Americans Are Siloing Themselves by Reproductive Freedom

At the 2004 Democratic National Convention, a state senator from Illinois named Barack Obama gave the keynote address. He spoke to a vision of national unity, decrying the notion of a divided America.

There was not a conservative or liberal America, he argued, but a United States of America. There weren’t blue states or red states, but the United States. “We worship an awesome God in the blue states, and we don’t like federal agents poking around in our libraries in the red states,” he said. That’s an ironic sentiment, considering the attack on libraries and freedom of thought imposed by a far right seeking censorious book bans across the country.

Five years later, author and journalist Bill Bishop, along with retired professor Robert Cushing, published the book “The Big Sort: Why the Clustering of Like-Minded Americans is Tearing Us Apart.” They argued that Americans were siloing themselves into cities, even neighborhoods, that were homogenous by any number of dimensions: race, economic class, professional opportunity, religion and most certainly political leaning.

Twenty years after Obama’s speech, his wishful vision seems like a fantasy, and the warnings of Bishop and Cushing have yielded a horrifying reality.

The political divide has gotten more extreme — and more literal.

A study by the New York Times looked at 3.5 million Americans who relocated after the 2020 presidential election. Republicans moved into neighborhoods that Trump won in 2020 by an average of 19 points, with Democrats moving into locales that Biden won by a similar 19 points. Movers started in neighborhoods that were 31 percentage points apart politically, and landed in spots that were 38 points apart. The blue is getting bluer, and the red is getting redder.

But today we are not only separated by politics. We have embarked as well into a far more dangerous demarcation of red and blue: health care for women.

American states are splintering into bastions where women can receive medical care, and states where women’s health care and treatment is compromised or absent.

It started with abortion and the overturning of Roe v. Wade. It’s continuing — and getting worse — because of the kind of intentional sorting Bishop and Culling called out.

It’s a sorting that was expected and predicted, but is no less damaging and dangerous to women.

Reproductive Justice: It’s About Abortion…and So Much More

Amidst the dismantling of our federal government, deconstruction of American leadership in research and science, and the warned about — both in occurrence and their consequences — of a tariff crusade similar to the one that worsened the Great Depression, we can easily forget that during the 2024 election, reproductive justice — and Donald Trump’s hand in destroying it by appointing Supreme Court justices who lied about their takes on Roe v Wade during their confirmation hearings — was an issue at the forefront of the campaign.

And yes, with the government shrinking, and people losing their jobs, and national parks filling up with trash, and threats of war and hostile takeovers booming ever louder and louder, it’s difficult to pinpoint a single issue on which our political and social divide is most pressing.

But too many people have compartmentalized the matter of abortion and reproductive justice. They see it as not impacting them, that there are other, bigger, more important issues.

But that’s a misconception. Reproductive justice may not impact you physically, but it will impact people you know. People you love. People in your community. And not just those seeking to end a pregnancy. Because equitable, legal access to abortion is about so much more.

It’s literally a life and death issue. It’s also a bellwether marker of freedom. And it’s a leading indicator of what kind of society we want to live in. Or will be forced to live in.

Because there are the kinds of countries and governments and societies that ban abortion, and those that bestow reproductive freedom and choice.

Bad news: the places that restrict and punish abortion are inherently less free and prosperous than those that don’t.

An Attack on Half Our Bodies

But before we stare down authoritarianism and the dismantling of democracy that comes with banning abortion, let’s focus first on health.

It hasn’t taken long for disparities and inequality in women’s heath care to arise between states that keep abortion legal and those that don’t. The evidence is overwhelming and clear.

So clear, in fact, that it is already contributing to the kind of societal sorting that Bishop and Culling warned about.

According to Johns Hopkins (in the link above), even before Roe v. Wade was struck down, “the states that imposed abortion bans had much worse maternal and infant health outcomes, with many counties in these states considered maternity care deserts — a situation that is only worsening in recent years.”

It’s not a secret anymore.

People know that in states like Texas and others that have banned abortion, including abortion medication, and with so-called exceptions causing confusion and being rarely applied, abortion restrictions threaten care for all pregnant patients.

Think about that for a moment. The so-called pro-life movement — which wants more pregnancies and all those pregnancies carried to term, regardless of the medical realities of miscarriages and other risks of pregnancy — has increased the physical and health threats to pregnant patients, even to the point of death and not receiving any care at all.

In Texas, since 2021, rates of pregnancy-related sepsis and death have grown.

Without being able to administer the care they are trained to provide, members of the OB-GYN field have come under tremendous strain.

So much, in fact, that doctors are considering leaving or retiring early. Fewer medical students are applying to obstetrics and gynecology residencies in Texas.

But it’s not just Texas. It’s Idaho, which is losing its OB-GYN workforce, leaving rural women without the medical care they need.

And Mississippi. And Alabama, which saw a 20% drop in OB-GYN residencies. In Kentucky, which has the 6th-highest maternal mortality rate in the country, half of the state’s counties were absent of dedicated OB-GYN care in 2021.

Don’t forget Wyoming. In Montana, the medical establishment is openly clashing with state government over reproductive health care.

The bottom line: in terms of access, there is a growing swath of maternity care deserts, and where you live matters. Where a woman lives can determine if that woman lives or dies.

What Kind of Country Are We?

