essay on abortion in texas

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Texas Is the Future of Abortion in America

By Mary Tuma

Ms. Tuma is a Texas-based journalist who covers reproductive rights.

For half a year, Roe v. Wade — the 1973 Supreme Court decision that guarantees abortion rights for all Americans — has been effectively moot in the second largest state in the country, home to about 10 percent of the nation’s reproductive-age women.

On Sept. 1, the Supreme Court allowed Texas Senate Bill 8 to go into effect — the most restrictive abortion law to do so in the United States since Roe. There’s a good chance that Texans will not see their reproductive rights restored any time soon — because Roe itself could be overturned or gutted before the fate of S.B. 8 is resolved in the courts.

Over decades, in one situation after another, Texas has been the epicenter of America’s abortion rights battle. What happens in Texas rarely stays there.

I’ve lived in Texas my entire life. I have reported on reproductive rights for 10 years, and what is happening in the state still feels surreal. An untold number of Texans have suffered under S.B. 8, which bans abortion once embryonic cardiac activity is detected, typically around the sixth week of pregnancy, with no exception for rape or incest. S.B. 8 disproportionately affects vulnerable and marginalized Texans, who are most likely to continue pregnancies against their will, rather than travel to overburdened clinics in neighboring states — a worrisome prospect given the state’s already high maternal mortality rate .

Even before S.B. 8 took effect, reproductive rights advocates in Texas felt that most of the country wasn’t paying attention. This may be because many Americans have long regarded Texas politics as nothing but the right-wing fringe — easily dismissed and not to be taken seriously.

From a state board of education that has featured creationists to gaffe-prone governors to threats that the state would secede under a Democratic president, Texas is often treated as a punchline. But the state’s policies — on education, gun control, energy, public health and economic regulation — have influenced the national agenda for years, especially in other red states. Texas has been described in the press recently as a “leader” in charting the potential course of the Republican Party nationally.

Abortion is no exception. State lawmakers’ doomed attempts to punish abortion with the death penalty may be ridiculed, but Texas Republicans have succeeded in passing a slew of anti-abortion laws that have kept people from accessing care.

This is not a reflection of what many Texans want, however: According to an October 2021 University of Texas/Texas Tribune poll , 46 percent of voters disapproved of how state leaders have handled abortion policy. And a February 2022 poll from the University of Texas/Texas Politics Project found that 53 percent of voters in the state either strongly or somewhat oppose automatically banning abortion in the state if the Supreme Court overturns Roe.

Texas’ history as a vanguard for abortion rights battles goes back to the Roe v. Wade case itself. In 1970, a pair of young lawyers filed suit against the Dallas district attorney, Henry Wade, on behalf of Norma McCorvey, known under the pseudonym Jane Roe, who was barred from obtaining an abortion by Texas law. Of course, that case made it to the Supreme Court, and a right to abortion became the law of the land.

Several years later, Rosie Jimenez, from McAllen, Texas, was unable to afford a legal abortion and was forced to resort to an unsafe procedure that resulted in a deadly infection. Jimenez was the first known woman in the United States to die as a result of the 1976 Hyde Amendment, which bars federal Medicaid funds from covering most abortions — but she was almost certainly not the last.

Through the 1970s and ’80s, Texas Democrats controlled both houses of the State Legislature and most statewide offices. In the early ’90s, the state even had explicitly pro-choice leadership under a Democratic governor, Ann Richards (who, as it happens, was the mother of Cecile Richards, the former president of Planned Parenthood).

But since then, the state’s leaders have moved steadily to the right. Texas Republicans cemented their power after the 2010 Tea Party-led “red wave” that swept statehouses across the United States, and accelerated the party’s aggressive anti-abortion mission. In 2012, Gov. Rick Perry proclaimed he would try to “make abortion, at any stage, a thing of the past.”

His party has spent the ensuing years working hard to make that vision a reality. Anti-choice conservatives in Texas have passed some of the most restrictive abortion laws in the United States, including a 24-hour waiting period requirement, restrictions on judicial bypass for minors seeking abortions, a ban on abortions after the 20th week of a pregnancy, a ban on public and private insurance coverage of abortions, a ban on abortions provided via telemedicine, restrictions on access to medication abortions, and a law banning the most common type of second-trimester abortion. The Texas G.O.P. has simultaneously decimated the state’s family planning network and has repeatedly attacked Planned Parenthood — giving other states a blueprint for how to undermine reproductive health.

So it’s no surprise that at least 11 states have attempted to copy S.B. 8, including in many cases the law’s unusual enforcement mechanism , which has made it difficult to challenge it in the courts. Last week, the Idaho State Senate passed one such bill .

When I think back on the past decade of abortion rights battles in Texas, one moment in particular stands out. It was 2013, and Wendy Davis, then a state senator, captured international attention by launching an 11-hour filibuster to protest a sweeping anti-abortion law. I will never forget feeling the granite of the Texas Capitol building reverberate as thousands of pro-choice Texans rallied inside and outside the Senate chamber.

Ms. Davis’s filibuster stopped the law from passing that day, but a few weeks later, after many of the TV cameras had left, Republicans rubber-stamped the law, which by then was known as H.B. 2. Before the Supreme Court struck down much of the law in 2016, H.B. 2 shuttered about half of the abortion clinics in Texas, doing irreparable damage to the state’s reproductive health network.

Abortion rights advocates initially believed that the commotion over H.B. 2 might have galvanized lasting investment in reproductive rights in Texas — but the support inevitably waned. Today, many of those same advocates feel a sense of déjà vu with S.B. 8, as the initial national fascination with the law has faded. Frustrated and exhausted, the people working to secure access to abortion in Texas feel that years of sounding the alarm about the trajectory of reproductive rights in their state — and the nation — went largely ignored, even by some of their ostensible national allies.

In the meantime, Texans continue to suffer. Some people are terminating their pregnancies through unsafe means. Abortion providers are anxious about the future of their clinics and the fact that they have to turn away patients in need. Abortion funds are struggling to meet demand. And little relief has come from the federal government.

The tendency to dismiss Texas politics has had a high cost. And with the future of Roe v. Wade on the line, the stakes of looking away are growing by the day.

Mary Tuma is a Texas-based journalist who covers reproductive rights. Her work has appeared in The Guardian, Vice, The Texas Observer, The Austin Chronicle and Rewire News Group.

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Abortion bans and their impacts: A view from the United States

Laura j. frye.

1 Gynuity Health Projects, New York, NY, USA

Beverly Winikoff

A retrospective study of abortion facilities in and around Texas by White et al. 1 and a spatial analysis by Rader et al. 2 are combined to illustrate the detrimental effects of abortion bans enacted in the United States.

Abortion restrictions have been introduced in various forms across many states for years, but since June 2022, when the right to abortion was no longer federally protected, we have seen a rapid increase in these restrictions. We are just starting to quantify and qualify their effects. Two recent studies published in JAMA offer early indications of the effects of draconian bans.

In “Association of Texas’ 2021 Ban on Abortion in Early Pregnancy with the Number of Facility-Based Abortion in Texas and Surrounding States,” White et al. used a large dataset containing information before and after the passage of SB8 in September 2021. 1 This bill banned most abortions after 6 weeks in the state of Texas. The data presented in this article allow for a careful examination of the law’s effects, and the authors paint a picture of how rapidly destabilizing such bans can be. The study clearly shows that, in the immediate aftermath of SB8’s implementation, there was both an absolute drop in documented abortions and a shift in the location of abortions as Texans went to neighboring states for medical care.

