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Dobbs’s Confounding Effect on Abortion Rates

The Atlantic

www.theatlantic.com › politics › archive › 2023 › 10 › post-roe-national-abortion-rates › 675778

When the Supreme Court overturned Roe v. Wade, Diana Greene Foster made a painful prediction: She estimated that one in four women who wanted an abortion wouldn’t be able to get one. Foster, a demographer at UC San Francisco, told me that she’d based her expectation on her knowledge of how abortion rates decline when women lose insurance coverage or have to travel long distances after clinics close.

And she was well aware of what this statistic meant. She’d spent 10 years following 1,000 women recruited from clinic waiting rooms. Some got an abortion, but others were turned away. The “turnaways” were more likely to suffer serious health consequences, live in poverty, and stay in contact with violent partners. With nearly 1 million abortions performed in America each year, Foster worried that hundreds of thousands of women would be forced to continue unwanted pregnancies. “Having a baby before they’re ready kind of knocks people off their life course,” she told me.

But now, more than a year removed from the Dobbs v. Jackson Women’s Health Organization decision, Foster has revised her estimate. After seeing early reports of women traveling across state lines and ordering pills online, she now estimates that about 5 percent of women who want an abortion cannot get one. Indeed, two recent reports show that although Dobbs upended abortion access in America, many women have nevertheless found ways to end their pregnancy. A study by the Guttmacher Institute, a research group that supports abortion rights, signals that national abortion rates have not meaningfully fallen since 2020. Instead, they seem to have gone up a bit. A report released this week by the Society of Family Planning, another pro-abortion-rights group, shows that an increase in abortions in states that allow the procedure more than offset the post-Dobbs drop-off in states that closed down clinics.

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Some of this increase may be a result of trends that predate Dobbs: Abortion rates in the U.S. have been going up since 2017. But the reports suggest that the increase may also be due to travel by women who live in red states and the expanded access to abortion that many blue states enacted after the ruling. Still, it is not yet clear exactly how much each of these factors is contributing to the observed increase—and how many women who want an abortion are still unable to get one.

Alison Norris, a co-chair of the Society of Family Planning study, told me that she fears that the public will “become complacent” if they see the likely increase in abortion rates and believe that everyone has access. “Feeling like the problem isn’t really that big of a deal because the numbers seem to have returned to what they were pre-Dobbs is a misunderstanding of the data,” she said.

It seems illogical that more than a dozen states would ban abortion and national rates would hardly change. But even as red states have choked off access, blue states have widened it. And the data show that women have flooded the remaining clinics and ordered abortion pills from pharmacies that ship across the country. More than half of all abortions are done using medication, a pattern that began even before the Dobbs decision.

“It just doesn’t work to make abortion illegal,” Linda Prine, a doctor at Mount Sinai Hospital, told me. “There may be some people who are having babies that they didn’t want to have, but when you shift resources all over the place, and all kinds of other avenues open up, there’s also people who are getting abortions that might not have gotten them otherwise.”

With mail-order abortion pills, “it’s this weird moment where abortion might, ironically, be more available than it’s ever been,” Rachel Rebouché, an expert in abortion law and the dean of the Temple University Beasley School of Law, told me.

The Guttmacher Institute sampled abortion clinics to estimate the change in abortion counts between the first halves of 2020 and 2023. Areas surrounding states with post-Roe bans saw their abortion numbers surge over that period of time. In Colorado, which is near South Dakota, a state with a ban, abortions increased by about 89 percent, compared with an 8 percent rise in the prior three-year period. New Mexico saw abortions climb by 220 percent. (For comparison, before Dobbs, the state recorded a 27 percent hike from 2017 to 2020.) Even states in solidly blue regions saw their abortion rates grow over the three-year interval from 2020 to 2023: Guttmacher estimates that California’s abortion clinics provided 16 percent more abortions, and New York’s about 18 percent more.

