NOTES

Introduction

1. David Foster Wallace, This Is Water: Some Thoughts, Delivered on a Significant Occasion, About Living a Compassionate Life (Boston: Little, Brown and Company, 2009).

2. Michelle Oberman, “Sex, Drugs, Pregnancy, and the Law: Rethinking the Problems of Pregnant Women Who Use Drugs,” Hastings Law Journal 43 (1991–92): 505, http://digitalcommons.law.scu.edu/facpubs/518/.

3. M. Schäfer, B. Schnack, and M. Soyka, “Sexual and Physical Abuse During Early Childhood or Adolescence and Later Drug Addiction,” Psychotherapie Psychosomatik Medizinische Psychologie (2000), http://www.ncbi.nlm.nih.gov/pubmed/10721277.

4. Michelle Oberman, “Eva and Her Baby (a Story of Adolescent Sex, Pregnancy, Longing, Love, Loneliness, and Death),” Duke Journal of Gender Law & Policy 16 (2009): 213–22, http://digitalcommons.law.scu.edu/facpubs/44/.

5. Indeed, it has become common for states to enact ten or more such laws in a single legislative session. Steven Ertlet, “States Pass More Pro-Life Laws Saving Babies from Abortions in Last 5 Years Than the Previous 15,” LifeNews.com, January 4, 2016, www.lifenews.com/2016/01/04/states-pass-more-pro-life-laws-saving-babies-from-abortions-in-last-5-fives-than-the-previous-15/. These new laws govern practices ranging from prohibitions on buying human eggs to mandating physician disclosure of misleading and often inaccurate information. Texas and Arizona have passed laws requiring doctors to tell patients that the abortion drugs they are about to take can be reversed, should they change their minds and decide to keep their pregnancy. This in spite of the lack of any medical evidence proving it is true. Rick Rojas, “Arizona Orders Doctors to Say Abortions with Drugs May Be Reversible,” New York Times, March 31, 2015, http://www.nytimes.com/2015/04/01/us/politics/arizona-doctors-must-say-that-abortions-with-drugs-may-be-reversed.html. Other states require doctors to tell patients that abortion is correlated with elevated risks of breast cancer and suicide—findings lacking scientific support and rejected by the relevant medical authorities. Guttmacher Institute, “Counseling and Waiting Periods for Abortion,” State Policies in Brief (as of June 2013), http://www.guttmacher.org/statecenter/spibs/spib_MWPA.pdf.

6. For a detailed recounting of her story, see Michelle Oberman, “Judging Vanessa: Norm Setting and Deviance in the Law of Motherhood,” William and Mary Journal of Women and the Law 15 (2009): 337–59, http://digitalcommons.law.scu.edu/facpubs/498/.

7. Estimates range from sixty thousand to three hundred thousand abortions annually. E. Prada and H. Ball, “Induced Abortion in Chile,” In Brief, Guttmacher Institute, 2016, https://www.guttmacher.org/sites/default/files/pdfs/pubs/journals/IB_Abortion-Chile.pdf.

8. In the United States, legal induced abortion results in only 0.6 deaths per 100,000 procedures. Worldwide, unsafe abortion accounts for a death rate that is 350 times higher (220 per 100,000), and, in Sub-Saharan Africa, the rate is 800 times higher, at 460 per 100,000. “Facts on Induced Abortion Worldwide,” In Brief, Guttmacher Institute, 2012, http://www.who.int/reproductivehealth/publications/unsafe_abortion/induced_abortion_2012.pdf. See also Department of Reproductive Health and Research, World Health Organization, Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, sixth ed. (Geneva: World Health Organization, 2011), http://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241501118/en/.

9. E. Koch, “Impact of Reproductive Laws on Maternal Mortality: The Chilean Natural Experiment,” Linacre Quarterly (2013), https://www.ncbi.nlm.nih.gov/pubmed/24844146.

10. Lidia Casas Becerra, “Women Prosecuted and Imprisoned for Abortion in Chile,” Reproductive Health Matters (1997), http://www.rhm-elsevier.com/article/S0968–8080(97)90003-3/pdf. See also Lidia Casas and Lieta Vivaldi, “Abortion in Chile: The Practice Under a Restrictive Regime,” Reproductive Health Matters (2014), http://www.academia.edu/10146213/Abortion_in_Chile_the_practice_under_a_restrictive_regime.

Chapter 1: Beatriz and Her Case

1. Guillermo Ortiz, perinatologist at La Maternidad Hospital, in discussion with the author, June 2014 (notes on file with author).

2. Penal Code of El Salvador 1998, Title 1, Crimes Related to Life, Chapter II, Crimes Related to Unborn Humans, Art. 133–139, http://www.oas.org/dil/esp/Codigo_Penal_El_Salvador.pdf; Soledad Varela, “Persecuted: Political Process and Abortion Legislation in El Salvador: A Human Rights Analysis,” Center for Reproductive Law & Policy 27 (2001): 96n130, http://reproductiverights.org/sites/default/files/documents/persecuted1.pdf, http://www.reproductiverights.org/sites/default/files/documents/persecuted2.pdf; “El Salvador,” in UN Population Division Department of Economic and Social Affairs, Abortion Policies: A Global Review (June 2002), http://www.un.org/esa/population/publications/abortion/profiles.htm.

3. Guillermo Ortiz, author interview.

4. “Ectopic Pregnancy,” Cedars-Sinai, https://www.cedars-sinai.edu/Patients/Health-Conditions/Ectopic-Pregnancy.aspx, accessed November 8, 2016.

5. Alejandro Guidos, MD, president of El Salvador’s Association of Obstetricians and Gynecologists, in discussion with the author, June 2014.

6. Oswaldo Ernesto Feusier, “Pasado Y Presente Del Delito De Aborto En El Salvador,” Universidad Centroamericana “Jose Simeon Cañas” (2016), 135n, http://www.uca.edu.sv/deptos/ccjj/media/archivo/95bbb4_pasadoypresentedeldelitodeabortoenelsalvador.pdf.

7. Loida Martínez and Suchit Chavez, “Salud aboga por aborto terapéutico a mujer enferma,” La Prensa Grafica, April 17, 2013, http://www.laprensagrafica.com/Salud-aboga-por-aborto-terapeutico-a-mujer-enferma.

8. “Red Familia rechaza aborto de Beatriz,” editorial, La Pagina, April 18, 2013, http://www.lapagina.com.sv/nacionales/80505/2013/04/19/Red-Familia-rechaza-aborto-de-Beatriz.

