Not my most coherent post - I am still not exactly sure what my argument is. But I've had a lot of these thoughts in my head lately.

When you say, you don't know whether people ever get RU-486 through the mail, are you referring to Heebieville in particular?

For the past couple of years, people have been able to get those pills after telemedicine consults, but states are really cracking down on telemedicine across state borders. Conservative health systems (by which a I mean risk averse) are too.

There is an international organization that will mail people pills.

https://aidaccess.org/en/

When you say, you don't know whether people ever get RU-486 through the mail, are you referring to Heebieville in particular?

For the past couple of years, people have been able to get those pills after telemedicine consults, but states are really cracking down on telemedicine across state borders. Conservative health systems (by which I risk averse) are too.

There is an international

Whoops, sorry for the double post.

Yes, specifically in Heebie-ville. Whether there are established paths of know-how that are passed along when women are in need.

I'd think it'll be much more divided by class in the future. And then we'll get a national ban, and the class distinction will increase considerably. By my reckoning, at least 80% of 'send it back to the states' advocates will be on board with a national ban (one tell is how many of them are also arguing to send gun regulation back to the states -- oh wait, that's zero) and a patchwork of different states with different rules, and an underground railroad for moving people from ban-states to available-states, is likely to be untenable for very long. A Republican trifecta ends it.

Some smart person wrote on the internet the other day that the thing about abortion access is that most people don't spend much time thinking about it unless/until they suddenly are forced to think about it.

As of 5 years ago, Guttmacher says there were 55k abortions per year in Texas. https://www.guttmacher.org/fact-sheet/state-facts-about-abortion-texas Maybe overturning Roe knocks that down by 90%?

In the same period, in Montana we had 1500 abortions, at 5 locations. The end of Roe doesn't trigger a ban here -- our state constitution protects privacy -- but it does in Idaho. Washington and Oregon will get most Idahoans needing to end a pregnancy, though, so this probably doesn't change anything much, in the short run.

This has some useful numbers: https://yourlocalepidemiologist.substack.com/p/banning-abortions-will-not-stop-abortions?s=r

the number of legal abortions dropped in Texas. In August 2021, Texas recorded 5,377 legal abortions. In September 2021, this fell to 2,164. Compared to September 2020, this was a 50% decrease in abortions. ... From September to December 2019 (before the law), 514 Texans went to nearby states for legal abortions. From September to December 2021 (after the law), 5,574 Texans went to nearby states. Among those who traveled, the majority went to New Mexico or Oklahoma.

Requests for mailed abortion pills also significantly increased. A study published in JAMA assessed the request rates for Aid Access--an international nonprofit medication abortion service that sends pills in the mail while sidestepping U.S. abortion restrictions, by connecting people with overseas doctors and pharmacies. The team found that abortion pill usage in Texas increased after the state's law. In the first week, requests to Aid Access spiked by more than 1,180% --from about 11 requests per day to almost 138 requests per day. During the following three weeks, requests remained 245% higher than before the law. Overall, Aid Access received 1,831 requests from Texas for self-managed abortion in September 2021.

If we add # out-of-state abortions + # abortion pills + # in-state abortions, a small decrease (10%) in overall abortions was observed in Texas after the law was enacted. Even then, though, the discrepancy may be accounted by other avenues of abortion that are not readily available in data sources, like traveling to Mexico for prescriptions or procedures, or illegal procedures within the state. Nonetheless, a close to zero change in abortions is consistent with international research: the abortion rate is 37 per 1000 in countries that prohibit abortion and 34 per 1000 in countries that allow abortion.

Here's the abortion rate by state in 2019: https://www.statista.com/statistics/660661/abortion-rate-united-states-by-state/

Basically, it seems like barely anyone is getting abortions.

Here's the birth rate by state in 2022: https://worldpopulationreview.com/state-rankings/birth-rate-by-state

So Texas had ~1320 births per 100k and 9.5 abortions per 100K in 2019, which has fallen by 50% since then, per Nick.

So I imagine it feels incredibly distant and imaginary to women. That's just so few women taking up the option.

7 Oklahoma is a trigger state, as is Louisiana. New Mexico is, as heebie says, a long way away from where most Texans live.

So Texas had ~1320 births per 100k and 9.5 abortions per 100K in 2019, which has fallen by 50% since then, per Nick.

huh, that's a much bigger gap than I would have expected. I feel like I'm missing something. The Guttmacher Institute says

Eighteen percent of pregnancies (excluding miscarriages) in 2017 ended in abortion

At 2014 abortion rates, about one in four (24%) women will have an abortion by age 45.

8 Even in New York, it's only a little better than twice that.

Oklahoma is a trigger state

Interesting, but not actually reassuring, many stats with trigger laws have no plans for how to implement them.

Legal experts told Insider that they anticipate widespread uncertainty and confusion over what abortion care will look like across the country, as the 13 trigger laws take effect while emboldened lawmakers in around a dozen other states look to pursue additional bans and restrictions.