The paper explicitly examines abortions after 12 weeks as an important indicator of change, not because of the small decrease in safety and efficacy with increasing gestational durations, but rather because of the major increase in burdens to affected individuals (cost, time, travel) and to clinics (resources, scheduling) with gestations beyond this point.

A clearer and more detailed sense of how these patient travel dynamics play out can be found in the “Estimated Travel Time and Spatial Access to Abortion Facilities in the US Before and After the Dobbs v Jackson Women’s Health Decision” by Rader et al., which uses simulation and spatial analysis to measure changes in surface travel time to the closest abortion facility before and after the June 2022 Dobbs decision. 2

The average travel time to reach the nearest abortion facility significantly increased in the simulated post-Dobbs world, and, while the median change from 11 to 17 min is not jaw dropping, the spread of the data and the extremes of the curve are where the biggest problems lie. The authors show a doubling of the number of individuals who must travel more than 60 min to access abortion care. Then, through sensitivity analyses on geographic heterogeneity, they illustrate some of the extreme increases in travel time for people in the South, as in Texas, with a mean increase of over 7 h.

While the White paper notes that their data did not include individual-level demographic information (and thus was not able to explore the disparate effects of the ban on various subpopulations), the Raden paper is able to shed some light on the disproportionate impacts of abortion restrictions by use of census data. The latter paper shows that longer travel times occur more frequently in populations without insurance, with lower incomes, and who are racial and ethnic minorities. Documentation of these effects is important for advocacy, policy change, and resource allocation.

The White et al. paper wisely uses care in describing the data they have as “documented facility-based abortions,” acknowledging the now-frequent practice of non-facility-based self-managed abortion with pills. Similarly, Rader et al. note that their data are predicated on the idea of traveling to a physical facility and do not account for the mailing of pills to a person’s home. The TelAbortion study from 2016 to 2021 provided evidence on the safety and efficacy of direct-to-patient telemedicine abortion with mailing of pills, 3 , 4 and the FDA now allows for this method of abortion pill provision. We also know that self-managed abortion can be a safe and effective option 5 and is currently common in the United States. 6 , 7 There is increasing interest in determining its role in the care landscape. 8 , 9 , 10 Moving forward, it would be beneficial to see more information on how remote provision of care and self-management play into the dynamics illustrated in these articles.

These two papers, used together, can help prepare clinics in protective states for the influx of affected individuals as additional oppressive laws are passed in other states. The lessons documented only grow in relevance as the map of the United States darkens with more and more states passing restrictive abortion laws. We can use these data both to decry the negative and disproportionate effect of these bans and to call for action to prepare receiving clinics in protective states as they take on the care of more people who are denied medical services in their home states.

Declaration of interests

The authors declare no competing interests.

Home — Essay Samples — Social Issues — Abortion — The Legality of Abortion in Texas

The Legality of Abortion in Texas

• Categories: Abortion Texas

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Words: 1381 |

Published: Jun 20, 2019

Words: 1381 | Pages: 3 | 7 min read

Works Cited

• Delgado, R., & Stefancic, J. (2012). Understanding words that wound. Westview Press.
• Downey, D. B., & Condron, D. J. (2016). Fifty years since the Coleman Report: Rethinking the relationship between schools and inequality. Sociology of Education, 89(3), 207-220.
• Glenn, E. N. (2015). Forced to care: Coercion and caregiving in America. Harvard University Press.
• Gonzales, A. (2016). Lives in limbo: Undocumented and coming of age in America. University of California Press.
• Goodwin, R. E., & Jasper, J. M. (Eds.). (2004). Rethinking social movements: Structure, meaning, and emotion. Rowman & Littlefield Publishers.
• Gusfield, J. R. (2014). Symbolic crusade: Status politics and the American temperance movement. University of Illinois Press.
• Hays, S. (1996). The cultural contradictions of motherhood. Yale University Press.
• Luker, K. (2013). Abortion and the politics of motherhood. University of California Press.
• Mansbridge, J. J. (2003). Rethinking representation. American Political Science Review, 97(4), 515-528.
• McAdam, D. (1999). Political process and the development of black insurgency, 1930-1970. University of Chicago Press.

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EXPLAINER: What to know about the new Texas abortion law

Un guardia de seguridad abre la puerta de la clínica Whole Woman’s Health, en Fort Worth, Texas, el miércoles 1 de septiembre de 2021, la cual tiene un letrero que informa al público que está abierta. (AP Foto/LM Otero)

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AUSTIN, Texas (AP) — The Supreme Court allowing a new Texas law that bans most abortions is the biggest curb to the constitutional right to an abortion in decades, and Republicans in other states are already considering similar measures.

The law prohibits abortions once medical professionals can detect cardiac activity, usually around six weeks — before some women know they’re pregnant. Courts have blocked other states from imposing similar restrictions, but Texas’ law differs significantly because it leaves enforcement up to private citizens through civil lawsuits instead of criminal prosecutors.

Here’s what to know about the new Texas law that took effect Tuesday, which already has abortion clinics in neighboring states reporting a surge in the number of Texas women seeking the procedure :

WHAT DOES THE TEXAS LAW DO?

It allows any private citizen to sue Texas abortion providers who violate the law, as well as anyone who “aids or abets” a woman getting the procedure. Abortion patients themselves, however, cannot be sued.

The law does not make exceptions for rape or incest. The person bringing the lawsuit — who does not have to have a connection to the woman getting an abortion — is entitled to at least $10,000 in damages if they prevail in court. Texas Right to Life, the state’s largest anti-abortion group, launched a website to receive tips about suspected violations and says it has attorneys ready to bring lawsuits.

HOW MANY PEOPLE COULD BE AFFECTED BY THE TEXAS LAW?

The new Texas law could affect thousands of women seeking abortions, though precise estimates are difficult. In 2020, Texas facilities performed about 54,000 abortions on residents. More than 45,000 of those occurred at eight weeks of pregnancy or less. Some of those abortions still could have been legal under the new law, if they occurred before cardiac activity was detected.

HOW IS THE TEXAS LAW DIFFERENT FROM THOSE IN OTHER STATES THAT HAVE TRIED TO RESTRICT ABORTION EARLY IN PREGNANCY?

The key difference is the enforcement mechanism. The Texas law relies on citizens suing abortion providers over alleged violations. Other states sought to enforce their statutes through government actions like criminal charges against physicians who provide abortions.

Texas is one of 14 states with laws either banning abortion entirely or prohibiting it after eight weeks or less of pregnancy. The rest have all been put on hold by courts. Most recently, a court halted a new Arkansas law that would have banned all abortions unless necessary to save the life of the mother in a medical emergency. Other states with blocked laws banning abortions early in pregnancy are Alabama, Georgia, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Ohio, South Carolina, Tennessee and Utah.

HOW DID THE TEXAS ABORTION LAW COME ABOUT?

Texas has long been a major battleground over abortion rights and access, including a 2013 law that closed more than half of the 40-plus abortion clinics in the state before it was blocked by the Supreme Court.

Emboldened by victories in the 2020 elections, Republicans responded with a hard-right agenda this year that included loosening gun laws and further tightening what are already some of the nation’s strictest voting rules . Anti-abortion groups say the new law was in response to frustration over prosecutors refusing to enforce other abortion restrictions already on the books.

Before Republican Gov. Greg Abbott signed the law in May, voters in Lubbock, Texas, approved an ordinance similarly intended to outlaw abortion in the city by allowing family members to sue an abortion provider.