9. Carmen Rodriguez, “Mamá de Beatriz: ‘No quiero que mi hija muera,’” La Pagina, May 14, 2013, http://www.lapagina.com.sv/nacionales/81629/2013/05/15/Mama-de-Beatriz-No-quiero-que-mi-hija-muera.

10. Although there is no information about El Salvador’s IML online, see this description of Colombia’s IML: Medicina Legal y Ciencias Forenses, http://www.medicinalegal.gov.co/en/quienes-somos;jsessionid=2BB1C1A65FC88B98BAA84D741EA0CC34, accessed May 31, 2017.

11. Jose Miguel Fortin Magana, MD, director of the Instituto de Medicina Legal, in discussion with the author, June 2014.

12. “El Salvador,” Center for Justice & Accountability, http://cja.org/where-we-work/el-salvador/.

13. Pew Research Center, Religion in Latin America: Widespread Change in a Historically Catholic Region (Washington, DC: November 13, 2014), http://www.pewforum.org/2014/11/13/religion-in-latin-america/.

14. Paul Glader, “Christianity Is Growing Rapidly in El Salvador,” Washington Post, April 8, 2015, https://www.washingtonpost.com/news/acts-of-faith/wp/2015/04/08/christianity-is-growing-rapidly-in-el-salvador-along-with-gang-violence-and-murder-rates/.

15. Xochitl Sandoval, MD, gynecologist, in discussion with the author, June 2014.

16. Alejandro Guidos, author interview. Guidos explained his association’s opinion as a matter of scientific fact: “It’s well known that a pregnant patient with Lupus is considered high risk, especially if she had preeclampsia in a prior pregnancy. So, taking all this into account, and finally because of the fetal abnormality, we published an opinion supporting the termination of pregnancy.”

17. Christian Melendez, “La Sala de lo Constitucional recibió ayer el informe médico que había solicitado sobre la joven con lupus,” La Prensa Grafica, May 8, 2013, http://www.laprensagrafica.com/iml—beatriz-puede-continuar-con-su-embarazo.

18. Fortin Magana, author interview.

19. Carmen Rodriguez, “Salud pone en duda resultados de Medicina Legal en caso de Beatriz,” La Pagina, May 11, 2016, http://www.lapagina.com.sv/nacionales/81502/2013/05/11/Salud-pone-en-duda-resultados-de-Medicina-Legal-en-caso-de-Beatriz.

20. “El Presidente de El Salvador dice que la mujer que pidió aborto tiene el derecho a decidir,” Qué!, May 13, 2013, http://www.que.es/ultimas-noticias/espana/201305132346-presidente-salvador-dice-mujer-pidio-efe.html.

21. Maria R. Sahuquillo, “Beatriz: Pido al presidente Funes que salve mi vida,” El Pais, http://sociedad.elpais.com/sociedad/2013/05/30/actualidad/1369922985_768623.html; Karla Zabludovsky, “A Salvadoran at Risk Tests Abortion Law,” New York Times, May 28, 2013, http://www.nytimes.com/2013/05/29/world/americas/pregnant-sick-and-pressing-salvadoran-abortion-law.html.

22. Adam Cassandra, “HLI President Calls on El Salvador Supreme Court to Protect Life,” Human Life International News, May 16, 2013, http://www.hli.org/2013/05/hli-president-calls-on-el-salvador-supreme-court-to-protect-life/.

23. “En defensa de nuestra soberania” (author’s translation), elsalvador.com, May 8, 2013, http://www.elsalvador.com/opinion/editoriales/106401/en-defensa-de-nuestra-soberania/.

24. Amnesty International, On the Brink of Death: Violence Against Women and the Abortion Ban in El Salvador (2014), https://www.amnestyusa.org/sites/default/files/el_salvador_report_-_on_the_brink_of_death.pdf.

25. Nelson Rauda Zablah, “Magistrates Finalized ‘Historic’ Hearing to Resolve Abortion Petition,” La Prensa Grafica, May 17, 2013, http://www.laprensagrafica.com/csj-da-un-plazo-maximo-de-15-dias-para-caso-beatriz.

26. Karla Aabludovsky and Gene Palumbo, “Salvadoran Court Denies Abortion to Ailing Woman,” New York Times, May 29, 2013, http://mobile.nytimes.com/2013/05/30/world/americas/salvadoran-court-denies-abortion-to-ailing-woman.html?from=world.

27. Corte Suprema de Justicia, Case BC, Amparo 310–2013 at 10 (El Salvador).

28. Guillermo Ortiz, author interview.

29. Thomas Aquinas is credited with introducing the principle of double-effect in his discussion of the permissibility of self-defense in the Summa Theologica (II-II, Qu. 64, Art. 7). Killing one’s assailant is justified, he argues, provided one does not intend to kill him. “Doctrine of Double Effect,” Stanford Encyclopedia of Philosophy, revised September 23, 2014, http://plato.stanford.edu/entries/double-effect/, accessed May 31, 2017. See also “The Principle of Double Effect,” Catholics United for Faith, November 1997, http://www.cuf.org/2004/04/principle-of-double-effect, accessed May 31, 2017.

30. Jorge Ramirez, MD, chief assistant to the minister of health, in discussion with the author, June 2014.

31. Wayne R. LaFave, Substantive Criminal Law § 10.4, at 142, second ed. (St. Paul, MN: Thomson/West, 2003).

32. The fundamental right to life and enjoyment of health appear in the Salvadoran Constitution.

33. Corte Suprema de Justicia, Case BC, Amparo 310–2013, at 22 (El Salvador). “In the event of termination of the pregnancy after twenty weeks gestation, the aim is not to destroy the fetus, and that the medical team will take all necessary measures to ensure, as far as possible, extrauterine life.”

34. LaFave, Substantive Criminal Law.

35. Corte Suprema de Justicia, Case BC, Amparo 310–2013, at 14 (El Salvador).

36. Karla Zabludovsky, “A Salvadoran at Risk Tests Abortion Law,” New York Times, May 28, 2013, http://www.nytimes.com/2013/05/29/world/americas/pregnant-sick-and-pressing-salvadoran-abortion-law.html.

37. A zygote is the fertilized egg cell that results from the union of a female gamete (egg, or ovum) with a male gamete (sperm). In embryonic development, the zygote stage is brief and is followed by cleavage, when the single cell becomes subdivided into smaller cells. The zygote represents the first stage in the development of a genetically unique organism. Encyclopaedia Britannica Online, s.v. “zygote,” https://www.britannica.com/science/zygote, accessed November 8, 2016.