Some shifts predated the court’s intervention. After a decades-long decline, abortions began ticking upward around 2017. In 2020, they increased by 8 percent compared with 2017. The researchers I spoke with for this story told me that they couldn’t point to a decisive cause for the shift that started six years ago; they suggested rising child-care costs and Trump-era cuts to Medicaid coverage as possible factors. But the rise in abortion rates reflects a broader change: Women seem to want fewer children than they used to. Caitlin Myers, a professor at Middlebury College, told me that abortion rates might have increased even more if the Court hadn’t reversed Roe. “It looks like more people just want abortions than did a few years ago,” she said. “What we don’t know is, would they have gone up even more if there weren’t people trapped in Texas or Louisiana?”

One of the most significant factors in maintaining post-Roe abortion access dates from the latter half of 2021. As the coronavirus pandemic clobbered the health-care system, the FDA suspended its requirement that women pick up abortion medications in person. A few months later, it made the switch permanent. The timing was opportune: People became accustomed to receiving all of their medical care through virtual appointments at the same time that they could get abortion pills delivered to their doorstep, Rebouché told me. People no longer have to travel to a clinic and cross anti-abortion picket lines. But access to mifepristone, one of the most commonly used drugs for medication abortions, is under threat. After an anti-abortion group challenged the FDA’s approval of the drug, a federal court instated regulations that would require women to visit a doctor three times to get the pills, making access much more difficult. The Supreme Court is weighing whether to hear an appeal, and has frozen the 2021 rules in place while it decides.

But paradoxically, several of the factors that may have contributed to the rise in abortion rates seem to have sprung directly from the Dobbs decision. In the year since the ruling, six blue states have enacted laws that allow practitioners to ship abortion pills anywhere, even to deep-red Texas. Although these laws haven’t yet been litigated to test whether they’re truly impenetrable, doctors have relied on them to mail medication across the country. Aid Access, an online service that operates outside the formal health-care system, receives requests for about 6,500 abortion pills a month. (The pills cost $150, but Aid Access sends them for free to people who can’t pay.) Demand for Aid Access pills in states that ban or restrict medication abortion has mushroomed since the Dobbs decision, rising from an average of about 82 requests per day before Dobbs to 214 after. The Guttmacher report doesn’t count abortions that take place in this legally fuzzy space, suggesting that actual abortion figures could be higher.

As the Supreme Court revoked the constitutional right to an abortion and turned the issue back to the states, it also hardened the resolve of abortion-rights supporters. In the five months after Roe fell, the National Network of Abortion Funds received four times the money from donations than it got in all of 2020. People often donate as states encroach on abortion rights. In many cases, they bankrolled people’s travel out of ban states. Community networks also gained experience in shuttling people out of state to get abortions. “There’s definitely been innovation in the face of abortion bans,” Abigail Aiken, who documents abortions that occur outside of the formal health-care system, told me.

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Some researchers believe that the Dobbs decision has actually convinced more women to get abortions. Abortion-rights advocacy groups have erected highway billboards that promise Abortion is ok. Public opinion has tilted in favor of abortion rights. Ushma Upadhyay, a professor at UC San Francisco, told me that California’s rising abortion rates cannot all be due to people traveling from states that ban abortion. “It’s also got to be an increase among Californians,” she said. “It’s just a lot of attention, destigmatization, and funding that has been made available. Even before Dobbs, there was a lot of unmet need for abortion in this country.”

Abortion used to be a topic that was “talked about in the shadows,” Greer Donley, an expert in abortion law and a professor at the University of Pittsburgh, told me. “Dobbs kind of blew that up.” Still, she believes that it’s unlikely that people are getting significantly more abortions simply because of changes within blue states. Just as obstacles don’t seem to have stopped people from seeking abortions, efforts that moderately expand access are unlikely to lead people to get an abortion, she said.

The people I spoke with emphasized that even though overall abortion rates might be going up, not everyone who wants the procedure can get it. People who don’t speak English or Spanish, who don’t have internet access, or who are in jail still have trouble getting abortions. “What I foresee is a bunch of Black women being stuck pregnant who didn’t want to be pregnant, in a state where it’s incredibly dangerous to be Black and pregnant,” Laurie Bertram Roberts, a founder of the Mississippi Reproductive Freedom Fund, told me.

