parents often feel surrogates are “<a href="https://www.ucpress.edu/book/9780520259645/birthing-a-mother">gifts from God</a>” who help them reach their dream of parenthood. Meanwhile, some surrogates believe their powers of procreation provide them with a unique opportunity to help others. Many surrogates see their ability to create life as a source of power, a profound act of altruism that is part of their legacy.</p>
<p>When I spoke with a group of surrogates in Austin, Texas, while conducting research for my book, I found that their stories aligned with <a href="https://www.routledge.com/Surrogate-Motherhood-Conception-In-The-Heart/Ragone/p/book/9780367289249">the findings of other researchers</a> who discovered that many surrogates had positive experiences in which they <a href="https://www.ucpress.edu/book/9780520259645/birthing-a-mother">experienced themselves as heroes</a>. These women felt empowered because they helped infertile heterosexual couples and <a href="https://doi.org/10.1016/j.rbms.2018.10.019">gay couples</a> create families. Without surrogacy, these individuals would have no way to have a genetic connection with their children. </p>
<p>The surrogates acknowledged that sometimes intended parents could be difficult, that pregnancy and labor could be challenging, and that it could be confusing when a checkout clerk at the grocery store asked what they were planning to name the baby.</p>
<p>Becoming a parent through surrogacy can be awkward and humbling, confusing and miraculous all at the same time.</p>
<p>But when surrogates and intended parents can act freely, with <a href="https://www.ucpress.edu/book/9780520259645/birthing-a-mother">appropriate regulations and the support of society</a>, there is the potential for them to discover that family is not just biological but also social and relational. In those encounters, many experience the technology as life-giving, both metaphorically and literally.</p>
<p><em>This is an updated version of an <a href="https://theconversation.com/becoming-a-parent-through-surrogacy-can-have-ethical-challenges-but-it-is-a-positive-experience-for-some-167760">article first published on Oct. 6, 2021</a>.</em></p><img src="https://counter.theconversation.com/content/220761/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danielle Tumminio Hansen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Surrogacy can exploit women, but others may choose to be involved for altruistic reasons. A scholar points out that surrogacy’s ethical value is dependent upon the people and systems who use it.Danielle Tumminio Hansen, Assistant Professor of Practical Theology & Spiritual Care, Emory UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2187642024-01-09T13:26:55Z2024-01-09T13:26:55ZVoters don’t always have final say – state legislatures and governors are increasingly undermining ballot measures that win<figure><img src="https://images.theconversation.com/files/566723/original/file-20231219-19-nsxbqv.jpeg?ixlib=rb-1.1.0&rect=14%2C7%2C4778%2C3176&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Supporters of Issue 1, which would codify reproductive rights, including abortion, in the Ohio Constitution, cheer election results on Nov. 7, 2023.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/supporters-of-ohio-issue-1-cheer-as-results-come-in-at-a-news-photo/1769693584?adppopup=true">Andrew Spear/Getty Images</a></span></figcaption></figure><p><a href="https://www.pewresearch.org/science/2023/11/14/confidence-in-scientists-medical-scientists-and-other-groups-and-institutions-in-society/">Less than half of Americans</a> trust elected officials to act in the public’s interest. </p>
<p>When voters want something done on an issue and their elected officials fail to act, they may turn to citizen initiatives to pursue their goals instead. The citizen initiative process varies by state, but in general, citizens collect signatures to have an issue put directly on the ballot for the voters to voice their preferences. Nearly half the states, 24 of them, <a href="https://www.ncsl.org/elections-and-campaigns/initiative-and-referendum-processes">allow citizen initiatives</a>. </p>
<p>These measures, also called “ballot initiatives,” often focus on the controversial issues of the day. Citizen initiatives <a href="https://ballotpedia.org/Marriage_and_family_on_the_ballot">on same-sex marriage</a> and <a href="https://www.sciencedirect.com/science/article/pii/S0955395922000056">marijuana legalization</a> have been on many state ballots through the years. Abortion rights have repeatedly <a href="https://www.nbcnews.com/politics/elections/abortion-rights-won-every-election-roe-v-wade-overturned-rcna99031">been on the ballot since 2022</a>, after the Supreme Court <a href="https://www.oyez.org/cases/2021/19-1392">overturned the constitutional protection for abortion</a>, and more voters can expect to <a href="https://apnews.com/article/abortion-ballot-measure-2024-state-vote-e7d635835dc3a440789ad87787553ec1">vote on the issue in 2024</a>.</p>
<p>I am an <a href="https://annewhitesell.com/research-2/">American politics scholar</a> who studies the connection between representation and public policy. In American democracy, the people expect to have a voice, whether that comes through electing representatives or directly voting on issues.</p>
<p>Yet it is <a href="https://www.bloomberg.com/news/articles/2018-10-12/where-the-people-s-vote-can-be-negated-by-legislators">becoming increasingly common</a> for lawmakers across the country to not only ignore the will of the people, but also actively work against it. From 2010 to 2015, about 21% of citizen initiatives were <a href="https://ballotpedia.org/Legislative_alterations_of_ballot_initiatives">altered by lawmakers</a> after they passed. From 2016 to 2018, lawmakers altered nearly 36% of passed citizen initiatives. </p>
<figure class="align-center ">
<img alt="A big sign projected on a wall that says 'Eggs & Issues' with a man to the right at a lectern, talking." src="https://images.theconversation.com/files/566717/original/file-20231219-27-klyniy.jpeg?ixlib=rb-1.1.0&rect=17%2C4%2C2977%2C1904&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566717/original/file-20231219-27-klyniy.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566717/original/file-20231219-27-klyniy.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566717/original/file-20231219-27-klyniy.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566717/original/file-20231219-27-klyniy.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566717/original/file-20231219-27-klyniy.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566717/original/file-20231219-27-klyniy.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Maine Gov. Paul LePage refused to expand Medicaid in his state after voters in 2018 passed an initiative authorizing it.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/gov-paul-lepage-speaks-at-eggs-issues-breakfast-at-the-news-photo/987167644?adppopup=true">Gregory Rec/Portland Portland Press Herald via Getty Images</a></span>
</figcaption>
</figure>
<h2>Invalidate, weaken, repeal</h2>
<p>Here’s what some of those cases look like, from successful to unsuccessful efforts to alter the will of the people: </p>
<p>• In November 2023, <a href="https://apnews.com/article/ohio-abortion-amendment-election-2023-fe3e06747b616507d8ca21ea26485270">Ohio voters passed an amendment to their state’s constitution</a> protecting the right to abortion. Within a week, a group of Ohio Republican lawmakers <a href="https://ohiocapitaljournal.com/2023/11/13/some-ohio-gop-lawmakers-attempting-to-undermine-democratic-process-after-voters-protect-abortion/">declared the amendment to be invalid</a> and <a href="https://www.theguardian.com/us-news/2023/nov/17/ohio-abortion-rights-republicans-overturn">introduced legislation</a> that would strip state courts from having authority to rule on the issue of abortion. Ohio House Speaker, Republican Jason Stephens, <a href="https://ohiocapitaljournal.com/2023/11/15/pumping-the-brakes-ohio-house-speaker-dismisses-effort-to-limit-court-jurisdiction-on-issue-1/">rejected the proposed legislation</a>.</p>
<p>• In July 2018, Washington, D.C., voters approved an <a href="https://www.washingtonpost.com/dc-md-va/2022/11/08/dc-initiative-82-results-wage/">increase in the minimum wage</a> for tipped workers. Three months later, the City Council <a href="https://ballotpedia.org/Washington,_D.C.,_Initiative_77,_Minimum_Wage_Increase_for_Tipped_Workers_(June_2018)">repealed the initiative</a>.</p>
<p>• In 2016, voters in South Dakota <a href="https://www.nytimes.com/elections/2016/results/south-dakota-ballot-measure-22-campaign-finance-overhaul">supported an initiative</a> to revise campaign finance and lobbying laws and create an ethics commission. Governor Dennis Daugaard <a href="https://www.argusleader.com/story/news/politics/2017/02/02/daugaard-signs-bill-eliminating-voter-approved-ethics-law/97399274/">signed a law</a> repealing the initiative in February 2017. Another citizen initiative to create an ethics commission was <a href="https://www.governing.com/archive/gov-campaign-finance-ethics-ballot-measures-2018.html">on the ballot in 2018</a>, but did not pass.</p>
<h2>Revise and amend</h2>
<p>Often lawmakers rewrite laws passed through initiative. Some revisions change key components of the initiatives, while others amend technical details.</p>
<p>• <a href="https://boltsmag.org/ohio-voters-issue-2-legalized-marijuana-equity-provisions-expungement/">Ohioans voted in favor of legalizing marijuana</a> in November 2023. In that initiative, part of the tax revenue from marijuana sales would go to a financial assistance program for those who show “social and economic disadvantage.” The Ohio Senate <a href="https://www.cleveland19.com/2023/12/09/breaking-down-bud-ohio-senate-passes-bill-that-nixes-social-equity-fund-put-place-under-issue-2/">passed a bill</a> the following month that would instead use the tax revenue to fund jails and law enforcement.</p>
<p>• Massachusetts voters <a href="https://ballotpedia.org/Massachusetts_Marijuana_Legalization,_Question_4_(2016)#:%7E:text=The%20law%20implemented%20the%20following,retailer%20operating%20within%20the%20locality.">passed recreational marijuana legalization</a> in 2016. In 2017, the Legislature passed a bill to <a href="https://apnews.com/3cbe8b27c83144f391713d6d1fb31978">increase the excise tax</a> on marijuana from the 3.75% set in the citizens’ initiative to 10.75%. </p>
<p>• In 2018, Utah voters made adults with income up to 138% of the federal poverty level eligible for Medicaid – a federal-state health insurance program for low-income individuals and those with disabilities. The state Legislature applied to the federal government for waivers to <a href="https://www.commonwealthfund.org/blog/2019/one-step-forward-two-steps-back-utahs-medicaid-expansion">lower the income limit to 100% of the federal poverty level</a>, which curtailed the expansion voters approved.</p>
<p>• Arizona voters <a href="https://apnews.com/article/business-education-arizona-971374029a2af7d8f67b8366bdd89c3b">approved a tax increase</a> on the wealthy to fund the state’s schools in 2020. In 2021, the Legislature responded by <a href="https://apps.azleg.gov/BillStatus/BillOverview/75928">exempting business earnings from the tax</a>. There was an attempt by citizen initiative later that year to <a href="https://apnews.com/article/business-arizona-phoenix-doug-ducey-arizona-supreme-court-b8adfe654d0a5aa12b5054170e0f7df4">repeal the legislature’s law exempting business earnings</a>, but it did not gather enough signatures from citizens to make it to the ballot.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566732/original/file-20231219-17-jxqxos.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A green-bordered sign on a window that says 'VOTE NO on Initiative #77.'" src="https://images.theconversation.com/files/566732/original/file-20231219-17-jxqxos.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566732/original/file-20231219-17-jxqxos.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566732/original/file-20231219-17-jxqxos.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566732/original/file-20231219-17-jxqxos.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566732/original/file-20231219-17-jxqxos.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566732/original/file-20231219-17-jxqxos.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566732/original/file-20231219-17-jxqxos.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Initiative #77 was a 2018 ballot measure to gradually raise the minimum wage that tipped workers receive; passed by Washington, D.C. voters, the City Council repealed it.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/man-walks-by-a-vote-no-on-initiative-poster-on-june-18-2018-news-photo/977876412?adppopup=true">Mandel Ngan/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>Governors object</h2>
<p>In some cases, it is not the legislature that opposes the will of the voters, but the governor. In recent years, several Republican governors have refused to implement Medicaid expansions passed by voter initiatives.</p>
<p>• Maine’s former governor, Paul LePage, said he would go to jail before he would <a href="https://www.pressherald.com/2018/07/12/paul-lepage-says-hed-go-to-jail-before-he-expands-medicaid/">implement Medicaid expansion</a> after it passed by voter initiative in 2017. Medicaid was not expanded until <a href="https://www.pressherald.com/2019/01/03/mills-signs-executive-order-to-implement-medicaid-expansion/">Democrat Janet Mills took office</a> in 2019.</p>
<p>• <a href="https://www.nbcnews.com/politics/politics-news/missouri-governor-won-t-fund-medicaid-expansion-flouting-state-constitution-n1267265">Missouri Governor Mike Parson</a> said he would not move forward with the 2020 voter-passed Medicaid expansion because it would not pay for itself. In 2021, the <a href="https://apnews.com/article/courts-michael-brown-medicaid-3690befde29aa1b27406a3472fb566aa">Missouri Supreme Court</a> ruled the initiative valid and Medicaid expansion moved forward.</p>
<h2>Why they do it</h2>
<p>Lawmakers who rewrite or overturn ballot initiatives sometimes argue that <a href="https://doi.org/10.1007/s11109-014-9273-5">voters do not understand</a> what they are supporting. Lawmakers, unlike citizens, have to balance state budgets every year, and they often raise questions about how to pay for the policies or programs passed by initiative. </p>
<p>Lawmakers also argue that outside groups play an outsized role in passing ballot initiatives. While <a href="https://doi.org/10.1007/s11109-014-9282-4">political science research</a> provides some support for this claim, outside groups also have influence in the regular legislative process. And they often work to defeat initiatives as well.</p>
<p>Citizen initiatives became popular <a href="https://ballotpedia.org/History_of_initiative_and_referendum_in_the_U.S.">during the Progressive Era</a> of the early 20th century as a way to give power back to citizens. Then, as now, citizens felt political power was too concentrated in the hands of the wealthy. Initiatives were one way for everyday people to get more involved in their government. </p>
<p>That only half of states permit citizen initiatives suggests that political elites are <a href="https://doi.org/10.1177/153244000100100402">not always supportive</a> of a process that limits their own power. Historically, though, legislators have <a href="https://doi.org/10.1057/palgrave.polity.2300087">respected the results</a>. Some lawmakers, including Ohio Governor Mike DeWine, state they will continue to <a href="https://ohiocapitaljournal.com/2023/11/11/ohio-gov-dewine-accepts-will-of-the-people-on-abortion-marijuana-but-hold-on/">“accept” the will of the people</a>. To do otherwise undermines democracy.</p><img src="https://counter.theconversation.com/content/218764/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne Whitesell does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Election year 2024 will see citizen initiatives on the ballot across the country, some focused on abortion rights. But there’s a growing trend of lawmakers altering initiatives after they have passed.Anne Whitesell, Assistant Professor, Political Science, Miami UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2176612024-01-08T13:35:39Z2024-01-08T13:35:39ZSouth Korea’s gender imbalance is bad news for men − outnumbering women, many face bleak marriage prospects<figure><img src="https://images.theconversation.com/files/563900/original/file-20231206-21-smw7n5.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5573%2C3699&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In South Korea, there are nor enough young Korean women for young Korean men to marry.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/airport-business-man-royalty-free-image/166973187?phrase=south+korea+men+together&searchscope=image%2Cfilm&adppopup=true">RUNSTUDIO/Getty Images</a></span></figcaption></figure><p>South Korea’s bachelor time bomb is about to really go off. Following a historic 30-year-long imbalance in the male-to-female sex ratio at birth, young men far outnumber young women in the country. As a result, some 700,000 to 800,000 “extra” South Korean boys born since the mid-1980s may not be able to find South Korean girls to marry.</p>
<p>As a <a href="https://scholar.google.com/citations?user=jAfhO2YAAAAJ&hl=en">demographer</a> who over the past four decades has conducted extensive research on East Asian populations, I know that this increased number of South Korean boys will have huge impacts throughout South Korean society. Coincidentally, similar trends are <a href="https://doi.org/10.1080/17450128.2011.630428">playing out in China</a>, Taiwan and India. </p>
<p><iframe id="matBO" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/matBO/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>The reasons</h2>
<p>In most countries, more boys are born than girls – around 105 to 107 boys per 100 girls. That sex ratio at birth (SRB) is a near constant. The gender imbalance is likely an evolutionary adaptation to the biological fact that females live longer than males. At every year of life, men have higher death rates than women. Hence an SRB of between 105 and 107 boys <a href="https://www.cambridge.org/core/books/population-and-society/5D47EB8139ED72FD59F7379F7D41B4FB">allows for there to be roughly equal numbers of men and women </a> when the groups reach childbearing ages.</p>
<p>The SRB in the United States in 1950 was 105 and was still 105 in 2021; in fact, it has been stable in the U.S. for as long as SRB data has been gathered. In contrast, in South Korea the SRB was at the normal range from 1950 to around 1980, but increased to 110 in 1985 and to 115 in 1990.</p>
<p>After fluctuating a bit at elevated levels through the 1990s and early 2000s, it returned to the biologically normal range by 2010. In 2022, South Korea’s SRB was 105 – well within the normal level. But by then, the seeds for today’s imbalance of marriage-age South Koreans was set.</p>
<h2>A preference for sons</h2>
<p>There are several reasons why South Korea’s SRB was out of balance for 30 years.</p>
<p>South Korea experienced a rapid fertility decline in a 20- to 30-year period beginning in the 1960s. From six children per woman in 1960, fertility fell to four children in 1972, then to two children in 1984. By 2022, South Korea’s fertility rate had dropped to 0.82 – <a href="https://theconversation.com/south-korea-has-the-lowest-fertility-rate-in-the-world-and-that-doesnt-bode-well-for-its-economy-207107">the lowest fertility rate in the world</a> and far below the rate of 2.1 needed to replace the population.</p>
<p><iframe id="FNa7q" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/FNa7q/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Yet, South Korea’s long-held <a href="https://www.jstor.org/stable/2584733">cultural preference for sons</a> did not shift as quickly as childbearing declined. Having at least one son was a strong desire influencing fertility preferences in South Korea, especially up through the early years of the 21st century. </p>
<p>And the declining fertility rate posed a problem. When women have many children, the probability that at least one will be a boy is high. With only two children, the probability that neither will be a son is around 25%, and when women have only one child, it is less than 50%.</p>
<p>In order to ensure that families would continue to have boys, many South Koreans turned to readily available techniques to identify the gender of the fetus, such as screening in the early stages of pregnancy. Abortion, which is legal and socially acceptable in South Korea, was then often used to allow families to select the sex of their child. </p>
<h2>Sex by the numbers</h2>
<p>In South Korea, beginning in around 1980 and lasting up to around 2010 or so, many more extra boys were born than girls. When these extra boys reach adulthood and start looking for South Korean girls to marry, many will be unsuccessful.</p>
