A sermon by Dr. Carrie Baker on January 26, 2025

Dr. Baker is the Sylvia Dlugasch Bauman Professor of American Studies and Chair of the Program for the Study of Women and Gender at Smith College. Dr. Baker’s new book, Abortion Pills, is available on open access and in print.

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Thank you for inviting me back. Wonderful to be here with you today.

On January 22, 1973, 52 years ago last Wednesday, the U.S. Supreme Court decided Roe v. Wade, which recognized that the constitutional right to liberty included the right to make reproductive decisions without government interference. On June 22, 2022, the Supreme Court overturned Roe v. Wade, opening the door to state abortion bans across the country. Today, 12 states prohibit abortion entirely; 4 states ban abortion at 6 weeks, 2 at 12 weeks, and 1 at 18 weeks. In the fall elections, 7 states passed constitutional amendments protecting abortion rights, including Missouri and Arizona, which had previously banned abortion. But in the last year other states have passed new bans, such as Florida, which now bans abortion at six weeks.

Despite these bans, the number of abortions in the U.S. has actually increased since Dobbs. In 2020—the year before Texas became the first state to ban abortion—the number of abortions in the U.S. was 930,160. In 2023, there were 1,026,700 abortions in the U.S.—an increase of close to 100,000. These numbers do not count the many people obtaining abortion pills outside of the medical system today.

How do we make sense of this? The number of abortions in the U.S. has increased for several reasons.

First, states banning abortion are also making access to contraception increasingly difficult, especially for young women, resulting in more unwanted pregnancies and more people needing abortions.

Second, anti-abortion policymakers do not support the kinds of policies that help people carry pregnancies to term and care for the children they have, such as paid parental leave, publicly funded childcare, living wage jobs, free school lunches and SNAP benefits. In fact, conservatives are now redirecting meager welfare dollars away from poor women trying to feed their children toward anti-abortion “crisis pregnancy centers” that use disinformation and coercion to pressure women to have children they cannot feed. If women can’t afford to care for their children, they will most often not want to carry unplanned pregnancies to term.

Third, conservative anti-abortion policymakers are passing laws that prevent health care professionals from providing life-saving medical care when women encounter complications during pregnancy, making giving birth in America much more dangerous. Maternal mortality and morbidity significantly increased in states that banned abortion after Dobbs. Anti-abortion prosecutors have also increased criminalization of pregnant women. I’ll say more about these two factors in a moment. But together, they discourage women from carrying pregnancies to term by making them medically and legally dangerous.

Finally, the increase in abortion is also due to the strengthening of abortion rights in states protecting them and the development of new avenues to access abortion pills, which are now used in over two-thirds of all abortions. Advocates have pioneered telehealth abortion, where health care providers consult with patients online and mail pills to them. They have also pioneered new avenues outside of the medical system, such as community networks sharing pills for free and websites selling pills very inexpensively.

These new avenues undermined the key anti-abortion strategy of limiting abortion to freestanding brick and mortar clinics, and then regulating these clinics out of existence—or terrorizing them. Since 1977, there have been 11 murders, 42 bombings, 200 arsons, 531 assaults, 492 clinic invasions, 375 burglaries, and thousands of other criminal activities directed at clinic patients, providers, and volunteers. Since Dobbs, there have been sharp increases in violent anti-abortion attacks on clinics, especially in states that protect abortion rights.

Last month, I published a book on the history and politics of abortion pills in the U.S., which thoroughly explores how these medications were developed, the fight to bring them to the U.S., the intense restrictions placed on them by the FDA and the medical system, and the campaign to increase access in recent years, including the development of telehealth abortion as well as the underground networks dispensing pills that are so critical to maintaining abortion access post-Dobbs. The book is available open access through Amherst College Press, and I have print copies here today available if you’d like one.

Abortion pills are more important than ever now that Donald Trump is in the White House again. But he and his people are coming after abortion pills because they know they are a critical path to accessing abortion. The Heritage Foundation’s Project 2025 policy agenda for Trump takes direct aim at abortion pills, with plans to roll back FDA approval of mifepristone and misuse a nineteenth century anti-obscenity law to criminally prosecute anyone who mails abortion pills, including distributors and doctors. While so far abortion bans have targeted medical providers and those helping people obtain abortion care, anti-abortion politicians are now proposing laws that target people who have abortions.

Legislation proposed in South Carolina, Oklahoma, North Dakota, and Indiana would reclassify abortion as homicide and prosecute patients. In South Carolina, Oklahoma and Indiana, that could mean giving women who have abortions the death penalty. In Texas, which also has the death penalty, twelve lawmakers recently pledged to bring forward similar legislation.

Health Consequences of Bans

The harms of abortion bans have fallen most heavily on people who are carrying wanted pregnancies to term, have health complications and are being denied care—and are dying.

In last summer’s Supreme Court case involving denial of emergency care to pregnant women, the National Women’s Law Center filed a brief documenting more than 70 cases of women almost dying, and one who did die—when they were denied emergency medical care because of abortion bans enacted across the country. “The true number of cases is likely significantly higher,” said the brief.

