Air Date: 8-29-2026

Today we examine what happens when the state wants to decide whether a person reproduces. A century ago, American courts sanctioned the forced sterilization of women deemed unfit to reproduce. 60 years ago, a communist dictator ran a pronatalist experiment with disastrous results. Now, abortion access is collapsing and a new pronatalist movement is rising to wreak havoc.

Full Show Notes

Welcome to this episode of the award-winning Best of the Left podcast.

Today we examine what happens when the state wants to decide whether a person reproduces. A century ago, American courts sanctioned the forced sterilization of women deemed unfit to reproduce. 60 years ago, a communist dictator ran a pronatalist experiment with disastrous results. Now, abortion access is collapsing and a new pronatalist movement is rising to wreak havoc.

For those looking for a quick overview, the sources providing our Top Takes in about 50 minutes today include

5-4

Who Did What Now

Bitch Talk Podcast

rePROs Fight Back

and Boom! Lawyered

Then, in the additional, Deeper Dives half of the show, there'll be more in 4 sections;

Section A, Eugenic Legal Foundation

Section B, Coerced Sterilization Today

Section C, Post-Dobbs Legal Battlefield

And Section D, Pronatalism, State-Directed Reproduction in Reverse

And now, on to the show.

let's talk about the law a little bit. and this law is challenged under the 14th Amendment's due process and equal protection provisions, which say that the states shall not, quote, "deprive any person of life, liberty, or property without due process of law, nor deny to any person within its jurisdiction the equal protection of the laws," end quote.

And so the question is whether forced sterilization imposes on the bodily integrity of these women, in violation of their entitlement to due process of law and/or equal protection under the 14th Amendment. And the court holds that it is not a violation of the 14th Amendment, finding that all three generations of Buck women were, quote, "feeble-minded" and, quote, "promiscuous," and that the state had a legitimate interest in their sterilization.

And the court starts out by stating the reasons for the law Saying that the sterilization of mental defectives is for the benefit of the patient and society generally, and that the sterilization allows mental asylums and similar institutions to discharge those patients without concern that they might reproduce.

yeah. Awful. 

It's so awful. 

Yeah. Cr- and the court notes, quote, "Experience has shown that heredity plays an important part in the transmission of insanity, imbecility, et cetera," unquote. Which is- I love the et cetera there. Yeah. these guys. 

But note that's a direct lifting from the Virginia statute- That's right ... that's at issue, right? they just- They, they- They adopt it. 

It's a very weird thing to say experience has shown when we're talking about, a scientific question, right? 

Yeah. 

There, there's another et cetera that I really liked when he's describing the law, and he says, "Look, the health of the patient and the welfare of society may be promoted in certain cases by the sterilization of mental defectives under careful safeguard, et cetera."

whatever. Whatever that entails. 

So a, a couple things. One is this opinion is, three pages long. Yeah. Yeah. And the dissent is silent. It's just someone saying they dissent. And then also you have- ... this, et cetera thing. Being a Supreme Court justice back then was the shit. You didn't have to do anything.

He's like- Well- ... "Yeah, insanity, imbecility, et- et cetera. Let me throw an et cetera in here." 

I don't know what copies you read, but the PDF I found included both briefs, which brought it to- yeah ... a grand total of eight pages. That's right. 

Oh 

my God. 

That's right. I found that one 

too.

They're, like, the briefs were about two pages each. Worth the read. Very interesting. 

Yeah. Very interesting. So one key theme here is, the sheer confidence the court has in what is now clearly a completely outmoded science, right? 

Yeah. And that combines with this sort of underlying moral assumption that the life of a disabled person is both a burden on society and less important than that of a non-disabled person.

Yes. 

And- Yeah ... the court explains that the superintendents of the institutions, like the State Colony for Epileptics and Feebleminded Must, before sterilizing anyone, petition their board, there would be evidence presented, and the person could appeal the decision to sterilize them to the, county circuit court.

And so Holmes is trying to say "Look, obviously procedurally this is airtight," right? "We're all good. Don't even worry about 

it." Yeah, 

yeah. And he says that the benefit to society justifies the sterilization here. And it's worth noting that Holmes doesn't really provide any actual reasoning. Part of this is like a relic of court decisions from the time, which were, they're shorter, they're more conclusory. But in any event, he genuinely gives zero thought in the opinion to what the burden imposed on these women actually is. And- ... there's no discussion about the importance of the ability to procreate if you want to or to try.

Nothing is articulated about what they're actually being subjected to. Instead- ... he frames it in terms of sacrifice, saying that the general welfare often calls upon citizens to sacrifice their lives and wellbeing. Which I guess is true in like the general sense. But first of all, it could be used to justify literally anything.

And this is 1927, we're about a decade out from World War I, and it seems clear that he's gesturing towards that sort of sentiment accompanied by war and, the massive human toll that faces. But he's not talking about the domination of Europe by Austrians- ... or whatever.

He's telling some lady, "You can't have your dumb kids. Your kids are gonna be too stupid." "Lady, let me tell you about sacrifice."

And Holmes ends this opinion With what might be the most offensive few sentences in Supreme Court history. 

It's awful. 

This is rough. 

This is a quote, "We have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the state for these lesser sacrifices, often not felt to be such by those concerned, to prevent our being swamped with incompetence.

It is better for all the world if, instead of waiting to execute degenerate offspring for crime or let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the fallopian tubes.

Three generations of imbeciles is enough." End 

quote. End of the opinion. 

Ouch. 

Three generations of imbeciles is enough. 

I don't- 

It 

is- I don't feel good. Do you guys feel good? 

No. 

No. obviously, that is transparently horrific. It is ridiculous. 

And I don't think there's much more to say about it.

There is a fact, though, that we should discuss, and that is that underlying all of this reasoning The court is accepting without question that these people are in fact mentally deficient somehow. And on that front, I have bad news. 

Most likely they were not, and in fact, the story as we understand it appears to be fairly horrific.

Yeah, that's right. It's like multiple layers of being horrific. so first let's just start with the law and the court case itself. By all accounts, the case, bringing the legal challenge was actually like a purposeful act of collusion. The State of Virginia wanted a sterilization law, and they wanted it to pass legal challenge.

So as superintendent of one of the state institutions, that guy Priddy was looking for a patient to do forced sterilization on and have it be challenged in court. John Bell was the surgeon who performed the surgery on Carrie Buck, and he wrote in his surgical report in October 1927, quote, "This is the first case operated on under the sterilization law, and the case was carried through the courts of the state and the United States Supreme Court to test the constitutionality of the Virginia Act."

So this was brought on purpose. Wow. And Carrie Buck was the like, random unconsenting party that this, legal challenge- ... was brought on. secondly, there is a lot of doubt that Carrie Buck was at all intellectually disabled to begin with. Not only do reports from researchers and people who knew her indicate that she was by all accounts of average intelligence, one of the main arguments used to establish her disability was her supposed promiscuity and that she got pregnant at the age of 17, right?

it turns out actually that Carrie Buck was raped by a member of the family that adopted her, and that rape resulted in her pregnancy, and it's been reported that the family who adopted her, they actually had her committed to the state institution on purpose to save their reputation.

In 1961, Fannie Lou was dealing with some abdominal pain. Naturally, she went to the doctor. I say naturally. She went to the doctor after Pap told her that she sh- had to stop suffering, and she should go to the doctor And so he told her that she had to be seen. So she was complaining of a knot in her stomach.

And there's a few different theories kicking about this. she had suffered from polio, as a child, and so this would have effects later on in her life. She may have had polycystic ovary syndrome, so PCOS, which would have affected her too. she'd also suffered several miscarriages, so it, it could be connected.

Now, was it fibroids? Was it tumors? so she had suffered, for years, and this knot at the time when she went to see this doctor, it was believed to be a uterine tumor. And the white doctor said that she would have to have surgery to remove the mass. So while she's undergoing surgery to remove cancer, or at least what they believed to be cancer, the doctor, for absolutely no medical reason, also decided to perform a hysterectomy without his patient's knowledge or consent Like, oh, this is gonna get worse, by the way.

This is gonna get just terrible. She wasn't even informed by the doctor that her womb had been removed. She found out Through a game of telephone, right? The reason she found out that she had a hysterectomy was because the doctor's wife told one of her white friends and her cook overheard it. And this cook passed the information on and the information about her own surgery made its way back to her because of a doctor's wife gossiping.

And if you thought that this gets worse, then congratulations, you're correct. Mississippi legislation gave doctors the right to perform hysterectomies or tie the tubes of women without their knowledge or permission.

Nothing quite like a white man in a position of power asserting control over a woman's body when she's unconscious. And this act, this was known as a Mississippi appendectomy in Black communities.

And this was a tactic used to limit Black population in the South, involuntary sterilization. Now, we know that approximately over 60,000 people were sterilized in the US under programs of eugenics up until the 1970s.

Now, this is men, women, and people of various races and disabilities. The Mississippi appendectomy, where thousands of black women went to, into doctor's office for gynecological healthcare and left without their reproductive organs unwillingly and unknowingly.

The choice was taken from them, right? Oh, you're thinking, "Katie, you're really fucking mad about this." Absolutely I am. That is medical abuse. That is violence, okay? I don't care how you wanna dress it up.

We have Erika Cohn on the show. She's the director of the documentary Belly of the Beast. We're so pleased to have her here. And, I'm gonna start off asking if you can, tell our audience a little bit about your film, and then how did you find this story? 

Yeah. In 2010, a decade ago, I was introduced to one of the protagonists in the film, attorney Cynthia Chandler, and she had this organization called Justice Now, which was one of the only organizations in the country at the time, perhaps the only organization, that had board members who were currently incarcerated.

really informing strategy and informing policy from the inside out, as opposed to so many other organizations that work from the outside in. And they had this campaign called the Let Our Families Have a Future campaign, which essentially exposed the multiple ways that prisons destroy the basic fundamental human right to family.

One of the most heinous, of course, being the illegal sterilizations primarily targeting women of color. And to me, immediately that screamed eugenics. as a Jewish woman, the phrase never again was always profoundly in the back of my mind. And when I learned about this different kind of genocide that was happening through imprisonment, that was happening through forced sterilizations behind bars, I knew that I wanted to get involved some way, somehow.

And initially, that was as a volunteer. Cynthia actually invited me into the organization where I became a volunteer legal advocate, providing direct services- Oh ... for over 150 people inside California's women's prisons. And from there, really began collaborating with people inside on a project that would ultimately become Belly of the Beast.

And the initial idea with this film was to chronicle the incredible human rights documentation process that was happening inside prison. how that information that the prison didn't want to get out, didn't want to be exposed, was funneled out through this amazing underground network of activists.

And that all changed when I met our other protagonist, who the film completely centers around, Kelli Dillon. And I met her a couple of years into the process, and at the time she was working as a gang interventionist and, domestic violence counselor doing a lot of community intervention work. And when I first met her, I asked her if she wanted to be involved.

She was a sterilization survivor. She was the initial catalyst to expose this entire issue to begin with. I have to say, if it wasn't for Kelli, there wouldn't be a film. there wouldn't have been this incredible, reporting that came from her work. We wouldn't even know that this existed, or the scale to which it existed And, at that moment she wasn't interested in telling her story, but was very interested in becoming involved behind the scenes as an advisor.

And so as we went on through this journey together, everything changed when the Center for Investigative Reporting in 2013 released their series of articles by Corey G. Johnson, who's also in the film. 

and all of a sudden there was this tremendous momentum, this huge national attention, potential for legislation, potential for real legal action, and that was the moment that Kelli got called back into the movement, sucked back in to tell her story.

And that was the moment that Kelli and I both decided that we would start filming her on her way to testify. And the more we filmed with her in front of the camera, it became more and more clear that the story really needed to center around her experiences, her courage in advocating for others inside prison, and how she continues to do the work, outside of prison as well.

So that's how it all got started and, how this collaboration be- came to be. And so the film really follows Kelli Dillon and Cynthia Chandler as they take on the Department of Corrections, exposing modern-day eugenics and reproductive injustice in our prison system. 

Ooh, wow. Yeah. Yeah, it's- 

Let, let, I, I want everyone to let that digest 

it for a minute.

let it sink in. Yeah. Yeah. 

Yeah. 

And I think, Belly of the Beast is really just another example of this is why documentaries are so important. You put a spotlight on so many things that, we're both ca- born and raised in California, so many things that I did not know. I didn't know that California was the home to the largest women's prison in the world.

Yeah. I obviously didn't know the history of eugenics in California and that sterilization, that it had to even be illegal at one point in prisons. I would never even think that would e- be a necessity, let alone that it was happening and to the rate that it was happening in. And, obviously Kelli's bravery sparked it all, but how did you feel when speaking with other women that this happened to?

were they open to speak about this? there's just such a stigma and fear of retaliation, fear of so many things. What was your experience in, talking to other women that this happened to? 

I just wanna b-, comment on something that you just said. When I first started this, this project, I didn't know that Nazi Germany actually came to California to learn from- California's heinous eugenics policies, and that was something that was really important to me. we think of eugenics as something that's associated with Nazi Germany, and have no idea that this is, homegrown in our country, in our California. And so it was really important to connect that historical precedence as well as the legacy of forced sterilization in the country, and how it's so deeply rooted in white supremacy.

And so when we look at these as isolated incidents, they're incredibly shocking, but when we look at them with historical context, it's more, it's understandable to see where this really comes from, and until there's accountability, these heinous abuses will continue to occur. In terms of, how many people this happened to and what it was like speaking to the survivors, through our own reporting process, we found that 1,400 people were sterilized in California's women's prisons between 1997 and 2013.

And in the beginning of this film, prior to the Center for Investigative Reporting releasing their findings, no one believed me that this was happening. No funder believed- ... that this could actually be happening. And so the, trying to get this project off the ground was incredibly difficult, despite the fact that from my legal advocacy work and through Justice Now, we had hundreds of testimonials talking about what had happened to them And there's a lot of, a lot of barriers that prevent people from coming forward.

And just the, the, the 100, you know, people that we had spoken with or the 100 cases that we knew about, we knew there were so many more because people oftentimes don't come forward out of shame, not wanting to experience, or relive the trauma or feeling like it's their fault what happened to them.

and in addition to that, prisons are retaliatory environments, as you mentioned, and your daily existence is threatened by force. And so in order to be eligible for litigation, one has to file a complaint against the person who committed that harm against them. So people don't do that out of fear of retaliation.

And in addition to it being a retali- retaliatory environment for people who are incarcerated, it's also retaliatory for those who work in the prison. And so we saw this past fall a really unique situation with the whistleblower, Dawn Wooten, from the Georgia Immigration Detention Center when she exposed the mass hysterectomies that were going on- 

in that facility. And it's because of her courageous, in just ... her courageousness and deep commitment to e- exposing these human rights abuses, that she faced retaliation, just by questioning the procedures and then, even more retaliation when she finally came forward.

So it's very unique that, people like Kelli actually pursue litigation inside or whistleblowers like Dawn Wooten

 

c- can come forward. 

so let's turn to pronatalism W- what is it? I think some people probably have a general idea. It's been more and more in the discourse lately, but what are we talking about when we talk about that? 

Yeah. So I w- I wanna start with pronatalism, the sort of movement around pronatalism is grounded in this, as I said, kernel of truth, right?

Which is that at least in sort of high-income, highly developed countries, birth rates and fertility rates are declining, right? So pronatalism is this ideology, this, emerging policy framework, this cultural orientation that promotes higher birth rates, specifically by framing reproduction as a social duty or as a sort of, moral good.

And particularly, I think nefarious in this particular strand of pronatalism is how tied it is to a certain... who should have children, and who should not have children- Yeah ... which is a little bit less explicit. It's very nationalistic, very patriarchal. it emphasizes a really certain traditional gender roles, and it's being driven increasingly by governments with all of the power and all of the resources and all of the funding that they wield.

and that is really concerning because, of course, when you're deciding, for another person whether and how many children they should have, you're, fundamentally attacking this sort of system of individual and human rights. 

And that's, such a personal decision that there are so many factors that underlie it.

It is probably the most personal decision you can make. I'm just thinking about my own sort of personal journey, right? Which is, it's hard to always conflate policy and personal, but, yeah. becoming a mother it affects every aspect. It affected every aspect of my life, every single one, right?

the only other decision that's analogous is who you marry, right? But marriage, and I'm sure we'll talk about this, marriage is a decision that, if things go really wrong or, the love isn't there, so to speak, you can seek a divorce or a separation. Your children are your children for life, and once you become a parent, that's never something you're gonna step away from, and it affects everything in your life.

It is the most personal decision you can possibly make. 

I feel like the next thing we need to talk about is the language being used when talking about this. I just... what is, forefront in my mind, and probab- it was not, originally on our agenda when we first were talking about doing this, but we can't not talk about underbabied.

it was, like, s- Oh my 

gosh ... 

so-- how do they find the most cringe-inducing language to explain things? there are a couple things that this administration has done that I've had, a visceral reaction to. Underbabied was one, and describing, the new terrible version of the, the global gag rule as, human flourishing.

the first time somebody said that in a meeting, I was like, "Ugh, oh my God, what?" Oh, it just, it... I felt it in my body. 