WHAT HAPPENS NEXT?

A case is still proceeding in the 5th U.S. Circuit Court of Appeals, though the timing of future action is unclear.

WHAT IMPLICATIONS ARE THERE FOR ABORTION LAWS IN OTHER STATES?

The Supreme Court’s action does not reinstate any stricken abortion laws in other states. But “essentially, the Supreme Court has now given other states a roadmap for circumscribing Roe vs. Wade,” said Steven Schwinn, a constitutional law professor at the University of Illinois Chicago.

Indeed, some Republican lawmakers already are talking about following suit.

In Arkansas, Republican state Sen. Jason Rapert on Thursday tweeted that he planned to file legislation mirroring Texas’ law for the Legislature to take up when it reconvenes this fall. But it’s unclear whether that will be allowed, because the session’s agenda currently is limited to congressional redistricting and COVID-19 legislation.

In Mississippi, Republican state Sen. Chris McDaniel said Thursday that he would “absolutely” consider filing legislation to match the Texas law.

“I think most conservative states in the South will look at this inaction by the court and will see that as perhaps a chance to move on that issue,” McDaniel said.

The Mississippi Legislature is scheduled to start meeting in January. The Supreme Court will hear arguments this fall on a 2018 Mississippi law that would ban most abortions after 15 weeks of pregnancy -- a case that is a direct challenge to Roe v. Wade.

COULD STATES TAKE A SIMILAR “CITIZENS” ENFORCEMENT APPROACH TO LAWS ON OTHER HOT-BUTTON ISSUES?

Some states already have turned to citizens to enforce new laws.

A Missouri law that took effect last week allows citizens to sue local law enforcement agencies whose officers knowingly enforce any federal gun laws. Police and sheriff’s departments can face fines of up to $50,000 per occurrence. The law was backed by Republicans who fear Democratic President Joe Biden’s administration could enact restrictive gun policies.

In Kansas, a new law prompted by frustration over coronavirus restrictions allows residents to file lawsuits challenging mask mandates and limits on public gatherings imposed by counties. Last month, the Kansas Supreme Court allowed enforcement of the law to proceed while it considers an appeal of a lower court ruling that declared the law unconstitutional.

Utah also took a similar strategy on pornography last year, passing a law that allows citizens to sue websites that fail to display a warning about the effects of “obscene materials” on minors. Though adult-entertainment groups warned it was a violation of free speech, many sites have complied with the law to avoid the expense of a possible onslaught of legal challenges.

Citizens filing their own lawsuits has long been a fixture of environmental and disability-rights law, said Travis Brandon, an associate professor at Belmont University College of Law. Environmental groups, for example, help file suits against businesses accused of violating federal pollution permits.

In California, Proposition 65 allows people who might have been exposed to potentially carcinogenic materials to both file their own lawsuits and collect a kind of “bounty” if they win. Those laws are different, though, in that people generally must show they have been directly affected by a violation of the law, a feature missing from the new Texas measure, Brandon said.

David A. Lieb reported from Jefferson City, Missouri. Associated Press writers Andrew DeMillo in Little Rock, Arkansas; Heather Hollingsworth in Mission, Kansas; Emily Wagster Pettus in Jackson, Mississippi; and Lindsay Whitehurst in Salt Lake City contributed to this report.

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An Overview of Abortion Attitudes in Texas: Four Things to Know

Since the political rise of the pro-life movement in the 1990s, it’s often been suggested that elected Republicans were less seriously committed to banning abortion than their public pronouncements may have conveyed. The rationale behind this logic was purely political: such a change to health, reproductive, and women’s rights would upend normal politics, resulting in a not-wholly, but largely, gendered political revolt against the GOP. But with Texas’ passage of one of, if not the, most restrictive sets of abortion laws in the country, impacting 85% of abortions in the state and sending women to Oklahoma (!) , it would appear that this particular theory of a just-below-the-surface political equilibrium on abortion policy is about to face a serious test. 

The reasons for the Texas GOP’s leap forward on abortion restirctions after a decade of chipping away at access are likely many, and worthy of their own piece of analysis (but the partisan sorting of college and non-college educated voters; the change in composition of the supreme court; the recent fending off of Democratic challenges in the state; and the chance to reinforce existing electoral advantages through redistricting in an increasingly competitive state are some possibilities that come to mind), but looking directly ahead to the next set of Texas elections in 2022, the sudden change in the reproductive health landscape begs the question: where do Texas voters stand on abortion? 

Below, we collect some observations to answer this question based on a decade of relevant University of Texas polling.

1. Equal shares of Texas voters identify as pro-life and pro-choice. The UT poll has asked respondents since October 2014 whether they tend to identify as “pro-life”, “pro-choice” or neither. In the most recent polling conducted in August, 2021, 41% of Texas voters identified as pro-life, 42% identified as pro-choice, 14% identified as neither, and 4% said that they didn’t know. Over the 23 surveys that have asked this question between 2014 and today, on average, 43% of Texas voters said they were pro-life, while 40% said that they were pro-choice. So despite the fact that the Texas Legislature passed one of the most restrictive abortion laws in the country, it’s not really fair to describe Texas as a “pro-life” state given an electorate that is clearly divided — at least in its description of itself.

Obviously, there are sharp partisan differences underlying these identifications, with an average of 70% of Republicans identifying as “pro-life” compared to 18% who identify as “pro-choice” over the course of the time series, while among Democrats, 67% identify as “pro-choice” on average, compared to 16% who identify as “pro-life.”

Among true political independents, on average, 37% identify as “pro-choice” across the 23 data points, while 33% identify as “pro-life.” It is worth noting, however, that the “pro-choice” identification appears to be increasing over the last year among some groups, notably women, Hispanics, and voters under-30 — all relevant voting blocs when considering the increasing competitiveness of Texas elections.

2. Only a small minority of Texas voters would entirely eliminate access to abortion. This is an important, missed consideration in political debates often driven by advocates claiming to represent a majority of voters in their efforts to end all abortions. Jim Henson and I wrote recently about how the state GOP’s push to toe the line of eliminating access to abortion may test voters’ patience given that as recently as February of 2021 , only 13% of Texas voters said that abortion should never be permitted, including only 21% of Republicans, among whom the plurality, 47%, would allow for access to abortion in the case of rape, incest (circumstances that the current 6-week ban makes no exceptions for), or if the life of the mother was endangered by the pregnancy, with another 28% in favor of allowing abortion in cases beyond those three (14%) or in most, if not all, cases (14%). Put another way, 79% of Republican voters said, at the beginning of the regular legislative session, that abortion should be permitted in at least some circumstances.

This is an extremely consistent finding on abortion attitudes in both Texas and nationally. In fact, having asked the same item to assess attitudes towards abortion access 10 times between February 2011 and February 2021 , no more than 17% of voters indicated in any of the surveys that abortion should never be permitted. So at least 83% of all Texas voters think that abortion should be permitted in at least some circumstances.

3. Texas voters appear to have become less receptive to the introduction of new abortion laws by the Texas Legislature. In general, abortion attitudes have tended to reflect a Texas electorate that is generally open to enacting limitations on the practice of abortion, but, as described above, is significantly less open to revoking access entirely. 

UT polling has tested public support for multiple instances of public policy proposed by the Texas Legislature over the past decade that would place limitations on the practice of abortion, regularly finding support among a plurality or majority of Texas voters. While the list of polling results isn’t a comprehensive accounting of every policy that the legislature has considered over the last decade, it does provide a pretty good summary of some of the ways in which the Legislature has sought to restrict the practice of abortion during that time frame and the public reaction to those proposals. 

