The Problem with Abortion Prohibition
If you believe life begins at conception and every abortion is murder, this post is for you.
Here is the harsh truth: even with a Constitutional Amendment to declare human life begins at conception, and laws making abortion illegal, millions of (illegal) abortions will continue to be done in America.
Abortion prohibition laws will be less effective than alcohol prohibition was in the 1920s, the war on drugs has been over the last 45 years, or attempts to stop prostitution have been for centuries, in preventing the prohibited act from taking place.
Why this is true has to do with the nature of pregnancy, abortions, possible methods of enforcement, and how technology has changed since 1973, when Roe. v. Wade became the law of the land.
Facts about pregnancy and abortion
The first fact is that about 30% of all conceptions end in natural miscarriages. This rate varies from 20% to 40% depending on whether the pregnancy was confirmed with a pregnancy test before miscarriage, or not, and how the pregnancy is measured. The middle of the estimates is 30%.
Many women don’t even know they have had a natural miscarriage. They just think they were “late”, then had a heavy period. Most miscarriages take place in the first trimester, the same time frame as over 90% of abortions today.
The second fact is that abortions are an induced — caused by an outside actor — miscarriages. In fact, the full name is “induced abortion”. “Spontaneous abortion” is another name for miscarriage. Other than being induced, abortions are not significantly medically different from natural miscarriages.
The third fact is that there are twice as many natural miscarriages as abortions in America. In 2014, there were:
- 4.0 million live births
- 926,000 abortions
- ~1.8 million miscarriages*
Note that about 20% of abortions — since all were confirmed with a pregnancy test so the percentage is lower — would have spontaneously miscarried anyway.
The fourth fact is how abortions are induced has changed dramatically since 1973. Chemical abortions are now widely available, effective, and inexpensive. In addition, pregnancy has become dramatically cheaper and easier to detect in the first few weeks, making chemical abortions more effective and relevant.
In 1973, there was no home pregnancy test that could tell most women they were pregnant 9 days after ovulation as there are today. If a woman wanted to confirm a pregnancy, she had to go to a doctor and get a lab test, not simply buy an inexpensive over the counter test at the local drugstore.
Women often waited 5 weeks or more from their last period to begin to suspect they were pregnant.
In 1973, there was no “Plan B”, which some abortion foes consider an abortion drug, and is simply a high dose of regular hormone contraceptives. Taken within 72 hours of unprotected sex, over 85% of pregnancies are prevented.
In 1973, there were no mifepristone and misoprostol, which are 98% effective in inducing a chemical (also known as medical to contrast with surgical) abortion in the first 5 weeks after a pregnancy first is detectable on a home pregnancy test (43 days after ovulation; 8.5 weeks gestational age).
All these drugs and testing kits are generic, cheap to produce, and legal in many countries of the world, including China.
The chemicals in Plan B will continue to be legal in America, because they are common components of regular birth control pills. Pregnancy tests will continue to be legal, since knowing whether one is pregnant or not is important if a woman intends to give birth for the health of the fetus and mother.
Chemical abortions are already 45% of all abortions done before 9 weeks of gestation. If abortions were illegal, the incentive to simply take a pill at home, rather than trying to find an (illegal) surgical abortion provider, will rise dramatically.
Similarly, if abortions were illegal, the current rate of 67% of abortions taking place before 8 weeks gestation would also rise. Women would have a strong incentive to know if they were pregnant early given the effectiveness of chemical abortion drops later in the pregnancy.
Most pregnant women would know from a pregnancy test by 4 weeks gestation (4 weeks after the start of their last period), and would have a few weeks to find chemical abortion drugs on the black market and use them.
The fifth fact is that the skill required to do a surgical abortion in the first trimester (13 weeks gestation) is simple, the tools common place, and the information to train people widely available on the Internet.
The standard surgical abortion procedure in the first trimester is a dilation and curettage (D & C). Videos of how to do them are already available on YouTube. The hand tools (medical instruments) required are simple, cheap, and necessary for medical procedures other than abortions, so will be readily available.
Any person with decent hand-eye coordination can learn to do a surgical abortion for pregnancies in weeks 9 to 13, when abortion drugs are less effective, and have the surgery be safe for the woman.
The sixth fact is that at 8 weeks gestation the fetus is 0.6 inches long and weighs 0.04 oz (1 gram). At 13 weeks, the fetus is 2.9 inches long and weighs less than 0.8 oz.
A chemical abortion at 8 weeks will leave almost no visible remains. A surgical abortion at 13 weeks will leave 2 tablespoons of fetal tissue to dispose of.
The last fact is that currently 92% of abortions are in the first 13 weeks.
What have we learned?
