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      ‘They hate God’: US anti-abortion activists aim to fight back on 51st Roe anniversary

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      Within the subterranean levels of a fancy hotel in downtown Washington, just a few days before the 51st anniversary of Roe v Wade, the anti-abortion movement was trying to mount a comeback.Kevin Roberts stood on stage in a cavernous ballroom aglow with neon shades of blue, purple and pink. As president of the Heritage Foundation, Roberts leads one of the main thinktanks behind recent conservative attacks on abortion. And he is not happy with how things are going.“We meet today amid a pro-abortion media narrative of smug triumphalism,” Roberts told hundreds of young abortion foes, who had gathered in the ballroom from across the country to hear him and other anti-abortion leaders speak.“You’ve heard the story. Less than two years after the supreme court overturned Roe, the abortion-industrial complex is celebrating an unprecedented political winning streak. Across the country, pro-life bills have failed. Abortion referenda have passed. Democrat leaders are crowing while too many Republican leaders are cowering from the fight.”Roberts was speaking at the annual National Pro-Life Summit, a one-day organizing camp for high school- and college-aged anti-abortion activists. This year, the summit faced a monumental task: organizers and attendees alike hoped to reinvigorate a movement that, 18 months ago, soared to the height of its power with the overturning of Roe – and then, in the months that followed, has repeatedly crashed-landed back on earth.Since Roe’s demise, seven states have voted on abortion-related ballot referendums. In each case, voters have decisively moved to protect abortion rights, even in ruby-red states like Kentucky, Kansas and Montana.The stakes are even higher in 2024. Not only are roughly a dozen more states gearing up to potentially vote on abortion-related referendums, but the future of the White House is on the line. If abortion hurts Republicans the election – as it’s widely thought to have done in the 2022 midterms – anti-abortion activists may see the GOP brand their movement as ballot-box poison.The National Pro-Life Summit is generally a peek into what the anti-abortion movement is telling itself about itself – and at present, it is not happy with Republicans. For years, the anti-abortion movement has corralled voters for Republicans. On Saturday, they repeatedly condemned the GOP for failing to adequately support their cause.The last Republican president appointed the justices who overturned Roe, while red states have enacted more than a dozen near-total abortion bans since the ruling fell. But many Republicans have begun to back away from the issue. Before the 2022 elections, several quietly downplayed their stances, while dozens of House Republicans have delayed signing onto a bill to nationally ban abortions.“Our friends in the Republican party need to touch some grass,” said Kristan Hawkins, the president of Students for Life of America, the organization behind the summit. “Those who say now that we shouldn’t be talking, that Republican candidates, those seeking for office, should hide from the abortion issue – they continue to be wrong. We won’t win if we put our head in the sand.”Democrats are already attempting to use Roe’s impact on doctors to win votes, as Joe Biden’s re-election campaign has launched a blitz of events and ads timed to the Roe anniversary on Monday. Vice-President Kamala Harris will kick off a tour devoting to spotlighting abortion access, while Biden will assemble a meeting of his reproductive health taskforce.His administration has also announced plans to expand access to contraception under the Affordable Care Act as well as an initiative to spread information about a law that, the administration says, guarantees Americans’ legal rights to emergency abortions, even in states that ban the procedure.A thin lineThe mood on Saturday wasn’t totally dour.Attendees could buy baseball caps that read “I’m just out here saving babies,” sweatshirts that bore an image of a newspaper front page that proclaimed “ROE REVERSED”, as well as red hats adorned with the words “Make America Pro-Life Again” in the unmistakable style of Trump’s Maga hats. Young people excitedly posed for group photos in front of a backdrop that read, “EQUAL RIGHTS FOR THE PREBORN!” An illustrated fetus was curled up in one corner.Yet, in speech after speech, activists told young people that they were the victims of vast forces arrayed against them. They accused abortion rights supporters of spreading misinformation about ballot referendums and said they were simply outspent by the opposition. In Ohio, abortion rights supporters reported receiving about three times as much money as a coalition that opposed abortion rights.