April 16, 2024

U.S.A.

  • Alec Baldwin’s Rust, the on-set shooting, and the ongoing legal cases, explained
    by Aja Romano on April 15, 2024 at 7:16 pm

    Rust’s chaotic production resulted in the death of a cinematographer when Alec Baldwin’s prop gun accidentally discharged. | Angela Weiss/AFP via Getty Images Armorer Hannah Gutierrez-Reed has been convicted of involuntary manslaughter in the 2021 shooting death of Halyna Hutchins. By all accounts, it was an accident everyone saw coming, but the questions and chaos surrounding the death of cinematographer Halyna Hutchins while filming the Alec Baldwin movie Rust have only grown more numerous in the two years since the fatal incident. In the latest development in an ongoing legal battle, armorer Hannah Gutierrez-Reed, the chief weapons handler for the film, was convicted of involuntary manslaughter on March 6, 2024, despite supporters arguing that she was being scapegoated; after all, she reportedly spent the weeks leading up to the shooting warning her supervisors of unsafe conditions while seeking — and being denied — more opportunities to attend to gun safety. On April 15, Gutierrez-Reed was sentenced to 18 months in prison. Santa Fe District Attorney Mary Carmack-Altwies announced exactly a year ago that the county would bring charges against Baldwin, who was one of the film’s producers, and Gutierrez-Reed for the cinematographer’s death. Hutchins was killed in October 2021 on a ranch near Santa Fe, after a prop gun Baldwin was holding accidentally discharged. The film’s director, Joel Souza, was also non-fatally injured in the shooting. Baldwin was formally charged, but prosecutors soon dropped all charges against him. Yet the charges were dropped without prejudice, meaning prosecutors could still choose to refile them or file different charges against Baldwin in the future. Prosecutors claimed to have dropped and subsequently refiled the charges in January 2024 only because they had new forensic evidence regarding the gun Baldwin fired — a Pietta replica of a .45 Long Colt that seems to be the other central figure in this case. Baldwin has long maintained that he never pulled the trigger, but a new forensics report published in August claimed, in an apparent contradiction of previous tests on the prop, that he must have. On the strength of that new report, the prosecution revived the case against Baldwin. He can only be convicted of one of the two different counts of involuntary manslaughter against him, but faces up to 18 months in prison. Baldwin’s lawyers responded by saying, “We look forward to our day in court.” The back-and-forth prosecution follows an already lengthy investigation into the incident by the Santa Fe sheriff’s office that concluded in October 2022. The report, which was crucial in prosecutors’ initial decision to file charges, focused on lapses in safety procedures on the film’s highly criticized set, though it failed to determine the most important factor — exactly how loaded guns with live ammunition made it onto the set. This issue remains unsettled despite numerous investigations and lawsuits surrounding the production environment on the Rust set, alongside conflicting views of the accident itself. The assignment of blame has also proved elusive on a set plagued by claims of labor exploitation, rushed work, unsafe conditions, and “very fast and loose” handling of weaponry. At the center of the case are two unsolvable mysteries At the center of the case against Baldwin and Gutierrez-Reed are two questions: Did Baldwin pull the trigger? And how did live rounds get on set to begin with? No one disputes the broad facts of what happened on October 21, 2021. Prior to the filming of the scene, Gutierrez-Reed, a props assistant who doubled as the on-set armorer, examined the gun. She looked inside the barrel, spun the barrel, visually confirmed what she believed were dummy bullets — fake bullets containing no live ammunition — and handed the gun over to assistant director and production safety coordinator David Halls to take to the filming location. (Halls avoided facing trial by pleading guilty to negligent use of a deadly weapon.) Safety protocol calls for Gutierrez-Reed to have checked all the bullets in front of Baldwin herself — and she claims to have intended to do so, asking Halls to let her know if Baldwin required her to come down to the filming location and directly examine the gun. But according to a lawsuit later filed by Gutierrez-Reed, the gun wasn’t actually intended to be used in that afternoon’s filming, and Halls was just “sitting in” with it, keeping it in case it became necessary for later use — which it did when Baldwin decided to rehearse an unscheduled scene that required the gun. At that point, Halls should have summoned Gutierrez-Reed to come back and further examine the bullets inside the gun. Instead, he yelled, “Cold gun!” — “cold” meaning a gun that was not loaded with live ammunition — to warn the crew that a gun was about to be discharged. Then he handed it over to Baldwin. While Baldwin was following Hutchins’s instructions to aim the gun toward the camera, the gun discharged, striking both her and Souza. Baldwin has always been adamant that he never pulled the trigger. He has explained that he would never pull the trigger on a prop gun while it was pointed at another human (though safety protocols forbid pointing any prop gun at any human for any reason), and that the gun discharged independently. He instead claims he cocked the gun — that is, he pulled the hammer back — and that when he released it, the gun suddenly discharged on its own. Later, FBI forensics reports on the same gun apparently contradicted Baldwin, suggesting that this particular prop gun could only be discharged by pulling the trigger after the gun was cocked or partially cocked. Yet those reports, according to Baldwin’s attorney, downplayed the fact that FBI investigators tried repeatedly to discharge it and were unable to do so, either by pulling the trigger or through any other means. “The gun fired in testing only one time — without having to pull the trigger — when the hammer was pulled back and the gun broke in two different places,” attorney Luke Nikas stated. “The FBI was unable to fire the gun in any prior test, even when pulling the trigger, because it was in such poor condition.” The new forensics report seems highly contestable from the outset because, again, the gun fell apart after the one and only time the FBI was able to get it to fire. In order to conduct testing, the new forensics expert, Lucien Haag, had to replace the broken gun parts, so his analysis was not based on the gun’s exact condition at the time of the shooting. Haag’s testing found that the gun, with replaced parts, was unable to discharge without at least two pounds of pressure being exerted to pull the trigger. He also cited the seemingly careless way Baldwin tended to place his fingers near the triggers of guns as evidence that he could have fired the gun. If Haag’s testimony sways a jury, it will likely be the most important evidence in the case. The assumption that Baldwin must have unsafely handled the weapon partially led Hutchins’s family to file a lawsuit against him in February 2022. That suit, which has since been settled, named Baldwin, Gutierrez-Reed, the ammo supplier, and a litany of Rust producers but took as its primary claim the allegation that Baldwin “recklessly shot and killed Halyna Hutchins,” and that he along with the staff had “failed to perform industry standard safety checks and follow basic gun safety rules while using real guns to produce the movie Rust, with fatal consequences.” Baldwin filed his own lawsuit in November 2022 against Gutierrez-Reed and the Rust producers, alleging that they were culpable for handing him a loaded gun to begin with. And he has a point: If the gun had contained blanks when discharged — if it had actually been a “cold” gun when Halls handed it over to Baldwin — Hutchins would still be alive. So how did a gun filled with live ammunition make it onto the set? This is where things get a lot more complicated — and we see a lot more finger-pointing. No one can explain how the live ammo wound up on set While someone obviously physically brought live ammo to the set, no one seems to know who it was. A search warrant filed in October 2021 speculated that Gutierrez-Reed might have accidentally purchased live ammunition along with dummy bullets from the gun supplier, PDQ Arm and Prop LLC, and its owner Seth Kenney. And Gutierrez-Reed speculated to investigators that live ammo had been “mixed in” with dummy bullets. In January 2022, she filed a lawsuit against the company responsible for supplying guns and ammunition to the film production. The suit paints a picture of a chaotic production full of underpaid and overworked staff — Gutierrez-Reed was to be paid just $7,500 for doing her two jobs on the micro-budget set — and contains ominously passive language about the source of the ammo, indicating that a mysterious box of dummy rounds for the prop gun “appeared on set” the day of the shooting. Gutierrez-Reed all but directly implies in the suit — the status of which appears to be unclear — that the production’s primary prop manager conspired with Kenney to bring live ammo onto the set in order to, essentially, set Gutierrez-Reed up. This, she argues, was because Kenney and the prop manager both resented her because she had criticized the prop manager for her role in one of the two previous accidental gun discharges on set. However, as part of the discovery in that lawsuit, texts from months earlier between Kenney and Gutierrez-Reed were made public — texts from a different movie set — in which Gutierrez-Reed expressed her interest in using prop guns to fire “hot rounds,” or live ammunition, after hours and not while on set. Not only that, but a report by The Wrap alleged that earlier on the morning of the incident, crew members on the set took prop guns — which aren’t supposed to be used to fire anything but blanks — to use in a game of “plinking,” which involved discharging live ammo in rounds of target practice. So was Gutierrez-Reed the person responsible for “mixing” ammo? Was it assorted crew members who took the guns, filled them with live ammo, and then replaced them without anyone being the wiser? At her trial, the prosecution argued successfully that Gutierrez-Reed was indeed responsible for bringing the live ammo on set, keeping it there for weeks, and then never doing safety checks. Gutierrez-Reed was convicted of involuntary manslaughter and found not guilty on a charge of tampering with evidence that her defense claimed had been brought solely as an attempted character smear. One juror told the Associated Press afterward that her failure to perform safety checks was what convinced them of Gutierrez-Reed’s culpability. But Gutierrez-Reed was also reportedly very overworked and had orders from her supervisor to spend less time on gun safety and training. In fact, even after Gutierrez-Reed’s conviction — which her attorneys have said they’ll appeal — the only thing that seems clear is that Rust was a set with disastrous working conditions. Hutchins’s death was part of a disastrous working environment Most of the public information about the conditions on the Rust set comes from a report completed in April 2022 by the New Mexico Occupational Health & Safety Bureau (OHSB). As a result of the OHSB’s investigation, the agency fined Rust about $137,000 for workplace safety violations, the maximum amount allowed under state law. The OHSB report found multiple problems with Rust’s on-set production environment, concluding that the production “demonstrated plain indifference to the safety of employees … failed to follow company safety procedures, which likely would have prevented the accident from occurring … [and] “did not ensure their own safety procedures [were] followed at the worksite.” The OHSB also castigated specific producers for ignoring their employees’ repeatedly voiced concerns about on-set safety, and rushing the employees who were tasked with ensuring that safety. One employee who voiced concerns and was overridden was Gutierrez-Reed. “Hannah was tasked with doing two jobs including props assistant and the very important job as armorer but not given adequate time and training days to do so,” Gutierrez-Reed’s attorney told ABC News, “despite repeated requests or the respect required of the armorer’s position and responsibilities.” Indeed, a week before the shooting, Rust’s line producer, Gabrielle Pickle, emailed Gutierrez-Reed to reprimand her for spending too much time on her armory duties — which included inspecting all weapons to ensure their safety — and not enough on her other duties as prop assistant. Gutierrez-Reed replied that “since we’ve started I’ve had a lot of days where my job should only be to focus on the guns and everyone’s safety,” and that “there are working guns on set every day and those are ultimately going to be a priority because when they are not that’s when dangerous mistakes can happen.” According to the OHSB report, there were two other accidental discharges on set, both on October 16, five days before the incident that killed Hutchins. A third dangerous incident involved a special effects explosive device accidentally exploding. It was partly in response to these incidents that one of Hutchins’s camera assistants, Lane Luper, quit the job the day before Hutchins’s death — citing rampant safety violations in his resignation email, among many other exploitative work conditions. Another crew member, Jonas Huerta, also resigned the same day, again citing exploitative, unsafe, and rushed working conditions. “I also feel anxious on set,” he wrote in his resignation email. “I’ve seen first hand our AD [the assistant director, Halls] rush to get shots and he skips over important protocols.” The reinstated criminal charges related to Baldwin seem to involve his specific act in handling the weapon, rather than his broader role as one of the film’s producers. But the lack of charges filed against any of the other producers on set, several of whom more directly oversaw the frazzled, unsafe filming conditions that led to the multiple accidental weapons discharges, is puzzling. The OHSB report criticized specific producers, including head producer Ryan Smith, for failing to take workplace safety concerns seriously despite repeated complaints by staff. Pickle also faced scrutiny for actively scolding Gutierrez-Reed, including ordering her off armorer duty and limiting her time spent training the cast and crew on how to safely handle weapons. It seems baffling, given this type of evidence, that Santa Fe prosecutors opted not to bring charges of negligence against the producers — charges that seem clearly provable according to the available evidence. The initial charges of involuntary manslaughter against Baldwin and Gutierrez-Reed seemed much harder to prove given how confused their roles were — though the uncertainty hasn’t quashed right-wing pundits like Tucker Carlson from arguing that Baldwin embodies Hollywood’s hypocrisy in decrying gun violence only to defend their own right to use guns in entertainment. Baldwin’s lawyer, Nikas, has vowed to “fight these charges,” as he said in a statement last year. (Baldwin has since put his home in the Hamptons up for sale, likely to help finance his defense.) “Mr. Baldwin had no reason to believe there was a live bullet in the gun — or anywhere on the movie set,” he said. “He relied on the professionals with whom he worked, who assured him the gun did not have live rounds.” What does seem clear is that, on this set and likely on many others, Gutierrez-Reed was one of countless crew members who were underpaid, overworked, harangued by equally frazzled supervisors, and pushed to cut corners to save money and time. Five days before Hutchins’s death, the International Alliance of Theatrical Stage Employees (IATSE) narrowly avoided an employee strike in response to pervasive exploitative conditions throughout Hollywood, including the prevalence of minimum wage gigs, stretched workers, strenuous labor conditions, and wide gender gaps in pay rates and opportunities. Hutchins’s death, as tragic as it is, seems to be the latest culmination of terrible working conditions found not just on set but throughout the industry. The advent of streaming media, the strain of supplying content in a post-pandemic world, and a widespread culture of demanding tireless work for little pay all contribute to the kind of callous disregard for safety and for employees that resulted in the Rust working environment. And while unionization efforts are bringing some meaningful change to the industry, Hutchins’s death arguably stands as a far greater indictment of the industry as a whole than individual indictments against Rust’s on-set players could ever be. Update, April 15, 2024, 3:15 pm ET: This story was originally published on January 23, 2023, and has been updated multiple times, most recently to reflect the sentencing of Hannah Gutierrez-Reed.