These survey items included assessments of:

• requiring transvaginal ultrasounds in 2011;
• a 20-week ban on abortion in 2013; 
• limiting the judicial bypass that would allow minors to receive an abortion without notifying their parents in 2015; 
• a fetal burial/cremation requirement in 2017; 
• a 6-week ban in 2019; 
• and in 2021, a 6-week ban, allowing any individual in Texas the right to sue an abortion provider, and a ban on abortion should the Supreme Court overturn Roe v. Wade .

What’s most notable about these proposals when considered both in comparison to each other and overtime is the extent to which their popularity has declined as the policies have become increasingly extreme — here defined as the increased likelihood that a law would lead to the prohibition of abortion as opposed to merely limiting access.

Majorities or near-majorities of Texas voters expressed approval for the sonogram requirement in 2011 (54% in February and 50% in May), with only 36% and 39% of Texas voters expressing opposition, producing a measurement of net support of +18 in February and +11 in May. Likewise, in February 2013, the 20-week ban (that now feels generous) registered 57% support and 26% opposition, resulting in net support of +31. Limiting the ability of a judge to bypass parental consent requirements was also broadly popular as of 2015, with 50% in support and 36% in opposition, resulting in net support of +14.

Then in 2017, the Legislature took things to another level, first with an emotional and lengthy debate about a proposed burial or cremation requirement for aborted fetuses — seemingly at the expense of the mother, or some “good” samaritan. This policy appears to have been a step too far for some, as less than a majority expressed support, 44%, with 39% in opposition, resulting in +5 net support — significantly less than the earlier proposals described above. The legislature first seriously considered a 6-week ban in 2019, and when polled, 48% expressed support, 42% expressed opposition (net +6).

In April of this year, voters were again asked about a 6-week ban along with “allowing any individual in Texas the right to sue an abortion provider they believe has violated state law” — a description which is less extreme than the law that ultimately passed — and “automatically banning all abortions in Texas if the U.S. Supreme Court overturns Roe v. Wade." The 6-week ban received equally ambivalent results in the survey as when asked in 2019, with 49% of voters supportive and 41% opposed (net +8), while allowing anyone to sue an abortion provider received similarly tepid support (44% support; 37% oppose; net +7).

However, a total ban on abortion saw a majority of Texas voters, 54%, in opposition and only 34% in support (net -20). * Asked again in June about the 6-week ban, presumably after learning that a six week ban, based on biology, would in fact act as a near total ban , 44% of voters expressed support for the law, 46% expressed opposition (net -2). A total ban on abortion remained unpopular, opposed by 53% of voters, supported by 37% (net -16).

It’s notable that this pattern of less enthusiastic or even declining net support was evident among most groupings of voters, and among most of the groups that we think of as consequential to elections in the state of Texas. Partisanship is obviously evident in the data, but still follows this pattern. Net opposition among Democrats (the share opposed minus the share who support the provisions) for the sonogram bill increased from 23-points to 42-points between February and May of 2011, however, the most recent 6 week ban is supported by only 15% of Democrats, with 77% in opposition (net -62).

Independents were, in general, supportive of the restrictions tested early in the time series, but that support appears to have flipped around the time of the fetal burial/cremation discussion, with 42% in support and 45% in opposition. The 6-week ban is currently opposed by 46% of independents and supported by 34% (net -12).

Also evident is a clear decline in the net support for the tested policies among different racial/ethnic groups.

And among urban, rural, and suburban voters.

It’s too soon to tell how reactions to these policies will play out in the 2022 elections, given uncertainty about judicial rulings in the interim. But expect this issue to become more salient to voters — which appears to be happening already.

4. Texas has received a lot of national attention lately for voting rights and the border, but no issue has garnered the same spike in attention as has Texas’ new abortion laws, despite stout competition. This is not polling data, but it’s worth noting the relative search volume in Texas for “voting”, “border”, and “abortion” since the beginning of the year. The spike in interest at the time that Texas passed its newest set of abortion restrictions might be taken as a first warning sign about the potential this topic has to motivate the electorate — one way or another.

The GOP’s success in passing its most restrictive abortion legislation yet in one of the youngest, most diverse, and most urban states in the country is about to set up a test of the power that abortion politics exerts on Texas politics, and in turn, on national politics. To say that Republican elected officials are beholden to their primary electorate is not a novel observation and should come as no surprise to anyone who has paid even scant attention to politics in the state. But after more than a decade of some tentative, some direct, forays into limiting access to abortion, a de facto ban clearly intended to appeal to a mobilized share of GOP primary voters may provide the most direct test yet of the long anticipated potential for counter-mobilization — perhaps even (maybe especially) among non-Democrats who repeatedly oppose abolition to abortion access. 

*   While 34% in support of a total ban on abortion should Roe v. Wade be overturned imply more support for an outright abortion ban than the data described above, in which 13% of Texans would ban abortion in all circumstances, the differences in those results is almost surely a reflection of what each question is asking. The item asking about support for banning abortion if Roe v. Wade is overturned makes no mention of specific circumstances, and as such, is a measure of a general orientation towards the most extreme prohibitions. However, we know from the polling described above, as well as from other survey items in the UT/TT poll that ask specifically about the circumstances under which a woman should be able to obtain an abortion, that there is significant, widespread support for allowing abortion in the case of rape and incest, which the item on a ban in response to the supreme court requires no consideration of on the part of the respondent.

clock This article was published more than  2 years ago

Opinion Uma Thurman: The Texas abortion law is a human rights crisis for American women

Uma Thurman is an actress and mother.

I have followed the course of Texas’s radical antiabortion law with great sadness, and something akin to horror. Now, in the hope of drawing the flames of controversy away from the vulnerable women on whom this law will have an immediate effect, I am sharing my own experience. You might not be interested in the opinions of an actress, but given this new outrage, I feel it is my responsibility to stand up in their shoes.

I started my acting career at 15, working in an environment where I was often the only kid in the room. In my late teens, I was accidentally impregnated by a much older man. I was living out of a suitcase in Europe, far from my family, and about to start a job. I struggled to figure out what to do. I wanted to keep the baby, but how?

I telephoned home. My mother was gravely ill in the hospital. My father went to her bedside to discuss my options. We had never spoken about sex before; this was the first time, and it was terrible for all of us. They asked me about the status of my relationship — it was not viable — and warned me how difficult it would be to raise a baby as a teen on my own. My childish fantasy of motherhood was soundly corrected as I weighed answers to their very precise questions. I was just starting out in my career and didn’t have the means to provide a stable home, even for myself. We decided as a family that I couldn’t go through with the pregnancy, and agreed that termination was the right choice. My heart was broken nonetheless.

An older female friend in Germany offered to help me. In her doctor’s office in Cologne, I was given a local anesthetic and had an abortion. I lay awake on the table while the doctor, who was a kind man, explained every step of the process as it happened. It hurt terribly, but I didn’t complain. I had internalized so much shame that I felt I deserved the pain.

My fingers were tightly locked across my chest, and when the procedure was done the doctor looked down at me said, “You have beautiful hands — you remind me of my daughter.” That single gesture of humanity is seared in my mind as one of the most compassionate moments I have ever experienced. In his eyes, I was a person, I was a daughter, I was still a girl.