“These people love chaos. That is the left. The left is inherently chaotic at its core,” said Will Witt, a conservative influencer who, like Roberts, spoke at the morning address to all attendees.After quoting from the Bible in an effort to demonstrate that God originated order, Witt continued: “This is why the left, this is why these pro-choicers, this is why they hate God. Because God represents order in the world, whereas they love chaos.”The summit speakers were attempting to walk a fine line. At the same time that they were attempting to convince attendees that they were the victims of a world turned against them, they also had to make the case that opposition to abortion is a majority view – and one issue that can get Republicans elected.“Our opinion on this issue, the issue, is not outside of the mainstream, no matter how many times ABC wants to try to tell me it is,” Hawkins told attendees at a workshop dedicated to understanding what went wrong with the abortion referendums. Most millennials and members of Gen Z, she added, “want some sorts of limits on abortion”.Polling on abortion is complex, since respondents’ answers can vary widely depending on how a question is asked or how much context is provided. Most Americans believe that abortion should be restricted after the first trimester of pregnancy, according to polling from Gallup. However, over the last two decades, more and more people have become open to keeping abortion legal later into pregnancy. Republicans in Virginia failed to take control of the state legislature last year after they ran on a promise of banning abortion past 15 weeks of pregnancy.Gallup has also found that, since 2020, more Americans identify as “pro-choice” than “pro-life”. More people have started to call themselves “pro-choice” since the US supreme court overturned Roe in 2022.Hawkins is not in favor of only “some sorts of limits on abortion”.“I want to see no abortions be legal, ever,” she said in an interview. She rejected the notion that abortions performed to save women’s lives qualify as abortions. “When you’re looking at a case where a woman’s life is at risk, where the physician believes that she can no longer safely carry her child in her womb, or she may lose her life – we wouldn’t consider that an abortion unless the abortionist goes in with the intention to killing the child.”Instead, she said, it’s a “maternal-fetal separation”.Hawkins’ point was an effort to contend with a phenomenon that has been particularly damaging for the movement: stories from women who have sued after they said they were denied medically necessary abortions.Every state with an abortion ban has some kind of exception for cases of medical emergencies, but doctors in those states have widely said that the exceptions are so vague as to be unworkable. In a recent study of 54 OB-GYNs in states with post-Roe abortion restrictions, more than 90% said that the law prevented them from adhering to the best clinical standards of care.‘You vote pro-life’Last year, when the National Pro-Life Summit held a straw poll asking attendees about their preferred 2024 president candidate, Ron DeSantis won. This year, with DeSantis a day away from dropping out of the presidential primary, Hawkins cheerfully proclaimed the latest straw poll victor: Donald Trump.As much as their leaders may lock heads with Republicans or Trump – who has suggested that hardline abortion stances hurt Republicans – they are ultimately unlikely to withhold votes from the GOP. Even Trump’s former vice-president, Mike Pence, who was a target of the January 6 riot and who spoke at the summit, indicated that people need to simply get on with it.“That’s why we have primaries. We sort ’em out at every level. But after the primary’s over, you vote pro-life,” Pence said. “You go get behind men and women who are going to stand for the right to life.”A booth for the Heritage Foundation was emblazoned with logos for its “Project 2025”, which includes a playbook for the next conservative president. It recommends that the US government stop funding or promoting abortion in international programs, turbocharge the government’s existing “surveillance” efforts to collect data about abortion, and enforce the 19th-century Comstock Act to ban the mailing of abortion pills. That would effectively result in the removal of abortion pills from the market, which Hawkins said is a policy goal of hers.“If Donald Trump would be elected again, the people he would appoint to his presidential administration would not be abortion activists,” Hawkins said in an interview. “Hands down, that’s a guarantee. And they’re going to be coming to Washington to protect the people and the people includes the pre-born children.” More

