New Yorker

WINNER—COLUMNS AND ESSAYS

In this series of articles, Jia Tolentino briskly summarizes the impact of the Supreme Court’s decision to abandon Roe v. Wade: “We have entered an era not of unsafe abortion but of widespread state surveillance and criminalization—of pregnant women, certainly, but also of doctors and pharmacists and clinic staffers and volunteers and friends and family members.” The judges who chose these articles as the winner of the National Magazine Award for Columns and Essays described them as “searing and beautifully articulated.” A staff writer at the New Yorker, Tolentino was also nominated for the National Magazine Award for Columns and Commentary in 2020. Her first book, Trick Mirror: Reflections on Self-Delusion, was published in 2019. The New Yorker received seven National Magazine Award nominations this year in categories ranging from Video and Photography to Reporting and Public Interest.

Jia Tolentino

A Post-Roe Threat and The Post-Roe Era and Is Abortion Sacred?

A Post-Roe Threat

January 22, 2022, marked the forty-ninth anniversary of Roe v. Wade—and, likely, the last year that its protections will remain standing. In December, during oral arguments, the Supreme Court’s six conservative justices signaled their intention to uphold a Mississippi law that, in banning almost all abortions after fifteen weeks of pregnancy, defies Roe’s protections. Most of those Justices seemed prepared to overturn Roe entirely. Without Roe, which prohibits states from banning abortion before fetal viability—at twenty-eight weeks when the law was decided, and closer to twenty-two weeks now—abortion could become mostly inaccessible and illegal in at least twenty states.

Some of the potential ramifications are obvious. The majority of people who get abortions are already mothers, and 75 percent live near or below the federal poverty line. It is the least advantaged of this disadvantaged group who will be unable to cobble together the time, money, and child care required to travel across state lines to determine their own reproductive futures. Some will be able to self-administer abortions through telemedicine and mail-order pills—a safe and increasingly common method for early pregnancies. But for those who can’t, the long-term consequences could be severe. The Turnaway Study, a research project that tracked a thousand women seeking abortions in the United States in the course of five years, found that women denied an abortion have an almost four times greater chance of living below the federal poverty line than women who were not denied one, as well as an increased risk of serious health problems, and their children are more likely to grow up in an abusive environment.

But there are other severe, metastasizing consequences that could follow Roe’s repeal. Roe rejects the idea of fetal personhood, which is a pillar of the antiabortion movement. It also repudiates the argument that the Fourteenth Amendment grants equal protection and consequently equal legal standing to fetuses. (That claim was used as early as 1971, when a lawyer filed suit against the state of New York over its liberalized abortion law, and it has been resuscitated by organizations such as the March for Life, whose 2022 theme is “Equality Begins in the Womb.”) The Supreme Court remains a distance away from this extremist position—even Justice Antonin Scalia said that the Constitution applies only to “walking-around persons.” Still, antiabortion groups have been pushing fetal personhood on state legislatures, which have introduced more than two hundred pieces of legislation supporting it in the past decade. Most of the bills have failed; they are unpopular as well as unconstitutional. But, in 2019, Georgia passed a near-total abortion ban that allows a fetus to be claimed as a dependent on one’s taxes. (The same year, a judge in Alabama allowed a man to sue an abortion clinic on behalf of an aborted embryo’s estate.) The Georgia law is currently before the Eleventh Circuit Court of Appeals, awaiting the Supreme Court’s Mississippi ruling. If such laws can no longer be challenged at the federal level, they will surely begin to proliferate in earnest.

Recent events in Oklahoma provide an example of what might follow. Though the state’s Supreme Court struck down a fetal-personhood amendment to the state constitution in 2012, the idea has been affirmed in other ways. In 2015, state law was amended to require that any fetal death past twelve weeks be reported as a stillbirth. The Humanity of the Unborn Child Act, passed in 2016, requires that the state department of health “clearly and consistently teach that abortion kills a living human being.” Since 2017, according to a report by the Frontier, an Oklahoma journalism nonprofit, at least forty-five women in that state have been charged with child abuse, child neglect, or manslaughter because of drug use during pregnancy. In 2020, according to the Frontier, the district attorney for Kay and Noble Counties charged seven women with felony child neglect for using marijuana during pregnancy, even though some of them had medical-marijuana licenses. The charge does not require the state to demonstrate actual harm.

The same year, the district attorney for Comanche and Cotton Counties charged three women—Brittney Poolaw, Ashley Traister, and Emily Akers—with manslaughter after they miscarried at seventeen weeks, twenty-one weeks, and twenty weeks pregnant, respectively. The fetuses were autopsied, as necessitated by the 2015 change in the law, and each tested positive for methamphetamine. As thirteen physicians and researchers recently affirmed in an amicus brief in support of Akers, studies have shown that meth use is associated with issues connected to low birth weight but not with miscarriage or stillbirth. Traister pleaded guilty and is awaiting sentencing. Akers’s case was dismissed due to lack of evidence, but Comanche County has appealed. Poolaw was incarcerated for eighteen months before being convicted by a jury that deliberated for less than three hours; she was sentenced, at age nineteen, to the minimum sentence of four years.

