One year ago, the United States Supreme Court decided that women do not have a Constitutional right to abortion.  The majority, who had previously announced at their confirmation hearings that the Roe v. Wade decision in 1973 was “established law,” realized that it was not as “established” as their testimonies had suggested. Nowhere in the Constitution was there any explicit reference to “abortion” or to “women.” The Fourteenth Amendment had previously been the basis for the 1973 Court’s claim that people, including women, had a right to privacy. This right extended to medical consultations and procedures, including the termination of unwanted, unintended, dangerous or unsustainable pregnancies.

The claim that this amendment afforded citizens a “right to privacy” had previously been adopted by the Court to strike down highly intrusive state laws restricting marriage between people of different races, a ruling that allowed Justice Clarence Thomas’s marriage to a white woman to be recognized as valid in all states and the District of Columbia. He and five other Justices decided that there was no Constitutional basis for protecting the rights of women to decide when, with whom or how often they had children. By extension, the Supreme Court had voided the basis for Clarence Thomas’s marriage being deemed valid. This must prompt interesting conversations at the Thomas’s dinner table.

More than 60% of Americans of voting age support the right of women to choose whether or not to continue with unwanted or unsafe pregnancies. That more than 50% of the states in the United States have effectively banned or imposed onerous burdens on women seeking abortions and only 11 states have passed laws to protect a woman’s right to choose is puzzling.  The Supreme Court did not rule that abortion should be illegal: it merely left it up to state legislatures to decide if they wanted to make abortion illegal or effectively unavailable in their states. The profound impact on women’s healthcare, including the exodus of obstetricians and gynecologist from states that threatened to revoke their licenses or imprison them for performing standard medical procedures or prescribing drugs that might be used to terminate a pregnancy, was foreseeable.

Texas was one of the states most aggressive in banning abortions.  Ironically, this state, which is trying to limit the influx of migrants from Latin America, experienced an abrupt increase in births to poor Black and Hispanic women after the full implementation of its anti-abortion laws.  Births to these women denied access to abortion and many other aspects of women’s healthcare jumped more than 3% above projections between April, 2022, and December, 2022.  An excess of 10,000 children were born to this group during the last 9 months of 2022, the first interval after the passage of Texas Senate Bill 8 for which numbers are available.  This growth in the population at the lowest end of the socioeconomic spectrum in Texas will impose burdens on the general population of the state that the harsh interdiction measures in place at the southern border were supposed to prevent.

Also endangering the health of women in states banning abortion is the inevitability of self-induced and “back-alley” abortions.  We know what happens in locations where pregnancy terminations are unavailable: botched procedures by unqualified providers increase.  Complications of these botched procedures put further strains on women’s healthcare resources that are already being diminished by the laws targeting obstetricians and gynecologists.

Of course, women with resources to travel to locations in the U.S. or outside the country that allow pregnancy terminations will be unaffected. Those state legislators insisting on laws that punish women for going outside their home state for abortions have certainly not read the Constitution’s demand for “due process” and “equal justice.” Unlike “abortion” and “women,” those words do appear in the Constitution. Nonetheless, the threat of sanctions will further dissuade women with unwanted pregnancies from getting abortions. 

The states restricting women’s reproductive choices must build more daycare centers, pediatric hospitals, elementary schools, and playgrounds. There is a baby boom brewing, and the women most affected will be those with the fewest resources.  Five percent of American girls and women, 15 to 44 years of age [reproductive years] have unintended pregnancies every year.  About 45% of pregnancies in the U.S. are unintended. This includes teenagers and women who have been date raped, denied birth control protection by their sexual partners, sold expired birth control pills, etc.  These are not criminals: these are our daughters, sisters, aunts, and mothers. Surely, in a true democracy these women would not face barriers to reproductive choices: they would not be denied the right to choose when, with whom, or how often they had children.

Statistics establish that the majority of Americans want women to have this choice and were comfortable with the Supreme Court decision in 1973 that legalized abortion throughout the United States. There must be a reason this choice was revoked despite widespread support for the status quo in 2022 before the Supreme Court ruling. There was no tsunami of altered opinions that prompted this change. There was, however, a resurgence of well-funded, special interest groups and generous, single-minded billionaires providing unsolicited largesse to Supreme Court justices and like-minded state legislators. Simply put, democracy was outbid.

The fertility rate in the United States has been falling steadily in recent decades. The general population is getting older, and the nonimmigrant workforce is getting smaller. Perhaps the wealthy men opposed to reproductive choices for women decided to re-invigorate America by forcing its women to have more children, rather than allowing more job-seekers to cross our borders. Perhaps they felt it was time to test their powers of persuasion and the impact of their wealth on a contentious issue under perpetual discussion. Perhaps they merely wanted to re-assert the dominance of men over women in our society and reestablish the societal norms that prevailed in that ‘golden’ epoch more than a century ago when women could not vote, had limited educational and professional options, and had no voice in deciding whether they had one or twenty pregnancies.

Women made enormous gains in business, politics, and other realms unrelated to child-bearing and child-rearing during the 50 years during which they had some measure of reproductive autonomy. Perhaps the billionaire men gifting our Supreme Court Justices and state legislatures who oppose reproductive choices for women are more concerned with the emergence of level ‘playing fields’ than with the ‘morality’ of abortion. Men can choose when, with whom, and how often they have children. It is odd that women are denied those rights.

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.

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