There is so much pain in this story. It has been my darkest secret until now. I am 51 years old, and I am sharing it with you from the home where I have raised my three children, who are my pride and joy. My life has been extraordinary, at times filled with heartbreak, challenge, loss and fear — just like so many women’s lives — but also marked, like theirs, by courage and compassion. I conceived my beautiful, magical children with men whom I loved and trusted enough to dare to bring a child into this world. I have no regrets for the path I have traveled. I applaud and support women who make a different choice. The abortion I had as a teenager was the hardest decision of my life, one that caused me anguish then and that saddens me even now, but it was the path to the life full of joy and love that I have experienced. Choosing not to keep that early pregnancy allowed me to grow up and become the mother I wanted and needed to be.

Alan Braid: Why I violated Texas’s extreme abortion ban

I have nothing to gain from this disclosure, and perhaps much to lose. In revealing the hole that this decision carved in me, I hope that some light will shine through, reaching women and girls who might feel a shame that they can’t protect themselves from and have no agency over. I can assure you that no one finds herself on that table on purpose.

The Texas abortion law was allowed to take effect without argument by the Supreme Court, which, due in no small part to its lack of ideological diversity, is a staging ground for a human rights crisis for American women. This law is yet another discriminatory tool against those who are economically disadvantaged, and often, indeed, against their partners. Women and children of wealthy families retain all the choices in the world, and face little risk.

I am grief-stricken, as well, that the law pits citizen against citizen, creating new vigilantes who will prey on these disadvantaged women, denying them the choice not to have children they are not equipped to care for, or extinguishing their hopes for the future family they might choose.

To all of you — to women and girls of Texas, afraid of being traumatized and hounded by predatory bounty hunters; to all women outraged by having our bodies’ rights taken by the state; and to all of you who are made vulnerable and subjected to shame because you have a uterus — I say: I see you. Have courage. You are beautiful. You remind me of my daughters.

• Opinion | His job is to interpret the Constitution. Would he rather run the FDA? March 28, 2024 Opinion | His job is to interpret the Constitution. Would he rather run the FDA? March 28, 2024
• Opinion | The Supreme Court’s latest abortion case has an obvious answer March 23, 2024 Opinion | The Supreme Court’s latest abortion case has an obvious answer March 23, 2024
• Opinion | Outlawing abortion is just the start for some conservative judges March 18, 2024 Opinion | Outlawing abortion is just the start for some conservative judges March 18, 2024

Samantha Casiano cries while visiting the gravesite of her daughter Halo with her daughter Camila and son Louie.

Her baby was going to die. Abortion laws forced her to give birth anyway

Photographs by Danielle Villasana Story by Rebecca Wright, CNN Published March 31, 2024

Samantha Casiano spent this month planning her daughter’s first birthday party. The 30-year-old east Texas mother of four knows how to throw a good party for her kids.

But this family get-together on Friday was not a traditional party, despite Casiano purchasing a cake and balloons for the event.

Instead, Casiano’s family spent the day at the gravesite of Halo Hope Villasana, Casiano’s daughter who was born with anencephaly, a fatal condition that prevents a child’s brain and skull from forming properly.

It affects about 1 in 1,000 pregnancies, most of which end in miscarriage or abortion.

But Casiano said she didn’t have the choice of an abortion.

“Unfortunately, I’m not allowed to do that because of the way the (abortion) law is written,” Casiano told CNN. Abortion in Texas is illegal in almost all cases because of a "trigger ban” that went into effect after the Supreme Court overturned Roe v. Wade in 2022.

There is an exception: the “medical emergency” statute in Texas allows for abortion if the mother has a “life-threatening” condition or is at “serious risk of substantial impairment of a major bodily function.” But these medical exemptions are rare and doctors, experts and patients — including Casiano — argue the wording in the law isn’t clear enough.

“I was lost,” Casiano said, remembering when she learned about the condition during her 20-week anatomy scan. “It was a very emotional day.”

After Casiano’s OB-GYN told her she wouldn’t be able to provide her with an abortion because of Texas’s restrictive abortion laws, Casiano and her husband, Luis Fernando Villasana, started looking into other options.

The closest abortion clinics were in New Mexico and Colorado, but getting there was simply financially and logistically impossible.

So, instead of being able to end her pregnancy, she spent months carrying a child she knew likely wouldn’t live more than a day.

“I’m her life support. I should be able to release my daughter,” Casiano said. “I am her mother. That is my right."

Halo died nearly four hours after she was born on March 29, 2023.

Casiano is one of 20 women challenging Texas’ restrictive abortion laws, claiming she was denied abortion care in Texas because of a lack of clarity in the state’s ” emergency medical ” exceptions in its abortion laws.

In August, a Texas district judge issued an injunction blocking Texas’s abortion bans as they apply to dangerous pregnancy complications, but an appeal from the state blocked the injunction shortly after. The Texas Supreme Court heard arguments in November but hasn't ruled on the case yet.

Texas Attorney General Ken Paxton and his office have not yet responded to a request for comment.

The case is one of many legal battles surrounding abortion since the Supreme Court overturned national abortion rights protections in June 2022.

Now, one year after Halo’s birth and death, Casiano’s world continues to turn. Her other kids keep growing. But she’s far from feeling any closure.

“I feel like I’m going to feel this way forever,” Casiano said. “I’m scarred forever, literally.”

Danielle Villasana , a Houston-based photojournalist unrelated to the family, met Casiano while on assignment last year.

“She really pulls you in,” Villasana said about Casiano. “She’s incredibly intelligent, welcoming and friendly, despite the somber nature of why we were connecting in the first place.”

What started as a simple portrait assignment turned into more than 10 months of documenting Casiano and her family navigating life after Halo’s death. Her photos illustrate what the family’s days look like — visiting Halo’s gravesite on Sundays, driving to Chuck E. Cheese for her son’s birthdays, drawing on the trampoline in her family’s yard — and the intimate moments in between.

“I remember when I went to Samantha's house for the first time and saw how she has an altar at the corner of her home,” Villasana said.

It’s a collection of items thoughtfully placed on an accent table: a sonogram showing Halo’s fingers, a baptismal certificate and candle from a ceremony at the hospital, a prayer candle, prints of Halo’s hands and a plaster cast of her feet.

“Knowing what (having a child) feels like and then immediately having to lose that child after childbirth and everything you’re going through, seeing that (display) was really impactful,” Villasana said.

Casiano keeps these physical items out not only for herself and her family to remember Halo, but to create an opportunity for others to learn about her, too. Her experience giving birth to Halo was traumatic, but she doesn’t shy away from sharing her story.

“I want people to ask questions. I want people to know about her. I want people to be aware of the situation and why abortion is health care and why my daughter had to wait all the way until birth to be released into heaven,” Casiano said.

Following the Supreme Court’s June 2022 decision in Dobbs v. Jackson Women’s Health Organization, nearly two dozen US states have banned or limited access to abortion. States where abortion is most limited, such as Texas, report higher rates of maternal and infant mortality , as well as greater economic insecurity .

Villasana hopes that photographing Casiano’s story puts a face to those statistics.

“As I’ve started to photograph this issue — not just Samantha’s story, but other women’s stories — I’ve been reminded that everyone’s life is so unique and different. There isn’t a cookie-cutter formula to everything, and it’s important to show the realities of these laws and what that looks like on a day-to-day basis right now,” Villasana said. “Often in the news and media, we see numbers and statistics and facts and figures, but we don’t see the humans behind those numbers.”

In December, Casiano finally received a headstone for Halo’s grave.