These cases are not anomalous—they’re part of an intensifying pattern. In the late eighties and early nineties, at least 160 women who used drugs while pregnant were charged with child neglect and distribution of drugs to minors. Between 2006 and 2016, according to ProPublica, some 500 Alabama women were charged with felony chemical endangerment for using drugs during pregnancy, even in cases in which the drugs were prescribed by doctors. One woman, Katie Darovitz, was arrested when her son was two weeks old and healthy; she had controlled a seizure disorder with marijuana after her doctors advised her that her normal medication could be unsafe for pregnancy. (The case was eventually dismissed.)

Every year, there are about a million miscarriages in the United States. Under the doctrine of fetal personhood, these common, complicated, and profoundly intimate losses could become legally subject to surveillance and criminalization. The blame, as always, would fall on individual behavior, not on the chromosomal or placental abnormalities that often cause miscarriage or the social factors that have been proven to increase a person’s risk of losing a pregnancy: poor nutrition, limited health-care access, night shifts and long hours, exposure to environmental toxins. Poverty and racism pose an unequivocal threat to fetal life and child well-being. In a post-Roe world, poor and minority women would find themselves not protected but targeted for further suffering.

The Post-Roe Era

In the weeks since a draft of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization—a case about a Mississippi law that bans abortion after fifteen weeks, with some health-related exceptions but none for rape or incest—was leaked, a slogan has been revived: “We won’t go back.” It has been chanted at marches, defiantly but also somewhat awkwardly, given that this is plainly an era of repression and regression, in which abortion rights are not the only rights disappearing. Now that the Supreme Court has issued its final decision, overturning Roe v. Wade and removing the constitutional right to abortion, insuring that abortion will become illegal or highly restricted in twenty states, the slogan sounds almost divorced from reality—an indication, perhaps, of how difficult it has become to comprehend the power and the right-wing extremism of the current Supreme Court.

Support for abortion has never been higher, with more than two-thirds of Americans in favor of retaining Roe, and 57 percent affirming a woman’s right to abortion for any reason. Even so, there are Republican officials who have made it clear that they will attempt to pass a federal ban on abortion if and when they control both chambers of Congress and the presidency. Anyone who can get pregnant must now face the reality that half of the country is in the hands of legislators who believe that your personhood and autonomy are conditional—who believe that, if you are impregnated by another person, under any circumstance, you have a legal and moral duty to undergo pregnancy, delivery, and, in all likelihood, two decades or more of caregiving, no matter the permanent and potentially devastating consequences for your body, your heart, your mind, your family, your ability to put food on the table, your plans, your aspirations, your life.

“We won’t go back”—it’s an inadequate rallying cry, prompted only by events that belie its message. But it is true in at least one sense. The future that we now inhabit will not resemble the past before Roe, when women sought out illegal abortions and not infrequently found death. The principal danger now lies elsewhere and arguably reaches further. We have entered an era not of unsafe abortion but of widespread state surveillance and criminalization—of pregnant women, certainly, but also of doctors and pharmacists and clinic staffers and volunteers and friends and family members, of anyone who comes into meaningful contact with a pregnancy that does not end in a healthy birth. Those who argue that this decision won’t actually change things much—an instinct you’ll find on both sides of the political divide—are blind to the ways in which state-level antiabortion crusades have already turned pregnancy into punishment, and the ways in which the situation is poised to become much worse.

In the states where abortion has been or will soon be banned, any pregnancy loss past an early cutoff can now potentially be investigated as a crime. Search histories, browsing histories, text messages, location data, payment data, information from period-tracking apps—prosecutors can examine all of it if they believe that the loss of a pregnancy may have been deliberate. Even if prosecutors fail to prove that an abortion took place, those who are investigated will be punished by the process, liable for whatever might be found.

Five years ago, Latice Fisher, a Black mother of three from Mississippi who made eleven dollars an hour as a police-radio operator, experienced a stillbirth, at roughly thirty-six weeks, at home. When questioned, she acknowledged that she didn’t want more kids and couldn’t afford to take care of more kids. She surrendered her phone to investigators, who scraped it for search data and found search terms regarding mifepristone and misoprostol, i.e., abortion pills.

These pills are among the reasons that we are not going back to the era of coat hangers. They can be prescribed via telemedicine and delivered via mail; allowing for the prescription of an extra dose, they are 95 to 98 percent effective in cases of pregnancy up to eleven weeks, which account for almost 90 percent of all abortions in the United States. Already, more than half of all abortions in the country are medication abortions. In nineteen states, doctors are prohibited from providing abortions via telemedicine, but women can seek help from clinicians in other states and abroad, such as Rebecca Gomperts, who leads Aid Access, an organization based in Austria that is openly providing abortion pills to women in prohibition states and has been safely mailing abortion pills to pregnant people all over the world since 2005 with the organization Women on Web. In advance of the U.S. bans, Gomperts has been promoting advance prescription: sympathetic doctors might prescribe abortion pills for any menstruating person, removing some of the fears—and, possibly, the traceability—that would come with attempting to get the pills after pregnancy. Misoprostol can be prescribed for other issues, such as stomach ulcers, and Gomperts argues that there is no reasonable medical argument against advance prescription. “If you buy bleach in the supermarket, that’s more dangerous,” she has said.

There was no evidence that Latice Fisher took an abortion pill. She maintained that she had experienced a stillbirth—an occurrence in one out of every hundred and sixty pregnancies in the United States. Nonetheless, she was charged with second-degree murder and held for several weeks on a hundred-thousand-dollar bond. The district attorney, Scott Colom, had campaigned as a progressive reformer; advocates pushed him to drop the murder charge and to provide a new grand jury with information about an antiquated, unreliable “float test” that had been used as a basis for the allegation that Fisher’s baby was born alive. The grand jury declined to indict Fisher again; the ordeal took more than three years.

