The mission of Issues in Perspective is to provide thoughtful, historical and biblically-centered perspectives on current ethical and cultural issues.

Most Americans are anxiously awaiting the Supreme Court’s decision on the Mississippi case (Dobbs v. Jackson Women’s Health Organization), which will most likely be handed down in late June 2022.  The impact this decision will have on abortion in America was the topic of Issues in Perspective for 8 January 2022.  This edition of Issues gives focus to a number of presuppositions related to the volatile ethical issue of abortion.

• First, the phenomenal growth of medical abortions.  The Guttmacher Institute, a research group that supports abortion rights, estimates that 54% of abortions in 2020 were medical abortions.  [Medical abortions account for about two-thirds of abortions in northern European countries and about 90% in India.] Women can be prescribed mifepristone, which blocks the pregnancy-enabling hormone progesterone, by an online consultation with a doctor and receive it in the mail.  A second drug, misoprostol, which causes the uterus to contract and expel the fetus, taken several hours later, has several uses (e.g., dealing with ulcers) and is available over the counter in pharmacies.  Abortion medication is much cheaper than going to a clinic.  In a clinic the cost of a drug-induced abortion is between $500 and $800.  Buying the pills from one of the growing number of telemedicine startups costs about $200.  For example, Aid Access, a European service, mails the necessary pills to women regardless of state laws.  There has been a surge in such orders in the state of Texas since the law banning abortions after six weeks was passed last year.  Women can also buy direct from overseas pharmacies.  Various groups in Europe provide online ordering of the pills, including to women in the US, from pharmacies outside the country.    In addition, women are often very creative is getting around various state laws.  Kate Zernike of the New York Times reports that a woman in a state that bans abortion can order the pills and have them mailed to a friend in a state that does not ban the pills and the friend then either delivers them to the pregnant woman or forwards the package to her friend.  [The FDA had initially approved the use of mifepristone to terminate a pregnancy in 2000, but required that it be provided in person by a doctor.  But with the COVID-19 crisis, it allowed obtaining the pills via online connections with a doctor.]
• Second, are states beginning to prohibit medical abortions?  Already 19 states prohibit pills from being prescribed by telemedicine or delivered through the mail.  Nine additional states are proposing to do the same.  Furthermore, about half of the states are expected to outlaw abortions if the Supreme Court overturns or weakens Roe v. Wade.  Zernike reports that telemedicine requires doctors to follow the law where the patient is, “so doctors in other states cannot prescribe or provide pills to women in any state that has a ban.  Many of the new bills layer criminal penalties on top of existing prohibitions, on the assumption that women will procure the pill illegally.”   For example, Texas recently passed SB 4 against medication abortions, which establishes a criminal violation for delivering the pills, making it a state felony punishable by a $10,000 fine and up to two years in prison.  A bill in Iowa would have similar penalties.  Zernike also details that a recent Kentucky law establishes a new state certification program for pill providers and will require their names to be published.  It also creates an anonymous “complaint portal,” which abortion rights supporters say will encourage harassment against providers.  Nonetheless, almost everyone agrees that “the laws against mailing pills will be hard to enforce, as laws generally avoid punishing women who get abortions.”  There is no question that regardless of the June decision of the Supreme Court, medical abortions are going to be much more difficult to regulate and to police.
• Finally, Tish Harrison Warren, a priest in the Anglican church, provides a penetrating set of insights into the ideology of abortion.  She writes that “when it comes to abortion, the left can speak of choice in overly simplistic ways . . . what kind of world [did Roe v. Wade create?]  What is often unacknowledged is that the widespread availability and at times encouragement of abortion creates systemic realties where abortion becomes the easier choice for women who have unintended pregnancies—to the extent that these women can feel that it is their only choice.”

1. “. . . a culture that embraces abortion on demand will end up, however unintentionally, incentivizing that choice.  This has downstream consequences from women deciding whether to continue with a pregnancy.  In extreme situations, employers have demanded that women have an abortion or lose their job.  But the pressure to abort is often more subtle.”
2. She goes on to give focus to the major [supposed] benefit of abortion:  “Stories abound of women who say that having an abortion is what allowed them to go on to a successful career.  But these stories tacitly acknowledge that abortion on demand has created a culture where the social status of women depends on us naming one, and only one, choice when faced with an unplanned pregnancy. Abortion is cast as the price for entry for women’s equality.  But it doesn’t have to be that way.  Many European countries have far more restrictive abortion laws and lower abortion rates that the US without curtailing the advancement of women.”
3. She concludes that “women feeling that they must extinguish life in their womb in order to be admitted into the world of success, career advancement and equality with men is a reality shaped more by sexual double standards and male-centric acquisitive capitalism than by valuing women’s choices, bodies and desires.  This allows a still-patriarchal society to not invest in systems that make childbearing an easier choice: a more just work culture . . . with paid parental leave, widespread availability of lactation rooms, better access to maternity care, affordable health care for children and government-subsidized child care.”

The abortion issue within American civilization remains one of the most decisive, gut-wrenching, polarizing issues in our culture.  Only the issue of slavery was more divisive.  Medical abortions are clearly the new frontier of the abortion “culture war.”  This will much more difficult to deal with than organizing protests at abortion clinics or passing state laws restricting access to these clinics.  It will be much more difficult to regulate and enforce laws against medical abortions.  It will be much easier for a woman seeking an abortion to find a way to get the pills necessary for an abortion than to find a clinic in another state where abortion is still legal.  Warren’s essay also raises several piercing questions about a woman’s choice.  She has shown convincingly that our culture actually fosters the choice of an abortion as a means to success, advancement and opportunity.  She is arguing that we must change the cultural norms that embrace babies as a natural aspect of life and make to easier for a woman to keep her child than to abort her child.  One may not agree with all of her proposals but she raises a very valid point about the American culture of abortion.  May God give us creative and imaginative wisdom to meet the next wave of abortions in America.

See Kate Zernike in the New York Times (6 April 2022); The Economist (5 February 2022), p. 24; and Tish Harrison Warren in the New York Times (24 January 2022).