"There has to be some form of punishment." These seven fatal words, famously uttered by Donald Trump at a Wisconsin town hall last March, are perhaps his ugliest promise to date about the future of reproductive rights under a Trump regime. They spoke, not just to increased abortion restrictions (which Trump has promised) or to the overturning of Roe v. Wade (which he also named as a priority, many times over) but to the kind of aggressive, state-enforced violence against women and trans people that we expect from totalitarian regimes: women forced to carry every fertilized egg to term, at all costs, and imprisoned or worse for not complying.

Punishment. Even among anti-choicers, the idea was so immediately upsetting that Trump had to walk it back more or less immediately. "Of course, women shouldn't be punished for having an abortion," said Ohio Governor John Kasich, himself arguably the most anti-choice candidate in the Republican primary. "We shouldn't be talking about punishing women; we should affirm their dignity and the incredible gift they have to bring life into the world," said Ted Cruz. Thus, the bar was set; criminalizing women for abortion was the one outcome so dark that even the most anti-choice Republicans would not contemplate it.

Yet stories like these are the product of desperation; they are entirely predictable outcomes when people can't access reproductive healthcare.

It's also, you know, already happening. In fact, "punishing" women for abortion has happened several times in 2017 alone. Increasingly, states are dredging up antiquated laws, often laws intended to punish illegal abortion providers or penalize abusers for causing miscarriages, to investigate and sometimes jail women whose pregnancies ended under suspicious circumstances. Not only is it common, it is the logical outcome of the more "civilized" anti-choice policies Trump and the GOP are pursuing, like term limits and defunding clinics—which may not ban abortion outright, but which do make it so hard to access that women and trans people are driven to acts of potentially criminal desperation.

The most recent case is that of Michelle Roberts, a Virginia woman currently facing charges of "producing a miscarriage" after fetal remains were found buried in her yard. The police were tipped off about the burial by a family member, and, after investigating the skeletal remains, apparently determined that it looked as if it had been aborted. Roberts' daughter has claimed that the baby was stillborn, at home, and that Roberts buried it herself out of love, not realizing that doing so could be illegal.

The ACLU of Virginia is defending Roberts, on the grounds that the law used to prosecute her was intended to punish back-alley abortion providers, not pregnant women—and, perhaps more importantly, that subjecting miscarriages to criminal inquiry punishes any woman who does not successfully carry her pregnancy to term. They're not wrong; in 2014, Lynn M. Paltrow and Jeanne Flavin claimed to have identified over 380 cases where women faced criminal charges for miscarrying –with the charges ranging from "attempted fetal homicide" for falling down the stairs to "second-degree murder" for a spontaneous miscarriage in the first trimester. Gail Deady, the ACLU of Virginia's Secular Society of Women's Rights Legal Fellow, says that "[it] is unclear from the questionable, selective release of information by the Chesterfield police exactly what happened [with Roberts], but it appears that this is another example of overreach and targeting of a pregnant woman in an attempt to shame and punish her for her circumstances."

But Roberts is not the only woman in 2017 to be so targeted . There is also the more famous case of Tennessee's Anna Yocca, who spent over a year in jail for trying—and failing—to induce an abortion with a coat hanger. She faced charges ranging from "attempted murder" to "aggravated assault with a weapon," before finally pleading guilty to "attempted procurement of a miscarriage" in exchange for her release.

Finally, and most disturbingly, there is 16-year-old Antonia Lopez of Omaha, Nebraska, who claimed she did not even know she was pregnant when she went into premature labor. After delivering in her bedroom, Lopez believed the baby was stillborn—"babe, I just had a miscarriage," she texted her boyfriend—and, panicked, threw it out of her window, before telling her mother what had happened. Autopsies of the baby revealed that Lopez's pregnancy had been between 25 and 28 weeks along, just over the fetal viability threshold of 24 weeks; with intensive medical care, a baby born at 25 weeks has a 50 to 80 percent chance of survival. Autopsies also showed that the baby's heart had been beating when Lopez threw it, though the defense said there was no evidence it ever started breathing. Regardless, Lopez was initially charged as an adult, and faced up to 20 years for "child abuse resulting in death," before being eventually transferred to juvenile court, where she was sentenced in March to be placed in a group home. She may have to wait; evidently, "officials have had problems finding a group home willing to take Lopez because many see her as a risk." Though Lopez had one prior theft charge, she did not have a record of violent offenses before her trial.