Even if it remains possible in prohibition states to order abortion pills, doing so will be unlawful. (Missouri recently proposed classifying the delivery or shipment of these pills as drug trafficking. Louisiana just passed a law that makes mailing abortion pills to a resident of the state a criminal offense, punishable by six months’ imprisonment.) In many states, to avoid breaking the law, a woman would have to drive to a state where abortion is legal, have a telemedicine consultation there, and then receive the pills in that state. Many women in Texas have opted for a riskier but easier option: to drive across the border, to Mexico, and get abortion pills from unregulated pharmacies, where pharmacists may issue incorrect advice for usage. Some women who lack the freedom and money to travel out of state, and who might fear the consequences of seeking a clinical confirmation of their gestational stage, will order abortion pills without a clear understanding of how far along they are in pregnancy. Abortion pills are safe and effective, but patients need access to clinical guidance and follow-up care. Women in prohibition states who want to seek medical attention after a self-managed abortion will, as a rule, have to choose between risking their freedom and risking their health.

Both abortion and miscarriage currently occur more than a million times each year in America, and the two events are often clinically indistinguishable. Because of this, prohibition states will have a profoundly invasive interest in differentiating between them. Some have already laid the groundwork for establishing government databases of pregnant women likely to seek abortions. Last year, Arkansas passed a law called the Every Mom Matters Act, which requires women considering abortion to call a state hotline and requires abortion providers to register all patients in a database with a unique ID. Since then, six other states have implemented or proposed similar laws. The hotlines are provided by crisis pregnancy centers: typically Christian organizations, many of which masquerade as abortion clinics, provide no health care, and passionately counsel women against abortion. Crisis pregnancy centers are already three times as numerous as abortion clinics in the United States, and, unlike hospitals, they are not required to protect the privacy of those who come to them. For years, conservative states have been redirecting money, often from funds earmarked for poor women and children, toward these organizations. The data that crisis pregnancy centers are capable of collecting—names, locations, family details, sexual and medical histories, nondiagnostic ultrasound images—can now be deployed against those who seek their help.

If you become pregnant, your phone generally knows before many of your friends do. The entire internet economy is built on meticulous user tracking of purchases and search terms. Laws modeled on Texas’s S.B. 8, which encourages private citizens to file lawsuits against anyone who facilitates an abortion, will proliferate, giving self-appointed vigilantes no shortage of tools to track and identify suspects. (The National Right to Life Committee recently published policy recommendations for antiabortion states that included criminal penalties for anyone who provides information about self-managed abortion “over the telephone, the internet, or any other medium of communication.”) A reporter for Vice recently spent a mere $160 to purchase a data set on visits to more than 600 Planned Parenthood clinics. Brokers sell data that make it possible to track journeys to and from any location—say, an abortion clinic in another state. In Missouri this year, a lawmaker proposed a measure that would allow private citizens to sue anyone who helps a resident of the state get an abortion elsewhere; as with S.B. 8, the law would reward successful plaintiffs with $10,000. The closest analogue to this kind of legislation is the Fugitive Slave Act of 1793.

For now, the targets of S.B. 8–type bounty laws are those who provide abortions, not those who seek them. But that seems likely to change. Connecticut, a progressive state on the matter of abortion, recently passed a law that prevents local agencies from cooperating with out-of-state abortion prosecutions and protects the medical records of out-of-state clients. Other progressive states will follow suit. If prohibition states can’t sue out-of-state doctors, and, if abortion pills sent by mail remain largely undetectable, the only people left to target will be abortion advocates and those trying to get abortions. The Stream, a conservative Christian publication, recently advocated mandatory psychiatric custody for women who get abortions. In May, Louisiana advanced a bill that would allow abortion patients to be charged with murder. The proposal was withdrawn, but the threat had been made.

The theological concept of fetal personhood—the idea that, from the moment of conception, an embryo or fetus is a full human being, deserving of equal (or, more accurately, superior) rights—is a foundational doctrine of the antiabortion movement. The legal ramifications of this idea—including the possible classification of IVF, IUDs, and the morning-after pill as instruments of murder—are unhinged and much harsher than what even the average antiabortion American is currently willing to embrace. Nonetheless, the antiabortion movement is now openly pushing for fetal personhood to become the foundation of U.S. abortion law.

If a fetus is a person, then a legal framework can be invented to require someone who has one living inside her to do everything in her power to protect it, including—as happened to Savita Halappanavar, in Ireland, which operated under a fetal-personhood doctrine until 2018, and to Izabela Sajbor, in Poland, where all abortion is effectively illegal—to die. No other such obligation exists anywhere in our society, which grants cops the freedom to stand by as children are murdered behind an unlocked door. In Poland, pregnant women with cancer have been routinely denied chemotherapy because of clinicians’ fears of harming the fetus.

Fetal-personhood laws have passed in Georgia and Alabama, and they are no longer likely to be found unconstitutional. Such laws justify a full-scale criminalization of pregnancy, whereby women can be arrested, detained, and otherwise placed under state intervention for taking actions perceived to be potentially harmful to a fetus. This approach has been steadily tested, on low-income minorities in particular, for the past four decades. National Advocates for Pregnant Women—the organization that has provided legal defense for most of the cases mentioned in this article—has documented almost 1,800 cases from 1973 to 2020 of prosecutions or forced interventions related to pregnancy; this is likely a substantial undercount. Even in states such as California, where the law explicitly prohibits charging women with murder after a pregnancy loss, conservative prosecutors are doing so anyway.