Bertram Roberts’s fund used to provide travel stipends of up to $250. Now women need three times that. Most people travel from Mississippi to a clinic in Carbondale, Illinois. The trip takes two days—48 hours that women must take off work and find child care for. “If you are in the middle of Texas, and you have to travel to Illinois, even if funds covered all the costs, to say that abortion is more accessible for that person seems callous and wrong,” Donley told me.

Many women spend weeks waiting for an abortion. “It is excruciating to be carrying a pregnancy that one knows they’re planning to end,” Upadhyay said. And although studies show that abortion pills are safe, women who take them can bleed for up to three weeks, and they may worry that they’ll be prosecuted if they seek help at a hospital. Only two states—Nevada and South Carolina—explicitly criminalize women who give themselves an abortion (and few women have been charged under the laws), but the legislation contributes to a climate of fear.

More than a year out from the Dobbs decision, the grainy picture of abortion access is coming into focus. With the benefit of distance, the story seems not to be solely one of diminished access, widespread surveillance, and forced births, as the ruling’s opponents had warned. For most Americans, abortion might be more accessible than it’s ever been. But for another, more vulnerable group, abortion is a far-off privilege. “If I lived in my birth state—I was born in Minnesota—my work would be one hundred times easier,” Bertram Roberts told me, later adding, “I think about that a lot, about how the two states that bookend my life are so different.”

‘What Comes Next Will Be … Spectacular’

The Atlantic

www.theatlantic.com › ideas › archive › 2023 › 10 › trump-immigration-rhetoric-2024 › 675775

As president, Donald Trump imposed an array of deeply divisive immigration restrictions on both Latinos and Muslims. And yet from 2016 to 2020, he increased his share of the vote among both groups. Even some Latino and Muslim voters who opposed Trump’s immigration agenda moved to support him anyway because of his record on other issues, particularly the economy and conservative social priorities.

Now Trump and several of his rivals for the 2024 GOP presidential nomination are doubling down on the bet that they can target each group with harsh immigration policies without paying an electoral price.

For months, they have proposed an escalating succession of hard-line measures aimed at deterring mostly Latino undocumented migrants from crossing the southern border. And following the Hamas terror attack on Israel earlier this month, they rolled out a wave of exclusionary proposals aimed at Muslims. Trump has pledged that, if returned to the White House, he will restore his travel ban on people from a number of majority-Muslim nations, expand ideological screening of all potential immigrants to ensure that they agree with “our religion,” and deport foreign students in the United States who express hostility to Israel.

Trump and other GOP 2024 candidates such as Florida Governor Ron DeSantis have unveiled these proposals even as many Democratic-leaning activists warn that support for President Joe Biden is suffering in Latino and Muslim communities. Polls have consistently shown widespread discontent among Latinos over inflation and the economy. And many Muslim Americans are angry at Biden for his strong support of Israeli Prime Minister Benjamin Netanyahu, as he pursues his military campaign to destroy Hamas in Gaza. “There is a level of disgust and disbelief and disappointment at the administration’s handling of the crisis so far,” Edward Ahmed Mitchell, the national deputy director of the Council on American-Islamic Relations, told me.

The movement of some of these voters away from Biden produces a powerful incentive for Republicans to escalate their rhetorical and policy offensive against immigrant communities. It means that Trump could achieve the best of both worlds politically: offering a harsh anti-immigrant agenda that energizes the most xenophobic white voters in his coalition while still maintaining, or even growing, his support among immigrant communities drawn to him (or repelled by Democrats) on other issues.

That process already seems well under way in the agenda that Trump and other Republicans are advancing about the southern border. The fact that Trump’s vote among Hispanics improved in 2020, even after he implemented such aggressive policies as starting the border wall and separating migrant children from their parents, has undoubtedly encouraged him to go even further with his new proposals for mass deportation of undocumented migrants in the U.S. and military action against Mexico (both of which DeSantis has also endorsed).