<p>The extra boys born in the 1980s and 1990s are now of marriage age, and many will be looking to marry and start a family. Many more will be reaching marriage age in the next two decades.</p>
<figure class="align-center ">
<img alt="Man kisses pregnant wife's belly." src="https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A deeply rooted cultural preference for sons was still influential in South Korea up through the early years of this century.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/asian-man-kissing-pregnant-wifes-belly-royalty-free-image/174522589?phrase=south+korea+abortion&searchscope=image%2Cfilm&adppopup=true">Greg Samborski via Getty Images</a></span>
</figcaption>
</figure>
<p>I have calculated that owing to the unbalanced SRBs in South Korea between 1980 and 2010, approximately 700,000 to 800,000 extra boys were born.</p>
<p>Already this is having an effect in a society where over the centuries virtually everyone was expected to marry, and where marriage was nearly universal. Recent <a href="https://www.wionews.com/world/south-koreans-losing-interest-in-marriage-report-finds-630642">research by Statistics Korea</a> showed that in 2023, over 36% of South Koreans between the ages of 19 and 34 intended to get married; this is a decline from over 56% in 2012.</p>
<h2>Foreign brides and ‘bachelor ghettos’</h2>
<p>The immigration of foreign-born women might help address the imbalance. Research by demographers <a href="https://doi.org/10.1177/0308518X18756640">Guy Abel and Nayoung Heo</a> has shown that financial assistance from the South Korean government is already supporting the immigration to South Korea of Korean women from northeastern China and of foreign women from some less wealthy countries, such as Vietnam, the Philippines and some Eastern European countries. </p>
<p>If the extra bachelors do not marry immigrant brides, they will have no alternative but to develop their own lives and livelihoods. Some might settle in “bachelor ghettos” in Seoul and in South Korea’s other big cities of Busan and Daegu, where commercial sex outlets are more prevalent. Such “ghettos” have already been <a href="https://www.aljazeera.com/news/2005/7/20/gender-imbalance-threatens-china">observed in other Asian cities</a> where men outnumber women, such as Beijing, Shanghai and Guangzhou in China.</p>
<figure class="align-center ">
<img alt="Bridegroom flashes victory sign." src="https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">While the desire for sons has been relaxed, the social issues, especially regarding the marriage market, remain.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/bridegroom-showing-victory-sign-royalty-free-image/903472740?phrase=south+korea+wedding&searchscope=image%2Cfilm&adppopup=true">RUNSTUDIO/Getty Images</a></span>
</figcaption>
</figure>
<p>The consequences for South Korean society of the higher than biologically normal SRBs is a problem of the country’s own making. South Korea’s high fertility of the mid-20th century was holding the country back economically. Its program to bring down a fertility rate of nearly six children per woman was hugely successful. But its very success has been problematic. </p>
<p>The speed of South Korea’s fertility transition meant that the evolution to a more modern familial normative structure – that is, with about two children per family and with less preference given to boys – lagged behind. Today, the SRB imbalances appear to be <a href="https://www.bbc.com/news/world-asia-38362474">a thing of the past</a>. Women in South Korea have greater access to education and employment, and there is less pressure for men to be sole wage earners. Together with the South Korean government’s efforts to reduce sex selection beginning in the late 1980s, the premium for boys over girls has dropped. </p>
<p>Yet despite the relaxed desire for sons, long-term social issues related to gender imbalance, especially regarding the marriage market, will remain in South Korea for decades to come.</p><img src="https://counter.theconversation.com/content/217661/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dudley L. Poston Jr. does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Following a 30-year boy-to-girl birth rate imbalance, up to 800,000 ‘extra’ men born since the mid-1980s will be unable to find a South Korean woman to marry. That has big demographic consequences.Dudley L. Poston Jr., Professor of Sociology, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2177692023-12-06T13:27:56Z2023-12-06T13:27:56ZTuberville ends holdout on most high-ranking military nominations<figure><img src="https://images.theconversation.com/files/563759/original/file-20231205-23-ex4w1f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Alabama Sen. Tommy Tuberville speaks to reporters at the U.S. Capitol in November 2023. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sen-tommy-tuberville-speaks-to-reporters-on-his-way-to-a-news-photo/1768727663?adppopup=true">Drew Angerer/Getty Images</a></span></figcaption></figure><p>After holding up the promotions or new assignments of several hundred senior officers for nearly a year, U.S. Senator Tommy Tuberville relented to pressure from both GOP and Democratic Senate members and <a href="https://www.pbs.org/newshour/politics/sen-tommy-tuberville-says-hes-ending-his-blockade-of-military-nominations">ended most of his campaign</a> against a military policy on abortion.</p>
<p>But while Tuberville’s announcement clears the way for about <a href="https://thehill.com/homenews/ap/ap-politics/ap-sen-tommy-tuberville-says-hes-ending-blockade-of-most-military-nominees/">400 appointments</a>, published reports said that Tuberville would continue to block the promotions of 10 four-star generals and admirals. </p>
<p>Within hours of Tuberville’s decision, the Senate confirmed hundreds of nominations.</p>
<p>Tuberville’s announcement come on the heels of growing pressure from Democratic Senate Leader Charles Schumer as well as several GOP senators who grew frustrated over Tuberville’s actions that many argued jeopardized national security.</p>
<p>In September 2023 and again in November, the Senate got around Tuberville’s blockage by <a href="https://www.marinecorpstimes.com/news/pentagon-congress/2023/11/02/no-2-marine-confirmed-by-senate-amid-top-marines-health-crisis/">voting on several individual nominations</a> for top-level positions, including the <a href="https://rollcall.com/2023/09/20/in-preemptive-strike-schumer-files-cloture-on-top-dod-jobs/">chairman of the Joint Chiefs of Staff</a>.</p>
<h2>A far-right fight</h2>
<p>Tuberville <a href="https://thehill.com/policy/defense/4116064-senate-democrats-press-mcconnell-on-tubervilles-reckless-military-hold/">had blocked the Senate from considering their nominations because he opposes a Defense Department policy</a> to reimburse travel expenses for military personnel who have to <a href="https://media.defense.gov/2022/Oct/20/2003099747/-1/-1/1/MEMORANDUM-ENSURING-ACCESS-TO-REPRODUCTIVE-HEALTH-CARE.PDF">leave their states to get abortions</a> or other reproductive care.</p>
<p>The policy was put in place after the Supreme Court’s 2022 ruling in <a href="https://www.supremecourt.gov/opinions/21pdf/19-1392_6j37.pdf">Dobbs v. Jackson Women’s Health Organization</a>, which overturned previous Supreme Court rulings affirming federal protections for abortion and returned the responsibility of passing abortion laws to the states.</p>
<p>A U.S. senator has the prerogative of placing <a href="https://crsreports.congress.gov/product/pdf/R/R43563">what is called a hold</a> on a measure, preventing the Senate from acting on that measure. </p>
<p>Secretary of Defense Lloyd Austin <a href="https://www.defense.gov/News/News-Stories/Article/Article/3458194/dod-officials-highlight-risks-to-force-posed-by-senate-nomination-hold/">characterized Tuberville’s hold as a threat</a> to national defense. Senate Democrats <a href="https://thehill.com/policy/defense/4116064-senate-democrats-press-mcconnell-on-tubervilles-reckless-military-hold/">have called him reckless</a>, and more than 550 military families petitioned Tuberville and Senate leaders <a href="https://www.military.com/daily-news/2023/07/24/military-spouses-deliver-petition-calling-end-tuberville-blockade-senior-officer-promotions.html">to end the stalemate</a>. Senate Minority Leader Mitch McConnell, a Republican from Kentucky, has said <a href="https://www.msnbc.com/rachel-maddow-show/maddowblog/mcconnell-dod-reject-gop-senators-blockade-military-promotions-rcna83827">he does not support a hold on military nominations</a>.</p>
<p>But Tuberville didn’t budge for months.</p>
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<a href="https://images.theconversation.com/files/539273/original/file-20230725-21-gdrpzc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man wearing a dark suit walks toward a lectern, carrying a white binder in his right hand and paper and a pen in his left. He is fallowed by a man wearing a brown military uniform, carrying papers clutched under his left arm." src="https://images.theconversation.com/files/539273/original/file-20230725-21-gdrpzc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539273/original/file-20230725-21-gdrpzc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539273/original/file-20230725-21-gdrpzc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539273/original/file-20230725-21-gdrpzc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539273/original/file-20230725-21-gdrpzc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539273/original/file-20230725-21-gdrpzc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539273/original/file-20230725-21-gdrpzc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">U.S. Secretary of Defense Lloyd Austin departs a news briefing on July 18, 2023, at the Pentagon in Arlington, Va. At right is Chairman of the Joint Chiefs of Staff General Mark Milley.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/secretary-of-defense-lloyd-austin-departs-a-press-briefing-news-photo/1553860889">Win McNamee/Getty Images</a></span>
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<h2>No monopoly on Senate holds</h2>
<p>The practice of senators placing holds on legislation <a href="https://www.heraldnet.com/opinion/comment-senators-holds-are-undermining-their-own-power/">has become more frequent in recent decades</a>. But it is not a practice confined to lawmakers of one party. </p>
<p>Republican Sen. J. D. Vance of Ohio <a href="https://www.nbcnews.com/politics/congress/ohio-republican-vance-will-hold-justice-dept-nominees-senate-trump-cas-rcna89109">placed a hold on the confirmation</a> of Justice Department officials to protest the federal indictment of former president Donald J. Trump. Independent Sen. Bernie Sanders of Vermont is <a href="https://www.washingtonpost.com/health/2023/06/12/sanders-hold-nih-director-drug-prices/">using the same tactic to block President Joe Biden’s nominee</a> to head the National Institute of Health until the Biden administration delivers a plan to lower prescription drug prices. Democratic Sen. Joe Manchin of West Virginia will not approve any nominees for positions in the Environmental Protection Agency because <a href="https://www.washingtonpost.com/politics/2023/05/10/manchin-biden-epa-power-plant-emissions/">he opposes proposed regulations to limit power plant emissions</a>. The holds these senators are using make a connection between the agencies the senators want to take an action and the agencies’ nominees.</p>
<p>Tuberville had been using the hold <a href="https://www.nbcnews.com/politics/congress/tuberville-military-hold-phone-call-defense-secretary-austin-rcna94913">to get the Senate to vote on a bill</a> introduced by Democratic Sen. Jeanne Shaheen of New Hampshire that, if passed, would make the Defense Department’s policy law. In that case, Tuberville said he would relinquish his hold. If the bill fails, he wants the Defense Department to end the policy on reimbursement for travel related to reproductive care.</p>
<h2>Holding promotions hostage</h2>
<p>This is not the first time senators have used the promotion process to object to military policy or practice. But, in most cases, those objections pertained to specific individuals. </p>
<p>Perhaps the most obvious cases occurred <a href="https://www.senate.gov/about/powers-procedures/investigations/joint-committee-conduct-of-war.htm">during the Civil War</a> when the Republican senators most committed to ending the war and ending slavery dragged their heels over promotions as a way to push that agenda.</p>
<p>General <a href="https://www.battlefields.org/learn/biographies/george-g-meade">George G. Meade</a> is perhaps best known as the victorious U.S. general at the battle of Gettysburg. You might think that leading the army that defeated Robert E. Lee’s Army of Northern Virginia in the war’s most famous battle would mean Meade would have no problem securing a well-deserved promotion. </p>
<p>But that was not the case. Meade’s handling of his forces at Gettysburg <a href="https://www.essentialcivilwarcurriculum.com/the-joint-committee-on-the-conduct-of-the-war.html">came under criticism from a congressional committee</a> – the Joint Committee on the Conduct of the War – as well as some of his fellow generals, <a href="https://www.youtube.com/watch?v=_-0_cfwB5f4">who wanted to highlight their own contributions, while diminishing his</a>.</p>
<p>Essential to that scrutiny was that Meade had a reputation as a Democrat who was not an enthusiastic supporter of emancipation as a war aim. His detractors, including committee members and several generals, embraced the destruction of slavery and <a href="https://www.essentialcivilwarcurriculum.com/the-joint-committee-on-the-conduct-of-the-war.html">wanted war to be waged vigorously against Confederate civilians</a> as well as enemy forces. </p>
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<a href="https://images.theconversation.com/files/539363/original/file-20230725-21-l92zfh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A street-level view of a five-sided office building." src="https://images.theconversation.com/files/539363/original/file-20230725-21-l92zfh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539363/original/file-20230725-21-l92zfh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=317&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539363/original/file-20230725-21-l92zfh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=317&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539363/original/file-20230725-21-l92zfh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=317&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539363/original/file-20230725-21-l92zfh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539363/original/file-20230725-21-l92zfh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539363/original/file-20230725-21-l92zfh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The Pentagon building, located in Arlington County, Va., across the Potomac River from Washington.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-pentagon-building-located-in-arlington-county-virginia-news-photo/1061919960?adppopup=true">Michael Brochstein/SOPA Images/LightRocket via Getty Images</a></span>
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<p>As a result, Meade’s <a href="https://www.usace.army.mil/About/History/Army-Engineers-in-the-Civil-War/Engineer-Biographies/George-Meade/">promotion to major general</a> in the regular army – a rank that would persist after the war – ran into snags, largely because of concern that if Meade were nominated, the Senate would not confirm him.</p>
<p>Although General Ulysses S. Grant repeatedly pushed for Meade’s promotion, it would not be until November 1864, after President Abraham Lincoln was safely reelected, that Meade’s name was presented for confirmation, according to the book “<a href="https://www.worldcat.org/title/24081924">Meade of Gettysburg</a>.” The Senate finally approved the promotion in February 1865, just two months before <a href="https://www.battlefields.org/learn/civil-war/battles/appomattox-court-house">Lee surrendered to Grant at Appomattox Court House</a>. </p>
<p>Other army promotions faced similar obstacles. Even Grant’s elevation to lieutenant general in the winter of 1863-1864 proved a struggle, as Congress wrangled over the wording of the bill that reestablished that rank. Some Republicans wanted to delay the promotion until the end of the war; others wanted to force Lincoln to nominate Grant for the new rank. It took over 11 weeks just to pass the bill, and Grant accepted his commission in March 1864, <a href="https://www.c-span.org/video/?305846-3/lincoln-congress-grant-lieutenant-general-act">some three months after the bill was introduced</a>.</p>
<p>These cases involve individuals, albeit in high positions, and in many cases political debate over the promotions involved discussions of their presumed support for the destruction of slavery as a war aim. </p>
<p>Tuberville’s actions were not focused in the way those previous cases were. He blocked consideration of all nominations because of an unrelated Defense Department policy. This public obstruction spotlights how Senate rules, written and unwritten, <a href="https://crsreports.congress.gov/product/pdf/R/R43563">offer opportunities for individual senators to impede the legislative process</a> until their demands are met.</p>
<p><em>This is an updated version of an <a href="https://theconversation.com/sen-tubervilles-blockade-of-us-military-promotions-takes-a-historic-tradition-to-a-radical-new-level-and-could-go-beyond-congress-august-break-209831">article published</a> on July 26, 2023.</em></p><img src="https://counter.theconversation.com/content/217769/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brooks D. Simpson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Republican Sen. Tommy Tuberville of Alabama had used a long-standing Senate practice to block military promotions.Brooks D. Simpson, Foundation Professor of History, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2162782023-12-05T19:24:20Z2023-12-05T19:24:20ZAbortion is now legal across Australia – but it’s still hard to access. Doctors are both the problem and the solution<figure><img src="https://images.theconversation.com/files/562649/original/file-20231130-29-sw6gc2.jpg?ixlib=rb-1.1.0&rect=15%2C23%2C5236%2C3464&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Cedric Faunterloy/Pexels</span></span></figcaption></figure><p>Abortion is now fully legal in every jurisdiction in Australia. Western Australia became the last state to decriminalise it just two months ago, in September 2023. And the Australian population is solidly pro-choice: a <a href="https://www.ipsos.com/en-au/majority-australians-report-unwavering-support-abortion-access">2021 study</a> found 76% of Australians support access to abortion.</p>
<p>Yet access to abortion care here has been described as a “lottery” in a 2023 <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ReproductiveHealthcare/Report">Senate inquiry report</a>. My research into abortion provision in Australia over the past 30 years doesn’t describe chance, but an inadequate system. </p>
<p>Doctors’ historical unwillingness to provide abortions is central to the access problem – and it’s underwritten by the failure of medical schools to adequately train them in this essential aspect of health care. The public health system is culpable, too, for its lack of responsibility for ensuring fair access to abortion services. </p>
<p>Since abortion laws were liberalised in the 1970s, abortions have been performed by a small number of doctors. During my research, I spoke to 12 of those doctors, from around Australia. Most began providing abortions before 2000 and decriminalisation – the oldest did so in the 1960s.</p>
<p>The key things we need now include more GPs providing medical abortions – especially in rural and regional Australia – and more doctors who will provide surgical abortion care, including at the later stages of pregnancy. We also need more basic training to introduce students to abortion. The actions of our medical schools and public hospitals will be central to meeting these goals.</p>
<p>In the past decade, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists <a href="https://ranzcog.edu.au/wp-content/uploads/2022/12/Fellowship-of-RANZCOG-FRANZCOG-SRH-Advanced-Training-Pathway-Overview.pdf">has developed a program</a> for trainees interested in specialising in sexual and reproductive health. The 2023 Senate Inquiry was “floored” to hear only two hospitals in the country provide abortion care to the level that enables them to host the program.</p>
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<figcaption><span class="caption">Abortion is now legal in Australia, but access is still a problem.</span></figcaption>
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<h2>Medical abortion</h2>
<p>Only around <a href="https://resources.mshealth.com.au/20230704-MS-Health-June-2023.pdf">10% of GPs</a> currently provide medical abortion – inducing a miscarriage using oral medication, ideally with mifepristone and misoprostol. That number is less in rural and regional areas.</p>
