There are two ways to reduce unmet need for abortion care. One is to increase access. The other is to decrease need.
I’ve always supported abortion rights. Even when I was a student at Wheaton College—not the women’s school in Massachusetts but the Evangelical flagship, Billy Graham’s own alma mater—I found the anti-abortion sentiments of some fellow students puzzling. My husband and I owe the existence of our first daughter to the fact I was able to terminate an unhealthy pregnancy and start over. My most widely read article ever was titled, “Why I am Pro-Abortion, Not Just Pro-Choice.” Even so, I find myself less concerned than many folks around me about the prospect that Roe v. Wade may soon be overturned.
Don’t get me wrong. I do think it’s going to happen—later if not sooner. The biases in the Supreme Court seem rather clear. But even if this weren’t the case, it likely would just be a matter of time. The Christian Right (whose political influence is supersized by lockstep moral certitude and longstanding religious privilege) has been like a dog on this bone ever since shrewd Republican operatives threw it over their fence. Those operatives may have been cynical or opportunistic, but they converted Evangelical True Believers into true believers on this topic. And religious fixations have uniquely inter-generational staying power.
That said, religious fervor isn’t the only problem for pro-choice advocates or even, perhaps, the biggest one in the long run. Improvements in medical technology have ensured there’s no going back, even if Evangelicalism continues to wane. When pro-choice advocates talk about medical changes related to abortion, we focus on early pregnancy detection, which allows women to end an unsought pregnancy within weeks rather than months. Or we talk about the morning-after pill, which prevents an embryo from forming or implanting. Or we talk about medications that trigger miscarriage at home, a less intrusive alternative to the doctor’s office procedure. But in the political fight, the biggest relevant medical changes are fetal monitoring and photography.
When Roe passed, pregnancy was a black box. There were no fetoscopes to detect and amplify the sounds made by a pulsing proto-heart in a 6-week fetus the size of a pea and shape of a grub. There were no grainy black ultrasound images with little penises or lack thereof for parents to hover over in anticipation of gender reveal parties. There were no 3-D color images of teeny fingers and toes. No Miracle of Life coffee table books. No weird spidery in-utero baby pictures on Facebook. (You may think they look like aliens, but trust me, the reaction of prospective parents is more like being kitten smitten.) Immediately post-Roe, abortion foes lacked the most powerful tools they now wield.
And wield them they do. Some years ago, I visited a science museum for children. One display was about fetal development. A sequence of large posters showed an egg being fertilized and cells beginning to divide and multiply. A round blastocyst emerged. And then (to my initial surprise) the series jumped past the stages in which a human fetus has a tail and looks rather the same as that of a dog or an elephant. It carried on with a series of photos showing something very much like miniature babies. Like the images on Facebook, only prettier, and targeted at children.
Roe v. Wade is likely going away.
Cause for serenity.
So why am I—outspoken pro-choice activist, congenital alarmist, and Planned Parenthood donor every year since grad school—not particularly worried?
- The benefits of Roe have dwindled. Some would say in fact that Roe has already died a death by 1000 cuts. An accumulation of abortion restrictions in the last 50 years have made the safeguards in Roe an illusion for many women, and legal rights are meaningless unless people have the means to act on them. In 2012, 87 percent of American counties lacked any abortion provider, with one third of reproductive age women calling these counties home. In red states, mandatory waiting periods, “safety” regulations and consent laws have driven up costs and increased other barriers to the point that many women can’t surmount them. The 2020 coming-of-age movie, Unpregnant, is quirky and funny, but the story line (two high school seniors travel from Missouri to New Mexico for an abortion) roots in a serious reality for many young women. Federal abortion rights have failed to create a uniform landscape of abortion access in the U.S.
- With Roe under threat, some states have been moving to secure or expand abortion rights. In 2019, 9 states passed a total of 15 bills that protect or expand abortion access. In 2021 11 more bills were enacted to protect or expand abortion access at the state level. In 2020, New Mexico removed a pre-Roe law that criminalized abortion. New York encoded the rights secured under Roe. Nevada decriminalized self-managed abortion, a practice that is likely to grow if both restrictions and effective self-care options expand. In states that have taken these steps, abortion care will likely see little change.
- Need for Abortion is in steep decline. In the U.S., abortions per capita peaked around 1990. For decades approximately 1 in 3 women had an abortion in her lifetime. Advocates for Youth hosted an abortion storytelling project called the 1-in-3 Campaign. Today that number is around 1 in 4 and continuing to decline, and the storytelling project is called, simply, Abortion Out Loud. Though restrictive laws may be a factor in some states, this drop in abortions is part of a broader decline in pregnancy, and unsought pregnancy specifically, which appears to flow from culture shifts and more widespread use of modern birth control—especially top tier “get it and forget it” contraceptives like IUDs and implants.