"It's really district by district, county by county, and the chilling effect is going to be the same regardless, because also prosecutors can change over time. So even if one declines to prosecute or enforce, the next one could," Jessica Arons, a senior advocacy and policy counsel for reproductive freedom at the ACLU, said. "Providers are really left in a situation of trying to suss out their risk level and whether it's safe for them to provide care to their patients or not, and it's a really untenable position for them to be in."

This ambiguity, the experts said, will likely hinder abortion access even in places where the procedure is still legal.

So Texas had ~1320 births per 100k and 9.5 abortions per 100K in 2019

I wonder if the Statistica data is displayed wrong and should be "per 1000" rather than "per 100K"

Then you'd have a fertility rate of 63.4 and abortion rate of 9.5 (both per 1000 women between 15-44).

That's still a bigger gap than I would have expected, but the ratio would be smaller in other states.

Didn't SCOTUS just decide a case that said if you're convicted and sentenced for something that statutes are interpreted as constituting a crime, and later courts say it actually wasn't a crime, you still have to serve your original sentence?

I had an abortion in dallas in fall 1971. lived in oklahoma. it was undeground network with clergy. it was safe and comfortable. suburban house in upscale neighborhood. anti abortion creeps not out in force then. I would like to see bodily autonomy live again. don't know how to help.

Thanks for sharing, Jackson. Welcome!

I think that red counties in a blue state basically don't change; people can rail against abortion Friday through Wednesday, get an abortion on Thursday, then line up with their peers to protest the clinic the next day again. After all, they're deserving, unlike all those strangers.

Basically, unless there's a nationwide ban, if blue states have abortion access, it won't matter much if your county is purple or red - there's probably a clinic not too far away, and no special hurdles to suck up your time, make you wait on the doctor to read a script, or anything else. (If a city or county tried to implement hurdles, it'd be quickly squashed by state or federal courts - at least in CA.)

Maybe it makes more sense on a non-mobile browser but the Statista chart linked in 8 says:

- per 100,000 population in the title
- but per 1000 women in the column header

and also it says

- by state
- but starts with DC
- and only has 48 entries

Oh, I see you have to expand a section below the chart to see the noted about the states not included.

17: Under that way of thinking, the penalty is predominantly the cruelty inherent in making people travel for the abortion, says the person who can contrast a traveled-for abortion to a non-traveled-for abortion. Since we seem as a country to be willing to make other people absorb nearly any amount of cruelty, it seems like a penalty that we'll bear. Honestly, I think we've lost the vision of what a gentle, convenient, compassionate lifestyle would be. Like, we have forgotten how to imagine being a nice supportive place.

I think we'll have a nationwide ban sooner rather than later, and then... I don't know. All hell breaks loose? It's just one among many terrible things that happen once we go full fascist? It's hard for me to have any optimism at all about the future of this country.

I'm over here still hoping for mutual dissolution into a few nations.

it's easy to think of abortion bans as a horrible but contained catastrophe - there's this one procedure that some women can't access. a catastrophe for them, but contained. this article https://slate.com/news-and-politics/2022/05/roe-dobbs-abortion-ban-reproductive-medicine-alabama.html does an excellent job destroying that delusion.

It's hard for me to have any optimism at all about the future of this country.

Same.

Did you see the 5th circuit's ruling holding that it was unconstitutional for Congress to delegate authority to an SEC judge to when the SEC is seeking penalties (fines) and that that defendants are entitled to a jury trial.

Bye bye administrative state.

12 The state may not know what to do, but providers are going to stop providing. Insurance isn't going to pay. Hospitals are going to tell docs they can't do procedures, including surgeries for ectopic pregnancies. Even without the state doing anything, you end up with a very different landscape.

What happens with the pills, though, is completely different. I suppose there, what'll happen is that the minority of people for whom something goes wrong will either try to tough it out (which will either work or it won't) or take the risk of getting reported by a pro-life nurse if they show up somewhere seeking medical help.

24 The dissent was quite persuasive, I thought, and maybe this'll get toned down en banc. And maybe there aren't really 5 votes at the SC for this radical a position on non-delegation.

25.2 - check out the link in 23, it's here already. & same will happen to women who miscarry w/o having taken an abortifacient as there is no way for dr to know how the miscarriage started

27 Exactly.

DQ, did you read that 5th Circuit decision?

27: right, plus there's just a bunch of stupid laws. With Roe, they could pass stupid laws but they could be disallowed. But if Ohio decides that all ectopic pregnancies must be reimplanted or the doctor is a murderer, how exactly does this get fixed? Oh, the legislative process. Cool, so we wait for someone well connected (not just any woman) to die so there's the political will to overcome the gerrymandering to fix it. Of course, the well connected are going out of state, so....

it's completely deranged. but also unsurprising given the direction all the fed soc nuts in the fed circuits have been aiming. but still deranged!

deviousness rarely leads to compelling argument.

tell everyone about Plan C and Aid Access, the possibility of getting pills by mail before you're pregnant & the medical and legal hotlines.

https://www.plancpills.org/
https://aidaccess.org/en/
https://www.mahotline.org/
https://www.ifwhenhow.org/

(for a lot of ppl in Texas Mexico may be the closest option. One of the two pills is available OTC there but the two-pill combo, which is a better experience and more effective, is a bit harder to obtain)

32 has a very high looks like spam but isn't spam score.