<p>Until recently, <a href="https://www.msiaustralia.org.au/tga-decision-improving-access-to-abortion-care-for-all-australians-welcomed/">medical practitioners were required</a> to register and be certified to prescribe abortion medicines and pharmacists had to register to dispense them. </p>
<p>In July, the <a href="https://www.tga.gov.au/news/media-releases/amendments-restrictions-prescribing-ms-2-step-mifepristone-and-misoprostol">Therapeutic Goods Administration</a> removed this restriction, also allowing any healthcare practitioner with appropriate qualifications and training to prescribe medical abortion pills – including nurses and midwives.</p>
<p>Legislation in South Australia, Victoria and Western Australia provides for qualified health professionals (not just doctors) to prescribe medical abortion and <a href="https://www.theguardian.com/australia-news/2023/nov/30/queensland-law-abortion-pills-midwives-nurses-prescribed-details">Queensland has just introduced</a> similar legislation. But elsewhere, laws would need to be changed to relax the hold of doctors on the future of this health care.</p>
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Read more:
<a href="https://theconversation.com/what-is-a-medication-or-medical-abortion-5-questions-answered-by-3-doctors-182646">What is a medication, or medical, abortion? 5 questions answered by 3 doctors</a>
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<h2>‘My wife doesn’t want me to’</h2>
<p>Anti-abortion doctors are a minority. But they can have an outsize influence. In the 2020s, their influence in <a href="https://www.abc.net.au/news/2023-01-20/medical-abortions-prescribed-secret-wagga-wagga-doctors-say/101870518">Wagga Wagga</a> limited services at the base hospital and inhibited local GPs’ provision of medical abortion.</p>
<p>The Australian Medical Association and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists have significantly liberalised their positions on abortion since the 1970s. However, both insist on legislation to protect doctors’ right to conscientiously object to performing abortion – even though professional codes of ethics already state this entitlement. </p>
<p>The medical profession’s moral and social conservatism has caused difficulties for both private providers and public hospitals. </p>
<p>Private clinics in regional Queensland and Tasmania have relied on fly-in, fly-out doctors, adding to clinic costs. Metropolitan locations sometimes struggled, too. In Perth, Dr Judith Nash’s clinic, which operated from 2001 to 2013, relied on abortion-providing locums from Sydney and Melbourne to allow her to take leave.</p>
<p>In Queensland, Cairns sexual health doctor Robbie described the lack of advocacy from the obstetrics and gynaecology profession in his state as “very disappointing”. He told me, “I think they don’t respect women’s rights”. </p>
<p>Ingrid, a South Australian abortion-providing GP, recalled doctors who had expressed interest in working alongside her in South Australian hospitals, but “then they’ve come back to me a couple of weeks later and said ‘Oh, actually I can’t do that, my wife doesn’t want me to’ or ‘my husband doesn’t’”. </p>
<p>For her, she told me, “it was really a feminist calling to do abortions”. </p>
<p>With some bravado, Rosalie, a GP who had provided abortions across three states before decriminalisation, told me abortion-providing doctors “just go ahead and do our own thing”. </p>
<p>Her social life could pose challenges though. “I’ve managed to silence some dinner parties when people have pushed me and said, ’Well where do you work? What do you do?’”.</p>
<h2>A brief history of abortion and doctors</h2>
<p>The first generation of post-liberalisation abortion providers, who practiced from the early 1970s until the 1990s, had seen the effects of unsafe illegal abortions.</p>
<p>In 1972, <a href="https://adb.anu.edu.au/biography/wainer-bertram-barney-15900">Dr Bertram Wainer</a> launched the first overtly operating abortion clinic in Australia, now known as The Fertility Control Clinic. It trained doctors and acted as an agent of social change. Those who set up private clinics in the early days were often represented as “mavericks”. Perhaps they needed to be. Peter Bayliss opened the first private clinic providing abortions in Joh Bjelke-Petersen’s Queensland in the late 1970s. It was raided by police in 1985.</p>
<p>Bayliss and his anaesthetist, Dawn Cullen, were arrested but subsequently acquitted, in a case that set the legal precedent for lawful abortion in Queensland. He ran the clinic until his death in the mid-1990s, a controversial media figure until the end.</p>
<p>A second generation of abortion providers led the expansion of the private sector in the 1990s and continued to advocate for reform and improved services.</p>
<p>A third generation of abortion doctor leadership matured in the 2000s, centred in the public sector. Many are feminist women who have published research about abortion, as well as campaigning for change.</p>
<p>In 2005, Cairns-based Caroline de Costa, Australia’s first female obstetrics and gynaecology professor, <a href="https://researchonline.jcu.edu.au/6883/1/6883_DeCosta_2005.pdf">initiated the campaign</a> to remove the Howard government legislation that prevented the importation of mifepristone (also known as RU486). She subsequently began providing it, in limited clinical circumstances.</p>
<p>GP Ea Mulligan in South Australia built on de Costa’s legacy, working to receive permission to use mifepristone for everyday abortions, before it was commercially imported. In the late 2010s, obstetrics and gynaecology abortion provider Paddy Moore led the improvement of late abortion services at Melbourne’s Royal Women’s Hospital. </p>
<p>In 2019, Brisbane obstetrician and gynaecologist and Uniting Church leader Carol Portmann appeared in the SBS reality TV program <a href="https://www.sbs.com.au/voices/article/heres-how-australia-responded-to-episode-1-of-christians-like-us/zsjzygf0d">Christians Like Us</a>, which featured ten Christians living as housemates for a week. She came out as an abortion provider to her ten Christian housemates. “I believe as a Christian, and as a doctor, I am here to help people and guide them through whatever situation they are in without judgement,” <a href="https://www.mamamia.com.au/christians-like-us/">she has said</a>.</p>
<p>Private sector doctors led the provision of medical abortion by telehealth. GP Philip Goldstone, medical director of not-for-profit national abortion provider <a href="https://www.healthdirect.gov.au/partners/msi-australia">MSI Australia</a>, piloted its telehealth service – now the biggest in the country. MSI provides about 40% of all abortions in Australia. </p>
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Read more:
<a href="https://theconversation.com/early-medical-abortion-is-legal-across-australia-but-rural-women-often-dont-have-access-to-it-125300">Early medical abortion is legal across Australia but rural women often don't have access to it</a>
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<h2>‘Rewarding work’</h2>
<p>Abortion care is rewarding work. As GP Simon said, “there’s not actually many areas of medicine where women – or patients – can come to you with a problem that you can solve on the day and they go home.”</p>
<p>In 2019, gynaecologist <a href="https://www.smh.com.au/politics/federal/no-one-approaches-this-lightly-leading-gynaecologist-speaks-about-abortions-20190912-p52qiw.html">Paddy Moore said</a> an “increasing number of junior doctors see abortions as ‘bread and butter medicine’”. </p>
<p>Nonetheless, abortion care still relies on “champions”. Doctors are not the only advocates for it, but their legal and cultural authority is still necessary. </p>
<p>While nurses and midwives are part of the solution to the problem of doctors’ reticence in providing abortions, the culture of medical schools and the profession more broadly must change. Abortion needs to become a normal part of universal health care.</p>
<hr>
<p><em>All interviewees are identified by pseudonyms. Barbara Baird’s <a href="https://www.mup.com.au/books/abortion-care-is-health-care-paperback-softback">Abortion Care is Health Care</a> (Melbourne University Press) tells the history of abortion provision in Australia since 1990.</em></p>
<hr>
<p> </p><img src="https://counter.theconversation.com/content/216278/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Barbara Baird receives funding from the Australian Research Council. She is Co-Convenor of the South Australian Abortion Action Coalition. </span></em></p>A 2023 Senate inquiry report described abortion access in Australia as a ‘lottery’. Barbara Baird’s research doesn’t describe chance, but an inadequate system. What needs to change?Barbara Baird, Associate Professor, College of Humanities, Arts and Social Sciences, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168972023-12-04T13:27:26Z2023-12-04T13:27:26ZTexas is suing Planned Parenthood for $1.8B over $10M in allegedly fraudulent services it rendered – a health care economist explains what’s going on<figure><img src="https://images.theconversation.com/files/562238/original/file-20231128-21-zr2ypf.jpg?ixlib=rb-1.1.0&rect=0%2C1087%2C5094%2C2238&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Texas authorities have long sought to kick Planned Parenthood out of the state.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/PlannedParenthoodMedicaid/61c31f85fab64d1893cc49aa2c9444ae/photo?boardId=37be9465fcce45d283d5431cccb20a6a&st=boards&mediaType=audio,photo,video,graphic&sortBy=&dateRange=Anytime&totalCount=469&currentItemNo=2">AP Photo/Eric Gay</a></span></figcaption></figure><p>Planned Parenthood no longer provides abortions in Texas, Louisiana and the other 10 <a href="https://www.guttmacher.org/2023/01/six-months-post-roe-24-us-states-have-banned-abortion-or-are-likely-do-so-roundup">states that have essentially banned abortion</a> <a href="https://theconversation.com/one-year-after-the-fall-of-roe-v-wade-abortion-care-has-become-a-patchwork-of-confusing-state-laws-that-deepen-existing-inequalities-207390">since the Supreme Court handed down its Dobbs v. Jackson decision</a> in June 2022.</p>
<p>But the nonprofit is still providing other services for patients in those places, including cancer screening, contraception and the treatment of HIV and sexually transmitted infections. And <a href="https://www.texastribune.org/2023/08/15/texas-abortion-planned-parenthood-lawsuit/">Texas hasn’t given up</a> on its long-running quest to force the group, which <a href="https://apnews.com/article/abortion-planned-parenthood-states-layoffs-equity-8ca79602fd28226538e5f6148a202646">provides reproductive health care</a> in its nearly 600 U.S. clinics, to stop operating within its borders.</p>
<p>Alongside an anonymous whistleblower identified as “Alex Doe,” <a href="https://www.texastribune.org/2022/01/13/texas-medicaid-planned-parenthood-lawsuit/">Texas authorities are suing Planned Parenthood</a> <a href="https://www.texastribune.org/2023/08/15/texas-abortion-planned-parenthood-lawsuit/">for more than US$1.8 billion</a> in penalties and fees over what they allege are fraudulent Medicaid reimbursements. </p>
<p><a href="https://www.plannedparenthood.org/about-us/newsroom/press-releases/the-facts-on-united-states-ex-rel-doe-v-planned-parenthood-federation-of-america-the-meritless-case-that-could-shut-down-planned-parenthood">Planned Parenthood denies</a> having committed Medicaid fraud. It calls the lawsuit “<a href="https://apnews.com/article/health-texas-medicaid-planned-parenthood-14379403b715dd838b0d18efab629db3">another political attack</a>.”</p>
<p>As an economist who <a href="https://www.grahamgardnerecon.com/">studies the health effects of restricted abortion access</a>, I believe that if Texas prevails in this federal lawsuit, Texans will have even less access to sexual and reproductive health care. Notably, <a href="https://www.texmed.org/Template.aspx?id=59688">the state ranked 50th</a> in access to high-quality prenatal and maternal health care in 2022, and maternal mortality rates in the state more than <a href="https://www.axios.com/local/dallas/2023/07/24/maternal-mortality-in-texas">doubled between 1999 and 2019</a>. The elimination of Planned Parenthood facilities across Texas will likely exacerbate the dismal conditions of reproductive care in the state.</p>
<h2>Blocking Medicaid funds</h2>
<p>Medicaid, a government program that helps low-income people get health care, <a href="https://www.kff.org/medicaid/issue-brief/medicaid-financing-the-basics/.">provides roughly $728 billion in services</a> annually. The federal and state governments split its costs.</p>
<p>In 2016, Texas <a href="https://www.texastribune.org/2016/12/20/texas-kicks-planned-parenthood-out-medicaid/">removed Planned Parenthood from its list of qualified Medicaid</a> providers, blocking Planned Parenthood clinics across the state from receiving any federal or state dollars to pay for expenses covered by Medicaid. Lower courts <a href="https://www.nytimes.com/2017/02/21/us/texas-planned-parenthood-medicaid.html">initially prevented this policy from going into effect</a>. </p>
<p>But in 2020, the <a href="https://www.texasattorneygeneral.gov/sites/default/files/images/admin/2020/Press/EnBancOpinion.pdf">5th U.S. Circuit Court of Appeals ruled</a> that the state may exclude Planned Parenthood from receiving Medicaid reimbursement. Since then, Planned Parenthood has continued to operate in Texas, but the availability of health services to the nearly <a href="https://www.plannedparenthood.org/planned-parenthood-gulf-coast/checkup-2021/texas-medicaid-exclusion">8,000 Planned Parenthood patients who rely on Medicaid</a> in the state has been put at risk. </p>
<h2>New legal salvo</h2>
<p>Texas now alleges that Planned Parenthood defrauded the state by billing expenses through Medicaid between 2016 and 2020 while its litigation was pending. The group counters that it legitimately billed Medicaid while the law was blocked by pending legal challenges. </p>
<p>Although Texas doesn’t dispute that the nonprofit provided the health care services for which it billed the state, and which the state paid for, Texas seeks the repayment of <a href="https://www.texastribune.org/2022/01/13/texas-medicaid-planned-parenthood-lawsuit/">$10 million in Medicaid reimbursements</a>.</p>
<p>The potential liability is far larger because it also includes interest, legal fees and civil penalties adding up to more than $1.8 billion. Planned Parenthood says <a href="https://www.plannedparenthood.org/about-us/newsroom/press-releases/statement-from-planned-parenthood-texas-affiliates-and-ppfa-following-oral-arguments-in-baseless-medicaid-false-claims-act-case">the financial burden of the lawsuit</a>, if the state wins, would significantly limit its ability to continue to operate in Texas. </p>
<p>This litigation originated in 2021, when the anonymous whistleblower brought a case against Planned Parenthood under the <a href="https://www.justice.gov/civil/false-claims-act">False Claims Act</a>, which allows an individual to file a lawsuit on behalf of the government.</p>
<p>The <a href="https://clearinghouse.net/case/43987/">state of Texas joined the lawsuit</a> under the direction of Attorney General Ken Paxton in 2022. The case was filed in Amarillo, an area without a Planned Parenthood facility – a jurisdiction that might seem an unlikely choice. There’s one good explanation, however: All cases filed there are heard by <a href="https://apnews.com/article/texas-judge-matthew-kacsmaryk-abortion-pill-fda-75964b777ef09593a1ad948c6cfc0237">U.S. District Judge Matthew Kacsmaryk</a>.</p>
<p>The Trump-appointed judge made headlines in early 2023 when he <a href="https://www.reuters.com/legal/us-judge-hands-anti-abortion-groups-partial-win-over-abortion-pill-2023-04-07/">suspended the approval of a common abortion-inducing pill</a>. Kascmaryk’s anti-abortion history on the bench makes him a strategic choice to rule on the case against Planned Parenthood.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/562240/original/file-20231128-29-q9upvc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man in a suit and tie looks askance." src="https://images.theconversation.com/files/562240/original/file-20231128-29-q9upvc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562240/original/file-20231128-29-q9upvc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562240/original/file-20231128-29-q9upvc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562240/original/file-20231128-29-q9upvc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562240/original/file-20231128-29-q9upvc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562240/original/file-20231128-29-q9upvc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562240/original/file-20231128-29-q9upvc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Texas is suing Planned Parenthood as directed by Ken Paxton, the state’s attorney general.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TexasAttorneyGeneralIndictment/64e2bf2f0f2547eab6935851fb542be2/photo?Query=ken%20paxton&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=868&currentItemNo=1">AP Photo/Eric Gay</a></span>
</figcaption>
</figure>
<h2>Reduced health care access</h2>
<p>Texas has been curtailing public funding to Planned Parenthood clinics since at least 2011, when the state cut its family planning budget from <a href="https://doi.org/10.1056%2FNEJMp1207920">$111 million to $38 million</a>.</p>
<p>Following those cuts, <a href="https://www.tpr.org/government-politics/2023-09-15/after-a-decade-of-state-led-attacks-texas-seeks-to-bankrupt-planned-parenthood">82 Texas clinics subsequently closed</a> or stopped providing family planning services, about one-third of which were Planned Parenthood affiliates. Many that remained open <a href="https://www.nejm.org/doi/10.1056/NEJMp1207920">reduced their hours</a> under the financial strain.</p>
<p>Texas’ publicly funded family planning clinics <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386528/">served 54% fewer patients after the budget cuts</a>. Then, in 2013, Texas stopped letting abortion providers and affiliates get any funding through the Texas Women’s Health Program – a decision that caused the federal government to remove all financial support to it.</p>
<p>In response, Texas restructured the program under a new name: “<a href="https://www.texastribune.org/2017/05/05/healthy-texas-women-program-billboards-are-not-enough/">Healthy Texas Women</a>,” entirely funded through the state.</p>
<p>Having lost those funds, <a href="https://www.washingtonpost.com/posteverything/wp/2017/02/07/defunding-planned-parenthood-was-a-disaster-in-texas-congress-shouldnt-do-it-nationally/">31 of Texas’ remaining 74 Planned Parenthood-affiliated clinics closed</a> by 2017.</p>
<h2>Trial slated for April 2024</h2>
<p>This case, which <a href="https://www.reuters.com/legal/planned-parenthood-must-face-trial-over-texas-medicaid-fraud-claims-2023-10-24/">goes to trial in April 2024</a>, targets the three remaining Texas Planned Parenthood affiliates that operate roughly 35 clinics – <a href="https://www.plannedparenthood.org/planned-parenthood-gulf-coast/patients/locations-hours">two of which are in Louisiana</a>.</p>
<p>By late 2023, <a href="https://www.guttmacher.org/state-policy/explore/state-family-planning-funding-restrictions">18 states had abortion-related laws</a> on their books restricting state funds for family planning. Most of these laws target abortion providers, but in only six states does this restriction apply to clinics affiliated with those organizations.</p>
<p>Currently, only Texas prevents Planned Parenthood from receiving any Medicaid funds. Louisiana had an opportunity to join the lawsuit in Texas but instead <a href="https://www.vox.com/politics/2023/5/24/23725897/abortion-planned-parenthood-matthew-kacsmaryk-supreme-court-medical-progress-medicaid">settled with Planned Parenthood</a>, which allowed the organization to continue to receive Medicaid funds in the state.</p>
<p>But legislation in Texas often spurs copycat bills elsewhere. A 2022 Texas restriction on abortion procedures after six weeks of gestation was <a href="https://www.cnn.com/2022/04/28/politics/oklahoma-heartbeat-act/index.html">quickly copied by Oklahoma</a>, <a href="https://www.austinwomenshealth.com/copycat-bans-follow-after-texas-sb-8/">South Dakota</a> and <a href="https://www.forbes.com/sites/alisondurkee/2022/03/23/idaho-enacts-law-copying-texas-abortion-ban---and-these-states-might-be-next/?sh=1a93969525c0">Idaho</a>. </p>
<p>It’s reasonable to expect that other states may pass similar restrictions on Medicaid funding to Planned Parenthood. Already, <a href="https://www.thecentersquare.com/national/article_88fa51ca-1146-11ee-a769-b3bafe8d2051.html">related litigation filed in South Carolina</a> <a href="https://governor.sc.gov/news/2023-06/governor-henry-mcmaster-releases-statement-following-us-supreme-courts-ruling-kerr-v">is pending</a>.</p>
<h2>IUDs and cancer screening</h2>
<p>Planned Parenthood clinic closures and the reimbursement restrictions it faces are reducing the availability of reproductive health services, particularly for low-income people.</p>
