My reaction is "ew", but it might be effective.

I suppose we should check in with some radical anti-marriage queers about how they feel things have gone in their movement and the broader LGBT+ movement.

Isn't this driven by the fact that teenagers stopped getting pregnant?

I think in the red regions, teenagers have not stopped getting pregnant.

2: I'm pro marriage equality, but it is pretty bourgeois. I was talking to an elderly Lesbian couple I know, and their comment was gay men are still men, I.e. there's a lot of sexism. The one thing I always admired about those communities was the concern they had for people who weren't their blood relatives. During the AIDS crisis, people took care of their friends, not just their family. Of course, they had to, because many were rejected by their families of origin, and they couldn't marry. So, now you have the freedom - if you have 2 good jobs and employer health insurance - not to give a shit about people who don't have those things.

Louisiana has decided to make misoprostol a controlled substance which is now, the actively anti Women's lives, position. https://lailluminator.com/2024/09/03/louisiana-women/

Whoops. 4 to 1.

It's certainly down even in the red regions. https://www.cdc.gov/nchs/pressroom/sosmap/teen-births/teenbirths.htm
From 2005 to 2022, births per 1000 females age 15-19:
MA: 20 -> 5.8
NY: 26 -> 8.6
CO: 41 -> 11
FL: 42 -> 13
KS: 40 -> 16
NM: 61 -> 19
TX: 61 -> 20
MS: 58 -> 26

I acknowledge that it's generally declined everywhere.

But to the point about abortion rhetoric, you also don't hear it about 23 year olds having unprotected sex and not wanting to have a kid with someone they're not serious about.

6 is really staggering. What exactly has changed between 2006 and 2022 to reduce teen pregnancy in Texas? I can't imagine it's access to birth control? It also doesn't seem like sex ed or rhetoric has changed all that much?

Access to IUDs, maybe?

6: How would you know the teen pregnancy rate? Like, in NY and MA, a pregnant teen is going to have an easier time getting an abortion. That said, I know the number of abortions performed in MA has gone up post Dobbs because people travel to get them.

One thing I wonder about is whether the current situation is actually worse for some married women than the status quo pre Roe. I have the sense that doctors would not have sent a white middle class woman away. They would have performed an abortion to save a woman's life but nobody would have talked about it.

Clarifying 10, we have some sense that the number of unwanted pregnancies went down in addition to teen births, because the number of abortions - at least surgical abortions - went down.

9: When did the morning after pill become available? Google tells me that OTC plan B was approved in 2013.

8: Alarmingly specific porn becomes easily available.

6: less lead in the bloodstream of modern teenagers, therefore fewer impulsive bad decisions, therefore less pregnancy.

There was a massive drop in rape of teenagers from the mid 90s to the late 00s (went from 11 per 100k to 4 per 100k) so fewer pregnancies by that route as well, but that's before the period those figures relate to and the trend might not have continued - I can't find more up-to-date numbers.

Also might be more people going into higher education. The age bracket is 15-19 - that includes a lot of adult women, and if they're living as independent adults then they'll be having kids. If they're students at university they're less likely to. (But did education rates go up that much from 2005 to 2022?)

And also higher obesity levels are going to hit fertility.

2: also because it's not an argument that rings with people. It's still true that most people don't have a college degree. A baby can't derail your UMC future that you weren't going to have anyway.

I agree 16-year-olds are not the examples being messaged. I think it's overstating to say the main messaging is "this helps traditional families form." The overwhelming takeaway I get is "These decisions are PRIVATE, the woman's, never to be interfered with." Which tracks with whatever conception of family one might have.

The paragraph we enshrined in the California Constitution to protect abortion, contraception, and other forms of reproductive freedom perhaps not yet enumerated, at a stroke started pit "The state shall not deny or interfere with an individual's reproductive freedom in their most intimate decisions..."

1, 4: The radical anti-marriage queers of my acquaintance both appreciate that things have gotten better in day-to-day life, and sincerely lament losing the utopian/countercultural aspects of the community - partially realized, because utopias, but bg is right about mutual aid during AIDS, and the same thing is happening now among trans people who need access to hormones, support around surgeries, etc. Being hated by the world is terrible but can also stiffen your spine, and that's part of what older cis queers are getting at when they say to me, "we're so boring these days, only trans people are edgy, you lucky bitch." (Parallel: the most acceptable transfeminine story is still the one that starts with an "I'm a girl" epiphany at age four and ends with vaginoplasty and marriage to a man, while the trans woman who doesn't want bottom surgery and/or might be attracted to other women is the one that TERFs truly can't abide.)

Lately the intra-community debates about "homonormativity" just collapse into arguments about Palestine, but everyone can agree on hating the post-Obergefell Pride parades where Amazon and Kaiser and everyone get their rainbow-washing in for the year by sponsoring a float. Market Street in June is a safe space but it's sorta ghastly.

Isn't the decline in teen pregnancy due to the decline in teens having sex? I have some memory that it's way down over the last twenty or thirty years.

