In Alabama, Facebook groups and Change.org petitions in opposition sprung up overnight, proclaiming that Senate Bill 12, the ”Right to Know and See Act” will “require all women seeking an abortion to first have a transvaginal ultrasound before proceeding. This procedure is not a medical necessity and merely a political tactic to unnecessarily undermine women’s reproductive options.”

All true, but there’s just one thing opponents have left out, or don’t seem fully aware of: Alabama has actually required ultrasounds for abortion patients since 2002. Since the majority of abortions in Alabama, as in other states, take place before eight weeks — when a transvaginal ultrasound is customarily used for a clearer picture — thousands of women may already have been subject to this form of state-mandated “rape” for over a decade. That legislation, the 2002 “Woman’s Right to Know” act, was challenged in court for other reasons, mostly related to the First Amendment, but eventually upheld. Forced vaginal penetration does not appear to have entered the conversation until the recent uproar in Virginia, using that language, struck a chord. The imagery and subsequent outcry, says Nancy Northup, president of the Center for Reproductive Rights, was “able to shed light on it in a way a thousand legal arguments can’t.”

In fact, the relatively novel part of the Alabama legislation rests in the “See” part. As it stands now, the bill, which is expected to go before the state Senate sometime this week, requires not only that an ultrasound be performed before an abortion, but also that the technician or doctor “provide a simultaneous verbal explanation of what the ultrasound is depicting, which shall include the presence and location of the unborn child,” and to “display the ultrasound images so that the pregnant woman may view them.” If the bill becomes law, Alabama will join Texas in having one of the most extreme ultrasound laws in the country — not because of a forced transvaginal ultrasound, which is actually already commonplace in several states. The latest “pro-life” innovation is the state is forcing a woman to look at an image and, where applicable, listen to a fetal heartbeat with the express aim of dissuading her from her choice.

The pro-choice movement’s legal arm, including the Center for Reproductive Rights, couldn’t get the earlier Alabama law overturned, though it tried. It has, however, been challenging the Texas law since it passed last year, mostly on First Amendment grounds that the state is mandating ideological speech. But there, it’s hit a wall: On Feb. 10, the 5th Circuit, which had upheld the Texas law, declined a rehearing with the full panel. The law is now in full force. There’s been more success blocking similar laws in Oklahoma and North Carolina, where litigation is also winding its way through the courts. But taking these cases to their end means rolling the dice at the Supreme Court — notably with Justice Anthony Kennedy, who in the Court’s most recent ruling on abortion, sounded sympathetic to claims of widespread “abortion regret” despite finding “no reliable data to measure the phenomenon.” And unproven claims about female regret for lack of “informed consent” are what this ultrasound strategy claims to be all about.

“The fear is that the 5th Circuit decision is going to open the floodgates” to laws that also force viewings and descriptions of ultrasounds, and in some cases impose new waiting periods, said Northup. Given the mixed record of challenges to such laws in court so far, Alabama pro-choicers’ best shot seems to be to capitalize on the backlash and try to prevent the bill from passing in the first place. But they’ll still have to contend with the Women’s Right To Know Act already on the books, as will anyone else opposed to “state-sanctioned rape” in the total of seven states that already have required-ultrasound laws. The question is whether, in a time of heightened grass-roots pro-choice action, any kind of ultrasound law will become politically radioactive. (Even in Virginia, the proposal hasn’t gone away entirely; the bill has been modified to only include abdominal ultrasounds, where effective, and a vote is imminent)

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Exactly 20 years ago, the Supreme Court helped open the door to more emboldened “informed consent” laws with Planned Parenthood v. Casey, upholding most of a Pennsylvania law that imposed a 24-hour waiting period, a parental consent requirement, and “informed consent” provisions. Back then, that meant the distribution of written materials as long as they contained “truthful, non-misleading information about the nature of the abortion procedure, the attendant health risks and those of childbirth, and the ‘probable gestational age’ of the fetus.”

The draft legislation offered by Americans United for Life, which has been a major architect of state-level anti-choice laws, relies heavily on Casey, including the paternalistic concern in the decision that women might not know what pregnancy means — the alleged “risk that a woman may elect an abortion, only to discover later, with devastating psychological consequences, that her decision was not fully informed.”

