With the exception of racism, nothing unites Trump supporters like their drive to outlaw abortion in the United States. Republican efforts to stack the Supreme Court may achieve their goal. Unfortunately for them, cheap international air travel, the Internet and technology will make this an empty victory. It is one thing to pass a law. It is another thing to actually enforce that law.
Republicans have a difficult time understanding that the world has changed since 1973; the year abortion became legal in the US. They think they can force women to resort to the horrific back room abortions prevalent before Roe versus Wade. It is a different world and women have options they never dreamed of before 1973.
The reality is that every time government passes over-reaching, unpopular laws, a demand driven crime machine is created giving citizens what they want. This happened with prohibition, it happened with the War on Drugs and it will happen with abortion. I expect if the US outlaws abortion, medical abortions online will become the predominant way women with money will get around the law for abortions in the first 12 weeks of pregnancy. Later abortions will happen outside US borders.
Looking at the big picture, the reality is abortion laws don’t reduce the number of abortions. In fact, studies have found that countries that outlawed abortion have the highest abortion rates. https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide
Medical abortions
The primary method US women will use to circumvent a US abortion ban is with medical abortions. A medical abortion uses two drugs, mifepristone and misoprostol, taken one day apart at home. Within 24 hours, the woman will have a miscarriage. The process is 97 percent effective.
Misoprostol is also used alone. This drug is also used to treat ulcers and is easier to obtain than mifepristone. It is effective in terminating pregnancies over 90 percent of the time. If it doesn’t work, a woman can wait 12 hours and repeat taking the drug.
There is no surgery and no vacuum procedure. In Sweden, 92 percent of abortions are medically induced. It is rapidly becoming the predominant form of abortion in the US. Medical abortions are used in the first 12 weeks of pregnancy.
Using these drugs in the US without a prescription is illegal, just like opioids. However, today, mifepristone and misoprostol can be ordered from a website https://www.womenonweb.org/en/page/3074/buy-abortion-pills-mifepristone-online-misoprostol-online
The above website is run by a non-profit group wanting to give women the option of safe abortions. That isn’t the future though.
When the War On Drugs was launched, few people dreamed of the sophisticated distribution system drug cartels would put in place. If you missed seeing what was going to happen in illegal narcotics distribution, you are now forewarned that mifepristone and misoprostol will be easily accessible for almost all women. With a US market of 940,000 abortions annually, there will be plenty of incentive to deliver customer-focused solutions to women with unwanted pregnancies.
It is impossible to predict how mifepristone and misoprostol will be distributed if abortion is outlawed in the U.S. Frugal Ron’s expectation is women will buy a prescription for misoprostol over the Internet. The doctor, physician’s assistant or nurse practitioner providing the prescription will be licensed in the US and located in a country with no extradition agreement with the US. The credit card charge will go to an offshore bank. The woman ordering the prescription can fill it at her local drug store. Her health insurance will most likely cover the cost of the drug.
Both drugs are patented. This doesn’t mean much to people selling it illegally, but it does mean the formulations are publicly available. Mifepristone and misoprostol can be used as liquids or pills and mixed in anything from sugar bags to cookies. Shipping the small amounts needed to women should also be relatively simple as an alternative distribution method. Current providers of illicit drugs may also be involved in the distribution of medical abortions.
Travel
A second option for women wanting an abortion is traveling to Canada. This will be the preferred method for later term abortions.
Traveling for abortions is already happening. There are no abortion clinics in either North or South Dakota. This certainly doesn’t mean women in those states aren’t getting abortions. Ten percent of the abortions performed in neighboring Minnesota are done on out of state women.
International air travel is cheap. And, airports are jammed everyday with women who are very comfortable traveling.
A recent price check finds that for $222, anyone can book a round-trip flight Monday, returning Tuesday from Chicago to Toronto. The same schedule will cost $352 from Los Angeles to Vancouver and $222 from New York City to Ottawa. US citizens need a passport to travel to Canada. But, a woman can get an expedited passport in 24 hours. Appointments at abortion clinics can be made online. If abortion is outlawed in the US, expect a large expansion of safe abortion clinics on the other side of the Canadian border.
Abortion is legal in Canada for all stages of pregnancy. It is one of the few countries in the world with no legal restrictions on abortions.
As an aside, Canada’s experience with abortion laws should give U.S. abortion opponents even more cause for concern. In 1969, the Criminal Law Amendment Act was passed in Canada. This law legalized abortion as long as a committee of doctors signed off that it was necessary for the physical or mental well being of the mother.
Dr. Henry Morgentaler started performing abortions without committee approval. In 1973, he claimed he had done over 5,000 illegal abortions. To make sure there was no doubt, he had one of these abortions videotaped.
