EBB 240 – Top Five Most Surprising Findings from the EBB Abortion Research Guide with Dr. Dekker & Doctoral Candidate Tyler Jean Dukes

• Access the free EBB Abortion Research Resource Guide hosted at ebbirth.com/birthjustice
• This podcast is also posted on our YouTube channel in case you want to access the video: https://youtube.com/evidencebasedbirth
• SisterSong Reproductive Justice Definition click here
• Ganatra, Bela, Caitlin Gerdts, Clementine Rossier, et al. “Global, Regional, and Subregional Classification of Abortions from a Bayesian Hierarchical Model.” The Lancet, vol. 390, no. 10110, 2017, pp. 2372-2381. Click here. 
• Stevenson, Amanda Jean. “The Pregnancy-Related Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant.” Demography, vol. 58, no. 6, 2021, pp. 2019-2028. Click here. 
• Thomsen, Carly. “Animating and Sustaining Outrage: The Place of Crisis Pregnancy Centers in Abortion Justice.” Human Geography, vol. 0, no. 0, 2022, pp. 1-7. Click here. 
• “Abortion Surveillance – United States, 2019.” Center for Disease Control and Prevention (CDC), Surveillance Summaries, vol. 70, no. 9, 2021, pp. 1-29. Click here. 
• “Abortion Trends by Party Affiliation.” Gallup, 2022. Click here.  
• “United States Abortion Demographics.” Guttmacher Institute, 2022. Click here. 
• Reagan, Leslie J. When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867-1973. University of California Press: Oakland, 1997. Click here. 
• Porter, Lindsey. “Adoption is Not Abortion-Lite.” Journal of Applied Philosophy, vol. 29, no. 1, 2012, pp. 1-16. Click here. 
• Sisson, Gretchen, Lauren Ralph, Heather Gould, Diana Greene Foster. “Adoption Decision Making among Women Seeking Abortion.” Women’s Health Issues, vol. 27, no. 2, 2017, pp. 136-144. Click here. 
• Roberts, Dorothy. Killing the Black Body: Race, Reproduction, and the Meaning of Liberty. Vintage Books of Random House: New York, 1997. Click here. 
• Leach, Brittany R. “At the Borders of the Body Politic: Fetal Citizens, Pregnant Migrants, and Reproductive Injustices in Immigration Detention.” American Political Science Review, vol. 116, no. 1, 2022, pp. 116-130. Click here. 
• Hutchens, Kendra. “‘People Don’t Come In Asking For The Gospel, They Come In For A Pregnancy Test!’: Feminizing Evangelism in Crisis Pregnancy Centers.” Gender & Society, vol. 36, no. 2, April 2022, pp. 165-188. Click here. 
• Thomsen, Carly. “Animating and Sustaining Outrage: The Place of Crisis Pregnancy Centers in Abortion Justice.” Human Geography, vol. 0, no. 0, 2022, pp. 1-7. Click here. 
• Thomsen, Carly and Morrison, Grace Tacherra. “Abortion as Gender Transgression: Reproductive Justice, Queer Theory, and Anti-Crisis Center Activism.” Signs, vol. 45, no. 3, 2020, pp. 703-730. Click here. 
• Borat Subsequent MovieFilm. Directed by Jason Woliner, performance by Sacha Baron Cohen and Maria Bakalova, Four by Two Films, 2020. Click here. 
• Fox, Jesse David. “On a Borat Shoot, Even the Director is in Disguise.” Vulture, 26 May 2021. Click here. 
• Pulliam, Sarah Bailey. “A New Chain of Christian Pregnancy Centers Will Provide a Controversial Service: Contraception.” The Washington Post, 7 November 2019. Click here. 

Rebecca Dekker:

Hi everyone. On today’s podcast, Tyler Jean Dukes and I are going to talk about the top five most surprising facts we learned from compiling an Abortion Research Resource Guide.

As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hi everyone. My name is Rebecca Dekker, pronouns she/her and I will be your host for today’s episode. Today, I’m so excited to talk with, Doctoral Candidate Tyler Jean Dukes, about the Abortion Research Resource Guide that she and I worked on here at Evidence Based Birth®.

I wanted to let you know that in this podcast, we’ll be talking openly about abortion research and history, which can be a very triggering topic. If while listening to this podcast or reading the transcript you feel your heart rate going up or you feel foggy, angry, intensely emotional, or sad or unable to shake a past memory, it could be that you are experiencing a trigger.

A trigger is a sign that you need to turn inward to process these emotions and not outward to lash out at me or Tyler or Evidence Based Birth®. Some tips for inward processing include journaling, going outside, meditating, praying, breathing, holding and being physically close to a loved one, or talking with a trusted friend or counselor.

And I highly recommend the after listening to his episode, that you take some time to yourself today to do one of those activities to show care for yourself. In this episode, we are not going to shy away from talking about the history of racism and how that topic interrelates with abortion.

We will also use a mix of gendered and gender inclusive language depending on the era of when the research was published, the quotes that we’re using or the population that was being studied or discussed. We will also talk specifically about these topics, maternal mortality, slavery abuse and immigrant detention centers, religion, and abortion.