Huh. My perception doesn't really match that of the OP.

I think I'm agreeing with Minivet in that the abortion messaging seems to have gone mostly in the opposite direction. The dominant post-Dobbs narrative -- to the extent that it has changed -- seems to me to be about women's empowerment more than it was in the past. The message seems to be: People are just fine with the Roe restrictions on abortion, except maybe those restrictions need to be loosened up a bit.

I don't see the evolution of gay rights the same way either. I mean, yeah, Andrew Sullivan really was out there saying that we should encourage gay marriage because it serves conservative ends.

But I perceive the actual message change -- with gay rights and with abortion -- to be fundamentally libertarian. "People should be able to do what they want as long as they aren't harming other people." Let's remember that gay marriage was pretty much the endpoint of that conversation -- the last right to be officially granted, and the last one to remain controversial.

And so the real change (as I perceive it) is that it's becoming more acceptable to acknowledge that abortion only involves one morally consequential human being.

But I occupy my own little informational bubble and may be missing the big picture.

As a straight man (bi now, but that doesn't add much), I admit I might not be well calibrated to read implicit messages to women in the public sphere.

I think this is all the result of complicated irrationality, mostly driven by dishonest pro-life rhetoric and practices that produce weird looking responses from the pro-choice side. I feel like I understand it, but there are enough back and forth steps that it's hard to explain clearly.

The first premise is that most people, particularly those who aren't super engaged in the issue, share the intuition that abortion is a morally weighty thing and more likely to be an importantly bad thing to do the later in gestation it is. Even a lot of pro-choice people share that as a general intuition. And so this drives a general sense that procedural barriers to determine if there's a good enough reason are okay, and they can be higher barriers the later in pregnancy the abortion is.

Once you know even a little bit more, though, that intuition gets balanced out by the fact that the later in a pregnancy an abortion is necessary, the more likely it is to reflect either a medical emergency or a personal tragedy like a fetus that either won't survive past birth or at least not long past birth. This means that procedural barriers to later abortions are very likely to cause significant risk or injury, usually medical although sometimes emotional, to the woman involved, and this is particularly going to be true if the barriers are always or at least often going to be enforced uncompassionately or in bad faith.

Prolifers exploit the original intuition by focusing on later abortions, and claiming that they happen whimsically. And where they're in power, they do enforce procedural barriers in bad faith, and it does injure the women affected.

So this whole strategy from the pro choice side is about foregrounding the results when antiabortion zealots have their way: it leads to women bleeding in hospital parking lots until they're close enough to death that doctors feel safe treating them. It's weird, though, because it's directly relevant to only a very small number of abortions. They're just extraordinarily rhetorically powerful ones on both sides of the issue -- either because they're "late term" or because the women affected are being tortured and dying.

18: I agree that it's libertarian, but see bg's 4: now you have the freedom... not to give a shit about people who don't have those things. Libertarianism goes swimmingly with pro-family discourse as long as you take the nuclear family to be an extension of the autonomous self. I think the message change on abortion is doing well in part because it appeals to fear rather than empathy: other people might make bad choices, and shame on them, but imagine that you or your wife, a normal woman who wants normal family relations, were suddenly prevented by the government from having them? It's visceral to more people.

18: MA definitely passed legislation that was less restrictive than what we had, in anticipation of Dobbs. Under 16, you still need a judicial bypass, but 16-18, you don't. And they're allowing later abortions now too.

Anecdata, but the "pro-family" pro-choice argument is the more personally relevant one to us even though we generally wouldn't think of it that way. Cassandane had an abortion because her first pregnancy had a chromosomal anomaly, and if she hadn't, Atossa probably wouldn't have been born. (Might not have been possible at all, probably wouldn't have wanted to take the risk.) And I can think of at least one friend who had a pregnancy rough enough that it's relevant, even though there wasn't an actual abortion in that case.

Ex recto, though, I don't think it's an "unpalatability of feminism" thing. I think that cases where restrictive reproductive health laws screw things up are just a lot more common post-Dobbs. Between Roe and Dobbs, pregnancies that really needed abortions got them with relatively little fanfare. (I realize those caveats are doing a lot of work, but anyways...) Most of the actual controversial abortions that happened were women who technically could have a healthy baby but it would have been bad circumstances (teen, abusive partner, etc.), so that's what dominated the pro-choice stories.

But actual birth defects or serious health risk? Even in red states, even by conservative women, they got abortions (or Plan B, or whatever). The only good abortion is their abortion, right? I've seen tons of stories about that sort of thing, anecdotes by healthcare professionals and activists. But now it's not just anecdotes about them happening, now it's actual legal cases and news stories about them being stopped or massively obstructed.

Only like 10 percent of people say they oppose abortions in all cases. Unfortunately, enough idiots felt icky about abortion but didn't really want to think about it for that 10 percent to capture the Republican primaries and the Supreme Court. Now all those people who felt icky about it have to think about it.