Casiano’s family had a small ceremony when the headstone was installed, framing the headstone with flowers and candles. Casiano’s daughter Camila placed two of her dolls on the stone.

“Seeing Camila leaving a doll for Halo, but also playing with the doll almost as if she’s playing with Halo, that was really tender to see,” Villasana said.

Casiano hopes that her daughter never has to go through the same pain she did.

“It’s the most traumatizing thing I’ve ever had to go through in my life,” Casiano said. “God forbid, if my daughter had to go through this, I would immediately be crying and furious.”

The headstone shows two etched images: one of Halo, surrounded by angel wings, and another shortly after Halo was born, with Casiano and her husband holding her in the hospital during their first and last moments together.

“It's not like it is total closure, but I felt like my daughter's free,” Casiano said. “My daughter is not imprisoned inside of my body waiting to be released. My daughter is free.”

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New Texas trigger law makes abortion a felony

Scott Simon

Scott Simon talks with Elizabeth Sepper, a law professor at the University of Texas at Austin about the legal landscape of abortion access in the state.

SCOTT SIMON, HOST:

Laws restricting access to abortion went into effect in a number of states this week, including Texas, which already has some of the toughest restrictions in the country. Its new law goes even further. It makes it a felony to provide an abortion, and that is punishable by up to life in prison. We're joined now by Elizabeth Sepper, who is a professor of law at the University of Texas at Austin.

Professor, thanks so much for being with us.

ELIZABETH SEPPER: Thanks for having me.

SIMON: Let's begin with this new law, if we could. What are some of the penalties for which it provides?

SEPPER: This is a law that criminalizes providing abortions. It comes with five years to life imprisonment, as well as civil penalties of $100,000 for abortion and administrative penalties in the form of mandatory revocation of a license to practice medicine, do nursing, pharmacy, so on.

SIMON: So providing abortion would presumably apply to medical personnel, but also, who else?

SEPPER: Given the existence of medication abortion, anyone who hands a medication abortion pill to another person would be subject to this criminal ban.

SIMON: So this could be not just a pharmacist. It could be a friend.

SEPPER: It could be a friend. It could be a stranger. It could be someone, a friend of a friend, a family member, so on.

SIMON: If you put this law together with the laws that are already on the books, what does the landscape of laws look like?

SEPPER: So there's dozens of sort of smaller criminal laws around informed consent, the timing, how often someone has to come, who can hand out medication abortion, even. Then we have this trigger ban, which went into effect on Thursday. And then we have a pre-Roe ban which prohibits furnishing the means of abortion as well as providing abortion services. And on top of that, we have a medication abortion-specific criminal law that means that mailing a medication abortion into the state or providing it to someone in the state is also a crime.

SIMON: As I'm certain you know, Professor, Texas has some of the best doctors and hospitals in the world. Would they be criminally liable for prosecution if they acted to save the life of a woman?

SEPPER: The Texas abortion ban does have an exception for life-saving abortion care. However, there was litigation just this past week. We'll see where it goes going forward. But Texas succeeded in convincing a federal judge that federal protections that would require physicians to provide abortion care where necessary to preserve a person's health in serious jeopardy don't apply in Texas. Only life-saving abortions are allowed.

SIMON: I gather some prosecutors have said that they just wouldn't bring criminal charges against abortion providers.

SEPPER: A number of prosecutors in big cities and counties have committed not to prosecute or to prioritize policing toward a provision of abortion. This isn't going to result in abortion providers beginning to perform abortions. They would still risk their medical licenses, as well as face a $100,000 in civil penalties that the attorney general can bring.

SIMON: And, Professor, there's a law that passed last year that allows Texas citizens to sue each other, isn't there? And that still stands?

SEPPER: Yes. In addition to our criminal laws, there's a private right of action. So even if prosecutors won't bring criminal charges, strangers could bring civil causes of action against people who aid and abet an abortion.

SIMON: What implications are there in other areas of the law in making abortions illegal?

SEPPER: I think the most immediate implication is for all kinds of medical practice. So emergency physicians are going to encounter people with pregnancy complications that are emergencies but haven't risen to life-threatening conditions. And they will have to sit on their hands until the person becomes so sick that their life is at risk.

SIMON: Could these laws add up to making abortion a homicide?

SEPPER: Yes. So in the early 2000s, the Texas legislature changed our homicide statute to include unborn children. But there was an exception for lawful medical procedures performed by a physician. Now that virtually all abortions are unlawful, virtually all abortions can be classified as homicides under Texas penal law.

SIMON: And Texas is a death penalty state, isn't it?

SEPPER: Yes. Homicide at the very highest levels comes with the death penalty here.

SIMON: Elizabeth Sepper is a professor of law at the University of Texas, Austin.

Thanks so much for being with us.

SEPPER: Thanks for having me on the show.

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At stake in mifepristone case: abortion, FDA’s authority and return to 1873 obscenity law

Lawyers from the conservative Christian group that won the case to overturn  Roe v. Wade  returned to the U.S. Supreme Court on Tuesday in pursuit of an urgent priority: shutting down access to abortion pills for women across the country.

The case challenges the FDA’s regulation of mifepristone, a prescription-only drug approved in 2000 with a  stellar safety record  that is used in  63% of all U.S. abortions .

Viewed across decades of anti-abortion activism, the case brought by the Alliance Defending Freedom represents a "moonshot" couched in technical arguments about pharmaceutical oversight and the resuscitation of an 1873 anti-obscenity law. A victory would lay the groundwork for a de facto nationwide abortion ban.

Abortion is illegal  in 14 states , but abortion pills have never been more widely available.

During the COVID-19 pandemic, the FDA suspended — and later formally lifted — the requirement that patients be at a health care facility when taking mifepristone, the first of two pills used in medication abortion. Physicians can now prescribe the drug online through telemedicine and pharmacies can dispense it through the mail.

Prep for the polls: See who is running for president and compare where they stand on key issues in our Voter Guide

"You don’t need to be handed the pill in the office," said Linda Prine, a family medicine physician, sitting on a couch in her Manhattan apartment answering texts and calls from patients about abortion care.

"It’s very effective," she said. "I don’t even have medications that are 98 to 99% effective. Our blood pressure medicines aren’t effective like that."

Prine, a co-founder of the Miscarriage and Abortion Hotline, works with other doctors operating under New York state’s shield law to prescribe and send abortion pills to people across the country. A review of Prine’s call log, stripped of personal information, showed hundreds of requests for pills from Texas, Louisiana, Tennessee, and other states where it is illegal for women to stop a pregnancy.

Anti-abortion groups unsuccessfully petitioned the FDA at least twice before, in  2002  and  2019 , to revoke mifepristone’s approval and curtail its availability. But in November 2022, following its victory in overturning federal abortion rights, the Alliance Defending Freedom filed a federal lawsuit in Amarillo, Texas, claiming the FDA’s safety review of mifepristone was flawed.

U.S. District Judge Matthew Kacsmaryk of the Northern District of Texas, who was appointed by President Donald Trump and openly opposes abortion, ruled  to invalidate the FDA’s approval of mifepristone . An appeals court later said the drug should remain available, but it reinstated restrictions, including prohibitions on telehealth prescriptions and mailing the medication. That ruling was put on hold while the Supreme Court considers the case.

The Biden administration and a manufacturer of mifepristone, Danco Laboratories, have argued in legal filings to the Supreme Court that federal judges do not have the scientific and health expertise to evaluate drug safety and that allowing them to do so undermines the FDA’s regulatory authority.