<p>After the change in the Healthy Texas Women program, the provision of Medicaid-funded, long-acting reversible contraceptives – a category that includes intrauterine devices (IUDs) and contraceptive implants – fell by 35%, and <a href="https://doi.org/10.1056%2FNEJMsa1511902">Medicaid-paid obstetric care for people giving birth increased by 27%</a>. </p>
<p>In 2015, Texas prohibited Planned Parenthood from receiving <a href="https://www.texastribune.org/2015/08/10/planned-parenthood-be-cut-cancer-screening-program/">state funds for breast and cervical cancer screenings</a> and terminated a contract with Planned Parenthood Gulf Coast to <a href="https://www.texastribune.org/2015/12/22/texas-drops-planned-parenthood-hiv-prevention-prog/">financially support its HIV prevention program</a>.</p>
<p>If the court rules against Planned Parenthood, and the ruling stands after the appeals process that would certainly follow such a decision, access to sexual and reproductive health services in Texas will decline further. </p>
<p>While the lawsuit could bankrupt Planned Parenthood affiliates in the state, driving the organization out at last, it does not appear likely that the national organization would have to foot this massive legal bill and face jeopardy on a larger scale.</p>
<p>And I have no doubt that Texas’ remaining reproductive health care clinics would surely experience an overwhelming demand for their services while trying to fill the gaps left behind.</p><img src="https://counter.theconversation.com/content/216897/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Graham Gardner is affiliated with the Society of Family Planning. </span></em></p>This lawsuit is only the latest chapter in a battle between the state and the reproductive health care provider that heated up in 2011.Graham Gardner, Assistant Professor of Economics, Texas Christian UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172492023-11-09T18:48:39Z2023-11-09T18:48:39ZAbortion rights victories show this issue is unlikely to fade in 2024 elections − 3 things to know<figure><img src="https://images.theconversation.com/files/558413/original/file-20231108-17-safd3t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Abortion rights supporters celebrate Issue 1 passing in Ohio on Nov. 7, 2023.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/abortion-rights-supporters-celebrate-winning-the-referendum-news-photo/1769771636?adppopup=true">Megan Jelinger/AFP via Getty Images </a></span></figcaption></figure><p>Abortion rights advocates <a href="https://www.npr.org/2023/11/08/1211429268/abortion-rights-2023-election-ohio-virginia-kentucky">won major victories</a> in several state elections on Nov. 7, 2023, signaling that abortion laws are likely to continue to play an important role in the 2024 elections. </p>
<p>In Ohio, the only state where abortion was directly on the ballot, more than <a href="https://www.washingtonpost.com/politics/2023/11/07/abortion-ohio-kentucky-virginia-elecitons/">56% of voters in the conservative-leaning</a> state approved a measure called Issue 1. </p>
<p>This <a href="https://apnews.com/article/ohio-abortion-amendment-election-2023-fe3e06747b616507d8ca21ea26485270">constitutional amendment protects people’s right</a> to <a href="https://www.ohioattorneygeneral.gov/getattachment/cf27c10f-b153-4731-ae9e-e3555a326ed9/The-Right-to-Reproductive-Freedom-with-Protections-for-Health-and-Safety.aspx">have an abortion</a> in Ohio, as well as to get contraception and receive treatment for fertility issues and miscarriages.</p>
<p>Virginia Democrats, who campaigned on preserving abortion rights, maintained control of the state Senate and <a href="https://apnews.com/article/virginia-legislature-election-2023-79f9337731c25decc83b83eeb4d3e00e">took control of Virginia’s House of Delegates</a> from Republicans. While <a href="https://lis.virginia.gov/cgi-bin/legp604.exe?231+sum+SB1483">abortion is legal</a> in Virginia until the 26th week of pregnancy, Republican Gov. Glenn Youngkin has said he wanted the legislature to enact <a href="https://www.washingtonpost.com/dc-md-va/2023/11/08/virginia-senate-house-election-results-2023/">a ban on abortion</a> after 15 weeks of pregnancy. </p>
<p>And in Kentucky, Gov. <a href="https://www.washingtonpost.com/politics/2023/11/07/kentucky-governor-election-results-2023/">Andy Beshear, a Democrat, won reelection</a>. During his campaign, Beshear promised to protect abortion rights and highlighted Republican opponent Daniel Cameron’s support for Kentucky’s <a href="https://theconversation.com/in-first-nationwide-election-since-roe-was-overturned-voters-opt-to-protect-abortion-access-194140">near-total ban on abortion</a>. </p>
<p>We are <a href="https://scholar.google.com/citations?user=CcAfO1UAAAAJ&hl=en">scholars of law,</a> <a href="https://scholar.google.com/citations?user=4bgaJCQAAAAJ&hl=en">gender and health</a> and co-direct Boston University’s Program on Reproductive Justice.</p>
<p>We wrote last year that new constitutional amendments protecting a right to abortion in states usually considered “red,” like Kansas, <a href="https://theconversation.com/in-first-nationwide-election-since-roe-was-overturned-voters-opt-to-protect-abortion-access-194140">were not flukes</a>. Rather, such wins, which have happened in <a href="https://ballotpedia.org/2023_and_2024_abortion-related_ballot_measures">six other states</a> since 2022, affirm a broader trend. The majority of U.S. voters support laws protecting access to abortion and other reproductive care. </p>
<p>Here are three important things to know about the election results.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/558418/original/file-20231108-21-dsckc0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman closes her eyes and appears to be crying, surrounded by other people." src="https://images.theconversation.com/files/558418/original/file-20231108-21-dsckc0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558418/original/file-20231108-21-dsckc0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558418/original/file-20231108-21-dsckc0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558418/original/file-20231108-21-dsckc0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558418/original/file-20231108-21-dsckc0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558418/original/file-20231108-21-dsckc0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558418/original/file-20231108-21-dsckc0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Abortion rights supporters in Columbus, Ohio, celebrate winning the right to enshrine abortion in the state’s constitution.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/abortion-rights-supporters-celebrate-winning-the-referendum-news-photo/1769779581?adppopup=true">Megan Jelinger/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>1. Votes amending state constitutions are key to protecting abortion rights</h2>
<p>Ohio voted for former President Donald Trump in 2016 and in 2020. In recent years, it has been considered a toss-up state that is turning “red.” </p>
<p>In the days leading up to the 2023 election, <a href="https://www.politico.com/news/2023/10/11/conservatives-ohio-abortion-referendums-00120837">some conservative commentators observed</a> that “anti-abortion groups are banking on Ohio to end the movement’s run of state-level losses and create a blueprint for battles in 2024 and beyond.”</p>
<p>Instead, most Democratic and independent voters, and some Republican voters, <a href="https://www.msn.com/en-us/news/politics/exit-poll-results-from-ohio-issue-1-ballot-measure-on-abortion-rights/ar-AA1jyKvR">cast their ballots in favor of Issue 1,</a> rejecting Ohio’s law that bans abortion after six weeks.</p>
<p>This followed on the heels of a recent high-profile case in which a 10-year-old Ohio girl had to travel to Indiana to <a href="https://www.nbcnews.com/health/health-news/indiana-doctor-gave-10-year-old-girl-abortion-disciplinary-hearing-rcna86214">have an abortion after she was raped</a> and could not have the procedure in Ohio. Notably, physicians <a href="https://twitter.com/OURR2023/status/1719345494130885114?s=20">vocally opposed</a> <a href="https://drive.google.com/file/d/1-hgtRAaGszSvdZy7krZ_FZrMKSgZqHSg/view">Ohio’s restrictive laws</a>.</p>
<p>This new constitutional amendment means that <a href="https://www.dispatch.com/story/news/2022/07/02/roe-v-wade-abortion-supreme-court-ohio-dewine-heartbeat-bill/7767433001/">Ohio’s 2019 law</a> that prohibited abortion as soon as fetal cardiac activity could be detected – as early as six weeks into pregnancy – will not be allowed to take effect. A lower state court stopped enforcement of the six-week ban, but the case was making its way to the Ohio Supreme Court, whose seven members are mostly Republicans that have publicly <a href="https://www.npr.org/2023/11/07/1209092670/2023-results-key-ohio-elections">opposed abortion rights</a>.</p>
<p>Now, the Republican-controlled Ohio legislature <a href="https://www.ohiosos.gov/legislation-and-ballot-issues/putting-an-issue-on-the-ballot/citizen-initiated-constitutional-amendment/">does not have the power</a> to amend or stop the new constitutional amendment or to enforce the six-week ban. </p>
<p>Lawmakers may still campaign to repeal Issue 1, but this change would require voters to first approve a different ballot initiative.</p>
<p>While state constitutions are amended much more frequently than the U.S. Constitution, a majority of voters in Ohio showed they support abortion rights, so another ballot measure seems unlikely. </p>
<h2>2. Reframing abortion restrictions does not fool voters</h2>
<p>In Virginia, Democratic candidates campaigned on preserving abortion rights, while Republican candidates <a href="https://abcnews.go.com/Politics/democrats-republicans-release-dueling-abortion-ads-high-stakes/story?id=103598015">charged Democrats</a> with being obsessed with abortion. </p>
<p>Some Republican candidates also denied that they supported an abortion ban. Instead, they attempted to describe Youngkin’s <a href="https://www.nytimes.com/2023/11/04/us/politics/abortion-ohio-kentucky-virginia-election.html">proposed 15-week ban</a> as “legislation that reflects compassionate common sense.”</p>
<p>The election results suggest that a majority of Virginia voters effectively rejected this proposed ban on abortion after 15 weeks.</p>
<p>Instead, they elected Democratic candidates who pledged to protect abortion rights in the one Southern state that had not enacted new <a href="https://www.forbes.com/sites/alisondurkee/2023/11/08/abortion-rights-victories-continue-here-are-all-the-wins-in-major-elections-since-the-supreme-court-overturned-roe/?sh=5825d21026ad">restrictive abortion laws</a> since the Supreme Court overturned Roe v. Wade in 2022.</p>
<p>With Democrats controlling both legislative chambers in Virginia, new bills will stall, and the legislative majority can counter other restrictive measures that are proposed. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/558422/original/file-20231108-23-ys1tah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Andy Beshear stands in a dark blue suit at a podium that has his name on it, surrounded by three women on a stage." src="https://images.theconversation.com/files/558422/original/file-20231108-23-ys1tah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558422/original/file-20231108-23-ys1tah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558422/original/file-20231108-23-ys1tah.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558422/original/file-20231108-23-ys1tah.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558422/original/file-20231108-23-ys1tah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558422/original/file-20231108-23-ys1tah.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558422/original/file-20231108-23-ys1tah.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Kentucky Gov. Andy Beshear, who campaigned on abortion rights, delivered his victory speech on Nov. 7, 2023.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/kentucky-incumbent-democratic-gov-andy-beshear-is-joined-by-news-photo/1781193061?adppopup=true">Stephen Cohen/Getty Images</a></span>
</figcaption>
</figure>
<h2>3. Abortion rights matter up and down the ballot</h2>
<p>Beshear placed abortion at the center of his campaign for governor in Kentucky, even though the state has a <a href="https://apnews.com/article/abortion-kentucky-governor-campaign-ec767bf7802852d48ea150b7118fc90c">near-total ban</a> on all abortions and does not have any exceptions for cases of incest or rape. </p>
<p>His win, as well as the <a href="https://www.inquirer.com/politics/election/pennsylvania-supreme-court-election-results-2023-20231107.html">Pennsylvania Supreme Court election</a> that resulted in one more Democrat joining the court and creating a majority, suggests that highlighting abortion rights in election campaigns can be an <a href="https://apnews.com/article/kentucky-primary-governors-race-election-2023-e8df45cd3978ce5a1691ba447c84bafc">effective way to draw in voters</a>. </p>
<p>While Kentucky voters said the economy is a top issue for them, they have also said <a href="https://www.kentucky.com/news/politics-government/election/article281536793.html">abortion and other basic rights </a> are important, too. </p>
<p>Beshear’s campaign <a href="https://www.youtube.com/watch?v=BQ_qeTQz_Es">ran an unusual advertisement</a> featuring Hadley Duvall, a Kentucky resident who was raped by her stepfather at age 12. She became pregnant but later miscarried. Duvall, now 20 years old, appeared in the television advertisement and challenged Cameron’s <a href="https://www.aclu.org/wp-content/uploads/2023/02/SCOKY-Opinion-Feb-16-2023.pdf">support for Kentucky’s law</a>, which allows an abortion only in order to save the life of a pregnant woman – while instructing doctors to try to save the fetus, too.</p>
<p>The ad <a href="https://www.cincinnati.com/story/news/local/northern-ky/2023/10/05/kentucky-abortion-debate-hadley-duvall-commercial-daniel-cameron-andy-beshear/71077318007/">resonated with voters</a>, even in a state that now <a href="https://www.axios.com/2022/04/14/kentucky-abortion-clinics-stop-provider-law-ban">has no abortion clinics</a>.</p>
<p>Beshear’s reelection shows that politicians can effectively push for laws that walk back from near-total abortion bans, such as making exceptions in cases of rape or incest. In 2022, Kentucky voters already <a href="https://www.pbs.org/newshour/politics/kentucky-voters-reject-constitutional-amendment-on-abortion">rejected a state constitutional amendment</a> that would have prevented recognizing a right to abortion in the state. </p>
<p>These different state elections point in one clear direction.</p>
<p>Abortion <a href="https://www.kff.org/womens-health-policy/press-release/abortion-access-rises-as-a-voting-issue-and-motivator-especially-among-democrats-and-reproductive-age-women-but-inflation-continues-to-dominate-as-americans-worry-about-bills/">increasingly matters to voters</a>. And most voters do not want laws <a href="https://news.gallup.com/poll/321143/americans-stand-abortion.aspx">severely restricting abortion</a> and other kinds of reproductive health care. </p>
<p>The 2023 election outcomes also suggest that Democratic candidates can effectively use abortion as a campaign issue. This will be critical for the general elections in 2024.</p><img src="https://counter.theconversation.com/content/217249/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The new constitutional amendment to protect the right to abortion in Ohio − as well as other wins for Democrats − shows the importance of ballot initiatives and focusing on abortion in elections.Nicole Huberfeld, Professor of Health Law and Professor of Law, Boston UniversityLinda C. McClain, Professor of Law, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168842023-11-09T13:35:47Z2023-11-09T13:35:47ZAs national political omens go, Republicans sought middle ground on abortion in Virginia − and still lost the state legislature<figure><img src="https://images.theconversation.com/files/558378/original/file-20231108-21-ta5abq.jpg?ixlib=rb-1.1.0&rect=2219%2C421%2C3631%2C3473&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Gov. Glenn Youngkin speaks during a rally in Leesburg, Va., on Nov. 6, 2023. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/gov-glenn-youngkin-speaks-during-a-get-out-the-vote-rally-news-photo/1779369936?adppopup=true">Alex Wong/Getty Images</a></span></figcaption></figure><p>The <a href="https://apnews.com/article/virginia-legislature-election-2023-79f9337731c25decc83b83eeb4d3e00e">election results</a> in Virginia offer Republicans across the country one key lesson before the 2024 presidential election: Revise the GOP position on the critical issue of abortion. </p>
<p>Though not on the ballot, GOP Gov. Glenn Youngkin had campaigned for other GOP members on his plan to <a href="https://www.thedailybeast.com/virginia-gov-glenn-youngkin-bet-on-a-less-extreme-abortion-ban-and-lost">ban abortions after 15 weeks</a>, as opposed to the outright abortion ban that some Virginia politicians have promised to pass. Political observers saw Youngkin’s plan as a compromise that would limit the political fallout for the GOP from the U.S. Supreme Court’s <a href="https://www.nytimes.com/2022/06/24/us/roe-wade-overturned-supreme-court.html">reversal of Roe v. Wade</a>, which constitutionally protected the right to abortion.</p>
<p>Since the spring of 2023, when Youngkin first weighed in heavily in Republican primaries for the state legislature, Youngkin and <a href="https://www.nbcnews.com/politics/elections/glenn-youngkin-united-virginia-republicans-15-week-abortion-ban-pushed-rcna119199">other GOP candidates</a> emphasized the 15-week ban in the face of <a href="https://www.washingtonpost.com/dc-md-va/2023/11/08/virginia-senate-house-election-results-2023/">relentless Democratic attacks</a>.</p>
<p>But Youngkin’s hopes that his 15-week ban would spare the party further political grief <a href="https://slate.com/news-and-politics/2023/11/virginia-election-abortion-glenn-youngkin-democrats-republicans.html">failed miserably</a>, as Democrats secured control over both legislative branches. </p>
<p>Largely on the strength of suburban voters outside Washington, D.C., and Virginia’s capital, Richmond, Democratic candidates who focused on the abortion issue <a href="https://www.nytimes.com/2023/11/08/us/politics/glenn-youngkin-virginia.html">captured a majority</a> of seats in the House of Delegates and retained their majority in the Senate. </p>
<h2>Abortion was the key issue</h2>
<p>In my view as a political scientist, the effectiveness of the Democratic position on abortion shouldn’t be a surprise to Virginia voters and politicians. </p>
<p>Polls, including a September 2023 <a href="https://www.umw.edu/news/2023/09/27/virginians-closely-divided-over-2023-legislative-elections-in-statewide-survey/">statewide survey</a> by the University of Mary Washington and Research America Inc., demonstrated that Democrats were far more likely to vote based on the abortion question than Republicans were.</p>
<p>In that survey, 70% of Democrats considered abortion a major factor for them in the upcoming elections, as compared with 35% of Republicans. </p>
<p>Among independents, 54% said the abortion ruling was a major factor as they considered how to approach the Virginia midterms.</p>
<h2>Straddling GOP extremes</h2>
<p>Youngkin was elected governor two years ago as a largely unknown conservative who had <a href="https://www.washingtonpost.com/local/virginia-politics/glenn-youngkin-fortune-carlyle-virginia/2021/08/02/aeeebab4-efc5-11eb-81d2-ffae0f931b8f_story.html">a lengthy business career</a> – and no legislative record. </p>
<p>In recent decades, Virginia went from a reliably Republican state in presidential elections to one where Donald Trump <a href="https://www.nbcnews.com/politics/2020-elections/virginia-results/">lost by 10 points</a> in 2020.</p>
<p>As a political novice, Youngkin successfully straddled the Republican dynamics of this purple state by trying to appeal to supporters of Donald Trump and his MAGA movement as well as moderate suburban Republicans uncomfortable with Trump’s chaotic administration and legal troubles. </p>
<figure class="align-center ">
<img alt="A middle aged white man dressed in a business suit watches another white man answer a question as he gestures with his hands." src="https://images.theconversation.com/files/558469/original/file-20231108-21-u6igh9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558469/original/file-20231108-21-u6igh9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558469/original/file-20231108-21-u6igh9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558469/original/file-20231108-21-u6igh9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558469/original/file-20231108-21-u6igh9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558469/original/file-20231108-21-u6igh9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558469/original/file-20231108-21-u6igh9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Candidate and former Democratic Virginia Gov. Terry McAuliffe, left, debates Republican gubernatorial candidate Glenn Youngkin on Sept. 28, 2021.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/former-virginia-gov-terry-mcauliffe-debates-republican-news-photo/1343654379?adppopup=true">Win McNamee/Getty Images</a></span>