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      Biden abortion ad marks campaign shift to emphasize reproductive rights

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      The Biden re-election campaign rolled out a new campaign ad Sunday, signaling a shift in emphasis to reproductive rights that the White House hopes will carry and define Democrats through the 2024 election cycle.The campaign ad, titled Forced, is designed to tie Donald Trump directly to the abortion issue almost 18 months after his nominees to the supreme court helped to overturn a constitutional right to abortion enshrined in Roe v Wade, which would have turned 51 this week.Dr Austin Dennard, a Texas OB-GYN and mother of three tells the camera her story about traveling out of her state to terminate her pregnancy after learning her fetus had a fatal condition, calling her situation “every woman’s worst nightmare”.In Texas, she said, her choice “was completely taken away and that’s because of Donald Trump overturning Roe v Wade”.The launch of the ad comes as anti-abortion activists descended on Washington DC this weekend. One event, the National Pro-Life Summit, activists came to celebrate anti-abortion activism in the US. At another, the March for Life, marchers called for advocacy against abortion rights.Vice-President Kamala Harris is now being placed to the forefront of the administration’s messaging on reproductive rights, a position Biden has said he is not “big on” because of his Catholic faith, though he believes the landmark 1973 decision “got it right”.On Monday, Harris will embark on a nationwide tour to focus attention on the administration’s efforts to protect the right of women to choose. Her tour will start in Wisconsin, where abortion rights propelled a Democratic victory in a key state supreme court election.A statement from Harris’s office said the vice-president will “highlight the harm caused by extreme abortion bans and share stories of those who have been impacted in Wisconsin and across the country”.“She will also hold extremists accountable for proposing a national abortion ban, call on Congress to restore the protections of Roe, and outline steps the Administration is taking to protect access to health care,” the statement added.Democrats this year are hoping to emphasize that a second Trump presidency would establish new personal health restrictions.“Donald Trump is the reason that more than 1 in 3 American women of reproductive age don’t have the freedom to make their own health care decisions. Now, he and MAGA Republicans are running to go even further if they retake the White House,” Julie Chavez Rodriguez, Biden-Harris 2024 campaign manager, said in a statement to The Hill.On Sunday, the Michigan governor, Gretchen Whitmer, told CBS Face the Nation that “it would be good” if Biden talked about abortion more than he does. “I know that one tenet of his belief system is that women and only women with their families and healthcare professionals are the one who know what decision is right for them.”Asked if the president needs to take up that message more forcefully, Whitmer said: “I don’t think it would hurt. I think people want to know that this is president that is fighting … but maybe to use more blunt language would be helpful.” More

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      ‘Showing the world what’s possible’: St Paul makes history with first all-woman city council

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      When Rebecca Noecker first decided to enter politics in 2016, she was a young mom with two kids and many questions. She had a background in education but no knowledge of how to run for office.“There were so many systems that I saw around me that just felt broken and people were in pain and I wanted to do something about that,” Noecker, 39, said. “And it felt like politics was a way to do it.”She found a teacher in the only woman on her city council in St Paul, Minnesota.“She would walk around the lake with her constituents and called them ‘lake laps.’ I went on a lake lap with her, and I was just so struck by how authentic and genuine she was,” Noecker said of her mentor, former council member Amy Brendmoen.“She had three children and talked a lot about how despite the fact that you make sacrifices and you’re not necessarily home every night, your kids have this remarkable opportunity to see you in leadership and see what a difference you can make.”Today, Noecker, who represents the second ward, is St Paul’s longest serving member on the council. But she is far from the only woman.Last fall, all seven city council seats were up for grabs. On 7 November, after a campaign season packed with candidates, Minnesota’s capital city elected its new city council – comprised entirely of women. Last week marked the group’s inauguration.Noecker’s fellow council members – Nelsie Yang, Cheniqua Johnson, Hwa Jeong Kim, Saura Jost, Anika Bowie and Mitra Jalali – are all women of color and, like her, progressive in their politics. All council members are also below the age of 40.The diversity of the group is something newly elected council member Johnson, AGE, called “amazing and affirming”.“When you spend almost a year and a half working to earn your community’s trust during the cycle and vocalizing the community’s priority, you see – as the elections come in – that community heard you, they showed up and essentially, they want you to continue the work with them,” Johnson said. “It means voters elected who they wanted to see represent them. Many candidates ran and yet, our city said, ‘We want an all-woman city council.’”A 2023 Pew research report on women leaders in US politics found that women’s representation in politics continues to grow across all forms of government including the US senate, house of representatives, state legislatures and governors.In 2019, Nevada became the first state with a majority-women state legislature. Today, women make up 62% of the Nevada state legislature – the largest percentage of any state.But experts have noted that no major city has achieved the feat of electing an all-woman city council like St Paul.Notably, St Paul has a population of roughly 300,000 people, the second most populous city in the state after fellow Twin city, Minneapolis. Around 46% identify as a race other than white, according to the US census.Jalali was also reelected to the council and will now serve as its leader. Elected president in a unanimous vote, she said an all-woman city council should be considered normal.“St Paul voters are showing the world what’s possible on city councils, county boards and local and state government everywhere,” Jalali, 37, said. “This shouldn’t be an exceptional story, but a quiet normal that communities everywhere get to experience.”Jalali is the first Iranian-American to hold office in Minnesota and her resume includes experience teaching and working for fellow political pioneer, Keith Ellison, a former US house representative for Minnesota. He was the first Muslim elected to Congress and the first African American representative from the state.“I’m excited to lead our council forward with our community’s voices at the table,” Jalali said.skip past newsletter promotionafter newsletter promotionKelly Dittmar, director of research and scholar at Rutger University’s Center for American Women and Politics (CAWP), said women’s representation in US politics is generally trending upward.“If you look across levels of office, we’re seeing pretty steady gains,” she told the Guardian. “Although for many years they were incremental, but they were still upward.”In a CAWP study titled Rethinking women’s political power, 192 political actors were interviewed within five states – Georgia, Illinois, Nevada, Oklahoma and Pennsylvania – “to examine both the state of and change in women’s political power from 2010 to 2023”.Several barriers to women’s political representation were discovered: women’s unequal access to monied networks in campaign fundraising, low salaries for public service jobs and political party influence.“State-level and national mapping of existing organizations and programs shows that the support infrastructures for Democratic women in politics are more robust than those available to Republican women,” the report said. “This is true as well in our case states, where fewer gender-targeted resources are available to Republican women than their Democratic counterparts, even where Republicans hold statewide control.”While Dittmar pointed out that some of these barriers are easing, she said it’s also important to note that women are still underrepresented across different levels of office. It is uncommon for women to hold at least one third of offices at any level of government.“In the cases where we do see women make up either a majority, or in this case, all of a governing body, they are still very few and far between,” Dittmar said.Dittmar also credited, in part, societal changes that have allowed women to have a more noticeable presence in politics.“Beyond politics, there are [elements] that better situate women to run and win. Those are not only things on an individual level – where women have more access to positions of power across institutions, access to capital, and access to time outside the home due to a shift in expectations of gender roles – but also in the private and public spheres,” Dittmar said.“You’re seeing shifts in perceptions, both in the importance of having women in office, as well as women’s qualifications – things that historically have been more biased in ways that could really present significant hurdles to women. Voters may be more prone to think about the potential, value, and capacity for women to hold political positions.” More