Here at EBB we are no strangers to publishing about controversial and triggering topics. We’ve hosted respectful dialogue on topics like circumcision, vitamin K, vaccines and more. Every time we learn more about how people respond to triggering topics and how we can prepare for that response.

With that being said, if you want to learn more about our EBB perspective on abortion either before or after you listen to this podcast, you can visit evidencebasedbirth.com/birthjustice. That’s all one word, birth justice and click on the Abortion Research Resource Guide button at the top of that page.

That will take you to a video that our team recorded explaining how the overturning of Roe v. Wade will impact our audience of childbearing families and birth workers, what we decided to do in response and our boundaries for engaging with the public on this topic. I will also link to this research guide from the show notes of this podcast.

So if you have any questions or comments or response that you want to make to us in relation to this episode, I ask that you first watch that video from our team or read the transcript. And then we also have a Read Me First document inside the Abortion Research Resource Guide, because your question or concern is most likely already addressed inside the Read Me First document.

If you still have something you want to say to us, after listening to this episode, there is a simple feedback form inside the Abortion Research Resource Guide where you can submit questions, suggestions and feedback. That is the best way to give us feedback on this episode since we will not respond to people who contact us via other methods.

So, we thank you for respecting our boundaries in this matter. And now I would like to introduce our honored guest, Tyler Jean Dukes, pronouns she/her is a doctoral candidate and graduate instructor at Texas Christian University.

During the 2020, 2021 academic year, Tyler worked with me here at EBB as part of a graduate fellowship program, which she talked about in EBB Podcast episode 185. Tyler returned to EBB in the spring of 2022 as a research assistant to help work on a special project.

And that project was compiling an Abortion Research Resource Guide for our audience. Tyler specializes in the medical humanities, the history of medicine and how childbirth has been portrayed in early British literature. She is also a trained childbirth doula, which informs her scholarly and personal interests.

Tyler teaches many classes for college students, including introduction to literature fiction and narrative medicine. And she is currently wrapping up her dissertation. I’m so thrilled that Tyler Jean Dukes was able to take time out of her busy schedule to work on this project for Evidence Based Birth®.

And today she’s here to talk with us about some of the surprising findings that made it into the Abortion Research Resource Guide. Welcome to the Evidence Based Birth® Podcast. So Tyler, it has been a true honor to work with you for the first half of this year on this project.

So I want to go back to the beginning when I first reached out to you, what were your thoughts when I asked you about, if you were interested on working on an Abortion Research Resource Guide for Evidence Based Birth®?

Tyler Jean Dukes:

Well, I am a researcher through and through, so of course, I was excited by an opportunity to hyperfocus on a topic – and in this case, what turned out to be 15 subtopics.

Deeper than my intellectual curiosity was an acute awareness that abortion affects the lives of pregnant people every single day, and that real people with real stories and million degrees of nuance make these reproductive choices. So it was important for me to be able to hold this kind of both/and phenomenon when doing this research.

So for example, it’s okay both for you to see abortion as a lifesaving procedure and for you to be part of a religious tradition that on paper formally opposes abortion. And it’s okay for you to have zero regrets about your abortion procedure and be processing feelings of loss or shame regarding your pregnancy.

So, it was crucial for us to be able to kind of hold these multiple truths simultaneously when doing this research. I think in the media and in politics we so often see this kind of oversimplification and highly inflammatory approach to abortion.

So, something that Dr. Dekker and I talked about was creating research that was more humanitarian and while still relaying the kind of historical contextual and evidentiary details regarding abortion across time.

Rebecca Dekker:

Yeah. I think it’s interesting that you bring up the both/and concept because part of white supremacy culture is an either or kind of binary and focusing on, you can only have one or the other. So what you’re saying is that when it comes to abortion there’s nuance and there’s mixed feelings and there’s both kinds of feelings in all aspects of this topic.

Tyler Jean Dukes:

Yes, exactly.

Rebecca Dekker:

So what was the scope of the project for our listeners who aren’t familiar, maybe they haven’t checked it out yet. What did I ask you to pull the research on and how is it organized? And at first of all, I want to acknowledge Dr. Sayida Peprah of Black Women Birthing Justice for encouraging us to make this research guide public.

Because first I was just going to use it to educate our own employees, to educate myself out of curiosity and also knowing that we’re entering a new era of abortion access or lack of access. So I wanted to make sure we were all educated on our team.

And then Dr. Sayida Peprah said, “You really need to make this public so that organizations working on reproductive justice can also have access to this information.” So talk to us about what was included in the research guide.

Tyler Jean Dukes:

When making our initial research plan, you and I formulated a set of questions that we wanted answered. And eventually, we ended up settling on 15 subtopics.

The documents in the Google folder where the research guide is housed are numbered to kind of logically steer you through the subtopics, but they’re also, you can peruse them in whatever order you see fit, or if something particularly sparks your attention.

But in the numbered order, the guide moves you through kind of frequently asked questions to then some background information. So evolutionary theory, the history of abortion including historical timeline, statistics, and demographics.

And then it moves on to reproductive justice and crisis pregnancy centers, then from religion to philosophy and bioethics and from law and litigation to mental health, spontaneous miscarriage then wanted abortion, unwanted abortions and to adoption and then finally to storytelling and abortion.