Most pregnancy-related prosecutions, so far, have revolved around drug use. Women who used drugs while pregnant or sought treatment for drug use during pregnancy have been charged with child abuse, child neglect, distribution of drugs to a minor, assault with a deadly weapon, manslaughter, and homicide. In 2020, law enforcement in Alabama investigated a woman named Kim Blalock for chemical endangerment of a child after she told delivery-room staff that she had been taking prescribed hydrocodone for pain management. (The district attorney charged her with prescription fraud—a felony—before eventually dropping the prosecution altogether.) There has been a string of shocking recent prosecutions in Oklahoma, in which women who used drugs have been charged with manslaughter for miscarrying well before the point of viability. In Wisconsin, state law already allows juvenile courts to take a fetus—meaning a pregnant woman—into custody for the fetus’s protection, resulting in the detention and forced treatment of more than 400 pregnant women every year on the suspicion that they may be consuming controlled substances. A proposed law in Wyoming would create a specific category of felony child endangerment for drug use while pregnant, a law that resembles Tennessee’s former Fetal Assault Law. The Tennessee law was discontinued after two years because treating women as adversaries to the fetuses they carry has a chilling effect on prenatal medicine and inevitably results in an increase in maternal and infant death.

The mainstream prochoice movement has largely ignored the growing criminalization of pregnancy, just as it has generally ignored the inadequacy of Roe. (It took Joe Biden, who campaigned on making Roe the “law of the land,” more than a year to say the word “abortion” on the record after he became president; the Democrats, given the chance to override the filibuster and codify Roe in May, predictably failed to do so.) Many of those who support the right to abortion have tacitly accepted that poor and minority women in conservative states lost access to abortion long before this Supreme Court decision and have quietly hoped that the thousands of women facing arrest after pregnancy, miscarriage, stillbirth, or even healthy deliveries were unfortunate outliers. They were not outliers, and, as the columnist Rebecca Traister noted last month, the chasm between the impervious class and everyone else is growing every day.

Pregnancy is more than thirty times more dangerous than abortion. One study estimates that a nationwide ban would lead to a 21 percent rise in pregnancy-related deaths. Some of the women who will die from abortion bans are pregnant right now. Their deaths will come not from back-alley procedures but from a silent denial of care: interventions delayed, desires disregarded. They will die of infections, of preeclampsia, of hemorrhage, as they are forced to submit their bodies to pregnancies that they never wanted to carry, and it will not be hard for the antiabortion movement to accept these deaths as a tragic, even noble consequence of womanhood itself.

In the meantime, abortion bans will hurt, disable, and endanger many people who want to carry their pregnancies to term but who encounter medical difficulties. Physicians in prohibition states have already begun declining to treat women who are in the midst of miscarriages, for fear that the treatment could be classified as abortion. One woman in Texas was told that she had to drive fifteen hours to New Mexico to have her ectopic pregnancy—which is nonviable, by definition, and always dangerous to the mother—removed. Misoprostol, one of the abortion pills, is routinely prescribed for miscarriage management because it causes the uterus to expel any remaining tissue. Pharmacists in Texas, fearing legal liability, have already refused to prescribe it. If a miscarriage is not managed to a safe completion, women risk—among other things, and taking the emotional damage for granted—uterine perforation, organ failure, infection, infertility, and death.

Most miscarriages are caused by factors beyond a pregnant person’s control: illnesses, placental or uterine irregularities, genetic abnormalities. But the treatment of pregnant people in this country already makes many of them feel directly and solely responsible for the survival of their fetus. They are told to absolutely avoid alcohol, coffee, retinol, deli turkey, unpasteurized cheese, hot baths, vigorous exercise, drugs that are not prescribed to them, drugs that they have been prescribed for years—often without any explanation of the frequently shoddy reasoning behind these prohibitions. Structural factors that clearly increase the likelihood of miscarriage—poverty, environmental-chemical exposure, working night shifts—are less likely to come up. As fetal personhood becomes law in more of the land, pregnant people, as Lynn Paltrow, the director of National Advocates for Pregnant Women, has pointed out, “could be sued, or prevented from engaging in travel, work, or any activity that is believed to create a risk to the life of the unborn.”

Half a century ago, the antiabortion movement was dominated by progressive, antiwar, pro-welfare Catholics. Today, the movement is conservative, evangelical, and absolutely single-minded, populated overwhelmingly by people who, although they may embrace foster care, adoption, and various forms of private ministry, show no interest in pushing for public, structural support for human life once it’s left the womb. The scholar Mary Ziegler recently noted that today’s antiabortion advocates see the “strategies of earlier decades as apologetic, cowardly, and counterproductive.” During the past four years, eleven states have passed abortion bans that contain no exceptions for rape or incest, a previously unthinkable extreme.

In Texas, already, children aged nine, ten, and eleven, who don’t yet understand what sex and abuse are, face forced pregnancy and childbirth after being raped. Women sitting in emergency rooms in the midst of miscarriages are being denied treatment for sepsis because their fetuses’ hearts haven’t yet stopped. People you’ll never hear of will spend the rest of their lives trying and failing, agonizingly, in this punitive country, to provide stability for a first or fifth child they knew they weren’t equipped to care for.

