The fall of ‘Roe,’ the rise of minoritarian governance, and an impending public health crisis

Banning abortion doesn’t end abortion — it just makes them now come with deadly risk

click to enlarge Banning abortion just makes abortion less safe — it is violent. - SHUTTERSTOCK
Banning abortion just makes abortion less safe — it is violent.

In medical school, I had the opportunity to sit with a young woman who was making a decision about whether or not to complete an abortion. I remember how she wrestled with her competing emotions — frustration at having gotten pregnant, sadness that she couldn’t carry the pregnancy to term, and fear about what her impending choice would mean.

My overwhelming take-home was simple: decisions this complex and final can only be made by the person carrying the pregnancy.

That simple principle — one that’s been enshrined in our federal law for nearly half a century — is what the Supreme Court seems set to violently upend per a leaked draft majority opinion.

And yes, this is violence.

I doubt the justices ever happened upon gas gangrene of the uterus in law school. But it's one of my most haunting memories from medical school. You see a lot of horrific pictures during your medical education, but gas gangrene stays with you. It’s the result of the introduction of an anaerobic bacterium, usually Clostridium perfringens, into the soft tissue of the uterus. Once inside the tissues, bacteria produce a mixture of gasses that bubble through them, destroying the uterus from the inside out. If untreated, it is deadly. But even treatment often requires the removal of the decimated organ.

Thankfully, gas gangrene of the uterus has been rare since 1973. Roe v. Wade virtually eliminated the kinds of unsafe abortions that caused it. But if this opinion drops, gas gangrene of the uterus may no longer be a thing of the past. It looks more likely to be a growing part of our future.

Banning abortion doesn’t end abortion. People who need abortions will get them. They always have. It’s just that those abortions will now come with deadly risk. Banning abortion just makes abortion less safe — it is violent.

Anti-abortion activists claim that forcing women into this risk is justified to save the “life” of an unborn fetus. But the question of when life starts is technically immeasurable and by no means agreed upon. Rather, the unsaid, underriding assumption that life begins at conception is imputed from the most extreme interpretation of one faith. It’s an assumption that shares little consensus among other faith traditions. In some Muslim jurisprudence traditions a fetus does not take on the status of a life until 120 days after conception.

At issue isn’t simply when life starts — but whose life takes precedence. Consider third trimester abortions, the 1% of all abortions which anti-aborition activists raise to illustrate what they see as the inhumanity of abortions. When you zoom back in and ask why someone might have to undergo a third trimester abortion, it illustrates the inhumanity of denying them that right. These are almost always fetuses that were intended to be carried to term. Would-be parents who would have picked out names, bought cribs and baby blankets in anticipation of a healthy newborn. But because of some catastrophic medical indication that threatens the life of mother or baby, those cribs will go unused. Nobody suffers that worse than the person forced into this decision.

If Roe falls, many of the abortion bans currently on the books in states across the country would make abortion in those circumstances a crime, potentially forcing a mother to risk her life under penalty of the law. Implicit in these bans is that the life of a fetus always trumps the life of a mother, turning her womb into a loaded gun and every sexual encounter into a twisted form of Russian roulette that could kill her under the wrong circumstances.

Yet again, these interpretations borrow from extreme interpretations of a single faith. Rather than bias the life of the fetus over that of the mother, Jewish and Muslim traditions, for example, always give precedence to the life of the mother over the life of the fetus. Draconian abortion bans violate the religious freedoms of adherents of other faiths — let alone those of people who claim no faith at all.

I raise the diversity of faith opinions here to illustrate the extent to which the fall of Roe is about nothing more than attempting to read the religious edicts of one particular faith into the law in a secular, pluralistic society. It is, in that way, the ultimate ascent to minoritarian rule, one faith exerting its laws on everyone else.

This is about power — not “life.” After all, if it were about life, perhaps those who architected the fall of Roe might also have supported the Child Tax Credit, or expanded Women, Infants, and Children (WIC) benefits, or Medicaid.

And it’s not even like Roe forces an abortion on anyone — if having an abortion doesn’t comport with your values, then by all means, you can choose not to get one. It just leaves the door open for people to make their own decisions. This is about taking away the right to those decisions.

The irony, of course, is that rightwing anti-mask activists were screaming “my body, my choice” just months ago in protest of the inconvenience of wearing a mask in public spaces. Now, the same crowd has architected the fall of Roe, forcing women to put their very lives at risk by allowing the government to commandeer their most private spaces of all — their bodies.

And this won’t end at Roe. The invictive Justice Alito scrawled into his opinion tears apart the very foundation of “unenumerated” rights — rights that aren’t specifically declared in the Constitution. Alito said “the Constitution makes no reference to abortion and no such right is implicitly protected by any constitutional provision.” Well, neither is the right to contraception or the right choose your partner — be they of the same sex or a different race. A post-Roe America could see GOP-led state governments pass anti-miscegenation laws (that outlaw interracial marriage) or laws that curb access to contraception, which could then be deemed constitutional under precedent set by this ruling.

The consequences of this — like all minoritarian policies designed to put the wishes of a single powerful group over the needs of everyone else — fall hardest on the most marginalized. Poor women, Black and brown women, disabled women — all of them will suffer worst of all, pushed by this ruling and society into the kinds of procedures that cause gas gangrene.

What next? The ruling looks slated to drop in June. And until then, we must push Congress to act. Women around the country cannot wait until then. Congress must act to move to codify Roe in federal law. Indeed, that may require sacrificing the filibuster. But if a reconstruction era parliamentary rule is more important to Democratic senators than the health and human rights of millions of women, then they don’t deserve their offices to begin with.

Originally published May 5 in The Incision. Get more at

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About The Author

Abdul El-Sayed

Dr. Abdul El-Sayed is a physician, epidemiologist, public health expert, and progressive activist who served as Detroit’s health director and ran for governor in 2018. He is the author of Healing Politics: A Doctor's Journey Into the Heart of Our Political Epidemic and Medicare for All: A Citizen's Guide, as well...
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