Reader Request Week 2023 #1: The Fallout From Abortion Restrictions

John Scalzi

Time to begin this year’s Reader Request Week, and why not start on an absolutely-non-controversial-in-any-way topic, suggested by LadyCat:

Quick sum up: What are your thoughts about your family, specifically your wife and daughter, remaining in Ohio for the long term due to its strict limits on abortion and the spillover from this into other aspects of women’s healthcare?

Specifically, I’m thinking about news stories of women being denied access to desperately needed arthritis medication because that medicine could be considered an abortifacient and they “might” get pregnant while on the medication. Or of a woman who had already gone through menopause having to have her doctor wrangle the pharmacy to dispense pills she needed for some urgent uterine issue, because the pharmacy claimed she couldn’t “prove” that she couldn’t get pregnant and therefore wasn’t using the pills for a secret abortion.

Let me answer this two ways, first, directly with regard to the specifics of the question (my family, and also the state of Ohio), and, when that’s dealt with, more generally.

So, first, at the moment, abortion in Ohio is still legal through 21 weeks and six days; there was a law passed to limit that to six weeks, but it was immediately challenged and is working its way through the courts now. So if any of this were an issue right now, it would still be solvable in-state.

If things change, and they very well might?

Well, look: we’re rich. It’s pretty trivial for anyone in my family who might need an abortion and/or medication that might have abortifacient side effects to cross a state line and deal with it. Inconvenient? Yes! Might we have to pay for these things out of pocket rather than through our insurance provider? Perhaps! But, again, we’re rich and such things would be within our budget.

And if, should the GOP take all three branches of the national government, and set about doing the things we all know they would do, there’s a USA-wide abortion ban? Well, rich people are able to travel abroad, aren’t they, and medical tourism is not unknown even now. It can be cheaper in some circumstances to give yourself a vacation in Europe and get some medical issue attended to while you bask in the sun — even in a private hospital! — than to stay at home and wrangle with your insurance provider about it. So at the first hint of an issue: Oh, look, a trip to France! Or Italy! Or Germany! Isn’t the continent lovely this time of year, we’ve always wanted to go and only now have found the time.

So, yes, short of an acute, emergency issue — which could happen! And then we’re fucked! — my family will have no problem being in Ohio and the US for the long term. That’s because rich people don’t and never have had the same restrictions as anyone else, geographically, financially or otherwise, on this or nearly any other issue you might be able to mention. We can fix so many of our problems with money, and very likely won’t miss the money that solved our problem for us.

This is, obviously, hideously fucking unfair.

Not because the rich need to be dragged down to the same level of medical inaccessibility and consequence as everybody else, but because everybody else should have the same level of medical access and care that the rich get as a matter of course. And everyone, rich, poor and anything in between, should have access to competent and comprehensive medical care across the board, including access to abortion, wherever it is that they live.

But they don’t — particularly women (and other folks with uteruses, and if you’re about to whine “if you have a uterus you’re a woman” please feel free to fuck right off, your binary bullshit has no relation to reality and I’m not entertaining it here and now), and particularly in GOP-controlled states. Make no mistake, limiting abortion access will kill and is killing people, and making medical consequences for the people who don’t die so much worse; by now we’ve seen the stories of women who are actively miscarrying being told by doctors and hospitals that they can’t do anything for them until they are very nearly on the edge of death. If you have to go to the very edge of death to get medical care, one, you might well go right over that edge, and two, the way back from that edge is far harder than what it would have been if you had been able to get competent and compassionate medical attention at an earlier stage.

(And let’s be clear that in GOP-controlled states competent care for health care, and pregnancy-related health care in particular, is going to become harder to get because doctors quite reasonably don’t want to work in a state where the practice of their profession could land them in jail — Idaho, the legislature of which has passed some of the most bugfuck ridiculous restrictions on abortions, has hospitals ceasing pregnancy care and OB/GYNs leaving or planning to leave the state. This is only going to get worse, not better, as we go along.)