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      A skirt served my grandfather well in the first world war | Brief letters

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      Re your letters about men’s skirts (12 January), I am proud to say that my grandfather fought his way through the whole of the first world war wearing a khaki skirt. As a soldier he was part of the London Scottish regiment fighting in the trenches. Furthermore, it is said that his fellow soldiers told that he shaved every day.Mary TippettsBristol It’s useful to get a clear sight of what really matters to the UK and US governments. The prompt military action against Houthis in Yemen (Report, 11 January) shows clearly that any threat to global trade and the smooth running of capitalism is far more important than meaningful action to protect Palestinian civilians in Gaza.Norman MillerBrighton I agree with the first eight reasons (Yes, it’s cold, it’s wet and it’s dark – but here are nine reasons to love January, 14 January), but I take issue with number nine: “It really can’t get any worse.” What about February?Geoff SmithEndon, Staffordshire Re dramas that have changed history (Letters, 14 January), Harriet Beecher Stowe, who wrote Uncle Tom’s Cabin, was allegedly greeted by Abraham Lincoln during the American civil war with the words: “So you’re the little woman who wrote the book that started this great war.”Tom StubbsLondon What’s all this about men in their 70s wearing underpants (Letters, 14 January)? Gosh, I must try it sometime.Toby WoodPeterborough More

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      US supreme court allows Idaho’s strict abortion ban to stand pending hearing