These are grim, upsetting stories, even—or maybe especially—if you're pro-choice. We all want to believe that a woman looking to abort an unwanted pregnancy has better options than a coat hanger, or that a teenage girl would know her own body well enough to find out she was pregnant before she went into labor. Given the grisly details of the cases, some of us may even sympathize with the urge to "punish" the women and girls in question—which, of course, is exactly what GOP lawmakers are counting on. Yet stories like these are the product of desperation; botched amateur abortions, secret fetus-burials and child abandonment or worse are all entirely predictable outcomes when people can't access reproductive healthcare and information by other means. Nebraska has the sixth-worst sex education program in the United States according to WHO. Tennessee has only seven abortion clinics, none of which perform abortions after the 16th week of pregnancy. Under conditions like these, cases like Lopez's and Yocca's are far from surprising.

As reproductive-rights advocates have warned us a thousand times over, banning abortion does not end abortion. It only leads to messier, more dangerous, less ethical abortions. Women with unwanted pregnancies have always resorted to shocking and violent measures—everything from puncturing their own cervixes with knitting needles to having a friend punch them in the stomach—when they could not get help any other way. And, though the GOP may not be able to formally ban abortion right now—though God knows that's probably pinned up on Mike Pence's vision board—that may not matter, if they can make abortion and contraception hard enough to get.

If the GOP rebounds after the failure of the AHCA to continue its attacks on Obamacare, they will almost certainly target prenatal care and birth control coverage, meaning there will be more miscarriages and more unwanted pregnancies. If Planned Parenthood is successfully defunded, women in need of abortion, or emergency contraception, or even a simple pregnancy test and a talk about their options—which might have saved Lopez—will have fewer places to go. A federal ban on abortions after 20 weeks, which Trump has promised to sign, would potentially leave every woman in America in the same spot as Yocca: frantically looking for medical help, unable to find it in time, and, in desperation, taking matters into her own hands. Under conditions like these, it's hardly even necessary to overturn Roe v. Wade; a right that you only have in theory is a right you don't have at all.

It's all very well for the Kasichs and Cruzes of the world to claim they don't "punish" women. Their civilized, "moderate" anti-choice policies do all the punishing for them—first, by making sex and pregnancy a risk instead of a pleasure, and secondly, by putting women on trial and in prison for the gruesome and even criminal outcomes which result. Turning miscarriages and stillbirths into an excuse for criminal inquiry, as seems to have happened with Roberts, is a way to keep all women in their place, and remind them that their chief value is to produce offspring. It's also a way of scapegoating women (and transgender people with uteruses) for the cruelty and insufficiency of a system maintained by men.

The ur-case here, of course, is Purvi Patel, a woman who falsely claimed to have had a stillbirth because she did not want her parents to know she'd given herself an abortion with pills she bought online. The pills, unsurprisingly, were not safe to take without a prescription, and Patel was "caught" when she went to an emergency room for help with the resultant bleeding. Yet, in retrospect, it's staggeringly hard to say what she was "caught" doing; Patel had a right to abortion. As a human being with dignity, she should also have had the right to a safe, medically supervised one. Instead, she'd been forced to resort to self-medication and shady websites—and, for the crime of being thus failed by the system, she was imprisoned, by Indiana Governor and current Vice-President Mike Pence.

It's the failure of that system to support women and trans people, not the ugliness or gruesomeness of the individual failures, that we should be looking at. The GOP and the anti-choice movement are dead set on producing more Yoccas, more Roberts, more Lopezes, and more Patels. That they will be blamed and punished is no surprise. But nothing should stop us from looking at the powerful men up top, putting their catastrophes in motion.

Sady Doyle Sady Doyle is the author of 'Trainwreck: The Women We Love to Hate, Mock, and Fear ...

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