38. Cass R. Sunstein, “On the Expressive Function of Law,” University of Pennsylvania Law Review 144 (1996): 2021, 2031.

39. Ibid., 2045.

40. Ibid., 2047.

Chapter 2: Assessing the Impact of El Salvador’s Abortion Ban

1. Penal Code of El Salvador 1998, Title 1, Crimes Related to Life, Chapter II, Crimes Related to Unborn Humans, Art. 133–139, http://www.oas.org/dil/esp/Codigo_Penal_El_Salvador.pdf.

2. Abortion being illegal, it is hard to get accurate information about the rates of abortion. The WHO bases its estimations on numbers of women hospitalized for abortion complications (where available) and information on the safety of abortion, as well as on findings from surveys of women and studies using an indirect abortion estimation methodology from countries where those were available. E-mail from Dr. Gilda Sedgh, Guttmacher Institute, to author, July 7, 2012 (on file with author). See article by Gilda Sedgh, https://www.guttmacher.org/sites/default/files/pdfs/pubs/journals/Sedgh-Lancet-2012-01.pdf.

3. A recent survey by the El Salvador Ministry of Health reported 19,290 between 2005 and 2008; other surveys put that number as the annual average. See Nina Strochlic, “On the Front Lines of El Salvador’s Underground Abortion Economy,” Foreign Policy, January 3, 2017, http://foreignpolicy.com/2017/01/03/on-the-front-lines-of-el-salvadors-underground-abortion-economy/?utm_source=Sailthru&utm_medium=email&utm_campaign=New+Campaign&utm_term=%2AEditors+Picks.

4. Vinod Mishra, Victor Gaigbe-Togbe, and Julia Ferre, Abortion Policies and Reproductive Health Around the World (New York: UN Department of Economic and Social Affairs, Population Division, 2014), http://www.un.org/en/development/desa/population/publications/pdf/policy/AbortionPoliciesReproductiveHealth.pdf, accessed January 24, 2017.

5. For an excellent history of abortion in pre-Roe America, see Leslie J. Reagan, When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867–1973 (Berkeley: University of California Press, 1996), http://ark.cdlib.org/ark:/13030/ft967nb5z5/. For an equally rich history of abortion doctors in pre-Roe America, see Carole E. Joffe, Doctors of Conscience: The Struggle to Provide Abortion Before and After Roe v. Wade (Boston: Beacon Press, 1995).

6. Tekoa King and Mary Brucker, “Pharmacology for Women’s Health,” Journal of Midwifery & Women’s Health 55 (2010): 394, doi:10.1016/j.jmwh.2010.05.005.

7. Mifeprex, RxList, http://www.rxlist.com/mifeprex-ru486-drug.htm, accessed June 2, 2017.

8. Beverly Winikoff and Wendy Sheldon, “Use of Medicines Changing the Face of Abortion,” International Perspectives on Sexual and Reproductive Health 38, no. 3 (September 6, 2012), https://www.guttmacher.org/about/journals/ipsrh/2012/09/use-medicines-changing-face-abortion. The most widely available illegal abortion drug in Latin America is misoprostol (brand name is Cytotec), which is less effective than mifepristone (brand name is Mifeprex). Nguyen Thi Nhu Ngoc et al., “Comparing Two Early Medical Abortion Regimens: Mifepristone Plus Misoprostol vs. Misoprostol Alone,” Contraception 83, no. 5 (2011): 410–17.

9. “Abortion Induction with Misoprostol Alone in Pregnancies Through 9 Weeks’ LMP,” Gynuity, October 2013, http://gynuity.org/resources/read/misoprostol-for-early-abortion-en/, accessed August 30, 2017.

10. Anibal Faundes, “Use of Misoprostol in Obstetrics and Gynaecology,” Latin American Federation of Obstetrics and Gynaecology Societies (FLASOG) (Santa Cruz, Bolivia: Industrias Gráficas Sirena, April 2005), www.ibrarian.net/navon/paper/Translated_from_Spanish.pdf.

11. Donna Bowater, “Abortion in Brazil: a Matter of Life and Death,” Guardian, February 1, 2015, https://www.theguardian.com/world/2015/feb/01/abortion-in-brazil-a-matter-of-life-and-death, accessed January 23, 2017.

12. See Bela Ganatra et al., “From Concept to Measurement: Operationalizing WHO’s Definition of Unsafe Abortion,” Bulletin of the World Health Organization 92, no. 155 (2014), doi: http://dx.doi.org/10.2471/BLT.14.136333 (discussing the definition of “unsafe abortion,” in view of factors ranging from legal context to relative risks depending on access to trained health care providers and medical abortions).

13. According to the World Health Organization (WHO), Latin America and the Caribbean have the highest regional rate of unsafe abortions per capita in the world (31 per 1,000 women, aged fifteen to forty-four) and see an estimated 4.2 million unsafe abortions every year. See Department of Reproductive Health and Research, World Health Organization, Unsafe Abortion.

14. Alejandro Guidos, author interview. For a thorough discussion of these conflicting laws, see Heathe Luz McNaughton et al., “Patient Privacy and Conflicting Legal and Ethical Obligations in El Salvador: Reporting of Unlawful Abortions,” American Journal of Public Health 96 (2006): 1932.

15. McNaughton et al., “Patient Privacy and Conflicting Legal and Ethical Obligations in El Salvador.”

16. For a detailed history of the Hippocratic oath and its ongoing relevance, see Steven H. Miles, The Hippocratic Oath and the Ethics of Medicine (Oxford, UK: Oxford University Press, 2004).

17. Raphael Hulkower, “The History of the Hippocratic Oath: Outdated, Inauthentic, and Yet Still Relevant,” Einstein Journal of Biology & Medicine 25/26 (March 2010): 43, https://www.einstein.yu.edu/uploadedFiles/EJBM/page41_page44.pdf.

18. El Salvador’s Health Code 287 states that breaching [patient] confidentiality may result in oral reprimand, written reprimand, a fine, a five-year suspension or the loss of one’s medical license. For US law requiring doctors to maintain confidentiality, see Health Insurance Portability and Accountability Act, Pub. L. No. 104–191 (1996), requiring health-care providers and health plans to have policies and procedures concerning use and disclosure of protected health information.