In the face of all this, there has been so much squeamishness, even in the prochoice camp: a tone that casts abortion as an unfortunate necessity, an approach to messaging that values choice but devalues abortion care itself, that emphasizes reproductive rights rather than reproductive justice. That approach has landed us here. We are not going back to the pre-Roe era, and we should not want to go back to the era that succeeded it, which was less bitter than the present but was never good enough. We should demand more, and we will have to. We will need to be full-throated and unconditional about abortion as a necessary precondition to justice and equal rights if we want even a chance of someday getting somewhere better.

Is Abortion Sacred?

Twenty years ago, when I was thirteen, I wrote an entry in my journal about abortion, which began, “I have this huge thing weighing on me.” That morning, in Bible class, which I’d attended every day since the first grade at an evangelical school in Houston, my teacher had led us in an exercise called Agree/Disagree. He presented us with moral propositions, and we stood up and physically chose sides. “Abortion is always wrong,” he offered, and there was no disagreement. We all walked to the wall that meant “agree.”

Then I raised my hand and, according to my journal, said, “I think it is always morally wrong and absolutely murder, but if a woman is raped, I respect her right to get an abortion.” Also, I said, if a woman knew the child would face a terrible life, the child might be better off. “Dead?” the teacher asked. My classmates said I needed to go to the other side, and I did. “I felt guilty and guilty and guilty,” I wrote in my journal. “I didn’t feel like a Christian when I was on that side of the room. I felt terrible, actually.… But I still have that thought that if a woman was raped, she has her right. But that’s so strange—she has a right to kill what would one day be her child? That issue is irresolved in my mind and it will eat at me until I sort it out.”

I had always thought of abortion as it had been taught to me in school: it was a sin that irresponsible women committed to cover up another sin, having sex in a non-Christian manner. The moral universe was a stark battle of virtue and depravity, in which the only meaningful question about any possible action was whether or not it would be sanctioned in the eyes of God. Men were sinful, and the goodness of women was the essential bulwark against the corruption of the world. There was suffering built into this framework, but suffering was noble; justice would prevail in the end because God always provided for the faithful. It was these last tenets, prosperity-gospel principles that neatly erase the material causes of suffering in our history and our social policies—not only regarding abortion but so much else—that toppled for me first. By the time I went to college, I understood that I was prochoice.

America is, in many ways, a deeply religious country—the only wealthy Western democracy in which more than half of the population claims to pray every day. (In Europe, the figure is 22 percent.) Although seven out of ten American women who get abortions identify as Christian, the fight to make the procedure illegal is an almost entirely Christian phenomenon. Two-thirds of the national population and nearly 90 percent of Congress affirm a tradition in which a teenage girl continuing an unplanned pregnancy allowed for the salvation of the world, in which a corrupt government leader who demanded a Massacre of the Innocents almost killed the baby Jesus and damned us all in the process, and in which the Son of God entered the world as what the godless dare to call a “clump of cells.”

For centuries, most Christians believed that human personhood began months into the long course of pregnancy. It was only in the twentieth century that a dogmatic narrative, in which every pregnancy is an iteration of the same static story of creation, began both to shape American public policy and to occlude the reality of pregnancy as volatile and ambiguous—as a process in which creation and destruction run in tandem. This newer narrative helped to erase an instinctive, long-held understanding that pregnancy does not begin with the presence of a child and only sometimes ends with one. Even within the course of the same pregnancy, a person and the fetus she carries can shift between the roles of lover and beloved, host and parasite, vessel and divinity, victim and murderer; each body is capable of extinguishing the other, although one cannot survive alone. There is no human relationship more complex, more morally unstable than this.

The idea that a fetus is not just a full human but a superior and kinglike one—a being whose survival is so paramount that another person can be legally compelled to accept harm, ruin, or death to insure it—is a recent invention. For most of history, women ended unwanted pregnancies as they needed to, taking herbal or plant-derived preparations on their own or with the help of female healers and midwives, who presided over all forms of treatment and care connected with pregnancy. They were likely enough to think that they were simply restoring their menstruation, treating a blockage of blood. Pregnancy was not confirmed until “quickening,” the point at which the pregnant person could feel fetal movement, a measurement that relied on her testimony. Then as now, there was often nothing that distinguished the result of an abortion—the body expelling fetal tissue—from a miscarriage.

Ancient records of abortifacient medicine are plentiful; ancient attempts to regulate abortion are rare. What regulations existed reflect concern with women’s behavior and marital propriety, not with fetal life. The Code of the Assura, from the eleventh century BCE, mandated death for married women who got abortions without consulting their husbands; when husbands beat their wives hard enough to make them miscarry, the punishment was a fine. The first known Roman prohibition on abortion dates to the second century and prescribes exile for a woman who ends her pregnancy because “it might appear scandalous that she should be able to deny her husband of children without being punished.” Likewise, the early Christian Church opposed abortion not as an act of murder but because of its association with sexual sin. (The Bible offers ambiguous guidance on the question of when life begins: Genesis 2:7 arguably implies that it begins at first breath; Exodus 21:22–24 suggests that, in Old Testament law, a fetus was not considered a person; Jeremiah 1:5 describes God’s hand in creation even “before I formed you in the womb.” Nowhere does the Bible clearly and directly address abortion.) Augustine, in the fourth century, favored the idea that God endowed a fetus with a soul only after its body was formed—a point that Augustine placed, in line with Aristotelian tradition, somewhere between forty and eighty days into its development. “There cannot yet be a live soul in a body that lacks sensation when it is not formed in flesh, and so not yet endowed with sense,” he wrote. This was more or less the Church’s official position; it was affirmed eight centuries later by Thomas Aquinas.

