The XX Factor

Most U.S. Women Live in States With Abortion Laws That Conflict With Science and Facts

“I am lying to you because the law says I have to.”

At a celebratory Rose Garden gathering after House Republicans passed the American Health Care Act last week, Majority Whip Steve Scalise lauded one of bill’s most important goals: “making sure that patients and doctors are the ones that make their own health care decisions.” Scalise may be sad to learn that a slight majority of U.S. residents have the pre-existing condition of womanhood, and the majority of those women-people live in states where abortion restrictions divorced from medical reality limit the decisions they and their doctors can make.

In 2016, a study of just two months of U.S. state legislative action found that 353 abortion-restriction bills had been proposed, and 70 percent were based on lies. A new analysis from the Guttmacher Institute has identified 10 types of these anti-abortion laws that directly contradict scientific research and medical knowledge. People in Kansas and Texas have it worst: Their states have laws on the books in eight of the 10 categories. Louisiana, Oklahoma, and South Dakota are close behind with laws in seven of the categories. In these places, when women meet with their doctors, they’re not alone. The spirits of right-wing state legislators past and present are right there with them, whispering conspiracy theories and erecting themselves like a border wall between a patient and the medical procedure she needs.

Many of these laws are the kinds of targeted regulations on abortion providers that have grown in popularity in recent years under the guise of protecting women’s health. Eighteen states compel abortion clinics to meet the exacting standards of ambulatory surgical centers, with detailed requirements for things like hallway width and never-used medications they must keep in stock. Other states require abortion providers to have admitting privileges at nearby hospitals, even though hospitals must admit any patient in an emergency, and less than one-third of 1 percent of abortion patients end up hospitalized. Some states prohibit doctors from administering medication abortion through telemedicine, a critical resource for reaching remote patients, even though the American College of Obstetricians and Gynecologists advises that it can be done safely and effectively. Studies have shown that physician assistants and other advanced practice clinicians such as nurse practitioners can perform abortions without a significant increase in complication rate over those performed by doctors, but 38 states have passed laws that only let physicians provide abortion care.

There are also limits in some places on when in pregnancy a patient can get an abortion, based on made-up claims that fetuses can feel pain at 20 weeks’ gestation. Other states force patients to wait days between her initial appointment and her abortion—legislators justify these laws with the paternalistic argument that women who visit abortion clinics don’t know what’s going on and need a mandatory time-out to think about what exactly they’re doing. Large and longitudinal studies have shown that the vast majority of abortion-seeking women are already sure of their decision and don’t regret it later.

Then there’s the really fun stuff: the straight-up lies some states make doctors tell their patients to try to scare them out of abortions. No other medical procedure has been legislated to require doctors, against their will, to say things that contradict scientific evidence. But for abortion, doctors practicing in 11 states must tell abortion-seeking patients that the procedure might cause mental health problems (wrong), loss of fertility (nope), and breast cancer. That last one—where have I heard that one before? Oh, right. The people in charge of our federal health agency! Donald “Loves Women” Trump recently appointed two anti-abortion zealots to top roles at the Department of Health and Human Services, and both insist that abortion makes women get breast cancer. Against all scientific research and the consensus of the major institutions in cancer research and women’s health, Charmaine Yoest and Teresa Manning, who are now directing and spinning U.S. health policy, claim that abortion providers are in cahoots with scientists to hide evidence that breast cancer is a side effect of abortion.

When she was heading up the radical anti-abortion group Americans United for Life, Yoest drafted many of the “women’s health”-related restrictions on abortion providers that states passed in 2011 and 2012. The Supreme Court tore up those claims of protecting women in its Whole Woman’s Health v. Hellerstedt decision in 2016, arguing that abortion is already safe and added restrictions only harm women’s health by impeding their access to care.

Now that that argument no longer flies, Yoest, Manning, and their allies in Republican-majority statehouses must be working hard to come up with the next exciting trend in health-care obstruction. I, too, spend a lot of my time thinking about right-wingers forcing women to carry unwanted pregnancies to term, so I’ve come up with a few suggestions of policies they could try:

  • Any patient who wants an abortion must come up with a list of 10 pros and 10 cons about “killing my baby,” then discuss with a priest.
  • During their mandatory 72-hour waiting period, abortion-seeking patients must wear those little aborted-fetus foot pins on their lapels.
  • Abortion clinics must install embryo-patterned wallpaper, except the “embryos” will be sobbing fully-developed infants instead of dispassionate clumps of cells.
  • Abortion providers must tell all patients that abortion carries with it the risk of developing unsightly facial hair, flabby upper arms, MRSA, and vocal fry.
  • Abortion providers must ask a patient, “Are you sure?” before performing an abortion. If she says yes, the required follow-up is “But are you really sure?” followed by “Really really sure?” followed by “Pinky swear?” followed by “Cross your heart, hope to die, stick a needle in your eye?” followed by a thorough check to make sure none of the patients fingers or toes are crossed.
  • Before authorizing a woman’s abortion, every doctor must weep silently while reading “Love You Forever” aloud to her.
  • When patients arrive for an abortion procedure, they must get in a little boat and float through a 45-minute “It’s A Small World After All”-like ride depicting the long and fulfilling life a fetus might have. The last scene is an approximation of hell, where the patients will spend eternity.