On May 15, 2019, the Alabama State Senate passed a bill that restricts the right to abortion by criminalising doctors who do the procedure. This was followed the next day by the Missouri State Senate passing a law forbidding abortions after 8 weeks of pregnancy. These two bills are the latest in a rapidly escalating attack on a woman's constitutionally protected right to an abortion. Alabama, Georgia, Mississippi, and Ohio have all already successfully passed legislation banning abortion after 6 weeks of pregnancy this year.

We reported , in 2017, on the start of the race to deny women their reproductive rights as Texas, Kentucky, and Utah introduced bills fundamentally undermining abortion access. The 2 years since have seen these laws increasing in number and scale to the point where the right to access abortion is now an empty construct in some states in the USA.

This is what the law makers who passed these unconstitutional bills want. They wish for the bills to be struck down in the lower court, and to be taken on to a Supreme Court now tilted in their favour by President Trump's two appointees. It is very much the case that tackling the destruction of reproductive rights in one state could lead to Roe v Wade, and the freedoms it granted, being dismantled across the entire nation.

23·7% of US women will have an abortion by the age of 45 years and 926 000 abortions were done in the USA in 2014 . Restrictions will hit poor women and women of colour the hardest. UN human rights spokeswoman Ravina Shamdasani went as far as to call them “inherently discriminatory” in an interview with Reuters Television on May 21. The need for women to access these services, to which they are currently constitutionally entitled, is not something that can be addressed with a ban, much less a ban of the sort that fails to allow for abortion in even the most extreme cases, such as rape. That these bans, the majority of which claim to act in the interest of women's health but show little or no relation to public health or scientific endeavour worldwide, have been voted into law largely by a Republican cadre made up of white men is an irony that will not be lost on women worldwide.

The Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights (SRHR) explained why protecting safe abortions should be a high priority. In South Africa, the number of women who died during abortion fell by 91% after the introduction of laws safeguarding abortions. In Nepal and Mexico, two other countries that have recently seen abortion law move in the opposite direction to the USA, abortion complications and the use of unsafe abortion methods dropped dramatically in recent times. Importantly, the Commission concluded: “to move the SRHR policy agenda forward, advocates and policy makers should bring scientific evidence to legislative and other policy debate”. As our 2019 Commission on the legal determinants of health stated, “laws that are poorly designed, implemented, or enforced can harm marginalised populations and entrench stigma and discrimination”. The laws passed this week are demonstrably poorly designed, implemented, and enforced, and will have these described effects.

The near total restriction of abortion law in Alabama has served to highlight the ongoing lack of protections afforded to women in Northern Ireland. Showing how retrograde both pieces of law-making are, abortions in Northern Ireland are still governed by an 1861 act threatening people accessing or providing an abortion with life imprisonment. There should be no feelings of moral superiority in the UK on viewing the problems women in Alabama have accessing abortion while a country in the UK places the same restrictions on women.

So, among all this regressive, religious, and repressive law-making, where are the advocates for women? The American Medical Association (AMA), in association with several other medical organisations, has issued the following statement : “The [AMA] supports access to abortion and strongly condemns government interference that compromises the ability of doctors to help patients choose options for medically appropriate treatment.” It is right for these organisations to stand up for the rights of doctors, who are criminalised for doing their jobs, but we must all stand up for women. Abortion is a settled, inviolable right that is central to achieving not only reproductive health goals but women's freedom over their own bodies. It is of the utmost importance that medical organisations, journals, NGOs, and advocates come together to condemn the rolling back of abortion laws and campaign for rights to be respected.

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