  • We can make birth safer for Black mothers. Here’s how.
    by Anna North on April 15, 2024 at 5:58 pm

    Getty Images/Paige Vickers/Vox What doulas, midwives, and policymakers are doing to end the maternal mortality crisis. Over the last 30 years, nearly every wealthy country in the world has made it much safer for people to have babies. Only one outlier has moved in the opposite direction: the United States, where the rate of people dying in childbirth continues, stubbornly and tragically, to rise. In 2021, 1,205 US women died from birth-related causes, up from 754 in 2019. Many of those deaths — a full 89 percent in one Georgia study — are potentially preventable with the proper care. There’s some dispute over whether the US Centers for Disease Control and Prevention overcounts maternal deaths, but experts agree that regardless of methodology, mortality rates are troublingly high — and Black birthing people are at disproportionate risk. Nationwide, the maternal mortality rate for Black women is 2.6 times the rate for white women. Some regions have even bigger disparities: In Chicago, the rate for Black women is almost 6 times the rate for white women; in New York City, it’s 9 times. The causes are big societal problems: failing hospitals (or no hospitals at all), lack of access to affordable health care, and doctors and nurses who dismiss Black women’s pain. These issues may seem intractable, but activists, clinicians, and scholars around the country are already working on solutions: ensuring access to Black doctors and nurses, creating new models of prenatal care that give Black patients a bigger support system, and expanding Medicaid to make sure patients can get care from preconception to postpartum. Karie Stewart, for example, started Melanated Group Midwifery Care three years ago to provide prenatal and postpartum care “for Black people, by Black people.” As a labor and delivery nurse in Chicago, Stewart said that she always noticed that Black patients were treated differently. “Their care was not even close to what their counterparts were getting,” she said. To help combat those inequalities — and the dangers birthing people and babies can face when they get substandard care — Melanated Group connects each patient with a Black midwife, doula, nurse, and social worker. Together, they make sure that no matter what issues come up during or after pregnancy, patients always have someone to reach out to — someone who will actually listen to their concerns. Black families and reproductive justice advocates have been sounding the alarm on maternal deaths for years, and lawmakers are beginning to listen. Almost all states have extended Medicaid coverage for 12 months postpartum, the period when most maternal deaths occur, and a dozen states have expanded Medicaid to cover doula services. New York Gov. Kathy Hochul recently proposed a six-point plan to address maternal mortality, including provisions to improve mental health care and make prenatal care more affordable and accessible. Much more is necessary, and with every birth, researchers like Stewart are hoping to provide a roadmap for policymakers and hospitals looking to combat centuries of racism and save Black birthing people’s lives. “[We can’t] let the 400 years of colonialization, enslavement, Jim Crow, and discrimination be so paralyzing that one is disinclined to act,” said Amanda P. Williams, an OB-GYN and clinical innovation adviser at the California Maternal Quality Care Collaborative. “It really is possible to be better.” These four solutions can make birth safer Behind the statistics are countless devastating stories: In 2023, Christine Fields, 30, bled to death after giving birth to her son at Woodhull Medical Center in Brooklyn, the New York Times reported. A pregnant Illinois teenager experiencing chest pain visited the ER, but doctors tested her urine for drugs and sent her home, according to a state study of maternal deaths between 2018 and 2020 reported in the Chicago Sun-Times. After another hospital visit, she was diagnosed with a heart condition, but doctors didn’t schedule a follow-up cardiology appointment with her until weeks later. She died of cardiomyopathy when her baby was a month old. Serena Williams, the groundbreaking tennis champion, said in 2018 that she wasn’t taken seriously by medical staff when she experienced a pulmonary embolism after giving birth to her daughter, Olympia; it was a reminder that wealth, education, and socioeconomic status do not protect Black birthing people from racism in the delivery room. Across the country, however, researchers, midwives, doulas, and doctors are studying interventions that can protect Black families through pregnancy, birth, and beyond. Below are four of the most promising approaches: Having Black doctors and nurses on the medical team. Some research has found better outcomes for Black patients who are treated by doctors of the same race — for example, one 2020 study found that Black newborns had lower mortality when they were cared for by Black doctors. The reason may have to do with the “shared experience of having had to deal with racism and discrimination,” said Doee Kitessa, an OB-GYN and professor at the University of Maryland School of Medicine. Many Black patients “have not had a doctor that looks like them,” and when they do get the opportunity to see a Black physician, “it’s like a relief that they feel, like, I’ll be heard and listened to,” Kitessa said. “It is not going to be necessary that every Black patient is going to find a Black doctor, and they may not want that,” Kitessa said. But “having that greater diversity among the pool of physicians brings greater diversity of perspectives.” Diversifying the medical workforce is also Williams’s top recommendation for making birth safer for Black people. Today, only about 5.7 percent of doctors in the US are Black, even though Black Americans make up about 13 percent of the population. Melanated Group and other programs around the country are working to match Black patients with Black midwives and OB-GYNs, but there’s an urgent need for more practitioners of color. “We have to have scholarships for first-generation families and historically marginalized communities to start developing that pipeline,” Williams said. Anti-affirmative action rulings and conservative anti-DEI initiatives threaten to make the problem worse by making it harder for colleges and medical schools to recruit students from historically marginalized groups, she added. Improving access to doulas. Doctors and nurses aren’t the only ones who can help Black patients have safer births. Research has shown that having a doula can lower the likelihood of birth complications and reduce postpartum depression and anxiety. The latter is especially important since mental illness is the top cause of maternal death in the US, driving suicides and opioid overdoses, according to an evidence review published earlier this year in the journal JAMA Psychiatry. A doula’s job is to support and advocate for the birthing person during labor and delivery, which can be crucial for Black patients, who often face discrimination or disregard in medical settings. Black and other marginalized birthing people sometimes “need that extra person there to really stand up for them,” said Thomecia Busby, a doula and leader of the Georgia Doula Access Working Group. “I’m just really being that third eye in the room and really sitting in as that liaison between you and the hospital staff, and making sure that even if things change from the plan, you are always feeling comfortable in your decisions.” Doulas can also offer prenatal support, answering questions and even attending appointments with clients. After birth, they can help with breastfeeding, household tasks, postnatal massage, and connecting patients to outside services such as support groups. Doula services can be expensive, ranging from $500 to more than $2,000, putting them out of reach for many low-income families. A growing number of states, including Florida and Virginia, now cover doula care under Medicaid, but access hurdles remain. Other states, such as Georgia, have launched pilot programs to cover doula care on a smaller scale. Group prenatal care. In addition to who provides care for Black birthing people, some researchers are looking at how that care gets delivered. Melanated Group Midwifery Care and other practices around the country are experimenting with group prenatal care, in which patients join cohorts of eight to 10 people who meet with a doctor for regular two-hour discussion sessions (physical exams and other tests can still be done privately). The groups help break down the hierarchical nature of doctor’s appointments and can make patients feel more comfortable asking questions, said Stewart, the Melanated Group founder. “We all sit in a circle,” Stewart said. “It’s really like a gathering, a little prenatal party.” Past research has found that group prenatal care can reduce the risk of preterm birth, especially for Black birthing people, possibly by reducing stress. The approach also helps patients feel more ready for labor and more satisfied with their care overall. In addition to Melanated Group, researchers in Missouri, California, and elsewhere are studying the model to learn more about the benefits. “I felt really embraced with every appointment,” said Richelle Smith, who got group prenatal care as part of the EleVATE initiative in St. Louis and now conducts trainings for the program. Smith says her prenatal care experience helped her have a smooth birth. “I was empowered and my husband was empowered to advocate for me.” Medicaid expansion. While interventions like group prenatal care can be implemented on a small scale, there’s one big policy change that’s been shown to have a major impact on maternal health: States that took the Medicaid expansion under the Affordable Care Act, allowing more people to qualify for affordable health insurance, have fewer maternal deaths than states that did not expand their programs, according to a 2020 study. The expansion had an especially big effect on Black birthing people. “There are such stark disparities in maternal health,” said Erica Eliason, a postdoctoral researcher at the Brown University School of Public Health and the author of the study. “The group that we’re going to see benefit the most is the group whose outcomes are the worst.” Despite such benefits, 10 states — including some with the highest maternal mortality rates, such as Texas and Florida — still have not taken the Medicaid expansion. Most states have extended Medicaid eligibility to cover birthing people for 12 months postpartum, an important move because most maternal deaths happen in the year after birth. But just covering people after birth misses out on a crucial benefit of the Medicaid expansion: better health care for people before they even get pregnant. More people in expansion states can get timely care for chronic conditions like diabetes and hypertension, Eliason said, making for a safer pregnancy and birth down the road. Helping Black birthing people means getting hospitals — and Congress — on board Policymakers and clinicians are experimenting with other interventions too, from hospital equity trainings to prenatal leave. The California Maternal Quality Care Collaborative, for example, has created a hospital action guide for equitable obstetric care, covering issues from visiting hours to drug testing, and is studying whether training based on this guide can reduce C-section rates. In New York, Gov. Hochul’s plan would provide 40 hours of paid leave for prenatal care appointments, addressing what experts say is a significant barrier: time off from work to go to the doctor. Meanwhile, researchers like Stewart are working to find the best ways to combine different programs and scale up their work — Melanated Group is in the third year of a five-year study, having enrolled about 150 of a prospective 400 people. It hasn’t published its results yet, but it has hosted reunions where new parents bring their babies and talk about their experiences. “They’re very excited and grateful,” Stewart said. Even though the work is ongoing, federal and state lawmakers, as well as hospitals and health systems, can use as soon as possible what Melanated Group and others have learned to help Black patients have safer pregnancies and births. But it will require surmounting major barriers. One is opposition in Congress. The Black Maternal Health Momnibus Act, a 13-part piece of legislation that includes funding for diversifying the birth workforce and improving maternal mental health, has been at the top of many maternal health advocates’ wish lists since it was first introduced in 2020, but only one part, a provision to help pregnant and postpartum veterans, has made it into law. At the state level, Republican legislators and governors have blocked Medicaid expansion because they oppose government spending, though pro-Medicaid momentum has been building in recent months. In other cases, policy changes haven’t always led to improvements in access. In California, for example, only about 70 claims for doula services were filed last year out of about 200,000 Medicaid births, Williams said. “Just because you have a benefit doesn’t mean that you know where to go, how to sign up, how does this work. So it’s the connecting of the patients to the doulas.” Low reimbursement rates can also be an issue for doulas — Busby works on a new Georgia program that reimburses doulas $1,000 per patient, which she described as “a minimum of what doulas should be getting paid.” Hospitals also need to work to integrate doulas into their care. “There’s certain hospitals that allow the doulas to come in, but then there’s certain people that are on staff who may not like doulas being in the space,” Busby said. No program to help Black birthing people can have its full effect if hospitals aren’t on board, experts say. Some Melanated Group patients have reported that the support they felt in their group prenatal care appointments went out the window when they showed up to deliver the baby. When they get into labor, sometimes “it’s a battle,” Stewart said. Collaboration — between hospitals and midwives, and between doctors and the pregnant patients who come in for care — is crucial to helping people give birth safely, experts said. “This is just the wave of the future, and how we should be providing prenatal and postpartum care for the Black community,” Stewart said. Update, April 15, 2024, 2 pm ET: This story, originally published on Apple News on March 11, has been updated to acknowledge recent research on the methodology used by the CDC to count maternal mortality.

