Margaret Atwood’s The Handmaid’s Tale was published almost 30 years ago as a dystopian view of the United States in the future. In the novel, the United States has changed into the totalitarian theocracy called the Republic of Gilead with the motto “One Nation, Under One God.” The writings in the Bible’s Old Testament ruled the country. Because much of the population in the novel is sterile because of environmental pollution, fertility is prized. The few fertile women have only one purpose—to make babies. Any fertile women who break rules and conventions are consigned to the status of “Handmaids,” forbidden from reading, working outside the home, or spending money.

Even in the Reagan era when it was first published, the premise seemed far-fetched. Yet, twenty-eight years later, the book seems far more realistic. Recently Atwood talked about the way to take control of the United States:

“Nations never build apparently radical forms of government on foundations that aren’t there already. … The deep foundation of the US – so went my thinking – was not the comparatively recent 18th-century Enlightenment structures of the republic, with their talk of equality and their separation of church and state, but the heavy-handed theocracy of 17th-century Puritan New England, with its marked bias against women, which would need only the opportunity of a period of social chaos to reassert itself.”

Although the U.S. Constitution has not been overturned—yet—areas of the U.S. are showing Gilead-like conditions, especially in the South. Between 2011 and 2013, 30 states enacted 205 abortion restrictions, more than the total of the previous decade. Anti-choice activists have used the Affordable Care Act to assault insurance coverage for contraception. In Hobby Lobby, they achieved a tremendous advantage in being able to disallow any contraception as causing abortions with no facts on their side.

Adding to the image of women as only fetus-holding vessels, states are beginning to hold women accountable for the outcome of their pregnancies. An Indiana woman was charged with attempted murder for a suicide attempt while she was pregnant; a Mississippi woman was indicted for “depraved heart murder” after traces of a cocaine byproduct were found in her stillborn baby’s blood. Across the country, hundreds of pregnant women have been detained, arrested and sometimes convicted on charges as serious as murder for activities that authorities viewed as dangerous or harmful to their unborn child.

While people claim that they are justified in their concern for the fetus, the need to control women comes from a demand for “traditional Christian values.” Recently, Alabama’s Chief Justice Roy Moore ruled that the use of the word “child” in the state’s statute applies to a fetus:

“This natural life being, as was before observed, the immediate donation of the great creator, cannot legally be disposed of or destroyed by any individual, neither by the person himself nor by any other of his fellow creatures, merely upon their own authority.”

Moore used the Equal Protection Clause of the Fourteenth Amendment to give the same obligation to protecting a fetus as to “persons already born.” The mandate that “all men are created equal and are endowed by their Creator with certain unalienable rights” begins with conception, according to Moore, even if the statement is in the Declaration of Independence and not the Constitution.

The poorer states in the country have failed to accept Medicaid for most of their residents. Poor care for pregnant women results in higher infant mortality rates. Mississippi has the highest rate of infant deaths in the United States; Alabama is second. Tennessee has the fourth highest rate. None of these states accepts federal funds for Medicaid expansion, leaving the poorest and most vulnerable residents without access to health care. Yet women are held responsible for birth outcomes.

On July 1, Tennessee’s law to criminally charge pregnant women for using illicit drugs went into effect. Although the governor claimed that the purpose was to get pregnant women into drug treatment programs, the first woman to deliver a newborn testing positive for methamphetamine was arrested and charged with assault. At two days old, the newborn was too young for a medical diagnosis of drug-related harm.

The American College of Obstetrics and Gynecology wrote:

“Although legal action against women who abuse drugs prenatally is taken with the intent to produce healthy birth outcomes, negative results are frequently cited. Incarceration and the threat of incarceration have proved to be ineffective in reducing the incidence of alcohol or drug abuse. Legally mandated testing and reporting puts the therapeutic relationship between the obstetrician–gynecologist and the patient at risk, potentially placing the physician in an adversarial relationship with the patient. “Pregnant women who do not receive treatment for drug dependence cannot be assumed to have rejected treatment. The few drug treatment facilities in the United States accepting pregnant women often do not provide child care, account for the woman’s family responsibilities, or provide treatment that is affordable. As of 2010, only 19 states have drug treatment programs for pregnant women, and only nine give priority access to pregnant women.”

Criminalizing and disempowering women diverts attention away from the real problems of poverty, inadequate housing, food insecurity (aka hunger), lack of health care, violence, unemployment, environmental hazards, etc. The same people who place all the blame on the woman if her fetus is not perfect refuse to place regulations on the environment that will add to the fetus’s health. Many pregnant women tested for chemicals have high levels of lead, mercury, bisphenol A, flame retardants, pesticides that disrupt the development of the brain or reproductive systems. Some of the chemicals increase the risk of birth defects or cause future problems such as cancer, autoimmune issues, asthma, and other disorders.

Not all persecuted pregnant women are poor, however, or live in the South. After a woman told her doctor during a prenatal checkup that she had a history of medication addition but had quit on her own, he ordered her to take an anti-addiction drug. She refused, and the state arrested her and sent her to court in shackles where she was told that her fetus had a lawyer. She was sent to a treatment facility under threat of jail. Forced to spend three months there, she lost her job. Wisconsin is one of four states, along with Minnesota, Oklahoma and South Dakota, to legally confine pregnant women for substance abuse.

The conservative Wall Street Journal is complaining about giving equal employment rights to pregnant women after the EEOC issued new guidelines to oppose pregnancy discrimination. As common with arguments against regulations, the WSJ falsely claimed that pregnant women are already protected by federal law. The U.S. Supreme Court has declared that excluding pregnant women from some workplace benefits is not sex-based discrimination. This was after the court did admit that “pregnancy-related disabilities constitute an additional risk, unique to women.” Congress passed a law in 1978 to nullify the Supreme Court ruling in connection to Title VII employment law, but the court’s ruling still leaves pregnant workers “unprotected under federal law.”

Women working at Pier 1, Walmart, and other companies have been forced to take unpaid leave because their doctors prescribed light duty. Even non-pregnant fertile women suffer discrimination. A battery manufacturing company excluded all fertile women from jobs that might pose a hazard to unborn children but didn’t exclude fertile men. A high-level executive was demoted two weeks after she told her manager she was planning to get pregnant although she had always receive outstanding performance reviews.

Democrats continually introduce the Pregnant Workers Fairness Act, and Republicans continually kill it. Ten states have passed laws of varying strength to protect pregnant workers: Alaska, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, New Jersey, Texas, and West Virginia. New York City and Philadelphia also have city-wide protections. Mississippi is not one of those states, and that’s where the Christian, family-friendly person-corporation Hobby Lobby supposedly fired a pregnant woman without giving her an opportunity for maternity leave.

As the nation gradually moves toward making the pregnant woman solely responsible for the health and well-being of the fetus, the United States becomes more and more like the Republic of Gilead. In Atwood’s country, there is no need for amniocentesis, ultrasound, or other modern prenatal health detection techniques, because abortion is illegal and medical doctors who perform them face capital punishment. At least Gilead takes care of the children after they are born; the United States won’t even do that.

The United States has become a country where pregnant women can be persecuted and prosecuted without having many rights guaranteed to other people under the U.S. Constitution. Unlike over industrialized nations, pregnant women don’t automatically receive health care for herself and the fetus and lack a guarantee of medical leave for delivery.