Likewise, if Trump wins the 2024 election and more Muslim Americans vote for him than in 2020, despite his threats to target Muslim immigrants, he will undoubtedly feel emboldened in a second term to impose more exclusionary policies on that community. Stephen Miller, the hard-line architect of much of Trump’s immigration agenda as president, offered a preview of the deportation agenda that might be ahead when he posted a video of a recent pro-Palestinian demonstration and wrote that ICE agents “will be busy in 2025.”

Over his four years in office, Trump instituted policies more resistant to immigration than any president had since the 1920s, and repeatedly disparaged immigrants with openly racist language (including calling Mexicans “rapists” and decrying immigration from mostly Black “shithole countries”). He is now pushing beyond even that agenda. “What comes next will be … spectacular,” Miller posted recently.

As just a first step, Trump has proposed to reinstate all of the key policies he implemented that raised nearly insurmountable hurdles for those who sought to claim asylum in the U.S., including the “remain in Mexico” policy that required asylum seekers to stay in that country, typically in crowded and dangerous makeshift camps, while their cases were adjudicated. He’s promised to finish his border wall. And during his CNN town hall last spring, Trump refused to rule out reinstating the separation of migrant children from their parents, his most controversial policy. The Biden administration has reversed all of these policies, and it recently settled a lawsuit in which the federal government agreed not to restore the child-separation policy. Still, experts say that a reelected Trump would almost certainly seek to void or evade that agreement.

After the Hamas attack in Israel, Trump also pledged to bring back his travel ban. A bitterly divided Supreme Court upheld the rule in a 5–4 vote in 2018; if reelected, Trump could unilaterally restore the policy through executive action. “The legal framework,” Mitchell from the Council on American-Islamic Relations told me, “is still there just waiting to be used.”

But Trump has new ideas too. These include ending birthright citizenship (though his legal authority to do so is highly questionable) and launching military actions against Mexican drug cartels. In a speech to a conservative group earlier this year, he promised to “use all necessary state, local, federal, and military resources to carry out the largest domestic deportation operation in American history.”

He is also calling for requiring prospective immigrants from any country to pass intensified ideological screenings: “If you want to abolish the state of Israel, you’re disqualified; if you support Hamas or the ideology behind Hamas, you’re disqualified; and if you’re a communist, Marxist, or fascist, you are disqualified,” he said earlier this month in Iowa. Monday in New Hampshire, Trump raised the ante when he said he would bar entry for those who “don’t like our religion,” without explaining how he defined “our religion.” He’s pledged to deport students and other immigrants who express what he called “jihadist sympathies.”

David Leopold, a former president of the American Immigration Lawyers Association, says Trump’s record as president shows that it would be a mistake to dismiss even the most extreme of these proposals as simply campaign rhetoric designed to stir his crowds. “Every word that comes out of Donald Trump’s mouth ought to be taken seriously,” Leopold told me. If Trump returns to power, he said, we will see a version of his first term’s “anti-immigrant policy on steroids.”

While Trump was president, and his agenda was in the spotlight, most of his core immigration policies provoked majority opposition in polls. In a compilation of results from its annual American Values Survey polls late in Trump’s presidency, the nonpartisan Public Religion Research Institute (PRRI) found that just over half of Americans opposed his Muslim travel ban, about three-fifths opposed his border wall, and fully three-fourths opposed the child-separation policy.

But public tolerance for some of these ideas may be growing amid dissatisfaction with Biden’s record in managing the border and immigration. Less than a third of adults overall—and only about one-fourth of independents—said they approved of Biden’s handling of those issues in the latest annual American Values Survey, released yesterday. A recent national Marquette University Law School Poll found that Americans preferred Trump over Biden on controlling the border by nearly two to one.