Yeah, you can, and you have done entire podcasts on human flourishing and what that means and what that doesn't mean. Yeah. And suffice to say, I, I also have lots and lots of thoughts on that.

but they are very much intertwined, and I'm glad that you brought them up in the same sentence. Yeah, so for anybody who's not familiar with this, is Dr. Oz, the TV personality, TV doctor who is now a member of the Trump administration, I think in May, I think it was last month, right next to Trump and RFK Jr.,

talked about how, there's a real crisis in America, and I think that's really important to point out, is that the language around pronatalism is very much rooted in this idea that it is a crisis, that we have to act immediately, that, the sky is falling. and in this case, the sort of twin crises that were talked about on that day are women are underbabied, and men have, low testosterone, right?

And so combined, you... that's a, a really potent message to be sending Americans. What I think is so visceral reaction, absolutely. I just cannot with the under-babied. and frankly, I'd be super curious for those, comms folks who are listening to this, one of the things that's really hard to do when you're talking about pro-natalism is talk about it in language that doesn't sound clinical, and that doesn't sou- that actually means what it is.

right? pro-natalism sounds like you're, like, pro-healthy birth or pro-babies or pro any of this. Dr.- Yeah ... Oz may have inadvertently just given this movement the best name possible, right? Because women being under-babied almost immediately l- leads you to question, okay, so it's the women's fault, number one.

Yeah. But also it's, not about what you do for the babies when they arrive, right? It's, the number of babies that matters. It's not, the quality. 

And there's a magic number that the government wants. 

There's a magic number that the government wants, and none of those babies' actual lives are part of that calculation, right?

And part of what we're seeing, at least in the, this sort of Heritage Foundation's version that the Trump administration has adopted to a large and frightening degree, it's not about improving the lives of women or of children, right? In fact, almost everything that they're doing is on the contrary.

Yeah. I just it's just so blatant. I think there's That's the thing about this administration, right? the-there is no quiet part anymore, right? They just say the things, and so keeping a, keeping an eye on, the language that has been used and they continue to use is really important.

Yeah, I think that... So Heritage Foundation in January came out with what I think of as Project 2025, but for the future, right? This is Project 2026, Project 2027, Project 2028, and the title of that piece is called Saving America by Saving the Family, right? And that in and of itself, I think has to raise some eyebrows.

It's 168 pages of policy proposals and policy recommendations, and I think that it would be really lovely to dismiss this as just another report that's gonna sit on a shelf somewhere. But we know, from Heritage itself how successful and how deeply aligned and how open the lines of communication are between the sort of levers of government, particularly with the Trump administration as well, between them and the Heritage Foundation.

Kevin Roberts re-recently went out and talked about how of the 1,900 or so recommendations that they issued in Project 2025, 1,100, more than 1,100 have already been implemented, and that's not a humble brag. That sort of 55% figure is being tracked by multiple sort of watchdog groups. So that's-- That, that is not a bloviation.

It's so much. And- So much ... if you dig into their finances and you don't, there's not a ton of transparency around here. When I mean dig into their finances, I literally just mean googling their 990s. The latest that we have is from 2024, and they control over 400, almost $500 million in financial assets.

That's just what they claim, right? And, if you compare that on the sort of more pro right side, on the more left side, the Center for American Progress is probably the most analogous foundation that you might see, and they control, I think, $84 million. So we're just, seeing these two thought leaders, if you can call both of those thought leaders, batting and playing on very different playing fields.

Let's talk about Clarence Thomas. Box, Planned Parenthood of Indiana and Kentucky versus Box. It was 2019. The court declined to review an Indiana law that prohibited sex, race, and disability-selective abortions, reason bans or discriminatory abortions. Thomas agreed the court shouldn't take that issue, and then he decided to have himself a little word anyway. He wrote a concurrence to the denial of cert on that reason ban issue, laying out all the legal reasoning that lower courts could use to uphold reason bans. Now let's talk about reason bans.

These are abortion restrictions that said you couldn't get an abortion based on your reason for wanting one. You can't get an abortion because you don't wanna have a girl. You can't get an abortion because you don't wanna have a Black child, which, and I need to pause here, was always a little bit unhinged as a premise.

Like, how many pregnant Black people are sitting in a doctor's office like, "Give it to me straight, Doc. Is my baby gonna be Black?" It was nonsense. But Thomas was using it to signal ways to get around Roe, to get around Planned Parenthood versus Casey, and to chip away at the pre-viability abortion framework he'd spent his whole career hating.

And the whole opinion in Box ends up being a diatribe against none other than Margaret Sanger. Now, if you know me, Margaret Sanger is my jam, right? I wrote what I will humbly describe as the seminal piece debunking the bullshit the right likes to spew about her. They love to distort her eugenicist beliefs and convince people, Black people primarily, that Margaret Sanger was trying to eliminate the Black population through contraception and abortion.

It was like, the founder of Planned Parenthood hated you people, so why are you getting abortions at Planned Parenthood? The right discovered the word eugenics and kept using it to distort Sanger's beliefs. Now, Sanger was a eugenicist, but not in the way the right was claiming. I actually attended an event at the Brooklyn Historical Society about eight or nine years ago, and I told Margaret Sanger's grandson, Alex Sanger, to his face that I thought his grandma was ableist.

And you know what? He agreed. Because in truth, she did want to eliminate what she called morons, idiots, and imbeciles. But that's not what Thomas was talking about. Margaret Sanger talked a lot about, quote, racial betterment. And reading that cold, you might think she was pushing for something like what the Nazis did, which they learned from us by the way, to better the race by eliminating everyone else.

But that's not what she meant. Sanger wanted poor people and people she deemed, quote, insane or feeble-minded to stop breeding irrespective of race. When she talked about racial betterment, she meant bettering the human race. Her eugenics beliefs were based on disability status, not race or ethnicity.

Clarence Thomas collapsed that distinction on purpose. He treated eugenicists who wanted to curb Black reproduction and eugenicists who wanted to sterilize disabled people like they were the same project. They weren't. Both projects were disgusting, don't get me wrong, but they were not the same. And Thomas wasn't making a legal argument in that concurrence.

He was making an emotionally manipulative, historically dishonest argument that hijacks the history of racism against Black people to argue against abortion access. And it was sitting in a Supreme Court opinion written by a justice on an issue in the case the court declined to hear. It was Thomas telling every lower court judge and anti-abortion advocate, "Here's your roadmap.

Here's the argument. Come back with the right case. I'll be waiting." And that's what I'm talking about, right? The other side wasn't keeping its moral and cultural arguments separate from its legal arguments. It was weaving them together. And what were we doing? We were out here busy citing longitudinal studies.

The public health evidence was there. The question is whether it ever became the center of the story. And look, I want to be clear about something. Organizations like ANSIRH, that's the Advancing New Standards in Reproductive Health Research Program at the University of California, San Francisco, those organizations were doing their jobs.

The data existed. The public health case was being made. The problem is what the rest of us did with it. And that brings me to Roe. Roe versus Wade was a privacy case. I wanna sit with that for a second because sometimes I think people forget that, or maybe they never knew it, or they knew it and it just didn't quite land what that means.

Roe was not a health case. It was not even a women's rights case, not really, not in the way that we'd use that language now. It was a privacy case. The right to abortion was located in a constitutional right to privacy that the court had been constructing since Griswold versus Connecticut in 1965. That case was about contraception.

It gave married couples the right to use contraception, and it was also a privacy case. The privacy framework said there are certain intimate decisions that are so personal, so fundamental to individual autonomy, that the government cannot intrude on them without a very good reason. Abortion is one of those decisions.

Now, Roe talked about medicine. It talked about physicians. It even talked about maternal health, but it didn't locate the right to abortion in public health outcomes. It located that right in liberty, in privacy, the zone of personal autonomy that the state cannot enter until they can. So from the jump, Roe made the constitutional case for abortion through privacy and liberty.

Medicine mattered, maternal health mattered, but the right itself wasn't grounded in public health outcomes. And then we just defended Roe's constitutional framework for 50 years. We were obsessed with Roe. So much energy and attention went into protecting that one decision. And when you're in fortress mode, the wall becomes the center of gravity.

Other work still existed, obviously, but Roe became the thing most institutions were organized around. It felt like mainstream repro institutions couldn't criticize Roe out loud, even when many people in the movement knew it had limitations. Because the other side was already trying to burn the house down and saying, "Actually, this foundation is shaky," felt like handing them a match.

So these mainstream repro institutions treated it like gospel, and they rarely, if ever, made the affirmative case for abortion rights that didn't depend on Roe surviving Well, Black women did. In 1994, Black women built the reproductive justice framework precisely because they knew Roe wasn't enough.

SisterSong, Loretta Ross, Rickie Solinger, an affirmative vision of reproductive rights that went beyond Roe and didn't depend on it, that centered the actual lives of people most harmed by abortion restrictions, not just the constitutional right. And what did the mainstream movement do with that? a lot of them adopted the language.

They put reproductive justice on their websites. They started saying reproductive health rights and justice in their mission statements. And then they kept doing the same Roe-focused legal work they'd always been doing. They took the framing of reproductive justice without taking the organizing principles, which meant that they got to feel like they were doing the broader work of the reproductive justice wing without actually doing it.

So what the Heritage report lays out in their sort of saving America plan, and I really wanna emphasize, I read all hundred and sixty-eight pages. I used zero AI note-takers. I took notes myself. And then I sent these notes, which were all in a Google Doc, like around to folks in my orbit, and they were like: "You need to create a presentation about this."

And I stayed up really late and just PowerPointed like nobody's business has ever PowerPointed before. And I analyzed it prong by prong. Now I'm taking it on a virtual road show. But what their sort of policy proposals boil down to are essentially in two different buckets. One is around government restrictions.

to heck with limited government, these are the new restrictions that we're going to impose, and some of them are incentives too, and maybe we'll talk about that. And then second prong is around cultural interventions, and that is work for the Heritage Foundation and its aligned actors to do, but they also see a role for government in that.

And this is leading to, and you talked about the importance of language, and if I can leave anybody with a sort of message is like this pronatalist vision, what they call saving America, is built explicitly on the back of we are building a world where women cannot. Women cannot. They cannot leave their husbands if they need to.

They cannot go to school. They cannot get a job. They cannot have financial independence. They cannot access healthcare. They cannot access quality childcare. They cannot, bottom line, choose when, whether, or how many children to have. And so if there's any message that sort of burbles up from the depths of these hundred and sixty-eight pages is that this is not a forward-looking vision.

This is really looking not just to the nineteen fifties, but to a world in which women really had zero autonomy. 

And I feel like this is the important moment to be like This is when you're gonna hear people be like, "You were saying the sky is falling, and this is never gonna happen. Women aren't gonna lose voting rights."

this is n- this is not gonna happen. But, the moves are being made. The arguments are getting louder from more people in power. This is like all of the people who said Roe was never gonna fall, and like they're not coming for birth control, and they are very clearly coming after access to birth control.

It may not look like taking a bite of the entire thing all at once. you're talking about women not being able to vote. That looks like starting at the Save Act, where it changes, like- I'd 

argue even before that. Yeah. 

But yeah. it's like chipping the knit, right? We 

didn't get to Save without covering, a few of, of the other sort of dismantlings of the Civil Rights Acts, right?

this is what they learned from Roe, and the sort of overturn of Roe was also a Heritage project, right? And it started very much, post 1970s, right? And you've had podcasts about the- podcast episodes about this, right? they didn't come after women's access to healthcare until they realized it could be a politically potent tool.

But that project was, a, a 40-year project, right? Yeah. and that's exactly what's happening here. And just to your point about where and how it's already happening, and you're exactly right, I sound like a conspiracy theorist. I, and I often will if I'm at... I was just at my college reunion, my 20-year college reunion, and, when people inevitably ask you what you do, I try to disarm, I don't know if it's successful, by being like, "I know I sound very tinfoil hatty when I say this," and I start to talk about this movement and how concerned I am about it.

But if you look at what's already happening, a lot of what they lay out, what they, being Heritage, lays out in, in this Women Cannot plan is already happening, right? they promote this idea in sort of their cultural sections about how, if women go to school or college, colleges should be basically marriage boot camps and we should be turning pastor- or we should be turning, faculty members into pastors, and we should be giving discounts for, married couples in dorms, and we should be, giving motherhood medals a la Hungary, and we should be promoting, we should be using the media to tell more effective stories about the importance of marriage, right?

in our culture right now, in The New York Times a couple of months ago, we had a whole, and I'm, we're not on being- Excuse me, I'm putting this in air quotes. Like we had a debate, air quoted, in The New York Times around whether women have ruined the workplace, right? Like we had this comment from a man who h- who commands a lot of TV access, Dr.

Oz, about women being under babied. We have the entire existence of the manosphere. We have the entire existence of trad wives, right? Like in this sort of very aesthetically pleasing, imagine how much propaganda it took you to reject fill in the blank, right? We also have the government Incentives and restrictions in motion, right?

So on the incentive side, we already have, the Department of Transportation saying that they're gonna prioritize public transportation projects in areas of the country where marriage rates and fertility rates are higher, right? You have, for the first time, HHS or the Department of Health and Human Services, which administers the Title X program, so this is the nation's family planning program.

It's been in effect for about fifty years. You have, for the very first time in fifty years, contraception is mentioned only once, and it's in the context of over-medicalization, and instead, they are promoting, they are incentivizing states to apply for grants that can study, quote-unquote, "body literacy" and low testosterone, right?

this is the nation's family planning program, right? 

That was bipartisan when it was founded. 

Absolute- that's the thing is so many of these things were bipartisan because they were evidence-based and they were things that Americans wanted and needed and asked for, and Congress could decide, yes, it would be great if we could, have healthier populations.

That was an agreed-upon principle. I would say that the last thing that is really, I think, concerning is how much legislation is moving, and this is much more around the restrictions side but, at the federal lev-level, you have the SAVE Act, which may not, may, I'm gonna hope and keep my fingers crossed that it just died on the Senate floor.

I'm sure it will be revived in some other form. That would, of course, curtail married women's ability to vote. You have seven different states right now pursuing proposals to c-curtail no-fault divorce, basically through the promotion of what is called covenant marriage. You have thirty-two states that have laws on the books that, would ban same-sex marriage if Obergefell were to be overturned.

You have, oh my gosh, in n- in North Carolina, I don't know if you saw this, but this bill that was just introduced that would authorize the use of quote-unquote, "deadly force" against women seeking IUDs. You have parents Being charged in states like Idaho and Tennessee and Texas with trafficking their daughters for seeking or helping them to seek abortions outside of state lines.

You have states that are moving to automatic fifty/fifty custody awarding, which again, sounds great on paper, but what is in practice, it does end up trapping women in abusive marriages, right? In a country where one in four women is still experiencing intimate partner and/or sexual violence, most likely in her marriage.

These are real things, and it's already tightening that noose 

around women's ability to do literally any of the things that are these personal decisions, right? Get married to the people that they want to, have the number of children that they have, go to school. one of the big things that passed last summer through the Medicaid bill, the slashing Medicaid bill, was they capped the amount of loans that individuals-- federal loans that individuals could access for very specific degree categories.

And what were those degree categories? Oh, I'm so glad you asked, Jenny. They are things like counseling and teaching and nursing and speech language pathology, right? Like who owns, who-who-who are in this-- those careers It's women, right? so much of this is already happening. So much of this already happening is in play, and I understand how tin- tin hat-y I sound, tinfoil hat-y I sound, but when you see, when you look up and you look all around, there's no way to unsee it.

We've just heard clips starting with

5-4 examining how the 1927 Supreme Court upheld Virginia's forced sterilization law in Buck v. Bell, with Justice Holmes declaring "three generations of imbeciles is enough."

Who Did What Now told how a white Mississippi doctor removed Fannie Lou Hamer's uterus during a 1961 surgery without her knowledge, a practice she later called "Mississippi appendectomies."

Bitch Talk Podcast traced how the illegal sterilization of 1,400 people in California's women's prisons grew from the state's eugenics programs, policies so extreme Nazi Germany studied them.

rePROs Fight Back defined pronatalism as an ideology pushing higher birth rates as a moral duty, tied to nationalist, patriarchal views on who should and shouldn't have children.

Boom! Lawyered broke down how the reproductive rights movement spent 50 years defending Roe's privacy framework instead of making an affirmative case for abortion access.

And rePROs Fight Back in part two of their discussion described the Heritage Foundation's "Saving America" plan as a project to build a world where women cannot leave abusive husbands, work, access health care, or control their own reproduction.

And those were just the top takes, there's lots more in the deeper dives sections,

If you get value out of the show - and want to make sure we can keep going while getting it delivered ad-free to the new, members-only podcast feed that you'll receive, sign up to support the show at bestoftheleft.com/support - there's a link in the show notes - through our Patreon page, or from right inside the Apple Podcasts app.*

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or you can simply email me to [email protected]

Last week, I explained that I was going to cut my commentaries down to one per week to give myself a bit of breathing room to get over some work burnout and get past what I'm calling a work task bottleneck. So, on the days I take off from researching and recording a full commentary, I'll just be giving quick updates on how things are going here at the show.