Let’s go back to the original question. I don’t think there’s any problem for my family to stay in Ohio long-term, because our access to competent care is not likely to be constrained by geography. Would I recommend Ohio, or any other GOP-controlled state, to people who might get pregnant, with any and all the medical issues that arise from that condition? Not, really, no, even if one has been intentionally trying to become pregnant. As a general rule, if one has a choice, and isn’t rich enough not to have it really matter, I think it’s smarter to live in a state where the law allows for sane and sensible health care, doesn’t relegate half the population to second-class status in terms of body autonomy and medical access, and doesn’t consider you a potential criminal if you don’t go to term, even when you fully intended to and your body (or the body of the fetus) wasn’t able to do it. If you have a choice, live in a kinder state.

The thing is, there are people in Ohio and other GOP-controlled states who are getting pregnant, and don’t have the means to move to a state where care and options are better. They’re stuck with what they have where they are.

Which is another reason for us not to leave Ohio: the state needs people who believe foursquare in the right to full and complete access to be best possible medical care for everyone, regardless of the state of their uterus, or whether they, simply, have one. We can go anywhere to take care of our medical needs. We shouldn’t just tell the ones who can’t that they’re on their own.

— JS

(Have a question for Reader Request Week? Leave in the comment thread at this link.)

42 Comments on “Reader Request Week 2023 #1: The Fallout From Abortion Restrictions”

  1. This obviously has the potential to be a contentious thread, so the Mallet is out.

    What we will not be entertaining here:

    Who is or is not a woman, regardless of uterine possession;

    The philosophical/moral question of whether a fetus (or anyone else) should have more of a right to, and say about, a pregnant person’s body than the pregnant person (as opposed to current state of laws in various states and/or the US).

    If you want to argue those things, you have the whole rest of the internet to do that, and you can do it there. Here, you’ll just get your comment malleted, so do me a favor and save us both some time.

    Otherwise, as always, be polite to other commenters and keep your comments a decent level of civil. I appreciate it, thanks.

  2. I don’t want to argue. I want to scream at the top of my lungs that this is happening!

    I want to believe this will come back and bite the GOP but given all the gerrymandering, voter suppression, and other dirty tricks in their playbook, I doubt the consequences will be as severe as they should.

  3. As someone who lives in Texas, it’s very frustrating to hear comments online about how awful my state is, or how people with my political leaning should just move out. I grew up here, most of the people I care about live here, and I want it to be better. I can’t fight for it to be a better place if I leave. I hope we can make some kind of difference.

  4. Another significant problem (highly correlated, alas) is the gerrymandering of representation to deny such to anyone not GOP. The attempt to restrain constitutional amendments in OH is also correlated (they don’t want people going over them to make abortion legal). The overall goal appears to be to make only votes that support the GOP here (and other places) count and to govern accordingly.

    I don’t want to leave, because my job is unusual and only here. I have to raise my kids here because this is where they grew up and I’m divorced. I don’t think that OH (if current gov’t succeeds) is likely to be congenial to many people, and while cost-of-living is important, being alive and being able to live a life are likely more important. So it’s difficult to advocate coming here, because a government concerned with making sure the people it hates are hurt (and not much else, including competence) is unlikely to do anything good for anyone. I also wonder how long the United States can exist (as said once, we hoped for the last time) “half slave and half free”.

  5. So, John, your answer is, in effect: “Because I have this gigantic unsought and unearned privilege, I’m going to sit tight here where other people who don’t have the same privilege are at risk, because my family isn’t at risk, and I wish this all weren’t the case in that I wish there was no risk and/or everyone enjoyed the same privilege we do”?

    Honestly, I don’t know that my answer would be any different if I were in a similar position.

    But what I’d LIKE to be able to answer, in that position, would be something to the effect of “I am currently mulling the painful choice between ‘costing myself and my family an enormous amount of stress and pain to repudiate this privilege by leaving the state’ and ‘putting my wealth and resources on the line to stay in this state and work actively with Planned Parenthood and a bunch of other people to change things here'”.

    But I’m not sure I would, either, so no asparagus from me. It’s a painful situation all around.

  6. Scalzi,

    Quick note to thank you for 1) acknowledging publicly being rich. There seems to be a shame for the (like me) nouveaux-riches in admitting we got lucky – hard work is never enough. And 2) acknowledging publicly that health care is about health when you’re rich, not money. I find the obsessive “I got mine, f*#k you” attitude of Republican run states disturbing. I find the trade offs people without health care insurance have to make inhuman. Insure everyone already.