  • Many coral reefs are dying. This one is exploding with life.
    by Benji Jones on April 15, 2024 at 3:00 pm

    A brain coral off the coast of Cambodia releases bundles of sperm and eggs during a rare spawning event. | Matt Glue/Fauna & Flora Scientists have declared a mass global bleaching event. But some reefs are still hanging on — and even thriving. Coral reefs around the world are turning white and dying. Today scientists from the National Oceanic and Atmospheric Administration declared the world is currently experiencing its fourth global bleaching event on record. Bleaching is bad. During long spells of extreme heat, the relationship between coral and the algae that live inside its tissues breaks down. Those algae give the corals most of their food and their brilliant color in exchange for nutrients and a place to absorb sunlight. White, or “bleached,” corals aren’t dead; they are starving to death. Since early last year, NOAA scientists have confirmed mass bleaching in the Atlantic, Pacific, and Indian oceans, including along the coastlines of Florida, the Caribbean, and the Great Barrier Reef. The first bleaching event on a global scale was in 1998. “As the world’s oceans continue to warm, coral bleaching is becoming more frequent and severe,” Derek Manzello, a coral reef ecologist at NOAA, said Monday in a statement. This is bleak for pretty much everyone on the planet. Coral reefs operate like seawalls, helping minimize flooding during hurricanes. They provide homes to roughly a quarter of all marine species including the fish people eat at one point or another. And they are an engine of the tourism economy in many places, such as the Florida Keys, Mexico, and Australia. But amid all this destruction — which will almost certainly get worse in the decades to come — there are still some signs of hope. Not all coral reefs are dying. Indeed, some are teeming with life. In March, a team of marine biologists was diving off the coast of Cambodia when they witnessed something that filled them with awe. An explosion of life Once a year, after dark, a bit of magic happens in the ocean. Within tropical waters worldwide, large chunks of coral — those colorful rocklike structures in shallow, coastal seas, each a colony of living animals — start puffing out hundreds of little pearl-sized balls. Some are pink. Others are red, orange, or yellow. For a few minutes, the ocean is a snow globe, and then the balls float away. This phenomenon, known as spawning, is how many corals reproduce. Each ball is a bundle of eggs and sperm from an individual coral colony. Different colonies of the same species somehow know how to spawn on the same day and same time, so their eggs and sperm can meet and form baby corals. Spawning is incredibly hard to observe. Again, it happens only once a year, and often only for a few minutes at night. Plus, bleached corals are less likely to spawn successfully. Yet, in March, a team of marine biologists got lucky: They witnessed a massive spawning event off the coast of Cambodia, in the Gulf of Thailand. Not long after sunset, several different kinds of coral filled the water with pearls. The team, led by Fauna & Flora International, an environmental group, was able to capture the event on video, shown in a series of clips below. “It was like it was snowing,” Tharamony Ngoun, a marine species and ecosystems officer at Fauna & Flora, who observed the spawn, told Vox. “It was so amazing.” Spawning on Cambodia’s reefs is not only thrilling to witness (I’ve been lucky enough to see coral spawning before, though not in Cambodia). It also offers hope for these important ecosystems as many of them are under siege. Globally, coral reefs have declined by half since the 1950s, largely due to climate change. Indeed, the leading scientific authority on climate change suggests that if the world warms by 1.5 degrees Celsius, relative to pre-industrial times, coral reefs could decline by 70 percent to 90 percent. And we’re basically already there. The reefs in Cambodia and in the broader East Asian region, however, appear to be bucking this trend. Surveys indicate that they haven’t declined in recent decades, perhaps because they’re more resilient to warming. Their secret to survival may ultimately help safeguard ailing reefs elsewhere. Southeast Asia’s reefs are hanging on The dire outlook for coral makes this spawning event even more special. While many reefs are disappearing, others are relatively healthy and capable of producing a new generation of corals. “The coral is thriving,” said Matt Glue, a marine technical specialist at Fauna & Flora, which sent a team in March to try to observe spawning. “Everywhere we would go we would see more colonies that were spawning. It’s very hopeful.” The reefs in Cambodia are not free of problems. Overfishing has diminished larger predators, like groupers, which help maintain the health of the reef. And although the amount of coral has remained relatively stable, contrasting global declines, it’s likely that more sensitive species have become less abundant and others more abundant, tweaking the makeup of the ecosystem. Nonetheless, this reef does seem more resilient, according to Glue. While this region has experienced plenty of marine heat and some amount of bleaching, the heat typically doesn’t cause a mass die-off like what you see elsewhere. The secret to the reef’s survival may be in the diversity of its corals. East Asia has a huge number of coral species and a lot of genetic diversity within individual species. The more varieties of coral a reef has, the more likely it is that some of them may have slightly more or less tolerance to various stresses, such as high temperatures. During a bout of severe warming, some coral colonies may die off, but others can take their place, Glue said. Within East Asia, “high coral cover and diversity on the coral reefs within this critically important region may have conferred a degree of natural resistance to elevated [sea surface temperatures],” coral scientists wrote in a 2020 report. Matt Glue/Fauna & Flora A close-up look of coral in the genus favites releasing a bundle of sperm and eggs. What’s more is that these corals may help reefs elsewhere withstand the worsening wrath of climate change. Research has found that tolerance to heat is baked into the DNA of some coral colonies. And importantly, two heat-tolerant parents tend to produce heat-tolerant babies. “If these corals are indeed unusually tolerant in whatever manner, the fact that they are actively producing larvae provides the direct possibility for those larvae to disperse to adjacent reef areas,” said Margaret Miller, one of the top coral experts in the US and research director at the conservation group Secore International. (She was not part of the team that observed the spawning.) In other words, all of that new spawn may help seed the ocean with more resilient corals. “It feels really great to be part of this,” Glue said, of observing spawning with his team. “And hopeful — hopeful for the future of reefs in the Gulf of Thailand.” Update, April 15, 11 am ET: This story was originally published on March 14 and has been updated with NOAA’s declaration of a fourth global bleaching event.