This week, there's not too much to report because, it turns out, burnout is really hard to overcome and it doesn't happen in a week.

Also, good for everyone to know, the impacts of burnout from work don't stay confined to the realm of work so there've been some life maintenance tasks that have needed to take priority this week in response to the sort of cascading effect that burnout can have.

Finally, this just reminds me of a quick story about an American friend of mine who lives in Europe and went through a period of work-related burnout. While talking to this person about their experience, they explained to me that when looking for resources about dealing with burnout as an expat living in Europe, it's entirely necessary to avoid getting American books about burnout. It would be equally important for someone living in the U.S. to not accidentally get books about burnout that are written for a European audience.

This person explained to me that the reason is that the books are written completely differently, with very different assumptions built into them. Books written for Europeans giving advice about overcoming burnout will talk matter-of-factly about reaching out to your corporate HR and seeing about taking an extended, paid leave of absence or applying for government programs to accomplish the same goal.

Books written for Americans will invariably focus more on breathing exercises and meditation practices or other self-care strategies to help reduce the effects of burnout while doing absolutely nothing to solve the problem at the source.

If Europeans tried to take American advice, they'd be drastically shorting themselves by not seeking the kind of help available to them that would get to the root of the problem. If Americans tried to take European advice, they'd just end up reading about a fantasy land, completely out of reach for them which would actually be a bit cruel to do to yourself while suffering from burnout. That would just be a reminder of the larger injustice on top of the acute stress you're living through.

So, that's my burnout update rather than my Best of the Left work progress update because that's what there is to share.

And now, we'll continue to dive deeper on 4 topics today. First up;

Section A, Eugenic Legal Foundation

Followed by Section B, Coerced Sterilization Today

Section C, Post-Dobbs Legal Battlefield

And Section D, Pronatalism, State-Directed Reproduction in Reverse

Attorney Aubrey Strode's Supreme Court brief in Buck versus Bell argued that Virginia's eugenics sterilization law was constitutional. His arguments were informed by legal challenges that had already been made to other states' sterilization laws, many of which have, as we've said, had been documented by Harry Laughlin.

This included arguing that Virginia's law was not cruel and unusual punishment under the Eighth Amendment to the Constitution since these sterilizations were not being performed as punishment for committing a crime. He also argued that the patients were given due process before these surgeries were authorized, and he argued that because the law protected public health and safety by keeping dangerous and undesirable people from reproducing, it was a valid use of the state's police power.

Whitehead continued to represent Carrie Buck, and he argued again that the law violated her rights to due process and equal protection under the Fifth and 14th Amendments, generally being less detailed and thorough than Strode was. 

I feel I could have put the word represent in scare quotes in that sentence.

Yes. 

He was physically there. 

He showed up, enough of a job that people didn't immediately go, "You're not doing your job, man." The Supreme Court heard oral arguments in the case on April 22nd, 1927, and issued its decision less than two weeks later. The Supreme Court upheld the lower court's ruling eight to one, meaning that Virginia's sterilization law was constitutional.

Associate Justice Oliver Wendell Holmes Jr. authored the court's opinion, which incorporated a lot of language that was already widely used within the eugenics movement. This opinion was also exceptionally short at under three pages. If you've ever read a Supreme Court opinion, that's basically- It's so short

scribbles. that's scratch paper. That's 

notes. 

recapped the steps that were required to approve a sterilization surgery under Virginia's law, saying those steps met the constitutional standard for due process. 

From there it said, quote, "The attack is not upon the procedure, but upon the substantive law.

It seems to be contended that in no circumstances could such an order be justified. It certainly is contended that the order cannot be justified upon the existing grounds. The judgment finds the facts that have been recited and that Carrie Buck is the probable potential parent of socially inadequate offspring likewise afflicted, that she may be sexually sterilized without detriment to her general health, and that her welfare and that of society will be promoted by her sterilization, and thereupon makes the order.

In view of the general declarations of the legislature and the specific findings of the court, obviously we cannot say as matter of law that the grounds do not exist, and if they exist, they justify the result. We have seen more than once that the public welfare may call upon the best citizens for their lives.

It would be strange if it could not call upon those who already sap the strength of the state for these lesser sacrifices, often not felt to be such by those concerned, in order to prevent our being swamped with incompetence. It is better for all the world if instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind.

The principle that sustains compulsory vaccination is broad enough to cover cutting the fallopian tubes. Three generations of imbeciles are enough." 

The principle of compulsory vaccination is a reference to Jacobson versus Massachusetts, which the court had decided in January of 1905. In that case, the Supreme Court had upheld a compulsory smallpox vaccination law, ruling that, quote, "It is within the police power of a state to enact a compulsory vaccination law, and it is for the legislature and not for the courts to determine in the first instance whether vaccination is or is not the best mode for the prevention of smallpox and the protection of the public health."

Jacobson versus Massachusetts established a basic standard for when public health measures could overrule a person's individual liberty and still be considered constitutional. The measures in question had to be necessary to protect public health, reasonable, and proportional, and they had to prevent harm.

So in the context of vaccines in Jacobson versus Massachusetts, the general public was being protected through requirements that people be vaccinated for smallpox, and those requirements were reasonable and proportional. In the context of Buck versus Bell, according to this court decision, the general public was being protected from the feeble-minded and their associated s- societal burdens by removing their ability to bring about another generation of feeble-minded people.

And according to the reasoning of this decision, surgically sterilizing them was reasonable and proportional. 

The decision continued, quote, "But it is said, however it might be if this reasoning were applied generally, it fails when it is confined to the small number who are in the institutions named and is not applied to the multitudes outside.

It is the usual last resort of constitutional arguments to point out shortcomings of this sort. But the answer is that the law does all that is needed when it does all that it can, indicates a policy, applies it to all within the lines, and seeks to bring within the lines all similarly situated so far and so fast as its means allow.

Of course, so far as the operations enable those who otherwise must be kept confined to be returned to the world and thus open the asylum to others, the equality aimed at will be more nearly reached." 

In other words, Virginia's law didn't violate the constitutional guarantee of equal protection under the laws by applying only to people who were institutionalized, in part because people could then be freed from asylums once they'd been sterilized, and that would make more room in the asylums for more people to be sterilized.

And regarding this, quote, "three generations of imbeciles" that Justice Holmes referred to, actually not a lot is known about Carrie's mother, Emma Buck, except that she was poor. She was abandoned by her husband early in marriage. After being accused of immorality, prostitution, and having syphilis, she was also committed to the same institution, this Virginia State Colony for the Feeble-Minded.

And then there's Carrie's daughter, who was named Vivian, and her mom, Vivian was also of reportedly average intelligence. She attended school for a few years, where she received average or even above average grades. She died at the age of eight due to complications from measles. But again, the cruelty of this quote, the three generations of imbeciles, there aren't even facts that support that 

realistically.

Yeah. Also, and a society that is condemning people it deems stupid to institutions and sterilization but can't cure the fucking measles, 

Yeah. 

I also doubts about promiscuity being ... one of the criteria here. Whether or not she was raped I think that goes to, just- 

Yeah.

look, if I had to guess, they are just, it's literally a series of check boxes when they're, compelling someone- ... to, live in one of these institutions. and they're just looking things- Yeah ... "Oh, she's promiscuous." 

And then finally, just to highlight, how rampant this eugenics stuff was, as soon as the states got the green light from the Supreme Court on, sterilization statutes this, the State of Virginia was so giddy for this family to not be able to reproduce, that Carrie Buck's sister, Doris Buck, was also forcibly sterilized.

She actually wasn't told that procedure was being done to her. It happened completely without her consent during what she was told was a surgery for appendicitis. She never knew why she couldn't conceive, until she learned the real reason why in 1980. Lived her whole life not knowing that this- Fuck

had happened to her. 

Jesus. 

Ugh. So I wanna talk a bit about, eugenics and elite academic institutions that were pushing it. In the early 1900s, the idea of forced sterilization to eliminate heritable disorders was popular in mainstream academia, right? Oliver Wendell Holmes authored this opinion.

He has close ties to Harvard. He went there. His father was dean of the medical school. And Harvard was pushing these theories very aggressively. A huge percentage of the scholarship about eugenics and promoting eugenics came out of Harvard. And all of this is to say that powerful institutions in this country work in close concert.

Elite universities and instruments of government power, the court, are often composed of the same people from the same- Yes ... socioeconomic classes. And so you often- ... see them serving the same interests. And- The overlap of dubious academic work with the courts isn't some ancient thing. just to give a slightly more recent in the '80s, the field of law and economics gained steam in academia, in legal academia, designed to more aggressively map economic theory onto the practice of law.

Yeah. 

very popular at the time. Still maintains some popularity today. the, the one thing you need to know about law and economics is that if someone is, a, an expert in neither law economics, that does not rule you out from being a professor of law and economics. 

That's all you need to know.

It's a bullshit little field, it, that just combines the most fraudulent aspects of economic theory with 

Most notably at the University of Chicago, right? Law School. Yeah, 

that's their- That's right. That's right ... yeah, that's 

their big- 

The center of the- 

Yeah ... 

intellectual movement 

there. Yeah. And, I...

Just a, a quick note before we move on, Rhiannon referenced this earlier. We often deal with reactionary politics on this podcast and, obviously I think we all believe that e- eugenics is fundamentally reactionary, but it needs to be noted that it was closely tied to the progressive movement at the turn of the 20th century.

Yeah. I bring this up mostly because if you're a progressive or otherwise on the left, I think it's important to acknowledge that the movement got caught up in this dangerous thinking at one point, and being intellectually honest about this shit is part of what separates us from the right.

Because Planned Parenthood has admitted that their founder, Margaret Sanger, believed in eugenics, and they've denounced those beliefs. But the American conservative movement, rather than admitting to their past failures, maintains an entire cottage industry dedicated to rewriting history to make believe that they aren't the villains the entire fucking time.

Yeah. So you have these fucking weirdo freaks Dinesh D'Souza who do nothing but churn out books saying that the KKK were liberals, actually." 

Yeah. 

And Nazis- Yeah ... national socialism's in the name. 

They're 

right there. And shit that.

Then that passes for actual and, intellectual honesty on the right. And it's important to just, back, reflect on your movement's errors, and, and not be one of these fucking morons. they go through all these lengths to say, back in the 1870s, the KKK were all Democrats," but, simple question would be What party do you think the modern KKK identifies with?

Another thing I wanna point out is, 

Buck v. Bell hasn't been overturned. 

Still on the books. Nope. 

Good law. and not to say that it's, consistently relied upon by the court or anything. That's not the point we make entirely. A huge component- ... of our legal system is its reliance on the body of common law, meaning the law that comes from judicial decisions, and that reliance is predicated on the idea that body of law is the manifestation of reasonable and reliable legal principles that have been passed down over time.

But the reality is that the common law is littered with outdated relics of reasoning and science and history, this case, and that is what our law is built on. The law is predicated on the assumption that our predecessors were eminently wise, but of course, they had all the same flaws of judges today.

They were uninformed, biased, hubristic, and it's crucial for the legal profession to operate as if those flaws are present and not as if the passage of time has bestowed a untouchability on the past, right? The way that precedent works is that courts are made to rely on existing rules rather than question their wisdom or utility.

Obviously, the primary purpose of this is to promote consistency in the law. But not only does it lead to the entrenchment of some horrible ideas, it's inherently conservative. 

Exactly. 

This plainly outrageous case law can't be easily disregarded, because- Judges are told to respect precedent.

And instead it needs to be rooted out steadily over the course of many to the point where it's still on the books today. 

All that being said, it is actually true though that as recently as 2001, a federal appeals court in the Eighth Circuit Buck v. Bell approvingly in holding that involuntary sterilization of the mentally handicapped could be constitutional, with the right procedural protections.

Ooh. Which is pretty indistinguishable from what 

from what Buck v. said. Things are not good. Things are not good. Yeah. I 

understand. 

And it's He's putting up the alarm. 

Look, that was- Yeah. Was it pre... You said 2001. Was it pre 

9/11? Ooh. Yeah, exactly. Things really changed. Yeah. We have to reckon with the idea that eugenics have never really left us.

Yeah. era was plainly horrible, and I don't wanna say everything's the same or whatever, but, I think i- in that era sterilized 65,000, quote-unquote, disabled people. And you might think, when I say the eugenics era, this case is a century old, so that means forever ago.

But, Carolina was operating its program until 1974. 

Wow. 

And course, Rhiannon gestured to this earlier, but in the South, everywhere really racial and class components to this. In the South, for example, this tended to fall most heavily on the Black community.

Yes. which interestingly enough, in its short two pages, the plaintiff's brief anticipated that. So it's not people didn't know that might be the case. In Buck v. Bell, they're saying, look, this could be turned to, to sterilize, Black and poor people. 

and there you go.

Yeah. Yeah. And we also still to this day have this idea that somehow, genetically inferior people are the ones who are more likely to commit crime, and there's a way that white supremacy connects genetic inferiority to criminal behavior to justify still to this day this eugenics-adjacent stuff- Right

in the criminal punishment system. So for example, in 2009, a woman in West Virginia was required to get her tubes tied at the age of 21 years old as part of the requirements of her probation deal. The offense for which she was going on probation, marijuana possession. . She's... 

What, do who the judge was in that case and what their address was?

I, I do not. I do not, actually. 

Just asking. Just wondering. Thinking out loud. 

Just- Okay. Sure. Yeah. in 2017, really recently, a Tennessee judge issued a standing order that offered inmates a 30-day reduction in their sentence if they underwent some long-term or permanent, birth control procedure.

So that's if men got vasectomies or if women got a four-year birth control implant. And this idea, they make it legal by keeping it voluntary, right? It's not forced on anybody. But of course this is super coercive if you're sitting in jail and you can't get out, right? Yeah. And we don't have to think long about who this disparately impacts.

A policy this is never going to touch a rich person because a rich person is never going to be in the position where, can't get out of jail at the time that they wanna get out, where their lack of resources is the thing that's keeping them locked up and repeating into the system. And obviously this is gonna impact people of color more who are pulled into the criminal punishment system at higher rates than everybody else. 

As we've discussed, feeblemindedness was an umbrella category that just does not hold up under scrutiny. Beyond that, there is general agreement today that Emma's diagnosis is suspect because it was based mainly on unreliable IQ tests, and that neither Carrie nor her daughter Vivian was disabled.

This does not mean that Carrie's sterilization was somehow more tragic than it would have been if she had a disability. Disabled people's bodies and bodily autonomy are not worth less than that of non-disabled people. The point is that the justification for her sterilization and the Supreme Court case that upheld it was not even true.

After Buck versus Bell upheld Virginia's sterilization law as constitutional, other states and Puerto Rico began passing their own laws. By 1937, 32 states had some compulsory sterilization law, and five other states had carried out procedures without some law on the books. It's believed that at least 60,000 people in the United States were sterilized without their consent over the course of more than 50 years.

As had happened with Doris Buck Figgins, sometimes people were not even told this was what was happening, and they thought they were having surgery for some other reason. While the Bucks were white, these surgeries were disproportionately performed on Black women and other women of color. Fannie Lou Hamer popularized the term Mississippi appendectomy to describe the forced sterilization of Black women in the Southern United States.

And there were also sterilization programs in other parts of the world. 

Nazi Germany passed its Law for the Prevention of Offspring with Hereditary Diseases in 1933. This paved the way for approximately two million sterilizations in Nazi-occupied Europe 

After World War II, Buck versus Bell was cited as a defense during the Nuremberg trials.

There are also other connections between American and Nazi eugenics. For example, in 1936, the University of Heidelberg, which was under Nazi administration, awarded Harry H. Laughlin an honorary doctorate in medicine for his contributions to, quote, "the science of racial cleansing." 

We said at the top of the show that Buck versus Bell has never been directly overturned.

One case that might have done that was Skinner versus Oklahoma, which followed Oklahoma's passage of its Habitual Criminal Sterilization Act of 1935. That law required a person to be sterilized if they had been convicted of three or more felonies of moral turpitude. The Supreme Court ruled that this was unconstitutional because it was a cruel and unusual punishment and was applied arbitrarily.

But it did not apply this ruling to involuntary sterilizations more broadly. 

In 1980, the American Civil Liberties Union filed suit on behalf of thousands of women who had been sterilized under Virginia's eugenics law. This led to Poe versus Lynchburg, which was ultimately settled at the district court level in 1985 without overturning the original law.

Most of the sterilization laws that were passed in the US in the early 20th century have been repealed today. Virginia repealed its law in 1974 and removed other legal references to sterilization of people with, quote, "hereditary forms of mental illness that are recurrent" in 1979. Virginia also apologized to the victims of its sterilization law in 2002.

