New England Journal of Medicine: “The just-announced U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization represents a stunning reversal of precedent that inserts government into the personal lives and health care of Americans. Yet it was not unexpected. In the long, painful prelude to the decision, many states have severely limited access to reproductive health care. The fig-leaf justification behind these restrictions was that induced abortion was a dangerous procedure that required tighter regulation to protect the health of persons seeking that care. Facts belie this disingenuous rhetoric. The latest available U.S. data from the Centers for Disease Control and Prevention and the National Center for Health Statistics are that maternal mortality due to legal induced abortion is 0.41 per 100,000 procedures, as compared with the overall maternal mortality rate of 23.8 per 100,000 live births.Experience around the world has demonstrated that restricting access to legal abortion care does not substantially reduce the number of procedures, but it dramatically reduces the number of safe procedures, resulting in increased morbidity and mortality. Millions of persons in states lacking protections for abortion care are also likely to be denied access to medication-induced abortions. It may be difficult for many Americans in 2022 to fully appreciate how complicated, stressful, and expensive, if even attainable, their most private and intimate decisions will become, now that Roe has been struck down. A recent New York Times article recounted the experiences of women, now in their 60s and 70s, who sought abortions before Roe. They described humiliating circumstances, unsafe procedures literally performed in back alleys, and the deep shame and stigma they endured. Common complications of illegal procedures included injury to the reproductive tract requiring surgical repair, induction of infections resulting in infertility, systemic infections, organ failure, and death. We now seem destined to relearn those lessons at the expense of human lives. Without federal protection, recent state laws curtailing or eliminating the right to abortion care will deny Americans’ reproductive autonomy and create an Orwellian dystopia. Examples are the Oklahoma law enacted on May 25, 2022, that declares life to begin at fertilization and the Texas bill that went into effect on September 1, 2021, which empowers third parties to bring civil suits and collect damages against persons who perform, aid, or abet abortions. Defendants in such suits will bear their legal costs, while plaintiffs are indemnified against countersuits for bringing groundless actions. Use of postcoital contraception, either hormonal contraception or placement of an intrauterine device, could be equated with abortion and prosecuted; some jurisdictions (e.g., Mississippi) are already considering such actions. A single act of coitus not timed with respect to the menstrual cycle has a 3% probability of causing conception.

• After conception, approximately 14 days elapse before chorionic gonadotropin reaches detectable levels in maternal blood. Approximately 30% of recognized pregnancies result in miscarriages. Thus, in some jurisdictions, people could be prosecuted for aborting a pregnancy by using postcoital contraception, despite a 98% probability that their actions did not cause an abortion, but there is no way to prove or disprove that they were pregnant.