On May 29, author and professor Sandro Galea sent out a series of tweets regarding abortion in which he criticized states like Alabama and Missouri, which recently passed laws pertaining to the procedure:

Here’s the full thread (tags and hashtags omitted):

Thread – thoughts on the unfolding abortion crisis in the US, and its implications for health. Access to legal abortion is under threat in this country as never before in the post-Roe era. Recent anti-abortion laws passed in states like Alabama and Missouri have all but ended legal abortion access in these areas.

If legal challenges to these laws reach the Supreme Court, the Court’s new conservative majority raises the possibility that the precedent set by Roe will not be upheld. The end of Roe as we know it will have consequences for health. I have written about how threats to reproductive health are threats to population health.

To imagine what a future without Roe could be like, it is worth looking to the pre-Roe era, when women seeking abortions found themselves facing circumstances that could put their health in danger and lead to death. We cannot know for sure how many women died from illegal abortions. What data we have are old, much of it coming from a time when stigma, and the procedure’s then-illegality, could mean underreporting of maternal deaths caused by abortion.

The number of yearly deaths could well have been in the thousands. A [Guttmacher] report contains data indicating that in 1930 abortion was named as the cause of death for nearly 2,700 women. Other estimates place the number of annual deaths higher or lower, depending on the year and available data. Again, these numbers are hard to know given past conditions. What we can know are the many abortion-related deaths in countries where restrictive laws are currently making the practice less safe.

Each year, at least eight percent of global maternal deaths are estimated to have been caused by complications from an unsafe abortion, with as many as 22,800 women dying annually. Much has changed in the last 50 years, changes which have resulted in fewer maternal deaths due to illegal abortions. These changes include the passage of Roe and the work of [Planned Parenthood act].

The potential downstream consequences of a movement against legal abortion include attacks on reproductive health, ranging from contraception bans to new social norms based on misinformation and stigma. An abortion ban could also result in increased reluctance among women to seek medical care for other reasons.

In practice, a ban will likely do what bans have done globally – ensure that safe, legal abortion is available only to the well-off, and that dangerous, illicit abortions are the lot of the socioeconomically marginalized. This will kill women, particularly poor women of color.

The exact number of maternal deaths a US abortion ban will cause is unknowable. But the exact number ultimately should not matter to anyone for whom even one such death is unacceptable. Threats to undermine Roe should be unacceptable to anyone who cares about ensuring safe abortion access for women.

This piece isn’t about the number of deaths from illegal abortions prior to Roe v. Wade. However, for reference, Planned Parenthood President Leana Wen has tweeted on multiple occasions that “thousands of women died every year pre-Roe.” In response to this, The Washington Post’s Glenn Kessler conducted a fact-check. Citing estimates from multiple sources, Kessler noted that even by the late-1940s, abortion-related deaths were much lower than is suggested by Wen and company, who have cited statistics from before the advent of antibiotics.

He concluded by giving Wen’s claim “Four Pinocchios,” and writing:

Wen is a doctor, and the ACOG is made up of doctors. They should know better than to peddle statistics based on data that predates the advent of antibiotics. Even given the fuzzy nature of the data and estimates, there is no evidence that in the years immediately preceding the Supreme Court’s decision, thousands of women died every year in the United States from illegal abortions.

With that cleared up, let’s move on to the primary problem with Galea’s series of tweets.

Instead of addressing whether or not it’s morally acceptable to terminate a fetus at various stages of development, which is the primary driver of the recent spate of pro-life laws being passed in several states, Galea pivots to the possible physical impact that such legislation may have on women who want abortions.

This diversionary tactic is frequently used by abortion advocates to knock opponents off balance, and avoid arguing on the merits of actual abortion procedures.

Another variant of this tactic may include the statement, “If you’re pro-life,” followed by questions such as:

  • Why aren’t you encouraging better sex-ed in schools?
  • Why haven’t you adopted any children?
  • Why not focus on fixing the foster care system?
  • Why aren’t you promoting better access to contraception?

In the form of a question, Galea’s position can be articulated thusly: “If you’re pro-life, why don’t you care about the women who will die getting back-alley abortions if Roe is overturned?”

These questions are posed as if no more than one thing can be true at the same time. If someone opposes abortion, they cannot also advocate for a better foster care system. If someone opposes abortion, they cannot also believe in affordable and widely-available contraception. If someone opposes abortion, they cannot also have empathy for pregnant women who find themselves in difficult situations.

This is, of course, preposterous. Human beings are capable of holding multiple ideological positions.

Abortion is either morally acceptable or morally unacceptable. When engaging with people like Galea, it’s important to maintain awareness of the direction of things, and protect the argument from being deliberately sent off the rails.

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