In the early modern era, European attitudes began to change. The Black Death had dramatically lowered the continent’s population and dealt a blow to most forms of economic activity; the Reformation had weakened the Church’s position as the essential intermediary between the layman and God. The social scientist Silvia Federici has argued, in her book Caliban and the Witch, that church and state waged deliberate campaigns to force women to give birth, in service of the emerging capitalist economy. “Starting in the mid-16th century, while Portuguese ships were returning from Africa with their first human cargoes, all the European governments began to impose the severest penalties against contraception, abortion, and infanticide,” Federici notes. Midwives and “wise women” were prosecuted for witchcraft, a catchall crime for deviancy from procreative sex. For the first time, male doctors began to control labor and delivery, and, Federici writes, “in the case of a medical emergency” they “prioritized the life of the fetus over that of the mother.” She goes on: “While in the Middle Ages women had been able to use various forms of contraceptives, and had exercised an undisputed control over the birthing process, from now on their wombs became public territory, controlled by men and the state.”

Martin Luther and John Calvin, the most influential figures of the Reformation, did not address abortion at any length. But Catholic doctrine started to shift, albeit slowly. In 1588, Pope Sixtus V labeled both abortion and contraception as homicide. This pronouncement was reversed three years later, by Pope Gregory XIV, who declared that abortion was only homicide if it took place after ensoulment, which he identified as occurring around twenty-four weeks into a pregnancy. Still, theologians continued to push the idea of embryonic humanity; in 1621, the physician Paolo Zacchia, an adviser to the Vatican, proclaimed that the soul was present from the moment of conception. Still, it was not until 1869 that Pope Pius IX affirmed this doctrine, proclaiming abortion at any point in pregnancy to be a sin punishable by excommunication.

When I found out I was pregnant, at the beginning of 2020, I wondered how the experience would change my understanding of life, of fetal personhood, of the morality of reproduction. It’s been years since I traded the echo chamber of evangelical Texas for the echo chamber of progressive Brooklyn, but I can still sometimes feel the old worldview flickering, a photographic negative underneath my vision. I have come to believe that abortion should be universally accessible, regulated only by medical codes and ethics, and not by the criminal-justice system. Still, in passing moments, I can imagine upholding the idea that our sole task when it comes to protecting life is to end the practice of abortion; I can imagine that seeming profoundly moral and unbelievably urgent. I would only need to think of the fetus in total isolation—to imagine that it were not formed and contained by another body, and that body not formed and contained by a family, or a society, or a world.

As happens to many women, though, I became, if possible, more militant about the right to an abortion in the process of pregnancy, childbirth, and caregiving. It wasn’t just the difficult things that had this effect—the paralyzing back spasms, the ragged desperation of sleeplessness, the thundering doom that pervaded every cell in my body when I weaned my child. And it wasn’t just my newly visceral understanding of the anguish embedded in the facts of American family life. (A third of parents in one of the richest countries in the world struggle to afford diapers; in the first few months of the pandemic, as Jeff Bezos’s net worth rose by 48 billion dollars, 16 percent of households with children did not have enough to eat.) What multiplied my commitment to abortion were the beautiful things about motherhood: in particular, the way I felt able to love my baby fully and singularly because I had chosen to give my body and life over to her. I had not been forced by law to make another person with my flesh or to tear that flesh open to bring her into the world; I hadn’t been driven by need to give that new person away to a stranger in the hope that she would never go to bed hungry. I had been able to choose this permanent rearrangement of my existence. That volition felt sacred.

Abortion is often talked about as a grave act that requires justification, but bringing a new life into the world felt, to me, like the decision that more clearly risked being a moral mistake. The debate about abortion in America is “rooted in the largely unacknowledged premise that continuing a pregnancy is a prima facie moral good,” the pro-choice Presbyterian minister Rebecca Todd Peters writes. But childbearing, Peters notes, is a morally weighted act, one that takes place in a world of limited and unequally distributed resources. Many people who get abortions—the majority of whom are poor women who already have children—understand this perfectly well. “We ought to take the decision to continue a pregnancy far more seriously than we do,” Peters writes.

I gave birth in the middle of a pandemic that previewed a future of cross-species viral transmission exacerbated by global warming, and during a summer when ten million acres on the West Coast burned. I knew that my child would not only live in this degrading world but contribute to that degradation. (“Every year, the average American emits enough carbon to melt ten thousand tons of ice in the Antarctic ice sheets,” David Wallace-Wells writes in his book The Uninhabitable Earth.) Just before COVID arrived, the science writer Meehan Crist published an essay in the London Review of Books titled “Is It OK to Have a Child?” (The title alludes to a question that Alexandria Ocasio-Cortez once asked in a live stream, on Instagram.) Crist details the environmental damage that we are doing and the costs for the planet and for us and for those who will come after. Then she turns the question on its head. The idea of choosing whether or not to have a child, she writes, is predicated on a fantasy of control that “quickly begins to dissipate when we acknowledge that the conditions for human flourishing are distributed so unevenly, and that, in an age of ecological catastrophe, we face a range of possible futures in which these conditions no longer reliably exist.”