  7. re: Hap’s post about gerrymandering.

    I live in a town that has very poor state-level representation because the Democratic Party gerrymandered the heck out of my town and it is split into literally four state house districts. Neighboring towns of the same population size are all in one district.

    The GOP gerrymanders better and more thoroughly but it is not something that is done solely by the GOP.

  8. I’m concerned that the objective of many in the GOP is to drive wealthy, privileged citizens like yourself out of these states in order to solidify their stranglehold on the local government. So staying put as long as you can, since it is less likely to impact you, is in fact a wise choice. I live in a blue state with some very red areas, and I worry all the time about where we are headed. All I can do is vote, in every election, and talk and protest and hope it makes a difference.

  9. This was pretty much what I thought you would say. It’s a perfectly sensible position.

    My great-nephew is finishing his freshman year at Case Western University in Ohio. If he had been a niece, I would have very much tried to convince her and her parents to go elsewhere. (He got a full academic scholarship so that was nothing to turn down lightly. College is extremely expensive.)

  10. I am not rich at your level (buying a six necked guitar for fun), but I am rich enough that a trip to Europe for medical reasons would not kill us. It sucks that these are conversations that need to be had. Thank you for your well articulated and unfortunately necessary position.

  11. Not so long ago, Democrats were being urged to move to, say, Texas, in order to increase the Democratic voter base. All choices for people with a moral code are difficult.

  12. Thank you for your honest opinion on this topic. I’m feeling so bad for many right now. I’m fortunate to live in CA and being a divorced man, no kids. Honestly I could live anywhere, but glad I can support my state in their stance of keeping healthcare for women in their own hands.

    These are dark times. I hope the lights don’t go fully out.

  13. So I’m actually one of those people confronting the issue right now in Wisconsin.

    My daughter has Juvenile Ideopathic Arthritis and the treatment is a weekly injection of Methotrexate, which is a chemotherapy drug AND just happens to be abortifacient. Two months ago I tried to get her prescription filled at Walgreens. No dice.

    Note that while Wisconsin has an 1840 ban the State Attorney General, a Democrat, has stated he will not enforce it and though there are suits due to go to the WI Supreme Court that now has a 3-2 liberal bent (by 11 points for Prosticiewicz), nevertheless Walgreens has not been terribly adamant about fulfilling Rx, if they MIGHT at some point in the future become problematic.

    I got the Rx filled at a local independent pharmacy and then poked Walgreens once more (as the issue was described to me as a “supply chain problem”). As it happened the “supply chain problem” extended into the foreseeable future and I decided that if I couldn’t TRUST the pharmacy or pharmacist to be honest with me they couldn’t count on my business. (I have two Rx still there, one a drug that isn’t exorbitantly expensive but is an issue because my insurance has a side deal with Walgreens over others resulting is a four fold cost increase, and one hideously expensive drug I sure don’t expect a small independent pharmacy to be able to profitably carry.).

    But to our hosts point, while I’m not rich I’m comfortably upper middle class, and hey, Illinois is RIGHT OVER THERE. It’s not even hard for me to go. It’d take me less time to drive across the border to get to the northern Chicago suburbs for care than it would take even a god-bothering Idahoan happy to get to the crappy health care they apparently want.

    But JFC did it INFURIATE me that my daughter’s knees not blowing up to the size of a grapefruit depended on a corporation with the spine of jellyfish coupled with the possibility of a pharmacist who thinks they should get to pick and choose what part of their job they should have to do.

  14. No, I know – gerrymandering was named for a Democrat (I think) who did it “well”. It’s just that it seems to be being employed more broadly as a strategy by the current GOP (OH, NC, TN for 3). They appear to have quickly grasped the neutering of the Voting Rights Act and acted to exploit it. At least part of the point was to implement restrictions on abortion and (if they succeed) birth control.

  15. 60 minutes had a segment on maternal mortality and how the Dobbs decision is going to make it worse. You will have a lot of OB doctors moving out of these states and I read where people graduating from Med school won’t even entertain the idea of doing their residency in these states. As usual, the GOP did not think of the long term consequences of these draconian laws though I suspect they don’t really give a crap.

