"We're not going to go back in time to a time before Roe, when thousands of women died every year because they didn't have access to essential health care," Wen said.
I, too, am fairly confident that the Supreme Court won't condemn women to a dystopian epidemic of abortion-related deaths. But that's because I'm fairly confident that very few women will die from illegal abortions even if Roe v. Wade is overturned.
In 1972, the year before Roe was handed down, the Centers for Disease Control reported that 39 women in the United States died of illegal abortions -- only 15 more deaths than were reported from legal abortions. And physicians' ability to treat surgical complications has improved greatly since the early 1970s.
There was a time when thousands of American women died from abortions every year. That time was before the invention of antibiotics. By 1945, still fairly early in the antibiotic revolution, the best estimates indicate that women's death rate from abortions had fallen into the hundreds, including deaths from legal therapeutic abortions. It had declined into the double-digits even before the procedure became broadly legal. So if you're worried about women dying from unintended pregnancies, antibiotic resistance probably poses a graver threat than outlawing abortion.
That observation may seem like a sneaky attempt to undermine the fight for abortion rights. It's actually a sneaky attempt to try to get pro-choicers to apply just a little of their ferocious energy to an even bigger problem, one that threatens not just reproductive health, but also nonreproductive health, as well as the whole sexual revolution.
That's not hyperbole, or not much, anyway. A few years ago, economist Andrew Francis pointed out something odd: American sexual behavior seems to have begun changing in the late 1950s, well before the advent of the contraceptive pill, which has been generally credited with jump-starting the sexual revolution. Francis' explanation: the invention of antibiotics that could cure syphilis.
Consider that in 1939, almost 20,000 Americans died from syphilis, more than the highest estimates for illegal abortions during that period. And it wasn't a pretty way to die -- demented, nose and fingers rotting, heart failing. The more you read about the complications of Treponema pallidum infection, the more appealing early marriage and lifelong monogamy seem.
It's unlikely that curing syphilis alone prompted the sexual revolution. But the usual suspects, contraception and culture, might not have mattered much if the nastiest of sexually transmitted diseases hadn't been tamed -- and if the danger of infection from abortion hadn't been radically reduced.
That medical progress will stall, and eventually reverse, if antibiotic resistance continues to increase. As it does, bacteria after bacteria, year after year. Eventually, there's a real risk that bacteria, not the Supreme Court, may bring about the world promised by both National Abortion Rights Action League pamphlets and Victorian novels: one where death stalks the sexually liberated woman.
Today, the most prevalent sexually transmitted diseases are generally treatable, or at least manageable, and abortion remains a safe procedure. But the threat is rising as profligate misuse of antibiotics encourages bacteria to evolve resistance, and global travel spreads those superbugs far and wide.
Syphilis hasn't yet developed resistance to penicillin, but extremely drug-resistant strains of gonorrhea are already here. It can't be assumed that syphilis and chlamydia will never follow, along with bacteria that used to routinely kill surgical patients -- including women who had abortions -- with secondary infections.
The best time to tackle such a serious threat is when it's still small, but growing. That time is now. Better global coordination of infectious disease protocols is essential, along with stronger support for public-health efforts in developing nations and far better incentives for pharmaceutical companies to develop new antibiotics to replace those that are fading away.
Unfortunately, as antibiotic policy researcher Ramanan Laxminarayan once told me, it may be hard to stir public interest until "a lot of antibiotics have failed."
The historical response to other crises suggests that he's right. But if we women could muster one-tenth as much passion about drug resistance as we pour into abortion rights, I'd bet we could prove him wrong. And prove Leana Wen right that we're not going back to such a world.
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