We need to talk about the abortion ban that is well on its way to becoming Wisconsin law. People who believe abortion is never justified need to talk about it. People who believe abortion is morally neutral need to talk about it. Most people’s take on abortion is more complex than either of the above, and they most of all need to talk about it. The ethics of abortion are hard, and I respect that different people will give these issues years of careful thought and still come to different conclusions. If we all endorse the adage that good ethics begin with good facts, then we have enough consensus to start a conversation, so let’s begin. If you disagree, then this is probably not the post (or the blog) for you. Perhaps you would like to pass the time instead by reading this heartbreaking classic by the great American poet Lucille Clifton. Clifton knew better than anyone that it would be easier not to talk about abortion. But that’s not good enough. So this is what I have to say.
There is no evidence that banning abortion late in pregnancy leads to fewer abortions. Other states have tried it, and there is no evidence that it worked. For one thing, very few such abortions are performed–as you probably know, they are only about one percent of all abortions in the U.S. As you also probably know, these are mostly abortions performed in response to a medical diagnosis, maternal, fetal, or both. One doctor has publicly speculated that the ban may lead to more abortions as families may not have time to wait to get all the information, and may wind up ending a pregnancy that could have led to a live birth.
These are the stories no one wants to think about. It’s easier to pretend that if you want a baby, and you take the greatest possible care trying to bring your baby into the world, if you believe in the sanctity of life, and try to be a good person and a good mother, that you and your baby will thrive. We could all pretend that no pregnant woman is diagnosed with cancer, that all fetuses develop kidneys and brains, that live-born children with Trisomy 18 don’t suffer in the 48 hours during which 95% of them will die. We could also pretend that these things only happen to people who did something wrong, or who are in some way different from us. Compassion is much harder. What if a few moments’ witness to the pain of a family having to lose the baby they wanted is just too much, and it breaks us?
Some of the figures involved in Wisconsin politics right now are claiming that pregnancy never kills. It’s an easy enough lie to tell, because these scenarios are rare. Most people don’t know anyone who had to end a pregnancy to save their own life, so it’s easy for them to dismiss such stories as abstractions. Not, however, for doctors. Doctors meet the people who are living this nightmare. They have to deliver the news no one ever wants to hear. That’s one of the reasons so many doctors oppose this kind of legislation. It’s one of the reasons why the Wisconsin Medical Society and the American College of Obstetricians and Gynecologists, neither of them known for their fringe political stances, have opposed this bill in Wisconsin. As of this writing the proposed law still contains an exception for cases when carrying a pregnancy to term would kill someone–at least I think it does. The language is pretty vague, and I’m no lawyer.
But the truth is, this is all beside the point. You may think parents should not have the right to make these decisions for any reason, but we can agree to disagree. Likewise you may feel persuaded by the argument that any amount of uncertainty over whether later abortions cause fetal pain means those abortions should not happen, even if the weight of the evidence is against it. That is also beside the point. It’s all beside the point as far as this law goes, because abortion bans don’t work.
What is the purpose of this bill? It pretty clearly won’t end abortions, late or otherwise. Wisconsin women will have to obtain them in other states. To quote this econometrics paper, “The demand for abortion is quite inelastic.” That could never be more true than in the case of late abortions. It should not surprise anyone that the consequences of having to travel for an abortion can be devastating for families living in poverty. As was the case before Roe and now, restrictions on abortion do not apply equally. Money could always get you an abortion, probably even a safe one.
The real purpose of this bill is probably to provoke a ruling in the U.S. Supreme Court. Then the conversation about abortion will change. Most of that conversation will surround the ethics of abortion. And it will be a waste of time. Not because the ethics aren’t important–they are–but because they are moot. Making abortion illegal doesn’t make abortion go away. These attempts tend to backfire. Looking at aggregate data, countries in which abortion is illegal actually have more abortions. The demand for abortion is inelastic. Abortion need not even be illegal to prove that point. Even within my time in medical school, a doctor here in Madison told me about a patient who was flown in from a rural area after she nearly died attempting to give herself an abortion with a knitting needle.
I still believe that it is possible to achieve consensus on abortion in the U.S. No one actually has to change their mind or compromise any ethics in order to achieve this consensus; all we need to do is embrace the practice of evidence-based policy. Cause the evidence suggests making abortion a crime is not going to reduce abortions. Are you bothered by how many abortions are performed in the U.S. right now? Guess what, me too. Let’s get cracking on preventing unwanted pregnancies. Are you bothered by the idea that someone might feel like they couldn’t continue a wanted pregnancy because of a diagnosis of Down Syndrome? Guess what, me too. How about we get some legislation going that supports families of children with special needs, and makes the deck a tiny fraction less stacked against people living with cognitive disabilities. I would so much rather be working on either of those issues, wouldn’t you?
And let’s not do a few other things. Let’s not make women choose between watching their child suffer and going to prison. Let’s not force women to risk their lives by continuing a pregnancy because they could not prove there was a zero percent chance of survival without an abortion. Let’s not create an underground economy for abortions because they are no longer performed legally by doctors.
On this blog I usually try to make my points with a dose of humor, but I can’t on this one. The truth is I’m profoundly depressed about the state of politics in Wisconsin, and the general unwillingness of the politicians who control all three branches of government right now to use evidence. I’m not utterly clueless. I have a pretty shrewd idea of what’s going to happen with this law. I sure hope it doesn’t lead to more abortions. But it probably will.