New Laws Haven’t Slowed Abortions, and They’re Costing Lives

If the right wanted to bring more babies into the world by banning abortion, the plan is backfiring.

In fact, abortions have increased since June 2022, when the Supreme Court overturned Roe v. Wade. Every state without a ban — especially those adjacent to red states — saw a rise in abortions from 2020 through 2023.

But even women facing severe restrictions have managed to end their pregnancies. In 2023, abortion in the U.S. reached its highest level in over a decade, according to the Guttmacher Institute — and that’s counting only terminations recorded by the formal health care system.

While surgical abortions are harder to get, the word is out about self-managed abortions using pills. Online services like PlanC, Aid Access, and Abuzz disseminate the information; shield laws protect blue-state providers from red-state prosecution if they prescribe pills via telehealth and mail them to patients living under the bans. Abortion funds are in overdrive helping abortion-seekers with travel, child care, and medical costs.

The right is actively seeking to ban every one of these tools: telehealth prescription, self-management, out-of-state travel, and funds that “aid and abet” abortion-seekers. At the same time, a U.S. feminist underground with links to overseas suppliers is outrunning the posse, sending out pills without professional intervention and at low cost, even gratis.

Ironically, now that abortion is gone or all but gone in 21 states, feminists have realized the dream of over half-century of activism: free abortion on demand without apology.

But abortion isn’t the only thing impeding births in the U.S. Since Dobbs v. Jackson Women’s Health Organization, the ruling that nullified Roe, a growing number of people still young enough to have children are getting sterilized. Tubal ligations and vasectomies among adults ages 18 to 30 were creeping up before the ruling. But following it, “we observed an abrupt increase,” report the authors of a research letter published last month in JAMA Health Forum.

The researchers couldn’t break the data out by state or race. But unsurprisingly, the trend is gendered. As with birth control, unwanted pregnancy, and parenthood, the greater burden of “permanent contraception” is falling on women: “The increase in procedures for female patients was double that for male patients,” write the authors, three Pennsylvania public health policy experts.

The U.S. could see more people choosing voluntary sterilization in the future. Birth control is still legal and constitutionally protected — and 9 in 10 American women have used it. But the religious right is chipping away at that too.

In 2014, in Burwell v. Hobby Lobby Stores, Inc., a split Supreme Court ruled that certain private companies can cite religious objections to get out of covering the cost of contraception for their employees under the Affordable Care Act. A few days later, the same slim majority decided that Wheaton College, a Christian school already exempt from using its insurance policy to pay for birth control, was unduly burdened by having to fill out a form so that a third party could cover the cost.

A 2020 lawsuit by a Christian father challenging his daughter’s right to get birth control without parental consent is a piece of the anti-contraception long game, modeled on the strategy that slowly killed abortion rights. Just three years after Roe, in 1976, a Missouri requirement that minors get written parental consent for abortion was the first restriction upheld by the Supreme Court. And Donald Trump, who likes to take credit for delivering Dobbs to the right, hinted that he’d be OK with state crackdowns on contraception. (Then he walked it back. As usual with Trump, who knows what’s true.)

Emotionally, early sterilization is not simple. The right has long claimed that women who terminate pregnancies suffer “post-abortion syndrome,” a lifelong residue of depression and regret. PAS does not exist. In fact, the most common post-abortion emotion is relief. But post-sterilization regret is real, and a 2005 study found that the younger a woman is when she has her tubes tied, the more likely she is to wish she hadn’t, request a reversal, or seek in vitro fertilization to have a baby.

The authors of the post-Dobbs sterilization study surmise that some of these procedures were contemplated before Roe was overturned, but felt suddenly urgent when the bans came down. If oral contraceptives, IUDs, or morning-after pills (all of which the antis have incorrectly called “abortifacients”) become unavailable, permanent contraception will be the last reliable option.

If sterilization with regrets can be sad, some other effects of the bans are tragic.

Almost immediately after the June 2022 ruling, stories started emerging of pregnant people forced to drive hours out of state while miscarrying, carrying dead fetuses, feverish and in pain; of women going into sepsis or losing their fertility — all because doctors feared breaking the law by practicing good medicine.