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In this edition:
2018 CDC numbers
Medical abortion and the Biden administration
Judith Jarvis Thomson (Oct. 1929 – Nov. 2020)
Quick links
Off topic
The CDC reported recently that the abortion rate climbed slightly between 2017 and 2018, though not by enough to erase the previous decrease between 2016 and 2017. Of reporting states, Illinois had the greatest increase in abortions from 2017 to 2018 (+3,112), while some states saw a decrease, such as New York, which had the greatest reduction (-5,519). If we focus on just 2018 itself, South Dakota had both the fewest abortions (382) and the lowest abortion rate. New York, on the other hand, had the most abortions in that year (77,447), while the District of Columbia had the highest rate (if we only include actual states, New York again had the highest rate).
To be sure, differences between states can trace to a number of factors, and the abortion rate in any given state isn’t simply determined by its abortion law. This becomes clear when you compare the CDC numbers with the 2018 “life list” put out by Americans United for Life (AUL). The latter ranks states according to how pro-life their laws are. Kansas, which was the 5th most pro-life state in the AUL list, had a higher abortion rate than Vermont, which was 48th in the AUL rankings. West Virginia, which was ranked 30th by AUL, had the 6th lowest rate. Georgia and Michigan both had among the highest abortion rates in the country, but were ranked 8th and 9th by AUL, respectively.
But policy does play a role. For example, as Michael New points out in reflecting on these CDC figures, “in 2018 [on Jan. 1st], Illinois began funding elective abortion through the state Medicaid program.” It seems likely that the subsequent increase in Illinois abortions noted above—the numbers at the end of the first full year of this change (2018) compared to numbers of the previous year (2017)—can be at least partly attributed to that policy change. (In one of those disingenuous moves that’s all too common on both sides of the abortion debate, an official with the Illinois Planned Parenthood tried to downplay the possibility that the Medicaid change raised the numbers; while she’s right that causation is obviously always complex, the pro-choice argument for covering abortion with Medicaid is precisely that it would allow more women to afford it).
Recent weeks have seen several abortion policy developments in states including Ohio, Massachusetts, Louisiana, Tennessee, Nebraska, and New Jersey. Some developments seem to have more potential to affect directly the abortion rate than others, but good policy pursued (or bad policy resisted) can make a difference.
To pick up a point from the previous section: If the Illinois Medicaid change really did contribute to that state’s abortion increase in 2018, then we have further evidence that repealing the Hyde Amendment, a policy shift that’s high on the pro-choice wishlist, could contribute to raising the abortion numbers nationwide. Recently, the Labor-HHS-Education House Appropriations Subcommittee held a hearing precisely designed to make the case for the amendment’s repeal.
Pending the outcome of the Georgia senate runoffs, however, the politics of pursuing a Hyde repeal and the mechanics of getting it through Congress could be difficult. There is another policy change open to the Biden administration, however, that would likely generate less controversy, bypass Congress, and just as drastically reshape American realities. It’s not the Mexico City Policy, which seems destined, more or less, to be tossed back and forth between Republican and Democratic administrations forever. Rather, it contains federal regulation of so-called medical abortions.
In The Atlantic, Greer Donley argues that the Biden administration could “look outside legislation and the courts” to advance a pro-choice agenda, specially by revising current FDA policies that restrict the distribution of mifepristone, “the only drug the FDA has approved to safely and effectively terminate an early pregnancy.” Donley lays out how it could be done, and argues (I think correctly) that “the political risks for Biden would be low.”
I agree that the political risks are low because this is precisely the kind of issue that the pro-life movement is currently unequipped to argue persuasively. In the event of a serious FDA review, pro-lifers would almost certainly defend the regulations on mifepristone on medical grounds—that they aren’t safe for the mother (or something to that effect). The substantive debate about the nature of what abortion is and does would be sidelined for a medical debate, which pro-lifers would both lose and be seen as disingenuous for invoking to begin with. If pro-lifers did engage the substantive point, they might also lose, but at least they would do so in a way that allows them to emphasize their central case.