</figcaption>
</figure>
<p>Youngkin offered up conservative cultural war messaging – particularly on parental rights in public schools that convinced Trump voters to cast ballots for him in his 2021 race against <a href="https://www.cnn.com/2021/10/07/politics/glenn-youngkin-parental-rights-education-strategy/index.html">Democratic candidate Terry McAuliffe</a>. </p>
<p>But in a nod to suburban Republicans, Youngkin <a href="https://www.cnn.com/2023/11/07/politics/virginia-elections-glenn-youngkin/index.html">kept his distance</a> from the former president’s insistence that the 2020 presidential election was stolen. Youngkin won the <a href="https://www.nbcnews.com/politics/2021-elections/virginia-governor-results">2021 election</a> by two points. </p>
<p>As the first Republican to win a statewide election since 2009, his victory – and that of the newly Republican House of Delegates majority – <a href="https://www.wsj.com/articles/youngkins-virginia-win-offers-midterm-road-map-for-gop-warning-for-democrats-11635942003">energized the dispirited Republicans</a> lamenting the political changes in the state.</p>
<h2>Shifting political landscape</h2>
<p>To be sure, Youngkin wasn’t just another fresh face touting radically new ideas for his party. </p>
<p>His campaign’s focus on giving <a href="https://abcnews.go.com/Politics/gov-youngkin-makes-final-pitch-virginia-voters-education/story?id=104678396#:%7E:text=In%202021%2C%20Youngkin%20ran%20on,could%20advance%20more%20education%20legislation.">parents more control</a> over local school districts connected with many white conservatives who were incensed that their children were being forced to read books that touched on contentious topics such as racism and sexuality.</p>
<p>Governing as a strident conservative focusing on easing COVID restrictions, cutting taxes and, above all, shifting the direction of public education, Youngkin ran into roadblocks <a href="https://apnews.com/article/religion-education-race-and-ethnicity-racial-injustice-virginia-490f552bb055df29af890b703e06e605">in the Virginia Senate</a>, where Democrats remained in the majority. </p>
<p>In one example, the Youngkin administration <a href="https://richmond.com/news/local/education/new-draft-history-standards-reorient-framing-of-race-relations/article_4504a142-7775-546d-9ea0-3c4272436a00.html">proposed a set of revisions</a> to the state’s Standards of Learning in history and social sciences. </p>
<p>Those proposed standards failed to mention Juneteenth and Martin Luther King Jr. Day and drew the ire of Black politicians and parents <a href="https://www.virginiamercury.com/2022/11/17/missing-context-political-bias-some-of-critics-objections-to-virginias-new-history-standards/">who criticized the proposal</a> as “whitewashing.” </p>
<p>Youngkin’s proposals <a href="https://richmond.com/news/state-and-regional/govt-and-politics/board-of-education-rejects-youngkins-proposed-revisions-to-k-12-history-standards/article_ac6dbdb1-8632-5abd-97e4-39b978982b3f.html">were later rejected</a> by the state Board of Education.</p>
<p>After two years of <a href="https://www.cnn.com/videos/politics/2021/06/23/virginia-school-board-critical-race-theory-mh-orig.cnn">contentious suburban school board meetings</a> in places like Loudoun and Spotsylvania counties, Democrats had a response to Youngkin’s views on <a href="https://www.theguardian.com/us-news/2023/nov/02/parents-right-movement-virginia-republicans">parental rights </a>. They argued that the GOP empowered extremists who want to ban books and tell lies about U.S. and Virginia history. </p>
<p>As a result, a <a href="https://www.umw.edu/news/2023/09/27/virginians-closely-divided-over-2023-legislative-elections-in-statewide-survey/">preelection statewide poll</a> showed that the education issue largely split the electorate down the middle, with roughly equal numbers of Democrats and Republicans saying that school policies were important to their choice in the Virginia midterm elections. </p>
<h2>Where does election leave Youngkin and GOP?</h2>
<p>With the failure of his plan to recast the abortion debate, Youngkin faces another loss that has significant influence on how he might achieve any legislative victories in the remaining two years of his term. </p>
<p>Democrats control the state legislature, and Youngkin’s tenure may be marked by more legislative gridlock. </p>
<p>Youngkin might want to cooperate more with Democratic lawmakers going forward, but as a longtime analyst of Virginia politics, I believe the time when an olive branch would have been most effective was two years ago.</p>
<p>Instead, Youngkin started his term by defining himself as a partisan champion, albeit not a fully pro-Trump Republican.</p>
<p>He has reached the halfway point in his tenure where neither of those positions were rewarded by voters. That’s not a good sign for a guy once touted as a possible GOP presidential candidate.</p><img src="https://counter.theconversation.com/content/216884/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen J. Farnsworth does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Democrats regained the Virginia legislature in the 2023 election, and that spells trouble for Republicans seeking to win the White House in 2024.Stephen J. Farnsworth, Professor of Political Science and International Affairs and Director of the UMW Center for Leadership and Media Studies, University of Mary WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2154082023-11-06T13:34:33Z2023-11-06T13:34:33ZAs Ohio and other states decide on abortion, anti-abortion activists look to rebrand themselves as not religious<figure><img src="https://images.theconversation.com/files/557473/original/file-20231103-20-fp6fav.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Roman Catholic nuns pray with anti-abortion activists across the street from a Planned Parenthood clinic in New York in September 2023.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/roman-catholic-nuns-pray-with-a-group-of-anti-abortion-news-photo/1655599179?adppopup=true">Robert Nickelsberg/Getty Images</a></span></figcaption></figure><p>Abortion has become an increasingly polarized, political issue in the United States since 2022, when the <a href="https://www.oyez.org/cases/2021/19-1392">Supreme Court overturned</a> <a href="https://www.oyez.org/cases/1971/70-18">Roe v. Wade</a>, which guaranteed the constitutional right to an abortion. This decision threw the question of abortion rights back to states. </p>
<p><a href="https://www.dispatch.com/story/news/politics/elections/2023/08/24/ohio-abortion-issue-on-the-november-7-2023-ballot-election-results/70672454007/">Ohio voters</a> will cast ballots on Nov. 7, 2023, to determine abortion rules in their state, joining <a href="https://www.nytimes.com/2023/09/12/magazine/abortion-laws-states.html">six other states</a> that have put the decisions before voters in ballot initiatives since 2022. </p>
<p>Currently, Ohio’s constitution does not mention abortion. Ohio residents will <a href="https://www.npr.org/2023/10/31/1209593353/abortion-ohio-issue-1-vote-election-roe-dobbs">vote on “Issue 1,”</a> which would amend the state constitution to explicitly protect an individual’s right to get an abortion. The amendment would still allow the state to prohibit abortion after a <a href="https://www.acog.org/advocacy/facts-are-important/understanding-and-navigating-viability">fetus is considered viable</a>, with an exception when the health of the pregnant person is at stake. </p>
<p>The initiative is supported by a coalition of abortion-rights organizations, collectively called <a href="https://ohioansunitedforreproductiverights.win/">Ohioans United for Reproductive Justice</a>. </p>
<p>Some anti-abortion activists in Ohio <a href="https://www.ncregister.com/cna/ohio-abortion-supporters-outraise-pro-life-side-3-to-1-ahead-of-november-referendum">have said that Issue 1</a> is “too radical” for the state. But an October 2023 <a href="https://www.bw.edu/news/2023/fall/10-bw-ohio-pulse-poll-shows-ohio-voters-favor-issues-1-and-2">survey showed</a> that 58% of likely Ohio voters support Issue 1.</p>
<p>I am an <a href="https://annewhitesell.com">American politics scholar</a> who focuses on how groups outside of government attempt to influence policy. </p>
<p>Since the <a href="https://www.oyez.org/cases/2021/19-1392">Supreme Court overturned</a> the federal right to get an abortion, I have interviewed 45 anti-abortion activists across the country and collected Facebook data from approximately 190 organizations. I wanted to better understand how anti-abortion groups are working in a post-Roe v. Wade world to ban abortion.</p>
<p>Prominent anti-abortion groups continue to reference religion, and specifically Christianity, in their arguments against abortion. But I found that these activists also recognize that framing abortion as a human rights issue may appeal to a broader audience. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/557476/original/file-20231103-21-jr0953.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman wearing a yellow shirt holds a rosary around her neck and appears to pray with her eyes closed." src="https://images.theconversation.com/files/557476/original/file-20231103-21-jr0953.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557476/original/file-20231103-21-jr0953.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557476/original/file-20231103-21-jr0953.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557476/original/file-20231103-21-jr0953.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557476/original/file-20231103-21-jr0953.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557476/original/file-20231103-21-jr0953.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557476/original/file-20231103-21-jr0953.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Anti-abortion activists pray in New York in August 2022 outside a Planned Parenthood clinic.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/anti-abortion-activists-pray-in-front-of-the-planned-news-photo/1413322749?adppopup=true">Robert Nickelsberg/Getty Images</a></span>
</figcaption>
</figure>
<h2>Perceptions of the anti-abortion movement</h2>
<p>Religious objections to abortion center around the sanctity of human life and the belief that humans are made in God’s image. To end a human life, including the life of a fetus, is to play God.</p>
<p>According to a <a href="https://apnorc.org/wp-content/uploads/2020/02/December-Topline-with-MIP-final.pdf">2019 poll</a>, 77% of Americans believe religion has some or a lot of influence on U.S. abortion policy. </p>
<p>In my interviews, anti-abortion rights activists said they understood that the public views <a href="https://www.press.uillinois.edu/books/?id=p082467">their movement</a> as anti-woman and driven by conservative Christians. More recently, the movement has adopted <a href="https://www.tandfonline.com/doi/full/10.1080/1554477X.2021.1925478">pro-woman messaging</a> to counter the perception that they do not support women. </p>
<p>These organizations are increasingly choosing to speak less about religion and more about human rights and science to combat the narrative that the <a href="https://www.cambridge.org/us/universitypress/subjects/sociology/sociology-general-interest/pro-life-activists-america-meaning-motivation-and-direct-action?format=HB&isbn=9780521660440">anti-abortion movement</a> is solely a Christian movement.</p>
<p>This movement does have a religious history – the <a href="https://www.jstor.org/stable/23052569">U.S. Conference of Catholic Bishops</a> created the predecessor of one of the most well-known anti-abortion organizations, the <a href="https://www.nrlc.org/">National Right to Life Committee</a>, in 1966. </p>
<p>In the 1980s, <a href="https://www.operationrescue.org/">Operation Rescue</a>, which blockaded abortion clinics and had thousands of their activists arrested, brought an evangelical religious fervor to the anti-abortion movement. </p>
<p>Stopping abortion was seen as a <a href="https://doi.org/10.5744/florida/9780813044972.003.0009">Christian duty</a>, even if it meant resorting <a href="https://press.umich.edu/Books/O/Opposition-and-Intimidation2">to violence</a>.</p>
<h2>The changing role of religion</h2>
<p>The religious environment in the U.S. has changed in recent decades, however. </p>
<p>While evangelicals remain a <a href="https://news.gallup.com/opinion/polling-matters/324410/religious-group-voting-2020-election.aspx">powerful voting bloc for Republicans</a>, the percentage of Americans identifying as Christian has declined over the <a href="https://www.pewresearch.org/religion/2022/09/13/how-u-s-religious-composition-has-changed-in-recent-decades/">past 50 years</a> from 90% to 63%. At the same time, the percentage of Americans who identify as religiously unaffiliated has increased from 5% to 29%. </p>
<p>In 2020, <a href="https://news.gallup.com/poll/341963/church-membership-falls-below-majority-first-time.aspx">less than half of Americans</a> belonged to a church, synagogue or mosque – marking an all-time low in affiliation with a religious institution since 1940. </p>
<p>For anti-abortion activists, this means fewer people may connect to their religious appeals. One activist I interviewed put it bluntly: “Why talk the Bible to people, many people, who say the Bible is a fairy tale?”</p>
<h2>What anti-abortion organizations say</h2>
<p>My research shows that anti-abortion organizations in the U.S. fall into one of three camps. Some are openly religious. Others may have religious staff, but refrain from using religion in their advocacy. A small proportion outright reject the use of religion.</p>
<p>I analyzed how anti-abortion organizations use Facebook to promote their work. At least on this social media platform, most anti-abortion organizations do not use religious language.</p>
<p>Between June 2022 and September 2023, 193 anti-abortion groups posted 44,639 times on Facebook. Approximately 11% of these Facebook posts made explicit religious references, ranging from Bible verses to prayer requests. </p>
<p>Some organizations use religious references in nearly all of their Facebook posts, while other groups make only passing references to religion. </p>
<p>Texas Right to Life, for example, posted 770 times between June 2022 and September 2023, and 50% of its posts mentioned religion. In contrast, the group Ohio Right to Life posted 586 times in the same time period. Only 8.7% of their posts mention religion.</p>
<p>More than 15% of the 193 anti-abortion organizations in my sample, however, make no religious references in their Facebook posts from June 2022 through September 2023. </p>
<p>Indeed, the majority of the 45 activists from anti-abortion groups I spoke with said they kept their religious beliefs separate from their activism.</p>
<p>As one anti-abortion activist told me, when someone finds out “you believe that all life is created in the image of God, they completely dismiss you.”</p>
<h2>Other findings</h2>
<p>Most of the activists I interviewed said their organization does not have a formal stance on religion. Approximately one-quarter of the 45 activists I interviewed, however, said their organizations are explicitly Christian. </p>
<p>When asked about the choice to frame anti-abortion arguments around faith, one advocate said, “We 100% present the faith and the theological argument of things. Yeah, part of our culture is being Catholic.”</p>
<p>This advocate continued: “We understand that we also have a responsibility before God on these subjects, so we’re not going to shy away from that.” </p>
<p>A few interviewees stressed that they are not religious. One described herself as an “atheist, vegan pro-lifer.”</p>
<p>Instead of using religion to bolster their arguments against abortion, <a href="https://www.democratsforlife.org/index.php">these activists</a> frame abortion as a <a href="https://www.nbcnews.com/nbc-out/out-news/anti-abortion-lgbtq-groups-roes-reversal-human-rights-victory-rcna35716">human rights issue</a>. For them, any loss of human life is tragic, whether it is from abortion, war or the death penalty.</p>
<p>This kind of framing could help the anti-abortion movement shift conversations about abortion away from religious beliefs.</p>
<h2>Ohio’s vote</h2>
<p>People in all six states that have voted on abortion since 2022 have affirmed broader abortion rights. But <a href="https://www.nytimes.com/2023/11/02/us/abortion-ballot-ohio-vote.html">Ohio is the first red state</a> to vote on adding a right to abortion to the state’s constitution.</p>
<p>Local anti-abortion groups like Cincinnati Right to Life are pushing back <a href="https://www.facebook.com/100064698580681/posts/697161332450480">against Issue 1,</a> saying, for example, that the amendment is too wide-reaching, and that “Issue One will only hurt women & children and not help them.” </p>
<p>Ohio Right to Life has framed Issue 1 as a matter of safety in their <a href="https://www.facebook.com/100064601747509/posts/689319569898095">Facebook posts</a>. </p>
<p>Ohio voters will be the ones to decide which way to move the issue forward.</p><img src="https://counter.theconversation.com/content/215408/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne Whitesell does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An analysis of anti-abortion rights groups in the US shows that while some specifically turn to Christianity to explain their positions, others are looking at broader, human rights arguments.Anne Whitesell, Assistant Professor, Political Science, Miami UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2163092023-10-31T12:34:44Z2023-10-31T12:34:44ZAre journalists serving Virginia’s voters well? Election could offer insights on media on national level<figure><img src="https://images.theconversation.com/files/556325/original/file-20231027-21-u501nd.jpg?ixlib=rb-1.1.0&rect=826%2C71%2C5164%2C3907&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Virginia Gov. Glenn Youngkin gives a thumbs-up during an Economic Club of Washington event on Sept. 26, 2023. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/virginia-governor-glenn-youngkin-gives-a-thumbs-up-during-news-photo/1702783557">Chip Somodevilla/Getty Images)</a></span></figcaption></figure><p>As Virginia holds elections on Nov. 7, 2023, to fill <a href="https://apnews.com/article/virginia-election-youngkin-e5ba1b4b0349ba7401722ab829b22f02">all 140 seats</a> in the state legislature, the results will likely offer insights on the nation’s political pulse. Voters’ preferences for Democrats or Republicans may well reflect how they feel about Joe Biden or Donald Trump – and about key issues such as <a href="https://www.nytimes.com/2023/10/26/us/politics/abortion-virginia-republicans-youngkin.html">abortion</a>, the <a href="https://abcnews.go.com/538/virginias-legislative-contests-important-races-2023/story?id=104299286">economy</a> and <a href="https://www.washingtonpost.com/education/2023/10/22/virginia-education-poll-results/">public education</a>.</p>
<p>The election also will hold important lessons for the nation’s journalists as they gear up for the 2024 presidential race. </p>
<p>As a <a href="https://robertson.vcu.edu/directory/south.html">journalism professor</a> and diligent voter in Virginia, I’ve been closely following the news about the state’s upcoming elections. Much of the reporting has provided readers with stories about candidates’ qualifications and positions on critical issues – the kind of information voters need to cast their ballots.</p>
<p>But I also have seen articles that may discourage voting or undermine the democratic process. Those stories tend to <a href="https://nypost.com/2023/09/11/house-candidate-susanna-gibson-performed-sex-acts-on-webcam-for-tips/">hype fleeting scandals</a> and mostly serve to generate clicks on social media. </p>
<p>What I have learned in my years studying the role of journalism in civic discussion is that democracies are best served when media coverage focuses on issues that affect society and people’s everyday lives and minimizes “horse race” reporting that obsesses over who is ahead in opinion surveys or fundraising. </p>
<h2>At stake in Virginia</h2>
<p>Journalism matters because elections have consequences. </p>
<p>Virginia is the only Southern state that has not put new restrictions on abortion since the <a href="https://www.nytimes.com/2022/06/24/us/roe-wade-overturned-supreme-court.html">U.S. Supreme Court</a> overturned Roe v. Wade. The legislative elections probably will determine whether abortions remain <a href="https://law.lis.virginia.gov/vacodefull/title18.2/chapter4/article9/">legal in Virginia through the second trimester</a>, or 26 weeks, of a pregnancy. </p>
<p>Virginia’s off-year elections carry national significance because the state is a deep shade of <a href="https://fredericksburg.com/news/local/government-politics/umw-poll-shows-virginia-has-rapidly-returned-to-purple-state-status/article_f46bd2ca-5e0e-11ee-9174-ff1be1fe1493.html">purple</a>. </p>