The Quebec government took Morgentaler to court twice. Both times juries refused to convict him even though he admitted to doing thousands of abortions. The government appealed one acquittal and the appellant court overturned the jury’s verdict. Morgentaler was sentenced to 18 months in jail. Public outcry over the appeal court’s decision caused the federal government to pass a law (commonly known as the Morgentaler Amendment) preventing appeal courts from overturning a jury’s not-guilty verdict. Morgentaler was again acquitted at a third trial, causing the Quebec government to declare the law unenforceable. Eventually, Canada passed its current law granting women abortion rights at any stage of gestation.
If the Supreme Court outlawed abortions, it is quite likely many urban counties would elect district attorneys who refused to prosecute abortion cases. If U.S. attorneys attempted to prosecute these cases in federal courts in urban areas, it is very likely juries (like those in Quebec) would refuse to convict, making the laws unenforceable.
This is the problem with abortion laws that are passed legislatively and judicially by straight party line votes. In this case, the majority of US citizens will have no ownership or buy in to any law outlawing abortion.
What a CF!
Republicans and their evangelical supporters may well get their holy grail of an abortion ban in the US in the next year. While they are celebrating, they probably won’t notice abortions are more accessible and easier to get for women with money than ever before. No more “cooling off periods”, no more being forced to watch ultrasound presentations, no more required parental involvement and no more doctor appointments for medical abortions. More than likely, abortions will be cheaper than they are now.
The point is, for women with a credit card, a responsible boyfriend with a credit card or a caring parent with a credit card, a US abortion ban will simply be a hassle, not an impediment. The only losers out of this whole mess will be the poorest; least educated and most isolated women. This will result in more brown and black skinned babies, the worst possible outcome for Trump and his racist supporters’ efforts to, “Make America White Again”.
A real solution
Ironically, while big-government, liberal Republicans seek to use the jack-boot of unenforceable laws and the threat of locking people up in jail with lifetime sentences to reduce abortions, they are ignoring technology that can virtually eliminate abortions in the US.
Eliminating abortions means preventing unwanted pregnancies. In a 2011 survey, about 45 percent of pregnancies in the U.S. were unintended, of which 42 percent ended in abortion. The solution should seem fairly straightforward to most rational people. Let’s eliminate unwanted pregnancies and thereby make abortions obsolete. This solution requires a two-pronged strategy:
- Universal and free access to contraceptives, including Long Acting Reversible Contraceptives (LARC).
- Universal access to sex education and information on reproduction and pregnancy prevention.
LARCs
Long Acting Reversible Contraceptives are implants that a woman can use that provides extremely effective birth control. Studies find they are 20 times more effective than birth control pills, the patch, or the vaginal ring. One important reason why is the LARC removes the “user error” factor that can make other methods less effective. No need to remember to take a pill daily, or have a diaphragm on hand, ready to go.
Once a LARC is in place, it does its job for years with no input from the user, acting as a “set it and forget it” method. Also, if a woman decides she wants to have a baby, the LARC can be easily removed, hence the “reversible” in the name.
How effective are LARCs at reducing abortions? The Contraceptive CHOICE Project was launched in St. Louis, Missouri in 2007 at George Washington University Medical College with the goal of studying how to reduce unintended pregnancies and hence abortions.
The CHOICE project enrolled over 9,000 women between 2007 and 2011 to receive free contraceptive counseling and the contraception of their choice for two to three years. The researchers found that from 2006 to 2010, teen study participants had an average annual abortion rate of 9.7 per 1,000 teens — significantly lower than the 41.5 abortions per 1,000 sexually active teens nationwide in 2008.
In the contraceptive CHOICE project, teen participants learned about all methods of contraception, including LARCs. Seventy-two percent of the teens then chose to use an IUD or an implant as their own form of birth control. Among the general population, only 7.2 percent of women use LARCs. This shows that women who receive a comprehensive education about birth control methods are more likely to choose the most effective and long-lasting kind.
Among the CHOICE participants who opted not to use LARCs as their birth control method, there were 4.55 unintended pregnancies per 100 women every year. There were only 0.27 unintended pregnancies per 100 women per year for the CHOICE participants who chose the LARCs. This is what Frugal Ron calls the almost complete elimination of the need for abortion. This is a real world study involving real people.
In another real-world application, The State of Colorado found similar results. After handing out free IUDs and implants to teens and poor women over six years, the statewide teen birthrate dropped 40 percent from 2009 to 2013, while the abortion rate dropped 42 percent. The results were especially dramatic in the state’s poorest regions.
Cost
LARCs are highly effective and cheaper over the long term, but they can be expensive up front for uninsured or underinsured women. Out-of-pocket costs can range from $500 to $1,000, putting them out of reach for teens and poor women — those most at risk of an unintended pregnancy.