Donley notes that even if FDA rules were revised, 19 states have their own restrictions on the drug that would still be in effect—and more states might pass such restrictions in the event of an FDA change. Still, if the FDA were to alter its policy, the current regulations (unlike the Mexico City Policy) would be difficult, if not impossible, to reinstate, and the impact of this shift could be profound. This possible change, more than the Mexico City Policy or even (pending the Georgia results) a Hyde amendment repeal, is the more urgent priority for pro-lifers to try to prepare for more effectively.
Judith Jarvis Thomson died on November 20th. She was famous, of course, for her arguments that abortion could be morally licit, the so-called ‘violinist’ and 'people-seeds' thought experiments. Responding to Thomson’s arguments became a standard task in pro-life literature, and philosophers and others are still taking it up. For example, Angela Knobel, an Associate Professor of Philosophy at The University of Dallas published a (gated) article last year on the topic, issuing a less standard response that is well worth engaging with.
I won’t get into responding to Thomson’s arguments here. Without doing so, however, I will point out a couple of notable things about her original paper from the standpoint of today’s debate. One is how much Thomson concedes about the nature of the fetus—more than many, if not most, pro-choice writers would concede today:
I am inclined to agree, however, that the prospects for "drawing a line" in the development of the fetus look dim. I am inclined to think also that we shall probably have to agree that the fetus has already become a human person well before birth. Indeed, it comes as a surprise when one first learns how early in its life it begins to acquire human characteristics. By the tenth week, for example, it already has a face, arms and less, fingers and toes; it has internal organs, and brain activity is detectable.
Of course for Thomson, this is just the beginning of the argument, not the end—hence her thought experiments and the majority of her paper. But it is striking that many prominent pro-choice voices would concede less in this regard today than Thomson did in 1971, writing just at the start of the decade when ultrasounds would become more widely used.
And then there is this remarkable quote from Thomson, which matches pretty precisely a critique that has been made from within a pro-life perspective:
Opponents of abortion have been so concerned to make out the independence of the fetus, in order to establish that it has a right to life, just as its mother does, that they have tended to overlook the possible support they might gain from making out that the fetus is dependent on the mother, in order to establish that she has a special kind of responsibility for it, a responsibility that gives it rights against her which are not possessed by any independent person--such as an ailing violinist who is a stranger to her
Finally, relevant to the possibility of ectogenesis, Thomson remarks: “All the same, I agree that the desire for the child's death is not one which anybody may gratify, should it turn out to be possible to detach the child alive.”
Quick Links:
Barbara Waxman Fiduccia recently received an obituary as part of the NYT’s “Overlooked” feature, in which “remarkable people whose deaths, beginning in 1851, went unreported in The Times” receive belated acknowledgment (h/t Leah Libresco Sargeant). Fiduccia was a disability advocate with spinal muscular atrophy. For a time, she worked for Planned Parenthood as a “health educator and disability project coordinator.” “But,” the obituary notes, “Fiduccia eventually left Planned Parenthood, pained by what she called a ‘strong eugenics mentality that established disdain, discomfort and ignorance toward disabled babies.’” She died in 2001.
In the NYT, Ian Marcus Corbin urges Americans to “stop being ashamed of weakness.” Relatedly, Leah Libresco Sargeant discusses “a re-appreciation of weakness” as part of Plough’s family issue (more). Also in the Plough issue: Ross Douthat on “The Case for One More Child” (more).
Sarah Zhang reports in The Atlantic on prenatal testing, Down syndrome, and abortion. In America, J.D. Flynn responds to The Atlantic story, reflecting on his own experience with two kids with Down syndrome: “But I have realized they are not unique because they suffer. They are unique because they do not hide suffering well.”
A new book on premature birth: “In What We Didn’t Expect, Melody Schreiber brings together acclaimed writers and thinkers to share their diverse stories of having or being premature babies…”
A run down of possible abortion cases that could come before the Supreme Court. There’s nothing definite here, and nothing that seems like a slam dunk case, but it’s useful to see what might make the headlines in coming months.
Off-topic:
“We who must die demand a miracle.
How could the Eternal do a temporal act,
The Infinite become a finite fact?
Nothing can save us that is possible:
We who must die demand a miracle.”
-From Auden’s “For the Time Being”
Happy holidays, all.