The Future of Human Reproduction (Part 1)
Intro
On June 24, 2022, with the decision of Dobbs v. Jackson Women’s Health Organization, The Supreme Court of the United States, by a vote of 6 to 3, overturned Roe Vs. Wade. This court case, which was decided in 1973, gave federal protections to women who sought abortions, overriding many laws states already had in place. The overturning of Roe V Wade returned abortion laws to be primarily a state issue and subsequently had people asking what’s next.
The Current State of Affairs
To answer that question, we will begin by looking at what has changed since 1973, primarily in the USA, as well as making comparisons to other nations. According to Guttmacher Institute, in 2020 there were 14.4 abortions in the U.S. per 1,000 women between the ages of 15 to 44. Its data shows that the rate of abortions among women has generally been declining in the U.S. since 1981 when it reported there were 29.3 abortions per 1,000 women in that age range. This represents a 50% drop over the last 4 decades.
Not only has the rate of abortion changed over time, but also the methodologies used to perform them. Since they became legal in 2000, medication abortions involving pills now account for about half of the abortions performed in the USA.
There has undoubtedly been an inverse relationship between abortion rates and the availability of birth control. When Roe V Wade was codified, there were around 4 methods of birth control widely available. Today we have about 18 types, ranging from non-hormonal and hormonal to single and long-lasting use. Emergency contraception, such as Plan B One-Step, also known as the morning-after pill, being the most recognizable, has also been growing in popularity, especially with them being available over the counter.
I believe that these trends will not only continue but will likely accelerate with 3D printed medications, which became FDA approved in 2015, becoming more widespread. These technologies will also give health professionals the ability to have personalized medicine for their patients. On the other hand, the black market for both birth control and abortion pills will likely also expand from being primarily driven by the resale of prescribed pills to the illegal manufacturing of them outright with these emerging technologies. What impact will the expansion of this black market have on abortion rates? Is there a potential for a rise in birth defects due to faulty printing of abortion pills?
“Law and Order”
Another lasting consequence of Roe V Wade was the division of pregnancy policy by trimester. As of the latest data, approximately 90% of abortions in the US take place in the first trimester (0–13 weeks).
When it comes to abortion laws between states, they vary greatly. As of the publication of this article, a number of states had trigger laws that would automatically go into effect if Roe V Wade was ever repealed. A very up-to-date resource would be the State Legislation Tracker of the Guttmacher Institute.
Is there a chance of a federal abortion law being passed? According to the polling data by Pew, not only are Americans extremely divided on the issue, the general views haven’t changed much over the last 3 decades as seen in the chart below:
Furthermore, the opinions on this issue aren’t usually absolute. While only 8% of US adults polled said that they believe that abortion should be illegal in all cases without exception, 19% of adults polled said that they believe that abortion should be legal in all cases without exception. This means that the remaining adults polled (73%) have views that are contingent on a number of factors, including the viability of the fetus, trimester of the procedure, health reasons, as well as manner of impregnation (i.e rape or incest). Looking at the data, I don’t believe that there is enough support for a federal abortion law being passed anytime soon.
Intended and Unintended Consequences
With the recent Supreme Court decision, some are predicting the rise of abortion tourism, where a woman in a state with restrictions will cross state lines in order to obtain an abortion. Will this have an impact on the economies of these states, in a similar way that medical tourism currently has? And is there any danger of a woman being prosecuted for traveling to another state to obtain an abortion that would have been illegal in their state of residence?
Recently, a number of US corporations have recently been weighing in on abortion and birth control conversations. A few years ago, Hobby Lobby got negative publicity for not covering certain types of birth control. On the other hand, some corporations have said that they will cover the travel expenses of their female employees. Will states that have more restrictions lose out on potential employers who don’t want to move there? Will existing companies in these states lose potential or even current employees due to these restrictions?
There has been much talk about the consequences of too many restrictions on abortion, but what about the inverse; Too few? After ultrasound imaging allowed parents to see the sex of the fetus, a trend emerged in many Asian nations such as China, South Korea, Pakistan, and India, for sex-selective abortion, in favor of males over females. This trend, which was first observed in 1975, was spurned by many factors: including cultural biases as well as government programs (such as China’s one-child policy). Some consequences of sex-selective abortions are a large male-to-female ratio, as well as increased human trafficking of women to meet the demand for brides in these nations due to the massive shortage of women available for marriage. Several of the responses to this trend has been government restrictions on fetal screening and abortions, such as the Pre-Conception and Pre-Natal Diagnostic Techniques Act of India. However, will this eventually become an issue in the USA, especially with immigrants bringing some of their old social norms to their new home?
Asian nations are not the only ones that are prenatal screenings for selective abortions. The country of Iceland recently revealed that it had practically eliminated down syndrome from its nation. According to an investigation from CBS, the Combination Test, as it’s known in Iceland, utilizes ultrasound, blood test, and the mother’s age, to determine whether the fetus will have a chromosome abnormality. Down syndrome, which is the most common of these abnormalities, results in children with developmental issues.
Around 80–85% of pregnant women opt to take the test, and of those, virtually 100% of those choose to abort if the likelihood of down syndrome was high. Iceland may be leading the pack, but other nations aren’t far behind. Similar trends have been observed in Denmark (98%), the United Kingdom (90%), France (77%), and the US (67%). Some may see this trend as progress, but for others, it also raised ethical dilemmas. Don’t disabled people have a right to life? Are we seeing the beginnings of eugenics making a comeback? And who gets to decide which genetic disorders should be eliminated?
In the next part, we will focus on assisted reproductive technologies, declining birth rates, genetic counseling, as well as other topics about the future of human reproduction.