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      The US supreme court on Friday allowed Idaho to enforce its strict abortion ban, even in medical emergencies, while a legal fight continues.The justices said they would hear arguments in April and put on hold a lower court ruling that had blocked the Idaho law in hospital emergencies, based on a lawsuit filed by the Biden administration.Hospitals that receive Medicare funds are required by a federal law to provide emergency care, potentially including abortion, no matter if there’s a state law banning abortion, the administration argued.The legal fight followed the court’s decision to overturn Roe v Wade and allow states to severely restrict or ban abortion. The Joe Biden White House issued guidance about the law, the Emergency Medical Treatment and Labor Act – or Emtala – two weeks after the high court ruling in 2022. The Democratic administration sued Idaho a month later.US district judge B Lynn Winmill in Idaho agreed with the administration. But in a separate case in Texas, a judge sided with the state.Idaho makes it a crime with a prison term of up to five years for anyone who performs or assists in an abortion.But the administration argues Emtala requires healthcare providers to perform abortions for emergency room patients when needed to treat an emergency medical condition, even if doing so might conflict with a state’s abortion restrictions.Those conditions include severe bleeding, pre-eclampsia and certain pregnancy-related infections.“For certain medical emergencies, abortion care is the necessary stabilizing treatment,” the solicitor general, Elizabeth Prelogar, wrote in an administration filing at the supreme court.The state argued that the administration was misusing a law intended to prevent hospitals from dumping patients and imposing “a federal abortion mandate” on states. “[Emtala] says nothing about abortion,” Idaho’s attorney general, Raul Labrador, told the court in a brief.skip past newsletter promotionafter newsletter promotionJust on Tuesday, the federal appeals court in New Orleans came to the same conclusion as Labrador. A three-judge panel ruled that the administration cannot use Emtala to require hospitals in Texas to provide abortions for women whose lives are at risk due to pregnancy. Two of the three judges are appointees of Donald Trump, and the other was appointed by another Republican president, George W Bush.The appeals court affirmed a ruling by US district judge James Wesley Hendrix, also a Trump appointee. Hendrix wrote that adopting the Biden administration’s view would force physicians to place the health of the pregnant person over that of the fetus or embryo even though Emtala “is silent as to abortion”.After Winmill, an appointee of Democratic president Bill Clinton, issued his ruling, Idaho lawmakers won an order allowing the law to be fully enforced from an all-Republican, Trump-appointed panel of the ninth US circuit court of appeals. But a larger contingent of ninth circuit judges threw out the panel’s ruling and set arguments in the case for late January. More

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      Why are there so few Black sperm donors in the US? – podcast

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      When Angela Stepancic decided to have a baby with her wife, the couple were full of hope. Her partner was keen to carry their child, so the pair began looking for potential sperm donors to help them conceive. But they soon hit a problem: at the four main cryobanks in the US, there were only a dozen Black sperm donors. The reporter and assistant professor of journalism Lisa Armstrong explains to Hannah Moore that Black women in the US are twice as likely to face infertility, and half as likely to seek help for it. The lack of donors is one more barrier Black people can face when trying to start a family. There is too little research into the reasons for the shortage, explains Armstrong, but a complicated application system and invasive questioning are thought to be part of the problem, as well as a history of systematic racism. In the end, says Stepancic, she was so frustrated by the lack of black donors and the industry’s lacklustre attempts to combat it that she set up her own cryobank for Black, Brown and Indigenous people. She realised, she says, that ‘we need to do this for ourselves’. More

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      More Americans are stockpiling abortion pills without pregnancy – study

