Vol. 258 June 15, 2021 Is Roe vs. Wade Really Under Attack?

The U.S. Supreme Court has agreed to hear an appeal of a Mississippi law banning abortions after 15 weeks of pregnancy. If the Mississippi state law is upheld by the Supreme Court it will increase the time restriction on abortion by reducing the allowable window from the 22 weeks (“point of fetal viability out of the uterus”) established in Roe vs. Wade (1973) and many subsequent federal and state court cases.

Is this an attack on access to abortions as allowed by the Roe vs. Wade decision? Or just a new position on the slippery slope of abortion timing? Or an affirmation of the increasing number of state laws restricting access to abortion clinic services? What are the actual “stakes” of this Supreme Court deliberation? As is true of many issues in the medical/political interface, “it depends on how you look at it”. Some people view this as a frontal attack to overturn Roe. Others view it as a somewhat moot point because of the changes in abortion technology since 1973.

To help understand the stakes involved, let’s list some of the stated concerns and some facts related to them.

  • if Roe is overturned, legal abortion clinics in the South and MidWest will decrease markedly, but will remain unchanged in half of our states.
  • if Roe is overturned, the average distance to travel to an abortion clinic in some states may go from 35 miles to 279 miles.
  • if Roe is overturned, there will be an estimated 14% decrease in legal abortions. Clinic abortions have declined by 7% from 2014 to 2017 probably due to better contraceptive use (“Plan A” and “Plan B”) and increased “self-management” using medications (“Plan C”).
  • 40% of all clinic abortions in 2017 were actually medication abortions – two different pills taken over 5 days; 98% effective if taken within 10 weeks of pregnancy initiation; no surgery required; very rare side effect incidents.
  • both medications are available online without a prescription and with instructions for about $200. A clinic-supervised medication abortion costs about $500.

Non-invasive plans to avoid having a baby:
Plan A
– use of contraception to prevent fertilization
Plan B -use of an emergency contraceptive pill known as the “morning after pill” which temporarily delays ovulation so that fertilization does not occur. No prescription, no identification, and no age requirement needed to obtain this medication across the counter.
Plan C-self administration of two pills before 10 weeks after a missed period, one pill is a hormone blocker and one causes uterine contractions  Pills are available online and are the same medications used by clinics in medication abortions.

“When you say a self-managed abortion, people think about a coat hanger or a back-alley abortion,” said Abigail R. A. Aiken of the University of Texas at Austin, who has studied the safety of self-managed abortions and the reasons women choose them. “The reality is we’re sitting here in 2019, and it’s not like that anymore. You can go online, and you can fill out a form, and you can get this safe and effective technology delivered to your home.”

Most polls since 1995 indicate that public opinion on abortion access has been fairly steadily positive unlike the wildly swing of views on same-sex marriage and marijuana legalization. People have different views of the type of restrictions or eligibility criteria for abortion, but the opinions are steadfast. Today over 50% polled by Gallup or Pew polls support access to abortion, and about 35% of those polled want some level of restrictions.

Some political observers suggest that a Supreme Court decision to limit abortions to the first 15 weeks of pregnancy could even benefit those advocating continued access to abortions because over 90% of legal abortions done now are already done before 15 weeks, and de-escalation of the rancorous debate over Roe vs. Wade might occur if pro-abortion advocates would no longer have to defend some of Roe’s more restrictive clauses.

In reviewing the real data of current practice and current statistics I feel that the Supreme Court decision, either way, will not have the cataclysmic consequences that zealots on both sides imagine. We have been on a “slippery slope” since 1973, and as an eternal optimist I doubt that a Supreme Court decision either way in this case will change the “slipperiness” very much. But, I would probably feel a lot less comfortable if I were the owner of the only remaining abortion clinic in Mississippi.  

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