One involved a woman experiencing preterm premature rupture of membranes (PPROM), which is when the amniotic sac breaks prior to viability. Rather than treat her by terminating her pregnancy, the hospital sent her home. She returned to the emergency room two days later with severe sepsis. In another case, a doctor said to a nurse, “so much as offering a helping hand to a patient getting onto the gurney while in the throes of a miscarriage could be construed as ‘aiding and abetting an abortion.’ Best not to so much as touch the patient who is miscarrying…”

In another case, Mylissa Farmer was denied the emergency abortion care she needed, first by her local hospital in Missouri, and then by a hospital in Kansas. After diagnosing her with PPROM, doctors at both hospitals told Mylissa her fetus could not survive, and continuing her pregnancy would put her at risk of serious infection, hemorrhaging, the loss of her uterus, and even death.

Still, both hospitals refused to end the pregnancy. With her health deteriorating rapidly, Mylissa and her boyfriend drove more than four hours to an Illinois abortion clinic while she was in labor. 

She survived, but the medical and financial consequences of crisscrossing state lines to obtain life-saving abortion care linger to this day. Mylissa was docked pay for missing work and had to raise funds to pay for the Illinois care that her insurance refused to cover. Her boyfriend also lost his job because he was forced to miss work over the days he helped her travel. They could not regain steady employment for months.

Some women never get the care they need. A Texas woman, Yeniifer Alvarez-Estrada Glick, died from pregnancy complications on July 10, 2022, after a Catholic hospital in Texas failed to offer her an abortion. 

Other women who have died because of abortion bans include:

• Josseli Barnica, Texas
• Amber Nicole Thurman, Georgia
• Candi Miller, Georgia
• Porsha Ngumezi, Texas
• Taysha Wilkinson-Sobieski, Indiana
• Nevaeh Crain, Texas

… Say their names.

There are more, but we may never know because states with bans are disbanding their maternal mortality committees, so no one finds out about the deaths. Georgia fired everyone on their maternal mortality committee after Pro Publica publicized the deaths of Amber Nicole Thurman and Candi Miller. Texas has legally prohibited its committee from reviewing deaths that are considered abortion related. The NIH and the CDC do not require states to collect information about abortion-related deaths. And that was under Biden.

States with bans have higher maternal mortality and morbidity, and higher infant mortality. ProPublica has found, pregnant women have bled to death, succumbed to fatal infections and wound up in morgues with what medical examiners recorded were “products of conception” still in their bodies.

It’s hard to hear, but we must listen.

And remember, these same states are those with the weakest support systems for new mothers and poor children.

Criminalization of Pregnant Women

In addition to the harmful health consequences of bans, pregnant women are also facing increasing criminalization. Recent research from the organization Pregnancy Justice revealed that at least 210 women faced criminal charges because of their pregnancies or pregnancy outcomes in the year after Dobbs—the highest number of documented prosecutions ever in a single year. The real number is likely much higher. Most of the charges involved allegations of child abuse, neglect or endangerment, but they also included 9 cases of alleged homicide where there were pregnancy losses.

Many of these cases involved pregnant women who had positive drug tests, but most of these did not require any evidence that the drug use harmed the fetus or newborn. A significant number of the cases were based on prosecutors’ after-the-fact opinions on when and how pregnant women should have interacted with healthcare providers.

In 15 cases, the charging documents alleged women failed to obtain adequate prenatal care, and two alleged noncompliance with a medical provider’s recommended treatment.

Ten cases referred to failure to seek help during or after birth.

Three condemned mothers for breastfeeding their infants.

Pregnant women are in a special class of persons, under an exacting microscope and subject to arrest for otherwise non-existent crimes, such as “unlawful delays in obtaining health care.” 

Women’s reluctance to seek medical care is understandable, given the frequency with which medical providers share information about their pregnant patients with child welfare authorities and police. In over half of the cases, police relied on information obtained or disclosed in a medical setting. In 114 cases, the “child welfare” system was involved. 

“Out of fear of criminalization and family separation, many pregnant people avoid healthcare settings, even when they desire care,” said the report.

In a recent Georgia case, while experiencing a miscarriage, Candi Miller refused to go to a hospital because she feared criminal prosecution. She died in her bed, cradling her 3-year-old daughter.

Most of the people targeted for prosecution are poor or have low incomes.

Women are in a catch 22. If they go to the doctor, they may be denied care or criminalized. If they don’t go to the doctor, they may be criminalized. Rather than compassion and support, they receive judgment and punishment.

Meanwhile, prosecutors are not bringing criminal cases against companies and policymakers who release toxic agents into the environment that have clear causal connections to fetal harm, such as government officials in Flint, Mich., who knowingly switched the city’s drinking water supply to a source contaminated with lead, tripling the incidence of dangerously-high blood levels of lead in the city’s children.

Reproductive Coercion Is Violence Against Women

Laws that try to force women to continue pregnancies are a form of violence that subjects them to involuntary servitude and deprives them of bodily autonomy, dignity and equality. Abortion bans place pregnant women under state control and require them to endure the dangers of pregnancy, labor and childbirth against their will.