But there are still laws on the books in various states allowing for involuntary sterilizations in some circumstances, including laws that allow parents, guardians, or other caregivers to approve sterilizations for their disabled children and other dependents. This is an incredibly sensitive and contentious topic because it involves figuring out how to simultaneously respect disabled people's rights to privacy and bodily autonomy while also allowing people to make m- medical decisions for them if they are genuinely unable to communicate their own wishes or make decisions for themselves.

Next, Section B, Coerced Sterilization Today

A whistleblower account of forced sterilizations in a Georgia ICE detention facility recently shocked the nation, but this horrendous crime is nothing new. The US has a lengthy and well-documented history of medical and government authorities forcibly sterilizing Black, Latina, Indigenous, disabled, incarcerated, and poor women.

Here are just a few examples. The most obvious was the movement for eugenics, a blatant effort to arrange reproduction so as to eliminate, quote, unquote, "undesirable traits among the population," which was openly based on racist theories. Eugenicists established research and foundations that popularized eugenics in the scientific community and society as a whole.

The movement gained popularity in the 1920s, which, no coincidence, was a time of severe anti-immigrant restrictions and the Great Migration of Black people into urban areas. The practice of forced sterilizations was institutionalized by the Supreme Court itself. In the 1927 Buck versus Bell case, the Supreme Court allowed the State of Virginia to carry out compulsory sterilizations.

The state sought to sterilize a young woman for having a child out of wedlock, with some records suggesting that she was raped. Justice Wendell Holmes wrote, quote, "It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for imbecility, society can prevent those who are manifestly unfit from continuing their kind."

More than 30 states passed legislation in support of forced sterilizations according to the standards set in Buck v. Bell. Many states created eugenics boards to promote and oversee the forced sterilizations of mostly Black women and immigrants. To this day, the ruling has yet to be overturned. In the early 20th century, forced sterilizations in the US were so widespread and disturbingly effective that Hitler himself reportedly told a Nazi colleague that, quote, "I have studied with interest the laws of several American states concerning prevention of reproduction by people whose progeny, in all probability, would be of no value or be injurious to the racial stock."

Even after eugenics fell out of favor in academic circles, sterilization abuse continued. It took place in the form of medical coercion and deception in situations where a woman does not know she is being sterilized or concedes to sterilization under duress. Overall, the practice was so common in the South that Mississippi appendectomies became a nickname for unnecessary hysterectomies on Black women, largely performed at teaching hospitals as training for medical students.

Born and raised in Mississippi, the renowned civil rights activist Fannie Lou Hamer was one of the most well-known victims of these, quote-unquote, appendectomies in 1961 when she underwent surgery to remove a tumor from her uterus. And in the South, it wasn't just Mississippi. North Carolina sterilized over 7,600 people between the 1930s and 1970s, 65% of whom were Black women.

A third of the sterilizations were done on girls under 18, even as young as nine years old. As early as 1909, forced sterilizations took place in California, and the state was the national leader in the number of sterilization procedures performed without consent. An estimated 20,000 sterilizations took place in state institutions, making up a third of the total number performed in the country.

These sterilizations targeted women with Spanish surnames, many of Mexican descent. A 2015 documentary film, No Más Bebés, follows a class action lawsuit representing hundreds of mostly Mexican women who say they were sterilized without informed consent shortly after giving birth in Los Angeles public hospitals.

This crime against humanity was not confined within the US mainland borders. In the colonized nation of Puerto Rico, population control remained a major effort of the US government since it seized the island nation from Spain in 1898. In 1976, the US Department of Health, Education and Welfare reported that one in three Puerto Rican women of childbearing age had been sterilized by coercion or without their consent.

The US policy of forced sterilizations was so common in Puerto Rico that it was simply referred to as La Operacion. American doctors trained staff at private and public hospitals across the island and instituted the practice of sterilizing mothers of two or more children after birth Indigenous peoples across the US have been subjected to this inhumane practice during much of the 20th century.

A 2010 study found that as many as 25 to 50% of Native women were sterilized by the Indian Health Service between the years of 1970 and 1976 alone. In a harrowing example, two Cheyenne girls were admitted into an IHS hospital in Montana for emergency appendectomies. Doctors sterilized both girls while they were sedated without their consent or that of their parents The fight against sterilization abuse became a major front of struggle for the women's movement and women who were members or influenced by the radical organizations of the 1970s.

As a result of their struggles and exposure, the Department of Health and Human Services published guidelines for sterilization procedures in 1974. It mandated a 72-hour waiting period between the signing of a consent form and the procedure, and created a moratorium on sterilization of women under 21 years old and others lacking the right to give consent.

But unfortunately, that hasn't stopped the abuse of sterilizations altogether. More and more, they are occurring for incarcerated women in particular. A recent study found that almost 150 women were illegally subjected to sterilization in California prisons between 2006 and 2010. A majority were Black and Latina.

The latest whistleblower account brought by Dawn Wooten, a Black woman and nurse in Georgia, revealed that an untold number of immigrant detainees may have received such procedures in the Irwin County Detention Center. Mounting evidence shows there is extreme medical neglect occurring in ICE facilities and private detention centers nationwide.

So in a nation founded on the genocide of native peoples, the enslavement of Black people, and cheap immigrant labor, forced sterilizations are not as uncommon as we'd like to believe. It took a powerful and radical women's movement and a massive social movement of poor and oppressed people to make these abuses a big issue in the 1970s, and it's going to take an equally powerful movement today to root out these abuses for once and for all.

let me ask about this, because last week, Julie, you brought attention to the Greenland case where, 143 Inuit women are suing Denmark for forced birth control in the 1960s and '70s. You don't hear about this happening to Caucasians, 

Trump did it in his first term to migrant women who were forced to undergo involuntary hysterectomies, which w- I, if it had happened to a Caucasian female, we'd still be talking about it in the news. And it's my understanding this still happens in some places in Canada as well. what is this moment of reckoning that we're witnessing with these women suing Denmark?

what could that mean for indigenous women globally? 

before, before I get to that, you mentioned that, Trump was doing this to migrant women. Those are, for the most part, indigenous women. those, those- yeah ... brown women- Exactly ... coming, over the border.

Exactly. but as you were saying, m- most people, maybe a lot of your listeners don't know, but indigenous people know that, this just didn't happen in Greenland. So this was happening to the indigenous women in Greenland, the Inuit women. it happened here in the United States as well.

It happened in Canada as well. 

Yeah. 

And in some places, as you said, it's still happening. So in the United States, from the late '60s through the '70s, the Indian Health Service, they sterilized thousands of Native American women without consent, and a government report from '76 confirmed that over 3,400 Native women were sterilized in just four years.

So in Canada, sterilization of indigenous women was legally sanctioned, and that was i- in the '60s and '70s. And so even after the eugenics laws were repealed, doctors and hospitals continued to practice under the radar, targeting indigenous women. And that's not just in the distant past.

That was happening in the 2000s, 2000 and, Yeah ... 2010s, and it's still happening today. And so under international law, forced sterilization of a specific group with intent to eliminate future generations- ... is one of the clearest legal definitions of genocide, and that's what's happening, and that's, I think it's so important that these women are standing up and suing, the Danish, the, or Denmark, so the Danish government, the, ... in Canada, it's happening as well. 

Yeah. Simon, this is state violence. This is not abuse. This is violence by the state, and it's a part of colonial history that, as Julie said, is still so hidden, and yet it has shaped- Yeah

generations. 

Yeah, it's a modern form of genocide. think about it. Here you have... There was a case in Canada most recently of a, I think it was a young girl, and she had a baby, and then she went to go see her gynecologist sometime later and wanted to know why she couldn't have a baby. she didn't know she had an IUD in her.

She didn't know. And this is what they were doing to Indigenous- Ah. She didn't know she- right? And and then also some of them have their- Oh ... tubes tied. Yeah. And again- No ... so this is while they're, under the knife, if it's, there's, or they're in the middle of giving birth. And so again, for Indigenous people, the shit part is that when you bring this up, people are gonna go, "Oh, they did a lot of stuff in the 1800s, didn't they?

Or in the early 1900s." Always. Yeah. Fuck you. Always about history. This was recently. Always about history. This was most recently to the point where even in Canada, there is a group of Indigenous women pushing a bill that would make it a crime for any of this to ha- They would, if you were found by, as a doctor or anybody, a, a healthcare professional that did this, if you an- gave a young person or e- anybody, any woman an IUD against their consent or tied their tubes, you could face 14 years in jail.

But personally, I think that's not enough. Because again, how do you look at that and say, "This isn't genocide"? You're preventing these- You're taking someone's future away ... 

Indigenous 

babies. 

Yes. It's... Yeah. Yes. Yeah, you're taking someone's entire future away. You're taking someone's entire future genealogy in attempt to...

my God, we're not even talking about generational wealth, we're just talking about taking away generations. 

And I want everybody to wonder why. Why would they do that to Indigenous women and not white women? And I think we all know- I know ... the answer- Yeah ... but I want people to really think about that tonight.

Why would they do this to Indigenous people today? 

And may I just say, I'm gonna go back to Dark Winds because, they really touch on so many important issues that people didn't realize, you know, had been going on. So Dark Winds, as we know, takes place on the Navajo reservation in the '70s, and there is a scene that hits really hard because it is not fiction.

So Emma Leaphorn, who is the, police officer's wife, she's a, a nurse on the Navajo reservation, and there's a scene where she's in the exam room with a young Navajo girl and a white doctor, and the doctor asks the young girl if she's planning to have a home birth, and then encourages her to come to the hospital instead and have her baby there.

And Emma, the nurse, in Navajo, in their language, in the Dine language, says to the, the young girl- 

so that the doctor won't understand what she's saying. She quietly warns the girl, "If you have the baby here at the hospital, they will sterilize you while you're under." And the doctor says, "Oh, what is she gonna, what is she gonna do?

is she gonna have the baby at the hospital?" And the girl goes on this big, rant about, Yeah ... the way that society is right now against Native people, and the, the nurse just says she'll think about it. And that moment reflects the lived truth of so many indigenous women, 'cause for years sterilization wasn't an exception in hospitals.

It really was a routine, and it was normalized. Yeah. And so that quiet act of resistance speaks for, all of the nurses, all of the aunties out there who really did try to protect us when no one else would, and that is... It's just, it's horrific to think that these women still are fighting for justice in Greenland, Canada, and the United States.

And that's why IHS hires more Natives, because Natives have that cultural competence and know the language, and can give them those warnings in our own language. 

It makes me wanna ask, we've never discussed this, but h- how do indigenous concepts of reproductive autonomy differ from Western models, and how can they guide us?

Julie? 

as I said, indigenous people, or at least on my nation, we believe that, women's bodies, we have the right to make decisions about our bodies. most, indigenous, nations had ways of carrying out, an abortion. They did. And so a woman really did have a right to her body.

And so to have, a whole race of people, of women, have those rights taken away, and I know that this is happening right now with, the general population, and it's just so wrong. And so I just really want to encourage people to read up about, what's going on and what has been going on for so long.

Well done. And so indigenous women, have always had that, that, that matriarchy. there's a lot of power and when the settlers came over, they were afraid of that, and they tried to bury it. Oh, absolutely. And one of the reasons, one of the ways was, basically genocide, getting rid of indigenous people, and they did that in many different ways, and the most recent or one of the ways that still is lasting is this forced sterilization.

I wanted to ask you, because you end on this note, about the reparations bill, and that Kelli, was really fighting for that, and Cynthia.

Do you have any more information about what's going on with that? And I love that Kelli is now, she's in it to win it. She's like, "I'm here and we're gonna get reparations." 

There's a lot going on with the reparations movement, and I'm so happy that you highlighted that scene too, because I will tell you, we thought we were finished with the film, and the, many things happened at the, at, towards the end of the process.

We found the deposition footage of Kelli, we found the whistleblower nurses, and the reparations movement gained momentum. And so all of a sudden we had an ending scene. But what's really fascinating about this process is we knew we wanted to have a musical voice in the film. We knew we wanted to get someone involved, to really help tell the story of the survivors through music.

So we asked people, who were advising the film, who were in prison, "Who do you want to be the musical voice of the film? If you could have anyone in the world, who would it be?" And literally everyone said it has to be Mary J. Blige. 

Ooh. Thanks a lot, Erika. Yes. I had that as my, like- ... last question.

Sorry, it's 

a passage of the scene. I love 

it, yeah. 'Cause we love Mary J. Blige. yeah. Keep going. yeah. Love it. 

So we sent the cut to Mary J. It was a rough cut. 

As, as you do. You just sent it over, yeah. you just press send to Mary J. Blige. 

we went through our incredible music supervisor, Tracy McKnight, and we wrote a letter explaining kind of our process of making this film, and how her music helps so many people inside prison get through their time inside- and how we all wanted her to be the musical voice. But the film wasn't finished, and so typically when you approach an, a, an artist to be, to write an original song for a film, it would, the film would be done. She loved the film. She said yes immediately, but we didn't have an ending. So it was this fascinating, unique creative process of trying to come up with how the film would end, and it, s- just through, so much synergy, the reparations movement happened at the same time the hearings were happening, the same time we were talking to Mary and her team, DJ Camper and Nova Wav, and we said, we want people to be inspired when they leave this film.

The reparations movement has not yet gained enough traction. It has not yet passed. We have to inspire people to create change, to take action, but we don't want this to be neatly tied up in a bow, because it's not a happy ending yet. Kelli hasn't gotten her happy ending, and how can you tie a story like this up neatly in a bow when there's so much wor- work to be done and that modern-day eugenics is still at work?

And so we went back and forth. We found this incredible moment, to film with Cynthia and Kelli, and, Mary J and her team really created a song that could not have articulated the film's message in any better way, and that's what we end the film on. That's what we cut the ending scene to.

And so- ... where we are now in the reparations movement is that there is a bill and a budget request to pass reparations for those who were illegally sterilized in California's women's prisons, as well as those who were sterilized historically to the historic eugenics program. And the reparations, movement also calls for everyone who still to this day doesn't know that they were sterilized to be notified- Oh.

... 

which is so important to note that so many people still don't know to this day. 

That's insane. Yeah. 

As well as having a historical monument that acknowledges California's heinous eugenics past so that it may never continue again. And I really believe, and our team really believes, that California's reparations bill will be key to ensuring that incidents like what happened in the Georgia detention center and other illegal sterilizations across this country don't continue to occur So I have to say, go to bellyofthebeastfilm.com and sign our petition for reparations for California's forced sterilization survivors.

Great. Yeah, I just wanted to bring up one other thing, because it just, o- obviously this is, it's heinous what has happened to these women, and I can speak for my co-host and I when we can say we're so sick of women's bodies being up for debate and- Yep ... in the hands of the government or law enforcement or whoever it is.

Yep. and who are we to deem who's worthy to be parents? That's just it's crazy to me. And if we really want to reform our prison systems and, we need to start looking at each other as equals and realizing that we're more than the worst thing that we did one day, and it's just, it's bigger than that.

and thank you for highlighting all of that, and it just adds to our fury, which we can- ... translate into work and spreading the word about your film and the works of the Justice Network on women in organizations like that. 

Now, Section C, Post-Dobbs Legal Battlefield

So after Dobbs was decided, the Supreme Court case that overturned Roe versus Wade, a number of grassroots activists in various states decided that they were going to take to the ballot constitutional amendments to state constitutions to protect reproductive freedom. And so it's important to note that even if the federal Constitution no longer protects abortion, state constitutions always have independently and always can independently of the federal Constitution.

So activists saw this as an opportunity to protect, and in some cases restore, the right to abortion in their states. So through the process of getting measures on the ballot, activists gathered the signatures, raised the funds, and took to the ballot these reproductive freedom amendments to their state constitutions that protect, a whole host of reproductive freedoms, including the right to abortion, contraception, prenatal care, pregnancy care.

And they're all worded a little bit differently, but all have the same goal of enshrining the right to reproductive freedom in state constitutions. 

It was so energizing, just in a time when there was always so much bad news on our issues, to see just these huge wins at the state level. What was it?

Seven of 10 states where it was on the ballot. Honestly, eight, 'cause Florida had that super high threshold. I still see that as a really good news story out of Florida, even though it lost. And so I think a lot of people thought, "Great, we did it. It's done. This, the, it was expanded." But that's actually not the full story, is it?

Correct. So a lot of people think that once these amendments get passed by the voters, that means that all of the bad abortion laws in that state are wiped off the books. And unfortunately for most of the states, that is not true. These amendments are not what we call self-executing. They don't just automatically take care of the bad laws.

the next step in the process is that we, the litigators, have to go to court and challenge the abortion restrictions and abortion bans under these state constitutions, and say, "Under this new state constitutional right, your abortion restriction is unconstitutional, and please strike it down." so that's what we have been busy doing in the context of our role as litigators enforcing the ballot initiatives.

So where are we now? 

Yeah, so as you say, it's all very exciting because, the tremendous advocacy and all of the voters who went to the ballot box, we get to now- Tell the courts that the voters have spoken. They want a state that does not have abortion restrictions, and we have gone into court along with various partners in a bunch of states saying that these restrictions and bans that were on the books are unconstitutional.