19. Breach of Professional Confidentiality Sect. 187.

20. See Republic of El Salvador, Criminal and Procedural Codes: Prison Law and Its Regulations, Editorial Jurídica Salvadoreña, 2001, Penal Code, Art 312.

21. See Republic of El Salvador, Health Code (with incorporated reforms), Criminal and Procedural Codes: Prison Law and Its Regulations, Editorial Jurídica Salvadoreña, 2001, Penal Code, Art 232. Doctors, pharmacists, nurses, and other health professionals must report unlawful criminal acts that they become aware of in the context of their professional relationship, unless the information they acquire is protected under the terms of professional secrecy (translation; italics added).

22. “Miscarriage,” Medline Plus, reviewed by Cynthia D. White, MD, November 16, 2014, http://www.nlm.nih.gov/medlineplus/ency/article/001488.htm.

23. OBOS Pregnancy & Birth Contributors, “Miscarriage in the First Trimester,” Our Bodies, Our Selves, April 9, 2014, http://www.ourbodiesourselves.org/health-info/miscarriage-in-the-first-trimester/.

24. As applied in homicide cases, the term corpus delecti has at least two component elements: the fact of death, and the criminal act or agency of another person as the cause thereof. “Homicide,” American Jurisprudence, second ed., section 4.

25. Michelle Oberman, “Cristina’s World: Lessons from El Salvador’s Ban on Abortion,” Stanford Law and Policy Review 24 (2013): 271, http://digitalcommons.law.scu.edu/facpubs/794/; Tracy Wilkinson, “El Salvador Jails Women for Miscarriages and Stillbirths,” Los Angeles Times, April 15, 2015, http://www.latimes.com/world/great-reads/la-fg-c1-el-salvador-women-20150415-story.html.

26. Another study confirmed the disproportionate reporting patterns by doctors treating patients at public hospitals, and suggested three possible explanations. First, public health institutions are more likely to treat indigent women and adolescents who often resort to unsafe, low-cost, and readily detectable abortion methods (e.g., insertion of foreign objects). Second, private-sector providers have an explicit profit motive to protect their individual patients’ privacy and avoid legal inconveniences. Finally, because public health-care workers are subject to governmental oversight and are susceptible to shifting ministerial politics, they may be more fearful of reprisal if they do not comply with prevailing governmental ideology or policies. McNaughton et al., “Patient Privacy and Conflicting Legal and Ethical Obligations in El Salvador.”

27. Dr. Bernadette Rosario (pseudonym), in discussion with the author, March 2014. Transcription and notes on file with author.

28. Ibid.

29. Samantha Artiga, “Disparities in Health and Health Care: Five Key Questions and Answers,” Kaiser Family Foundation, August 12, 2016, http://kff.org/disparities-policy/issue-brief/disparities-in-health-and-health-care-five-key-questions-and-answers/.

30. Details of this case are drawn from the trial transcript, on file with author.

31. Ibid.

32. Dr. Marvin Diaz (pseudonym), in El Salvador, May 23, 2012, in discussion with the author. Transcription and notes on file with the author.

33. Jessica Alpert, “El Salvador Virtual Jewish History Tour,” Jewish Virtual Library, http://www.jewishvirtuallibrary.org/el-salvador-virtual-jewish-history-tour#life, accessed May 31, 2017.

34. For a detailed history of Conversos in the Iberian Peninsula, see Norman Roth, Conversos, Inquisition, and the Expulsion of the Jews from Spain (Madison: University of Wisconsin Press, 2002); for an analysis of the effect of Conversos on Judaism and Christianity, see also Jose Faur, In the Shadow of History: Jews and Conversos at the Dawn of Modernity (Albany: State University of New York Press, 1992).

35. Dr. Marvin Diaz, in discussion with the author. In asserting that the defendant’s mother pressed charges against her daughter, Dr. Diaz made the common mistake of confusing civil and criminal charges. Even if her mother had found the baby and called the police, as opposed to simply permitting them to enter and search her apartment, in criminal actions, it is the state that presses criminal charges.

36. Citizen’s Coalition for the Decriminalization of Abortion on Grounds of Health, Ethics and Fetal Anomaly, El Salvador, “From Hospital to Jail: The Impact on Women of El Salvador’s Total Criminalization of Abortion,” Reproductive Health Matters 22, no. 44 (2014): 52–60, http://www.rhm-elsevier.com/article/S0968–8080(14)44797–9/fulltext.

37. Ibid. Of women arrested in abortion-related cases, 46.5 percent involved cases of advanced pregnancy and resulted in charges of simple or aggravated homicide.

38. Lauren Bohn, “El Salvador’s ‘Abortion Lawyer,’” New York Times, September 12, 2016, http://kristof.blogs.nytimes.com/2016/09/12/el-salvadors-abortion-lawyer/.

39. See Rebecca G. Stephenson and Linda J. O’Connor, Obstetric and Gynecologic Care in Physical Therapy, 2nd ed. (Thorofare, NJ: Slack, 2000).

40. Dr. Anne Drapkin Lyerly, associate professor of social medicine and obstetrics and gynecology, University of North Carolina, in telephone discussion with the author on August 2, 2012.

41. Ibid.

42. To get a sense of the scope of Agrupación Ciudadana activities, see its website, at https://agrupacionciudadana.org.

43. Morena Herrera, in discussion with the author, June 2014.

44. Citizens’ Coalition for the Decriminalization of Abortion on Grounds of Health, Ethics and Fetal Anomaly, El Salvador, “From Hospital to Jail: The Impact on Women of El Salvador’s Total Criminalization of Abortion.”

45. The only women excluded were those whose cases were still on appeal, so their sentences were not yet final. Munoz, author interview.

46. Citizen’s Coalition for the Decriminalization of Abortion on Grounds of Health, Ethics and Fetal Anomaly, El Salvador, “From Hospital to Jail: The Impact on Women of El Salvador’s Total Criminalization of Abortion.”

47. Liz Ford, “El Salvador Pardons Woman Jailed After Birth Complications Led to the Death of Child,” Guardian, January 22, 2015, https://www.theguardian.com/global-development/2015/jan/22/el-salvador-pardons-woman-guadalupe-stillbirth-miscarriage-anti-abortion-laws.

48. Marisela Gloria Moran, “Seis mujeres libres de condenas por aborto,” Contrapunto, September 20, 2016, http://www.contrapunto.com.sv/sociedad/ddhh/seis-mujeres-libres-de-condenas-por-aborto/1717.