21: I mostly agree. Although, I 'll add that I think the incest message is also resonating. People seem to have been blown away by Hadley Duvall. Stephanie Ruhle on MSNBC used to be a business corredpondent, and she highlighted Duvall's question: "what is so beautiful...carry a parent's child?" Ruhle seems to understand the metro-NY suburban Republican type, and I think she has her finger on the pulse of a certain type of moderate voter more than the others on MSNBC.

Although, I 'll add that I think the incest message is also resonating.

Which one?

23: I also wonder what doctors did pre Roe as well without talking about it, but now governments are inserting themselves.

I laugh though when people talk about keeping the government out of healthcare decisions. There are all kinds of quality metric and payment policies which absolutely affect what your doctor wants you to do and a lit of reviews of data from EHRs, so you don't really have privacy any more.

25: Is that s joke I'm missing. Basically, modt people thought victims of incest shouldn't have to carry a baby to term.

Also, I would venture to suggest the majority of 16-year-olds considering abortion have as a a primary motivation having a family on decent terms later in life.

I have observed elsewhere (time to inaugurate 'IHOE'?) the freaks in the state legislatures passing legislation that didn't just stop abortions but also put a chill on doctors treating miscarriages was an own goal. It creates tons of horror stories that turn ever more people against Dobbs. Dobbs might be a lot safer if they had just given doctors safe harbor to decide when a miscarriage required abortion-like treatment.

But this wasn't a random accident. The desire to prevent anything that might possibly be abortion comes from the same freakazoid nature that led them organizing for many decades to their current victory in the first place. They didn't want to give doctors safe harbor because they feared doctors would dress up abortions as something else, and even now they refuse to make exemptions even when the political problem is staring them in the face.

Republic of Ireland lawmakers made the same mistake, adopting an extreme ban from the wishlist of American Christian Right and not, AFAIK, making a miscarriage fix all the way until the passage of the 36th Amendment.

27: Yes. But really it's more rape that's the issue there, even though the rape is also incestuous.

30: ok, sure. Most people also agree that brothers and sisters shouldn't marry each other.

There's also, the unspoken view that was pretty common in the 90's that some women behave in ways that are just asking for it, etc. nobody thinks a 12 year-old did anything to deserve having her stepfather rape her.

The fundamentally weird thing about hard-line pro-life beliefs (which drive 29) is that a large minority of people really do believe that abortion is murder, and also really haven't thought about it in a serious way, and moreover refuse to think about it in a serious way. No one actually thinks fertilized eggs failing to implant is the biggest health-related problem facing humanity, no one actually thinks that it'd be better to save 10 frozen embryo's from a fire than one baby, no one actually thinks that miscarriages should be investigated the way that deaths are, but at the same time the hard core pro-life crowd refuses to even think about these scenarios and wants laws that express their simplistic unconsidered viewpoint.

I remember Theodore Lowi hammering (as a commenter at a college political event, not a class) about how the obvious tell that they didn't believe abortion was murder was that their legislation didn't penalize mothers, only doctors. But I'm not sure if that remained the case since I was in college.

33 is because they don't think women are fully morally responsible, it's like trying people as children.

a large minority of people really do believe that abortion is murder, and also really haven't thought about it in a serious way

Belle Waring was just writing about this: https://crookedtimber.org/2024/09/05/am-i-the-immoral-person/

"Pittsburgh Mike" isn't me. But it's not a bad pseud if you can play pool or poker.

34: Yes, he emphasized the true motivation was pushing women into being childbearers.

The new, and I think still uncommon, idea that an ectopic pregnancy isn't a justifiable abortion shows its not even that. Some just want women to suffer.

My version of historical context: Evangelicals didn't care about abortion before they lost on the issue they did care about, segregation. After that their leadership needed a new cause. Why there are so many people willing to be led this way I don't really understand-- the simplest explanation (these are people too stupid to understand anything more complex than good vs evil) seems unkind and must have serious defects.

Less harshly: thinking about consequential stuff is unpleasant and can result in serious errors if you make mistakes, so most people strongly prefer not to. I recognize that similar characterizations of other people's ideas are also used by shitty people, but on this issue imo reasoning is a factor.

a large minority of people really do believe that abortion is murder, and also really haven't thought about it in a serious way

Another way to say that is there are people who don't think about the issue, but like to consider abortion to be murder because they like the social consequences of that belief.

I think you have to use the word "belief" carefully when you talk about the rightwing swamp. The word means something different there. I wouldn't want to hazard a guess as to whether Trump "believes" that Haitian immigrants are eating cats in Springfield.

I would agree there are lots of people that don't think about this very deeply, but among the serious anti-abortion activists there are some who take the charge of hypocrisy and inconsistency very seriously, and this results in their views becoming more insane.

No one actually thinks fertilized eggs failing to implant is the biggest health-related problem facing humanity, no one actually thinks that it'd be better to save 10 frozen embryo's from a fire than one baby, no one actually thinks that miscarriages should be investigated the way that deaths are, but at the same time the hard core pro-life crowd refuses to even think about these scenarios and wants laws that express their simplistic unconsidered viewpoint.