So it’s kind of a journey from one to 15, but it’s ordered in such a way to provide you some kind of contextual information at the beginning and then get into more specific subtopics as it goes along.

And then also at the very end, there are additional documents with actionable resources and a spot for people to submit feedback and suggestions. So, the guide’s always a work in progress and we will update it as time goes on.

Rebecca Dekker:

Yeah. And I also wanted to kind of let our listeners know that the research guide includes peer-reviewed research studies published in medical and historical journals. And then we also include relevant books that are considered by scholars in the field to be excellent books on this topic.

So basically, each section summarizes some of the studies and books that we selected so that you don’t have to go find the research article for yourself. And oftentimes they’re stuck behind a paywall, and you can’t read them.

So, the studies are summarized for you and we include bullet points, the summary of the study. And then we have bullet points with quotes from the study and then the same goes for the books.

And I also wanted to use this chance in this research guide to uplift and amplify the voices of these researchers and scholars who have been writing about and studying this topic for a long time and most of the general public never even reads or knows that their research exists.

So, we were excited to highlight that research. So, Tyler, now I thought it might be interesting to go over five of the most surprising or interesting facts that we learned together when we were compiling the abortion research guide.

Because when we first started, we would meet weekly and you would educate me on what you learned and sometimes I would gasp and like, “Oh my goodness, I did not know that there’s so many things that were kept hidden from me in my education.”

So, for this podcast, let’s talk about what we think are some of the top five most surprising or interesting findings and I’ll let you go first. What topic do you want to talk about first?

Tyler Jean Dukes:

Okay. So, number five, we’re going to market as the demographics and statistics of abortion. So I think a lot of us have some preconceived notions about how abortion functions globally, nationally and also who exactly gets abortions in the United States.

And I think some of the demographics and statistics are surprising to a lot of people. So as far as on the macro level or globally, roughly 121 million pregnancies occur each year and 61% of those in abortion. So, of the 61%, that’s about 73 million abortions per year.

And out of those 73 million, 54-ish percent are safe, 30% are less safe and 14% are incredibly dangerous. So, some researchers have a way of marketing what’s safe, less safe and dangerous. So over 50% are safe because of increases in abortion access and abortion litigation.

So unsurprisingly, unsafe abortions occur more frequently in countries with highly restrictive laws. So essentially in places where abortion is banned or where there’s heavy legal or bureaucratic barriers to abortion access are the places with the most unsafe abortions.

So as far as how the US fits into this kind of global understanding of abortion though, is the US is sort of a global outlier in that it’s only one of three countries and since 2000 that have continued to restrict abortion rights. So over 30 countries in the last 20 years or so have expanded these rights.

And the US is one of three countries that has continued to restrict abortion rights in many ways. So then zooming into the US, we know that abortions have declined about 18% from around 2010 to 2019. So, abortions are on decline, but it’s still a very common medical procedure.

About one in four women will have an abortion in their lifetime. So, what we know in the US is that the gestational age in which abortion occurs, 42% are before nine weeks and 49% are before 13 weeks. So, when you add those together, this means that about 91% of abortions occur before 13 weeks of gestation and only 8% occur after 13 weeks.

So, in the US in 2018, there were only two deaths related to legal abortion out of almost 600,000 abortions. So, 2000 deaths for legal abortion out of 600,000. And another statistic in the US is that 90% of US counties do not have an abortion provider.

So overall then in the US, we know that abortion has been on the decline. We know that most abortions occur before 13 weeks. We know that there are only two deaths related to legal abortion out of 600,000 total abortions.

So, another kind of area that we were interested in was interrogating the question of who really gets abortions in the United States. There is this kind of stereotype of young unmarried women.

Oftentimes people indicate teens or college students as the majority of individuals receiving abortion, but the statistics don’t really support that fact. So, in fact, 9% of people who get abortions are teens, and this used to be a higher number, but teen pregnancy has been on the decline since 1991.

So, 9% are teens, 28% or 20 to 24 years old, 29% are 25 to 29 years old and 20% are 30 to 34 years of age. So, the last 15% are 30 year older. So, most of abortion patients are in their twenties and contrary to popular stereotypes, six in 10 pregnant people seeking abortions already have children.

So, this was an interesting statistic to us because we have kind of preconceived stereotypes in our mind about who is getting abortions, whether it’s what the media is saying or what we know from previous biases.

Some other interesting statistics of note are that most people who are seeking an abortion have never had one before. Most of them have some level of education. About half of them are below the poverty line and almost half of them are married or cohabitating. And over 50% self-identify as Christian.

So, it’s this really fascinating compilation of statistics when you look at them, about these cohabitating women or pregnant people in their 20s who have some level of education, but are mostly below the poverty line and over 50% are Christian. I just don’t think those are the general things that we would associate with people who are getting abortions.

Rebecca Dekker:

And most of them already have children of their own.

Tyler Jean Dukes:

Yes, six out of 10 already have children. So, another thing we wanted to investigate were the demographics of individuals that support abortion and that oppose abortion. So, we know that 22% of Republicans believe that abortion should be illegal in all circumstances whereas 4% of Democrats believe it should be illegal in all circumstances.