  • The Supreme Court effectively abolishes the right to mass protest in three US states
    by Ian Millhiser on April 15, 2024 at 2:26 pm

    Demonstrators march from Baton Rouge City Hall to the Louisiana Capitol to protest the shooting of Alton Sterling by a police officer on July 9, 2016, in Baton Rouge, Louisiana. | Mark Wallheiser/Getty Images It is no longer safe to organize a protest in Louisiana, Mississippi, or Texas. The Supreme Court announced on Monday that it will not hear Mckesson v. Doe. The decision not to hear Mckesson leaves in place a lower court decision that effectively eliminated the right to organize a mass protest in the states of Louisiana, Mississippi, and Texas. Under that lower court decision, a protest organizer faces potentially ruinous financial consequences if a single attendee at a mass protest commits an illegal act. It is possible that this outcome will be temporary. The Court did not embrace the United States Court of Appeals for the Fifth Circuit’s decision attacking the First Amendment right to protest, but it did not reverse it either. That means that, at least for now, the Fifth Circuit’s decision is the law in much of the American South. For the past several years, the Fifth Circuit has engaged in a crusade against DeRay Mckesson, a prominent figure within the Black Lives Matter movement who organized a protest near a Baton Rouge police station in 2016. The facts of the Mckesson case are, unfortunately, quite tragic. Mckesson helped organize the Baton Rouge protest following the fatal police shooting of Alton Sterling. During that protest, an unknown individual threw a rock or similar object at a police officer, the plaintiff in the Mckesson case who is identified only as “Officer John Doe.” Sadly, the officer was struck in the face and, according to one court, suffered “injuries to his teeth, jaw, brain, and head.” Everyone agrees that this rock was not thrown by Mckesson, however. And the Supreme Court held in NAACP v. Claiborne Hardware (1982) that protest leaders cannot be held liable for the violent actions of a protest participant, absent unusual circumstances that are not present in the Mckesson case — such as if Mckesson had “authorized, directed, or ratified” the decision to throw the rock. Indeed, as Justice Sonia Sotomayor points out in a brief opinion accompanying the Court’s decision not to hear Mckesson, the Court recently reaffirmed the strong First Amendment protections enjoyed by people like Mckesson in Counterman v. Colorado (2023). That decision held that the First Amendment “precludes punishment” for inciting violent action “unless the speaker’s words were ‘intended’ (not just likely) to produce imminent disorder.” The reason Claiborne protects protest organizers should be obvious. No one who organizes a mass event attended by thousands of people can possibly control the actions of all those attendees, regardless of whether the event is a political protest, a music concert, or the Super Bowl. So, if protest organizers can be sanctioned for the illegal action of any protest attendee, no one in their right mind would ever organize a political protest again. Indeed, as Fifth Circuit Judge Don Willett, who dissented from his court’s Mckesson decision, warned in one of his dissents, his court’s decision would make protest organizers liable for “the unlawful acts of counter-protesters and agitators.” So, under the Fifth Circuit’s rule, a Ku Klux Klansman could sabotage the Black Lives Matter movement simply by showing up at its protests and throwing stones. The Fifth Circuit’s Mckesson decision is obviously wrong Like Mckesson, Claiborne involved a racial justice protest that included some violent participants. In the mid-1960s, the NAACP launched a boycott of white merchants in Claiborne County, Mississippi. At least according to the state supreme court, some participants in this boycott “engaged in acts of physical force and violence against the persons and property of certain customers and prospective customers” of these white businesses. Indeed, one of the organizers of this boycott did far more to encourage violence than Mckesson is accused of in his case. Charles Evers, a local NAACP leader, allegedly said in a speech to boycott supporters that “if we catch any of you going in any of them racist stores, we’re gonna break your damn neck.” But the Supreme Court held that this “emotionally charged rhetoric … did not transcend the bounds of protected speech.” It ruled that courts must use “extreme care” before imposing liability on a political figure of any kind. And it held that a protest leader may only be held liable for a protest participant’s actions in very limited circumstances: There are three separate theories that might justify holding Evers liable for the unlawful conduct of others. First, a finding that he authorized, directed, or ratified specific tortious activity would justify holding him responsible for the consequences of that activity. Second, a finding that his public speeches were likely to incite lawless action could justify holding him liable for unlawful conduct that in fact followed within a reasonable period. Third, the speeches might be taken as evidence that Evers gave other specific instructions to carry out violent acts or threats. The Fifth Circuit conceded, in a 2019 opinion, that Officer Doe “has not pled facts that would allow a jury to conclude that Mckesson colluded with the unknown assailant to attack Officer Doe, knew of the attack and ratified it, or agreed with other named persons that attacking the police was one of the goals of the demonstration.” So that should have been the end of the case. Instead, in its most recent opinion in this case, the Fifth Circuit concluded that Claiborne’s “three separate theories that might justify” holding a protest leader liable are a non-exhaustive list, and that the MAGA-infused court is allowed to create new exceptions to the First Amendment. It then ruled that the First Amendment does not apply “where a defendant creates unreasonably dangerous conditions, and where his creation of those conditions causes a plaintiff to sustain injuries.” And what, exactly, were the “unreasonably dangerous conditions” created by the Mckesson-led protest in Baton Rouge? The Fifth Circuit faulted Mckesson for organizing “the protest to begin in front of the police station, obstructing access to the building,” for failing to “dissuade” protesters who allegedly stole water bottles from a grocery store, and for leading “the assembled protest onto a public highway, in violation of Louisiana criminal law.” Needless to say, the idea that the First Amendment recedes the moment a mass protest violates a traffic law is quite novel. And it is impossible to reconcile with pretty much the entire history of mass civil rights protests in the United States. Morton Broffman/Getty Images Dr. Martin Luther King Jr. leads marchers in what the Fifth Circuit calls an “unreasonably dangerous” activity. In fairness, the Court’s decision to leave the Fifth Circuit’s attack on the First Amendment in place could be temporary. As Sotomayor writes in her Mckesson opinion, when the Court announces that it will not hear a particular case it “expresses no view about the merits.” The Court could still restore the First Amendment right to protest in Louisiana, Mississippi, and Texas in a future case. For the time being, however, the Fifth Circuit’s Mckesson decision remains good law in those three states. And that means that anyone who organizes a political protest within the Fifth Circuit risks catastrophic financial liability.

  • How Trump’s hush money trial went from an afterthought to the main event
    by Andrew Prokop on April 15, 2024 at 11:30 am

    Former President Donald Trump speaks to the media after a pretrial hearing on March 25, 2024, in New York City. | Justin Lane/Getty Images The trial on the least important topic may be the most important to the 2024 election. When former President Donald Trump was indicted in New York for falsifying business records last March, many anticipated that would be the prologue to the main event: charges over Trump’s attempt to steal the 2020 election. Yet the two election indictments — and another prosecution of Trump for hoarding classified documents — have moved slowly and been beset with delays. That means that, suddenly, the question of whether or not Trump will be convicted of crimes before November’s election may hinge on the Manhattan trial that starts Monday. Which is a bit awkward, because the actual matter at the heart of this trial is clearly the least important — having the least significant implications for the country — of the four prosecutions brought against Trump. The New York trial is broadly about the $130,000 hush money payment Trump’s lawyer and fixer Michael Cohen paid Stormy Daniels shortly before the 2016 election, so Daniels wouldn’t go public saying she’d had a sexual encounter with Trump. But the 34 charges are specifically about whether, when Trump later repaid Cohen for that money, the Trump Organization falsely logged those payments as “legal expenses” in company records. That false labeling, prosecutors allege, is the crime here. Compared to trying to steal the 2020 election or hoarding documents with national security secrets, this doesn’t seem like the most substantively important topic. But the Washington, DC, election case has been delayed by Trump’s appeal to the Supreme Court, and while a trial could still happen before November, the window is narrow. The Florida documents case has been held up by a slow-moving, Trump-appointed judge who appears to be in no rush to resolve key pretrial issues. And the Georgia election case is so complex, involving so many defendants, that it was never expected to move quickly. No trial date has yet been set. So the questions of whether Trump will face voters in November as a convicted felon — or even a convicted felon with a prison sentence hanging over his head — may well be determined by what happens in a Manhattan courtroom over the next few weeks. Why it’s so important to be honest on your internal corporate documentation of how you repaid your fixer for the hush money he paid to an adult film actress, explained Paying “hush money” sounds shady, but in and of itself, it’s not illegal. Well-known figures from time to time pay people off to keep them from coming forward with embarrassing stories. But Cohen had paid Daniels $130,000 for her silence shortly before the 2016 election. Federal prosecutors have argued that this payment was clearly designed to help Trump win, and that therefore, it was effectively a campaign contribution from Cohen to Trump, far greater than the maximum contribution allowed in federal campaign finance law. Cohen pleaded guilty to this in 2018, saying he was acting at Trump’s direction. But Trump was not charged by federal prosecutors — Justice Department guidance about not charging a sitting president took that off the table. And even when Trump left office, the DOJ decided not to reopen the case. So state prosecutors in the Manhattan district attorney’s office stepped in, launching a sprawling investigation of Trump’s business affairs that, after a long and winding road, ended back at the hush money. More specifically, it ended with charges that Trump’s repayments to Cohen for the hush money were improperly classified as legal expenses in internal Trump Organization documents. This violated New York law against falsifying business records, prosecutors allege. Furthermore, the DA’s office argued that these charges should be felonies rather than misdemeanors — because the records were falsified with the intent to commit or conceal another crime. What crime that would be exactly has been the subject of some dispute, but they have said that federal election law, state election law, or tax law could all fit the bill. Still, the somewhat bizarre situation here is that Trump isn’t being charged for paying hush money — he’s being charged for failing to scrupulously keep honest records about it. Jury selection is up first — and it will matter hugely District Attorney Alvin Bragg’s case was greeted with much tut-tutting from pundits and some legal experts, who argued the legal reasoning behind the case was flawed. Yet all the doubts big legal brains might have about the theories behind the prosecution won’t necessarily matter to jurors, who are tasked with answering the basic question: Did he do it or not? In this case especially, the first stage of the trial — jury selection — will be tremendously important. Jurors are told not to let their outside information and political leanings affect their judgment, but obviously, that could still happen, either deliberately or simply through bias. Trump’s biggest problem is geography. Jurors will be from Manhattan, where President Joe Biden won 84.5 percent of the vote in 2020. Trump has dealt with Manhattan juries in three civil trials over the past year, none of which went well for him: He was found liable for sexual abuse, and defamation, and was ordered to pay hundreds of millions of dollars in fines. Still, Trump’s biggest advantage is that he only needs to convince one juror. Conviction requires unanimity on the jury, so if even one juror wants to acquit, Trump skates. And not everyone in the jury pool will be a die-hard Trump hater; there will be some Republicans and some who are not politically engaged. What happened to the other Trump prosecutions? The other three prosecutions of Trump are all currently in limbo. 1) DC: Federal charges for trying to steal the 2020 election: This trial was originally supposed to kick off in early March. But things have been on hold while the Supreme Court weighs Trump’s argument that presidential immunity should prevent him from being prosecuted here. Lower court judges have rejected this claim, but SCOTUS is taking its time, with arguments taking place next week. It is still theoretically possible for this trial to happen this year. Since the pause occurred when the trial was three months away, we might expect a new trial date three months after the Supreme Court’s likely May or June ruling — so, starting in August or September. But the trial is expected to be lengthy, and Trump’s team will surely argue against setting a date that would eat up much of the fall campaign season. Judge Tanya Chutkan would get to make the call. 2) GA: State charges for trying to steal the 2020 election: The recent drama over District Attorney Fani Willis has subsided, as she was permitted to stay on the case. But from the start, experts have been highly skeptical that the complex Georgia racketeering case against Trump and many other co-defendants would happen before November. And there is still no trial date in sight. 3) FL: Federal charges over retaining classified documents: Judge Aileen Cannon, a Trump appointee, has taken an unusual amount of time to rule on various pretrial issues in the documents case, and has often entertained bizarre legal arguments. Critics have theorized she is deliberately trying to delay the trial until after November. The legal wrangling has gotten increasingly tense, and though Cannon has ruled in special counsel Jack Smith’s favor on two recent matters, a whole lot more has to get done before this trial can happen.

