Thread by @Info_Rosalie

🧵I see the takes saying that the abortion ban explains Iowa, and I agree it does partially. August 2024 is the first total ban in decades. But what else happened that could move even people who wanted a ban?

I'll tell you—Iowa has been unable to recruit OBGYNs. In the last few months, areas that previously had OBGYNs don't.

Iowa's Jasper County's sole delivery center, MercyOne Newton, stopped providing labor and delivery services on Oct. 15, forcing expectant mothers to go elsewhere.

The data show that it will not be the only location. Iowa struggles to recruit all types of doctors, not just OBGYNs. In a country where some states threaten prison time if they disagree with your assessment, successful people with money don't choose to go there.

The state's OBGYN program saw a steep decline in interest (especially for a specialty). If you're risking prison, you're not doing it live in Iowa.

Before the ban, most OBGYNs who had trained in Iowa had left. desmoinesregister.com/story/news/hea…

According to a 2022 study published in the American Journal of Obstetrics and Gynecology, Iowa has the nation's lowest per capita ratio of OBGYN providers to Medicare beneficiaries.

That was BEFORE Roe was overturned. Somehow, even though Iowa was one of the worst, it got worse. cnn.com/2024/08/05/us/…

The consequences for Iowa will be long-lasting and dire, even if it is reversed because now the possibility exists where it was only theoretical before.

Places where you can't have babies aren't easy places to have a family. People with options will choose elsewhere, and many other things in society decline as talent leaves. For example, the value of your home depends upon the idea someone else would buy it. But what if the most successful people aren't there anymore? What if they leave? One can imagine a more diffuse version of what happens with "White flight."

First, they will lose providers. Those who have the means will move to where providers are. From there, quality of education declines. Businesses that want the best employees want to be able to say, "Come here because we have good schools, good hospitals, etc." But lately, Iowa has gutted its schools, and now its minimally existent OBGYN amenities are about to dive.

All of this is now on the minds of even those who approved the ban. Many of them are women who have multiple children. And if you have children, you know things can go wrong unpredictably. You know that a seemingly limitless range of things can go wrong in pregnancy, labor, and delivery. And now you realize you may be far away from help when it happens.

Perhaps most worthy of note here is that, on the national level, abortions increased. All of this is the opposite of the stated intended goal. More sources and explanations can be found in this report, which discusses how medical students and current healthcare providers' decisions are changing. infoepi.org/posts/2023/12/…

Do you know what everyone agrees on, no matter their party? I'm not guessing here. I used to be in the pro-life movement, and, like many, I am mistrustful of major parties in the US.

Everyone wants to see the abortion rate decline. The movement could have taken two approaches. One was legal, and the other was to look at the reasons women were aborting and address the drivers we could ethically control.

Why do women choose abortion? Money is a major one. Most women seeking abortion already have children. They have to be able to feed them. It is a travesty that in the wealthiest nation on earth, anyone is choosing to end a pregnancy because of money. That we thought we could solve this with simple legal categorization is an indictment of our ignorance of women and our lack of commitment to this issue.

A study by the Guttmacher Institute found that 73% of women cited financial inability to afford a baby as a reason for seeking an abortion. Imagine the potential to reduce the rate of abortion by almost 3/4. Any reduction would be better than the results now (a marginal increase). guttmacher.org/journals/psrh/…

That is our failure as a society. We failed to prioritize and value families. We continue to do so.

Another reason women cite is healthcare access. Overall, states enacting abortion bans have not implemented measures to expand healthcare access, and in many cases, these bans have intensified existing healthcare challenges. One woman who couldn't access healthcare ultimately died because of it.

A single state-level policy has many consequences, and the predictable harms obligate the state to address them intensively. Those who promised to increase healthcare access in their push for these policies bear responsibility for deaths like this. When you take away bodily autonomy, you become responsible for that person, much in the way the state is responsible for people in its custody.
newyorker.com/magazine/2024/…

Thousands of women abort each year owing to fear of domestic violence. The laws heavily favor the perpetrator of violence, and so many women feel they have little hope of justice. In that context, some fear what will happen to them. They can't rely on society to protect them.

This is our failure. We could correct this. medicalnewstoday.com/articles/reaso…

In that setting, some women who otherwise don't want an abortion get one. That is our failure as a society. It is our shame, but for people whose express aim was to lower the rate of abortion, these outcomes are especially damning. Under these policies, both the rate of abortion and the obstacles and threats women face have increased.

We would find this to be a policy failure by any measure of policy success.

And what might the outcome be of us addressing three significant issues women choose abortion (money, healthcare access, and fear of violence)? Potentially, a dramatic decline in abortion by choice, at levels no data-literate person would ever suggest, could be achieved with legal categorization.

I used to believe this issue was about protecting life. But the more I learned, the more I questioned whether we might be causing harm. That realization, as well as the hostility toward peer-reviewed research and evidence-based solutions, was deeply unsettling.

Was it possible to want to reduce the rate of abortion and increase it or cause significantly more harm? The evidence strongly suggests that this is the case. Maybe some don't understand this, but I understand epidemiology. The clarity of the data indicted me.

An address on the intentional shift in language around this issue.

This policy review has been updated to reflect the laws today. It was drafted a year ago. Only the laws have been updated. infoepi.org/posts/2023/12/…