“The idea that women can access preventive methods and preventive health care at low cost or no cost is essential,” states Dr. Jeffrey Peipert, chair of the department of obstetrics and gynecology at Indiana University School of Medicine. “Every dollar invested in contraception can save between four and 17 dollars down the road in health care costs.”
Republicans complain about the high cost of Long Acting Reversible Contraceptives. Yet, what is the gain of eliminating abortion as one of the most divisive issues our country deals with? On an individual level, individuals and families that have to decide whether or not to have an abortion have to make wrenching decisions. If government can eliminate this kind of pain, it has truly made the world a better place. This is not some abstract academic argument. One in four US women over 44 had an abortion.
The Republican Christian alternative
(Note, Frugal Ron recognizes Republican Christians are totally different from real Christians. The two groups are not to be confused or generalized together.)
Republicans and their Christian followers propose required abstinence only education as a faith based solution. Making this even more ludicrous, they have “Raw Dog” Trump as their point person promoting abstinence.
A review published in the Journal of Adolescent Health https://www.guttmacher.org/news-release/2017/abstinence-only-until-marriage-programs-are-ineffective-and-harmful-young-people
found, “In theory, abstinence is 100% effective at preventing pregnancy and Sexually Transmitted Infections (STIs). However, many adolescents who intend to practice abstinence fail to actually do so, and they often fail to use condoms or other forms of contraception when they do have intercourse. Considerable scientific evidence accumulated over the past 20 years has found that Abstinence Only Until Marriage (AOUM) programs are not effective at preventing pregnancy or STIs, nor do they have a positive impact on age at first sexual intercourse, number of sexual partners or other behaviors.”
Another study, “Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S.“ found similar results.
The author’s reported, “Using the most recent national data (2005) from all U.S. states with information on sex education laws or policies (N = 48), we show that increasing emphasis on abstinence education is positively correlated with teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic status, teen educational attainment, ethnic composition of the teen population, and availability of Medicaid waivers for family planning services in each state. These data show clearly that abstinence-only education, as a state policy, is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S.”
States that emphasize abstinence-only programs have the highest rates of teen pregnancies and teen births. However, it should also be noted these states are also the ones making it most difficult for teenagers to get contraceptives by limiting Planned Parenthood’s efforts. Over and over, the same points keep slapping us in the face and say, “Wake-up, if you want more abortions, restrict access to contraceptives and implement faith based abstinence only education. If you want to make mega progress in eliminating abortions, make LARCs universally available for free and provide fact and science based sex education.”
Real sex education is key to preventing abortions
California is an example of how states adjusted when it became clear that abstinence-only education isn’t working. In 1992, the state’s teen pregnancy rate was 157 per 1,000 teens aged 15 to 19 — the highest rate in the nation. To combat the problem, the state launched a three-year abstinence-only sex education effort. After finding the program had absolutely no impact on teens’ decisions to start having sex, the program was scrapped in 1995. In 2003, lawmakers passed the California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act.
The law, forbade classes from promoting religious doctrine or bias against people, and required all sex education programs be medically accurate, age-appropriate and comprehensive. From the inception of the program in 2003 to 2013, California’s teen abortion rate dropped 55 percent 1. compared to the national teen abortion rate drop of 46 percent 1. in the same period. While these numbers are impressive, they understate the results of California’s comprehensive sex education.
California does not keep separate records for women from other states getting abortions in the state. Also, California does not require parental authorization for teen abortions and has no waiting period. Consequently, many teens from neighboring states that did not get California’s sex education come to the state for abortions. We can assume that these women would have close to the national average abortion rates and would thereby raise California’s teen abortion rate compared to if only California teens were counted.
Critics complain that sex education promotes promiscuity. However, a 15 year old California boy intent on having sex with as many similarly aged girls as possible would jump for joy if he found out his family was moving to Texas. While 28 percent 1. of California girls reported having sex in high school, 38 percent 2. of Texas girls had sex during their high school years. Texas schools have either no sex education or abstinence only education.
California’s success in preventing teen-age abortions is no accident. It also had nothing to do with restricting access to abortions.
- California state law requires that comprehensive sex education is taught in grades 7 to 12. A school can choose to offer sex education earlier than grade 7 as well.
- Sex education must include information about the effectiveness and safety of all U.S. Food and Administration (FDA)-approved contraceptive methods, including emergency contraception.
- California requires that instruction and materials are appropriate for students with disabilities and students of all races, genders, sexual orientations and ethnic and cultural backgrounds.
- California law also requires instruction about gender, gender expression, gender identity and gender stereotypes.
- California requires that students in grades 9 to 12 learn about sexual harassment and violence, consent and prevention and reporting of sexual harassment.
- Parents or guardians can remove their children from sex education classes. This is known as an “opt-out” policy.
- In California, teens can get a prescription for birth control without a parent’s permission.