In late 2021, as Omicron brought New York to another COVID peak, a Gen Z boy in a hoodie uploaded a TikTok, captioned “yall better delete them baby names out ya notes its 60 degrees in december.” By then, my baby had become a toddler. Every night, as I set her in the crib, she chirped good night to the elephants, koalas, and tigers on the wall, and I tried not to think about extinction. My decision to have her risked—or guaranteed—additional human suffering; it opened up new chances for joy and meaning. There is unknowability in every reproductive choice.

As the German historian Barbara Duden writes in her book Disembodying Women, the early Christians believed that both the bodies that created life and the world that sustained it were proof of the “continual creative activity of God.” Women and nature were aligned, in this view, as the material sources of God’s plan. “The word nature is derived from nascitura, which means ‘birthing,’ and nature is imagined and felt to be like a pregnant womb, a matrix, a mother,” Duden writes. But in recent decades, she notes, the natural world has begun to show its irreparable damage. The fetus has been left as a singular totem of life and divinity, to be protected, no matter the costs, even if everything else might fall.

The scholar Katie Gentile argues that in times of cultural crisis and upheaval, the fetus functions as a “site of projected and displaced anxieties,” a “fantasy of wholeness in the face of overwhelming anxiety and an inability to have faith in a progressive, better future.” The more degraded actual life becomes on earth, the more fervently conservatives will fight to protect potential life in utero. We are locked into the destruction of the world that birthed all of us; we turn our attention, now, to the worlds—the wombs—we think we can still control.

By the time that the Catholic Church decided that abortion at any point, for any reason, was a sin, scientists had identified the biological mechanism behind human reproduction, in which a fetus develops from an embryo that develops from a zygote, the single-celled organism created by the union of egg and sperm. With this discovery, in the mid-nineteenth century, women lost the most crucial point of authority over the stories of their pregnancies. Other people would be the ones to tell us, from then on, when life began.

At the time, abortion was largely unregulated in the United States, a country founded and largely populated by Protestants. But American physicians, through the then newly formed American Medical Association, mounted a campaign to criminalize it, led by a gynecologist named Horatio Storer, who once described the typical abortion patient as a “wretch whose account with the Almighty is heaviest with guilt.” (Storer was raised Unitarian but later converted to Catholicism.) The scholars Paul Saurette and Kelly Gordon have argued that these doctors, whose profession was not as widely respected as it would later become, used abortion “as a wedge issue,” one that helped them portray their work “as morally and professionally superior to the practice of midwifery.” By 1910, abortion was illegal in every state, with exceptions only to save the life of “the mother.” (The wording of such provisions referred to all pregnant people as mothers, whether or not they had children, thus quietly inserting a presumption of fetal personhood.) A series of acts known as the Comstock laws had rendered contraception, abortifacient medicine, and information about reproductive control widely inaccessible, by criminalizing their distribution via the U.S. Postal Service. People still sought abortions, of course: in the early years of the Great Depression, there were as many as 700,000 abortions annually. These underground procedures were dangerous; several thousand women died from abortions every year.

This is when the contemporary movements for and against the right to abortion took shape. Those who favored legal abortion did not, in these years, emphasize “choice,” Daniel K. Williams notes in his book Defenders of the Unborn. They emphasized protecting the health of women, protecting doctors, and preventing the births of unwanted children. Antiabortion activists, meanwhile, argued, as their successors do, that they were defending human life and human rights. The horrors of the Second World War gave the movement a lasting analogy: “Logic would lead us from abortion to the gas chamber,” a Catholic clergyman wrote, in October 1962.

Ultrasound imaging, invented in the 1950s, completed the transformation of pregnancy into a story that, by default, was narrated to women by other people—doctors, politicians, activists. In 1965, Life magazine published a photo essay by Lennart Nilsson called “Drama of Life Before Birth,” and put the image of a fetus at eighteen weeks on its cover. The photos produced an indelible, deceptive image of the fetus as an isolated being—a “spaceman,” as Nilsson wrote, floating in a void, entirely independent from the person whose body creates it. They became totems of the antiabortion movement; Life had not disclosed that all but one had been taken of aborted fetuses and that Nilsson had lit and posed their bodies to give the impression that they were alive.

In 1967, Colorado became the first state to allow abortion for reasons other than rape, incest, or medical emergency. A group of Protestant ministers and Jewish rabbis began operating an abortion-referral service led by the pastor of Judson Memorial Church, in Manhattan; the resulting network of prochoice clerics eventually spanned the country, and referred an estimated 450,000 women to safe abortions. The evangelical magazine Christianity Today held a symposium of prominent theologians in 1968, which resulted in a striking statement: “Whether or not the performance of an induced abortion is sinful we are not agreed, but about the necessity and permissibility for it under certain circumstances we are in accord.” Meanwhile, the priest James McHugh became the director of the National Right to Life Committee and equated fetuses to the other vulnerable people whom faithful Christians were commanded to protect: the old, the sick, the poor. As states began to liberalize their abortion laws, the antiabortion movement attracted followers—many of them antiwar, pro-welfare Catholics—using the language of civil rights, and adopted the label “prolife.”

