In the decades in which Roe v. Wade was the law of the land, abortion rights groups tried to garner support for it by declaring that “abortion is health care.”
Now, two years after the Supreme Court eliminated the constitutional right to abortion, and just six months before the presidential election, that slogan has become reality.
The public discussion about abortion has become about the complications of pregnancy and reproduction, as the consequences of the bans have been revealed in the news. The question now is not just whether you can get an abortion, but also whether you can get an abortion if you go into septic shock because of pregnancy complications? Can you find an obstetrician, even though many people are leaving states with bans? If you have a miscarriage, will the hospital send you home to have blood drawn? Can you and your partner have in vitro fertilization?
This shift helps explain why a record percentage of Americans are now declaring themselves single-issue voters on abortion rights — particularly among black voters, Democrats, women, and people ages 18 to 29. Republican women are increasingly saying their party’s opposition to abortion is too extreme, and Democrats are now moving forward on the issue after shying away from it for years.
“When the Dobbs case came out, I said to my friends — somewhat, but not entirely jokingly — that America was about to be treated to a long seminar on obstetrics,” said Ellen Kamarck, a fellow at the Brookings Institution, referring to the Supreme Court decision overturning Roe v. Wade.
Abortion opponents say that stories of women experiencing medical complications are exaggerated and that women who genuinely need abortions for medical reasons have been able to obtain them under exceptions to the restrictions.
Still, a poll taken in April found that 46 percent of registered voters had heard stories that women had to cross state lines to get abortions because of pregnancy complications — an 11-point increase from September. In the latest abortion case before the Supreme Court, justices of both ideologies pressed Idaho lawyers to explain how the state could refuse to allow a woman who was bleeding uncontrollably after her water broke early.
The Biden campaign has dispatched six women to battleground states as it tries to mobilize voters around Monday's two-year anniversary of the decision to overturn Roe: Five were denied abortions while they went into septic shock, fainted, had a miscarriage or learned the fetus did not have a skull; the sixth woman could not fulfill her plans to have a second child through IVF because an Alabama Supreme Court ruling closed clinics in the state.
Tressa Andam, who has been polling public opinion on the abortion issue for 25 years, estimates that before the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, the case that overturned Roe, less than 15 percent of the public considered abortion personally relevant — those women who could get pregnant and choose abortion.
“Now it's about pregnancy, and everybody knows someone who has had a baby or wants to have a baby or might be pregnant,” she said. “It's extremely personal for most people.”
In their surveys and focus groups, voters link abortion to concerns about safety, health, and medical care. 73 percent of independents who support abortion rights said stories of women nearly dying because of restrictions would influence how they vote.
“People used to talk about politicians trying to control our bodies,” he said. “Now it's like they have no say in these medical decisions, these politicians don't have medical expertise, they're making these laws, and they're not basing it on health care or science.”
Americans have generally been vague about the details of reproduction. When Ms. Undem asked adults in a survey in August 2020 if it was true that “most women have their period on the first of the month,” 75 percent answered correctly — false — but a remarkable 21 percent said they were “not sure.” Two months after Dobbs, 22 percent of adults said they were unsure whether there are (are not) egg shells inside a woman’s ovaries.
But in the past two years, women have spoken openly publicly and on social media about pregnancy complications that could have led to, or become, a miscarriage. Many had stories similar to those of model Chrissy Teigen, who announced in September 2022 that she belatedly realized that the procedure she had previously described in a social media post as a miscarriage at 20 weeks was actually a miscarriage caused by pregnancy complications.
Anti-abortion groups have responded by trying to distinguish between “elective abortion” for unwanted pregnancies — which they want banned — and “maternal fetal separation” in medical emergencies. (The medical procedure is the same.)
“Pro-abortion Democrats resort to fear-mongering to advance their radical abortion agenda rather than giving women the facts they deserve,” said Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America.
Still, there is a push by anti-abortion activists to establish that life begins at conception, raising concerns about how restrictions on abortion affect popular health care procedures. Republicans in Congress stepped in to defend IVF this month after the Southern Baptist Convention voted to oppose it. Men and women at the convention pleaded with other church members to support IVF, tearfully describing how it has allowed them to grow their families.
Opponents have long stigmatized abortion as something that irresponsible women use as a form of birth control or because they care more about their careers than having children. “When the focus is on the dangers that abortion restrictions pose to pregnant people, it’s easier for Americans to talk about it,” says Reva Siegel, a constitutional law professor at Yale who has written extensively about the country’s abortion struggle.
It's not just that stories about pregnancy complications are circulating more now, he said. Technology and criminal law have flipped the script.
Although abortion is now out of reach for millions of women, especially poor women, women with unwanted pregnancies can use home tests that let them know in advance whether they are pregnant, and they can order abortion pills online.
But for women with pregnancy complications, there are new obstacles. Before Roe legalized abortion nationally in 1973, the law allowed more leeway for what were considered “therapeutic abortions.” Doctors, often practicing alone, could provide them using their good faith judgment. Even the Southern Baptist Convention supported abortion in cases of fetal deformity or when a woman’s physical or mental health was at risk.
Now, the threat of prosecution, fines of up to $100,000 and the loss of their medical licenses is making doctors and hospital systems afraid to treat women with pregnancy complications. In some states, it's often lawyers who are making the decisions.
“People are starting to realize how much this affects more than just abortion care,” said Dr. Nisha Verma, a Georgia-based complex family planning specialist and a fellow of the American College of Obstetricians and Gynecologists who has testified before Congress.
In Georgia, she said, more people opposed the state's ban on abortions after six weeks of pregnancy because they were told it meant two weeks after the average woman's period stops — not, as her own partner believed, six weeks after conception. She said some voters believed six weeks meant six weeks after women found out they were pregnant.
“We don't want to justify just some abortions,” Dr. Verma said, adding: “'Our bodies, our choices,' is what we did for a long time, but it didn't work. Our movement's historic message has value, but it can be too polarizing for people who are struggling with the complexities of abortion, which is the vast majority of Americans.”