  16. I was wondering if you would answer that one. Thank you for your honesty.

    I fear for my niece growing up in Texas. And it sickens me that my mother/her grandmother is actively anti-women’s choice.

  17. I live in the state just east of OH, and am concerned about the Rs not only imposing abortion restrictions to the point of outlawing it but bringing along all the other baggage their candidates advocate for, everything from greatly restricting Medicaid (because people deliberately impoverish themselves for that sweet, sweet, sweet marginal health care) to eliminating all firearms restrictions to hating on LGTBQ+ individuals as much as they can to restoring their flavor of Christianity to a position of legal primacy.

    In my area we’re seeing an orchestrated campaign to take over school boards to implement the “Moms for Liberty” agenda. Candidates are popping up with dog whistle positions on parental rights, curriculum transparency, and eliminating CRT from K-12 curricula (where it doesn’t exist, but apparently any discussion of the history of slavery, Jim Crow, and racism in this country and how the echoes of our Peculiar Institution/Original Sin continue to reverberate today is unacceptable). It’s like playing whack-a-mole, challenging these people with what their positions really mean so people will know what they’re REALLY voting for.

    I’m on my local library board (libraries are private non-profits here, and not government organizations). The libraries on either side of us are currently undergoing challenges to their collections by Moms for Liberty affiliated groups/members; we’ve prepared ourselves to be next.

  18. I really appreciate your honest perspective on the challenges surrounding privilege and the decision to stay or leave states with restrictive abortion laws. I currently live in Texas, and I was 10 weeks pregnant awaiting genetic test results when Roe v. Wade was overturned, I was terrified and emotionally drained for pretty much the entirety of my pregnancy. I tried to leave my state while pregnant, but was denied a transfer. Though, it’s looking like companies are shifting to allow for more remote employment to mitigate the retention issues they are facing with folks who no longer wish to live in states with these barbaric laws. I’m not sure what it will mean for the shift in the political landscape, and remote work is a whole other privilege to consider, but I do not think people should feel pressured to remain in a state with these laws in place purely in a show of support. While it’s essential to fight for better healthcare access, it’s also vital to consider our well-being and that of our families. This doesn’t mean abandoning the cause but rather exploring new ways to advocate for change and support those who may not have the same opportunities we do.

  19. If I were still of child-bearing age, I think the restrictions (present and to-be-enacted) would drive me out. Imagine carrying a wanted pregnancy, only to have something horrible happen that needs treatment Right Now. No time to travel, or find competent care elsewhere. Get treatment or die. And being told that treatment is not available, no matter what.

    So…do you go home to die? Die right in the hospital? Hope you can search out strangers in a neighboring state, travel there, get tested & diagnosed (again), and get treatment before death or permanent bodily damage ensues? And then worry about how to pay for out-of-network providers?

    At the very least, if I were pregnancy-eligible in one of the restrictive states, I would research and pre-qualify some out of state health care providers, just in case. Seems like most OB/GYNs are going to be relocating in any case.

    But we shouldn’t have to. Internally, I’m screaming with rage at these old white men (and the GOP female collaborators who enable them) who want to impose religious laws on an unwilling populace. We truly have to vote these dinosaurs out. (apologies to any dinosaurs reading this)

  20. “Which is another reason for us not to leave Ohio”

    Thank you. I’ve been saying this in relation to Texas for looks at watch 20-25 years. sigh

  21. “…by now we’ve seen the stories of women who are actively miscarrying being told by doctors and hospitals that they can’t do anything for them until they are very nearly on the edge of death.”

    It was widespread revulsion at just this outcome (the death of Savita Halappanavar in 2012) that led to the repeal of the Republic of Ireland’s abortion ban in 2018. Meanwhile, Republicans in the US are hell-bent on passing legislation that guarantees women will die as a result of pregnancy. This is a feature, not a bug.

  22. Speaking as someone, not very binary, but in possession of a (no longer finctioning, because, old) uterus, I find it terrifying that some supposed human who just happens to own testicles should tell me what to do. It really is an old-white-men thing, doncha think? And, I can’t help noticing the elevated mortality rates among pregnant POC, here in the UK as well as in so much of the rest of the world.. Sigh

  23. In the US and UK, yes, because numbers and the group of people strangling power. The color changes in the rest of the world.