These people think about things like this and instead of abandoning their anti-abortion position, decide that they need to be intellectually consistent, and believe all these things that decadent liberals think that no one thinks. There aren't a huge number of people like this, but I would guess they form a large portion of those making policy for pro-life groups.

One legal change that has reduced abortions for all age groups in all states since 2005 is the Affordable Care Act, aka Obamacare, which requires insurance companies to cover contraceptives, and requires at least some forms to be availalbe without copays. I believe thsese provisions cover all 50 states. Even in Mississippi, more people have insurance than don't. Independently, ACA also increased the number of Americans who have health insurance, although not in the states that declined to participate. Specirfic to teens, HIPAA has been expanded a bit over the years to prorect the ability of teenagers to obtain birth control without parents being informed.

I really genuinely think even the most intellectually consistent actually care about saving the lives of naturally produced unimplanted fertilized eggs. Maybe you can somehow make this work with some bizarre theories about intention, but I think at the end of the day it's just so obviously absurd that no one is willing to go there. Like no one actually thinks heaven and hell are half populated by the souls of unimplanted fertilized eggs.

What you do get is people maintaining intellectual consistency by denying reality. The ectopic pregnancy one is a big example, but you also see it with the whole Akin "you can't actually get pregnant from rape" thing that Republicans keep losing elections over, and probably just people refuse to believe how common it is for eggs not to implant.

43: I really genuinely think even the most intellectually consistent actually care about saving the lives of naturally produced unimplanted fertilized eggs.

There's a "don't" missing, right?

I don't what anyone genuinely believes, and I don't know that anyone succeeds in being intellectually consistent, but being anti-ivf, which is very unpopular and doesn't fit with the generally pro-natalist vibe of the pro-life movement, only makes sense to me as a serious attempt to be intellectually consistent.

Independently, ACA also increased the number of Americans who have health insurance, although not in the states that declined to participate.

Even there, via healthcare.gov, but not the poorest among them in the states that also opted out of Medicare expansion.

26, after a fashion: My friends at NARAL asked me to tell you what it was like before Roe vs. Wade. They asked me to tell you what it was like to be twenty and pregnant in 1950 and when you tell your boyfriend you're pregnant, he tells you about a friend of his in the army whose girl told him she was pregnant, so he got all his buddies to come and say, "We all fucked her, so who knows who the father is?" And he laughs at the good joke.
They asked me to tell you what it was like to be a pregnant girl -- we weren't women then -- a pregnant college girl who, if her college found out she was pregnant, would expel her, there and then, without plea or recourse. What it was like, if you were planning to go to graduate school and get a degree and earn a living so you could support yourself and do the work you loved -- what it was like to be a senior at Radcliffe and pregnant and if you bore this child, this child which the law demanded you bear and would then call "unlawful," "illegitimate," this child whose father denied it, this child which would take from you your capacity to support yourself and do the work you knew it was your gift and your responsibility to do: What was it like?

It is kind of bullshit that California passed a sweeping constitutional amendment protecting abortion as a right, but they also say it doesn't affect California's existing restrictions on abortion including the third-trimester ones that were so harsh on one commenter.

41: A similar point was made by one of the Deep Thinkers over at Nick's Crooked Timber link.

Like no one actually thinks heaven and hell are half populated by the souls of unimplanted fertilized eggs

Of course not, that's what the Limbo of the Infants is for!

Speaking "seriously," I think official Catholic doctrine is currently undecided as to whether ensoulment takes place at the moment of fertilization or a few weeks later, when a rudimentary body is present (Thomas Aquinas thought the latter), and, since Benedict XVI, they also leave open the possibility that pregnancies not carried to term may in fact ascend to the beatific vision rather than being stuck in limbo. You can imagine where plenty of lay Catholics and evangelicals with less interest in logic-chopping would land on these. Like, I'm pretty sure my cousin in New Mexico wholeheartedly in believes the heaven of the unimplanted fertilized. It's not like she's imagining a bunch of zygotes bopping around up there; the mental image is probably "the baby that would have been," as providentially created by God at the moment of mystic fusion.

I don't what anyone genuinely believes

As proof of my intellectual inconsistency, I note that just after pointing out that Unfoggetarian left out a word, my very next sentence I left out a word.

50: TBH I have a hard time picturing any version of the afterlife.

On a related topic, I've always wondered what Dante thought about the afterlife. Presumably he believed in Hell, Purgatory, and Heaven, but he didn't actually think it was just like he portrayed it, did he?

I recently had this very weird epiphany about my own family. I can't ask my parents about it because the realization came to me only after both had died.

My parents had four kids in the late '50s, and it is part of our family lore that my mother had three miscarriages after the birth of their fourth child. One of those miscarriages was a very late-term situation, and was more properly described as a stillbirth. The baby had hydrocephalus.