  • Israel beat Iran — for now
    by Zack Beauchamp on April 15, 2024 at 11:15 am

    Explosions are seen in the skies of Israel’s capital, following the retaliatory attack from Iran over the weekend. | Mostafa Alkharouf/Anadolu via Getty Images Iran’s Saturday attack on Israel was a military failure. But things could still get a lot worse. When Iran launched a large retaliatory drone and missile assault on Israel on Saturday night, it raised fears that the Middle East was on the precipice of a regional war. But by Sunday morning, the situation looked far less dire. Iran had telegraphed elements of its attack and its willingness to end the two-week period of hostilities there. And assisted by the United States and its Arab neighbors, Israel shot down 99 percent of the drones and missiles heading in its direction. Those strikes that got through did not kill anyone, doing minor damage to a military base and injuring a child. If this sounds like an Israeli victory, that’s because it was. Two weeks earlier, Israel escalated its several-year-old assassination campaign against top Iranian security figures by killing a senior Iranian general at the country’s embassy in Syria — a brazen move given that states generally treat embassies as militarily out-of-bounds. Iranian Supreme Leader Ali Khamenei billed Tehran’s response as “punishment” for that attack, but the failure to do significant harm illustrated that Israel is fairly well shielded from Iran’s vaunted drone and missile fleet. Iran “had to realize that any strike on Israel would benefit Israel’s end game far more than Iran’s. That they chose to attack anyway shows one again that strategy is always the victim of emotion,” writes Afshon Ostovar, an expert on the Iranian military at the Naval Postgraduate School. Israel hit Iran in an especially harsh way and more or less got away with it. But this does not mean things are stable between Israel and Iran. Far from it. The immediate question is whether Israel’s leadership understands when to leave well enough alone. Prime Minister Benjamin Netanyahu has proven himself reckless during the Gaza war and depends on some exceptionally extreme governing partners to stay in power. The United States is trying to restrain him — with President Joe Biden reportedly telling Netanyahu to “take the win” — but it’s unclear if he will. And even if Israel chooses restraint for now this episode may have permanently raised the risk of a wider war between Jerusalem and Tehran. What was Iran thinking? When news of Iran’s attack broke Saturday night, a former US military officer who studies Iran texted me skeptically. “None of these drones get through,” he correctly predicted. Iran had indeed chosen a curious strategy. Tehran had been telegraphing a response targeting Israeli territory for weeks, giving Israel and its allies plenty of time to prepare. The drones it chose to launch were slow-moving, taking hours to reach Israeli airspace and passing over neighboring countries (notably Jordan) that shot them down. Fears that Iran would overwhelm Israel’s air defenses with fast-moving missiles proved largely unfounded. There are two basic ways to think about Iran’s intent in light of this failure. It’s entirely possible that Iran miscalculated. In this scenario, Iran attempted to do real damage to Israel and simply failed to appreciate its enemies’ capabilities. Leading military analysts and defense reporters see this interpretation as consistent with the structure of Iran’s strike, particularly its use of ballistic missiles and targeting of a military base in Israel’s south. But it’s also possible Iran didn’t intend to do serious damage to Israel. In this second scenario, Tehran merely aimed for a symbolic strike so it wasn’t seen as backing down after Israel struck its embassy. There’s precedent for this. After the United States killed Qassem Soleimani, the leader of Iran’s elite Revolutionary Guard Quds Force, in 2020, Iran’s military retaliation was limited to firing missiles at a US airbase — a response successfully calibrated not to force the United States to retaliate further. Indeed, Iran is publicly signaling a similar intent: An official government account tweeted that “the matter can be deemed concluded” even before the first drone reached Israeli airspace. That’s as close to publicly saying “this is a fake attack” as it gets in international relations. If Iran wasn’t intending serious damage, then the attack wasn’t as obviously a failure — but it still looks like a kind of strategic defeat. Iran’s ineffectual response sends a signal that Israel can attack Iranian interests with relative impunity because it is outclassed by Israel and its allies. How things could calm down — or get worse With Iran’s retaliation largely a dud, Israel is in a stronger position than it was before it hit the Damascus embassy. Israel conducted arguably its most politically risky assassination of an Iranian military commander yet — one that could have triggered an outright war. And it emerged not just unscathed, but having demonstrated that its homeland appears safe from direct Iranian assault in the immediate future. The mass Iranian assault also seems to have galvanized Israel’s Republican supporters in Congress, where an aid package has been held up for months as part of the fight over support for Ukraine. But if Israel responds aggressively to Iran’s attack, all bets are off. Any major retaliation would force an Iranian response, potentially leading to an escalatory cycle that ends in a full-scale war. This would certainly pull in Iran’s regional proxies, most notably Hezbollah in Lebanon, and would result in tremendous amounts of death. Even if this disaster is averted, an Israeli response would infuriate the American government — which both played a critical role in intercepting Iran’s missile barrage and are strongly opposing any future Israeli retaliation. Israeli escalation would snatch strategic defeat from the jaws of victory. Yet Israel’s government is reportedly considering it anyway. A source told reporter Ronen Bergman that “if the [internal government] talks were broadcast live on YouTube, you’d have 4 million people clamoring at Ben Gurion airport trying to get out of here.” Prior to October 7, Netanyahu had a reputation for being cautious about using force. But since the Hamas attack, he has been astonishingly aggressive — embracing a maximalist, open-ended campaign in Gaza that has killed tens of thousands of Palestinians while putting Israel on the road to strategic defeat. The general sense among Israeli analysts is that Netanyahu’s shift is in large part political: With his poll numbers in the toilet and a radically right-wing coalition, he needs war to stay in power (and keep himself out of jail). This politically cornered Netanyahu might be open to taking more risks — including the risk of a wider confrontation with Tehran. The cooler heads in Israel seem to recognize reality. When war cabinet member Benny Gantz vowed that “this event isn’t over yet,” he also said that “we will build a regional coalition and we will make Iran pay the price at a time and in a manner that we choose” — framing that at least implies that Israel isn’t planning imminent unilateral action. So Israel might yet get out of this mess without a major disaster. Yet experts also warn that this attack might have longer-term destabilizing ramifications. “Even if Israel chooses not to retaliate now, we are not quite back to where we were before. Status quo has changed with the precedent of a large-scale Iranian attack on Israel,” writes Thomas Juneau, a Middle East scholar at the University of Ottawa, who predicted “a higher baseline of tension and violence” going forward. A post-attack statement from Hossein Salami, the leader of Iran’s Revolutionary Guard, supports Juneau’s analysis. Salami said Iran has “decided to create a new equation” with Israel, one where any Israeli attack against Iranian personnel anywhere will be met with direct attacks by Iran on Israel. Previously, Israel had managed to conduct strikes on Iranian interests in places like Syria without direct retaliation — which carries greater risks of escalation to out-and-out war. On Saturday night, the term “World War III” began trending on Twitter/X. It’s safe to say at this point that these fears were overblown. But the Middle East remains a powder keg — one that’s slightly more stuffed with gunpowder than it was before. This story appeared originally in Today, Explained, Vox’s flagship daily newsletter. Sign up here for future editions.