  24. Very depressing to read all this. Scalzi lives in Ohio, which used to be the nation’s bellwether, and I live in Florida, which used to be the swingiest of swing states, and each formerly Centrist enclaves are run like fascist micronations these days.
    DeSantis by fiat it seems has basically made LGBTQdom punishable by death. Ohio will be just one state of many that doles out the same punishment for a difficult pregnancy.
    My partner and I for several good reasons are never going to be faced with an unwanted pregnancy, plus we’re hetero! So we won’t really face the major consequences of this rush towards theocratic dictatorship.
    But more and more I feel as if I’m a good Christian in 1932 Berlin, guilty of doing nothing while a country’s humanity and morality disintegrates. This feeling is exacerbated by the fact that my inflated rent and groceries means I lack the money to donate meaningfully and the fact that my job plus its awful commute mean I don’t have the time to demonstrate.

    You should see the bumper of my car though. :-/

    I am afeared that there are just more bad Americans these days, and that they’re multiplying faster than the good people. The balance seems to have shifted since the 90’s, when as bad as it was, it all seemed like a winnable struggle.

    Like I said, I don’t have any f***ing money. But if I did I would be listing countries, not states, as potential destinations.

  25. My wife and I are staying in Texas for now. We have long roots here (I had family at the Alamo). People keep calling Texas red, but it’s really purple. It’s the gerrymandering and voter supression that’s keeps the GOP in power. Austin, already liberal, gets a lot of new immigrants from Silicon Valley, also usually liberal. So the legislature gerrymandered Austin into several districts so that only one wound up with a Democrat legislator. I wish more liberals would move to Texas, but I can’t blame anyone for refusing to, just as I can’t blame anyone who says enough and leaves. We seriously considered leaving the country if Trump won in 2020. A total GOP takeover would probably make us consider it anew.

  26. Thanks for weighing in on my question. I knew you had money, I didn’t realize you had THAT much money. Lucky you (meant sincerely not sarcastically).

    As I mentioned in my original post, I don’t plan on going anywhere for at least a few years, just to see how things shake out – as you said, we could have a nationwide abortion ban at some point, which would render moving moot. And I do want to stick around and vote blue and not abandon the people who can’t move. But as I said, it’s scary thinking about all the other ramifications that are only starting to pop their head up.

    @Doug Clark, your situation is exactly the kind I was talking about, where the medical issue has nothing to do with reproductive health, but the access to care is going to be dramatically different based on whether you have a uterus or not. I don’t live in Wisconsin but I donated money for the Supreme Court race, and I hope the current outcome indicates a turn for the better.

    I hope that women who are on the fence about where current abortion laws are going start thinking about these kind of outcomes. For example, if fetal “personhood” is established, will women below the age of 50 be allowed to drink? Alcohol can harm the fetus – would that not be considered child abuse? How would a bartender be able to know who’s newly pregnant and who’s not – will they just decide to not serve alcohol to women to avoid a possible felony conviction? What about energy drinks? Etc.

    And again, for people who say, well, maybe pregnant people shouldn’t be doing drugs, etc., the point I’m making is that these laws are going to be used to control people who “could be” or “might get” pregnant, not just the people who are actually, temporarily pregnant. All supposedly, “for the children”.

    Steps off soapbox

  27. So… for rich people (including the “the only moral abortion is my abortion” people who pass these laws) abortions for non medical reasons will remain equally accessible. But they will get screwed for any emergent conditions, meaning that if you have the means and want a family you will pretty much have to move out of state to be safe. Especially since the OB medical system will start decaying really fast. So the whole state becomes family unfriendly. As for poor people being screwed either way… welcome to the US?

  28. Living in Norway, I don’t follow US politics all that closely. However, I have read somewhere that some states are considering bills that would make it a crime to travel out of the state to have an abortion elsewhere. I don’t know if any such law has been enacted, but if it is, then even being rich won’t save you.

    It’s a scary world to be a woman in.

  29. Along with gerrymandering we have both Tennessee and Montana kicking out Democratic legislators for standing against the majority. I suspect we’ll see much more of this.