You know how I used to get all defensive and angry when everyone here would talk about what assholes surgeons (and other doctors, but especially surgeons) are? If you don't, it's probably because I mostly kept my mouth shut. Anyway, I take it all back, you were right, and I was wrong. I have spent the last 2 weeks fighting with the American College of Surgeons on whether they should do something as minimal as issue a statement declaring that overturning Roe would be a bad thing. Because the structure of the College provides little direct access to the boards of Regents or Governors (although I do know one of the Guvs personally), I did it through the community discussion forums. I knew before I started that the surgeons who participate in the forums are, even for surgeons, predominately good ol' boys, but I didn't know how else to stir up a fuss. The reaction was predictable, a lot of old guys trying to explain constitutional theory to me, explain that abortion wouldn't really go away, and most entertainingly that the ACS shouldn't say anything because it would be divisive. There were a couple or three pro-lifers who were very embarrassingly irrational about the topic, embarrassing not because of their views but for their immediate collapse into stupidity and calling people murders. I expected most of it, and the majority of the discussion was a good romp of bopping idiots on the head without any real chance of meaningful repercussion as long as I was more adult than they were, which isn't hard.
What I did not suspect was the leadership's attempt to calm things down by reaching out (through intermediaries) and explaining gently that these things take time, everyone is pretty sure someone else is working on it, and it often takes as much as a year before they can agree on a public statement. I got that from multiple people.
So, there is actually a question for the group here. I hooked up with a bunch of like-minded women, and we are drafting a letter to the board members along with a suggested statement they could make. Many people have suggested polling the members of the College, and so we are also working on suggested questions. The intermediary grapevine reports that they don't like surveys, but whatever. I am not sure how I expect them to respond, but if they remain silent, I think my very first op-ed might be in order. Someone here on one of the other threads had some experience with placing op-eds, I think, but does anyone have any suggestions?

Welcome Jackson!

35: I don't have any immediate suggestions, but it might be worth looking at some of the resources from Medical Students For Choice to see if they are applicable (or if there's reason to touch on both the importance of abortion access and training): https://msfc.org/medical-students/msfc-abortion-training/faq/

While looking that up, the situation seems bad

In 2020, Stanford University researchers said they found that half of medical schools included no formal abortion training or only a single lecture.
"Abortion is one of the most common medical procedures," they wrote. "Yet abortion-related topics are glaringly absent from medical school curricula."

McGlaun helped sponsor a measure last year that asked the American Medical Association to support mandated abortion education in medical schools, with an opt-out provision. The influential group has long opposed curriculum mandates and turned down the proposal, but it said it supports giving medical students and residents the chance to learn about abortion and opposes efforts to interfere with such training.

For what it's worth, both the AMA and the American College of Obstetricians and Gynecologists not only issued statements, but summitted amicus briefs for the Dodd case. So it isn't even that they would be sticking their neck out.

I plan to submit a letter to the Journal of the American College of Surgeons, and General Surgery News, which is the trade rag, but I am concerned that it won't be accepted because I may have pissed off some people. I really was very well behaved, I swear. I have a pet theory, supported by the one response I got from the BOG Chair, who said that they value 'success' over visibility, and that's why they are more successful than their other medical association counterparts (I have no idea if this is true). The only surgeon in Congress currently is a guy named Greg Murphy, who is a complete psychopath and also a pro-life campaigner. I have worked with him very closely at my last job, so my opinion might be colored by the fact that I personally loathe him with the fire of a thousand suns, but I wonder if they are afraid of alienating him. If so, it makes me even more outraged....

Good luck; that sounds like a productive (if frustrating) think to attempt.

-k

Good luc?

In my culture "good luc" means extra good wishes.

May your Luc be long.

*groan*

The gun is good, the penis is bad. Pence-DeSantis 2024.

Good news, maybe my yelling is working. The association of women's surgeons did just release a good statement, they are closely associated with the American College of surgeons, so this may help. I will be sad if my carefully drafted letter goes to waste, but we can't have everything I guess. Off to continue shaming the Congress!

Good news, maybe my yelling is working. The association of women's surgeons did just release a good statement, they are closely associated with the American College of surgeons, so this may help. I will be sad if my carefully drafted letter goes to waste, but we can't have everything I guess. Off to continue shaming the Congress!

Good news, maybe my yelling is working. The association of women's surgeons did just release a good statement, they are closely associated with the American College of surgeons, so this may help. I will be sad if my carefully drafted letter goes to waste, but we can't have everything I guess. Off to continue shaming the Congress!

I knew that was going to happen when I did it... So sorry. Does good news come in threes as well?

Maybe it's easier to get into a surgical journal if you work in a joke about a missing wrist watch?

Yeah, I got to tell you it did not go over well at two in the morning when my boss asked how big the peri-rectal abscess was, and I said "you know how bad women are at estimating size...."

That reminds me, I'm now camera-up-butt years old.

Livestream.

I said I didn't believe in colons and am taking Ivermectin.

54: And thus Moby was left with a choice between these two: a semicolon and an interrobang.

If you gaze long enough into the void...

46-49: That's awesome.