- Spontaneous early termination of pregnancies, miscarriages, are common and natural
- Induced miscarriages, abortions, are not significantly different from miscarriages that occur spontaneously
- Out of ~7 million conceptions a year, ~4 million end in live birth, ~2 million in miscarriages, and ~1 million in abortions
- Unlike in 1973, today there are effective and cheap home pregnancy tests and chemical abortion drugs. Tests confirm pregnancy as early as 3.5 weeks gestation, chemical abortion drugs are 98% in the first 9 weeks, and nearly half of all these early abortions are now chemical.
- The skills needed to do a surgical abortion up to 13 weeks gestation are simple and easy to learn from the Internet. The tools required are cheap and available.
- Fetuses before 13 weeks are small, weighing less than an ounce.
- Today, 92% of abortions are in the first 13 weeks.
Could abortion prohibition be enforced?
Several factors make abortion prohibition difficult to enforce. It is hard to:
- prevent women from knowing at an early stage they are pregnant
- prevent a black market in illegally imported abortion drugs
- prevent the spread of information and tools, so anyone with good hand-eye coordination could perform a surgical abortion up to 13 weeks
- prevent people of few other opportunities from taking the easy money in performing surgical abortions
- detect abortions in the first 13 weeks with certainty, given that so many conceptions end in natural miscarriages (spontaneous abortions).
If you want to institute an abortion prohibition in the US, how draconian do you want the police and courts to be to discourage abortions, at what cost to personal privacy and American society?
Let’s imagine Carol Tobias, chair of the National Right to Life Committee, is made absolute ruler of America, so can introduce any laws and enforcement mechanisms she wants. What could she do to prevent abortions?
If Supreme Leader Tobias simply makes abortion illegal, but has no enforcement with meaningful penalties for those who participate in abortions — the mothers, the abortionists, the abortion drug makers and/or abortion drug dealers — then there will no be no meaningful change in the rate of abortions in America.
For example, it has been illegal for decades to enter America and work without a visa. Without strong enforcement of that prohibition, millions of people did it anyway. Even with better enforcement today, millions still do.
Pro-life people already advertise extensively that women should not have abortions because it is morally wrong. What more does making it illegal without penalty do? Illegal with no penalty is no more likely to discourage abortions than immoral with no penalty (in this life).
A starting place for enforcing the prohibition would be to crackdown on the distribution of abortion drugs. How effective will the government be in preventing the illegal importation and distribution of abortion drugs made legally in labs in, e.g., China?
About as effective as the government has been in stopping the illegal importation and distribution of opiates from China today: not at all. The “war on abortion,” using our current methods to punish the sale of illegal drugs, will be exactly as effective as our “war on drugs.”
Illegal opiate use in America is at an all-time high. Illegal opiates are widely available and cheap, despite 45 years of the “war on drugs” against the sellers of illegal opiates, and often the users of illegal drugs. We are being flooded with opiates made in labs in China.
Even with strong enforcement against importers and distributors, it is unlikely the street price of abortion drugs will be more than $1000, or about twice the current medical price. In fact, the drugs on the street may be cheaper, since the price now is well above the manufacturing price, since it includes counseling, other medical tests, supervision by a medical professional, etc.
If Supreme Ruler Donna Tobias cannot stop chemical abortions, perhaps she can stop surgical abortions? Let’s ignore surgical abortions would be a shrinking fraction of all abortions.
Like alcohol prohibition in the 1920s, a substantial percentage of Americans would still consider abortions fine, not in anyway immoral, even if there were an abortion prohibition. Currently 29% of Americans believe abortion should be legal under any circumstances. Those people would provide a large pool who would be willing to break the law to provide women abortions.
Some abortion providers, like prostitutes today, would just do it for the money. The current typical price is $500 per surgical abortion. A surgical abortion takes about 5 to 10 minutes to complete in the first trimester.
Performing surgical abortions is something almost anyone with good hand-eye coordination and who is not squeamish might do to make good cash, not unlike the appeal of being a prostitute to some.
If the government were effective in cracking down on surgical providers, that will just push the price for a surgical abortion up to $1000 or more, making it even more worthwhile for criminals to do abortions. Where else could a high school dropout make $1000 for 10 minutes of work?
Going after the abortion drug dealers and abortionists to stop abortions would not be effective, just as going after illegal drug dealers and prostitutes has not been effective in significantly reducing illegal drug use or prostitution.
What about the going after the pregnant women?
Pregnant women will have even the $1000 needed to get the abortion drugs or an abortion. Unlike heroin addicts, the women have no trouble working, and will only need the money once. All women in America today who get abortions find private sources of money to pay for abortions that cost about $500.
Hence attempting to find women having abortions based on suspicious bank withdrawals, or expecting the “high” cost to keep them from getting an abortion, is unlikely to work.
Women who have abortions would also not be easy to identify.
Police would have to investigate millions of pregnancies each year to make sure they were not ended illegally prematurely. How will police know which women are pregnant?
About 70% of early terminations today are natural miscarriages. How will police tell with certainty which abortions are spontaneous, and which are induced?