  • The charitable deduction is a complex, broken mess. There’s a better way.
    by Dylan Matthews on April 15, 2024 at 10:00 am

    Then-UK Prime Minister Tony Blair and comedian Dawn French with a £4.3 million Gift Aid subsidy check marking the conclusion of a charitable fundraiser in 2001. | Michael Stephens/PA Images via Getty Images Companies sometimes match donations to charity. What if the government did too? Imagine a charity comes to you with an offer. If you give them a donation now, they’ll get it at least partially matched — so for every dollar you give, a wealthy benefactor will add 25 cents. Your giving has a higher bang for the buck than normal. Now imagine the charity instead tells you that your gift might help your taxes … but it probably won’t. In fact, there’s a 90 percent chance it will do nothing to reduce your tax burden. But there’s a small chance it will help. How much will it help? Hard to say; you might get anywhere from 10 to 37 percent of the donation back on your taxes next year, depending on a ton of other factors that have nothing to do with charity. Which of these options sounds better to you? And more importantly: Which of them is more likely to spur you to donate? The second option is how the United States charitable deduction currently works. It’s only available to people who “itemize” their deductions, meaning they eschew the standard deduction for specialized benefits based on mortgage payments, state taxes, and other factors. But barely 9 percent of filers even did that in 2021, and they are disproportionately wealthy ones. How much the charitable deduction reduces your taxes, and thus benefits you, depends on your tax bracket, which means it could be worth as little as 10 percent of your gift or as much as 37 percent. It’s a complex, difficult-to-understand program, which surely limits how effective it can be at its main goal: encouraging Americans to give to charity. The first option, the 25 cents on the dollar match? That’s what the United Kingdom does. When you donate to a charity there, you can check a box confirming you’re a UK taxpayer. The charity then gets a 25 percent match from the government on all donations from taxpayers. The program is called Gift Aid, and it has helped the UK preserve its system of pay-as-you-earn income taxes, in which about two-thirds of Britons don’t have to file tax returns at all. Most things that would be deductions in the US instead exist outside the tax system in the UK, in programs like Gift Aid. It seems to work at making giving more popular: A recent global survey found that 71 percent of Britons donated to charity, compared to 61 percent of Americans, and a sharp contrast from the very low rates of giving in much of mainland Europe (37 percent in France, 42 percent in Italy). It’s a simpler way to incentivize charity, and as Tax Policy Center economist Robert McClelland explains in a new report, it’s a more effective way too. Many studies suggest matches are more effective than deductions In recent decades, economists and psychologists have taken to conducting studies trying to uncover biases in the way people respond to economic situations, a research program known as “behavioral economics.” For instance, people tend to be more sad about losing something they have than happy when gaining something of equivalent value (“loss aversion”); they tend to put undue weight on the first thing they hear about a certain subject (“anchoring bias”). Partly due to this research program, a number of economists have conducted experiments to see whether matching grants or a “rebate” like the charitable deduction work better. McClelland reviews many of these experiments and finds that they overwhelmingly show matches are more effective. The team of Catherine Eckel and Philip Grossman conducted many of these trials. A paper of theirs in 2003 found that a match was about three times as effective as a rebate; a 2017 paper includes three experiments, all of which find matches are more effective if your goal is maximizing the ultimate resources of the charity. Gift Aid means a simpler, fairer tax system The UK model has other advantages too. Gift Aid functions as a universal, refundable charitable credit of 20 percent, available to all of its residents regardless of their tax bracket or situation. It is not solely available to a minority of taxpayers who claim a special set of itemized deductions. It is available to all Britons regardless of income. That means a wider share of donors get their philanthropic preferences reflected. The administration is also simpler than a credit because donors need not remember their donations when filing taxes. Administration for charities is also relatively simple, requiring only a report of eligible donations to His Majesty’s Revenue & Customs. This is equivalent to the Form 990 reports already required of large charitable institutions in the United States. The additional reporting burden would be fairly minimal. What’s more, this kind of approach would make it easier for the US to eliminate its itemized deductions, a long-held goal of tax reformers. Economists generally believe the home interest deduction is a disaster that makes homes more expensive and encourages excessive debt; the state and local tax deduction is mostly a regressive transfer to wealthy people in high-tax states. Eliminating the charitable deduction in favor of a Gift Aid program would reduce the number of people using these deductions too, by making itemizing less attractive overall. If, as expected, Congress votes to continue the larger standard deduction passed as part of the Trump tax cuts in 2017 (and which is currently set to expire in 2025), these deductions will continue to be claimed by only a small share of taxpayers. Getting rid of the charitable deduction would make that share smaller still, and help shrink itemized deductions to a size where they might be junked entirely. A Gift Aid program would also eliminate certain key abuses of the charitable deduction. In recent years, wealthy donors have flocked to “donor-advised funds,” investment vehicles at financial institutions like Fidelity or Charles Schwab that promise their proceeds will eventually be dispersed to charitable institutions. Donors receive immediate charitable deductions for their contributions to these funds, irrespective of when or even if their donations are actually dispersed (there is no time limit within which they have to spend the money). This has provoked attempts at reform meant to speed disbursement, but as of this writing, no reform has passed Congress. More daringly, some taxpayers have used the charitable deduction to subsidize what amounts to personal consumption. A number of wealthy art collectors have in recent decades claimed large deductions for donations to museums they themselves have created — and which are rarely, if ever, open to the public. The Brant Foundation Art Study Center, located close to the home of its benefactor Peter Brant in Greenwich, Connecticut, provided Brant with tax breaks for all the art he endowed it with, despite only being open to the public by appointment. Without a charitable deduction, these kinds of abuses would not be possible, and they would not be possible under a Gift Aid regime either. While a billionaire-controlled nonprofit art museum would be eligible for Gift Aid reimbursement, it would be legally required to use that money to further its philanthropic mission. By contrast, money a taxpayer saves due to the charitable deduction could be legally used for any purpose. Donor-advised funds could give to charities that then in turn receive Gift Aid subsidy, but the subsidy would only come when the funds were actually dispersed. 2025 is a time to get creative about taxes While much of the focus today is on this year’s taxes — get them in by the end of the day — next year is set to be one of the most consequential years in a long while for the federal tax code. Most of the individual provisions of the 2017 Trump tax cuts — the rate cuts, the larger standard deduction and child credit, limits on the state and local and mortgage interest deductions — are expiring. With Trump wanting to defend his legacy and Biden refusing to raise taxes on people earning under $400,000 a year, both parties desperately want to preserve the bulk of these cuts. One of my biggest hopes is that they do this in a way that makes the code overall less, not more, complicated and reduces taxpayers’ burden in time and energy. Replacing the charitable deduction with a Gift Aid program would go a long way toward that, pushing the US further away from specialized deductions for this and that and toward a simpler system where everyone at a given income pays the same amount.

  • How should I plan for retirement when the future is so uncertain?
    by Nicole Dieker on April 14, 2024 at 11:10 am

    Paige Vickers for Vox Plus, how to think about building your legacy. On the Money is a monthly advice column. If you want advice on spending, saving, or investing — or any of the complicated emotions that may come up as you prepare to make big financial decisions — you can submit your questions on this form. Curious about what a financial expert would suggest about planning for the future. Seems like there is a lot of uncertainty — and as a millennial, lots of income difference within my generation. What happens if they raise the retirement age to 70? What if something else changes before millennials are able to retire? I don’t know if you know much about Dale Carnegie, but in addition to writing the famous self-help book How to Win Friends and Influence People, he also wrote a slightly less popular book called How to Stop Worrying and Start Living. There’s a reason why How to Win Friends and Influence People is the kind of book that everyone’s heard of and How to Stop Worrying and Start Living isn’t. Everyone wants to become an influencer, after all — and not everyone is ready to do the work required to stop worrying and start living. One of the first tasks, as Carnegie explains, is to imagine the worst-case scenario in all its worst-cased-ness. Then, Carnegie advises, ask yourself what you can do to either prevent or accept that worst-case scenario. And then — and here’s why nobody reads this book anymore — you have to do it. In your case, you’re worried about the federal government raising the retirement age to 70. This is not an unreasonable concern. I’m an “elder millennial,” so I was alive when the government raised the retirement age from 65 to 67, and it’s not much of a stretch to imagine a future in which we can only begin collecting full Social Security benefits after our 70th birthdays. Can either of us prevent this scenario? Maybe, depending on how we choose to vote in the next few elections, but it’s unlikely we’ll have any direct impact. This means that you have to accept the scenario as a possibility — and to stop worrying and start living, you have to plan for a future in which you do not receive full Social Security benefits until age 70. You may even want to plan for a future in which you are no longer allowed to collect partial benefits if you retire early. Does that mean you need to put more money into savings and/or investments every month? Not necessarily. Depending on your current retirement plan, the compound interest associated with your accumulated assets could help you cover the three-year gap between 67 and 70. On the other hand, a bear market (that’s the bad one) could decimate the value of your portfolio no matter how much you save in the next three decades. This is why I always advise people to focus on savings vehicles that provide guaranteed returns, such as CD ladders, as well as methods of building wealth that aren’t directly associated with investments. Getting promoted — or, in some cases, changing careers — could earn you much more money than you might get from a mutual fund. Moving to a lower cost-of-living area could also allow you to save more, as well as take advantage of opportunities like homeownership that might otherwise be more difficult. Living near family and/or living within a strong community can also provide the kind of support that can sustain you when times get tough. And if you live in the kind of area that allows you to participate in activities you love with people you care about, you might be less likely to spend money on distractions like impulse purchases, streaming media, and expensive vacations. This, in turn, could give you the financial and social resources to help other people who might need support, which is one way to address the income inequality issues that are prevalent across nearly all generations. All of these changes take work, and some of them come with up-front costs — which is another reason why How to Stop Worrying and Start Living never really took off as a self-help text. Still, it’s an extremely good template to help you prepare for the uncertainty of the next 30 years. Why save? I’m retired. You can’t take it with you … No, you can’t. As long as you have enough set aside to cover your expenses for the rest of your estimated lifespan (factoring in inflation, naturally), as well as any money you may need for end-of-life care (which is more expensive than many people realize), you can spend the rest on personal indulgences if you want! That said, I’d advise you to stop thinking about taking it with you and start thinking about how you can give back. Do you really want your life’s work to end up in the pockets of Amazon and Margaritaville? Isn’t there someone a little closer to home who might benefit from your legacy? If you have family or a community of friends who have provided comfort, support, and connection throughout your life, for example, ask yourself whether you have the extra resources to provide support in return. Some people leave an inheritance; other people make financial gifts while they’re still alive. If you’d rather not use financial resources, consider giving your time. Driving a friend to a medical appointment, sitting with them as they meet their medical team, and taking notes on the recommended treatment plans is one of the best things you can do for someone you love. If you don’t have a lot of close family or friends at the moment, consider supporting an organization or a local cause, and consider volunteering in order to start making a few more in-person connections. They’ll be worth more than you realize, especially as the decades continue to progress. There’s one more factor to consider, and that’s whether you might be eligible for Medicaid in your later years. If you’re thinking about Medicaid as an option, perhaps after spending down the last of your savings, you may want to set up a meeting with a financial adviser to discuss how to ethically take advantage of this government aid program. Medicaid is designed to help lower-income households access medical care, and many older Americans use both Medicaid and Medicare (a federal health insurance program) to help them manage the expenses associated with advanced aging. That said, accessing Medicaid could place a burden on your surviving family members. Many people don’t realize that Medicaid may be able to claim any remaining financial assets to cover the costs of providing end-of-life care, including real estate. The recent New York Times article “When Medicaid Comes After the Family Home” offers a good summary of what to expect, so read that carefully and include it in your long-term financial planning. It’s also worth remembering that the infamous Medicaid five-year “Look-Back Period” prevents people from gifting or donating their assets immediately prior to applying for benefits. Some people set up trusts to preserve their assets while remaining eligible for Medicaid, but this is the sort of issue that you’ll need to discuss with a professional. All I can tell you, as an advice columnist, is to think carefully about where you want your money to go since you already know that you can’t take it with you — and to have conversations with family members and financial professionals to ensure that any remaining assets are distributed in a way that feels meaningful to you and the people you love.