49. “El Salvador: liberan a María Teresa Rivera, condenada a 40 años tras un aborto,” BBC World, May 21, 2016, http://www.bbc.com/mundo/noticias/2016/05/160520_america_latina_salvador_liberan_maria_teresa_rivera_aborto_dgm.

50. Kathy Bougher, “Salvadoran Council Uses Poverty to Justify Keeping Las 17 in Prison,” Rewire News, January 7, 2015, https://rewire.news/article/2015/01/07/salvadoran-council-uses-poverty-justify-keeping-las-17-prison/.

51. As translated in The Portable Nietzsche, ed. Walter Kaufmann (New York: Viking, 1954), 458.

52. Nina Strochlic, “On the Front Lines of El Salvador’s Underground Abortion Economy,” Foreign Policy, January 3, 2017, http://foreignpolicy.com/2017/01/03/on-the-front-lines-of-el-salvadors-underground-abortion-economy/.

53. Twenty-four percent of pregnancies occurred in women from fifteen to nineteen years old. The specific fertility rate of women from fifteen to nineteen years old was eighty-nine per one thousand. Seven of ten adolescents with sexual experience had a pregnancy, and 8.9 percent of this group had had a previous pregnancy. See Pan American Health Organization, “Health in the Americas: El Salvador,” 2012, http://www.paho.org/salud-en-las-americas-2012/index.php?option=com_content&view=article&id=36%3Ael-salvador&catid=21%3Acountry-chapters&Itemid=145&lang=en.

54. Anastasia Moloney, “Rape, Abortion Ban Drives Pregnant Teens to Suicide in El Salvador,” Reuters Health News, November 12, 2014, http://www.reuters.com/article/us-el-salvador-suicide-teens-idUSKCN0IW1YI20141112.

55. Carlos Mayora, in discussion with the author, June 5, 2014.

56. This description is taken from the facts of “Manuela’s case,” which resulted in an appeal to the InterAmerican Court of Human Rights in Peru. She died in prison of cancer, which the prison doctors misdiagnosed and failed to treat. Charlotte Krol, “Are El Salvador’s Extreme Anti-Abortion Laws Justified?,” Telegraph, February 14, 2015, http://www.telegraph.co.uk/news/worldnews/centralamericaandthecaribbean/elsalvador/11412550/Are-El-Salvadors-extreme-anti-abortion-laws-justified.html.

57. See Ferguson v. City of Charleston, 532 U.S. 67 (2001) (holding that a urine test conducted by the hospital in conjunction with law enforcement absent the patient’s consent was a violation of the Fourth Amendment right to be free from unreasonable searches). The use of criminal sanctions in the public hospital setting disproportionately affects poor, minority women. See, generally, Dorothy E. Roberts, “Punishing Drug Addicts Who Have Babies: Women of Color, Equality, and the Right of Privacy,” Harvard Law Review 104 (1991): 1419 (arguing that given the historical context of devaluing black mothers, prosecuting these women violates their equal protection and privacy rights regarding reproductive choices); Michele Goodwin, “Prosecuting the Womb,” George Washington Law Review 76 (2008): 1657, 1661 (describing how fetal drug laws are inconsistent, ineffective, and exempt reproductive practices by affluent groups that are equally risky to the unborn fetus).

Chapter 3: The Reddest State

1. See CNN Election Center 2008, http://www.cnn.com/ELECTION/2008/results/individual/#mapPOK and Politico’s 2012; Oklahoma Presidential Results, http://www.politico.com/2012-election/results/president/oklahoma/, last updated 11/19/12.

2. The AUL’s Life List report card is compiled by looking at abortion-related measures by state. Four states earned AUL’s 2017 All-Star Status for their implementation of legislation written by AUL. See AUL’s 2017 Life List, http://www.aul.org/2017-life-list/.

3. Joshua Holland, “When Southern Baptists Were Pro-Choice,” Moyers & Co., July 2014, http://billmoyers.com/2014/07/17/when-southern-baptists-were-pro-choice/.

4. Edward Lee Pitts, “Successful State Strategies Saving Babies,” The World, January 22, 2014, https://world.wng.org/2014/01/successful_state_strategies_saving_babies.

5. In 1910, Tony Lauinger’s ancestor founded PennWell Corporation, a privately held company in the fifth generation of continuous family ownership. The company today has over 600 employees across offices worldwide, with 343 at its headquarters in Tulsa. His family has endowed Georgetown University with a Library Fund to foster Catholic values through the acquisition of current and retrospective books, journals, periodicals, audio-visuals, computer archives, and other library materials supportive of the teachings of Magisterium on the issues of abortion, contraception, infanticide, homosexuality, assisted suicide, euthanasia, reproductive technologies, and other similar issues related to marriage, family, human sexuality, human life, and bioethics.

6. Kristen Luker, Abortion and the Politics of Motherhood (Berkeley: University of California Press, 1984).

7. Ibid., 128.

8. For details about the paper and its circulation, see http://www.baptistmessenger.com.

9. Chris Doyle, “Rose Day at 25,” Baptist Messenger, February 3, 2016, https://www.baptistmessenger.com/rose-day-at-25/.

10. Bernest Cain, in discussion with the author, July 2013.

11. Andrew Spiropoulus, in discussion with the author, June 2013.

12. See “Timeline: Oklahoma Abortion Legislation at a Glance,” Oklahoman, November 4, 2013, http://newsok.com/article/3901078.

13. For a detailed overview of Trisomy 18, see http://www.trisomy18.org/what-is-trisomy-18/.

14. Mike Reynolds, in discussion with the author, June 2013.

15. Ryan Kiesel, in discussion with the author, June 2013.

16. “Tom Smith,” in discussion with the author, June 2013.

17. Kiesel, author interview.

18. Kris Steele, in discussion with the author, June 2013.

Chapter 4: The Abortion-Minded Woman and the Law

1. Lawrence Finer, Lori Frohwirth, Lindsay Dauphinee, Susheela Singh, and Ann Moore, “Reasons US Women Have Abortions: Quantitative and Qualitative Perspectives,” Perspectives on Sexual and Reproductive Health 37 no. 3 (2005): 110–18, http://www.guttmacher.org/pubs/psrh/full/3711005.pdf.

2. Adoption lurks in the corners of any serious conversation about abortion, and I recognized Chisko’s tacit reference to it here. I don’t discuss adoption in this book. In a world where abortion is legal, issues surrounding adoption—its regulation, its impact on all those involved—are only tangentially relevant. Were abortion to become illegal, relinquishing a child for adoption would be the only legal way to avoid motherhood. In that world, adoption and its consequences would be at the heart of the conversation.