Do we really want cops accusing every woman who is trying to get pregnant and has a natural miscarriage of murder?
If the punishment is severe, e.g., 20 years in jail if a woman is convicted of having an abortion, women will have a strong incentive to fight legally an accusation, and the legal standards to convict will be high.
Investigating the 3 million potential murders that currently happen each year, the spontaneous and induced abortions, would be wildly expensive.
Murder investigations and trials are expensive. It is not uncommon for a case to cost $300,000 for police and legal costs. Investigations and criminal prosecution of miscarriages and abortions could easily be over $300 billion/year, or about $2,000 for every working American.
Why aren’t murder cases bankrupting us now? There are only about 30,000 homicides each year in America, or 1% of the number of induced and spontaneous abortions each year.
If the punishment for getting an abortion were light, e.g., a $5,000 fine, and the chances of getting caught low, then the punishment would not be sufficient reason for a woman who does not want a baby to carry a fetus to term.
There are no law enforcement options Supreme Leader Donna Tobias could use that would substantially reduce the number of abortions per year.
The most effective, draconian punishment of pregnant women, would be intrusive and not likely to accepted by American citizens, given the reaction on both sides of the abortion debate to Donald Trump’s floating that idea.
What would reduce abortions?
If legal prohibition would not reduce abortions, what would?
Without abortion prohibition, but with better medical care, more available and better contraception, the general increase in wealth in America, changes in attitudes towards single women taking contraceptives, and advertising by pro-life groups, the rate of women having abortions per year today — 14.6 abortions per year per 1000 women 15–44 in 2014 — is half the rate in 1980. The abortion rate is at an all-time low since reporting began.
Doing more of those things would help. A trial done in Colorado has shown that giving young and low-income women free long acting contraception dramatically decreased unintended pregnancies and abortion by 40% in the targeted group.
Simply giving free long acting contraception to more women would reduce abortions. Sure, such a program is “rewarding” women, who are “bad” for having sex when they don’t want to get pregnant.
Is your goal to shame women, or to prevent them from murdering babies?
Another option is to continue to do what pro-life groups do today. Talk to women and girls, before they get pregnant and after, and try to convince them abortion is murder. It would be a good idea to talk to men too about how having sex may cause them to be accomplices to murder.
Changing beliefs is slow, like the now 50+ year effort to convince people not to smoke tobacco, but could eventually change attitudes. All women may eventually see that having sex without effective contraception when they don’t want a baby is wrong.
It is OK to wish abortions did not exist
Abortions are much easier today then in 1973 when Roe v. Wade was decided.
Similar attempts at prohibition, like of alcohol, illegal opiates, and prostitution, have failed miserably even with strict and extensive law enforcement.
Even in the “best case” scenario, with draconian punishments for women and providers for abortions and invasive government investigations of women of childbearing age, it is unlikely abortions would be reduced by more than 50%.
America would still have about 500,000 “babies murdered” each year.
This is where data and desire collide.
I understand the person who believes life begins at conception, every life is sacred, and abortion is murder.
I understand such a person has a deep desire that abortions just would no longer exist. Unfortunately, we do not live in a world where wishes come true just because we want them.
We live in a country with 320 million people who have a wide range of beliefs. Between 25 and 80% do not believe abortion is murder in some or all cases.
The data say making abortion illegal will not get rid of abortions in America.
An abortion prohibition would fail in its mission, like many earlier prohibitions. It would also have all the negative side effects, the criminal gangs, the corruption of police, the putting of lives at risk with unknown substances, that alcohol prohibition had.
If you have a deeply held religious conviction abortion is murder, perhaps the best approach is to leave judgement to God. No one can hide from God. The women who have abortions, the abortionists, and the abortion drug dealers will face God’s judgement in the end.
Copyright © 2017 by Al Lee. All rights reserved.
This piece is an attempt to change the conversation about abortion in America. I have friends who are adamant that abortion is murder. Other friends are adamant that women have an absolute right to choose whether to have an abortion or not.
While these debates are theologically and philosophically interesting, neither side can prove the other is wrong. The first principles, the definitions of what is a separate human vs. part of a woman’s body, decide the question before the debate is started.
While I may come back to the philosophical questions with data about embryology to argue a side, I don’t expect anyone’s mind will be changed. :-)
The challenge I am laying down here for people who believe abortion is murder is, what do you gain by making abortion illegal that is more than what is gained by simply spreading the word that abortion is immoral?
The challenge I am laying down for people who believe women have a right to an abortion is, are you happy enough if people who believe women who have abortions are murderers agree there is no point in making abortion illegal?
*The number of miscarriages is found by calculating the number of would-be live births, 4 million live births plus ~80% of the 926,000 abortions that would have been live, dividing by 70% to get the number of conceptions, then subtraction off the live births and abortions. (4.0+0.8*.926)/.7-(4.926) = 1.8 million