So, on the other side of that spectrum, 10% of Republicans believe it should be legal under any circumstance and 57% of Democrats believe abortion should be legal under any circumstance. So that leaves us kind of wide swath of people in the middle of these two extremes.

So, 55% of Republicans and 38% of Democrats believe it should be legal in certain circumstances. So, there’s kind of this swath of people in the middle that are moderate in their opinions on abortion and have more complex and nuance understandings than rather just illegal or legal.

The last set of demographics that we found interesting was how abortion bans impact maternal mortality rates. So, there is a greater mortality risk associated with pregnancy than there is with legal induced abortion.

So, there are a lot of scholarly estimates about how abortion bans will affect maternal mortality rates, but one scholar estimates that in the first year after an abortion ban in the US pregnancy related deaths will increase by 7% and 21% in subsequent years.

So, there is estimation that due to abortion ban and the reversal of Roe v. Wade, that there’s going to be a high increase in maternal mortality deaths.

Rebecca Dekker:

And that is partially due to the fact that pregnancy and childbirth are inherently more dangerous than abortion. So, more people will be going down that path and partly due to perhaps illegal access to abortion, or maybe later or more complicated abortions.

Tyler Jean Dukes:

Yes, definitely. So, there will be an increase of illegal abortions if legal abortion is banned.

Rebecca Dekker:

And when you look at that study, a really interesting study by Amanda Stevenson, they found that pregnancy related mortality will increase when abortion is not permitted, even if unsafe abortions do not increase and additional births are accounted for.

So, they did find that there will be an increased burden in our country of mortality due to bans.

So, let’s move on to the next topic and the number four. So we’re kind of moving from number five, most interesting, to number one.

With number four, that one is when abortion was illegal the last time in the United States. So we did a lot of looking at history, Tyler focused more on ancient history. I was looking more at kind of history from the last couple hundred years.

And there was a book by Leslie J. Reagan, a professor, and it’s a really interesting book called When Abortion Was a Crime: Women, Medicine and Law in the United States, 1867 to 1973. So when I found this book, I was just engrossed in it. It was so interesting.

And one of the reasons I picked out this book before Roe v. Wade was even overturned, I kind of could see that it was coming. And I was curious, what was life like before Roe v. Wade? And this book was just an excellent expose of that time period.

So Leslie J. Reagan is a professor of history at the University of Illinois, Urbana-Champagne, and she compiled thousands of original and primary data sources all for focus on exploring this one time period in the US in which abortion was criminalized from 1867 to 1973.

And Leslie Reagan focuses on the rich detail of the actual lives of women who had abortions during this time. And the book is analyzing how doctors, state authorities and families were interacting when abortion was criminalized. She investigates how abortion was carried out, how it was policed and how it impacted politics.

And during this time period when abortion was criminalized for almost 100 years, Leslie writes really interesting data about how the demand for abortions never lessened during this time point. So during the late 1800s, some doctors believe that there were up to 2 million abortions in the United States every year.

In the 1920s, anywhere from 10 to 23% of middle-class women were estimated to have had an abortion. In the Bronx in New York in 1931 35% of all Protestant Catholic and Jewish women had had an illegal abortion. And most of the people having abortions during these time periods were already married.

The other thing I learned from reading this book, which I’d kind of heard of before, but the author went into a lot of detail was about how organized medicine, especially the American Medical Association fought to criminalize abortion and keep abortion criminal.

Still, there were so many doctors in midwives all over the country who were providing abortions primarily driven by their sympathy for the plight of their patients.

The author also pulls all these original newspaper sources and articles, and most of the newspaper articles from the time period when abortion was criminal condemned abortion and talked about its dangers and immorality, but they completely ignored the voices of the millions and millions of people who were having abortions during this time period, their family members, spouses, partners and friends who helped them as well as the midwives and doctors who helped them.

And we also learned through the course of doing this research that for hundreds of years, perhaps thousands of years, people did not consider an abortion to be an abortion if it happened before quickening, before you could feel the fetus move.

And there was an understanding around the world that pregnancy and human development was a process, not a single moment, like we said earlier, it was not either or, it was nuanced and that it was appropriate and acceptable to “restore” the menses and in the pregnancy as long as you did that before the quickening.

Also in this book, they talked about abortion as an open secret. So people didn’t use the word abortion. Again, they didn’t think of it as an abortion if it happened before the quickening, they would say something like the pregnancy slipped away, or I got fixed up or I’ve been relieved.

So they kind of had these open secret ways of talking about it. And they had all kinds of methods for restoring their period, as they called it, all kinds of different herbs. Herbs could be gathered in your own garden or combined and sold by doctors, apothecaries and other healers.

However, there were some herbal medications that killed the people who took them and were considered poisonous. And then the book goes on to describe in great detail of the different instrumental or physical methods that were used to abort the pregnancy, violent exercise, hot baths, irritating the cervix using different instruments to invade their own uterus.

And during this time period when abortion was criminal, actually most of the deaths from abortions from these illegal abortions were caused by physician performed abortions, either through introducing infection or perforating or puncturing the uterus.