W. A. Criswell, a Dallas pastor who served as president of the Southern Baptist Convention from 1968 to 1970, said, shortly after the Supreme Court issued its decision in Roe v. Wade, that “it was only after a child was born and had life separate from his mother that it became an individual person,” and that “it has always, therefore, seemed to me that what is best for the mother and the future should be allowed.” But the court’s decision accelerated a political and theological transformation that was already under way: by 1979, Criswell, like the SBC, had endorsed a hard-line antiabortion stance. Evangelical leadership, represented by such groups as Jerry Falwell’s Moral Majority, joined with Catholics to oppose the secularization of popular culture, becoming firmly conservative—and a powerful force in Republican politics. Bible verses that express the idea of divine creation, such as Psalm 139 (“For you created my innermost being; you knit me together in my mother’s womb,” in the New International Version’s translation), became policy explanations for prohibiting abortion.

In 1984, scientists used ultrasound to detect fetal cardiac activity at around six weeks’ gestation—a discovery that has been termed a “fetal heartbeat” by the antiabortion movement, though a six-week-old fetus hasn’t yet formed a heart and the electrical pulses are coming from cell clusters that can be replicated in a petri dish. At six weeks, in fact, medical associations still call the fetus an embryo; as I found out in 2020, you generally can’t even schedule a doctor’s visit to confirm your condition until you’re eight weeks along.

So many things that now shape the cultural experience of pregnancy in America accept and reinforce the terms of the antiabortion movement, often with the implicit goal of making pregnant women feel special or encouraging them to buy things. “Your baby,” every app and article whispered to me sweetly, wrongly, many months before I intuited personhood in the being inside me or felt that the life I was forming had moved out of a liminal realm.

I tried to learn from that liminality. Hope was always predicated on uncertainty; there would be no guarantees of safety in this or any other part of life. Pregnancy did not feel like soft blankets and stuffed bunnies—it felt cosmic and elemental, like volcanic rocks grinding or a wild plant straining toward the sun. It was violent even as I loved it. “Even with the help of modern medicine, pregnancy still kills about 800 women every day worldwide,” the evolutionary biologist Suzanne Sadedin points out in an essay titled “War in the Womb.” Many of the genes that activate during embryonic development also activate when a body has been invaded by cancer, Sadedin notes; in ectopic pregnancies, which are unviable by definition and make up 1 to 2 percent of all pregnancies, embryos become implanted in the fallopian tube rather than the uterus and “tunnel ferociously toward the richest nutrient source they can find.” The result, Sadedin writes, “is often a bloodbath.”

The Book of Genesis tells us that the pain of childbearing is part of the punishment women have inherited from Eve. The other part is subjugation to men: “Your desire will be for your husband and he will rule over you,” God tells Eve. Tertullian, a second-century theologian, told women, “You are the devil’s gateway: you are the unsealer of the (forbidden) tree: you are the first deserter of the divine law: you are she who persuaded him whom the devil was not valiant enough to attack.” The idea that guilt inheres in female identity persists in antiabortion logic: anything a woman or a girl does with her body can justify the punishment of undesired pregnancy, including simply existing.

If I had become pregnant when I was a thirteen-year-old Texan, I would have believed that abortion was wrong, but I am sure that I would have got an abortion. For one thing, my Christian school did not allow students to be pregnant. I was aware of this and had, even then, a faint sense that the people around me grasped, in some way, the necessity of abortion—that, even if they believed that abortion meant taking a life, they understood that it could preserve a life, too.

One need not reject the idea that life in the womb exists or that fetal life has meaning in order to favor the right to abortion; one must simply allow that everything, not just abortion, has a moral dimension and that each pregnancy occurs in such an intricate web of systemic and individual circumstances that only the person who is pregnant could hope to evaluate the situation and make a moral decision among the options at hand. A recent survey found that one-third of Americans believe life begins at conception but also that abortion should be legal. This is the position overwhelmingly held by American Buddhists, whose religious tradition casts abortion as the taking of a human life and regards all forms of life as sacred but also warns adherents against absolutism and urges them to consider the complexity of decreasing suffering, compelling them toward compassion and respect.

There is a Buddhist ritual practiced primarily in Japan, where it is called mizuko kuyo: a ceremony of mourning for miscarriages, stillbirths, and aborted fetuses. The ritual is possibly ersatz; critics say that it fosters and preys upon women’s feelings of guilt. But the scholar William LaFleur argues in his book Liquid Life that it is rooted in a medieval Japanese understanding of the way the unseen world interfaces with the world of humans—in which being born and dying are both “processes rather than fixed points.” An infant was believed to have entered the human world from the realm of the gods and move clockwise around a wheel as she grew older, eventually passing back into the spirit realm on the other side. But some infants were mizuko, or water babies: floating in fluids, ontologically unstable. These were the babies who were never born. A mizuko, whether miscarried or aborted—and the two words were similar: kaeru, to go back, and kaesu, to cause to go back—slipped back, counterclockwise, across the border to the realm of the gods.

There is a loss, I think, entailed in abortion—as there is in miscarriage, whether it occurs at eight or twelve or twenty-nine weeks. I locate this loss in the irreducible complexity of life itself, in the terrible violence and magnificence of reproduction, in the death that shimmered at the edges of my consciousness in the shattering moment that my daughter was born. This understanding might be rooted in my religious upbringing—I am sure that it is. But I wonder, now, how I would square this: that fetuses were the most precious lives in existence, and that God, in His vision, already chooses to end a quarter of them. The fact that a quarter of women, regardless of their beliefs, also decide to end pregnancies at some point in their lifetimes: are they not acting in accordance with God’s plan for them, too?