3. CBS/AP, “California to End Contentious ‘Maximum Family Grant’ Welfare Policy,” CBS SF Bay Area, June 14, 2016, http://sanfrancisco.cbslocal.com/2016/06/14/california-end-contentious-maximum-family-grant-welfare/.

4. Jamelle Bouie, “The Most Discriminatory Law in the Land,” Slate, June 17, 2014, http://www.slate.com/articles/news_and_politics/politics/2014/06/the_maximum_family_grant_and_family_caps_a_racist_law_that_punishes_the.html.

5. Christine Jolls, Cass Sunstein, and Richard Thaler, “A Behavioral Approach to Law and Economics,” Stanford Law Review 50 (1998): 471.

6. Dan Kahan, “Gentle Nudges v. Hard Shoves: Solving the Sticky Norms Problem,” University of Chicago Law Review 67 (2000): 607.

7. Ibid., 626.

8. “Since the Hyde Amendment passed, only four states have voluntarily decided to use their funds to cover abortion. Another thirteen states are required to do so by court order, just as they would other forms of health care. Thirty-two states and the District of Columbia basically follow the Hyde Amendment as the congressman intended, with some small variations. One state, South Dakota, only pays for abortion when a woman’s life is in danger, but not in cases of rape and incest—an apparent violation of federal law.” See John Light, “Five Facts You Should Know About the Hyde Amendment,” Moyers & Company, January 25, 2013, http://billmoyers.com/content/five-facts-you-should-know-about-the-hyde-amendment/.

9. Tribune News Service, “Democrats Seek Repeal of Ban on Federal Funding of Abortion,” Chicago Tribune, August 16, 2016, http://www.chicagotribune.com/news/nationworld/ct-abortion-federal-funding-ban-20160816-story.html.

10. Rebecca Blank, Christine George, and Rebecca London, “State Abortion Rates: The Impact of Policies, Providers, Politics, Demographics, and Economic Environment,” NBER Working Paper No. 4853 (September 1994), http://www.nber.org/papers/w4853.

11. Post-Roe laws from “Timeline of Abortion Laws and Events,” Chicago Tribune, http://www.chicagotribune.com/sns-abortion-timeline-story.html: “1976—Congress passes the Hyde Amendment, banning the use of Medicaid and other federal funds for abortions. The legislation is upheld by the Supreme Court in 1980. 1979—A Missouri requirement that abortions after the first trimester be performed in hospitals is found unconstitutional. Another law mandating parental consent is upheld. 1981—In Bellotti v. Baird, Supreme Court rules that pregnant minors can petition court for permission to have an abortion without parental notification. 1983—The court strikes down an Akron ordinance that requires doctors to give abortion patients antiabortion literature, imposes a 24-hour waiting period, requires abortions after the first trimester to be performed in a hospital, requires parental consent and requires the aborted fetus to be disposed of in a human manner. 1989—In Webster v. Reproductive Health Services, a law in Washington State declaring that ‘life begins at conception’ and barring the use of public facilities for abortions is found unconstitutional. It marks the first time the Supreme Court does not explicitly reaffirm Roe v. Wade. 1992—In Planned Parenthood v. Casey, the court reaffirms Roe’s core holding that states may not ban abortions or interfere with a woman’s decision to have an abortion. The court does uphold mandatory 24-hour waiting periods and parental-consent laws.”

12. Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833 (1992).

13. Ibid., 878.

14. Niraj Chokshi, “Abortion Doctors Would Lose Medical Licenses Under New Oklahoma Bill,” Washington Post, April 23, 2016, https://www.washingtonpost.com/news/morning-mix/wp/2016/04/23/this-is-our-proper-function-oklahoma-advances-measure-to-revoke-licenses-of-doctors-that-perform-abortions/?utm_term=.40a7b2951ca9.

15. The Data Team, “The Abortion Rate in America Falls to Its Lowest Level since Roe v. Wade,” Economist, January 18, 2017, http://www.economist.com/blogs/graphicdetail/2017/01/daily-chart-16.

16. See debates between Michael New, Marshall Medoff, and Christopher Dennis; Michael New, “Analyzing the Effect of Anti-Abortion U.S. State Legislation in the Post Casey Era,” State Politics and Policy Quarterly 11 (2011): 28–47; Marshall Medoff and Christopher Dennis, “Another Critical Review of New’s Reanalysis of the Impact of Antiabortion Legislation,” State Politics & Policy Quarterly 14, no. 3 (2014): 207–27; Marshall Medoff, “Biased Abortion Counseling Laws and Abortion Demand,” Social Science Journal 46 (2009): 632–43, https://www.infona.pl/resource/bwmeta1.element.elsevier-141efa1a-29c3-3dfa-83f9-73903a82b670/tab/summary.

17. Sarah Roberts, David Turok, Elise Belusa, Sarah Combellick, and Ushma Upadhyay, “Utah’s 72-Hour Waiting Period for Abortion: Experiences Among a Clinic-Based Sample of Women,” Perspectives on Sexual and Reproductive Health 48 no. 4 (2016): 179–87, doi: 10.1363/48e8216.

18. Erica Hellerstein and Tara Culp-Ressler, “Pricing American Women out of Abortion, One Restriction at a Time,” ThinkProgress, February 25, 2015, https://thinkprogress.org/pricing-american-women-out-of-abortion-one-restriction-at-a-time-c545c54f641f#.jzr6c8z64.

Chapter 5: America After Roe

1. Jeffrey Antevil, “Supreme Court Rules on Roe vs. Wade in 1973,” New York Daily News, January 21, 2015, http://www.nydailynews.com/news/national/supreme-court-rules-roe-v-wade-1973-article-1.2068726.

2. Constitutional Amendment Process, National Archives, August 15, 2016, https://www.archives.gov/federal-register/constitution. For a time, the pro-life movement threw its support into campaigning for such a change in the form of the “Human Life Amendment.” Although the Republican Party’s platform continues to support the Human Life Amendment, the movement has had little traction in Congress. It has been decades since Congress even considered the issue. See the Human Life Action website for an account of activity on the Human Life Amendment, https://www.humanlifeaction.org/sites/default/files/HLAhghlts.pdf.

3. Pete Williams, “Abortion Could Be Outlawed in 33 States if Roe v. Wade Overturned: Report,” NBC News, January 23, 2017, http://www.nbcnews.com/news/us-news/report-abortion-could-be-outlawed-33-states-if-roe-v-n710816.