My parents later had four more kids. Yes, we're Catholic. Why do you ask? (I was No. 5 and my name reflects the patron saint of my miraculous birth.)

I have a memory of one of the times my father explained this. In my memory, it was a routine conversation and so I don't clearly remember the details, but there are two things I believe to be true:

1. My stillborn sibling was born into a situation where choices about its birth had to be made. I remember finding my parents' choice surprising.
2. My parents consulted with a priest to get his approval for their plan. The priest provided that approval.

My parents were very anti-abortion. (Did I mention we're Catholic?) But the only conclusion I can draw from this is that my mother had a late-term abortion.

48: Yeah, for a second I thought that this might be a moment to go farther than Roe but politicians are being pretty cautious. The slogan I heard and liked was "as early as possible; as late as necessary."

Another difference from pre Roe is technology has changed radically. Now it's easy to detect or confirm a pregnancy almost at the moment of implantation, while in the 1970s pregnancies were well into the first trimester when they were generally established in the medical record. This gave a woman and her doctor a lot more plausible deniability for an early first tri abortion.

Also Gen Z isn't having sex because they're too busy on the internet.

On the previous point, medical advances can also help women get earlier abortions. There's a blood test at 9-11 weeks and a 12 week ultrasound to detect issues that used to be picked up at the 20 week anatomy scan. I know women who TFMR'd around 11-15 weeks when they would have had to wait until 22-25 weeks 30 years ago. If doctors are allowed to actually practice appropriate medical care the number of late term abortions will naturally decrease as medical breakthroughs continue.

47: I was specifically referring with the phrase "some women" to married women with desired pregnancies whose health was at risk. See 10.2 as well.

52.2: there's a whole tradition of medieval visionary literature of which the Divine Comedy is considered the pinnacle. The dreamer, usually someone suffering a life crisis, is transported to an allegorical landscape and often given a guide to help them through. The poem expresses things that Dante believes to be theologically true, but the truth-claim is allegorical; there's no contradiction in the supernatural manifesting in different ways to different visionaries.

53 is fascinating, and kind of what I was talking about.

people refuse to believe how common it is for eggs not to implant.

I've thought about this a lot in the past few years, and I think some of this can be attributed to the fact that the oversimplified version of human reproduction that most living US adults were taught* is one in which basically everything goes right.

Ovary releases egg, egg travels down fallopian tube, sperm somehow is magically there, egg implants in uterus, boom! nine months later, baby.

But of course, there are a million moments along the way where things can go wrong.** But because that default version got cemented into so many people's minds the first time they formally learned about sex, they go years and often decades without questioning it. And when something DOES come along to shake that belief, they can't really understand that it's not a one-in-a-bazillion exception. (cont)

*assuming they were lucky enough to be taught anything
**assuming that your worldview/religion believes that every attempt at reproduction must succeed

(cont)

Some of the legislators who listen to heartwrenching testimony from doctors about what will happen if anti-reproductive-rights legislation is passed are acting in bad faith. But I think others are genuinely unable to grasp that these "unlikely" risks are in fact UTTERLY PREDICTABLE in a universe of x million pregnancies a year.

So you get things like Louisiana's law making abortion medication a controlled substance, which means hospitals can't have it on the "crash cart" that is in the hospital hallway for emergencies. So the *entirely predictable* outcome is that doctors are already being traumatized by being unable to provide their patients the standard of care, and people will unquestionably die, if they have not done so already.

(Content warning for deeply upsetting imagery)

Don't even get me started on how Texas appointed an anti-abortion zealot to their maternal mortality committee and she is advocating for doctors to conduct c-sections on nonviable pregnancies so that they can deliver an "intact fetal body." Because subjecting a grieving woman to unnecessary major abdominal surgery because of some stranger's fetishization of babies is more important than giving her the abortion she needs.

Yes, I am very angry.

61 really is enraging.

People are realizing, too, I think, that badly written trigger laws aren't just cruel to women that need abortion care, but women who need reproductive care adjacent to abortion, like a D & C after a confirmed miscarriage, either because the doctors are going to be extra cautious, or because the local hospital no longer exists or has anyone on staff that could assist.

My sister recently miscarried and needed a D&C. If she's lived an hour north of me over the Idaho border she'd have to had to cross state lines to get help. But she's in PA, which is still same.

60 reminds me of the shock people (including female people with children, before anyone asks) display when I explain to them that there are two sorts of pregnancy, low-risk and high-risk, and that 75% of pregnancies round here are classed as high-risk, which means they shouldn't be delivering anywhere except a major hospital with a neonatal intensive care unit, a full consultant-led obstetric team, and a consultant paediatric anaesthetist. Their gut feeling is that 95% or so are just normal and really only need a jolly midwife played by Julie Walters on a bike. But this is not so.

nobody thinks a 12 year-old did anything to deserve having her stepfather rape her.

I have bad news about human beings.

Like no one actually thinks heaven and hell are half populated by the souls of unimplanted fertilized eggs.