So we have cases pending in Missouri and Ohio. I think we have five cases in Ohio, a couple of cases in Arizona, and in Michigan, and we are in the process of blocking and striking down various abortion restrictions, which we can also talk about more in terms of what that looks 

Yeah. I would love to hear, yeah, what do, what does it look right now?

Yeah, so I- it's very exciting, and for, for us to be fighting the threats at the federal level, being able to do this proactive work at the state level is so exciting and so meaningful. so for a state Ohio, which was one of the first states to pass one of these reproductive freedom amendments, we have been able to create a state, where abortion is accessible, and we have been able to increase access to abortion, and Ohio has become a place in the region where people can travel to for abortions because it's surrounded by many states that have, banned abortion.

So for example, we've been able to block the six-week ban under the new constitution. we have been able to block 24-hour waiting period two-trip requirement, in the state. We have blocked a ban on telehealth for abortion, and a whole host of other things. So I said, we have five cases in the s- in the state, and so far we've been successful in blocking various restrictions that has really increased access both for people who, live in Ohio, but also for people who need to travel.

So if you think of someone coming from Kentucky, where previously they had to make two trips to a clinic in Ohio to see, to be seen there, now that two-trip requirement with a 24-hour waiting in between those two trips is blocked. So they can make one trip, to Ohio. Now, obviously we wish that we could restore abortion access in Kentucky too, and nobody would have to travel, but until we can do that, this means that people have increased access in Ohio.

Yeah, that's a huge win for not having to do the two trips. That's, we always talk about what a huge hurdle that is, even though it- I think a lot of people feel it sounds such a low bar, but it is actually a really high bar for people to have to clear. And it was so great. We do an annual 50 state report card on sexual reproductive health and rights in the States, and this year's will be coming, will be out by the time this episode comes out.

And it was so great to see the changes in some of the states that we were able to show improved access. 

Yeah, absolutely. and a state Arizona that had a 15-week abortion ban that we almost immediately got blocked after the constitutional amendment was passed, and we have now also have a permanent injunction against the two-trip requirement, and telehealth ban in that state as well, and recently filed a new case challenging the prohibition on advanced practice clinicians from providing abortions in Arizona.

So we just filed that case too. So we are on a roll, and with our partners in these various states, we'll continue to try to push to wipe all abortion restrictions off the books. 

That is so exciting, and also exciting was seeing that there are some ballot initiatives that are gonna be happening this year as well, and one of the ones that really stood out to me is Missouri.

And you've been fighting in Missouri, and now they are trying to hold the opposite of the ballot initiative to... I- and with the same name to, confuse people. Do you maybe wanna talk a little bit about what's happening in Missouri? 

Yeah, absolutely. And so just to back up a little bit, abortion was heavily restricted in the state even before Roe versus Wade was overturned, with, so many restrictions in the state piled on top of each other, which meant that there was very little abortion provision happening in the state altogether, even before Roe was overturned.

And then the constitutional amendment... Then, sorry, abortion was banned completely after, Roe was overturned, and then, the, the coalition got the ballot measure passed, amending the Constitution, to protect reproductive freedom. And almost immediately with, Planned Parenthood, we went into court and blocked a number of abortion restrictions, including bans at different points in pregnancy, a whole bunch of the targeted regulation of abortion providers, the TRAP laws that dictate things how wide your hallways need to be and things that, that have really prevented access in that state.

And we were able to restore procedural abortion care. We recently had a trial in January where we're hoping to also be able to restore medication abortion provision. But as of now, at least there's med- there's, procedural abortion care in Missouri. But obviously the other side is not content with the decision by the voters, the will of the people, to amend the Constitution.

And so there will be a ballot measure, that will try to repeal the constitutional amendment to, that protects reproductive freedom. And I think it's also just a lesson that we always need to keep fighting, for the rights that we have fought to establish, and, we will never be able to just say, "Oh, we have a constitutional amendment, and so therefore we can rest easy."

There will always be attacks. There will always be ways to try to unravel the progress we've made, and I think we clearly saw that with Roe versus Wade, right? We saw that as soon as Roe was decided, the other side started attacking the right and chipping away at it. And we always said it, the chipping away will result in the overturning of Roe versus Wade, and I think people didn't necessarily believe us, but those, that chipping away led to the downfall of Roe.

So that I think, what we are bracing for in other states, and Missouri is a direct attack to just repe- direct attack to repeal the amendment altogether. And it's gonna be a tremendous fight in terms of people power and also financing to prevent that change from happening. 

Yeah, Roe was already, on life support before it was finally lost.

It was definitely a death of a thousand cuts and then a very fast end, I think. it was hard to brace for that 

moment. 

It was. And also, I should say what all of us know, that Roe was never enough. Roe was the floor, it's not the ceiling, and these reproductive freedom amendments at the state constitution get us closer to the f- to the ceiling.

They are really super protective, both in terms of the broad range of reproductive healthcare they protect, and also creating a very high legal standard, that we get to use in court to say that these abortion restrictions must be struck down under this very high legal standard. And we did not have such a high legal standard, to protect the fundamental right to abortion that was provided to us in Roe.

Let's talk about the MAGA justices, Thomas and Alito. We'll start with Thomas, and his dissent was so insane. So he wrote that abortion providers who mail mifepristone should be thrown in prison rather than granted relief by the Supreme Court.

He claimed, I'll just quote here, "It is a criminal offense to ship mifepristone for use in abortions under the Comstock Act of 1873." And then he added, "Applicants," which are the makers of these drugs- Are not entitled to a stay of an adverse court order based on lost profits from their criminal enterprise.

They cannot, in any legally relevant sense, be irreparably harmed by a court order that makes it more difficult for them to commit crimes. Madhura- That's so 

outrageous. 

Th- it's actually heavily contested whether the Comstock Act does apply to this conduct, right? There are multiple interpretations of it.

The Biden administration made a very strong argument that it did not apply in this context. What do you make of Justice Thomas just throwing down as, making the Comstock Act great again and declaring that all of these providers who are mailing these pills are felons who should be locked up immediately?

He really describes these pharmaceutical companies as if they're some guy on the corner selling heroin. "Oh, their profits from their criminal enterprise." I'm just "Okay, buddy, somebody's been watching too much crime TV." It is really egregious and just really trying to legitimize what was once a fringe theory, that the Comstock Act does apply here, that it is valid, that it's still good law, and should be used to prosecute so many people.

How many individuals would be caught up in this? We're thinking about people at the pharmacies, at the companies themselves, the doctors. This is Threatening to incarcerate so many people for the crime of pursuing basic healthcare and, helping make that possible, it's truly something absurd. I think it just shows how far gone Clarence Thomas is.

The language is on another level. 

And we should note that Thomas' language here comes straight from the crazy far-right anti-abortion advocates' arguments and briefs, right? They have been saying for years that this is a criminal network and a criminal conspiracy, and Thomas is just "Absolutely. I'm just gonna copy/paste that stuff into the US reports," right?

for sure. I think you have seen this trend for Thomas for a while. He always describes abortion as this really nefarious, racist, eugenics operation happening across the country. And yeah, he's really seized the opportunity to put that, into his dissent here, and mix in some criminality for good measure.

And let's just be clear, Madiba is not exaggerating. He literally described abortion as racist eugenics in a previous opinion. So this guy is not pretending to be a neutral judge in these cases. He is "We must outlaw abortion and imprison everyone who participates in it," including, quite possibly, patients.

let's turn to Justice Alito, whose dissent is longer and I would say slightly less crazy, but also way funnier because he's just so big mad. 

Yeah. 

So Justice Alito has this whole dissent where he's complaining that blue states are undermining his decision in Dobbs, which had overruled Roe v. Wade, by allowing their providers to, of course, mail these medication abortion pills into red states where abortion is totally banned.

And Alito actually points out that there are more abortions happening in Louisiana now than before Dobbs because of telehealth abortion, and he faults the FDA because- Good for you, 

Louisiana. 

Yeah, totally. Totally. rock on, Louisiana. We love reproductive freedom. We love owning Sam Alito, too. but he's "This is the FDA's fault.

They are facilitating this felonious conduct because they're allowing for the telehealth prescription and mailing of abortion pills." 

Again, direct quote, he said, "Felonious." 

Yes. Again, and the funny thing is, we should just pause here to note- Louisiana, if it wants, can choose to arrest people who use abortion pills.

It hasn't done so yet, but it may be going down that path. It does have laws that prohibit the dispensation of abortion pills within its state lines. Louisiana has many tools at its disposal to persecute people who participate in reproductive freedom. What Louisiana cannot do is reach across its state lines into New York and somehow prosecute or fine a provider in a completely different state who is engaging in conduct that is completely legal under those state laws.

And that's what Alito just can't wrap his head around, and it seems he really thought Dobbs was gonna end abortion in red states just, forever. And he is sore as hell that he did not successfully strip more people of their fundamental rights. 

Yeah. He is shocked and appalled. It was honestly pretty funny.

what do you mean there are more abortions happening now than there were before? And it gives the game away a bit that this was never actually about restoring freedom to the states he likes to claim. It was about just ending abortion. And so that he didn't do that, he's, now he's upset.

Yeah. And he's all about Louisiana state sovereignty and Louisiana's rights to, enact these laws. What about New York's sovereignty? What about New York's right to enact these laws? New York gets to have a say in this as well, I had thought. But you said, Madiba, it totally gives away the game.

He hates pro-choice laws and wants to find a way to block them, and he loves anti-abortion laws, and he will just bend and twist and contort the law to make them do their work of ending abortion, which he really thought was gonna happen with Dobbs. 

Something I thought was interesting about him getting real mad about shield laws in blue states was that he portrays them as something untoward, something nefarious targeting red states.

He doesn't see it as protecting the doctors in those states to continue prescribing medicine. He's "They are trying to mess with red states. They're trying to undermine red states' abilities to ban abortion," which is not really what's happening. They're just trying to make sure that they can allow the doctors in the states to continue providing services to their patients, wherever those patients may be.

There's no ulterior motives. But he makes it seem there's this, grand evil scheme going on. Again, he uses, very comical language. He says scheme. He says this operation, this enterprise, all of these criminal-esque, language. And again, it's really jarring to me that, we've had this conversation before, 150-odd years ago.

The same things, he's talking about the shield laws. These are so similar to the personal liberty laws back in the 1800s when states said, we're not going to return Black people who escaped from slave states." And here again, we have some of these states, and we have some of these justices and right-wing judges endorsing this idea that unfree states should be able to reach out into free states and impose their laws on everyone else and impose their unfreedom across the whole country.

They're trying to say that free states should not be able to assist other people fleeing injustice. These are the reasons why we have the 14th Amendment. This is exactly the thing that the Constitution should prevent. But because the right-wing movement has been dismantling the Reconstruction amendments, that leaves us where we are today instead.

In Alito's view, red states have absolute freedom to persecute abortion providers and patients, but blue states have absolutely no authority to protect abortion providers and patients. It's just so obvious what he's doing here. And by the way, we should give a shout-out to the law professors who really devised and pressed these shield laws in state legislatures after Dobbs, David Cohen, Rachel Rebouché, and Greer Donley, also writers sometimes for Slate.

For anyone who says that law professors don't matter and law review articles don't matter, I raise you these three, because- ... Sam Alito is actively mad at them for their work, which is having very serious and important real-world implications. So finally, just real quick, Madiba, the dark cloud looming over all this is that Trump's FDA is currently undertaking this review of mifepristone at the behest of anti-abortion advocates.

And reportedly, the agency has delayed that review till after the 2026 midterms because, in fact, reproductive rights are very popular. But the FDA is now facing this intense pressure from anti-abortion politicians Josh Hawley and anti-abortion activists who say they need to restrict mifepristone ASAP.

It seems That's gonna happen. The FDA is going to crack down on telehealth mifepristone, but after the midterms. And the Fifth Circuit just jumped the gun on that plan that the Trump administration had laid out and gotten ahead of 

it. And so is the Supreme Court's order best understood in some way as, the savvier conservative justices just restoring the original plan to let the Trump administration slow walk this crackdown on mifepristone until after the elections?

Yeah. We see this so much, not just in the case of abortion, but across the far right agenda. We see the Supreme Court actively advancing that agenda, but trying to do so in a way that it thinks it might sustain its power, both the power of the court and the power of that right-wing movement. They don't want to set up conditions where there might be too big a backlash.

And so it's funny when you see these ideologues, whether in the lower courts or sometimes, in Congress or just, other activists, being too eager and just going ham, and the court trying to get them to pump the brakes just a little bit. We're seeing that here, and I feel we just saw this with all the fallout from Callais, where the Supreme Court's Republican majority straight up is "It's totally okay to racially gerrymander as long as you don't say it's racially gerrymandering and you call it partisan gerrymandering instead."

And then you get something Republican legislators being "I'm so excited to racially gerrymander. This is awesome." And it's you guys, there was one thing I said not to do. please just keep it ho- keep it together. 

Follow the playbook. John Roberts knows what he's doing, right? Listen to him and you can be as racist and as horrible on reproductive freedom and as anti-LGBTQ as you want.

You just have to do it the right way. 

one of the things we've really seen be the new targets, it seems to be medication abortion and telehealth.

Why have they become the, new focus? 

Yeah. So medication abortion has been a lifeline after Dobbs, and I don't want to suggest that it's a solution for everyone in every situation 'cause it's definitely not, and there are lots of people who can't use medication abortion, and it's not the care provided for every, every stage of pregnancy, so it leaves people out.

But for sure, it has allowed access to continue after Dobbs, and it's the reason that abortion rates have not decreased, including in states with abortion bans or severe restrictions. So you might know about the amazing WeCount data, which the most recent findings, which I think were of, from December of last year, found that about fifteen thousand abortions A month are provided under shield laws into states where abortion is severely restricted or banned, or they don't allow telehealth.

We can talk about shield laws, which are a piece of the medication abortion picture. But because it allows people to access from where they live, from providers who can be located anywhere in the country, including in states with protections, medication abortion has been a lifeline, and that is why there are so many attacks on it right now.

Yeah, we just had Dr. Angel Foster on talking about telehealth provision and the benefits of the shield laws, and it really, it is making a huge difference to ensure that people are still able to access care. And you said, that is clearly not... It is clearly really important, but not enough. We need to make sure that not everybody wants to do medication abortion or can, and we need to make sure people are able to access in any way they can, but the shield laws go a long way to help expanding access via telehealth.

So true. 

there's been, some chaos that has-- there, it has been chaos honestly since the Dobbs decision, but recently there was chaos with the, the Fifth Circuit was gonna stop all telehealth provis- or mifu provision. And so that, introduced chaos and extra chaos into the system.

How are patients and providers dealing with, all of this, uncertainty and this rapidly chang- changing landscape? 

I think uncertainty now is a given. Of course, we can't lose sight of that after Dobbs, providers had to leave a lot of states, including clients that we at the center had worked with for decades and were mainstays and also pillars of their communities in states like Texas and North Dakota and Oklahoma, just to name a few, Mississippi.

This is not exhaustive at all, and they just had to leave. So since then, there, there's still whiplash. I would say that whiplash is not something uniquely post-Dobbs, and just because reproductive rights have been under attack forever, and in some ways, when the federal courts offered more options to block things, then things would get blocked and go into effect.

Things could change a lot more quickly. Now, four years post-Dobbs, there's been a little bit of settling. We'll have to talk about the huge looming, potential threats around medication abortion that could affect everyone in the country. But I think, providers are stoic. they know that this is How it works, and they just continue to try to provide the care that they, the best care that they can, because they care so much for their patients.

I would say that for people seeking ab- abortion, it's clear that telehealth is, it's not just a lifeline post-ops, it's a, it's a genuinely great thing because it gives people a lot more options, and it's aligned with how people wanna access healthcare generally, on their own terms, on their own timeline, often in their home, being able to choose from a lot of providers, not just limited by who is close by or the ability to get to somebody.

So all of these are, genuine innovations. It's a great thing. What we need is to get rid of all of the legal attacks, complexities, restrictions, so it doesn't have to be operating in this gray space with uncertainty. But I think in general, telehealth has been a, a great thing for abortion access, and that should be a step forward if we could, figure out the legal crisis.

Yeah. It's definitely worth circ- circling back to the attacks on mifepristone, which is just, it just has the potential to just cause so much damage, right? even if they do the narrower version with, just getting rid of telehealth, we just talked about, how, game-changing that was for people to be able to access care, and it's so much better for them to be able to access via telehealth.

It's getting into states where it is banned, but, the system, the clinics that exist, if people have to start coming in person, the system can't currently support them. So I think there's a lot of, People don't quite understand the full ramifications of, what could happen if any version of these miffy bans take place.

I think that's right. 

And definitely people in blue states thinking that they are safe. 

No, we could never think that.

And I think it's just worth... I always try to point out as we're having these conversations about how Roe was chipped away at as we are seeing this exact same playbook playing out around gender-affirming care and transgender rights, and we need to make sure that we are in lockstep solidarity and not letting the same playbook be used again and again.