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      More Americans are now stockpiling abortion pills in case they get pregnant, according to new research published Tuesday.Before Roe v Wade was overturned in June 2022, Aid Access, an organization that mails abortion pills to people across the US, received an average of 25 requests a day from people seeking the pills despite not being pregnant. After the leak of the supreme court decision to overturn Roe, that average shot up to 247 requests each day, the research published on Tuesday found.That number fell after the actual decision, but rose again to 172 a day in April 2023, as US courts signaled a willingness to restrict the availability of a major abortion pill.People have been turning to Aid Access for “advance provision” pills since September 2021, after Texas enacted a six-week abortion ban but long before the US supreme court overturned Roe and abolished the national right to abortion. Now, with wide swathes of the US south and midwest under abortion bans, an online market to request and obtain abortion pills is thriving.The study tracks requests between the beginning of September 2021 and the end of April 2023. In December 2023, the US supreme court announced that it would hear arguments in a case regarding the future of mifepristone, a major abortion pill. That case is expected to be decided by this summer.In total, over the study’s time frame, Aid Access tracked roughly 48,400 advance provision requests. It received more requests for advance provision pills from states that were anticipated to enact bans – even more than the requests from states that did enact bans.“It seems to suggest that what people are reacting to is the threat of reduced access, the threat of curtailment of reproductive rights,” said Dr Abigail Aiken, an associate professor at the University of Texas at Austin and a co-author of the study. “When you think about what advanced provision is, that makes sense, right? Advanced provision is getting out ahead of things. Advanced provision is advanced planning. Advanced provision is a way to protect a potential need you might have in the future if you think access to the service that would fulfill that need is going away.”Over the study period, Aid Access also received more than 147,00 requests from people seeking to end their existing pregnancies. Medical experts widely agree that it is safe to “self-manage” your own abortion, or perform an abortion outside of the formal US healthcare system, using pills within the first trimester of pregnancy.Compared with the people who wanted to terminate their existing pregnancies, people who sought advance provision pills were more likely to be white, child-free and living in urban areas. Choosing from a list of reasons, they most frequently told Aid Access that they wanted the pills to “ensure personal health and choice” and to “prepare for possible abortion restrictions”.Aid Access was launched in 2018 by Dr Rebecca Gomperts, a Dutch physician and one of the most visible abortion providers in the world. Gomperts, who co-authored the study published Tuesday, previously founded Women on Web, an organization that, like Aid Access, shipped abortion pills. However, Women on Web didn’t provide pills to the United States. Ultimately, Gomperts decided that the state of abortion access in the country was too dire to ignore.Advance provision pills cost $150 and should arrive within a few days of ordering, according to Aid Access’s website. During the time frame of the study, most of the pills were being shipped by overseas pharmacies, Aiken said.Now, to send abortion pills, US-based physicians associated with Aid Access have begun to rely on what are known as “shield laws”: protections in Democratic states for abortion providers who prescribe pills for patients in abortion-hostile states. This transition to focusing on using US providers was part of the reason for the study’s conclusion in April, Aiken said.skip past newsletter promotionafter newsletter promotion“It made sense to look at a time period where the service was entirely outside of the formal US healthcare setting,” Aiken said. “Now, I think a lot of people would argue that it’s happening within the formal healthcare setting, because it’s US provider-led and -based.”But while the US providers in blue states may be operating with the formal healthcare system, their patients in red states are not necessarily afforded the system’s protections and guidance. Someone who wants to get a check-up after an abortion, or even just talk to their doctor about their experience, may not feel able to.“In terms of the experience of the person actually using the pills, it may still look a lot more like a self-managed abortion,” Aiken said. “What that means for the nature of the service is an ongoing, interesting question that we’re thinking about now in the research field.”There was not much data available on what people ended up doing with the advance provision pills, Aiken said, since only a fraction followed up with Aid Access. However, of that fraction, most people still had the pills on standby months later.Last year, Gompertstold the Guardian that she wanted people to stock up on pills to protect themselves.“Don’t wait for the decision. Just get the medication now, get it in your house, get it in your hands,” she said. “If you’re in a war zone and the war is coming, you also make sure you have enough food in your house. This is how it feels. It really is a war. It’s a war on women.” More

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      The fight for abortion rights: what to know going into 2024