  30. The same people who want to make sure you have a gun and the right to shoot anyone who intrudes into your home want to make sure that women cannot defend themselves against an intruder in their own body.

  31. Hap wrote at May 1, 2023, 3:39 pm “No, I know – gerrymandering was named for a Democrat (I think) who did it “well”.”

    Governor Elbridge Gerry of Massachusetts back in 1812. He was a member of the Democratic-Republican Party (yeah, THAT’s not confusing nowadays :) that dissolved almost 200 years ago.

  32. Ironically I’m contemplating the dilemma in reverse. I’ve got a trans teen who’s approaching the possibility of going away to college. They’ve also got multiple chronic conditions and a uterus. So now the question is can we afford for them to leave California? We already have the job of finding an appropriate school that meets their needs an interests but now we have to make sure it’s in a state that hasn’t outlawed or likely will outlaw some form of healthcare they need or might need. You imagine the kind of map we need to figure this out.

    As for folks in gerrymandered states keep talking. I used to be one of those people who didn’t get what was being done to folks from states with crazy laws and insane governs and now I do.

  33. Fun fact: I lived in Idaho for 6 years and tried to change it from the inside. Welp, while I was there, teaching all my students about feminism and encouraging them to vote, the state got worse instead of better. Plus it destroyed my physical and mental health. I moved to California. It took nearly a year to recover my health.

    I know some people can’t move, and that sucks for them. But I’m staying the FUCK outta all red areas, forever. I can donate to Planned Parenthood from a location that allows (!) me to access actual medical care.

  34. Yesterday out of curiosity I browsed some of the early Whatever blogs and read with interest the Being Poor post from September 5, 2005. I’m so glad that “getting rich” (Congrats, you earned it!) hasn’t changed your views or sensibility.

    Last Sunday I was in a discussion group and the topic was facing adversity. Without planning, it. I found myself talking about the fact that as soon as I get comfortable my priority is to defend it — entirely understandable but not actually the best thing for me. Thanks for so ably voicing the notion that a better follow-up to success and comfort is to help others.

    PS: I’m not sure that you’re rich. Where’s the trail of lawsuits, distressed women & children, embarrassing hospitalizations and post-rehab talking tour?

  35. Nortally, John’s so rich he’s paid off Big Media to cover it all up. Just like they covered up how he personally delivered 50 million fake ballots for Biden in the last election! It all makes sense!

  36. Sometimes, they walk away from Omelas…

    The concept has stayed with me, ever since I first read Ursula K. LeGuin’s short story in the Norton Anthology of literature.

    By the way, the Omelas story is on the web.

  37. For all the Americans talking about going to Europe for medical care, Canada is a lot closer and cheaper. All are welcome here. If you decide to stay, we’d love to have you. We have labour shortages in every field, and we have an annual immigration goal of 500k people per year, agreed upon by all major political parties. It’s nice here! You’ll like it. Also abortion is enshrined in law here, and medical care is all free, of course.

  38. Sometimes I think about how even during the Troubles, most Irish people didn’t emigrate. Sometimes I tell myself the other version of the serenity prayer, “Sometimes our fate is to suffer.”

    Still. I am already subject to civil suit in the state of Texas (I donate to abortion funds) and thus cannot safely visit my partner’s parents there. (Sucks for the 2026 solar eclipse.) I have a still-functional uterus and a nonbinary kid. I am looking at the potential President DeSantis and wondering if I can call myself a good parent if I stay for that. I am currently in California, and that’s how I stayed for Trump, but even we can’t buffer much oppression if it’s federal. And even that’s only for so long as I can afford rent here.

  39. Apologies for bringing-up something less important than the issues discussed here, but:

    Before abortion was legal in New York, it was generally known that women who could find the money could get an abortion in Puerto Rico if a doctor could be convinced that it were necessary to the health of the woman, some of them being relatively simply, if not inexpensively, convinceable. This is directly relevant to science fiction in that it is the basis of a now-{generally incomprehensible} joke in John Brunner’s Stand_on_Zanzibar: in a U.S. subject to draconian population control laws, people go to Puerto Rico to get children…I must admit that I can’t recall if it’s to bear them, which would be directly apposite, or to adopt.

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