  • Every year, tuberculosis kills over a million people. Can a new vaccine turn the tide?
    by Jess Craig on April 14, 2024 at 11:00 am

    A single dose of the BCG anti-tuberculosis vaccine. | Nikolay Doychinov/AFP via Getty Images For the last 100 years, we’ve only had one TB vaccine — and it leaves a lot to be desired. It’s 2024, and people are still dying from … consumption. This ancient disease, known today as tuberculosis or TB, has plagued humanity for thousands of years, and as recently as a few hundred years ago, was thought to be responsible for some 25 percent of all deaths in Europe and North America. Today, TB is both preventable and treatable — there’s a century-old vaccine, effective antibiotics, and known behavioral and sanitation safeguards that disrupt transmission. Yet in 2022, more than 10 million people globally still fell ill from TB and 1.3 million died, making it the second deadliest infectious disease that year. (More people die from TB generally, but Covid-19 temporarily outpaced it.) More than 80 percent of those TB cases and deaths occur in low- and middle-income countries. That’s largely because people in those countries are more likely to suffer from contributing risk factors to TB, such as malnourishment and HIV. But beyond those factors, when it comes to preventing illness and death in these regions, physicians, researchers, and public health officials say that the available vaccine and treatments don’t do enough: The vaccine is given to infants and only offers protection in the first few years of life, leaving large swaths of people at risk, while antibiotic treatments take months to cure the disease. “TB is a disease of poverty,” explained Helen McShane, professor of vaccinology at the University of Oxford, where she and her team are developing a new TB vaccine among other TB research. “There have been decades of neglect where there was no funding for new drugs or new vaccines for TB.” But for the first time, promising new vaccines are now in the pipeline and may help prevent TB in adolescents and adults who currently have no such protection. These vaccines might also be more effective than what we have right now. Several are undergoing phase 3 trials — the last step before vaccine makers can apply to international and national agencies for approval. “It is excellent news,” said Matteo Zignol, unit head of the WHO’s Global Tuberculosis Programme. The success of the first wave of vaccines has helped usher in more support and funding to the field, but many researchers say we will need more than just a few effective vaccines. “We all wish [the M72/AS01E vaccine trial] is going to be a successful trial, but in any case, this is going to be like a first generation sort of new vaccine, and we really need more candidates to be able to help the epidemic.” It’ll likely still take years for the vaccines to be rolled out, but if approved, the new vaccines have the potential to save hundreds of thousands of lives, making an enormous dent in a disease that has killed humans for millennia. Why do we need another TB vaccine? One of the strange things about tuberculosis is that having the bacterium that causes TB doesn’t mean you have the disease. In a 2016 paper published in PLOS Medicine, researchers estimated that nearly 25 percent of the world’s population has a latent TB infection. For most people, though, the bacteria remain dormant and never go on to cause disease. Basic preventative measures — such as improving sanitation, ensuring proper ventilation in hospitals and laboratories, and proactively identifying and treating high-risk patients — helped greatly reduce TB cases in developed countries like the US, where there were around 8,000 TB cases reported in 2022. Many lower-income countries, unfortunately, still have underdeveloped public health systems and lack the resources to implement the multipronged approach necessary to stamp out TB. That is where vaccination can be a critical tool. The world’s first and only available TB vaccine, the Bacille Calmette-Guérin (BCG) vaccine, was created in 1921. Given the low burden of TB in the US, BCG is not routinely given to infants, but it is commonly used in many other countries. In Africa and Southeast Asia — the regions with the highest TB burden — 80 and 91 percent of 1-year-olds received the BCG vaccine in 2022, respectively, according to estimates by the WHO. The BCG vaccine is considered safe with rare side effects, but it’s not very effective. One meta-analysis of 26 studies reported that when the BCG vaccine was given during infancy, it was 37 percent effective against all forms of TB during the first five years of life, but did not offer protection among adolescents and adults. The way TB infects someone also plays a role in how contagious the disease can be and limits the vaccine’s ability to prevent disease. Usually, TB infects the lungs — that’s pulmonary TB. But Mycobacterium tuberculosis can infect the liver, bones, spinal cord, brain, urinary tract, bladder, kidneys, and even the intestines. When TB infects organs other than the lungs, it’s called extrapulmonary TB. Individuals with extrapulmonary disease don’t usually infect others, while those with TB in their lungs can more easily spread the bacterium to others by breathing, coughing, or sneezing. Pulmonary infections account for the majority of TB morbidity and mortality. Exact percentages vary by country, but globally around 63 percent of all TB cases were pulmonary in 2021, according to the WHO. BCG vaccine efficacy against pulmonary TB infections still remains a bit of a mystery as studies have reported efficacy rates ranging from 0 to 80 percent and efficacy tends to be lowest in high-burden countries close to the equator. Researchers are not quite sure why this is. One theory is that those who live closer to the equator are more likely to be exposed to non-tuberculous mycobacteria, which are similar to the pathogen that causes TB. This exposure confers preexisting immunity which may actually hinder the BCG vaccine from doing its job, McShane said. All in all, researchers estimate that the BCG vaccine prevents only 5 percent of all vaccine-preventable deaths due to TB. For comparison, vaccines for measles, smallpox, and polio are 93, 95, and 90 percent effective in preventing disease, respectively. So why now? What can a new TB vaccine actually accomplish? Despite the limitations of the BCG vaccine, no new vaccine candidates have emerged in the past 100 years. M. tuberculosis is notoriously difficult to make a vaccine for because the bacterium has an adept ability to evade the human immune system. As Vox’s Dylan Matthews reported last year, “TB is a hard disease to vaccinate against. While most vaccines target viruses, TB is a bacterium, and one with a strange lifecycle.” Economic and political factors play a role as well. After many high-income countries made huge strides in reducing TB in the late 1990s and early 2000s, they allocated few resources to further research and development of new vaccines and treatments, focusing instead on other health threats such as cancer and cardiovascular disease. TB fell into the category of neglected diseases. McShane recalled when her team conducted the first trials of a new generation TB vaccine in 2002. “At the time, there were about 50 candidate vaccines being tested for malaria and about 50 for HIV,” she said. “Of course, for both of those pathogens, there is a Western market. There is no Western market for a TB vaccine.” Since then, however, there have been renewed efforts to eradicate TB. The emergence of drug-resistant TB has threatened to reverse what global gains against TB have been made and may even cause a TB resurgence in the US and other low-burden countries, spurring more attention and funding to the disease. The Global Fund and the Stop TB Partnership have also launched major advocacy campaigns to bring more attention to the epidemic. Additionally, in 2016, the World Health Organization set a goal to end the TB epidemic by 2030. The US government has also ramped up investments in global TB eradication efforts. In the 2023 fiscal year, the US contributed more than $400 million to the cause, nearly double its total investments for global TB in fiscal year 2013. As of last year, there are 16 new TB vaccine candidates in development, four of which are in phase 3 clinical trials — which, if successful, would likely be the last phase of trials before FDA or WHO approval. Some vaccines aim to replace the BCG vaccine altogether while other candidates will serve as boosters to the BCG vaccine among adolescents and adults, McShane explained. One vaccine, M72/AS01E, seems to be the most promising candidate, buoyed by support and funding from the Bill and Melinda Gates Foundation. In a phase 2B clinical trial conducted in South Africa, Kenya, and Zambia, more than 3,500 adults with latent TB were randomly assigned to receive either two doses of the M72/AS01E vaccine or a placebo. Initial vaccine efficacy was 54 percent. Three years later, a follow-up analysis revealed that the vaccine had prevented active TB cases in 49.7 percent of people who received the vaccine. Most other TB vaccine candidates have demonstrated similar efficacy rates. “It’s unlikely that we’re going to get a vaccine against tuberculosis that is 100 percent effective anytime soon,” McShane said. But even a TB vaccine with low efficacy can have profound global implications. If the M72/AS01E vaccine demonstrates safety and efficacy in the ongoing phase 3 trial, then for the first time, the world could prevent at least a good portion of infections among adolescents and adults. “One of the big issues is that even if we’ll have a vaccine, it’ll be a game changer, but the effectiveness is around 50 percent. So it’s not one of the best, but it is something,” said Eliud Wandwalo, head of TB at the Global Fund to Fight AIDS, Tuberculosis and Malaria. Given the relatively low efficacy rates, these new TB vaccines are not a silver bullet for eradicating TB globally. For most of the world, improvements in sanitation, infrastructure, and medication are also urgently needed. Currently, it takes six months of ongoing therapy to cure TB, and as drug-resistant strains of TB become more common, existing antibiotics will become less and less useful. The vaccine will be just one of the tools in the toolbox, Wandwalo said. “If you look at the trajectory and projections, if we continue the same pace with the same tools, we’ll be ending TB in the next 180 years,” he said. “It’s a dire projection. But I think with a vaccine, we are likely to be able to end TB in our lifetime.”