That's absolutely right, and these are all questions of bodily autonomy. They are going after the most marginalized people first. They did it with abortion. They're doing it with gender-affirming care. That means minors, people who have Medicaid for their insurance. We see exactly, the same type of tactics in the gender-affirming care space that we have in the abortion space.

Is there anything else you're keeping an eye on right now? I know there's so many things happening in the legal space around reproductive health. Is there anything else that you feel maybe isn't getting enough attention? 

the other thing I'll just mention is in addition to the reproductive freedom amendments, there have been equal rights amendments passed as well.

So in Nevada, for example, there was an equal rights amendment passed, a couple of years ago, and we were able to take that equal rights amendment and say that the state's prohibition on Medicaid coverage for abortion violated the Equal Rights Amendment because prohibiting abortion is, or prohibiting coverage of abortion rather, is, sex discrimination because it discriminates based on pregnancy-related care.

So that's another avenue that we have been able to use to protect the right to abortion and expand access to abortion is the Equal Rights Amendment. So New York also passed an equal rights amendment recently, too, and I know advocates are looking at ways to try to implement that to expand, abortion access in a state that's already- provides a, a tremendous amount of abortion care, but, we're always looking at ways to remove barriers and make it easier for people to access abortion care.

Yeah, and since you mentioned Nevada, worth mentioning, it is one of those states, again, that is gonna have a ballot initiative this fall because it had to b- has to be passed twice, correct? 

Correct. That is exactly right. Yep. and I think a lot of people say, if you have the Equal Ri- Rights Amendment, do you still need the Reproductive Freedom Amendment?"

And I say, "Yes." we need all the tools in the toolbox. We need belts and suspenders. We need everything, all the different protections we can get. Let's take them, let's enshrine them in the Constitution. And because of this chipping away effect that we've seen, we know that we need to really build our wall high and get all the protections we can.

I'm trying to think if there's anything else we should talk about. It 

feels Yeah, so look, I'll say, one of the things that makes me so hopeful in a time where I feel there's not a lot of hope- Ah, hope. Is I'm from Michigan. I was born and raised in Michigan, and, when I was growing up in the 1970s and '80s and early '90s, I just dated myself, abortion was heavily restricted in Michigan.

We had a very anti-abortion local government. Sorry, not local government, but state government. I grew up in Ann Arbor, which was very progressive. It was a progressive enclave in a very conservative state. And I saw, as a teenager, the difficulties in people accessing abortion, and I saw the very restrictive policies that my state government was placing on abortion.

And so to fast-forward in my lifetime to see my home state pass at the ballot a reproductive freedom amendment in such large numbers with such support, grassroots outpouring, so many people going to the ballot, I have so much hope that there can be change that in my lifetime. To be able to see that is, is just so meaningful.

And then in what happened in Michigan is the legislature, after the constitutional amendment was passed, repealed a whole host of abortion restrictions based on the constitutional amendment's passage. so that was also incredible, but also didn't go far enough. They, there were a number of abortion restrictions they didn't touch, including one that we challenged.

so we have a challenge to the prohibition on coverage for abortion in Medicaid, and the Center for Reproductive Rights challenged the two-trip requirement in Michigan and some other restrictions, and have been successful so far. We've not been successful yet in, in our Medicaid case, but we're still trying.

So I just think that when we h- are having these moments of feeling of dread and hopelessness, to remember a state Michigan and think of how far we've able to, been able to come in just a matter of a couple of decades, my not even my whole lifetime, 'cause even though I dated myself and I was a teenager in the 1980s, I'm, I still have hopefully a lot of life left.

So- So just thinking about that and thinking about progress and how progress really can happen, it gives me a lot of hope. 

Yeah, I, it is really hopeful to see a neighboring state do that. I was born and raised in Wisconsin, so I kinda had a little bit of the flip story of Wisconsin definitely had its, regression on a lot of those things, and still is not great on abortion.

V- had a big win with the, at the Wisconsin Supreme Court that at least got rid of, a complete ban, which was amazing, but still a long ways to go.

For years, I was saying, "Abortion is healthcare, motherfuckers," on main on Twitter, repeatedly, no regrets.

But I was doing something more specific than just stating a fact. I was pushing back on a particular liberal hedging, the, quote, "Nobody is pro-abortion move." the one. People on our side rushing to say, "We don't abortion. We just think it should be legal. We want it to be rare. We're not celebrating it.

We're tolerating it." I reject that hard. I said, "I'm pro-abortion the same way I'm pro-chemotherapy and pro-stitches. It's a medical procedure. When you need it, it should be available, full stop." Now Chemo and stitches is not a perfect analogy, and I knew it when I made it. Nobody has complicated feelings about stitches.

Nobody thinks their neighbor is a bad person for getting a stitch. But some of the people saying, "Nobody is pro-abortion," were genuinely trying to reach people who feel some type of way about abortion, saying, "I'm not asking you to love this. I'm asking you to recognize it's necessary." They were trying to meet people where they were, and I'm not sure I was giving them enough credit for that.

But anyway, abortion is healthcare, motherfuckers. I still believe it. But here's the trap door. When you say abortion is healthcare, a hostile court can pick that up and run somewhere you didn't intend. Oh yeah? You agree this is healthcare? Great. Here are our healthcare regulations: waiting periods, mandatory ultrasounds, admitting privileges requirements.

We're just regulating healthcare after all. You're the one who said it was healthcare. I don't think I talked about that trap enough. So here's a different version, one that I didn't come up with. Jess Pieklo did. Jess, my longtime co-host of Boom! Lawyered, the person who shaped the way I think about abortion rights for over a decade, one of the sharpest legal minds I know.

About five years ago, Jess launched this framing in an editorial report we published called The Future of Abortion Access. We were writing about medication abortion and how medication abortion was going to be the future of abortion access. That was in 2021. It was more than a year before the Supreme Court overturned Roe.

Jess saw where this was going, and she was already thinking about what the argument needed to look on the other side of it. Jess's framing wasn't abortion is healthcare, motherfuckers, it was abortion is good medicine. And that distinction matters because it's not conceding anything to a hostile regulatory apparatus.

It's saying, here is what clinical and social evidence shows. Here is what actually happens to people when they can access abortion care, and what happens when they can't. The most important study you've probably never heard cited in the political or legal argument is the Turnaway Study that the Answer Research Program conducted at the University of California San Francisco.

Ten years, a thousand women. Researchers recruited women from 30 abortion clinics across the country. Some got abortions because they showed up just before a clinic's gestational cutoff. Others were turned away because they showed up just after it. The women on either side of that line were often in very similar circumstances.

The difference was whether they got the abortion, and that's what the study tracked. Women denied abortions were four times more likely to live below the federal poverty line. They were more likely to stay tethered to abusive partners, more likely to experience serious life-threatening complications from the end of pregnancy, including eclampsia, more likely to experience chronic pain and poor physical health for years after.

And the consequences didn't stop with them. The study found serious implications for their existing children too And five years later, ninety-nine percent of the women who received an abortion said it was the right decision. A thousand women, ten years. That's what good medicine looks It shifts the ground from defensive legal definitions to undeniable human outcomes.

And the Turnaway Study made it all the way to Dobbs. It was cited in amicus briefs by social scientists, by public health researchers, by economists. It was right there in the record. And during oral arguments, Chief Justice Roberts looked at that mountain of evidence and said, out loud, "Put the data aside."

Now, Roberts didn't say that because the data was wrong. He said it because to him, the case wasn't a public health question. It was a question of legal doctrine and judicial philosophy. He wanted to use legal logic to find a middle ground. But the rest of the conservative majority didn't care about a middle ground, and they didn't care about the data either.

They had the votes. The decision wasn't going to turn on science, and it wasn't even going to turn on Roberts' institutional philosophy. It was going to turn on raw power. And that is exactly why evidence in a courtroom can never be the whole strategy. You can't win a public health argument in a room where the decision is already made.

You have to win it before you even get there, in the culture, in communities, in the way regular people understand what's actually at stake. That's the argument we should have been making all along. But we didn't make it loudly enough, consistently enough, or as the thing we built everything else around.

Okay, so I want to tell you why I care about this specifically, why this particular question has been keeping me up at night. I'm a Black woman who covers reproductive rights and justice, which means I am never not aware that the stakes of this argument are not evenly distributed. And I want to be specific about what by that.

Black and Brown women never had a constitutional right to abortion that automatically translated to actual access. Abortion deserts existed under Roe. Sky-high maternal mortality rates existed under Roe. The inability to afford to travel, to take time off of work, to find childcare for your kids, to find a provider, all of that existed under Roe.

The legal strategy won the right to abortion on paper for fifty years, but the public health crisis continued underneath it the whole time. So when Roe fell, Black and brown women weren't just losing a constitutional protection, they were losing a protection that was already failing them, and that's a different loss.

Black maternal mortality in this country is a catastrophe. Black women die from pregnancy-related causes at rates that should be treated as a national emergency, and largely are not. That is documented. It is not contested by anyone who has looked at the data honestly. But it is also a legal crisis. The policies that restrict abortion access, that close clinics and force people to travel or carry pregnancies they cannot safely sustain, those land hardest on Black women, on poor women, on people who are navigating a healthcare system that was already failing them before any of this happened.

And here's the danger of running the constitutional argument and the public health reality on separate tracks. When the legal argument is the main event, you can talk about abortion rights as an abstract liberty interest and never have to say who is actually dying. When your argument isn't grounded in good medicine, you can cite the data as a talking point without ever forcing the courts to connect that data to the specific policies producing the harm.

Now, I cover this beat, and I've done so for more than a decade. I've watched legal victories mean absolutely nothing on the ground for certain populations. I've watched health data get weaponized, and I've watched Black women's lives treated as case studies instead of the absolute center of the argument.

I don't get to treat this as academic, and honestly, neither does the movement. So here's the theory one more time. We had two strategies, a legal one and a public health one, and we used both. I want to be clear about that. We talked about abortion outcomes. We cited the studies. We wrote the pieces. We fought the court cases.

The question I'm wrestling with is whether we treated those as separate projects instead of part of the same argument, whether the legal argument became so dominant that the public health case never got built into something that could stand on its own, leaving us with nothing to lean on when Roe fell.

Because here's the thing about the legal strategy. It was built almost entirely on Roe, the liberty interest arguments, the undue burden standard, the privacy arguments, the whole constitutional framework. When the court overturned it, that strategy didn't just weaken. It lost its foundation. Now, the fight didn't end, but it definitely fractured.

Suddenly, it was 50 different state battles instead of one federal right to defend. But the public health argument doesn't work that way. The Turnaway Study findings are still true whether Roe exists or not. Black maternal mortality is still a crisis whether Roe exists or not. That data cannot be overturned.

what with, all you are saying, we've really been focused on abortion, but I think that the attacks we're seeing have implications for broader than just abortion on reproductive rights.

What are you seeing, and what are you, thinking about at the moment for the broader attacks beyond just abortion? 

Yeah. I do wanna talk about state court a little bit- 

Oh, yeah ... while 

we have a chance, but I think a lot of the a- attacks that are going beyond abortion right now are in federal court.

And there's one area that is very devastating and should never have happened in this way, and that is Dobbs has metastasized to trans rights. And just to tell the legal story of how this happened, it really comes down to just one line in the Dobbs opinion, which should never have been there. Dobbs was a case about the liberty right to abortion.

It was not about sex discrimination, but Justice Alito was so worried that sex discrimination might become a new basis for the right to abortion after they overturned liberty, that he included one line that says essentially regulation of medical procedures that when sex can undergo is not a problematic form of sex discrimination, so these kinds of laws should be upheld.

So this is so sweeping. It goes way beyond liberty and the right to abortion, which is what Dobbs was about, and it was about-- tried to make this about sex discrimination in all medical procedures. So of course, people who are hostile to trans rights and also states that are aligned with trying to oppose any bodily autonomy seized on this and started making argu- arguments that bans on gender-affirming care for minors fall outside sex discrimination protections because they essentially regulate a medical procedure, and Dobbs said that was just fine.

So this got all the way to the Supreme Court in Skrmetti last term, and the court used that logic from Dobbs to hold that the Tennessee ban on gender-affirming care for minors didn't discriminate based on sex or trans status. It said it just regulated a medical treatment that happens to be, to quote, "uniquely bound up in sex," and that's fine.

So before Dobbs, the court had never said anything that sex-based medical procedures are somehow outside of anti-discrimination protections, and that is a very radical rejection of a core premise of equal protection law, which is that- Discrimination often comes from differences in bodies and physical capabilities that are associated with sex and infused with stereotypes, and that, that biological piece is really what leads to invidious forms of discrimination.

But because of the overreach in Dobbs and Skrmetti, that's now binding precedent that other federal courts are using to reject discriminatory bans or to uphold discriminatory bans on healthcare for trans people. 

Yeah, this is one of those I think about a lot because you're seeing the same playbook being used, right?

this is how the attacks on abortion rights really started, was with putting bans on young people and saying young people needed parental consent. and so you're just seeing them use the exact same plays they used to get to the Dobbs decision, starting to attack gender-affirming care now, right?

using young people as, the tip of the spear to, start breaking off support, but also, "Oh, we're just, young people. We need to make sure that, they don't have the ability to make those decisions yet." And then now that the, the legal right has been established, then that you...

I fully expect to start seeing that, grow and attacking more abil- more people's ability to access gender-affirming care. 

It's so true, and the precedent that's getting built sweeps way broader, and then that can be used destructively, for, to attack lots of other people, groups, and even to go beyond trans rights, 'cause the, the underlying premise is really super broad.

Another similarity with abortion rights and trans rights is that the other side tries to manufacture medical uncertainty- 

Yeah ... 

and try to say, "Actually, s- science doesn't know anything about this. Let's just use common sense and say this is probably dangerous, probably has long-lasting negative effects.

If there's any uncertainty, then let's just err on the side of letting states ban things." And of course, that was a huge theme with anti-abortion advocacy, again, against so much data. we don't have to try to convince people. We know that abortion is incredibly safe, but that, that denying the evidence got a lot of traction and is one of the reasons that we ended up here.

Okay. So you said you wanted to talk about what you're seeing in state courts. Let's turn to that. What are you seeing? 

Oh, actually, I did wanna talk about other rights also. Oh, yes. Sorry. And another thing that we have to keep an eye on. So the trans rights, it's infuriating because it's about equal protection, and Dobbs wasn't supposed to be about that.

Dobbs was about history and tradition analysis for liberty rights and laid out that whole test that liberty protections have to be deeply rooted in this nation's history and tradition, which was frozen by the court in- 1868 when the 14th Amendment was ratified. So the court said if liberties were not protected then, they can't be fundamental today.

And of course, we know at that time it was men who were white who overwhelmingly possessed rights and other groups were shut out of even the process of defining the scope of rights and participation. So everyone worried after that, that this approach would reject everything from the right to marry who you want to contraception, to intimacy.

None of those were protected in 1868, but we didn't know at that point what kinds of cases would be cropping up to start putting these things on the line. So now four years later, we have federal courts citing Dobbs' history and tradition to undermine healthcare for trans kids, contraception, and recently, student privacy.

So I don't have to go into a lot of detail about the cases, but for trans healthcare, the Eleventh Circuit, which is the appellate court over the state of Alabama, held that parents don't have a liberty right to, quote, "Treat one's children with transitioning medications subject to medically accepted standards."

And the reason they don't have that right, they said, is this court said, is because this is a twentieth-century invention. 

That is wild. 

And the standard is also so subjective that it just allows courts to do whatever they want and act on their personal biases. So of course, we see parental rights being used, the flip side of it, to support parents' rights to do things that go against their children's bodily autonomy.

So in Texas, we had a judge holding that this was a challenge to part of the Title X program, which provides, as free or low-cost contraception. And Title X has always been run to n-not allow providers to notify parents when minors go seeking contraception from Title X providers. So a parent challenged this, saying that it violated his parental rights to make decisions for his kids.

And mind you, his kids had never tried to go to a Title X clinic, did not, a- according to the facts, express any interest in obtaining contraception, let alone without letting him know. But this was just another attempt to everybody based on really retrograde ideas. So this federal district court agreed that parents have a historically deeply rooted right to make important life decisions for their children, and it would violate that right for Title X providers to even have a policy out there that they can serve minors without parental consent.

So that's a big problem with history and tradition, and is... We're gonna just be seeing more of that on more kinds of reproductive rights as things go forward. 

Yeah, I, It's again, the-- You hear all the people being "They're not coming after birth control. why are you starting to panic about birth control?"

And you're No, but It, it is happening and courts are already starting to make decisions

 

that may limit people's access. this again is the, trying to crack open that door so that they can then expand it further. 

Yeah, and the legal test is just so sweeping. Yeah ... that's one of the giant problems with it.

It would cover everything if it were applied to mean what it says, and these judges to say they're being consistent, although obviously just these two cases- yeah ... that go different ways show, show that's not right. 

And Finally, Section D, Pronatalism, State-Directed Reproduction in Reverse

Simone, can you just describe to me where you live with your family a- and what your family looks like? 