That view is supported by  food and drug legal scholars  who wrote in court filings that the lower courts had replaced the "FDA’s scientific and medical expertise with the courts’ own interpretations of the scientific evidence." In doing so, they wrote, the courts "upend the drug regulatory scheme established by Congress and implemented by FDA."

In his ruling, Kacsmaryk cited two studies purporting to show an increase in emergency room visits and a greater risk of hospitalizations from medication abortion. They were  retracted in February  by medical publisher Sage Perspectives. The journal said the researchers erred in their methodology and analysis of the data and invalidated the papers "in whole or in part."

The research, supported by the Charlotte Lozier Institute, an anti-abortion group that filed a brief in the mifepristone case, "made claims that were not supported by the data," said Ushma Upadhyay, a professor of reproductive sciences at the University of California-San Francisco.

Legal scholars say the Supreme Court’s conservative justices have demonstrated a willingness to accept discredited abortion-related health claims. Justice Samuel Alito, writing the majority opinion in  Dobbs v. Jackson Women’s Health Organization , which overturned the constitutional right to abortion, cited statements  about harm to maternal health  presented by the state of Mississippi that contradict mainstream medical consensus.

"If this case is successful, it will be because the Supreme Court decided to ignore evidence that demonstrated mifepristone’s safety and said to a federal agency, the expert on drug safety, ‘You were wrong,’" said Rachel Rebouché, dean of Temple University Beasley School of Law.

The ‘politicization of science’

The mifepristone case crystallizes "the politicization of science" in abortion regulation, Rebouché said. "But the stakes are getting higher as we have courts willing to strip federal agencies of their ability to make expert decisions."

Rebouché said that if the Supreme Court overrides the FDA’s expertise in regulating a 24-year-old drug like mifepristone, anti-abortion groups, like Students for Life of America, could find judges  receptive to false claims  that birth control pills, intrauterine devices, emergency contraception, and other forms of hormonal birth control cause abortion. They do not, according to reproductive scientists and U.S. and international regulatory agencies.

Justice Clarence Thomas wrote in his  concurring opinion  in  Dobbs  that the Supreme Court should reconsider the 1965 decision that guaranteed a constitutional right to contraception,  Griswold v. Connecticut , and decide whether to return the power to allow or regulate access to birth control to the states.

Tucked into the Alliance Defending Freedom’s filings is what scholars describe as an audacious legal strategy once on the fringes of the conservative Christian movement: an appeal to the Supreme Court’s conservative members to determine that  the Comstock Act , a dormant 1873 anti-vice law, effectively bans medical and procedural abortion nationwide.

Passed at a time when the federal government did not give women the right to vote and the  prevailing medical literature  summed up women’s sexuality by saying that "the majority of women (happily for them) are not very much troubled with sexual feelings of any kind," the long unenforced law carried a five-year prison sentence for anyone mailing "every article, instrument, substance, drug, medicine or thing which is advertised or described in a manner calculated to lead another to use or apply it for producing abortion."

References to the Comstock Act appear throughout anti-abortion legal filings and rulings: Kacsmaryk wrote that the act "plainly forecloses mail-order abortion in the present";  the 5th Circuit Court of Appeals wrote  if Comstock was "strictly understood" then "there is no public interest in the perpetuation of illegality"; Republican attorneys general  threatened legal action against Walgreens and CVS  last year citing Comstock as did anti-abortion cases in New Mexico and  Texas .

" State attorneys general need to go after and prosecute those who are illegally mailing abortion drugs into their state," said Kristan Hawkins, president of Students for Life of America.

"It’s very simple. If your state has passed a law saying that preborn human beings deserve, at the very minimum, the right not to be starved and killed," she said, "then those who are committing those crimes and violating the federal Comstock Act by shipping chemical abortion pills over state lines, there should be consequences."

Tracking abortion pills by mail is difficult — and that’s the point, Rebouché said.

"These more diffuse and mobile ways to terminate a pregnancy," she said, "really threaten the control that anti-abortion advocates seek to exercise over who and where and how someone can seek an abortion." This story was republished from KFF Health News.

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Texas woman charged with murder in 2022 abortion sues prosecutors for $1m

Lizelle Gonzalez says she suffered harm from two nights in jail and being identified as a murder suspect before charges were dropped

A Texas woman who was charged with murder over self-managing an abortion and spent two nights in jail has sued prosecutors along the US-Mexico border who put the criminal case in motion before it was later dropped.

The lawsuit filed by Lizelle Gonzalez in federal court Thursday comes a month after the state bar of Texas fined and disciplined the district attorney in rural Starr county over the case in 2022, when Gonzalez was charged with murder in “the death of an individual by self-induced abortion”.

Under the abortion restrictions in Texas and other states, women who seek abortions are exempt from criminal charges.

The lawsuit argues Gonzalez suffered harm from the arrest and subsequent media coverage. She is seeking $1m in damages.

“The fallout from Defendants’ illegal and unconstitutional actions has forever changed the Plaintiff’s life,” the lawsuit stated.

The Starr county district attorney, Gocha Ramirez, said Friday that he had not yet been served the lawsuit and declined comment. Starr county judge Eloy Vera, the county’s top elected official, also declined comment.

According to the lawsuit, Gonzalez was 19 weeks pregnant when she used misoprostol, one of two drugs used in medication abortions. Misoprostol is also used to treat stomach ulcers.

After taking the pills, Gonzalez received an obstetrical examination at a hospital emergency room and was discharged with abdominal pain. She returned with bleeding the next day and an exam found no fetal heartbeat. Doctors performed a caesarian section to deliver a stillborn baby.

The lawsuit argues that the hospital violated the patient’s privacy rights when they reported the abortion to the district attorney’s office, which then carried out its own investigation and produced a murder charge against Gonzalez.

Cecilia Garza, an attorney for Gonzalez, said prosecutors pursued an indictment despite knowing that a woman receiving an abortion is exempted from a murder charge by state law.

Ramirez announced that the charges would be dropped just days after Gonzalez’s arrest but not before she’d spent two nights in jail and was identified by name as a murder suspect.

In February, Ramirez agreed to pay a $1,250 fine and have his license held in a probated suspension for 12 months in a settlement reached with the state bar of Texas. He told the Associated Press at the time that he had “made a mistake” and agreed to the punishment because it allowed his office to keep running and him to keep prosecuting cases.

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The Anti-Abortion Endgame That Erin Hawley Admitted to the Supreme Court

Somewhat lost in the debate around abortion pills and oral arguments that took place at the Supreme Court in FDA v. Alliance for Hippocratic Medicine on Tuesday was one deeply uncomfortable truth: The very notion of what it means to practice emergency medicine is in dispute, with anti-abortion doctors insisting upon a right to refuse treatment for any patient who doesn’t meet their test of moral purity. Indeed, the right asserted is that in the absence of certainty about which patients are morally pure, the doctors want to deny medication to all patients, nationwide.

In public, the plaintiffs in this case—a group of doctors and dentists seeking to ban medication abortion—have long claimed they object to ending “unborn life” by finishing an “incomplete or failed” abortion at the hospital. But in court, they went much further. Their lawyer, Erin Hawley, admitted at oral argument that her clients don’t merely oppose terminating a pregnancy—they are pursuing the right to turn away a patient whose pregnancy has already been terminated . Indeed, they appear to want to deny even emergency care to patients whose fetus is no longer “alive,” on the grounds that the patient used an abortion drug earlier in the process. And they aim to deploy this broad fear of “complicity” against the FDA, to demand a nationwide prohibition on the abortion pill to ensure that they need never again see (and be forced to turn away) patients who’ve previously taken it. This is not a theory of being “complicit” in ending life. It is a theory that doctors can pick and choose their patients based on the “moral distress” they might feel in helping them.