  • The history of Arizona’s Civil War-era abortion ban
    by Nicole Narea on April 14, 2024 at 10:00 am

    A protester holds a sign reading “My body my choice” at a Women’s March rally where Arizona Secretary of State and then-Democratic gubernatorial candidate Katie Hobbs spoke outside the State Capitol on October 8, 2022, in Phoenix, Arizona. | Mario Tama/Getty Images How conspiring doctors, questionable tonics, and twisted patriotism led to the 1864 Arizona abortion ban that was just upheld in court. Earlier this week, the Arizona Supreme Court ruled that a Civil War-era state law that amounts to a near-total ban on abortion can be enforced, putting access to reproductive care for about 1.6 million people of reproductive age under immediate threat. It’s one of several abortion laws enacted before the Supreme Court’s 1973 decision in Roe v. Wade that have been revived since the justices overturned Roe in 2022. Resuscitating these laws has created legal headaches, in part because they were written in a very different time for reasons that have little in common with the concerns of anti-abortion advocates today. Arizona’s ban, first passed in 1864 and codified again in 1901 and 1913, says anyone who “provides, supplies or administers” an abortion or abortion drugs will face a state prison sentence of two to five years unless the abortion is necessary to save the life of the person who is pregnant. Taken out of the 19th-century context in which it was passed, that language would seem to amount to a near-total ban on abortion. But that’s not how the law was originally enforced. Few people were prosecuted under the Arizona law or similar ones in other states. At the time, first-trimester abortions were widespread and widely accepted in the public conscience. Abortion laws of the mid-1800s were the product of discussions among lawyers and doctors and were designed to professionalize abortion services and medicine writ large — a seemingly noble cause, but also one driven by physicians’ self-interests and the desire to both boost (white) women’s birth rates and weaken a nascent feminist movement. There was no national abortion debate to speak of. Religion wasn’t yet a major factor in Americans’ views on abortion in the way it is today, and scientists had not yet developed methods to detect pregnancy during the first months of gestation. All of that meant abortion was a common, if not always safe, part of American life, despite what the old laws might suggest. “I think people imagine nobody did it because it was illegal. But we know that’s not true,” said Lauren MacIvor Thompson, a history professor at Kennesaw State University focusing on women’s rights and public health. Abortion was common and widely accepted in the 19th century For much of the first half of the 19th century, there were few laws in the US that were specifically concerned with abortion. Rather, abortion was understood in the tradition of British common law: It was only a crime after “quickening,” when a fetus’s movement could be detected — around four or five months of gestation. Before quickening, people could be ignorant (or have plausible deniability) about being pregnant. Generally, the American public at this time had few moral qualms about abortion before quickening. In particular, it was a service that many believed should be offered to unmarried women, who risked reputational ruin if they proceeded with the pregnancy and often came from poor backgrounds, as historian James Mohr writes in his 1978 book, Abortion in America. But around the mid-1800s, things started to shift. More people appeared to be seeking abortions, not just those who were unmarried. One estimate by physicians at the time that Mohr cites suggests that as many as one in five pregnancies ended in abortion. Partially because of this, birth rates fell dramatically: from 7.04 children per woman in 1800 to 3.56 by 1900, according to Mohr. Starting around the 1830s, abortion became a lucrative industry. It was still mostly unregulated but perceived as largely safe, especially when weighed against the risks of pregnancy. There is little available data on maternal mortality rates in the US at the time, but even by 1915, after the development of antisepsis, it was about 600 in every 100,000 births — higher than in some European countries at the time. In 2021, the US maternal mortality rate was 32.9 deaths per 100,000 live births. As Mohr writes, home medical manuals and midwifery texts advised readers on abortifacient substances (such as black hellebore) and practices that could bring about an abortion (such as bloodletting and “raising great weights”). Abortifacient tonics of varying effectiveness were prolifically advertised. Physicians, midwives, and even untrained practitioners offered procedures to clear “obstructed menses.” One abortion provider to the elites, known as “Madame Restell,” amassed a fortune estimated at up to $1 million. Increased access to abortion seen throughout the 19th century led to increased scrutiny, however, and that led to many of the laws and attitudes still with us today. The beginnings of the anti-abortion movement The anti-abortion movement began to take off in the 1850s for a few reasons. For one, anti-abortionists resented the fact that wealthy, white Protestant women were starting to drive demand for abortions, usually to limit their family size or delay having their first child. These women were seen as shirking their duties to “republican motherhood” — a concept that involved raising the next generation of productive citizens instilled with the values espoused by the young American republic and that excluded nonwhite women. They were maligned for indulging priorities outside of the home at a time when the women’s suffrage movement was taking shape. Some men were seen as complicit in this phenomenon, urging their wives to get abortions and paying for them. Anti-abortionists argued that laws specifically restricting abortion were necessary because otherwise, “nice white ladies who don’t want to be pregnant just won’t fulfill their obligation,” as MacIvor Thompson put it. Around this time, there were also a few highly publicized trials involving botched abortions, typically cases where the pregnant person died. This raised the profile of abortion as a safety issue for legislators. A broader movement to professionalize the American medical system also contributed to the first laws restricting abortion in the US. The Civil War laid bare the need for more competent medical professionals, and credentialed physicians known as “regulars” lobbied for laws on abortion for the stated reason of protecting people from quacks. But they also had selfish motivations to essentially establish a monopoly over the market for abortions and sideline their competition. Physicians — who, at that point, were nearly all white and male — had lost income and stature as a result of this competition with other medical practitioners, and performing abortions was a way to attract loyal long-term patients, Mohr writes. “What they’re trying to do is consolidate their professional dominance because they don’t want to be competing with midwives or competing with what they call ‘the irregulars,’” MacIvor Thompson said. This was despite the fact, she added, that the “outcomes that doctors got in terms of treating patients were really not that much better than people who didn’t have medical training.” Arizona’s abortion ban came amid a wave of early anti-abortion legislation The first standalone law to specifically prohibit abortion in the US was passed in Massachusetts in 1845. It made performing an abortion a misdemeanor for which an offender could serve five to seven years in jail and face up to a $2,000 fine — about $74,000 in 2024 dollars — or a felony in cases where the person having the procedure died. But as would be the case with others that came after it, the law was rarely enforced: No one was convicted under it between 1849 and 1857, according to Mohr. Generally, such early abortion laws mostly did not create penalties for the pregnant person who sought an abortion but only for those who performed them — and messed up. “Historians have argued that a lot of these initial laws were meant to protect women. They’re either next to poisoning laws, or they’re framed in a way where it’s like, this is to protect women from quacks,” said Shannon Withycombe, a history professor at the University of New Mexico who studies early abortion laws. Few religious leaders wanted to get involved in abortion politics. Some Catholic bishops espoused the position, as the church does now, that abortion is wrong because life begins at conception. But at the time, Catholicism was associated with European immigrants who weren’t “welcomed into white middle-class American society,” MacIvor Thompson said. However, Horatio Storer, a Harvard physician who converted to Catholicism in his 40s, set out to consolidate support for anti-abortion laws in the 1850s. He ultimately led the charge to criminalize those who sought abortions and to make the punishment more severe if the person was married. He even pushed physicians and legislators to abandon the earlier understanding of abortion as acceptable before quickening and to suppress it at any stage of pregnancy. Storer’s writings came to inform anti-abortion legislation across the country, though the physician lobby didn’t agree with everything he wrote. Many believed he had gone too far in framing abortion as a religious and moral issue, insisting that it was really a medical issue, Withycombe said. But physicians latched on to one particular point Storer made in his 1860 book On Criminal Abortion in America: that “doctors need to be able to practice abortion because there are lots of reasons why an abortion is important for the health and life of a woman,” Withycombe said. This supported physicians as the definitive source of medical expertise about when and how an abortion should be safely administered over other abortion practitioners. And Withycombe notes that in her readings of medical articles and obstetrical teaching texts of the time, she has found a broad array of circumstances in which physicians believed it was their medical duty to perform an abortion — including circumstances in which failing to do so wouldn’t necessarily result in a pregnant person’s death, such as “pernicious anemia,” “obstinate vomiting,” and “advancing jaundice.” Withycombe said the 1864 Arizona law was part of a wave of legislation, all with similar provisions informed by Storer’s writings, that swept the West in the 1860s while the Civil War was raging. Colorado passed a ban in 1861, Nevada in 1861, Idaho in 1864, and Montana in 1864. At the time, these states were trying to prove that they were part of modern America, emulating medical licensing laws and protections that had already been enacted in more cosmopolitan parts of the country. In that sense, the passage of these laws was more about professionalizing medicine than the moralistic arguments that later motivated the 1873 Comstock Act, a federal anti-obscenity law that also prohibited the mailing of “every article or thing designed, adapted, or intended for producing abortion.” However, Storer’s moral philosophy on abortion did eventually gain traction, and it influenced the next wave of anti-abortion lawmaking in the decades thereafter. About 40 states banned abortion by 1880. Where the battle over the Arizona ban stands now Arizona isn’t alone in dealing with a pre-Roe anti-abortion law. Oklahoma is currently enforcing a 1910 abortion ban. Wisconsin’s Democratic attorney general has asked the state Supreme Court to strike down that state’s 1849 ban. Delaware, New Mexico, and Michigan have repealed their pre-Roe bans only in the last few years. West Virginia’s 19th-century ban was blocked in court in 2022, but the state legislature moved quickly to codify a new abortion ban that allows few exceptions. The Arizona ban won’t go into effect until at least April 24 under the court’s ruling Tuesday. In the meantime, Democrats in the state legislature want to repeal the law and Republicans have stymied their attempts to do so. As part of the ruling, the state must ensure the 19th-century law is “harmonized” with a ban after 15 weeks of pregnancy passed in March 2022. It’s not yet clear, however, what that means in practice. Arizona Attorney General Kris Mayes, a Democrat, has indicated she would not enforce the 1864 ban. Even limited enforcement would look very different from the way the law was interpreted in the years immediately after its passage. As mentioned, enforcement was spotty in the 19th century, and unlike now, abortion providers continued to operate despite facing potential legal repercussions. Producers of abortifacients often circumvented bans by using euphemistic language to describe their products. Early abortion laws, including the Arizona ban, also empowered physicians to make decisions about abortion. “A lot of these laws were at least supported if not written by physicians,” Withycombe said. “Physicians agreed that they have complete discretion over whether an abortion is medically necessary.” However, doctors have often been sidelined in the enforcement of abortion bans post-Roe, with many choosing to leave states with restrictive laws because they feel they cannot perform lifesaving care. The medical and popular understanding of pregnancy and abortion has also evolved since 1864. We can now detect pregnancy much earlier than “quickening” using urine and blood tests. In the 1860s, early abortions were generally seen as morally equivalent to contraception, Mohr writes — a concept that the American right largely rejects today. “These laws are being upheld as proof that everyone was completely against abortion in all cases, from the moment of conception,” Withycombe said. “Given the understanding of human development at the time, that is not true in the 1860s.”

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