Our house is surrounded by a beautiful field that has fireflies in the summer, and, it's adjacent to the Valley Forge National Park, which is a quite large park in our area, hundreds of miles of walking trails and a stream.

Our kids love to play outside when the weather's good. And while our oldest is in kindergarten, our youngest, are either with me or with neighbors who live right next to us during the day while we work. 

and the chickens, Simone. 

Don't forget the chickens. Oh, yeah, yes, we have... We have a little chicken coop.

We have 12 chickens, which help to keep me sane because when the kids throw the vast majority of their food on the ground, I just feed it to the chickens, feed the eggs to the kids- And a dog ... and there's a beautiful circle. 

And Malcolm, how would you actually define pronatalism? 

Pronatalism is about bringing attention to falling fertility rates and the geopolitical and economic and social consequences of this, and looking for realistic and non-coercive solutions.

So if this is a solution, Simone, pronatalism, what is the main problem that you would say you're worried about? 

With demographic collapse, I'm worried not about the elite tech people that are often attributed with championing this cause, but rather the most vulnerable people in society. Like with climate change, demographic collapse disproportionately affects the people who are most dependent on social services, on governments working, on, medical assistance from governments.

And when you run out of taxpayers who can fund those programs, including pensions, infrastructure development, police, fire, security, things like that, you have huge swaths of people who are not only vulnerable, who not only don't have enough money for food or medical care, but who will likely die. so this is a very serious and very scary issue, and if governments can't figure out how to continue to support the vulnerable people in their societies when they run out of a tax-paying base due to so many old people, we are in really big trouble.

Nomia, Malcolm and Simone were explaining to me a couple of the ideas that seem very important in their lives, but can you help us understand how their definitions fit into a wider view? they gave us the definition of pronatalism, but it's actually more of an umbrella term, isn't it, for quite a broad range of beliefs.

It is. So a general definition would be it's any attitude or any policy that's pro-birth, that basically encourages reproduction. So any view that basically considers parenthood as the most amazing thing that you can do, the most powerful, incredible role. And so basically pronatalists think that people should have more babies.

others go further. They think it should be state-sponsored. And then you have this kind of crossover with those who are anti-abortion, and they believe in total abortion bans. 

What seems to unite all pronatalists though, Nomia, is this concern with population decline, and Malcolm and Simone talked about this a lot, this idea of demographic collapse.

What exactly is that? a- and are they right to be concerned? 

it means that there is a decline in birth rates and that is true. So for a country in the developed world like the US to increase or maintain its population, it needs a birth rate of 2.1 children per woman on average, and that's known as the replacement rate.

So here in the US, the fertility rate fell in 2023 to 1.62. That's a record low. And then last year it was 1.78, so it climbed up, but that's still low, especially if you think back to 1960. It was 3.65. And so if you're a pronatalist, generally speaking, your argument, certainly on the extreme end I would say of that movement, your argument would go something like this.

Birthrates are falling. If we don't take dra- take dramatic action, we're going to witness the extinction of entire societies, the economy will collapse, entire races and countries will be wiped out because of lower fertility rates 

Now, Mira, I've been speaking to quite a few people and asking them what their thoughts are around pronatalism, and I'm surprised how many people haven't actually heard of it.

How long has it been around for? I 

mean, it's not a new concept. if you read the Bible, you've got, be fruitful and multiply, and then there are lots of other religious traditions, and they go all the way back to, I think it's Louis, XIV's France. So they had a policy in France of encouraging large families back in 1666.

There was basically this edict offering tax privileges to fathers of 10 or more children, and that was aimed at increasing the population, strengthening the nation. You had Soviet Russia as well. they wanted to respond to population losses during and after World War II. The goal was increase the birth rates, bolster the workforce.

And then even here in the US in 1920s America, women had the right to vote. They could go to work, and so there were lots of concerns about what that meant in regards to having babies. And now we're seeing this resurgence, of pronatalism because you do have this modern tech look to it, don't you?

You have, many in Silicon Valley who have taken a big interest in pronatalism.

Simone, you're outlining a, a really big problem as you see it. But part of your solution is intensely personal in that you're having lots of children. And Malcolm, how many would you like to have? 

Oh, that's not really my choice as the husband. So I'll shoot that to Simone. 

I would love to have as many children as I can physically have.

So basically until my uterus is removed in a C-section that goes a little wrong or I am unable to carry more pregnancies, I will keep having children. 10, 14, however many I can have. 

So literally, Simone, you are putting yourself at risk, your life at risk for this. 

That's correct, yes. 

That... D- does that frighten you?

I'm really not afraid of losing my life in a pregnancy or compromising my health. This is something that throughout history has been something that women have gladly taken on. Basically, in the past, women died in childbirth at around the same rate that men died in battle, and yet you hear plenty of stories throughout history of both men and women being very excited to further their values, to support their families and their countries by doing these things respectively.

You must worry for her as well, though, Malcolm. This is your wife endangering her life- I 

do ... in order to have more children. and people have asked me, they go, "Oh, would you stop her from doing this?" And I'm like, but then that's stopping one of my kids from coming into existence." and I've interacted with my kids.

I love my kids. and I appreciate what she goes through and the risk she puts herself through and her body through. I also understand that if I tell her to stop, I'm functionally erasing all future kids we have from existence. if a, an intruder, had your wife and your kid at gunpoint and they're like, "Choose," like everybody knows the right choice in that situation.

It's just that the way our society views kids right now, we assign no value to the life of a child that isn't born or conceived yet. 

But Malcolm, I know for both of you, it's not just a question of how many children you have. It's kind of the other qualities that child also has too, and you use a lot of data and you make other considerations when it comes to having a child.

Can you talk us through that data? 

So one thing that we do with our embryos is called polygenic risk score selection, PGTP, which is a more advanced version of the typical pre-implantation genetic testing done by many couples who do IVF already. This has been done for over 10 years. This is just a more advanced and detailed version of it.

This allows us to look at which embryos have higher risks of things like cancer, which we're very concerned about, and then have the higher cancer risk children later with hopes that once they're adults, they're more likely to have access to screening and cures that will save their lives. Now, PGTP also enables families to test for things like height and intelligence, which are considered very controversial terms, but when you look at parents' interest in giving their children the best advantages possible, their willingness to pay for things like test prep courses and send them to all these special tutoring sessions, we really have trouble seeing a big difference between looking at an embryo's odds of having high educational attainment or high earnings, versus trying to intervene after they are born.

What about after the children are born, and the names that you choose to give your children? Because y- you obviously, your approach isn't just before they're born, it's after as well. 

We want to give our children very strong signals in many ways throughout their lives that we have high expectations for them, that they belong to a culture that expects them to contribute to a better future and to the betterment of humanity.

We also want a culture that differentiates them from the rest of society, because we've found that what we call the urban monoculture, basically the predominant culture in most developed countries and most urban areas, is very toxic. As we can see through declining birth rates, it is a sterilizing culture.

So we give our children names like Octavian and Torsten, Titan and Industry to show them, among many other things, that they are different and they are not like these other people, because we want to protect them from something we find to be very harmful

Now, Mia, the Collinses talked about the qualities that they want their children to have. So it's not just about having lots of babies, it's the kind of babies that the qualities that these children have. Is that also quite common among pronatalists? 

It's interesting, isn't it? The pronatalists, many of them don't want to just increase the birth rate.

Some want to optimize the children being born. you get those who are pro-family and pronatalist. I think that's probably how I would try and separate the two, and not everyone who is pro having kids probably tests their embryos to the extent that the Collins family do or even can afford to do it.

So you do get families who do the common testing to make sure their unborn child is healthy, not at risk of any hereditary diseases. But whilst the numbers doing what the Collins family is doing is much smaller, I think there is actually a huge push by the Silicon Valley tech world. Prominent figures in the tech industry, they're not just passive observers, but they're almost becoming like active participants in this reproductive revolution.

They're investing so much money, like millions and millions in startups focused on fertility and genetic technologies to try and encourage, super babies. And of course, that is just ethically hugely controversial.

Why do Elon Musk and JD Vance want us to have more babies? I want more babies in the 

United States of America. 

Musk himself is thought to have had 14 children, and there's other rich men in Silicon Valley pouring their money into fertility tech, and extremists who want to breed what they believe is a superior race.

So why do these people think society is about to collapse, and is there any truth to it? This couple are breeding to try and save the world. Simone and Malcolm Collins think they're intelligent, genetically superior to others, and so have a duty to produce as many babies as she can physically carry.

Simone's having her fifth child, and claims to have screened her embryos' IQ to check their intelligence. Pro-natalists like Simone and Malcolm think they've got support right at the top of the US government, but is that true? 

So JD Vance is, a self-professed pro-natalist. He wants Americans to have more babies, and he's been very vocal about that.

But he's also a figure of what's known as the tech right. Peter Thiel, who's a huge, venture capitalist in Silicon Valley, is the figurehead of this group. 

Peter Thiel, if you didn't know, co-founded PayPal, was an early investor in Facebook, and now runs Palantir, a controversial data company which has contracts with the US government and the NHS.

He's also an investor, and one of his interests is fertility tech. 

And JD Vance was sponsored by Peter Thiel. his Senate race was sponsored by Peter Thiel. These are very powerful and influential wealthy figures in American politics, who are very proactively putting out this message. 

What about Elon Musk?

We're talking about the tech right. He's sort of the final boss of the tech right. 

Elon is, yeah, very, openly pro-natalist as well. He believes he can create smarter children, and he should. When one of his kids was crawling around the Oval Office, where Trump said, "He's a high-IQ individual," this is clearly something that's very important to these people.

A lot of these men run companies or countries, so population growth is of particular interest to them. 

Population growth has always often been linked to economic growth, and population decline, they fear, is gonna cause economic decline. who's going to buy all this tech that they're, producing?

Who's gonna use all these- businesses that they're investing in 

So some right-wing tech bosses and politicians seem to be into this idea. But has the current administration actually done anything that could be seen as pronatalist? 

so far not very much. there was one executive order, very early on that said it was going to try and make IVF more affordable.

He's done a lot in the eight months he's been in office, but very little that would be seen as really obviously pronatalist. 

And a lot of these tech bosses will obviously be well across the developments in AI and how quickly that is speeding things up. How does that play into all of this? 

So you have, a lot of these rich tech entrepreneurs who are developing a technology and investing billions and billions of dollars in a technology that we- mostly agree will take away human jobs.

And at the same time, they're arguing that population's gonna decline and there's not gonna be enough workers. And those things seem to contradict each other massively. 

The tech right are not the only people in the US that want people to have more babies. Pro-natalism also has a more traditional religious strand, both Christian and some Jewish.

So in March, there was this conference, it was in Texas, and it brought together quite a few different strands of this pro-natalist movement. So you had people from the tech right, people who, like Simone and Malcolm Collins, and others who really support IVF and support embryo screening. And then there's a kind of Christian right, more traditional family values, who believe that, people should have as many children as they can because of some kind of moral, spiritual obligation.

But they don't all agree on everything. A lot of the traditional Christian right don't believe in IVF. They don't like the idea of creating embryos that might be destroyed. 

So we've spoken about a lot of men so far. Are there any women on board with this idea? 

Simone Collins is w- is a main figurehead of the movement.

and there were, there was a conference in March, there were a few women speakers- Okay ... but it was overwhelmingly men. But there are, there is a kind of growing movement in, on the conservative, right wing in American politics, trad wives, women who are saying that they don't want to work and they want to focus on family.

And I think Turning Point USA, Charlie Kirk's movement, there are a lot of people who identify with that movement because they identify with, traditional family values, and a lot of them are women. 

In a pro-natalist perfect vision, are women, if they're not working, are they basically just machines to keep having babies?

you could argue that. It's, maybe pro-natalists would defend themselves and say, "No, we're just arguing that, women focus on having babies while they're younger, and then move on to a career afterwards." I think there is an element that does believe women should just stay at home. 

There are some more extreme strands in this movement.

Some extreme pro-natalists are more worried about the population of white people than anyone else. They believe in the great replacement theory, a far right, white nationalist conspiracy theory, the idea that other cultures will replace white culture 'cause they're having more babies. So what's the truth about population decline then?

It is true that birth rates have been falling massively in lots of places, and that does matter. For a country in the developed world to increase or maintain its population, on average there should be 2.1 children for every woman. That's called the replacement rate. In England and Wales however, between 2022 and 2023, the average was just 1.44 children per woman.

That's a record low. In 2024, Scotland's was even lower at 1.25. And in 2023, the US's hit a record low at 1.62. And South Korea's is the lowest in the whole world at 0.75 children per woman in 2024. But it's not falling everywhere. Lots of countries in Sub-Saharan Africa are seeing higher birthrates. And you can see what birthrates do to a population through these pyramids.

Youngest are at the bottom, oldest are at the top. A growing population looks something like this. The pyramid is thicker at the bottom with new babies being born, and tails off towards the top as old people die. For example, Senegal. But in other places like Singapore, the pyramid looks more like this, getting thicker around the middle, around 20 and 30-year-olds.

So when they age up, there's not enough babies to replace them. That means less young people to pay taxes, help with pensions, and help care for older people, which worries some governments. So what can they do? Having more babies is not a quick fix. It'll be around 20 years before they actually start putting money back into the system.

An obvious answer to there being not enough people of working age is to make people work longer by raising the retirement age. China has opted to do that, and France is planning to do the same despite huge protests. And finally, governments could bring in young people from elsewhere. 

So the, the fertility levels have been dropping in the UK, since the, the '50s really, and immigration has been filling that gap more and more.

but people aren't happy about that. Clearly, politically, it's just not a popular solution. So you will have a lot of young people in Africa looking for work, but there's many people that, that don't want that to be the solution. 

And does that come back to the sort of great replacement theory where they don't actually just want young people at any cost, they want young Western people?

Yeah, I think there's real fear that will alter the cultures in our country, in a way that people aren't comfortable with. 

If economies improved around the world and people felt more financially comfortable, do you think that would naturally boost how many children were being had? 

I think it would a little bit, for sure, if people could afford a bigger house and if they weren't worried about childcare.

but I think there's something deeper in our choices to have few- fewer children. More children now survive because, as, as, like early- as healthcare for kids gets better, people choose to have fewer. And then I think there's another big shift, which is that whereas before you'd become an adult and you'd have

And you'd find a partner and get married pretty young, and it was the cornerstone of your adult life, whereas now it's the capstone. There's the stigma around having no kids is not as, as ... I think there is still stigma in most societies, but it's in no way as powerful as it once was. And then there's arguments that, young people aren't meeting each other anymore in the way that they used to, and that, marriages are down, even coupling up is down.

Again, these are all big cultural things that, that aren't gonna change just because people are earning a bit more money or feeling a bit more comfortable financially

it happened as Ceaușescu led a policy of economic growth through trying to increase the population.

Contraception and abortion were severely restricted, so many people had more children than they could cope with, then leaving them in state care. The problem did not end there. At the age of 18, most of them were sent out to fend for themselves with no support. nowadays, many of the children who suffered are adults still haunted by what happened.

Any efforts to have the abuse and deaths recognized have failed due to an alleged lack of evidence. All that as Romania sees a growing nostalgia for communism. Maria Gurt Nicolescu and Bastiaan Renwie revisit Romania's lost children for France 24.

This is the castle and the former children's medical institution of Sighet, where I grew up. We were sent here to die. We were abandoned and sentenced to death. 

This door marks the entrance to Simanca's hell. She was only three when her parents left her at a hospital. She was then sent to this center for children with disabilities deemed irrecoverable by Ceaușescu's regime.

We 

went through terrible times, terrible things here in Sighet.

During the communist era, thousands of children were placed in 27 medical institutions. They were abandoned, often after being wrongly diagnosed with cerebral diseases. This happened because of the regime's pro-natalist policies, which banned abortion, and widespread poverty. 

This was my bed right here

And look at what still hurts me the most

These are awful memories. We couldn't tell if it was day or night, just darkness. It was cold. We were naked and covered in our own waste. They never changed our sheets, nor our clothes

138 children died at Shige's more than eighty percent of those residing there

According to their death certificates, most died from pneumonia in secret, out of sight

The only memorial to these children is a few kilometers away across from the village cemetery. These crosses were put up after the fall of communism

This monument lists the names of the children who

died at Sighet. 

Most of them passed away before 

1989, 

and as you can see, 

they 

died very young. 

For seven years, Florin Soare 

has been investigating these irrecoverable children. He estimates 15,000 minors died in state-run institutions. 

For 

the Communist regime, these children were seen as an unnecessary burden that had to be removed.

How 

did they 

deal with this burden? By eliminating them physically. As a result, they were cut off from society and brought to these centers with no other purpose than to die. 

The

victims' bodies were never exhumed. Witnesses say they were buried here without graves or any religious ceremonies. 

From

what we know, the children died one after another. They were left to pile up, then taken here to be buried in carts or tractors. 

Everyone in the village knew about the horrors of Sighet. But most of the former workers are either dead or won't testify, making the investigation difficult. This woman is one of the few exceptions.