But one of the interesting things that I learned from this book as well, that is not really talked about in the birth world, is that a major reason that mainstream doctors and the American Medical Association decided to work really hard to criminalize abortion was because they wanted to basically compete with midwives.

And midwives were trusted members of their community who often helped their clients with abortion. So we talk a lot on this podcast about basically the oppression of midwives in the United States and why there are so few midwives today relative to other countries. And actually this abortion battle had a lot to do with it.

They were able to kind of demonize the midwives, say they were these illegal immoral abortion providers. And that was one reason they worked so hard to criminalize abortion was so that they could work towards the elimination of midwives.

So the book has some fascinating stories about why people sort abortions during this time period and just the different methods and how hard it was, but also how supportive everybody seemed to be and more details about the American Medical Association and how they really led this campaign to make abortion illegal at all stages of pregnancy.

It also talks about eugenics and the desire to have Anglo Saxon people outnumber immigrants, and they talk about genderism, the desire to keep women in their place and require people to become a mother. Then they also divide the four main periods of illegal abortion.

And I think it’s interesting when you look through the time periods of illegal abortion before Roe v. Wade was passed and the most dangerous period was actually in the 1940s because they started really cracking down on abortions yet there was a relentless increase in the demand for abortion.

So because they cracked down on abortion while abortion rates were increasing, and at this time abortion had become extremely medicalized and was primarily done with these sharp instruments and tools which could introduce infection and could perforate uterus. That’s why there were such devastating effects on the maternal mortality rate.

And the results and outcomes were much worse for people of color and much worse for people in the lower classes. And that period lasted until 1973 when abortion was decriminalized by Roe v. Wade. So obviously things will be different now because we have medication abortion and other methods that are considered much safer than what we had in the 1940s, ’50s, and ’60s.

But it was interesting that when abortion was criminalized before the author talks about how the popular sentiment was in support of abortion, as evidenced by the number of people who had abortions and all of their family and friends and medical providers and midwives who supported them.

So the author says, “Americans have a long history of accepting abortion in certain situations as a necessity, and is a decision that implicitly belongs to women to make.” So that was, I learned a lot, highly recommend that book.

And of course, there’s a lot more history in that subtopic of the research guide. So Tyler, do you want to tell people a little bit about the ancient timeline?

Tyler Jean Dukes:

Yeah. So I mean, just thinking about what you summarize, I think that, of course, there’s this debate between physicians and midwives and the 1800s that is more upfront and outright the American Medical Association.

But I think actually, I mean, it has roots as far back as the 1600s in the Renaissance when midwives were the primary reproductive healthcare givers for pregnant people. And they were also demonized at that point, they were called witches. They were burned. They were censured by the different religious organizations.

And so the further we went back in history, the more we realize the problems that are occurring now are recurring throughout time. And even as far back as I think the earliest kind of mention that we saw of abortion was in almost 3000 BCE, but even up until I think it was in 106 CE.

So Cicero was giving a speech about how he believed that abortion should be punished capitally so that people should be put to death for having abortion, but his wish to enforce the abortion wasn’t anything to do with the morality of the woman necessarily.

But they would punish the woman via death because of the injustice she did to the father or the supposed injustice that she did to the father of the child or the family name or their inheritance rights, or even a lot of discussion in the Greek Roman times about the human race and the state.

So any attempts to have abortions of that point where demonized and criminalized or, and punished in many ways because people felt like having abortion was a removal of a member from the state. So it’s just fascinating-

Rebecca Dekker:

Or the removal of the property of the owning male.

Tyler Jean Dukes:

Exactly, which is all a member of the state. So of the Republic, a Plato also talks about this and how they believe that an abortion is…

And I think that’s another reason why abortion is so unsettling to a lot of people, because in many ways it signals a pregnant person’s decision to not participate in compulsory heterosexuality and reproductive means in order to generate a population and all these kind of things, like you spoke about genderism.

So I think that that is one of the reasons why abortion is so heavily contested across time in all historical time periods is because it’s related to a person’s autonomy and their claim and their power and their relationship to the people around them and the conditions that they live in.

Rebecca Dekker:

Yeah. And if you want to learn more about that, I highly recommend the subtopic called The Evolutionary Theory, where we go into more depth about that. And then in the History subtopic, there’s a timeline where you can look at the direct quotes from the different ancient sources about abortion.

And there’s a range of findings from governments, mandating abortion in certain circumstances to forbidding it and having capital penalties. So it’s really interesting to see how it’s been legislated over time and how there’s kind of these swings back and forth. So Tyler, let’s talk about the third most surprising or interesting finding. Which one did you pick for that?

Tyler Jean Dukes:

So for the third most surprising topic, I wanted to talk about adoption and abortion. Obviously, adoption is a critical, legal and familial institution for children, for adoptive parents and for birth parents and for society in general.

So there was this one fascinating statistic that’s related to adoption and abortion. And that is that 30% of the people with the capacity for pregnancy will have an abortion at some point in their life. And only 1.3% of those people will place up their infant for adoption.

So I was interested in this statistic because in politics and in kind of our messaging from the media in other sources is that adoption is a sort of panacea to replace abortion in many instances, but the statistics show that people even when they can’t have an abortion will still not choose adoption.