Of course not, they're all in Purgatory on account of not having been baptized.

that 75% of pregnancies round here are classed as high-risk, which means they shouldn't be delivering anywhere except a major hospital with a neonatal intensive care unit, a full consultant-led obstetric team, and a consultant paediatric anaesthetist.

In defense of the people you're talking to, this does sound like a terrible way for the species to have survived the past 300,000 years. What exactly is going on where you live to cause this? Thalidomide in the wellwater?

50 should teach me to read the thread first for fear of pwnage

67: I'm guessing here, but at that percentage I'm figuring its a combination of maternal age, BMI, and prior csec history. Depending on the demographics of the area and your cutoffs on those factors, 75% seems plausible.

Does anyone know of any books on tube history of abortion and the law around it? It looks like hard-core regulations around abortion didn't really appear until the 19th century, but I'd love to learn more. Were abortions routinely performed by midwives in the 18th century? Is this a case of the AMA inserting themselves in something in a way that caused harm?

67: An awful lot of people died in childbirth in the past even if the species did survive.

The extreme inefficiency must be harder to swallow if you're also an intelligent designist.

"Can you fathom the mysteries of God?
Can you probe the limits of the Almighty?

I buy the 75% but think the necessary thing is the hospital in those cases, not the (comparatively more rare) level IV NICU. It is better if the baby needs it to be in the place with the specialist on site, but probably overkill as a necessity for most "high risk" pregnancies (e.g., over 35.).

(Relatedly, judging which hospital is better by C-section rate is also not great because the rural hospital with the 5% section rate is transferring all of its high risk patients to the hospital with the 21% rate, because that's the one with the better care for C-sections.)

Talking about reproductive issues openly is still somewhat stigmatized in larger culture compared to other illnesses. People are fairly open about things like cancer or heart surgeries but very few people publicize their miscarriages or non-viable pregnancy complications. For lots of men, childless women, and women who just had easy pregnancies it's easy to not realize how wrong pregnancy can go and how often it happens.

To the outside world I have two kids. Very few people know that it took 7 pregnancies, three of which required life-saving medical intervention, and IVF to have them.

The near misses aren't talked about much, either. My sister had an emergency C-section with a partial placental abruption, my niece needed significant assistance to boot up properly but with modern medicine it was an intensely terrifying experience with no lasting negative consequences. Mom and baby are fine and resting comfortably, you know?

75: The mayor of Boston is expecting her third child in January. She has two school-age children,9 and 7, and she's been open about the fact that there have been several miscarriages since her second. But that's definitely new. She was also open about how she had to take care of her mother and younger siblings when her mother developed a mental illness. Again, these are things most people don't talk about.

69 is spot on - the answer is that there are a lot of things that make a pregnancy high-risk that people don't instinctively think of as being particularly risky. And in fact aren't particularly risky, statistically - calling something "high-risk" makes people think it's like BASE jumping, but from memory the chance of any intervention at all being needed in a high-risk delivery is something like 0.5%.
High BMI is one. Another is having previously had a difficult delivery or a C-section. High blood pressure, gestational diabetes, all sorts of other health conditions, age over 35, multiple pregnancy, foetus in a weird position, and so on. Various infections during pregnancy. First births aren't explicitly high-risk but they normally get recommended for hospital birth anyway.

I buy the 75% but think the necessary thing is the hospital in those cases, not the (comparatively more rare) level IV NICU.

Yes. I should have said neonatal unit, not NICU.

In defense of the people you're talking to, this does sound like a terrible way for the species to have survived the past 300,000 years.

I cherish the memory of the retired vet who I explained this to, and whose response was "if I visited a farmer and he said that 75% of his cows were having high-risk calvings, I'd tell him to shoot the lot and try another line of work."

I guess the thing I'm wondering is: is Ajay's location worse than others on these risk factors? Or is he just speaking casually to others in real life about the city, and these are universal statistics?

78.last: Walking upright and having big brains has gotten us pretty far, but definitely childbirth is the limiting factor on brain size. We already have the adaptation of having the fourth trimester after birth instead of before, it's pretty extreme measures all around.

Here's a paper on 10 million US births between 2011-2013 and it says 62% were "high risk." You'd expect that number to be higher today. So I'd expect ajay's number isn't particularly unusual.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4728153/

I can't imagine we are much worse than the rest of the country. I had a quick look and couldn't find overall national figures for high-risk pregnancies, but 51% of all pregnancies are high risk due to high BMI alone, so it wouldn't take much of a contribution from the other risk factors to push that to 75% being high-risk from all causes.

79: Ex recto, I'd bet Ajay's location is roughly average for the developed world, maybe a little bit worse than average but not all that much.

We're a lot more risk-averse as a society than we were 100+ years ago, now that we're actually capable of predicting and averting risks. A 1 percent chance of maternal mortality is horrifying and unacceptable in modern times, the kind of thing where even a doctor in Kansas recommended an abortion 3 years ago, and probably would be amazingly good in 1800. (Actual maternal mortality seems hard to get numbers for, and of course we're concerned with not just maternal mortality but also serious injury and the health of the baby, but 1 percent seems to be if anything a very low estimate for maternal mortality before modern medicine.)

