Legislating abortion behavior: Lessons from Romania and Prohibition

An unprecedented epidemic of anti-abortion legislation swept across America after Republicans gained control of many state legislatures in 2010. Indeed, more new laws restricting access to or interfering with abortions were passed in 2011-2013 than in the prior decade.

Fetal fixation

This hostility to reproductive rights should not be surprising: a constitutional ban of abortion has been a plank in the Republican Party platform for decades. At the party convention in 2012, no mention was made of any exceptions for rape, incest, or a woman’s health. The 12-year-old impregnated by her mother’s boyfriend, the woman carrying a fetus with a lethal birth defect, the pregnant mother of four with heart failure—patients I have cared for as a gynecologist—are missing from the discussion. Many politicians have forgotten why clergy and physicians led the drive for the legalization of abortion: the needless suffering and deaths of countless American women. Ignoring women relegates them to the role of a Tupperware container or, as Katha Pollitt describes in her new book Pro: reclaiming abortion rights, “potting soil.”

Two tragic natural experiments offer a glimpse of the future if Roe v. Wade was overturned or abortion was made even less accessible. One is the pronatalist policies in Romania under Ceausescu and the other is Prohibition in the U.S.

Pregnancy police

When Ceausescu came to power in 1965, he implemented draconian pronatalist policies. Abortion was outlawed in Romania. The government established “pregnancy police” who monitored women to prevent clandestine abortions. Ceausescu’s policies failed: after a transient increase, the birth rate returned to usual levels. What did increase was maternal mortality, driven to the highest in all of Europe. Women desperate to control their fertility resorted to dangerous back-alley abortions once again. More than 10,000 died as a result. Under these harsh pronatalist policies, stillbirths, infant deaths, and abandoned children became more common as well. When Ceausescu was overthrown in 1989, abortion restrictions were repealed the very next day. Afterwards, maternal deaths plummeted.

The temperance movement

Prohibition in the U.S. revealed the dangers of attempting to legislate personal behavior. Led by evangelicals and social reformers, temperance advocates succeeded in adding the 18th Amendment to the Constitution on January 17, 1920. The manufacture, sale, and distribution of most alcohol became illegal (though not its consumption). Alcohol use decreased initially but rebounded thereafter.

The collateral damage was staggering. Modest numbers of legal bars were replaced by a much larger number of illegal “speakeasies.” Drinking was driven underground, and criminals benefitted most from this “noble experiment.” Organized crime took over alcohol manufacture and distribution: Al Capone reportedly made $60 million in 1927 alone. Bribery of law enforcement officers became a national scandal. Tainted liquor made from wood alcohol blinded and paralyzed many. Liquor made in stills containing lead poisoned others. Estimates of fatalities from adulterated liquor range from 1,000 to 50,000 persons during Prohibition.

The harms of trying to legislate personal behavior were quickly recognized. Public sentiment turned against Prohibition, and on December 5, 1933, the 21st Amendment repealed the entire 18th Amendment. Even evangelist and temperance promoter Rev. Sam Small acknowledged that Prohibition had created “an orgy of lawlessness and official corruption.”

Motivation for abortion regulation

Under the specious banner of promoting patient safety, needless abortion regulations are designed to discourage or prevent abortion. As Cheryl Sullenger, senior policy advisor for Operation Rescue (and a convicted felon for attempting to firebomb a clinic) has noted, the “flood of pro-life legislation” provides “tools we can use to close clinics.”

A non-problem

This legislative preoccupation with abortion is unwarranted. The Centers for Disease Control and Prevention has been monitoring the safety of abortion since the early 1970s. Over four decades, legal abortion has amassed an impressive safety record. The risk of death is one-fourteenth that of continuing pregnancy to childbirth. Nevertheless, states are frantically piling on more regulations to the safest conclusion of pregnancy. Meanwhile, the risks of childbearing attract no legislative interest, despite more than 500 deaths from pregnancy-related causes and more than 2 million complications each year.

What predicts anti-abortion legislation?

In 2011, Medoff and Dennis analyzed predictors of passage of state laws targeting abortion providers. Public attitudes, the proportion of Roman Catholics, and ideology did not predict passage. Instead, Republican control of the state legislature and governor’s office significantly predicted enactment of such laws. Clearly, these laws are motivated by politics, not by public health. Under the guise of improving safety, these gratuitous laws were crafted to drive our wives, sisters, and daughters into the back alley once again.

Children and savages

Harvard philosopher George Santayana warned that those unfamiliar with the past are doomed to repeat its mistakes. He further noted that inability to learn from the past is the hallmark of children and savages. More than 50 million women and their families have benefited from safe, compassionate abortion care since Roe v. Wade. Abortion has important medical, social, and economic benefits, documented by the prestigious Institute of Medicine as early as 1975. All major medical and public health organizations in the U.S. strongly endorse the fundamental importance of safe, legal abortion as well.

Abortion cannot be legislated away. An estimated 200,000 to 1.2 million illegal and presumably unsafe abortions took place each year in the U.S. before Roe v. Wade. As Romania and Prohibition demonstrate, trying to legislate personal behavior proves disastrous. Ronald Reagan aptly noted, “Government exists to protect us from each other. Where government has gone beyond its limits is in deciding to protect us from ourselves.”

One of the world’s leading abortion scholars, David A. Grimes, M.D. has studied, provided, and taught abortions for over four decades. Former Chief of the Abortion Surveillance Branch at the Centers for Disease Control and Prevention, Dr. Grimes helped to chronicle the public health benefits of legal abortion in the U.S. in the early 1970s, making several discoveries that improved its safety. Working with the CDC and the World Health Organization, he has conducted abortion research in the U.S. and overseas. Dr. Grimes has published more than 130 articles on abortion in peer-reviewed journals, including The New England Journal of Medicine, The Journal of the American Medical Association, The Annals of Internal Medicine, and The British Medical Journal. He was an editor of the first two editions of the National Abortion Federation textbook. He has been featured in the Los Angeles Times and has appeared on the Donohue Show, Anderson Cooper 360, MSNBC, Montel Williams, Sally Jesse Rafael, Nightline, and Good Morning America. He has received numerous awards for his contributions to women’s health, including a Commendation Medal from the U.S. Public Health Service, The Christopher Tietze Award from the National Abortion Federation, and the Alan Guttmacher Award from the Association of Reproductive Health Professionals. He received the Distinguished Service Award from the American College of Obstetricians and Gynecologists in 1997, was elected to membership in the Institute of Medicine of the National Academies of Science, and was made an Honorary Fellow of the Royal College of Obstetricians and Gynaecologists in the U.K.

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One Response to Legislating abortion behavior: Lessons from Romania and Prohibition

  1. In all his talk on safety and health risks, the author never once considers the safety and health of the unborn child. Its just taken for granted that the childs life is of no value. Its not a case of goverments protecting us from ourselves, but of protecting children from the evil inclinations of their murderous parents.