So I’ll explain that in a moment. So basically some of the factors that might influence a pregnant person’s decision-making when contemplating abortion or adoption includes their state’s legal regulations, community values, any kind of stigma related to abortion and a bunch of other social and familial factors.

But according to some analyses done of The Turnaway Study, when abortion was denied, most pregnant people would rather parent. So 91% of pregnant people would rather parent than put their child up for adoption. So many times adoption is ruled out because people feel it’s not right for them or right for them and their partner.

They might have health reasons for not wanting to continue with the pregnancy and carry to term, or they might believe that there’s already plenty of children that need homes. There’s a multitude of reasons why people might feel that adoption’s not the right option for them.

Rebecca Dekker:

So you’re saying the vast majority of people who get pregnant and seek an abortion are turned away and they don’t choose adoption. And there’s a whole host of reasons, but they overwhelmingly see adoption as the worst adoption.

Tyler Jean Dukes:

They will choose caring the fetus to term over caring and parenting it themselves versus caring to term and adopting that child to someone else. And there was one philosopher that I read whenever we were covering this section, Lindsay Porter, and they discuss how genetic obligation still lingers, even if a birth parent transfers kind of the day-to-day responsibilities to an adoptive parent.

So there’s a few examples when this genetic obligation, and I think he calls it sometimes progenitorial obligation. So basically, that means that you are the maker of something. And so, you still have obligations to that being, even if you adopt them out.

So, some examples that he gave were like, if a child is adopted and their adoptive parents suffer some kind of unforeseen destitution or death, and there’s no other kinds of support, oftentimes the birth parent could be considered or called upon to help that child who is now like has no parents.

Or in examples where maybe the adopted child needs a lifesaving organ donation from the birth parent, they could be called upon, to still be responsible. And even if it’s in a rarely occurring way, the philosopher is basically talking about how one of the reasons people subconsciously don’t want to adopt out their children is because there is always the possibility that that progeny will need your obligation one day.

So it’s really fascinating to me to think about, because obviously that’s not saying that adoptive parents are the ones doing the day-to-day task, and they’re the ones raising the children.

But he’s talking about in situations where something happens to those adoptive parents or where a medical situation where you need an organ donation, even if the birth parent is not a parent in any terms, like not parenting in any way, they can still be held responsible for the obligation.

So it was a really fascinating philosophical approach to it. So, between that kind of philosophical approach and The Turnaway Study, talking about maybe logistical reasons why people don’t want to adopt out their children…

Rebecca Dekker:

So Tyler Jean, after we published the Abortion Research Resource Guide, we got some really good feedback, and one feedback we got from a member at EBB, who is also an adoptive parent, disagreed with Porter’s article about this genetic obligation. And said, “While I do agree with the author in that adoption is not a fool-proof alternative to abortion, birth parents who create adoption plans for their children, and therefore sign legally binding surrender contracts, permanently sever any type of legal or parental obligation. In the great majority of cases, a child would never be placed back with his or her birth parent.” And they also talk about their being no legal or societal obligation to do anything for that child ever again. What are your thoughts on, kind of, connecting these two, seemingly different opinions?

Tyler Jean Dukes:

For sure. So Porter is definitely a philosopher, and so, they are considering the philosophical underpinnings of abortion and adoption. But as Porter says, that there could be kind of like an impetus for a birth parent to be called into action in regards to their child, even if they’ve given up rights. We should just also say that there are situations where birth parents don’t legally have rights anymore, I think what Porter is more talking about, is kind of like that genetic connection with an offspring that lives somewhere on this earth.

Rebecca Dekker:

So yeah, so what you’re saying is there is absolutely no legal obligation for the birth parent to take action, and sometimes not even a societal obligation, as our reader pointed out, but there could be… there’s still a genetic link there, that is not erased.

Yeah. I think it’s fascinating because basically it’s adoption is proposed as this “cure” for the abortion problem, but what you’re saying is that there’s a lot of trauma and a lot of negatives and drawbacks that families are considering.

And for many people adoption is not an alternative to abortion.

Rebecca Dekker:

It doesn’t solve the problem of an unintended pregnancy.

Tyler Jean Dukes:

No. No. And I think that on the last point on this is that it’s interesting also to consider the statistics of who is adopting children and what kind of children they’re adopting. So as far as in the US, domestic infant adoptions account for 15% of all adoptions. So, when people are adopting, yeah, domestic infant adoptions, 15%.

So, the kind of adoptions resulting from unintended pregnancy, okay. 59% are from the child welfare system and 26% are from other countries. So, the large majority of children being adopted are either adopted out of the welfare system or from other countries. It’s not from unintended pregnancies.

So, the people who are interested in adopting and the availability of a children to adopt, it’s contrary to the kind of narrative that we have that adoption is going to fix all of the kind of issues that some people perceive abortion as creating.

Rebecca Dekker:

Okay. So super fascinating. You can find more about that in the research guide that we’ve compiled. So, moving on to number two, I picked reproductive justice, which we talk about a lot here in the Evidence Based Birth® Podcast.