It is easier to get records for child mortality, for what it's worth. In 1800, 46 percent of kids didn't make it to age 5. I think that lumps together everything from complications from birth to a 4-year-old stepping on a rusty nail. You can see a big drop in that trend line in the 1850s, shortly after doctors figured out that washing their hands was a good idea.

That's good. It's what actually valuing life looks like, as opposed to last rites for clumps of fetal cells. But it does mean that our intuitions about how common this stuff is may need to be recalibrated.

Actual maternal mortality seems hard to get numbers for,

There's this, which seems well-sourced - deaths from any cause during pregnancy or childbirth, or up to 42 days post, per 100,000 live births.

https://en.wikipedia.org/wiki/List_of_countries_by_maternal_mortality_ratio

There's actually a strikingly wide spread even among wealthy countries which I didn't expect. UK 9.8, US 21.1, but Poland 2 and Norway 1.1.

I'd bet Ajay's location is roughly average for the developed world, maybe a little bit worse than average but not all that much.

Yeah, probably. Hard to compare country with country because everyone has different definitions, but our general health is about that so maternal health is probably the same.

I mean, I think of myself as having had an unusually easy time, but depending on standards, one or both of my deliveries was high risk -- Sally was unexpectedly breech, and then if having had something weird happen once makes the next one high risk, there's Newt as well.

I would have to check, but I recently read something about the alarmingly high US maternal mortality thing being a matter of record-keeping. But I would need to do some searching to back that up.

87: https://ourworldindata.org/rise-us-maternal-mortality-rates-measurement explains it. The figures are correct, now, but the gradual rise over the last 20 years was illusory; it was just a result of states changing from an old to a new and broader definition a few at a time. As more states adopted the new definition, the rate appeared to rise.

A breech birth would count as a high-risk delivery, but if it was unexpected then you'd still have been classed as having a low-risk pregnancy; just one that something went wrong with during birth.

Note that the figures in 88 are so different from those in 84 because one is looking at deaths per 100,000 live births, and the other is looking at deaths per 100,000 women per year.

76

My son was a perfectly textbook pregnancy until 35 weeks when he was diagnosed with IUGR. At 37 weeks he randomly decided to go into cardiac arrest, luckily while I was hooked up to monitors. They were able to stabilize him long enough for my husband to get to the hospital for the C-section. His initial APGAR score was a 2 and he had to be revived by a NICU team in the OR but didn't need any NICU time after that. They biopsied my placenta and cord but never figure out why he hated being a fetus so much. And of course none of that was on the birth announcement.

When women talk about how "our bodies are made for this" I roll my eyes.

The physical cost of asking women to carry a pregnancy to term is also under discussed, except maybe to imply women are vain about not wanting a postpartum body. My coworker had to have a C-section for her first because her pelvic bones fractured and she couldn't physically endure labor. A friend went into heart failure and was hospitalized for the last three months of pregnancy. She was told never to have another. In the summer of 2021 I know two women who died in childbirth. Both were white collar professionals with access to top level healthcare and no reason to think their pregnancies would kill them. One was even a second time mother.

How any woman's body will react to pregnancy is kind of a crap shoot but difficult and potentially permanent complications (including death) are again way more common than people realize and rarely talked about publicly.

why he hated being a fetus so much

You have to live at the office.

56.1 and the music at the gym made me wonder if other people chanted "everybody get fucked, get laid" at the appropriate moment of Mony, Mony?

56.1 and the music at the gym made me wonder if other people chanted "everybody get fucked, get laid" at the appropriate moment of Mony, Mony?

91: Goood friend wanted to go to the hippy birthing center in Cambridge. Son was premature and the birthing plan switched to Tufts for her slightly premature kid. She's very grateful for modern medicine.

Modern medicine is great, except that I've died every time I've gotten a covid vaccination.

I was just informed that my cousin is the named plaintiff in a last minute law suit to keep the pro-choice amendment off the ballot in Nebraska.

98: Try to avoid spending Thanksgiving with them.

I haven't seen them except at a funeral in twenty years.

Does anyone know of any books on tube history of abortion and the law around it? It looks like hard-core regulations around abortion didn't really appear until the 19th century, but I'd love to learn more. Were abortions routinely performed by midwives in the 18th century? Is this a case of the AMA inserting themselves in something in a way that caused harm?

I don't know of any detailed books on this (and would also be interested in any suggestions anyone has), but I've come across pieces of it incidentally in my other reading and it's fascinating.

The salience of abortion as both a moral and a medical issue really only rose to a significant level in the eighteenth century due to rather abstract Catholic theological questions about the status of the unbaptized dead; the church had always opposed abortion in theory but hadn't been very concerned about stopping it in practice before it became part of that concern. One practical effect of this was that priests became proficient at doing perimortem C-sections so they could maximize chances of baptizing the fetus before it died. There were multiple handbooks of obstetrics written in Latin and targeted at priests explaining how to do this. Missionaries in California, which was really the ends of the earth in those days, even did some of these! The opening scene of Tristram Shandy is a Protestant satire of this obsession.

