To the Citizen Who Expects Better,
I have spent some time with the Constitution and have yet to discover the uterus among the enumerated powers of government.
This omission has apparently proved no obstacle.
American women now inhabit a curious definition of liberty. An adult woman may vote, own property, enter contracts, command troops, perform surgery, raise children, hold public office, run a corporation, and make decisions upon which the lives of others depend. Pregnancy, however, may cause the law to regard her judgment as suddenly insufficient. Decisions concerning what happens inside her own body may then be transferred to legislators who will never examine her, never read her chart, never stand beside her hospital bed, and never personally endure a single physical consequence of the command they have issued.
The indignity of that arrangement should trouble us. Its consequences should enrage us.
The argument over abortion has been conducted for decades as though it were primarily an argument about morality. Americans disagree profoundly about when developing human life acquires moral status and what obligations follow from pregnancy. Those disagreements are real, deeply held, and unlikely to disappear. A free society must make room for citizens to hold them.
Government power is a different question.
Dobbs v. Jackson Women’s Health Organization ended the federal constitutional protection for abortion recognized under Roe and returned substantial authority over abortion policy to elected governments. The result is a country in which geography now determines dramatically different legal rights and medical options during pregnancy. As of September 2026, thirteen states enforce total abortion bans, while twenty-eight more prohibit abortion at some point in pregnancy.
We have now had enough time to discover that pregnancy does not conduct itself according to legislative schedules.
Pregnancies miscarry. Fetuses develop conditions incompatible with sustained life. Membranes rupture too early. Hemorrhage occurs. Infection develops. Ectopic pregnancies become emergencies. Physicians must sometimes make decisions quickly because the human body is notoriously indifferent to the wording of statutes.
The evidence emerging from states with severe restrictions deserves considerably more attention than another round of political slogans. Recent analysis of CDC data found that almost 200 women died following ectopic pregnancies between 2020 and 2025, compared with roughly 100 during the preceding six years; the increase was greater in states with abortion bans. That analysis does not establish that abortion bans caused every one of those deaths, and intellectual honesty requires saying so. It establishes something quite sufficient for public concern: women are dying in greater numbers from a condition modern medicine ordinarily knows how to treat, and the increase warrants serious investigation rather than political convenience.
Other evidence continues to accumulate. A 2026 peer-reviewed study found that implementation of Texas’s abortion restriction was associated with worsening self-reported maternal mental health compared with states without bans, although the authors appropriately caution that their observational study cannot establish every causal mechanism. Another peer-reviewed study found Texas’s 2021 restriction was associated with an unexpected increase in infant and neonatal deaths.
At some point, lawmakers who insist upon practicing medicine by statute must answer for what happens when their statutes meet actual medicine.
That sentence should make us uncomfortable.
It should.
The State has assumed an astonishing authority when it tells a competent adult that she must continue a pregnancy against her judgment. It assumes still more when the law constrains a physician deciding how sick she must become before intervention is legally safe. Such power cannot be made modest merely by calling it protection.
Nor is this question answered by assuring women that exceptions exist for their lives or health. An exception written comfortably into a statute is not the same thing as medical care delivered promptly in an emergency. Even current policy surveys caution that the existence of a legal exception does not ensure that a provider will be available or willing to perform the procedure.
We should dwell upon that distinction.
A legislator can write except to save the life of the mother and go home for dinner. The physician must decide what those words mean while the mother is bleeding.
How close to death must she come?
How much infection is enough?
How much blood must she lose?
How certain must the physician be that a prosecutor, licensing board, hospital attorney, or future jury will agree that the danger had become sufficiently grave?
These are grotesque questions to impose upon an emergency room, yet legislation can make such legal considerations part of the environment in which medical decisions occur.
The constitutional question extends beyond abortion. Americans should consider carefully the precedent inherent in granting government broad authority over intimate bodily decisions. A government powerful enough to compel one medical outcome because today’s majority believes that outcome morally necessary remains a government possessing that power when tomorrow’s majority arrives with different convictions.
Liberty has very little meaning if it protects only decisions with which the majority agrees.
I am equally unimpressed by the notion that opposition to these laws constitutes hostility toward pregnancy, motherhood, children, or families. A woman does not cease to possess constitutional dignity when she becomes pregnant. Her existing life does not become an asterisk beside another political objective. Her body is not public property merely because another potential life depends upon it.
Women are citizens.
That should have settled considerably more of this argument than it apparently has.
The State may regulate medicine. It may license physicians, establish standards of care, prosecute malpractice, protect patients, regulate pharmaceuticals, and enact laws within constitutional limits. None of that answers the deeper question of why pregnancy should grant government an extraordinary claim over the internal workings of one citizen’s body.
Those defending abortion restrictions offer an answer: they maintain that government is protecting prenatal human life and therefore has interests beyond the pregnant woman’s autonomy. That argument deserves to be stated fairly because millions of Americans sincerely believe it.
It does not end the inquiry.
Government frequently balances competing rights and interests. The existence of a legitimate governmental interest has never meant that every exercise of power undertaken in its name is therefore legitimate, proportionate, wise, or harmless. Constitutional government demands more than a noble purpose written at the top of a statute. We must examine what the law actually does to the people required to live beneath it.
That examination is becoming harder to avoid.
Women are traveling across state lines for care. Telehealth abortion provision into states with total bans increased from approximately 74,000 abortions in 2024 to 91,000 in 2025. The number of clinician-provided abortions nationally has not collapsed since Dobbs; Guttmacher estimates approximately 1.126 million occurred in 2025. Restriction has therefore produced, among other things, an elaborate interstate system in which medical access increasingly depends upon geography, travel, technology, money, and conflicting state laws.
One might reasonably ask what, precisely, we have accomplished.
We certainly have not eliminated abortion.
We have made circumstances matter more.
A woman with money can travel. A woman with reliable transportation can cross a state line. A woman with internet access and knowledge of shield-law providers may obtain medication remotely. The woman with none of those advantages encounters the full weight of the restriction.
There is something particularly offensive about calling such an arrangement equal liberty.
I am tired, moreover, of hearing women’s suffering discussed as an unfortunate complication of a grander political argument. The woman is not the complication. She is the citizen.
Her life counts before she is dying.
Her judgment counts before government agrees with it.
Her bodily autonomy does not become trivial because pregnancy makes its exercise morally difficult.
Her constitutional dignity does not depend upon whether strangers approve of the decision she makes.
Americans remain free to believe abortion is morally wrong. They may refuse one themselves, counsel against it, support alternatives, assist pregnant women, advocate for adoption, work to reduce unintended pregnancy, and persuade their fellow citizens. Persuasion is one of liberty’s great instruments.
Compulsion is another instrument altogether.
Any government that claims the power to compel pregnancy to continue must accept relentless scrutiny of the injuries produced by that power. Every delayed intervention matters. Every frightened physician matters. Every woman forced to travel hundreds of miles matters. Every poor woman who cannot make that journey matters. Every preventable medical catastrophe matters. Every death matters.
No political slogan absolves the State from answering for foreseeable consequences merely because the statute declared its intentions virtuous.
We have spent centuries arguing about the proper limits of government power. Perhaps women might finally be permitted the radical privilege of being included in that concern.
A woman’s body is not a committee room. Her pregnancy is not a legislative abstraction. Her medical emergency is not an opportunity for politicians to demonstrate ideological consistency.
She is not territory upon which the State may plant its flag.
She is a citizen of the Republic.
The distinction ought to be beyond debate.
I remain, in expectation,
Prudence C. Wilder
Letter's From Prudence 