Pregnancy causes nausea, fatigue, tender and swollen breasts, constipation, body aches, dizziness, sleep problems, heartburn and indigestion, hemorrhoids, itching, leg cramps, numb or tingling hands, swelling, urinary frequency or leaking, varicose veins—and many more deeply invasive and painful experiences.

Pregnancy takes over the entire body, affecting the cardiovascular system, kidneys, respiratory system, gastrointestinal system, skin, hormones, liver and metabolism. It increases blood volume by about 50 percent and depletes calcium from the bones, decreasing bone density. Risks of pregnancy include high blood pressure, gestational diabetes, anemia, depression, infection and death.

These risks are particularly acute for women of color and low-income women in the United States, which has the worst rate of maternal deaths in the developed world. Labor and childbirth are extremely painful and bloody experiences, even with pain medications.

To force this labor on women is a violation of the 13th Amendment, which prohibits involuntary servitude.

Abortion bans also violate women’s equality rights. No human being is required to donate their organs, blood or body to another human being against their will, except for pregnant women. If someone forces another person to donate a kidney, they are committing a crime. No law requires a parent to give their organs or blood to their child, even if the child desperately needs it. Yet, abortion bans force pregnant women to donate their entire bodies to serve fetuses for nine months—a right that born children do not even have. These laws treat pregnant women differently than all other people in violation of the 14th Amendment equal protection clause.

Any attempt by the government—or anyone else, for that matter—to force another person to continue a pregnancy is a form of bodily assault with surprisingly similar dynamics to domestic violence and sexual assault. The essence of rape is taking control over another person’s body and forcing them to do something with their body that is against their will. Abortion bans do the same: They force pregnant people to do something with their bodies against their will, denying their bodily integrity and autonomy. When legislators pass abortion bans and restrictions, they are engaging in a form of violence against women and girls.

As Irene Weiser asks, “How can we ever begin to end violence against women if the laws of our society will not even guarantee the most fundamental of human rights to women—to say at all times, under all circumstances, what we allow to happen to our bodies?”

Resistance

With Trump and MAGA now in control of the executive branch of the federal government, it’s going to get worse before it gets better. But many people are fighting back hard.

States supporting reproductive rights, like Massachusetts, have expanded access to abortion and contraception since Dobbs. To support people in states banning abortion, grassroots activists have worked to pass telemedicine abortion provider shield laws in 8 states, including Massachusetts, so that U.S.-based health-care providers in these states can offer FDA-approved abortion pills to people in all 50 states, including those with bans. We have one such provider here in Massachusetts, a Cambridge-based organization called the Massachusetts Medication Abortion Access Project, or The MAP. Staffed by doctors, The MAP provides telemedicine abortion to people in ban states for a sliding scale fee.

In addition, grassroots activists have developed a robust alternative delivery system providing abortion pills to people in all 50 states, including those banning or restricting abortion. Operating outside of the medical system and extralegally, this system provides abortion pills to people in two ways: 1) through vetted online vendors who sell generic abortion pills for as little as $28 with 3 to 6-day shipping; and 2) through activist networks that mail free generic abortion pills to people in restricted states who can’t afford or access care otherwise. These networks include Red State Access and Las Libres.

Several organizations and resources exist to support people seeking and using abortion pills, including Plan C, which shares information on how to obtain abortion pills at plancpills.org; the Miscarriage and Abortion Hotline, which provides free and confidential medical support for using pills; Reprocare, which provides logistical and emotional support; and Repro Legal Helpline, which provides free, confidential legal services.

This robust alternative delivery system has served tens of thousands of people in the U.S. in the last two and a half years—people not counted in the official number of abortions in the U.S. Luckily, abortion pills are 90% effective and safer than Tylenol so they can be safely used without medical supervision.

In addition to these ongoing efforts, Democratic attorneys general and governors are fighting to protect reproductive rights. The Massachusetts attorney general Andrea Campbell is part of DAGA—the Democratic Attorney Generals Association, which is suing to block Trump administration rollbacks of reproductive rights. Maura Healey is part of the Democratic Governors Association, which is also pushing back against the Trump administrations violations of women’s reproductive rights. Finally, we must organize to take back Congress in 2026 and the White House in 2028.

We can do it because Americans want it. Currently, 63 percent of Americans say abortion should be legal in all or most cases. Of the 17 ballot measures on abortion since Dobbs, 14 of them were decided in favor of abortion rights, including in very conservative states such as Ohio, Missouri, and Kansas.

As UN Population Fund Executive Director Dr. Natalia Kanem said, “We need laws that will enable, rather than constrain, our human rights. We need human rights defenders who will advocate for policies that advance gender equality and reproductive rights. We must be those human rights defenders.”

I will close with a powerful call to arms from the Feminist Majority President Ellie Smeal:

“It’s tempting to feel overwhelmed. But I urge you to remember: the night is always darkest before dawn. Despair is a cunning thief, whispering that our efforts are futile. But history is a testament to the opposite—our resistance, our persistence, and our hope have always been the catalysts for change.”

Thank you.

Photo by Gayatri Malhotra on Unsplash