And just as a quick definition, reproductive justice is defined by SisterSong Women of Color Reproductive Health Collective as the right to have a child, the right not to have a child and the right to parent the children we have in safe environments.

And SisterSong also says that unlike the pro-choice movement, which has a singular focus and isolates abortion from other social and human rights issues, reproductive justice movement, which is led by people of color, forefronts economic injustice, the environment, immigrant rights, disability rights, discrimination based on race and sexual orientation and other community-centered concerns.

And a popular way to conceptualize abortion rights is to emphasize your individual rights often using the language of the constitution, but those in the reproductive justice movement say that a big downfall of this framework is that it does not explicitly connect the birthing person or pregnant person to the status of their community.

And there are two sources I want to refer to, one briefly and then one more in depth. One is the book by Dorothy E. Roberts, a professor of law. And that book is called killing the Black Body. It’s a book that I highly recommend. It was authored in the 1990s.

And it is considered today to be a classic expose of the racism that’s embedded in our healthcare system and in particular, our reproductive healthcare system. And it goes back to the times of chattel slavery and talks about the regulation of black people’s reproduction and how that has played and continues to play a central role in racial oppression in the United States.

And she defines reproductive Liberty and talks about the meaning of Liberty and talks about stereotypes and the long history of forced reproduction in the United States. So I highly recommend this book.

If you are a doula, if you’re a midwife, a concerned parent, a nurse, a physician, or anyone who is interested in working against this kind of racial oppression, I highly recommend Dorothy Roberts book. It’s a must read. So that is also summarized for you inside the research guide.

But the other one that I wanted to talk about in the concept of reproductive justice, they talk about immigrants rights and you found, Tyler, a super fascinating article that when you told me about it, I just could not believe… I should believe, it was difficult to hear.

It was about reproductive injustice in immigration detention at the US border. And it was article by Brittnay Leach, a peer-reviewed article where the author examines a case, Garza v. Hargan. It was about an unaccompanied minor, a young 17-year-old who was seeking an abortion while being federally detained for trying to immigrate to the United States.

And in 2017, Jane Doe, this immigrant found out she was pregnant while she was being federally detained for immigrating. She wanted an abortion, but because she was a minor, she had to obtain a judicial bypass for Texas because they have a parental consent requirement.

She got the judge to bypass the consent, and even still the Office of Refugee Resettlement denied her request to get an abortion. And it wasn’t through until many weeks later when she was much farther along on pregnancy and through legal escalation, that she was finally able to get the abortion she needed.

And the author goes on to talk about how when you’re pregnant in an immigration detention center at the border in the United States, you’re going to be exposed to many factors that really increase your risk of having a miscarriage. You might be shackled, and you might even undergo forced sterilization.

You might be denied care for an incomplete miscarriage. You might be refused to have medication if you have high blood pressure or medication to treat or prevent life threatening complications.

And the author talks about how there’s this contradictory logic, where you have pregnant people in detention centers, they are prevented from accessing abortion to “preserve” the fetus, but then they’re also marked as a disposable population, and they’re not given proper medical care.

It’s like this really weird situation where they’re trying to protect the fetus, but abuse its parent. And there’s also this really interesting info about how some activists are constructing fetuses as citizens, or in Lauren v. Lance 1994 words, “super citizens” with “rights to the maternal body that no other humans possess over another’s body.”

And so just a really fascinating article about mistreatment of pregnant detainees in the US immigration and how there’s these policies that kind of pretend like they’re protecting life while they’re basically just barely keeping people alive in these detention centers.

And so, the author talks about ways to fix these injustices happening at the US detention centers, and really reentering the conversation about abortion to one of reproductive justice. Again, looking at the big picture, looking at the roots of this at the root causes of these kinds of conditions.

So, I highly recommend learning more about that subject because it was very eye opening for me. So, Tyler, let’s move on to the number one most surprising or interesting finding. And why don’t you tell our listeners about what you thought was the most interesting out of everything you studied?

Tyler Jean Dukes:

This could differ from person to person. So, a listener could go and look at the resource guide and say, you know what? This topic is actually really fascinating to me. So, this is subjective, but I thought that the crisis pregnancy centers, the research we did on them was the most surprising to me.

I think partially this is due to my just general ignorance and unfamiliarity with crisis pregnancy centers and because of how innocuous they seem and when you see them out in the world. I very clearly remember when I used to live in Austin, there was what they called a pregnancy resource center across from where I lived.

And honestly, I saw the sign every single day and I was like, that’s kind of weird, but I didn’t actually think about how that center could be enmeshed with national networks or be predatory in nature, et cetera. So, a crisis pregnancy center, just so we all understand what we’re talking about is a type of non-profit facility in the US that aims to persuade women against having abortions.

They are usually run by pro-life Christians. They do not provide abortion services and are not a medical facility. However, they do provide what they call abortion counseling or other services related to reproductive health or pregnancy.

And more and more frequently, these crisis pregnancy centers are what we call CPCs, are employing nurses and sometimes even doctors to join the mission of the counselors. And they also have kind of added these other medical elements such as ultrasonography to qualify for state funding opportunities and kind of present themselves as these pseudo medical establishments.