It should come as no surprise that the same judge who tried to ban mifepristone in this case, Matthew Kacsmaryk, has also attempted to legalize anti-LGBTQ+ discrimination in health care nationwide. This is the ballgame: weaponize subjective religious beliefs against secular society to degrade the quality of care for everyone. If you can’t persuade Americans to adopt hardcore evangelical views, exploit the legal system to coerce them into it anyway.

Alliance for Hippocratic Medicine is at once embarrassingly frivolous and existentially important. Don’t let the jokes about how silly the Comstock Act seems , or how speculative the theory of standing is, get in the way of taking a serious look at the claims on offer. The plaintiffs say they are terrified that one day, a patient may walk into their emergency room suffering complications from a medication abortion prescribed by some other doctor. This patient may need their assistance completing the abortion or simply recovering from the complete abortion, which these plaintiffs deem “complicity” in sin. And they say the solution is either a total, nationwide ban on mifepristone, the first drug in the medication abortion sequence, or a draconian (and medically unnecessary) set of restrictions that would place mifepristone out of reach for many patients. (The U.S. Court of Appeals for the 5 th Circuit ruled to reinstate those restrictions at their behest.)

It is a twisted line of logic, one that should never have reached the Supreme Court in the first place. But it is also a product of the court’s past indulgence of outlandish claims about moral “complicity.” As was made plain in the oral arguments and briefing, activist doctors are no longer satisfied with personal conscience exemptions already granted under state and federal law; they now insist that nobody, anywhere, should have access to the abortion pill, in order to ensure that they themselves won’t have to treat patients who took one. At a minimum, they say, they should be able to radically roll back access to the pill in all 50 states to reduce the odds that one of these handful of objectors might someday encounter a patient who took it. This extremist argument lays bare the transformation of the idea of “complicity” from a shield for religious dissenters to a sword for ideologues desperate to seize control over other people’s lives and bodies.

At oral arguments, several justices pressed Hawley, who argued on behalf of Alliance for Hippocratic Medicine, with an obvious retort: Why can’t her clients simply refuse to treat these hypothetical someday patients on the grounds that they cannot help end the “life” of a fetus or embryo? After all, federal law guarantees doctors the right not to have to provide an abortion if doing so is “contrary to his religious beliefs or moral convictions.” Justices Amy Coney Barrett and Brett Kavanaugh secured assurances from Solicitor General Elizabeth Prelogar, early in the arguments, that under no circumstances could the government force any health care provider to ever participate in an abortion in violation of their conscience. Justice Elena Kagan asked Prelogar: “Suppose somebody has bled significantly, needs a transfusion, or, you know, any of a number of other things that might happen.” Would the plaintiffs object to treating them? Prelogar said the record was unclear.

Hawley, who is married to far-right Republican Sen. Josh Hawley, then approached the lectern and cleared up any confusion: Yes, she insisted, treating a patient who has undergone a medication abortion violates the conscience of the plaintiff physicians even if there is no “live” fetus or embryo to terminate anymore. “Completing an elective abortion means removing an embryo fetus, whether or not they’re alive, as well as placental tissue,” Hawley told Kagan. So the plaintiffs don’t object just to taking a “life.” They also object to the mere act of removing leftover tissue, even from the placenta.

Of course, these doctors must remove “dead” fetal tissue and placentas all the time—from patients who experienced a spontaneous miscarriage. By their own admission, the plaintiffs regularly help women complete miscarriages through surgery or medication. Those women they will gladly treat. Other women, though—the ones who induced their own miscarriage via medication—are too sinful to touch. Before the plaintiffs can administer even lifesaving emergency treatment, they need to know the circumstances of this pregnancy loss: Spontaneous miscarriages are OK; medication abortions are not.

Justice Ketanji Brown Jackson, too, zeroed in on this admission. She told Hawley that she had thought the objection was to “participating in a procedure that is ending the life [of the fetus].” Hawley told her no: Any participation in an abortion, even through the indirect treatment of a patient without a “live” fetus, violated the doctors’ conscience. So, wait. What about “handing them a water bottle?” Jackson asked. Hawley dodged the question, declining to say whether helping a patient hydrate would constitute impermissible complicity in sin.

All this is reminiscent of Little Sisters of the Poor , a case about a Catholic charitable group that was afforded an exemption from the Affordable Care Act’s contraception mandate. The Little Sisters were asked to check a box signaling to the government that they could not comply with the mandate, at which point the government would step in to cover their employees. But the Little Sisters refused, viewing this action—the checking of a box to opt out of coverage—as “complicity” in abortion because it would in turn trigger government payment for contraception (which they viewed as abortifacients). The Supreme Court and the Trump administration ultimately indulged the Little Sisters’ claim .

Here, we have emergency room physicians asserting that they will not participate in lifesaving medical intervention unless they approve of the reason for the pregnancy loss. Presumably, if the pregnant patient is an unwed mother, or a gay or transgender person, the doctor would be similarly complicit in sin and decline service. Seen through this lens, since one can never know which sins one is enabling in the ER, each and every day, a narrow conscience exemption becomes a sweeping guarantee that absolutely nobody in the country can ever have access to basic health care, let alone miscarriage management. (Of course, these plaintiffs might focus only on one set of “sins” they see as relevant.) In a country effectively governed by Kacsmaryk and his plaintiff friends, a gay person suffering a stroke could be turned away from any hospital because of his sexual orientation, all to spare a doctor from a glancing encounter with prior sin. As Tobias Barrington Wolff, a professor of law at the University of Pennsylvania Law School, put it to us in an email, this unbounded view of complicity “is part of enacting the social death of people and practices you abhor, which in turn can contribute to the material death of people and practices you abhor.”

One of the most exhausting lessons of post- Roe America is that being “pro-life” definitively means privileging the life of the presumptively sin-free unborn—or even their “dead” remains—over the life of the sin-racked adults who carry them. This is why women are left to go septic or to hemorrhage in hospital parking lots; it is why C-sections are performed in nonviable pregnancies, at high risk to mothers; it’s why the women who sued in Texas to secure exceptions to that state’s abortion ban are condemned by the state as sinners and whores . And it’s why—in the eyes of the Alliance for Hippocratic Medicine — it is a greater hardship for a physician to “waste precious moments scrubbing in, scrubbing out” of emergency surgery, as Hawley put it, so long as they don’t believe that the emergency warrants their professional services, than it is for a pregnant person, anywhere in the country, including in states that permit abortion, to be forced to give birth.

At oral argument, Hawley explained that her clients have “structured [their] medical practice to bring life into the world. When they are called from their labor and delivery floor down to the operating room to treat a woman suffering from abortion drug harm, that is diametrically opposed to why they entered the medical profession. It comes along with emotional harm.” The emotional harm alleged here is that unless these doctors approve of the specific circumstances of the ER visit, they violate not only their own medical preference but also their religious convictions. But they will never truly know enough about the sins of their patients to be able to shield themselves against being a link in a chain of subjective lifelong sin. And to be a doctor, especially an emergency physician, should be to understand that your patients’ private choices and spiritual life are not really open to your pervasive and vigilant medical veto. This deep-rooted suspicion of patients deemed insufficiently pure for lifesaving treatment didn’t begin with the availability of medication abortion. It will assuredly not end there.