4. “Marina,” in discussion with the author, 2009.

5. Seth F. Kreimer, The Law of Choice and Choice of Law: Abortion, the Right to Travel, and Extraterritorial Regulation in American Federalism (1992), Faculty Scholarship Paper, 1336fn9, http://scholarship.law.upenn.edu/faculty_scholarship/1336.

6. See Colleen Heild, “New Mexico Becomes Abortion Magnet,” Albuquerque Journal, March 20, 2016, https://www.abqjournal.com/743253/more-women-coming-to-nm-for-abortions.html.

7. See Kate Sheppard, “Why This Woman Chose Abortion—at 29 Weeks,” Mother Jones, July 25, 2011, http://www.motherjones.com/politics/2011/07/late-term-abortion-29-weeks-dana-weinstein; also see Molly Hennessy-Fiske, “Crossing the ‘Abortion Desert’: Women Increasingly Travel out of Their States for the Procedure,” Los Angeles Times, June 2, 2016, http://www.latimes.com/nation/la-na-adv-abortion-traveler-20160530-snap-story.html.

8. Compare with Mark D. Rosen, “Extraterritoriality and Political Heterogeneity in American Federalism,” University of Pennsylvania Law Review 150 (2002): 855, http://scholarship.law.upenn.edu/penn_law_review/vol150/iss3/2. Rosen argues that the law actually permits states to regulate their citizens’ out-of-state activities for the purpose of ensuring the efficacy of constitutional state policies, and that state’s determinations to regulate citizens’ extraterritorial conduct is actually only a policy decision.

9. Alan Guttmacher Institute, “Abortion in Africa: Incidence and Trends,” May 2016, https://www.guttmacher.org/fact-sheet/facts-abortion-africa.

10. Andrew Downie, “Abortions in Brazil, Though Illegal, Are Common,” Time, June 2, 2010, http://content.time.com/time/world/article/0,8599,1993205,00.html.

11. Texas Policy Evaluation Project, “Texas Women’s Experiences Attempting Self-Induced Abortion in the Face of Dwindling Options,” November 17, 2015, https://liberalarts.utexas.edu/txpep/_files/pdf/TxPEP-Research-Brief-WomensExperiences.pdf.

12. See Tess Barker, “The New Reality: Women Charged for Murder After Self-Inducing Abortions,” Broadly, January 24, 2016, https://broadly.vice.com/en_us/article/the-new-reality-women-charged-for-murder-after-self-inducing-abortions. Also see Teresa A. Saultes, Diane Devita, and Jason D. Heiner, “The Back Alley Revisited: Sepsis after Attempted Self-Induced Abortion,” Western Journal of Emergency Medicine 10, no. 4 (2009): 278–80.

13. Paltrow, “Roe v. Wade and the New Jane Crow,” 17–21. A 2010 case from Utah involved a woman charged with illegal abortion after hiring a man to beat her up in order to bring on a miscarriage.

14. Matt Flegenheimer and Maggie Haberman, “Donald Trump, Abortion Foe, Eyes ‘Punishment’ for Women, Then Recants,” New York Times, March 30, 2016, https://www.nytimes.com/2016/03/31/us/politics/donald-trump-abortion.html; Tara Culp-Ressler, “Abortion Bans Are Putting Women Behind Bars,” ThinkProgress, March 9, 2015, https://thinkprogress.org/abortion-bans-are-putting-women-behind-bars-119b8fba1c70.

15. Rachel Lu, “Why Pro-Lifers Don’t Support Punishing Women for Abortion,” Federalist, April 5, 2016, http://thefederalist.com/2016/04/05/why-pro-lifers-dont-support-punishing-women-for-abortion/.

16. Flegenheimer and Haberman, “Donald Trump, Abortion Foe.” The day after Donald Trump’s remarks, the New York Times reported on the outpouring of condemnation by pro-life advocates throughout the country. The article quoted Jeanne Mancini, the president of the March for Life Education Fund, as saying that efforts to punish individual women would be “completely out of touch with the pro-life movement” and “no pro-lifer would ever want to punish a woman who has chosen abortion”; Bruce Haynes, a Republican strategist, as stating he could not recall “‘any credible corner of the movement’ calling for criminal sanctions against women who sought abortions”; Governor John Kasich as declaring, “Of course women shouldn’t be punished”; and Senator Ted Cruz as stating, with reference to a woman who has an abortion, “Of course we shouldn’t be talking about punishment.”

17. Clarke Forsythe, “Why the States Did Not Prosecute Women for Abortion Before Roe v. Wade,” Americans United for Life, April 23, 2010, http://www.aul.org/2010/04/why-the-states-did-not-prosecute-women-for-abortion-before-roe-v-wade/.

18. Reagan, When Abortion Was a Crime.

19. Ibid., 114, 164.

20. Leslie Reagan, “Victim or Accomplice? Crime, Medical Malpractice, and the Construction of the Aborting Women in American Case Law, 1860s–1970,” Columbia Journal of Gender and Law 10 (2001): 311, 332. “Although state laws provided for the prosecution of women who had abortions, late-nineteenth-century state prosecutors went after the abortionists. Juries were reluctant, however, to convict people accused of performing abortions. As a result, prosecutors increasingly focused on prosecuting abortionists whose practice had resulted in the death or severe injury of a woman patient. This emphasis did not change until around 1940 (332).

21. Samuel W. Buell, “Criminal Abortion Revisited,” New York University Law Review 66 (1991): 1774, 1785.

22. Suzanne M. Alford, “Is Self-Abortion a Fundamental Right?,” Duke Law Journal 52 (2003): 1011, 1022. New York, Laws of 1869, Chap. 631, entitled “An act relating to the procurement of abortions, and other like offences”: Every woman who shall solicit of any person any medicine, drug, or substance or thing whatever, and shall take the same, or shall submit to any operation, or other means whatever, with intent thereby to procure a miscarriage, shall be deemed guilty of a misdemeanor, and shall, upon conviction, be punished by imprisonment in the county jail, not less than three months nor more than one year, or by a fine not exceeding one thousand dollars, or by both such fine and imprisonment.

23. Louisiana, Mississippi, and North and South Dakota have laws in place that would automatically make abortion illegal if Roe v. Wade were to be overturned. Pete Williams, “Abortion Could Be Outlawed in 33 States if Roe v. Wade Overturned: Report,” NBC News, January 23, 2017, http://www.nbcnews.com/news/us-news/report-abortion-could-be-outlawed-33-states-if-roe-v-n710816.