And so it stands to reason that as part of the sorting of American society, there will be those who choose to live in places with adequate health care for women, and those willing to roll the dice with the lives of anyone needing or wanting reproductive health care. (What can also be included here is the access to medical care for transgender children, as parents of these kids won’t tolerate living in an environment — or a state, or country — that is hostile to their children and limits their medical options. It’s the same theme as the abortion debate: government mandating physical control of our bodies.)

The shift is already happening. Since Roe v. Wade was overturned, there has been a marked movement out of states with abortion bans, especially among younger Americans.

As the study linked to above explains, these shifts go beyond people choosing to be nearer to reproductive freedom. This sorting has demographic impacts on tax bases, housing markets, employment opportunities and so many other things.

One study estimated that the 13 states with the tightest abortion bans collectively lost 36,000 residents per quarter.

The moves are being driven by both single Americans, and those considering starting families.

It’s completely logical. Why wouldn’t someone thinking about becoming pregnant not want to live in a state where appropriate medical care is available, just in case something goes wrong? Why would anyone thinking of becoming pregnant want to live in a state that denies them appropriate health care?

So people will continue to migrate to states where being pregnant and starting or growing a family is less of a fatal risk. This is not an exaggeration.

Not everyone, of course, has the means or freedom to move. This further feeds a socio-economic sorting that intensifies the feedback loop of our political divide, making that divide wider and stronger.

Which means in addition to more sorting by our politics, a sort of self-gerrymandering, more Americans will continue to live in states that are increasingly misaligned with their politics and sense of freedom. So misaligned, that many states are even trying to restrict movement to other states that do offer equitable health care for women.

Reproductive justice, then, is not just another front of the stratification and political sorting of Americans. It is the front.

Abortion and reproductive justice are a bellwether of fascism and authoritarianism.

It may seem extreme or far-fetched to connect the dots between a woman’s right to terminate a pregnancy — for any reason — and something as grandiose and threatening as authoritarianism. But tell that to someone wanting an abortion and can’t get one.

It’s about one thing: control. Taking freedom away from one body is to take a way freedom from all bodies.

This is not hyperbole. There is a well-understood and documented connection between authoritarianism and the denial of reproductive justice. One study found “the most consistent predictors of abortion opposition were right-wing authoritarianism and being male.”

The “parallel global trends of rising authoritarianism and attempts to roll back women’s rights are no coincidence.” (With articles like that, it’s easy to see why institutions of higher learning like Harvard might come under attack from authoritarian-leaning governments.)

According to the American Constitution Society, curtailing reproductive rights is central to authoritarian governments because those restrictions reinforce the ideals of undemocratic societies. Why? Because of how expansive abortion restrictions are across a citizenry.

There is a direct connection between what we’re seeing in America today and other pro-natalist movements in the past. “Within authoritarian or fascist regimes, reproductive labor becomes a state obligation specifically for women,” says Denise Lynn, a professor of history and director of gender studies at the University of Southern Indiana.

“One of the problems in the United States is that not only are we limiting access to abortion and birth control, but we have forced birth policies in a country that has aggressively rejected things like maternity leave, Medicare for all, adequate prenatal and postnatal care and affordable childcare…This just further demonstrates that pro-natalism’s primary goal is to enforce second-class citizenship on women.”

By taking away reproductive freedom, nearly half of society loses autonomy and full and equal access to political participation. Reproductive and bodily autonomy are essential to being a citizen with equal rights. In a democracy, “all people, including those with the capacity for pregnancy, must be able to exercise control over their bodies in order to participate fully.”

Put another way, “if control over one’s body is not a legally protected individual right, it erodes the security of all other rights.” What other rights?

Perhaps the right not to be arrested without being charged, and then being denied due process before being shipped to a prison in a foreign country.

The playbook is not a secret. Under the guise of religion or sanctity of life, authoritarians who more power understand the connection between dismantling reproductive justice and the demolition of democracy.

This is where the rise of authoritarianism, the health care of women and reproductive justice, and the sorting of America intersect.

Even though the large majority — topping 80% — of Americans believe that government should stay out of regulating women’s health care and choices, the overturning of Roe v Wade has left access to women’s health an unequal, inequitable, tragic mess.

What Bishop and Cushing wrote about more than a decade ago was as much a warning as it was a thesis. What happens when half, or more than half, of the country sorts itself not just by economic status, but the type of government they prefer, and that type of government steadily approaches authoritarianism and puts women’s health at risk?

Sadly, we’re finding out.

In the time since I began writing this piece, a new study was released confirming that pregnant women in states with strict abortion bans are twice as likely to die during pregnancy, child birth or shortly after child birth as women living in states without such bans.

That this is happening at all is, to me, frightening. I find it an immoral injustice and a massive encroachment on bodily freedom.

While I live in a red state (in terms of presidential politics), and moved here from a different red state, I am not a Republican voter, and I am certainly not one of the many Republican voters who are perfectly copacetic with and desiring of authoritarianism.

And so perhaps that is where the lines are being drawn: between those who want liberal democracy to continue in the United States, and those who don’t. We’re seeing in real time what that looks like in red states. And now, with the military being sent in to police cities such as Los Angeles and Washington, D.C., we’re seeing in in real time in blue areas, too.

Pregnant women are dying at avoidable rates, women are losing access to the care they need, and deserts of reproductive health justice in the places that claim to cherish freedom are growing.

The U.S. has gone backwards in terms of women’s health care and reproductive freedom. It’s tracking at the same rate of us going backwards in terms of the strength of our democracy, too.

The questions now are, what other freedoms might be lost, and how many women will die along the way?