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      More than a year after the US supreme court overturned Roe v Wade, the dust from the landmark decision’s collapse has yet to settle.It has been a dramatic year of fallout, with abortion rights supporters and foes now waging a state-by-state skirmish for abortion rights. They are sparring in state legislatures, courtrooms, voting booths and hospitals, with each side racking up victories and losses.With a presidential election and another major supreme court case on the horizon, the coming year promises to be at least as eventful. Here’s what you need to know about the fight over abortion in 2023 – and what it means for 2024.Abortion rights supporters keep winning at the ballot boxIn 2022, Republicans underperformed in the midterms and abortion rights activists won a string of ballot measures to preserve abortion rights, even in conservative states. This year, activists extended their winning streak – and they hope to replicate their successes in 2024.In November, Ohio became the first reliably red state since Roe fell to vote in favor of proactively enshrining abortion rights in the state constitution, while Virginia Democrats successfully fended off Republicans’ attempt to retake the state legislature by campaigning on a 15-week abortion ban.For activists and Democrats, these victories were proof that abortion is an election-winning issue – and, potentially, an issue that can draw in voters from across both sides of the ideological spectrum. Activists are already at work on 2024 abortion-related ballot measures in roughly a dozen states, including swing states like Arizona and Nevada.Abortions are on the riseAfter abortion clinics across the south and midwest were forced to shutter, patients overwhelmed the country’s remaining clinics. In the first year after Roe’s demise, the average number of US abortions performed each month rose rather than fell. Clinics and their advocates are now struggling to keep up. “What actually is happening is a complete disruption,” one expert told the Guardian.There is also a gaping hole in the data, which was released in October by the Society of Family Planning: it does not include abortions performed at home, a practice known as “self-managed abortion”. Medical experts widely agree that it is safe to self-manage an abortion using pills early on in pregnancy, and a number of services shipping abortion pills have increased in visibility since Roe’s overturning. But while evidence suggests that self-managed abortion is on the rise, the lack of concrete data about the practice reflects a growing problem in the post-Roe United States: as abortion moves further into the shadows of US life, we will know less about it.Legal battles over abortion bans are ongoingAbortion bans continued to cascade across the country in 2023, with near-total bans taking effect in Indiana, North Dakota and South Carolina. South Carolina and Nebraska, meanwhile, enacted laws to ban abortion after 12 weeks of pregnancy. In total, 24 states or territories have now banned abortion before viability, or roughly 24 weeks of pregnancy, which would have been illegal under Roe.Litigation over abortion restrictions is still unfurling in many of these states, and court cases have frozen bans in states like Wyoming and Iowa. Wisconsin abortion providers, meanwhile, found themselves in a unique position this year: after a judge ruled that an 1849 law that had been interpreted to ban abortions instead only banned feticide and did not apply to what she called “consensual abortions”, providers resumed performing the procedure – even though the ban is still technically on the books.Lawsuits may force other hardcore anti-abortion states to soften their bans in 2024 to clarify exceptions when abortions are permitted in medical emergencies. While Tennessee and Texas carved out narrow exceptions in their abortion laws, abortion rights supporters have still filed lawsuits in those two states, as well as in Idaho, that challenge the language. One Texan mother of two filed a lawsuit seeking an emergency abortion while she was still pregnant. (She ultimately fled the state for the procedure.)Theoretically, people in medical emergencies should be able to access the procedure even in states with bans – but doctors say that, in reality, these bans are so vaguely worded that they block doctors from helping sick patients. This summer, one of these lawsuits led women to testify in a Texas court about their experiences of being denied abortions. It was the first time since Roe fell, if not the first time since Roe itself was decided, that women did so.Abortion pills are in perilThe most common method of abortion, abortion pills, is at the mercy of deeply conservative courts in 2024.In April, a conservative judge in Texas ruled to suspend the FDA’s approval of a key abortion pill, mifepristone, in response to a lawsuit brought by a coalition of rightwing groups determined to make the pill the next target in their post-Roe campaign against abortion. A federal appeals court soon scaled back that decision, ruling to keep the pill, mifepristone, available but impose significant restrictions on its use. The supreme court then stepped in and decreed that the FDA’s rules around mifepristone should stay the same while litigation plays out.The Biden administration and a manufacturer of mifepristone in September have asked the supreme court to formally hear arguments in the case. In December, the justices agreed.Although the justices indicated that they will only rule on the restrictions imposed by the appeals court, rather than on the overall legality of mifepristone, the case could still have enormous consequences. Rolling back the FDA’s rules could allow future lawsuits against other politicized medications, like gender-affirming care, HIV drugs or vaccines. Plus, the supreme court will probably rule by summer 2024 – just months before the presidential election.Mifepristone is used in more than half the abortions in the country. If access to the drug is curtailed, many abortion clinics have said they will pivot to using doses of a different drug, misoprostol, to perform abortions, but misoprostol-only abortions are less effective and associated with more complications.Doctors are fleeing states with abortion bansWith abortion bans endangering their patients and threatening to send doctors to prison, doctors are fleeing states where the procedure is banned. After Idaho banned abortion, at least 13 reproductive health physicians left the state and at least two rural labor and delivery wards have closed. Doctors in Tennessee, Texas, North Carolina, Ohio and Florida have also told reporters that they are leaving states with abortion bans or planning to do so.OB-GYNs are already in short supply in the United States. About half of US counties do not have a practicing OB-GYN, according to the American College of Obstetricians and Gynecologists. The US maternal mortality rates are also worsening, particularly for Black and Native people, at a time when the United States already has the worst maternal mortality rate among industrialized countries.Doctors are now even afraid to get trained in states with abortion bans. Applications to OB-GYN residencies in states with near-total bans fell by more than 10% the year after Roe’s demise, according to data from Association of American Medical Colleges. Applications to US OB-GYN residencies overall dropped by about 5% – indicating that fewer doctors are planning to become OB-GYNs at all. More