A recent Quinnipiac University national poll found that a majority of Americans support building a border wall for the first time since the pollsters initially asked about the idea, in 2016. “With frustration building” over Biden’s record on immigration, “it looks to me that some of these more extreme ideas are gaining traction in the country,” Robert P. Jones, the president of PRRI, told me.

Even many in the communities that Trump’s immigration plans would most directly affect appear more focused on other issues. Every major data source on voting behavior agreed that Trump grew his vote among Latino voters from about three in 10 to nearly four in 10 from 2016 to 2020, largely around economic issues, but also because of gains among cultural conservatives. Though the GOP advance among Latinos stalled between the 2020 and 2022 elections, polls continue to record widespread dissatisfaction among them about inflation, which could further erode support for Democrats in 2024.

The Muslim American community is much smaller—Muslims account for only about 1 percent of the total U.S. population—so reliable information on its voting behavior is less available. Youssef Chouhoud, a political scientist at Christopher Newport University, told me that Trump’s vote among Muslim Americans nationwide improved from about one in six in 2016 to roughly one in three in 2020. Key to those 2020 gains, he said, was sympathy to conservative GOP arguments on issues such as LGBTQ rights and discussion of sexual orientation and gender identity in schools.

Now, Chouhoud and others note, those Republican gains are being reinforced by the backlash among many Muslim activists against Biden’s expansive support for Israel in the conflict with Hamas. Waleed Shahid, a Muslim American Democratic strategist who has worked for several liberal groups and candidates, says that leading Democrats are underestimating the visceral anger over Biden’s words and actions. “I think, unfortunately, Democratic leadership has their heads in the sand about this,” he told me.

Both Chouhoud and Shahid told me they believed that Trump’s return to anti-Muslim rhetoric reduces the odds that any significant number of voters from that community will abandon Biden to vote for the former president. But they both said they considered it likely that some Muslim American voters disillusioned with Biden might stay home or drift to third-party candidates. “The fact that this chorus” in the Muslim community “is so loud” in criticizing Biden, “even given the full knowledge” of Trump’s bellicose rhetoric, “is telling you that there is a groundswell of real animosity toward the policies that the Biden administration is enacting right now,” said Chouhoud, who is also a fellow at the Institute for Social Policy and Understanding, a nonpartisan group that studies issues concerning Muslim Americans. This discontent could matter most in the swing state of Michigan, where Muslims are a sizable constituency: A mobile billboard drove through the Detroit area this week displaying a message proclaiming that “Israel Bombs Children” and “Biden Pays For It.”

Shahid says he fears that the 2024 election won’t look like 2020’s—when Democrats of all stripes unified behind the common mission of ousting Trump from the White House. Instead, he thinks, the next election will more closely resemble that of 2016, when a decisive sliver of Democratic-leaning voters, particularly younger ones, backed the third-party candidates Gary Johnson and Jill Stein rather than Hillary Clinton.

“The Democratic base did not turn out for Hillary in 2016, even though Trump was a right-wing extremist,” Shahid told me. “People somehow have collective amnesia about this. But Biden is historically unpopular with the Democratic base.”

Of course Biden may regain Muslim voters’ trust if he can jump-start renewed negotiations between Israel and the Palestinians after the fighting concludes. Similarly, very few Latinos may now be aware of Trump’s proposals for mass deportation of undocumented migrants and military action against Mexico; if he’s the nominee, that would likely change—and prompt substantial resistance, especially among Mexican Americans.

Still, these tensions reveal a larger dynamic underpinning the potential 2024 rematch between the two men. On almost every front, Trump has formulated a 2024 agenda even more confrontational to Democratic constituencies and liberal priorities than he pursued during his four years in the White House. Yet disenchantment with Biden’s performance could be eroding the will to resist that agenda among key components of the party’s coalition, particularly young people and voters of color.

The pressure that the Middle East crisis is placing on Muslim American support for Biden, even as Trump directly threatens that community, shows how hard it may be for Democrats to maintain a united front—even against an opponent whom they consider an existential threat to all that they value.