<p>Virginians <a href="https://rollcall.com/2021/11/16/so-what-color-is-virginia-now/">favored Democrats</a> in the past four presidential contests, but Republicans swept all three statewide races in 2021. </p>
<figure class="align-center ">
<img alt="A white woman with blonde hair gestures with her hands as she stands in the middle of a crowd of people." src="https://images.theconversation.com/files/556335/original/file-20231027-25-zqb7mb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/556335/original/file-20231027-25-zqb7mb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/556335/original/file-20231027-25-zqb7mb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/556335/original/file-20231027-25-zqb7mb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/556335/original/file-20231027-25-zqb7mb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/556335/original/file-20231027-25-zqb7mb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/556335/original/file-20231027-25-zqb7mb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Virginia state Senate candidate Russet Perry, a Democrat, speaks to campaign volunteers on Oct. 8, 2023.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/leesburg-virginia-virginia-state-senate-candidate-russet-news-photo/1730513107?adppopup=true">Pete Marovich For The Washington Post via Getty Images</a></span>
</figcaption>
</figure>
<p>During the 2023 legislative session, Democrats had a 22-18 majority in the Virginia Senate, and Republicans had a 52-48 majority in the state House of Delegates. Because of redistricting and retirements, there are 11 open seats in the Senate and 33 in the House. </p>
<p>Gov. Glenn Youngkin and GOP donors have <a href="https://abcnews.go.com/Politics/gov-glenn-youngkin-courts-donors-ahead-high-stakes/story?id=104095977">poured money</a> and political capital into helping Virginia Republicans capture both chambers in order to advance his legislative agenda – and possibly <a href="https://www.cbsnews.com/news/glenn-youngkin-anti-trump-donors-2024-presidential-run/">his presidential ambitions</a>. </p>
<p>As a swing state, Virginia is the testing ground for political parties’ future campaign strategies. </p>
<p>For instance, Virginia’s Republican legislative candidates have <a href="https://nymag.com/intelligencer/2023/10/will-voters-buy-youngkins-15-week-abortion-ban-gambit.html">echoed Youngkin’s call</a> to prohibit abortion after the 15th week of pregnancy except in cases of rape or incest or to save the mother’s life.</p>
<p>Youngkin <a href="https://www.washingtonpost.com/dc-md-va/2023/10/25/youngkin-abortion-15-week-elections/">portrays that limit</a> as “reasonable” and “common sense” – an alternative to the <a href="https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html">outright bans</a> that have drawn voter backlash in other states. But Democrats <a href="https://www.virginiamercury.com/2023/10/26/virginia-abortion-battle-could-come-down-to-how-voters-feel-about-the-word-ban/">have called</a> the 15-week proposal <a href="https://richmond.com/news/state-regional/government-politics/youngkins-pac-sets-1-4-million-ad-push-on-abortion-issue/article_2256a7ce-678c-11ee-93e8-1b49cbbcb646.html">a sign</a> that Republicans will impose stricter measures on abortion if they win control of the General Assembly. </p>
<p>Indeed, some Republican candidates say <a href="https://vademocrats.org/news/listen-swing-district-va-gop-candidate-pledges-support-for-100-abortion-ban/">their ultimate goal</a> is to ban all abortions, and Youngkin <a href="https://www.washingtonpost.com/dc-md-va/2022/06/29/youngkin-abortion-life-conception/">told an anti-abortion group in 2022</a>, “Any bill that comes to my desk I will sign happily and gleefully in order to protect life.”</p>
<h2>Informing the citizenry</h2>
<p>It’s my belief that the most useful news stories for voters are those that drill deep into candidates’ positions on pressing public policies.</p>
<p>What are they saying now, and what have they said in the past? Do they send different messages to different audiences? Have they voted or taken other actions on the issue? Have they courted endorsements, contributions and other support from groups with a vested interest in the matter?</p>
<p>Less useful are stories that treat politics as a competitive sport and fixate on who’s up or down in the polls or in campaign donations. Such “<a href="https://www.wbur.org/cognoscenti/2022/05/09/the-consequences-of-horse-race-reporting-rich-barlow">horse race</a>” journalism may appeal to political junkies, but <a href="https://journalistsresource.org/politics-and-government/horse-race-reporting-election/">research shows</a> that it leaves most people cynical, poorly informed and less likely to vote.</p>
<figure class="align-center ">
<img alt="A woman delivers a speech as stands behind a lectern surrounded by American flags." src="https://images.theconversation.com/files/556331/original/file-20231027-27-8ediim.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/556331/original/file-20231027-27-8ediim.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/556331/original/file-20231027-27-8ediim.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/556331/original/file-20231027-27-8ediim.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/556331/original/file-20231027-27-8ediim.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/556331/original/file-20231027-27-8ediim.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/556331/original/file-20231027-27-8ediim.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Republican presidential hopeful Nikki Haley speaks on abortion in Virginia on April 25, 2023.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/republican-presidential-hopeful-nikki-haley-speaks-on-news-photo/1252167577?adppopup=true">Stefani ReynoldsAFP via Getty Images</a></span>
</figcaption>
</figure>
<p>Further complicating election coverage is the blizzard of numbers found in polls and surveys that can make people feel that their votes won’t matter. Worse, journalists frequently misinterpret or oversimplify data – ignoring <a href="https://journalistsresource.org/media/margin-error-journalists-surveys-polls/">such factors</a> as the margin of error or methodology. </p>
<p>For example, several news organizations cited a <a href="https://www.wric.com/news/politics/virginians-prefer-youngkin-over-biden-in-hypothetical-presidential-matchup-poll-shows/">Virginia Commonwealth University poll</a> and reported that in a hypothetical presidential matchup, Virginians would favor Youngkin over Biden, 44% to 37%. </p>
<p>But the survey’s margin of error was <a href="https://drive.google.com/file/d/1Jjg0fNOrXLWovi-9UgCJGgyn3fFt9FGD/view">about 5.5 percentage points</a>. That means Youngkin’s support could have been as low as 38.5% and Biden’s as high as 42.5% – making the results too close to call.</p>
<p>Also problematic are salacious stories like the ones about <a href="https://www.susannagibson.com/">Susanna Gibson</a>, the Democratic Virginia House candidate who performed in <a href="https://apnews.com/article/susanna-gibson-virginia-house-of-delegates-sex-acts-9e0fa844a3ba176f79109f7393073454">livestreamed sex shows</a> with her husband.</p>
<p>In a competitive media environment driven by social networking, it is hard for journalists to ignore such scandals. But reporters should be honest about the story’s genesis – instead of <a href="https://www.washingtonpost.com/dc-md-va/2023/09/11/susanna-gibson-sex-website-virginia-candidate/">shielding the identity</a> of the Republican operative who tipped them off. </p>
<p>And some outlets seized any opportunity to revisit the controversy, no matter how trivial the <a href="https://themessenger.com/politics/virginia-dem-susanna-gibson-dips-in-polls-following-sex-show-scandal">news peg</a>.</p>
<p>A final step journalists can take in covering elections is to unpack the shorthand that politicians employ to curry votes. Candidates routinely use focus group-tested catchphrases that sound as appealing as apple pie but obscure far-reaching implications.</p>
<p>For example, when Democrats promote “<a href="https://apnews.com/article/virginia-election-prosecutors-primary-f3322cfed456ffbd7ba9d50f0b9d511a">criminal justice reform</a>,” do they mean eliminating cash bail even for people accused of violent crimes? </p>
<p>And when Republicans tout “<a href="https://www.usatoday.com/story/news/politics/elections/2023/03/24/glenn-youngkin-2024-parental-rights/11487311002/">parental rights</a>,” would they allow a minority of vocal parents to <a href="https://www.washingtonpost.com/education/2023/09/28/virginia-frequent-school-book-challenger-spotsylvania/">dictate the school curriculum</a> for all students?</p>
<p>After Virginia’s election, the focus of the national political coverage will turn to the 2024 presidential race – and what happens in Virginia may not stay in Virginia.</p><img src="https://counter.theconversation.com/content/216309/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeff South does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With the balance of political power at stake in the Virginia legislature, voters in this key swing state may reveal clues for the 2024 presidential election.Jeff South, Associate professor emeritus, Journalism, Virginia Commonwealth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2130332023-09-21T15:09:15Z2023-09-21T15:09:15ZA brief history of abortion – from ancient Egyptian herbs to fighting stigma today<figure><img src="https://images.theconversation.com/files/547772/original/file-20230912-9241-k9yjta.jpg?ixlib=rb-1.1.0&rect=502%2C90%2C3621%2C4365&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The first recorded evidence of induced abortion is from an ancient Egyptian papyrus.</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/pro-choice-posters-at-a-building-5841259/">pexels/karolina grabowska</a></span></figcaption></figure><p>You might be forgiven for thinking of abortion as a particularly modern phenomenon. But there’s plenty of evidence to suggest that abortion has been a constant feature <a href="https://muvs.org/en/topics/termination-of-pregnancy/abortion-in-antiquity-en/">of social life for thousands of years</a>. The history of abortion is often told as a legal one, yet abortion has continued regardless of, perhaps even in spite of, legal regulation. </p>
<p>The need to regulate fertility before or after sex has existed for as long as pregnancy has. <a href="https://www.britannica.com/topic/Ebers-papyrus">The Ancient Egyptian Papyrus Ebers</a> is often seen as some of the first written evidence of abortion practice. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/547764/original/file-20230912-21-i2tyac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/547764/original/file-20230912-21-i2tyac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=623&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547764/original/file-20230912-21-i2tyac.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=623&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547764/original/file-20230912-21-i2tyac.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=623&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547764/original/file-20230912-21-i2tyac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=783&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547764/original/file-20230912-21-i2tyac.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=783&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547764/original/file-20230912-21-i2tyac.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=783&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Ebers Papyrus (c. 1600 BC) from Ancient Egypt.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=18511551"> PEbers/Einsamer Schützederivative/Photohound (talk)</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Dating back to 1600BC, the text <a href="https://archive.org/details/contraceptionhis0000jutt/page/10/mode/2up">describes</a> methods by which “the woman empties out the conceived in the first, second or third time period”, recommending herbs, vaginal douches and suppositories. Similar methods of inducing abortion were <a href="https://archive.org/details/contraceptionhis0000jutt/page/10/mode/2up">recorded</a>, although not recommended, by Hippocrates around the fourth century BC. </p>
<p>Part of the daily life of ancient citizens, abortion also found its way into their art. Publius Ovidius Naso, commonly known as Ovid, was a Roman poet whose collection of works <a href="https://www.poetryintranslation.com/PITBR/Latin/AmoresBkII.php#anchor_Toc520535846">Amores</a> describes the narrator’s emotional turmoil as he watches his lover suffering from a mismanaged abortion: </p>
<blockquote>
<p>While she rashly is overthrowing the burden of her pregnant womb, weary Corinna lies in danger of her life. Having attempted so great a danger without telling me.
She deserves my anger, but my anger dies with fear. </p>
</blockquote>
<p>Ovid’s concern at first is with the risk of losing his love Corinna, not the potential child. Later, he asks the gods to ignore the “destruction” of the child and save Corinna’s life. This reveals some important aspects of historical attitudes towards abortion. </p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
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<p>While 21st-century abortion debates often revolve around questions of life and personhood, this was not always the case. The Ancient Greeks and Romans, for example, did not necessarily <a href="https://archive.org/details/contraceptionhis0000jutt/page/10/mode/2up">believe</a> that a foetus was alive. </p>
<p>Early thinkers such as St. Augustine (AD354-AD430), for example, distinguished between the <a href="https://archive.org/details/abortion0000pott/mode/2up">embryo “informatus”</a> (unformed) and “formatus” (formed and endowed with a soul). Over time, the most common distinction became drawn at what was known as the <a href="https://archive.org/details/abortion0000pott/mode/2up">“quickening”</a>, which was when the pregnant woman could feel the baby move for the first time. This determined that the foetus was alive (or had a soul).</p>
<p>As a delayed period was often the first sign something was amiss, and a woman may not have considered herself pregnant until much later, a lot of advice on abortion would focus on restoring <a href="https://www.routledge.com/Abortion-in-England-1900-1967/Brookes/p/book/9780415752466">menstrual irregularities</a> or blockages instead of terminating a potential pregnancy (or foetus). </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547767/original/file-20230912-31-6n0182.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Drawing of a woman making herbs for an abortion with patient lying on a bed." src="https://images.theconversation.com/files/547767/original/file-20230912-31-6n0182.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547767/original/file-20230912-31-6n0182.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=442&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547767/original/file-20230912-31-6n0182.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=442&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547767/original/file-20230912-31-6n0182.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=442&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547767/original/file-20230912-31-6n0182.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=555&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547767/original/file-20230912-31-6n0182.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=555&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547767/original/file-20230912-31-6n0182.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=555&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Art from a 13th-century manuscript features a herbalist preparing a concoction containing pennyroyal for a woman. The tea made famous in the Nirvana song, Pennyroyal Tea, was used in folk medicine to induce abortion and alleviate menstrual symptoms.</span>
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<p>As a result, much of the abortion advice throughout history does not necessarily mention abortion at all. And it was often down to personal interpretation whether or not an abortion had even taken place. </p>
<p>Indeed, recipes for “abortifacients” (any substance that is used to terminate a pregnancy) could be found in medical texts like those from the German nun <a href="https://daily.jstor.org/abortion-remedies-medieval-catholic-nun/">Hildegard von Bingen</a> in 1150 and in <a href="https://archive.org/details/abortion0000pott/page/284/mode/2up">domestic recipe books</a> with treatments for other common ailments well into the 20th century. </p>
<p>In the west, the quickening distinction gradually <a href="https://archive.org/details/abortion0000pott/page/284/mode/2up">went out of fashion</a> over the late 19th and early 20th centuries. Yet women continued to have abortions despite changing beliefs about life and the law. In fact, some sources claimed, they seemed to be more common than ever. </p>
<h2>“An epidemic of abortions”</h2>
<p>In 1920, <a href="https://www.routledge.com/Abortion-in-England-1900-1967/Brookes/p/book/9780415752466">Russia</a> became the first state in the world to legalise abortion, and in 1929, famous birth control advocate <a href="https://wellcomecollection.org/works/c6yxqrgn">Marie Stopes</a> lamented that “an epidemic of abortions” was sweeping England. <a href="https://archive.org/details/abortion0000pott/page/284/mode/2up">Similar claims</a> from France and the US also indicate a perceived uptick. </p>
<p>These claims accompanied a wave of plays, poems and novels that included abortion. In fact, in 1923, Floyd Dell, the US magazine editor and writer, published a new work of fiction, <a href="https://www.amazon.co.uk/Janet-March-Floyd-Dell/dp/B00085CQAE">Janet March</a>, where the main character complains about the number of novels that feature abortions, stating there “were dreadful things enough in novels, but they happened only to poor girls – ignorant and reckless girls”. </p>
<p>But the literature of the early 20th century, with many stories based on women’s real experiences, attests to a wider range of abortions than the stereotypical image of the poor and destitute backstreet operations of the 1900s. </p>
<p>For example, the English novelist, Rosamond Lehmann records a seductive “feminine conspiracy” of aborting women waiting with “tact, sympathy, pills and hot-water bottles”, in her 1926 novel <a href="https://www.amazon.co.uk/Weather-Streets-Virago-Modern-Classics/dp/1844083063">The Weather in the Streets</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/547765/original/file-20230912-29-ewkeg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Abortion advert from newspaper" src="https://images.theconversation.com/files/547765/original/file-20230912-29-ewkeg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/547765/original/file-20230912-29-ewkeg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=482&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547765/original/file-20230912-29-ewkeg1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=482&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547765/original/file-20230912-29-ewkeg1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=482&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547765/original/file-20230912-29-ewkeg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=605&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547765/original/file-20230912-29-ewkeg1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=605&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547765/original/file-20230912-29-ewkeg1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=605&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Advertisements for abortion services, like these in the New York Sun in 1842, were common during the Victorian era. At the time, abortion was illegal in New York.</span>
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<p>These texts form part of a long tradition of abortion storytelling that is a predecessor to contemporary activism. For example, <a href="https://www.abortion.shop/">We Testify</a> is an organisation dedicated to the leadership and representation of people who have abortions. And <a href="https://shoutyourabortion.com/">Shout Your Abortion</a> is a social media campaign where people share their abortion experiences online without “sadness, shame or regret”.</p>