24. See Commonwealth v. Weible, 45 Pa. Super. 207 (1911). Also see Crissman v. State, 93 Tex. Crim. 15, 245 S.W. 438 (Tex. Crim. App. 1922).

25. Carmen Hein de Campos, “Mass Prosecution for Abortion: Violation of the Reproductive Rights of Women in Mato Grosso do Sul, Brazil,” AWID Women’s Rights, 2016, https://www.oursplatform.org/resource/mass-prosecution-abortion-violation-reproductive-rights-women-mato-grosso-sul-brazil/.

26. “Abortion Prosecutions on the Rise in Many Mexican States,” Mexico Gulf Reporter, August 6, 2012, http://mexicogulfreporter.blogspot.com/2012/08/abortion-prosecutions-on-rise-in-many.html.

27. Center for Reproductive Rights and the Agrupación Ciudadana, Marginalized, Persecuted, and Imprisoned: The Effects of El Salvador’s Total Criminalization of Abortion (New York: 2014, https://www.reproductiverights.org/sites/crr.civicactions.net/files/documents/El-Salvador-CriminalizationOfAbortion-Report.pdf.

28. Hadley Arkes, “One Untrue Thing: Life after Roe,” National Review Symposium, August 1, 2007, http://www.nationalreview.com/article/221742/one-untrue-thing-nro-symposium.

29. Lynn Paltrow and Jeanne Flavin, “Arrests of and Forced Interventions on Pregnant Women in the United States, 1973–2005: Implications for Women’s Legal Status and Public Health,” Journal of Health Politics, Policy and Law 38, no. 2 (2013): 299–343, http://jhppl.dukejournals.org/content/38/2/299.refs.

30. L. M. Paltrow, “Roe v. Wade and the New Jane Crow: Reproductive Rights in the Age of Mass Incarceration,” American Journal of Public Health 103, no. 1 (2013): 17–21, doi:10.2105/AJPH.2012.301104.

31. Ibid.

32. Five states have laws explicitly criminalizing self-abortion. The other states use alternative theories to bring charges against women. For example, thirty-nine states make it illegal for anyone other than a medical provider to perform the procedure. Although some states explicitly exempt women from prosecution under state abortion laws, others are silent. As such, whether under self-abortion statutes or under laws restricting abortion to medical providers, women can be and have been charged with illegal abortion.

33. Sally Koh, “Indiana’s Other Outrageous Law,” CNN, March 31, 2015, http://www.cnn.com/2015/03/31/opinions/kohn-indiana-anti-abortion-law/. Prosecutors claimed that Patel ordered abortion-inducing drugs online and tried to terminate her pregnancy, but a toxicology report failed to find evidence of any drugs in her system. She received a thirty-year-sentence on the felony neglect charge, ten of which were suspended. A six-year sentence for feticide was to be served concurrently. Emily Bazelon, “Purvi Patel Could Be Just the Beginning,” New York Times, April 1, 2015, https://www.nytimes.com/2015/04/01/magazine/purvi-patel-could-be-just-the-beginning.html.

34. Calvin Freiburger, “Death, Lies, And Relativism in the Purvi Patel Feticide Conviction,” Live Action News, April 3, 2015, http://liveactionnews.org/death-lies-relativism-purvi-patel-feticide-conviction/.

35. Ibid.

36. Ibid. “The 33-year-old Patel is ‘an educated woman of considerable means,’ and ‘if [she] wished to terminate [her] pregnancy safely and legally, [she] could have done so.’ Instead, she repeatedly rejected a friend’s insistence that she see a doctor, simply because she didn’t want her traditional Hindu parents to know she’d had sex with a married co-worker. She didn’t get a doctor to do it, but killed her son herself. Her son who was viable.” See also, Texas Right to Life staff, “What Really Happened to Purvi Patel’s Baby Boy?,” Texas Right to Life News, April 9, 2015, https://www.texasrighttolife.com/what-really-happened-to-purvi-patel-s-baby-boy/. “Now, the liberal media’s spin on the story goes something like this: Purvi Patel suffered a miscarriage and was thrown in jail for something completely out of her control because Pro-Life feticide laws are that outrageous. Cue the evidence-spinning and abortion lobby pandemonium.”

37. Associated Press, “Indiana Court Tosses Purvi Patel’s 2015 Feticide Conviction,” NBC News, July 22, 2016, http://www.nbcnews.com/news/asian-america/indiana-court-tosses-purvi-patel-s-2015-feticide-conviction-n615026.

38. Paltrow and Flavin, “Arrests of and Forced Interventions on Pregnant Women,” 309.

39. Ibid., 309–10.

40. Ibid., 311.

41. Ibid., 311.

42. Tara Culp-Ressler, “This Woman Says She Had a Miscarriage. Now She Could Face 70 Years in Prison,” ThinkProgress, March 30, 2015, https://thinkprogress.org/this-woman-says-she-had-a-miscarriage-now-she-could-face-70-years-in-prison-c62d73ba32e1. “According to a study conducted by NAPW reviewing the prosecutions of women in relation to their pregnancies between 1973 and 2005, low-income women and women of color are disproportionately arrested under feticide laws. Black women are significantly more likely to be reported to authorities by hospital staff under suspicion that they harmed their unborn children.”

43. “Twelve Facts About the Abortion Ban in El Salvador,” Amnesty International Report, September 25, 2014, https://www.amnesty.org/en/latest/news/2014/09/twelve-facts-about-abortion-ban-el-salvador/. El Salvador has the highest rate of teenage pregnancy in Latin America. According to the National Family Health Survey, more than one-fifth (23 percent) of all teenagers aged between fifteen and nineteen in El Salvador have been pregnant at least once. Nearly half of them were under eighteen and didn’t intend to get pregnant.

44. Ibid. Suicide accounts for 57 percent of the deaths of pregnant females aged ten to nineteen in El Salvador, though it is likely many more cases have gone unreported.

45. Moloney, “Rape, Abortion Ban Drives Pregnant Teens to Suicide.”

46. Sunstein, “On the Expressive Function of Law,” 2021, 2031.

Conclusion: Parting Thoughts on Leaving Behind the Abortion War

1. George Orwell. “Looking Back on the Spanish War” (1943), reprinted in A Collection of Essays (New York: Harcourt, 1946), 193–94.