The analogies between Trumpism and Apartheid abound. (See Blog: "Trump, USA, RFK and Apartheid, September 18, 2024). The Supreme Court is playing a central role in creating a dystopian authoritarian America including the abrogation of the fifty year old constitutional right to abortion under the privacy provision of the Constitution.
What deeply disturbs Jay H. Ell is that it is one thing for politicians and "think tanks", (sic), to advocate for totalitarian measures, it is another for the Justice System to literally, arbitrarily flaunt their role and become the arbiters and be the creators and distorters of the intent of the Constitution. In addition to the latter, the Court, unbelievably has enacted legislation declaring them as the experts on every conceivable area such as Environmental Protection. In their total reversal of Roe, which was not an even an issue in the litigation before the court, they became the umpires, to use the term Chief Justice Roberts so loves, of what women's health care should encompass.
While Trump. McConnell and the Republican legislatures of 20 states did not care what the outcome of negating a women's right to choose would be, the Supreme Court, having put themselves in the role of the decision makers on the subject, sought no information into the fact that one out of five normal pregnancies could present with complications that are indistinguishable from those wrought by "abortions". So bad as banning abortions per se might have been, (incidentally they further worsened their edict by making no provision for rape and incest}, their ruling laid open the door for the chaos that has followed. A good start would have been researching the sequalae of "abortion bans" under apartheid rule. There they might have learned of the devastation it wreeked and that in effect they were impacting health care on a wide scale.
The Court also had to know that a slew of Republican State Legislatures had "trigger" anti abortion laws should Roe be overturned with draconian sentences for doctors who dared to intervene in the death threatening complications of any pregnancy gone wrong lest they be accused of aiding an abortion. Apparently they cared about the consequences of their legislation as much as the politicians did.
Jay H. Ell as a physician who acted in two capacities in the apartheid era from 1948 to 1990, primary and the emergency care, had personal experience of what the impact of an "abortion ban" was on reproductive and general medical care.
THE BACKGROUND OF SOUTH AFRICAN APARTHEID ABORTION LAW
Before 1975 there was no statutory legislation on the termination of pregnancy in South Africa. There was common law which was a de facto overall ban unless it be the saving of a woman's life. In the 1960's there were approximately 200,000 illegal abortions a year and that epidemic expanded to 250.000 in the 1970's, (Susanne Klaasen, Med. His., (58.2), 2014). (It should be noted in that period the population of South Africa was about 20 million). Klaasen states in the apartheid period 1 of 9 women had an abortion.
Professor Derek Crighton, head of the Department of Obstetrics and Gynecology at the University of Natal, in his defense at his trial for performing 26 abortions stated that between 1954 and 1973 his hospital had treated 40,000 Black Africans with complications from abortion. (In his evidence he apparently did not or could not distinguish between complications of a normal pregnancy and those by induced abortions), He maintained 1 in 200 of those had died and 5 percent had become sterile. In King Edward hospital, which was one of the hospitals that Crighton worked at in 1973, 934 cases of abortion complication were admitted of which 354 were septic. (Klaasen op citra).
A major difference of apartheid abortion care as compared to the current USA situation was. while the bans on abortion were draconian in both countries, if in South Africa, a woman pitched up to the hospital bleeding or with complications of pregnancy there was no effective legislation to prevent the doctors from treating the patients regardless whether this was a complication of a normal pregnancy or an "illegal" abortion.
In 1975 just about a few years after America interpreted the privacy provision in the constitution to permit a woman the right to control her own body, draconian legislation was introduced by the theocratic misogynistic Nationalist apartheid government entitled, "The Abortion and Sterilization Act". Ostensibly the South African allowed for abortions for the life threatening health conditions of the mother even mental health, in rape and incest and where gross fetal abnormalities were detected. However the legislation was similar to those now enacted by American States in that it was impossible to interpret these without fearing the penalties for the health care providers enshrined in the Act. In addition all abortions had now to be performed in State institutions and had to receive the "ok" from the head of those institutions.
The 1975 Legislation had the desired effect of putting the fear of G-D into anyone who had as much advocated an abortion and the backstreet abortion industry thrived. The medical profession had watched the public humiliation and termination of the career of the foremost academic in obstetric and gynecology in his public trial in 1972, so they had little doubt of the outcome as to the impact that their involvement might have on their ability to earn a living and their reputations.
Another important background fact. is that the anti abortion legislation throughout the apartheid history had a socio economic component. Those without resources were more likely than those without to obtain safe abortion care.
HOW DID THIS WORK IN THE REAL WORLD OF PATIENT CARE IN APARTHEID SOUTH AFRICA
There were two major differences in apartheid South Africa as compared to the current situation in the USA. There were no arbortifactient medications then so the "illegal" terminations had to be done by back street abortionists. (The introduction of mifesterone as an abortifacteint has revolutionized medical abortion care in that 63 percent of abortions in America utilize this method). So "illegal" procedures in apartheid South Africa were all performed by back street abortionists.