<p>Abortion has a long and varied history, but above all these texts – from the Egyptian papyri of 1600BC to the social media posts of today – show that abortion has been and remains central to our history, our lives and even our art.</p><img src="https://counter.theconversation.com/content/213033/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alisha Palmer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Abortion has a long and varied history and remains central to our culture, our lives and even our art.Alisha Palmer, PhD Candidate in English Literature, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2067062023-09-01T12:42:46Z2023-09-01T12:42:46ZWhite men have controlled women’s reproductive rights throughout American history – the post-Dobbs era is no different<figure><img src="https://images.theconversation.com/files/545354/original/file-20230829-23-mvx2g4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5964%2C3952&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">U.S. Rep. Cori Bush, a Democrat from Missouri, after participating in an abortion rights sit-in on July 19, 2022, in Washington.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/rep-cori-bush-leaves-a-processing-area-after-being-arrested-news-photo/1409761529?adppopup=true">Anna Moneymaker/Getty Images</a></span></figcaption></figure><p>More than a year after the Supreme Court ended federal protection for abortion rights in the United States, disagreements over abortion bans continue to reverberate around the country. <a href="https://www.youtube.com/watch?v=_brdDBHOT5E">Candidates sparred over the idea of a federal abortion ban</a> during the Aug. 23, 2023, Republican presidential debate. And abortion is likely to figure prominently in the November 2023 <a href="https://www.politico.com/news/2023/08/27/pennsylvania-supreme-court-abortion-00113074">contest for a seat on the Pennsylvania Supreme Court</a>.</p>
<p>When the U.S. Supreme Court overturned <a href="https://www.oyez.org/cases/2021/19-1392">Roe v. Wade</a> in June 2022, removing women’s federal constitutional right to get abortions and giving states the power to pass laws about the legality of the procedure, the 6-3 vote was by a four white men, one Black man and a white woman majority.</p>
<p>Since that decision – <a href="https://www.supremecourt.gov/opinions/21pdf/19-1392_6j37.pdf">Dobbs v. Jackson Women’s Health Organization</a> – more than <a href="https://www.theguardian.com/us-news/ng-interactive/2023/jun/22/abortion-ban-politicians-who-voted-for-restrictions-who-are-they-men-women">1,500 state legislators, who are overwhelmingly white men</a>, have voted for full or partial abortion bans. </p>
<p>This is not the first period in U.S. history when white men have exercised control over women’s right to bear – or not bear – children, including during slavery. Then, it was a matter of numbers. The more people they enslaved, the more money white male enslavers could earn either from <a href="https://www.vox.com/identities/2019/8/16/20806069/slavery-economy-capitalism-violence-cotton-edward-baptist">selling the enslaved or from the forced labor</a> of the enslaved. <a href="https://doi.org/10.1093/acrefore/9780199329175.013.430">White men controlled people’s reproductive rights during the 20th century</a>, too, with the <a href="https://www.genome.gov/about-genomics/fact-sheets/Eugenics-and-Scientific-Racism">American eugenics movement</a>. </p>
<p>From the late 1800s until the 2000s, white proponents of eugenics – the selective breeding of people – tried to determine who was fit or unfit to have children. While the American eugenics movement affected people of other races and ethnic backgrounds, as well as men, it was particularly harmful to Black women who, data from 1950 to 1966 shows, were sterilized at “<a href="https://theconversation.com/forced-sterilization-policies-in-the-us-targeted-minorities-and-those-with-disabilities-and-lasted-into-the-21st-century-143144">three times the rate of white women and more than 12 times the rate of white men</a>.” </p>
<p>During both periods, <a href="https://doi.org/10.1089/heq.2017.0045">Black women and their health bore the brunt of the consequences</a> of white men’s control.</p>
<p>As a researcher who specializes in the <a href="https://scholar.google.com/citations?user=566DVVQAAAAJ&hl=en">history of race and racism in the U.S.</a>, I study historical issues related to race, gender and social justice.</p>
<h2>Enslaved women forced to reproduce</h2>
<p><a href="https://www.jstor.org/stable/45129363">African midwives</a>, imported and enslaved as early as the 1600s, attended to the birthing needs of the <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674008526">enslaved and enslavers</a> until the beginning of the 19th century.</p>
<p>But, after 1808, enslavers in the United States <a href="https://www.archives.gov/education/lessons/slave-trade.html">could no longer legally import</a> enslaved people. With this shift, enslavers stepped up the <a href="https://www.google.com/books/edition/The_American_Slave_Coast/iwCKCgAAQBAJ?hl=en&gbpv=1&dq=slave+masters+forced+breeding+of+slaves+1808&pg=PT11&printsec=frontcover">forced breeding of enslaved women</a>. White men raped the Black women and <a href="https://ldhi.library.cofc.edu/exhibits/show/hidden-voices/enslaved-women-and-slaveholder/sexual-violence">girls they enslaved</a>, and then enslaved the children born from those rapes. White men also <a href="https://notchesblog.com/2020/10/27/the-rape-of-rufus-sexual-violence-against-enslaved-men/">forced the Black women and Black men they enslaved to have sex </a> with one another to generate more babies, who would be born into slavery.</p>
<p><a href="https://www.haymarketbooks.org/books/736-how-capitalism-underdeveloped-black-america">This was a systemic way </a> of ensuring enslaved women <a href="https://www.penguinrandomhouse.com/books/155575/killing-the-black-body-by-dorothy-roberts/">bore more children, which would increase profits</a> for their enslavers. </p>
<p>Because <a href="https://www.google.com/books/edition/More_Than_Chattel/td2yIa7X6H4C?hl=en&gbpv=1&bsq=midwives">the Black midwives and enslaved women often were blamed for or suspected</a> of using birth control and abortions to resist forced pregnancy and the enslavement of their offspring, enslavers turned increasingly away from midwives and to <a href="https://www.google.com/books/edition/Birthing_a_Slave/ZussEAAAQBAJ?hl=en&gbpv=1&pg=PP1&printsec=frontcover">white male doctors</a> to figure out why nearly half of enslaved infants were stillborn or died within their first year of life and why so many enslaved women were infertile. <a href="https://doi.org/10.2105/AJPH.2019.305243">These doctors also helped with difficult births</a>. </p>
<p>In the two decades after 1810, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716878/">population growth rate of the enslaved averaged about 30%</a>, despite the ban on slave importation. This was just under the 1800 to 1809 average of 31.6% which was a century high. </p>
<p>In the 1800s, as the slave population increased, <a href="https://www.vox.com/identities/2019/8/16/20806069/slavery-economy-capitalism-violence-cotton-edward-baptist">profits in cotton did too</a>. And after the legal importation of slaves ended, the <a href="https://ir.vanderbilt.edu/xmlui/bitstream/handle/1803/15814/vu06-w24.pdf?sequence=1&isAllowed=y">value of Black women of childbearing age increased</a> significantly. The forced breeding of these enslaved women was <a href="https://scholarlycommons.law.wlu.edu/crsj/vol7/iss1/4">linked to the profitability of southern economies</a>. </p>
<h2>Eugenics and control over women’s bodies</h2>
<p>Eugenicists believed that <a href="https://theconversation.com/forced-sterilization-policies-in-the-us-targeted-minorities-and-those-with-disabilities-and-lasted-into-the-21st-century-143144">increased breeding by white people</a>, whom they assumed had high IQs, would benefit American society. But people who did not embody their idea of racial perfection, such as Black people, Native Americans, certain immigrants, poor white people and people with disabilities, should be sterilized – typically via <a href="https://www.rutgersuniversitypress.org/fit-to-be-tied/9780813578910">tubal ligation and vasectomy</a>.</p>
<figure class="align-center ">
<img alt="A Black woman, surrounded by large plants, sits with both hands resting on her crossed legs as she stares ahead." src="https://images.theconversation.com/files/545356/original/file-20230829-17-nfjc7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545356/original/file-20230829-17-nfjc7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545356/original/file-20230829-17-nfjc7f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545356/original/file-20230829-17-nfjc7f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545356/original/file-20230829-17-nfjc7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545356/original/file-20230829-17-nfjc7f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545356/original/file-20230829-17-nfjc7f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Elaine Riddick, pictured at her home in Marietta, Ga., on July 15, 2022, was sterilized without her consent when she was 14, in North Carolina.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/elaine-riddick-at-her-home-in-marietta-georgia-on-july-15-news-photo/1242045819?adppopup=true">Tami Chappell for The Washington Post via Getty Images</a></span>
</figcaption>
</figure>
<p>In this <a href="https://www.genome.gov/about-genomics/fact-sheets/Eugenics-and-Scientific-Racism">debunked pseudo-science</a>, eugenicists often <a href="https://via.library.depaul.edu/cgi/viewcontent.cgi?article=1270&context=law-review">used intelligence tests</a> to determine who was fit or unfit to reproduce and to predict who would commit crimes, end up in poverty or have children who were mentally ill or intellectually disabled. And they worked to incorporate their ideas into state laws. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S1098360021025909">Thirty-two states</a>, between 1907 and 1937, enacted forced sterilization mandates to prevent births by people eugenicists considered socially inadequate. </p>
<p>State-mandated procedures resulted in the <a href="https://theconversation.com/forced-sterilization-policies-in-the-us-targeted-minorities-and-those-with-disabilities-and-lasted-into-the-21st-century-143144">coerced sterilization of women</a>, particularly <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/bioe.12977">African American, Native American and Hispanic American women</a>, and <a href="https://doi.org/10.1089/gyn.2021.0102">those from Southern and Eastern Europe</a>.</p>
<p><a href="https://library.law.howard.edu/civilrightshistory/blackrights/desegregation">Beginning in 1948</a> with President Harry Truman’s executive order to integrate the military, which extended to other areas, including education, employment and commerce, <a href="https://theconversation.com/forced-sterilization-policies-in-the-us-targeted-minorities-and-those-with-disabilities-and-lasted-into-the-21st-century-143144">sterilization rates for Black women increased</a>. For example, in North Carolina, which had the country’s third-highest sterilization rate, far more women than men were forcibly sterilized. And in the 1960s, <a href="https://socialequity.duke.edu/wp-content/uploads/2020/06/BreedingOutVol15No1-1.pdf">Black women in the state made up 65% of the women sterilized</a>, while only making up 25% of the population. </p>
<figure class="align-center ">
<img alt="With people standing around her, a woman wearing a shirt that reads, " src="https://images.theconversation.com/files/545359/original/file-20230829-23-1c4xtj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545359/original/file-20230829-23-1c4xtj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545359/original/file-20230829-23-1c4xtj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545359/original/file-20230829-23-1c4xtj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545359/original/file-20230829-23-1c4xtj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545359/original/file-20230829-23-1c4xtj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545359/original/file-20230829-23-1c4xtj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Abortion-rights activists counter-demonstrate as anti-abortion demonstrators gather for a rally in Federal Building Plaza on June 24, 2023, in Chicago to mark the first anniversary of the Dobbs v Jackson Women’s Health Organization Supreme Court decision.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/abortion-rights-activists-counter-demonstrate-as-anti-news-photo/1501196070?adppopup=true">Scott Olson/Getty Images</a></span>
</figcaption>
</figure>
<p><a href="https://bpr.berkeley.edu/2020/11/04/americas-forgotten-history-of-forced-sterilization/">Between 1930 and 1970</a>, close to 33% of the women in Puerto Rico, a U.S. territory, were forcibly sterilized. In California, between 1997 and 2003, 1,400 female inmates, <a href="https://www.insider.com/inside-forced-sterilizations-california-womens-prisons-documentary-2020-11">mostly Black, were forcibly sterilized</a>. </p>
<h2>The post-Dobbs era</h2>
<p>White nationalists and some right-wing politicians in the U.S. see the nation’s demographic changes as dangerous. The Census Bureau <a href="https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf">projects that in the 2040s</a>, non-Hispanic white people will no longer make up a majority of the U.S. population. The nation’s racial and ethnic makeup will then be what some call “<a href="https://www.nytimes.com/2021/08/24/opinion/us-census-majority-minority.html">majority-minority</a>.” Those projections scare racists, <a href="https://fivethirtyeight.com/features/the-twisted-logic-behind-the-rights-great-replacement-arguments/">who believe in a conspiracy about white people being destroyed</a>, which they label the <a href="https://doi.org/10.1080/1369118X.2022.2077654">great replacement theory</a> because they fear losing social, political and economic power.</p>
<p>There is no way to know if this theory factored into the majority’s votes in the Dobbs decision, but the argument that <a href="https://fivethirtyeight.com/features/how-the-fight-to-ban-abortion-is-rooted-in-the-great-replacement-theory/">not enough white people are being born</a> has been a <a href="https://www.theguardian.com/books/2022/jul/23/body-politics">common historical thread</a> in the American anti-abortion movement.</p>
<p>But, while believers in the great replacement conspiracy want white women to have more babies, actual anti-abortion decisions like the Dobbs ruling <a href="https://www.reuters.com/world/us/roe-v-wade-ruling-disproportionately-hurts-black-women-experts-say-2022-06-27/">harm Black women more</a> than any other group. <a href="https://theconversation.com/a-year-after-supreme-courts-dobbs-decision-black-women-still-struggle-for-access-to-reproductive-health-care-206369">Black women represent 39% of the country’s abortion patients</a>, but many live in communities that have limited access to <a href="https://doi.org/10.1017/S1743923X2100009X">family planning clinics</a>. And they have <a href="https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/">disproportionately</a> higher rates of complications during pregnancy.</p>
<p>As a result, Black women – who experience <a href="https://www.liebertpub.com/doi/full/10.1089/jwh.2020.8868">higher maternal complications</a> and mortality rates – <a href="https://www.whijournal.com/article/S1049-3867(23)00098-1/fulltext">will be forced to give birth to more babies</a>. </p>
<p>This is another period in the country in which the reproductive health decisions made by mostly white men will harm Black women.</p>
<img src="https://counter.theconversation.com/content/206706/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney Coates does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In the US, white men have long had the power to make decisions about women’s reproductive health care. Those decisions have often been especially harmful to Black women.Rodney Coates, Professor of Critical Race and Ethnic Studies, Miami UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2111672023-08-29T12:38:13Z2023-08-29T12:38:13ZWith ‘Goodbye Mary,’ Molly Tuttle extends country music’s lineage of reproductive rights songs to the post-Roe era<figure><img src="https://images.theconversation.com/files/544834/original/file-20230825-29-42xgcb.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C3872%2C2562&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Molly Tuttle is a rising star in American roots music.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/2023BonnarooMusicandArtsFestival-DayOne/c1e9d71f78c141cdb07b816d58d78934/photo">Amy Harris/Invision/AP</a></span></figcaption></figure><p>Jason Aldean’s song “<a href="https://dulerecord.bandcamp.com/track/jason-aldean-try-that-in-a-small-town">Try That In A Small Town</a>” extols small towns as bastions of conservative values standing up against a litany of violent big-city bogeymen. The song, and the <a href="https://www.npr.org/2023/07/20/1188966935/jason-aldean-try-that-in-a-small-town-song-video">backlash against it</a>, threatens to strengthen popular conceptions about the inherent <a href="https://www.npr.org/transcripts/7484160">conservatism of country music</a>.</p>
<p>As an <a href="https://www.middlebury.edu/college/people/william-nash">American Studies professor</a> who teaches courses on country music, I am interested in the <a href="https://www.npr.org/sections/therecord/2018/03/20/594043497/think-politics-is-gone-from-country-music-listen-closer">genre’s competing “liberal” lineage</a>. For example, I have written about <a href="https://theconversation.com/barbara-kingsolvers-demon-copperhead-and-the-enduring-devastation-of-the-opioid-crisis-205378">country musicians’ compassionate responses to the opioid crisis</a>.</p>
<p>Another group of songs casts light on abortion rights, a newly pressing issue in the wake of <a href="https://www.oyez.org/cases/2021/19-1392">2022’s Dobbs v. Jackson Women’s Health Organization</a> Supreme Court decision overturning the constitutional right to abortion. Rather than resort to angry polemics or pronouncements about morality, however, these country – and, more broadly, Americana – songs create intimate portraits of the women and men engaged in the painful realities of daily life. This helps maintain compassion and empathy in discussions of reproductive freedom.</p>
<h2>Stories in post-Roe America</h2>
<p>Perhaps the most striking of the new “abortion songs” comes from acoustic guitar wizard <a href="https://www.mollytuttlemusic.com/">Molly Tuttle</a>, a bluegrass musician and rising star in the American roots music scene. With “<a href="https://mollytuttle.bandcamp.com/track/goodbye-mary">Goodbye Mary</a>,” a track from her new album, “<a href="https://mollytuttle.bandcamp.com/album/city-of-gold">City of Gold</a>,” Tuttle creates <a href="https://thebluegrasssituation.com/read/the-inspirations-and-issues-behind-molly-tuttles-city-of-gold/">an intimate portrait of a woman’s struggle for bodily autonomy</a> that captures the potential terrors of a post-Roe America.</p>
<iframe style="border-radius:12px" src="https://open.spotify.com/embed/playlist/0cONwQ7rzk0BLszUUcMIuP?utm_source=generator" width="100%" height="352" frameborder="0" allowfullscreen="" allow="autoplay; clipboard-write; encrypted-media; fullscreen; picture-in-picture" loading="lazy"></iframe>
<p>The story chronicles the aftermath of a love affair between Thomas and Mary, whose language marks them as country folk. The song recounts Thomas’ abandoning the pregnant Mary, who chides him for failing to keep his promise to “build a cradle soon”; sending her directions on where to find an abortionist, who refuses to perform the procedure because “the baby’s too far ‘long”; encouraging Mary to fling herself down the stairs or “ride careless down a rocky road”; and saying that he “prays for her soul” after she finds and uses a “wire” in “the old tool shed” to abort the fetus. In the final verse, she asks him, from the confines of her jail cell, to “place pretty flowers on her grave.” </p>
<p>This last twist shifts the narrative from being solely a tale about the tragic failure of the man to own his part in the conception and destruction of their fetus. The story becomes a more layered statement about a woman’s grief when she is pushed to unbearable choices, and her need to balance control of her own body with the legal and psychological guilt imposed by society when she takes the only means of control open to her. </p>
<p>The result is an intimate portrait of a woman navigating a complex landscape made more perilous by the erasure of her rights. The agency left to her, in a world where male doctors can refuse her care and absentee partners can advocate for dangerous solutions, is self-destructive and scarring.</p>
<h2>Women’s voices</h2>
<p>With “Goodbye Mary,” Tuttle joins a line of female artists who have used country, folk or roots music <a href="https://www.thinkglobalhealth.org/article/loretta-lynn-and-beyond-reproductive-rights-country-and-folk-music">to emphasize women’s reproductive rights</a>. Perhaps the most famous example is Loretta Lynn’s “<a href="https://time.com/6219550/loretta-lynn-dies-the-pill-legacy/">The Pill</a>,” a song so controversial that it was effectively banned by country radio programmers after its 1975 release. Despite the resistance to the song, its message resonated so strongly with country listeners that it became one of Lynn’s biggest hits.