Like I said, you might hear terms faith-based pregnancy center, pregnancy resource center, crisis pregnancy centers, or kind of like what in scholarship most people call them. So that’s what we’ve referred to them as. So, one of the reasons they seem sort of innocuous is because they are kind of bound by the laws from which they receive funding.

So, for example, if a center receives government funding, they are not allowed to speak about religion unless a client brings it up, technically. Okay, whether that happens is unclear. So, they can’t speak about religion unless the client brings it up. So, they’ll say, “Well, we aren’t allowed to bring it up unless the client brings it up.”

The signs outside of the building from when you enter the lobby. So you might see religious iconography when you enter the lobby, there’s going to be religious pamphlets everywhere. There could be more religious iconography inside such as crosses, pictures of fetuses that are being aborted.

There’s all sorts of things that are inside the center and outside that generate a conversation or are meant to pull emotions out of people so that they ask some kind of question about religion. So it’s really interesting where they seem kind of innocuous like, oh, we’re helping people.

We are providing resources for pregnant people, but the intent is really to prevent people from having abortions. So in the US, there are 2,500 CPCs and 738 abortion clinics. So this statistic, it might be updated now, but basically before the 1960s CPCs really didn’t even exist.

And now they outnumber abortion clinics almost threefold. So in 29 states in the US CPCs receive state funding, including Title X funding. Pregnancy centers, they have kind of begun to displace low cost full spectrum providers with their free services.

So one of the reasons why people think CPCs have been so successful in proliferating is because they are offering support in an area that is unsupported because of our healthcare system. So yes, people need medical care, but maybe they can’t access it because there’s not abortions.

Rebecca Dekker:

I was going to say, even if you have an intended pregnancy, most providers won’t see you before a certain number of weeks. Right? So if you’re trying to even confirm that you’re pregnant or get some basic medical information, most providers won’t see you.

Tyler Jean Dukes:

Exactly. Yeah. So intended, unintended, the reality of getting reproductive care when you’re pregnant in the United States, it’s super difficult, especially if you live in a rural area or you have a long way to travel for care.

So these crisis pregnancy centers have popped up in all sorts of different places and they’re offering care that present themselves as offering care to people who are genuinely in need of medical services. So the majority of pregnancy centers attendees are disproportionately low income women of color who are uninsured or on Medicaid.

So one study by Hutchins talked about how the majority of people who are going to these centers are already people who are experiencing health equity in some sort of way. So as far as who the CPCs are affiliated with, they are usually affiliated with larger evangelical networks in the United States such as Heartbeat International, Care Net and a variety of other places.

And so this means that they sort of have these larger safety nets and to one, get more funding. Two, share their ideological similarities with one another. And also to discuss with other CPCs across the nation, sort of the laws and regulations of how they’re running their centers and the strategies that they’re using to get people to come in.

So some really important factors to consider with crisis pregnancy centers is that the counselors often mimic medical staff. So they wear white lab coats and try to present themselves as medical professionals, but they’re not.

Generally, one of the ways that they try to persuade people is to delay their abortion until the time period in which in the state it is then illegal to have an abortion. So if you go to a crisis pregnancy center, if they can’t get you to agree to cancel your abortion, they will try to get you to delay it.

So that way they can get you out of that time period of legality. And just in general, there’s a lot of emotional coercion going on at these centers, general predatory nature. So implying that they offer abortions when they don’t. Opening centers right next to abortion clinics, so people confuse the two buildings.

And scholars have found that 80% of CPC websites listed include false or misleading medical information. So in general, these centers are kind of hijacking the medical care that people actually need in pregnancy and replacing it with something that is predatory in nature and not medical care.

Rebecca Dekker:

So there’s very highly biased ideological information being presented at those places and people are truly in need when they go there. So they’re kind of in a vulnerable state to begin with. And I highly encourage you to go look at that section of the research guide.

There’s a lot of interesting statistics and facts about crisis pregnancy centers. We also added in a satirical video that was filmed on the latest Borat film, where they actually go incognito to a pregnancy crisis center.

And there’s a very interesting scene that the pastor at the crisis center basically is manipulating them into keeping the pregnancy of an ancestral relationship. So if you’re interested, you can also just go to YouTube and look for Borat and pregnancy crisis center to see that scene.

Thank you so much, Tyler, for coming on today, we’ve run out of time, but this is a huge topic. As you know, you’ve worked on this for months. So we could probably talk about this every week for the next couple of months, but here at Evidence Based Birth® we’re really thankful that you took time out of your schedule to work on this project with us.

And we want to encourage everyone to go to our webpage evidencebasedbirth.com/birthjustice. That’s all one word, birth justice. And at the top, you’ll see a button that will take you to the research guide which is housed on Google folders.

And I’d encourage everyone to go through the guide with a critical eye and as much compassion as possible for people who find themselves in situations where they need an abortion. And any final words from you, Tyler?

Tyler Jean Dukes:

Yeah. We would just like to reiterate that abortion is of course a medical procedure and so many other things, but it’s a deeply human experience first and foremost that can generate a range of emotions and questions. So we invite that you lean into those questions and try to hold space for those both/and truths while you’re working through the resource guide.

Rebecca Dekker:

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