Doctors and surgeons only became involved in any of this somewhat later, in the nineteenth century, and it was part of the broader trends of both trying to professionalize medicine and imposing new Victorian standards of morality on women. I don't know as much about this part of the story. But yes, it was largely a matter of medical groups butting into something that they hadn't had much to do with before.

56.1 and the music at the gym made me wonder if other people chanted "everybody get fucked, get laid" at the appropriate moment of Mony, Mony?

It's "get laid, get fucked," but yes.

I actually don't even know what the real lyrics are.

50 et seq. I believe the RC Church has abandoned the Limbo thing, but I'm not sure what, if anything, they've replaced it with.

It came from dear old Augustine using his logical powers to conclude that unbaptised infants had to be damned. But then he was human enough to add that it would be "minima damnatio".

92: I remember working out, that, in terms of risk of death or permanent disability, one pregnancy and birth equals about two months as a US soldier in Iraq at the height of the surge.

102: I guess that I get the lyric wrong is why everyone in the gym was staring at me.

92: This is very much understated in public discourse, largely, I think, because mothers have a strong disincentive to understate and deemphasize pregnancy suffering and injury because it's all worth it for having wanted children, and you don't want them to feel guilty. But the argument for abortion as self-defense against not only short-term suffering but very plausible lifelong injury is underrated.

...and you don't want them to feel guilty

I've heard that varies by ethnicity.

107: You mean "incentive to", right?

104: if you want to read the whole official document (2007), the Vatican has the text in English against a background that ensures somebody's eternal damnation.

91: my sister with the abruption wanted a birth center birth, which I opposed in part because she was 39 and in part because "we're ten minutes away from the hospital" doesn't help when you have thirty seconds. My experience with the Calabat was that his heart rate disappeared and they were ready to go with about 90 seconds (shiv describes it as "I woke up and somehow was wearing scrubs"), and then it came back as the obgyn walked in, and then he was fine and five hours later came out with forceps because he has a giant head. Bodies don't know jack. She wanted natural and was down the Ricki Lake rabbit hole.

Anyhow, sister gets mad at me over my I-am-saying-this-once objection, so we let it go. Most birth centers turned her down due to age. One didn't. She is in fantastic health otherwise . She wanted no interventions and so they didn't push her to leave their practice to induce at 41, but she went to 42 weeks and then they risked her out to their affiliated obgyn. Whom she doesn't know or trust. At that point sister calls me with a mad plan of waiting until 43 weeks before seeing the obgyn at which point about two trimesters worth of concern came out as "I know what you want, but the baby is racing the placenta now and she might lose." She went into labor a little later that day then went to the hospital fortunately, and then everything went sideways. The placenta was calcified and too old to deal with labor. Baby was looking a little thin, too.

But she's fine, sister is due with #2 in four weeks and planning a vbac which at least is in a hospital.

109: That's right -- I caught myself up in a double negative there.

107: You're kidding, but of course that's part of the pressure: women talking about the damage pregnancy and childbirth did to them are a joke about nightmarish guilt-tripping mothers. I wouldn't even say the social norm is necessarily a bad one: children shouldn't be made to feel bad about it. But it does distort the public conversation about what the physical risks and consequences are.

I just don't want to make Jewish jokes right now with everything going on and me being very gentile.

And there I thought you were making Italian jokes from a place of insider privilege.

My own mother only reluctantly agreed that she was in labor for over 36 hours with me. I was an adult and grandma mentioned it.

114: me too.

If I get too predictable, you'll replace me we AI.

97: I thought you were a whale, but you're actually a cat? What life are you on?

According to UPMC, I've had seven covid vaccinations.

The Catholics used to have a reputation for being big on guilt, but I think events of the last few decades have undermined that.

And speaking of the Catholics:

Pope Francis on Friday slammed both U.S. presidential candidates for what he called anti-life policies on abortion and migration, and he advised American Catholics to choose who they think is the "lesser evil" in the upcoming U.S. elections.

He declined, however, to express an opinion about which candidate was less evil.

120: My sense was that he was very serious about people's individual consciences. He then noted that he was not going to be at the rededication of Notre Dame but expressed an interest in going to the Canary Islands to be with the migrants there.

If they are only going to win by 2 over Northern Illinois, the pope is better to stay away.

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So, I was just in a CVS in Central MA, which happens to be the Trumpiest part of the State. Over the loudspeaker, they said that if you are 18 and older, you can have a consultation with a pharmacist to have them prescribe birth control. They have a minute clinic NP there, but I looked it up and this is a stare-wide initiative. The NP would probably be free on insurance. The pharmacist consult is $39, but it sounds like it's much easier to get now. Part of the challenge of a lack
Of primary care access.

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