</p><blockquote>You wined me and dined me when I was your girl<br>
Promised if I’d be your wife, you’d show me the world<br>
But all I’ve seen of this old world is a bed and a doctor bill<br>
I’m tearing down your brooder house ‘cause now I’ve got the pill</blockquote><p></p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/5xrjIsLmT0c?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Loretta Lynn’s song ‘The Pill’ became popular despite the country music industry’s efforts to stifle it.</span></figcaption>
</figure>
<p>Another well-known chronicler of women’s struggles is <a href="https://dollyparton.com">Dolly Parton</a>, whose 1970 track “<a href="https://www.lyrics.com/lyric/944906/Dolly+Parton/Down+from+Dover">Down from Dover</a>” chronicles the sufferings of an abandoned teenage mother who feels relief and grief when her baby is stillborn. Less well-known by the mainstream but no less critically important in this history is <a href="https://www.malvinareynolds.com">Malvina Reynolds</a>, whose 1973 “<a href="http://people.wku.edu/charles.smith/MALVINA/mr144.htm">Rosie Jane</a>” supported the Supreme Court’s <a href="https://www.oyez.org/cases/1971/70-18">1973 Roe v. Wade ruling</a> and whose 1978 “<a href="http://people.wku.edu/charles.smith/MALVINA/mr007.htm">Back Alley Surgery</a>” responded to <a href="https://www.cambridge.org/core/books/abs/abortion-and-the-law-in-america/hyde-amendment-and-its-aftermath/D0AF40D286D3AAD2DC617DEB5010947A">efforts to restrict Medicaid funding of abortion</a>. </p>
<p>There’s also a small but important history of male artists taking up these issues. Among the most moving of <a href="https://www.johnprine.com">John Prine’s</a> songs is “<a href="https://genius.com/John-prine-unwed-fathers-lyrics">Unwed Fathers</a>,” a pointed tale of Appalachian men who “can’t be bothered” with unwanted pregnancies and pursue personal and cultural freedoms that elude the women they have impregnated. </p>
<p>But not all the men in these situations are carefree. In “<a href="https://genius.com/Jason-isbell-and-the-400-unit-white-beretta-lyrics">White Beretta</a>,” a song from his “Weathervanes” album, <a href="https://www.jasonisbell.com">Jason Isbell</a> chronicles the retrospective grief and agony of a rural man who, when a teenager, failed to do more than the minimum for his pregnant girlfriend. The protagonist of the song does take her to have an abortion, but he offers her little empathy and sends her “in that room alone.” He does not regret the decision, thanking his former partner for her “grace/For the dreams we got to chase” because of her choice.</p>
<h2>Multidimensional portraits</h2>
<p>In the final analysis, both Tuttle and Isbell have created intimate, intricate portraits of people making decisions that cause them grief and bring them relief. Neither oversimplifies the issues at hand, just as neither artist wavers from the belief in the rightness of the decisions their respective characters make.</p>
<p>Put another way, these songs succeed in putting human faces on issues that have been depersonalized for political ends. Tuttle and Isbell remind their listeners that there’s more than one side to small-town life.</p><img src="https://counter.theconversation.com/content/211167/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>William Nash does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From the pre-Roe years to today, country musicians have written about the realities of life with restrictions on reproductive rights.William Nash, Professor of American Studies and English and American Literatures, MiddleburyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2107642023-08-23T12:27:04Z2023-08-23T12:27:04ZWhy have you read ‘The Great Gatsby’ but not Ursula Parrott’s ‘Ex-Wife’?<figure><img src="https://images.theconversation.com/files/543788/original/file-20230821-29-jhus0n.jpg?ixlib=rb-1.1.0&rect=68%2C53%2C1079%2C810&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Writer Ursula Parrott, pictured with her son, Marc, in 1935. </span> <span class="attribution"><a class="source" href="https://www.neh.gov/sites/default/files/styles/large/public/2023-04/Ursula_w_son_Fig_12_Gordon.jpg?itok=LBc8_0fM">ACME Newspapers</a></span></figcaption></figure><p>In 1925, F. Scott Fitzgerald published “<a href="https://www.simonandschuster.com/books/The-Great-Gatsby/F-Scott-Fitzgerald/9781982146702">The Great Gatsby</a>.” Four years later, Ursula Parrott published her first novel, “<a href="https://www.simonandschuster.com/books/Ex-Wife/Ursula-Parrott/9781946022561">Ex-Wife</a>.” </p>
<p>I probably read “The Great Gatsby” a dozen times between junior high school and my late 20s. But I had never even heard of Ursula Parrott or her 1929 bestseller until I stumbled across a screenplay adaption of one of Parrott’s short stories. </p>
<p>Fitzgerald, in fact, had been hired to write that screenplay. Even though “Infidelity” was never produced because it was <a href="https://collections.new.oscars.org/Details/Collection/627">deemed too risqué by Hollywood’s Production Code Administration</a>, its very existence piqued my curiosity.</p>
<p>Why was the most famous author of the Jazz Age hired to adapt a story by a totally unknown writer? And who on earth was Ursula Parrott?</p>
<p>I acquired a used copy of “Ex-Wife” on eBay and soon realized that Ursula Parrott was not unknown; she was just forgotten. </p>
<p>In April 2023, <a href="https://www.ucpress.edu/book/9780520391543/becoming-the-ex-wife">I published a biography</a> of Parrott. Since then, I’ve continued to try to understand just how and why she and her writing drifted into obscurity – how “The Great Gatsby” is required reading but few have heard of “Ex-Wife” or its author.</p>
<h2>Greeted by mixed reviews</h2>
<p>Both “Ex-Wife” and “The Great Gatsby” are modern novels of love and loss, money and (mostly bad) manners. They’re set in New York and saturated with the energy, language and spirit of the time. <a href="https://timesmachine.nytimes.com/timesmachine/1929/08/11/91915237.html?pageNumber=30">Both garnered mixed reviews</a>, deemed by many critics as entertaining and of the moment <a href="https://www.theatlantic.com/entertainment/archive/2015/04/to-early-reviewers-the-great-gatsby-was-not-so-great/390252/">but not great literature</a>.</p>
<p>At first, “Ex-Wife” was far more successful than “Gatsby,” blasting through a dozen printings and selling over 100,000 copies. It was translated into multiple languages and reprinted in paperback editions through the late 1940s. </p>
<p>Meanwhile, “The Great Gatsby” went through <a href="https://boydellandbrewer.com/9781571133717/american-icon/">a mere two printings totaling less than 24,000 copies</a>, not all of which sold. By the time Fitzgerald died in 1940, the novel had essentially been forgotten.</p>
<p>“Ex-Wife” centers on a 24-year-old woman named Patricia whose husband is divorcing her. Supporting herself with a job in department store advertising, she learns to navigate life in Manhattan as a divorcée. </p>
<p>Whereas “The Great Gatsby” is largely a suburban novel with trips into the city, “Ex-Wife” is fully immersed in Manhattan, especially Greenwich Village, where Parrott herself lived after she married her first husband. The novel’s characters drink Clover Clubs, Alexanders, brandy flips and Manhattans while frequenting the Brevoort, the Waldorf, Delano’s and Dante’s. </p>
<p>“Ex-Wife” revels in the rhythms of the city: One chapter even includes musical bars from George Gershwin’s hit “<a href="https://www.loc.gov/item/ihas.200156779">Rhapsody in Blue</a>” sprinkled between paragraphs. </p>
<figure class="align-center ">
<img alt="Musical notes appear on a page underneath dialogue." src="https://images.theconversation.com/files/544084/original/file-20230822-15-g3yjz0.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544084/original/file-20230822-15-g3yjz0.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=297&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544084/original/file-20230822-15-g3yjz0.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=297&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544084/original/file-20230822-15-g3yjz0.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=297&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544084/original/file-20230822-15-g3yjz0.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=373&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544084/original/file-20230822-15-g3yjz0.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=373&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544084/original/file-20230822-15-g3yjz0.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=373&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chapter 12 of ‘Ex-Wife’ features bars from ‘Rhapsody in Blue.’</span>
<span class="attribution"><span class="source">Marsha Gordon</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>But “Ex-Wife” is not all martinis and music. Parrott uses it to address, in unsparing directness, the challenges that women faced and the limited paths available to them. This alone sets it apart from the male protagonists of “The Great Gatsby” and the novel’s scant attention to the experiences of its female characters.</p>
<p>Parrott’s witty and biting novel was, in fact, concerned first and foremost with a generation of young women who had abandoned Victorian sensibilities: They got educations and jobs, drank, had premarital and extramarital sex, and cast aside pretensions of being the fairer, gentler sex. </p>
<p>But in shedding these mores, they also sacrificed protections. Patricia reflects on how men of their generation used women’s self-sufficiency and independence as an excuse to leave them to fend for themselves: “Freedom for women turned out to be God’s greatest gift to men.” </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/543765/original/file-20230821-29-lmgeo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Book cover featuring drawing of a young, forlorn woman." src="https://images.theconversation.com/files/543765/original/file-20230821-29-lmgeo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543765/original/file-20230821-29-lmgeo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=837&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543765/original/file-20230821-29-lmgeo5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=837&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543765/original/file-20230821-29-lmgeo5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=837&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543765/original/file-20230821-29-lmgeo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1052&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543765/original/file-20230821-29-lmgeo5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1052&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543765/original/file-20230821-29-lmgeo5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1052&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">‘Ex-Wife’ sold four times as many copies as ‘The Great Gatsby’ in the 1920s and 1930s.</span>
<span class="attribution"><a class="source" href="https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2Ff689e048-ef86-4a0b-bcff-e59400fd1186_413x576.jpeg">Screen Splits</a></span>
</figcaption>
</figure>
<p>“Ex-Wife” depicts a culture in which women often suffer at the hands of men. At one point, Patricia is brutally raped. In another scene, her husband throws her through a glass window during a fight, a moment as harrowing for its rendering of domestic violence as it is for Pat’s nonchalant reaction to it. In one of the book’s most moving episodes, Pat is compelled to procure a risky abortion at her soon-to-be ex-husband’s insistence but at her financial, physical and psychological cost. </p>
<p>“One survives almost everything,” Patricia unhappily realizes.</p>
<p>She survives, however, thanks only to a streetwise female friend and mentor, her own ability to earn a living, practiced if not heartfelt flippancy, the numbing effects of alcohol and an acceptance that everything in her life is both transient and precarious.</p>
<h2>Art imitates life</h2>
<p>Ursula Parrott <a href="https://www.ucpress.edu/book/9780520391543/becoming-the-ex-wife">had a keen understanding</a> of gender inequality and male privilege: Her own publisher made passes at her, her banker once proposed sexual favors in lieu of interest payments, and she experienced a rape not unlike the one she depicted in “Ex-Wife.”</p>
<figure class="align-right ">
<img alt="Black and white photograph of woman sitting on balcony smiling and using a typewriter." src="https://images.theconversation.com/files/543763/original/file-20230821-19-vgphn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543763/original/file-20230821-19-vgphn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=777&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543763/original/file-20230821-19-vgphn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=777&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543763/original/file-20230821-19-vgphn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=777&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543763/original/file-20230821-19-vgphn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=976&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543763/original/file-20230821-19-vgphn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=976&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543763/original/file-20230821-19-vgphn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=976&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ursula Parrott in California in 1931, two years after the publication of ‘Ex-Wife.’</span>
<span class="attribution"><span class="source">AP Photos</span></span>
</figcaption>
</figure>
<p>Before she became a novelist, Parrott, who earned a degree in English from Radcliffe, had desperately wanted a career in journalism. However, she was barred from employment at all New York newspapers because her ex-husband, <a href="https://www.nytimes.com/1987/09/21/obituaries/lindesay-parrott-ex-times-reporter.html">reporter Lindesay Parrott</a>, marked his professional territory by warning the city’s editors – all male, of course – not to hire her. </p>
<p>There is a similar form of male chauvinism at work in the way that Parrott’s writing was often treated by critics during her lifetime. Many described her books and short stories as romantic or melodramatic, fit only for consumption by women.</p>
<p>“Melodramatic,” <a href="https://www.ucpress.edu/book/9780520391543/becoming-the-ex-wife">Parrott once smartly observed in a letter</a>, is “just a word men use to describe any agony that might otherwise make them feel uncomfortable.”</p>
<h2>Gatsby’s boosters</h2>
<p>I am convinced that “Ex-Wife” deserves a place <a href="https://www.theparisreview.org/blog/2021/01/11/why-do-we-keep-reading-the-great-gatsby/">alongside Fitzgerald’s novel</a> in classrooms and in the hands of a new generation of readers based on the merits of its style and contents. </p>
<p>But more importantly, I’m convinced that the reason Fitzgerald’s novel is so ingrained in American life and letters has little to do with its originality, craft or quality and everything to do with <a href="https://bookshop.org/p/books/so-we-read-on-how-the-great-gatsby-came-to-be-and-why-it-endures-maureen-corrigan/110705">the way books were marketed and promoted</a> over the arc of the 20th century. </p>
<p>“The Great Gatsby” <a href="https://www.washingtonpost.com/news/achenblog/wp/2015/03/20/why-the-great-gatsby-is-the-great-american-novel/">owes its resuscitation from obscurity</a> in the 1940s to the efforts of prominent male critics and scholars – and even to the American military.</p>
<p>Fitzgerald had important friends and admirers, among them the esteemed literary critic Edmund Wilson, who was instrumental in the republication of “Gatsby” in 1941. <a href="https://paw.princeton.edu/article/enduring-power-gatsby">Thanks to Wilson’s efforts</a>, Fitzgerald’s novel could be taken up by other well-regarded and influential scholars like Lionel Trilling, <a href="http://thenation.s3.amazonaws.com/pdf/1949.pdf">who wrote admiringly</a> about Fitzgerald in The Nation in 1945, and <a href="https://www.nytimes.com/1989/03/29/obituaries/malcolm-cowley-writer-is-dead-at-90.html">Malcolm Cowley</a>, who edited collections of Fitzgerald’s short stories and celebrated his literary gifts.</p>
<figure class="align-center ">
<img alt="Seated man in suit holding a cigarette and looking out a window." src="https://images.theconversation.com/files/543773/original/file-20230821-10983-meide4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543773/original/file-20230821-10983-meide4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543773/original/file-20230821-10983-meide4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543773/original/file-20230821-10983-meide4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543773/original/file-20230821-10983-meide4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543773/original/file-20230821-10983-meide4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543773/original/file-20230821-10983-meide4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Critics like Lionel Trilling rescued ‘The Great Gatsby’ from obscurity.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-american-literary-critic-lionel-trilling-is-shown-here-news-photo/515252642?adppopup=true">Bettmann/Getty Images</a></span>
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<p>After Trilling, a parade of writers took up Gatsby’s cause, praising it for precisely the same traits that might also have been found in “Ex-Wife,” had anyone bothered to look: its use of contemporary language, its critique of hedonistic behavior, its rich attention to period detail and its depressing portrayal of aimless, unmoored characters trying and failing to find meaning in modern America.</p>
<p>Consider just one instance of differential legacy-tending: during World War II, the American military <a href="https://www.mentalfloss.com/article/62358/how-wwii-saved-great-gatsby-obscurity">provided over 150,000 free copies</a> of “The Great Gatsby” to American soldiers – ensuring a readership that well exceeded the number of people who had, to date, actually bought the book.</p>
<p>But when the <a href="https://www.nypl.org/blog/2012/07/25/victory-book-campaign-and-nypl">Victory Book Campaign</a> started its drive to collect novels for overseas servicemen, it explicitly warned potential donors to desist from handing over any “women’s love stories,” specifically naming Ursula Parrott among the authors whose books they would not be putting in soldiers’ hands.</p>
<h2>Making the case for ‘Ex-Wife’</h2>
<p>There are, of course, many other factors at play here. <a href="https://www.theawl.com/2014/01/all-the-drunk-dudes-the-parodic-manliness-of-the-alcoholic-writer/">There’s the tendency to romanticize</a> the tragic lives of male authors who drink heavily, spend recklessly and make bad decisions – departments in which Fitzgerald and Parrott seem pretty equally matched. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/543768/original/file-20230821-19874-9e3281.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Newspaper clipping suggesting authors to avoid when sending troops books." src="https://images.theconversation.com/files/543768/original/file-20230821-19874-9e3281.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543768/original/file-20230821-19874-9e3281.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=726&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543768/original/file-20230821-19874-9e3281.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=726&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543768/original/file-20230821-19874-9e3281.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=726&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543768/original/file-20230821-19874-9e3281.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=912&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543768/original/file-20230821-19874-9e3281.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=912&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543768/original/file-20230821-19874-9e3281.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=912&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Book donors were discouraged from sending ‘women’s love stories’ to troops during World War II.</span>
<span class="attribution"><span class="source">Moberly, Missouri Monitor</span></span>
</figcaption>
</figure>
<p>There’s also what can only be described as a collective <a href="https://www.usatoday.com/story/life/books/2013/05/07/why-the-great-gatsby-is-the-great-american-novel/2130161/">refusal to categorize</a> “The Great Gatsby” as a romance novel, a category that has historically been used <a href="https://theconversation.com/if-the-romance-writers-of-america-can-implode-over-racism-no-group-is-safe-130034">to diminish women’s writing</a>.</p>
<p>“The Great Gatsby”‘s ascension from obscurity to ubiquity is only one example of how Parrott’s book was passed over. “Ex-Wife” and William Faulkner’s “<a href="https://www.penguinrandomhouse.com/books/48428/the-sound-and-the-fury-by-william-faulkner/">The Sound and the Fury</a>” were marketed alongside each other by publishers Jonathan Cape and Harrison Smith. Faulkner biographer Carl Rollyson observes that Faulkner’s book <a href="https://www.nysun.com/article/even-as-william-faulker-struggled-ursula-parrott-thrived">sold “less than a tenth” as many copies as Parrott’s</a>. But Faulkner amassed critical praise in the right places, and Parrott, Rollyson concludes, “did not manage herself or her work the way writers like Faulkner did.” </p>
<p>But this is not merely a question of self-management. It is true that Parrott did not publish during the last, difficult decade of her life. After a series of public scandals, missed deadlines, ongoing battles with alcohol and financial missteps, she tried to write herself back into literary society, to no avail. </p>
<p>The real difference, in my view, is that Parrott had nobody to tend to her legacy – no Trilling or Wilson or Cowley in her corner to bring her writings back into circulation or make a case for her genius or her novel’s importance.</p>
<p>However, there is no reason to believe that the erasure of “Ex-Wife” from cultural memory is a fait accompli, or that “The Great Gatsby” will always be the go-to Jazz Age novel. Writer Glenway Wescott, <a href="https://newrepublic.com/article/116002/moral-scott-fitzgerald">in his February 1941 tribute to Fitzgerald</a>, wrote of “The Great Gatsby”: “A masterpiece often seems a period-piece for a while; then comes down out of the attic, to function anew and to last.”</p>
<p>Consider this article a “better late than never” effort to make the case that “Ex-Wife” deserves to come out of the attic of America’s lost literary past to be read, discussed and taught as one of the important American novels of the 1920s. </p>
<p>After McNally Editions republished “<a href="https://www.mcnallyeditions.com/books/p/ex-wife">Ex-Wife</a>” in May 2023, reviewers remarked on the “freshness of its prose” and the “remarkable erotic freedom” it depicted, as <a href="https://www.nytimes.com/2023/04/30/books/she-wrote-frankly-about-divorce-and-suffered-the-consequences.html">The New York Times</a> review put it; <a href="https://thebaffler.com/latest/the-dark-side-of-the-jazz-age-fletcher">The Baffler described Parrott’s writing</a> as “deftly crafted, wryly observed, and thoroughly unsettling.”</p>
<p>“The Great Gatsby” is a fantastic period piece. But “Ex-Wife” manages to be both that and to remain timely. Women’s lives and bodies continue to be subject to all manner of scrutiny, critique and legislation, which means that many of the things that Parrott wrote about in “Ex-Wife” – the double standard, women in the workplace, work-life balance, rape and even abortion – remain astonishingly relevant today.</p>
<p>In “Ex-Wife” – and in many of her 19 other books and over 100 stories – Parrott wrote from what amounts to Daisy Buchanan’s point of view rather than Nick Carraway’s, to use “The Great Gatsby” again as a reference point. </p>
<p>Imagine what a different story “Gatsby” would have been had the reader seen the world through Daisy’s eyes? </p>
<p>Or don’t imagine. Rather, give “Ex-Wife” a read.</p><img src="https://counter.theconversation.com/content/210764/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marsha Gordon has received funding from the National Endowment for the Humanities Public Scholar Program and the National Humanities Center.</span></em></p>‘Ex-Wife’ originally outsold ‘The Great Gatsby,’ but critics sniffed at the novel, deeming it a melodramatic period piece − even though it tackled timeless issues like gender, money and power.Marsha Gordon, Professor of Film Studies, North Carolina State UniversityLicensed as Creative Commons – attribution, no derivatives.