A major difference of apartheid abortion care as compared to the current USA situation was while the bans on abortion were draconian in both countries, if, in South Africa, a woman pitched up to the hospital bleeding or with complications of pregnancy there was no effective legislation to prevent the doctors from treating the patients.
The South African "illegal" abortion patients were predominantly non white and a percentage had serious complications, the most ravaging of which was sepsis. Which intern in South Africa cannot remember spending endless hours,"specialing" the septic patient, who was alert to what was happening as one adjusted the isoprenaline intravenous therapy according to the blood pressure which was measured every half an hour. To this day with all the medicine advances the sepsis survival rate is at best 25 percent and at worst 50 percent.
There were also the poorer whites. One which stands out in memory was a 12 year old from a rural area who came in holding her teddy bear. A routine chest X-ray revealed a safety pin, a picture to this day that is indelibly printed in my mind, both in the lateral and frontal X-ray views.
What is more memorable are those young women seen in general practice. These unfortunate patients were part of an ongoing relationship that is part and parcel of family medicine. "Unwanted" pregnancy knew no racial, political or cultural boundaries. The whole experience of devastation that the circumstance evoked in the family as well the life of the individual was ongoing lasting sometimes the length of the pregnancy and beyond. This was in stark difference as compared to the hospital encounters of patients, who had come from G-d's knows where and who would leave to pick up their lives in G-d knows whence.
As a physician I had the responsibility of putting the limited options to the patient knowing full well that it depended on their circumstances. There were the few who could get on a plane and fly to the United Kingdom. If they were old enough and had appropriate insurance or funds maybe the Gynecologist would do a Dilatation and Curettage. (Far less likely after 1975). There were those whose family insisted that they have the child. There was a rape victim who was referred to a "State Institution" where doctors had to decide whether her story was valid.
There were two seventeen year old teenagers who elected to go to an agency out of town where they could continue their schooling and give their babies out for adoption. They were of course far away from their families in this dark time but they had very few options.
As an activist against apartheid I had to be mindful that I was being watched. There was the time when I was faced with a young university student who was suicidally depressed at her pregnancy. A referral to a psychiatrist confirmed the diagnosis and a D and C was arranged. On completion of the latter the Security Police burst into the Operating Room. This was pre 1975 and a prosecution under common law would have probably failed. I was questioned and sought legal opinion.
Nobody arrived in the office announcing they were going to have an illegal abortion. Presumably some took that decision without needing a physician's counsel. There had to be some and I will never know
STATUS QUO IN USA - THE ROLE OF THE SUPREME COURT
The situation of health care providers in America is worse than it ever was in South Africa who in the hospital setting could treat "incomplete" abortions whatever the cause. Self righteous sanctimonious men have made life or death decisions concerning women illegal, rendering them helpless to respond whether the complications are in a normal pregnancy or as a result of an induced abortion.
Now 20 states have abortion bans some with a life time prison sentence for health care providers. One third of women in America are under an abortion ban. Anyone who assists in obtaining an abortion can be subject to penalties. Even the Uber driver who speeds you to the airport to go to a state where you can still get care. The plight of women mainly, with complications of a normal pregnancy has been graphically presented in the media. The examples to date have to be the tip of the iceberg as how many can be strong willed enough to share their personal stories of reproductive grief, loss or relive rape and incest.
The Supreme Court in the very near future might decide whether or not the FDA's decision to allow the prescription of abortion drugs is "constitutional" or not. They did not decide that issue last time on the basis of "standing". That is those that had brought the litigation had no right to do so. There are right wing judges who will need not much convincing that the FDA have acted "unconstitutionally" by allowing doctors to "subvert the Constitution" by providing all women in America, in person or by mail, the means to procure an abortion.
The Court has already ruled that reproductive freedom is not a constitutional right. If they ruled against the FDA that would put America, as bad as the situation is now, in a far far worse predicament than apartheid South Africa. It would open the door to back street abortionists with doctors powerless to mitigate the destruction of women's bodies and their lives.
AT THE END OF THE DAY
If in November 2024 the President of America is Donald Trump both the women and men of America will be to blame. However if men, particularly the youth, haven't the insight to recognize the danger, women have to really step up to the plate. If they can vote in every referendum in every state, red or blue, in favor of women's reproductive rights how can they then negate that vote by putting the dot next to Trump for President..........?
If in November 2024 Kamala Harris is the President of America and the Democrats retain the Senate and win the House she needs to support Senate Leader Schumer to pass Roe v Wade with a simple majority. The majority isn't "simple" by any means it is the broad will of the people. The issue itself isn't some distorted arcane interpretation of what the white men were thinking in the late eighteenth century it is rather the aspirational belief that "all men, (sic), are created equal". Mitch McConnell never hesitated to "break the rules" when he ensured that the Trump anti abortion judges were elected, neither should Schumer hesitate when the issue is undoing the law that the Supreme Court enacted in depriving women of their constitutional right to control their own bodies.
Lest anyone forget, the Supreme Court is on the ballot in 2024. With a Trump Presidency he will carry on his "proud" record and replace aging Alito and Thomas, who will go out to pasture, with two young Aileen Canons who will be there for the next forty years.
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