- Clinics called “Title X clinics” provide sexual and reproductive health care to both teens and adults. Title X clinics offer many services, including prescriptions for the Pill, pregnancy option counseling, and testing for pregnancy and sexually transmitted diseases (STDs) and infections, including HIV.
- Title X clinic appointments are completely confidential.
Abortion prevention is more than just preventing teenage pregnancies. Planned Parenthood has 115 clinics in California. Planned Parenthood is able to offer more education and free contraceptives, to people of all ages.
Republicans are especially indignant that California’s comprehensive sex education classes include fact based and science backed information about how sexual orientation is caused by biological factors that start before birth. It is difficult to maintain Republican hate-based homophobia in an environment where ignorance doesn’t reign supreme.
It is obvious that outlawing abortions in the US will only impact the poorest and least educated women. If policymaker’s goal is to reduce abortions, the logical plan combines California’s sex education with free distribution of Long Acting Reversible Contraceptives. There are problems with a logical solution.
The politics of stupid
Frugal Ron observes that almost all people wanting to outlaw abortion are very much against using more effective and wider distribution of contraceptives and comprehensive sex education. This makes no sense whatsoever. Why would someone who wants to end abortions be against practices that do just that? Could it be that these folks are far more dedicated to stopping people from having recreational sex than stopping the killing of unborn babies?
This brings us to Christian superstitions and mythology. Right wing preachers exhort their flocks that we are having more floods, more devastating hurricanes and wildfires because it is God’s punishment on America for our tolerance of abortion, homosexuality and promiscuity.
These preachers forget to mention that the first half of the 20th Century is recognized as the epoch of church membership and attendance in the US. In addition, during this period, abortion was illegal everywhere, every state had anti-sodomy laws, and divorce was virtually non-existent.
Yet, the period from 1900 to 1950 brought us World War I, the Dust Bowl, locusts, boll weevils, the Great Depression, World War II and the Holocaust. Sadly, many Republicans are gullible enough to believe these Bible thumpers and their myths.
The most outrageous example of top-down theocracy concerning birth control is the Catholic Church. While the hierarchy of the church condemns using any kind of contraceptive, according to Pew Research, 98 percent of Catholic women have used some form of birth control during their lives. This is probably about the same percentage of Catholics that were eating meat on Wednesdays and Fridays before the church hierarchy decided they wouldn’t go to hell for this indiscretion.
One might think that if the Catholic Church is promoting abstinence to the rest of us, they ought to be successful in promoting it to their own employees. This is not the case. The Boston Globe published a series Children of Catholic priests live with secrets and sorrow. The reporters identify and interview many Catholic priests’ children.
Paul Sullins, a priest and sociologist at The Catholic University of America, said his belief that priests with children may be more numerous than priests who abuse children is based on common sense: “It’s a much less common impulse for an adult male to want to have sex with a child than it is to have sex with a woman.” The U.S. Conference of Catholic Bishops estimates there are more than 18,500 victims of Catholic sex abuse.
This isn’t a new problem. At least four Renaissance era popes had children during their reigns.
The last impediment to implementing an effective plan to dramatically lower the number of US abortions is present day Republican inability to think logically. Republicans ignore research, knowledge and arithmetic in eliminating the federal budget deficit, eliminating our trade deficit and saving our planet from the impacts of climate change. Why is anyone surprised when Republicans ignore real world data and research showing comprehensive sex education and LARCs reduce abortions?
Summing-up
It is impossible to predict how the nine member Supreme Court will handle upcoming abortion cases. If lower courts follow precedent and rule against individual state laws outlawing abortion, the Court might let the lower court rulings stand, keeping Roe versus Wade intact. Or, the Court might hear the cases and allow individual states to keep their laws; creating a hodge-podge of differing rules for each state. Or, the Court might invalidate abortion protections for the entire country. This article anticipates the latter scenario.
While Frugal Ron points out how outlawing abortions will be ineffective in decreasing abortions, the frugal one also shows how abortion numbers can be dramatically reduced through comprehensive sex education and making state of the art birth control universally available and free.
The real work of making changes in reproductive rights belongs to women impacted by these laws. In the 2016 presidential election, only 46 percent of women 18-24 years old voted. This needs to change. Young women have the power to destroy the Republican party as it exists today.
Protest marches after an election just give Republicans something to joke about. When women vote, their laughing stops. Additionally, if Roe versus Wade is overturned, women serving on juries can make sure no one is ever convicted for providing abortion services.
Women will circumvent any abortion law that is passed. They’ve been doing this for many years. While this is sad, what is really sad is that we have the technology and the means to all but eliminate abortion in the US and we aren’t doing it.
Additional Sources
Excellent, well researched article Frugal Ron. Keep up the good work, eventually logical thinking will replace dishonest and hypocritical actions by some misguided individuals.
Thank you Marti!