The bigger picture. This doesn’t mean that those of us who care about abortion access should simply retreat to our gardens. No question, when women are denied access to abortion, suffering results—for them, for their families, and for their broader communities. That’s going to get worse. And there are ways we can help to maintain support for abortion rights and access. But if the whole point of the abortion fight is that people should be able to form the families of their choosing at the time of their choosing with the partner of their choosing, then there’s a whole lot we can do to advance the cause with or without Roe.
Advocates for reproductive freedom aren’t just fighting against an army of True Believers infected by anti-abortion brain worms, though that is true. And we aren’t merely fighting for an invasive, expensive medical procedure, though that is also true. We’re fighting for flourishing families and children who get the best starts in life. We are fighting for future generations of women who can fully participate in our democracy and economy (which requires that they can time and limit pregnancies). We are fighting for our sons and brothers whose lives, like those of our sisters and daughters have all too often have been derailed by surprise pregnancies. And we are safeguarding paths into the middle class for people who might otherwise get knocked into a chasm of poverty by unsought, unwanted, and unpredictable fertility.
Roe—and abortion access more broadly—was always a means to a higher end. We sometimes forget that. When we make abortion rights the be-all, end-all of the fight, or worse, when we make a specific Supreme Court decision the be-all, end-all, we set ourselves up to lose a struggle that is imminently winnable for most women and with a greater degree of equity than exists today.
Action. I said that abortion foes have more powerful tools at their disposal than ever before. But if we pop up a level—to the level of our actual objectives, people should be able to form the families of their choosing at the time of their choosing with the partner of their choosing—then so do we. We have birth control options that our mothers could only have dreamed of.
State-of-the-art IUDs and implants are so effective that they make the most common kinds of abortion literally obsolete. (Set aside physical health of the mother, fetal anomalies and sexual assaults, which comprise small if important segments of abortion care.) Over 90 percent of abortions are first trimester procedures triggered by mistimed and unwanted pregnancies. For upper and upper middle-class women, those abortions are largely a thing of the past. As one such acquaintance put it: In the 1980s, my mom took my friends to get their abortions. Instead, I’m taking my daughters’ friends to get their IUDs.
The challenge has been getting the same high-quality but expensive contraceptives to young women with fewer resources and whose lower income and racial minority communities often have complicated, wary relationships to reproductive medicine (with reason). The more vulnerable a young woman is to have her dreams and goals derailed by a surprise pregnancy, the less likely she is to have a mother or auntie or friend’s mother who can guide her to (and pay for) top tier preventive care. Consequently, when it comes to mistimed or unwanted pregnancies, there are deep chasms between have’s and have-nots—with cascading intergenerational consequences. It doesn’t have to be that way.
A few years back, Delaware teamed up with a nonprofit, Upstream USA, to transform contraceptive care across the state. Through Delaware CAN, professional trainers and university faculty taught primary care teams across the state to screen for pregnancy intentions, routinely asking women One Key Question during primary care visits, “Would you like to become pregnant in the next year?” They taught providers to offer the full range of contraceptive options while respecting patient preferences, and to provide IUDs and implants during that same visit rather than making the patient schedule another appointment. They included birth-spacing conversations in prenatal care and, when desired, provided immediate contraceptive care post-partum. The result was that both unplanned births and abortions plummeted. There are two ways to reduce unmet need for abortion care. One is to increase access. The other is to decrease need. The latter is what happened in Delaware. There was no decrease in access to abortion care—simply a profound change in need. A similar program in Colorado had similar results. And it can work across the country.
But sometimes we are our own worst enemies. The Religious Right makes everything about their (self)righteous crusade; and in turning to fight them, we forget where we were going in the first place. We gird in our own armor of righteousness and match their battle cries with our own. But in the heat of clashing passions, we lose focus. We get drawn away from the practical incremental changes through which people quietly gain the freedom to form the families of their choosing and live the lives of their choosing even in the midst of chaos and conflict. Improving medical practice—asking better questions, offering better options–isn’t sexy. It gives no-one an adrenalin rush. But it is powerful, and in the long run, that power is transformative.
This is where we should plant our flag: Each person able to manage their own fertility. Better knowledge, better medical practices, and better birth control technologies are our ways to infiltrate behind entrenched lines, to win the future even as we lose the legal tools of the past. Which we most likely will, sooner rather than later. But it was never about that in the first place.
Valerie Tarico is a psychologist and writer in Seattle, Washington. She is the author of Trusting Doubt: A Former Evangelical Looks at Old Beliefs in a New Light and Deas and Other Imaginings. Her articles about religion, reproductive health, and the role of women in society have been featured at sites including The Huffington Post, Salon, The Independent, Quillette, Free Inquiry, The Humanist, AlterNet, Raw Story, Grist, Jezebel, and the Institute for Ethics and Emerging Technologies. Subscribe at ValerieTarico.com.