Bulwark Against an Abortion Ban? Medical Advances

As partisans on each side of the abortion divide contemplate a Supreme Court with two Trump appointees, one thing is certain: America even without legal abortion would be very different from America before abortion was legal.

The moment Justice Anthony M. Kennedy announced his retirement, speculation swirled that Roe v.Wade, the landmark 1973 ruling that legalized abortion would be overturned.

Most legal experts say that day is years away if it arrives in the least.

A more likely scenario, they predict, is that a rightward-shifting the court would uphold efforts to limit abortion, which would encourage some states to further limit access.

Even then, a full-fledged return to an era of back-alley, coat-hanger abortions seem improbable.

within the decades since Roe was decided, a burst of scientific innovation has produced simpler, simpler, and safer ways to prevent pregnancies and to stop them after conception — advances that have contributed to abortion the rate that has already plunged by half since the 1980s.

“We’re during a new world now,” said Aziza Ahmed, a law professor at Northeastern University who writes about reproductive rights law.

“The majority of yank women are on some sort of contraception.

We take it without any consideration that we will control when and how we would like to breed.

We see pregnancy as within the realm that we will control.”

Women have powerful tools at hand: improved intrauterine devices and hormonal implants which will prevent pregnancy for years at a time;

inexpensive home pregnancy tests ready to detect pregnancy very early; and morning-after pills, some even available over the counter, which may prevent pregnancy if haunted to 5 days after unprotected sex.

Medication abortions enable women up to 10 weeks pregnant to require two pills, the first

supervised by a doctor and therefore the second reception, to terminate a pregnancy without surgery.

In 2013, nearly 1 / 4 of abortions were accomplished with medication, up from 10 percent in 2004.

Even in countries that have banned virtually all abortions, including some in Latin America, women have managed to urge these drugs from websites and abortion rights organizations that ship them.

And the Affordable Care Act, which has thus far defied repeated repeal attempts have made birth control available to poor and working-class women, and also to those with private coverage through employers, with its requirement that the majority insurers cover the complete cost of contraception.

Apps and telemedicine services are making contraception pills and other methods available without even a visit to a doctor.

Still, legal changes that make abortion less available would have profound effects on millions of women, disproportionately affecting African-Americans, Latinas, and ladies struggling economically.

And access to contraception is often problematic for low-income single women within the 19 states, including Texas and Florida, that has still not expanded Medicaid coverage for poor single adults.

Despite the new drugs and technologies, nearly half all pregnancies within the United States are unintended, a better rate than in many other developed countries.

A report this year by a committee of the National Academies of Sciences, Engineering and Medicine found that three-quarters of girls who have abortions are poor or low-income, and 61 percent are women of color.

Such women bear the brunt of state laws that restrict abortion, including those requiring multiple appointments or waiting periods or that limit which providers can perform abortions.

Such hurdles and delays could eventually threaten the consistently high level of safety in abortion procedures, experts said.

“We found that more and more regulations on abortion and abortion procedures reduced the standard of care,” said the committee’s cochairwoman,

Dr. Helene Gayle, president, and chief executive of the Chicago Community Trust.

“The people most impacted are the immigrant women already under siege, low-income women, women of color, transgender and queer women,” said Jessica González-Rojas, the executive director of the National Latina Institute for Reproductive Health, which works with women within the Rio Grande Valley in Texas.

“Having a Supreme Court friendly to those  restrictive laws makes it a de facto ban thereon quite health care, abortion, and contraception.

Legal access without real access isn't accessing in the least.”

In some states, though, the impact of anti-abortion laws are often hard to live.

A recent report on 2014 data by the Guttmacher Institute, a search the group that supports abortion rights, found that while the national abortion rate had reached its lowest since the Roe v.

Wade decision, the speed rose modestly in six states — five of which had introduced restrictive abortion laws.

The report also found that in states where the amount of abortion clinics had increased, women weren't necessarily having more abortions.

New Jersey went from having 24 clinics in 2011 to 41 in 2014, but abortions declined from about 47,000 to about 44,000 during that point.

Overall, abortion rates have declined almost steadily since 1981, when the speed was 29.3 per 1,000 women.

In 2014, there have been an estimated 926,200 abortions — a rate of 14.6 per 1,000 women, ages 15 to 44.

Back When Abortion Was Banned?

When abortion was outlawed, initially by state laws within the 19th century, women still managed to get them, sometimes with doctors or midwives, sometimes with unlicensed abortionists.

“Making abortions illegal didn’t stop them ever,” said Linda Gordon, a professor of history at any University.

The so-called Comstock obscenity laws passed from 1873 through the first 1900s made it illegal to offer, sell, mail, or transport any item used for contraception or abortion.

After that, “Margaret Sanger built a movement by compromising,” Dr. Gordon said.

“They would campaign for the legalization of contraception but not abortion.”

Even after the contraception pill went on the market in 1960, contraceptives were only provided to women who were married.

“When I used to be in college, there was a marriage ring that was shared among young women once they wanted to ascertain a doctor to urge contraception,” Dr. Gordon said.

Abortions were often arranged through networks of clergy or women who helped people find, visit, and buy providers.

Johanna Schoen, a professor at Rutgers University in New Brunswick, N.J., who specializes in the history of women’s reproductive health, said the fate and rate of abortion are going to be intertwined with the supply of contraception, and whether antiabortion political forces also aim at contraception.

Professor Schoen said many European countries have low abortion rates because birth control and sex education are widely available.

“But within us, the same people who try to limit abortions have tried to limit contraception, too.”

Death by Thousand Cuts?

Carol Sanger, who teaches reproductive rights at Columbia school of law, predicts that the Supreme Court won’t overrule Roe v. Wade anytime soon.

Developing a case that might be an immediate assault takes years, she said.

“You don’t say, ‘Kennedy’s out, Roe’s overturned,’” Ms. Sanger said.

The doctrine of precedent, referred to as stare decisis, “to stand by things decided,” is sturdy.

Circumstances must be extraordinary, a law unworkable, for a court to overrule itself, Ms. Sanger said.

“It stands for the thought that the substance of our law doesn’t blowback and forth simply because we get a replacement administration.”

Another reason Roe v. Wade might not be struck down? “You can do a heck of tons of damage without overturning it,” she said.

In the 45 years since the ruling, anti-abortion activists have largely focused on lobbying state legislatures for laws that delay or limit access to abortion, including mandating parental notification by teenagers, longer waiting periods, and strict requirements for clinics.

Among such initiatives, said Susan Swayze Liebel of the Susan B. Anthony List, an antiabortion organization, “fetal pain” laws became a “top priority.

” Some 20 states have enacted these laws, which assert that a fetus can feel pain at 20 weeks after conception — a claim refuted by most doctors.