She cooked for the children at the center for 35 years, and now claims that staff lacked resources and downplays 

her role. You knew they were dying, didn't you? 

I know they died,

but they didn't die of hunger, and they didn't die of cold in summer either. 

The 

death certificates say they mainly died of pneumonia. Yes, from

cold. 

It was very cold. There was no way to dry the sheets properly. If 

a 

healthy person sleeps with wet sheets, how will they feel? 

Like he had a dry 

sheet?

No, not good. There was no dryer. 

Those who are willing to testify often share similar views. Despite the challenges, Florin continues his investigation across Romania. 

It's important for 

us and future generations that the truth comes out. I believe 

those

responsible for these abuses should be held accountable. 

And

I think it's essential for the Romanian state to acknowledge these abuses, and for survivors to receive 

reparations. 

The

Institute for the Investigation of Communist Crimes has filed three complaints, aiming to shed light on the mistreatment and demand compensation for victims.

Here are the death certificates. These documents only cover three centers, 

but

they represent almost 2,500 death certificates. 

each 

one marks a child who lost their life in one of these homes. 

You 

can see how many of them died in the centers.

Two complaints have already been dismissed by prosecutors. They argue it's impossible to link the deaths to the conditions in the institutions, citing a lack of forensic autopsies. 

But Florin 

believes these investigations have been poorly handled. 

Many of the 

victims heard were not relevant, as 

they 

had been admitted after

1990. 

They also heard from parents who claimed the conditions were good in these centers, despite never having visited them. For our team, it

was extremely shocking to see that the thousands of documents and pieces of evidence we submitted to these cases were not considered by the prosecutors.

Near

I was chairing a research network on early experience and brain development, and two members of the group, Charlie Zeanah and Nathan Fox, and I launched what is now known as the Bucharest Early Intervention Project, which continues to this day.

And there were three goals. One was to examine the effects of institutionalization on brain and behavioral development. A second is to determine if these effects can be remediated through an intervention, in our case, very high quality foster care. And the third was to improve the welfare of children in Romania by establishing foster care as an alternative to institutional care.

In Romania at the time, they viewed institutional care as the intervention for child abandonment. So just by way of background, this really w-- was an experiment in social engineering engineered by Nicolae Ceaușescu, who is this individual here. So in nineteen sixty-six, Ceaușescu, who took o-over, the country, he was a shoe cobbler by trade, had an idea that he could increase his power if he increased the population.

And to increase the population, he set into motion a series of decrees which began with the menstrual police. So these were state gynecologists who conducted monthly checks of women, of childbearing age who had fewer than five kids to make sure they weren't using birth control or hadn't, terminated a pregnancy.

He established a celibacy tax whereby families received a stipend if they had more than two kids, but they were taxed heavily if they had fewer than five. And finally, he had outlawed all contraception and abortion. And the result was that in, before, before I go to that, was that by the time he was overthrown in nineteen eighty-nine, there were more than a hundred and seventy thousand children living in state-run institutions.

So I now wanna show you a brief video clip of an individual now in his thirties who was the byproduct of one of these early, orphaned children.

1989, communism fell and the world went to Romania to cover the fall of CeauÈ™escu. There were some medias that actually found institutions that were never meant to be discovered by the public or the outside world. It left the world in shock that such conditions even existed. 

Those of us who visited these institutions built by the communist regime are unlikely ever to forget them.

Hundreds of children not so much cared for as contained

at the age of six months old, I became ill and my parents took me to a hospital, to be treated for my illness. But instead of finding healing at a hospital, I actually ended up being infected with polio. My parents took me to a different hospital in Sighetu MarmaÈ›iei. They never came back, so the state put me in an institution for handicapped children, an orphanage known as Home Hospital for the Irrecoverable Children 

What's in this room, no one could prepare for.

Filthy, dark, and stinking. There's excrement everywhere. These boys are the most difficult cases. They deserve the best of care. Instead, they get the worst 

From the moment that we could remember for ourselves, that's all we knew. We didn't have compassion. We didn't have feelings or emotions. We just existed to just vegetate, We were just wild animals that needed to be caged up is what we were considered pretty much. Like 

Okay, I think we've seen enough of that. as someone who in my other life studies neurodevelopmental disorders, I actually recognize this phenotype. The difference is that the disorders I study usually are single gene mutations, whereas these are a byproduct of the environment for the most part.

we've known for decades that children, reared in institutions are at a very high risk for a variety of cognitive, social, and behavioral problems, including disturbances in social relatedness and attachment, externalizing behavior problems, inattention, hyperactivity, deficits in IQ and executive functions, and a synd-syndrome that mimics autism, and then growth stunting.

So here's an example of growth stunting. So I want you to be thinking if these are boys or girls and how old they are. So this is a seventeen-year-old girl, and this is a fourteen-year-old girl.

So the study we did is actually a randomized control trial of foster care as an alternative to institutional care. And the way we did this is that we screened more than a hundred and eighty y-y-infants and, f-baby-- basically kids under about a year or two to make sure they didn't have a frank neurological or genetic syndrome.

We could only do behavioral exams. We couldn't do blood work and the like. And of more than a hundred and eighty, we wound up with a hundred and thirty-six that we considered to be typically developing. Not easy to do when you're looking at babies who are nine, ten, or eleven months of age, but they looked to be typically developing.

And we also recruited a sample of seventy-two children in the community who had never been in an institution. They lived with their family. After an extensive baseline assessment, these hundred and thirty-six children were randomly assigned to either to remain in institutional care, what we'll call care as usual, or to be randomly assigned to a high-quality foster care program that we built, maintained, and paid for ourselves.

the original goal was to see these children for the first few years of life. So in fact, we saw them at nine, eighteen, thirty, and forty-two months, and at fifty-four months, at which point the intervention formally ended and was turned over to the authorities. And, then we thought we would go a little bit longer, so I found funding at age eight, and we saw them then.

And then I was tired of commuting to Romania, but then I found funding at age twelve. And I said, "That's enough," but then we found more money, and then we saw them at age sixteen. And we were just re-funded to see them again at twenty-one. In fact, I'm there in three weeks to launch the twenty-one-year follow-up of these kids.

So the three of us who do this work come from different backgrounds and we're all thick-headed. So when it came time to discuss what was the most important thing to study, this is the shortlist. Of what we came up with because we really couldn't agree on what were the most important things to study. I thought naturally it was the brain and Charlie Zeanah thought it was mental health.

so I'm su- going to summarize just a small set of the findings because of time limits. And all the findings I'll talk about today and for those of you here tomorrow are based on what's called an intent to treat design. There are a lot of ethics involved in this study that I'm not gonna talk about, but what this comes down to is that we fully expected over time the original-- the children in one group or the other would change group assignments.

A classic example would be a child who was randomly assigned to the institutional group, the authorities decided that child should be reunited with their biological family or that child should go into government foster care or be adopted. We had no say in this. We didn't interfere in this, but over time, children changed their group assignment.

But we analyzed their data based on their original randomization schedule 'cause that avoids the pitfalls of selective, of sample bias so I'll start with IQ and then move from there. At baseline, when the kids on average are about twenty months, using the Bayley exam, you can see that the children in the institutional group are actually below the cut point for intellectual disability compared to the children in the never institutional group.

So then the question is, what happens following random assignment to foster care? We'll start with this. This is going out to fifty-four months. At every age, you'll see that the children in foster care have markedly higher IQs than the children in the institutional group. And here, the more important finding is that this is only foster care.

The children placed under the age of two have markedly higher IQs than the children placed after two. Even as late as twelve years of age, what we see is we still see an intervention effect. Here's full scale IQ, never institutional group, foster care group, institutional group. And one thing to keep in mind is that this intervention was not designed as a cognitive stimulation program.

It was designed to build relationships. So we didn't have any idea that IQ would benefit like this. But nevertheless, we continue to see this, and we see no washout. Even through sixteen, where we're now going through the data, we still see an intervention effect. so young children living in institutions show reductions in IQs, removal from institutional care and placement into high quality foster care before two leads to a recovery, although not full recovery.

and we see stability across the first twelve years of life. The one thing I'm not going to show you is that when we look at placement disruptions, because it turns out because of the authorities, there were kids who made multiple placements. They went from the institution back to their biological family, re-abandoned, then to foster care.

The children who show more placement disruptions have much less favorable outcomes. Stability matters. Turning now to attachment, the issue-- the question now is, if you look back fifty years in this literature, what you often see are disturbances in attachment behavior. So this is the relationship a child has with a caregiver.

And so we assume that these perturbations in attachments early in life could alter the trajectories of other aspects of social emotional development. So let me give you an example, of this. This is, what's called the strange situation. This is the manipulation where a child is in a room with a caregiver and maybe some toys, and then a stranger walks in the room, how the child behaves with the stranger.

Then the caregiver leaves, how the child interacts with the stranger. Then the stranger leaves and is left alone, and then a, an adult comes back in the room and how they respond. So this is an eighteen-month-old, and I want you to watch, what goes on. So right now, this is the phase where the child's been left alone with the toys

Are they not my brother?

Are they not my brother? oh. You're the man you may embrace. oh. Yes, I'm ready. I'm ready. 

This looks like a classic reunion episode. he jumps into her arms, holds on to her, but that's the first time he's ever met this woman. And that's the indiscriminate behavior that w-is very common among kids with histories of neglect.

In fact, Mike Rutter, the distinguished child psychiatrist in the UK, argues that this is part of a syndrome of institutionalization syndrome. So what we see at baseline is among the never institutionalized children, about seventy percent look like they have a secure attachment. The same number of inst-- of, institutionalized children have an insecure attachment.

So it's profoundly disruptive at baseline. Now, if you look at the intervention, the children placed in foster care before twenty-two months, seventy percent have a secure attachment. The children placed in foster care after twenty-two months, twenty-- seventy percent have insecure attachment. So we see that same inflection point.

At fifty-four months, and then again at eight, and the findings are the same, we did a functional measure of attachment behavior. And what we did is we arranged with the caregiver or the mother that we said a stran-- someone was gonna knock on the door, let your child answer the door, and let your child do whatever they wanna do.

So with that arrangement, the stranger knocked on the door, the child answered the door, and the stranger said, "Come with me, I have something to show you." Took a lot to get this through our ethics board, and this is every parent's nightmare, right? and the question is, will they walk out the door and walk off with a complete stranger?

If you look at the institutional group, more than fifty percent of the kids in the institutional group walked off with a complete stranger. That was cut in half of the kids in foster care, and th-there was one in the community who did that, so we've been monitoring that child for twenty years now to see why they did that.

So children experiencing early institutional care are, far more likely to develop disturbances in attachment than those who did not. Children randomly assigned to foster care following institutional care, particularly if they were younger than twenty-two to twenty-four months, are like-- more likely to show an improvement in attachment behavior.

We're speaking to you ahead of the annual Natalism Conference. You've mentioned it already, Malcolm. It's happening in Austin this weekend, and you are going to be sharing the stage, though, with some eugenics advocates and some people who promote extreme views that you yourself have said you don't agree with, including, I know, Kevin Dolan, and he says that eugenics and pronatalism positions are very much aligned.

Malcolm, are you comfortable when you have to share a platform like that with someone like Kevin? 

it's a very different way of seeing the world. I personally, and as I've said, what I like about the pronatalist movement is the diversity of views within it, and that when I go to the Pronatalist Conference, I get to hear ideas and perspectives that I don't get to hear anywhere else 

There's been this investigation, Nomia, into the organizer, Kevin Dolan, and they found his pseudonym Twitter account, and on that he shares homophobic, racist, anti-Semitic views as well.

And you mentioned that great replacement theory. He promotes that conspiracy theory as well, and said that eugenics and pronatalism positions are very much aligned. How do you think, Nomia, the Collinses keep a distance between themselves and these groups when actually they're sharing the same platform with them?

the way they keep the distance is just by saying, don't they, that we don't agree with them. We agree with the actual movement of pronatalism. We agree with the concept of increasing birth rates, but, we don't share that view. That's why you do get critics of the pronatalist movement who say, if you want to advance this movement, if you believe that this is the right way to increase birth rates, then you've got to look at who else is joining you with that message.

And, just also worth saying that critics of pronatalism, they say it doesn't just overlap with racism. They also are concerned about misogyny. They think that the sort of the pronatalist movement certainly, again, the more extreme parts of it view women as breeding machines whose job is to repopulate the Earth.

When Donald Trump entered the White House for a second time this year, Nomia, his two top officials in his new administration, JD Vance, the vice president, and Elon Musk, are both men who have been very supportive of pronatalism in the past. Have they actually used their platforms though to push pronatalist ideas?

Elon Musk is constantly accompanied by his child everywhere he goes, whether it's the Oval Office, whether he's on Air Force One and what have you. And he recently welcomed his 14th child with another woman, but he's someone that's completely on record for saying that human population is on the verge of collapse.

he's really sowed panic over it, and he is saying that low birth rates present this huge risk to civilization, much more than global warming, he claims. You've got JD Vance, the vice president. He has three children. We know he's had a lot to say about women who don't have babies in the past, calling them childless cat ladies.

Before he was elected, he downplayed it, but, when he gave his first speech as vice president, this was at the March for Life in Washington, DC, regularly held every year by those who are anti-abortion and those who call themselves pro-life. He said that he opposes abortion because, to quote him, he wants more babies in the United States of America.

And then also another key member of Donald Trump's administration is Sean Duffy. He was confirmed as the transportation secretary, and shortly after that, he circulated an order telling his department to give preference to communities with marriage and birth rates higher than the national average when awarding grants 

If this continues, Nomia, and this Trump administration chooses to adopt even more pro-natalist approaches or policies, do you think that's gonna cause any tension with his more traditional conservative base?

Oh, very much Americans widely support access to IVF, and just to remind, inv- in vitro fertilization treatments. And, this is... and Donald Trump wants to make IVF free to people who want to grow their families, basically. but I have seen myself how the anti-abortion movement tends to oppose it on the grounds that it creates unused or discarded embryos which they consider to be children.

So the Alabama Supreme Court last year recognized embryos as children, and that caused a massive split in the conservative movement. I was speaking to Christians who were relying on IVF to make families, arguing, you can't get any more pro-life than IVF," and then speaking to others who said that IVF is not a normal way of having children, they would argue, and so you have that split.

The Collinses, though, Nomia, definitely feel like this new Trump administration poses a huge opportunity for them. Given what you've just said, you can see why. 

Definitely. And, Donald Trump is also very closely aligned with the tech world. Fertility generally is becoming this sort of pet project in Silicon Valley.

I think in 2023 there was about $874 million invested in it. You've got Sam Altman, he's the head of Open AI. He wants to have a big family. He's investing in experimental fertility technology. It's a startup working to make egg cells out of other cells in the body, which basically means that a woman without viable eggs or even two men could make a baby.

You've got some that are experimenting with using artificial wombs. And, in some ways, this, this technology-forward vision of pro-natalism has become a religion. And so I can see why families like the Collins would look at the Trump administration as a real great opportunity for them to push forward their philosophy.

Nomia, 

thanks so much. And 

you. Thanks so much, Lucy

Pro-natalism now has two very powerful advocates right at the heart of government in JD Vance, the vice president, and Elon Musk. Simone, what are your expectations of those two men in office? Elon 

Musk is a little bit busy with DOGE, so I don't expect him to be very involved in pro-natalist policy, but he's been always a huge advocate of pro-natalist policies, as well as raising awareness about demographic collapse.

We are profoundly grateful for that. We're thrilled that JD Vance is vice president, and that in his first speech as vice president, he talked about the importance of America having more babies. When you look not just at these two men, but many people within the Trump administration, you can see that pro-natalism is really permeated throughout the entire organization, from Karoline Leavitt, who sometimes brings her infant into work with her, to just the number of children that members of the administration have.

we're talking five, six, seven. You can see that these are people who just fundamentally agree that children are good and that the future is important, and we find that to be incredibly helpful. We have submitted executive order drafts to the administration for low-hanging fruit that we think could make lives a lot easier for parents and increase the total fertility rate of the United States.

We have very high hopes for this administration. 

going to be it for today.

As always, keep the comments coming in.

You can record - and re-record - a voice message by tapping the link in the show notes,

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or simply email me to [email protected]

The additional sections of the show included clips from;

Stuff You Missed in History Class

5-4

Bitch Talk Podcast

BreakThrough News

The John Fugelsang Podcast

Amicus

rePROs Fight Back

Boom! Lawyered

The Global Story

BBC News

FRANCE 24 English

and UCTV

Further details are in the show notes.

Thanks to everyone for listening, thanks to Deon and Erin for their production work for the show, thanks to Amanda for all of her work behind the scenes, thanks to our editors and thanks to those who already support the show by becoming a member, purchasing gift memberships, or making one-time donations.

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So coming to you from far outside the conventional wisdom of Washington, DC, my name is Jay! And this has been the Best of the Left podcast, coming to you twice weekly, thanks entirely to the members and donors to the show, from bestoftheleft.com.