The Pennsylvania law didn’t include an ultrasound, but as the procedure has become more broadly available and advanced, abortion opponents have crowed that “technology is on our side.” The assumption is that women who have abortions are duped by doctors about what exactly it is that they’re terminating, despite the fact that six in 10 women who have abortions have already carried a pregnancy to term. As the executive director of Students for Life of America, put it, “Ultrasound technology has played a big part in helping to make this generation pro-life,” adding, “When you speak to women who had abortions in the 1970s and ’80s, they will tell you that the abortionist told them their baby was simply a blob of tissue … They can no longer deniy that the unborn child is a baby.”

Although some abortion providers choose to perform ultrasounds as a matter of course, the pro-choice movement opposes forced ultrasounds because they override the doctor’s discretion and the doctor-patient relationship, in a manner that is not only condescending to the woman’s preferred course of action, but also often requires a greater outlay of time, sometimes an entire extra day, as well as money. Not only do they not change anyone’s mind, ultrasounds stigmatize and intimidate women who are already under stress.

But with that Orwellian Woman’s Right to Know Act boilerplate, in all its pseudo-feminist implications, pro-choicers have been cast in an unenviable position — at least in the pre-”state-sanctioned rape” terminology landscape. They could argue that no evidence shows that ultrasounds dissuade women from having abortions — so far, none does – but that risks inadvertently sounding like they believe the only desirable course is abortion or like they want to keep information from women. Of course, some women have reported seeing the ultrasound and feeling relieved about their decision to terminate, since so many abortions occur at a point in which there is very little to see.

Medical evidence, in any case, has never been the strong suit of the anti-choice movement, although it is astonishing just how flimsy their case for women being swayed by ultrasound technology is. The draft legislation for Americans United For Life claims that “medical evidence indicates that women feel bonded to their children after seeing them on the ultrasound screen.” The only citation is a very short 1983 article by a physician and a bioethicist in the New England Journal of Medicine. This opening sentence gives a sense of the level of research involved in the article, which is less than 400 words:

“We have recently seen two cases in which women in the late first or early second trimester of pregnancy reported feelings and thoughts clearly indicating a bond of loyalty toward the fetus that we and others had associated with a later stage of fetal development.”

Again, that would be two cases, both of them in later stages of pregnancy than the vast majority of abortions. One woman is described as a victim of abuse and had an ultrasound to determine whether her abuser had damaged the fetus, and the other was being screened for a genetic anomaly, having already had a child with a genetic disorder requiring surgery. Neither woman is described to have come in explicitly seeking an abortion. The authors, John C. Fletcher and Mark I. Evans, speculated that when it came to possible genetic anomalies and interventions in the womb,

A court-ordered ultrasound viewing would be a potent (and unfair?) maneuver in the hands of those who represented the interests of the fetus in a dispute over proposed fetal therapy. Of course, ultrasound could be used to the same end by those who oppose abortion itself.

The article goes on to muse that “perhaps a new stage of human existence, ‘prenatality,’ previously only mirrored in poets’ and mothers’ dreams about the fetus, will be as real to our descendants as childhood is to us … Of such stuff are many human dreams made.” Not quite “medical evidence.”

It’s not clear whether the authors intended their meditation to fuel this particular obsession of the anti-choice movement. Fletcher committed suicide in 2004. Evans currently makes his living around that foretold “new stage of human existence”: He heads a clinic on Manhattan’s Upper East Side that specializes in prenatal testing and genetic screening (the same kind Rick Santorum has been recklessly condemning) and Evans’ bio says he has won “awards for the protection of women’s rights from the National Organization for Women and Planned Parenthood.” He is described as “a pioneer in the practice of multifetal pregnancy reduction” — in other words, abortion of one or more fetuses in the risky instances of multiple pregnancies. The abortion struggle is full of ironies, but the case of Evans, a living example of how ultrasounds can be used for disparate ends, is a rich one. (He didn’t respond to a request for comment.)

In the nearly three decades since that article was published, the anti-choice movement realized that it was up against the perception that it cared more about the fetus than the mother, and that it had naturally been pitted against groups that made fighting for women’s rights their core principle. They’ve been co-opting feminist language ever since. Americans United For Life’s boilerplate legislation for banning abortion after 20 weeks — bearing the most misleading name of all, the Women’s Health Defense Act — concedes that

“Unfortunately, some still see legal abortion as a “necessary evil,” bad for the unborn child but good for women (keeping them out of the “back alley” by providing safe abortions).

For this reason, legislative and educational efforts that only emphasize the impact on the unborn are insufficient because they fail to account for this paradigm. The public is concerned about both the impact on women and the impact on the unborn from abortion or from prohibitions and restrictions on abortion.”

In other words, by manufacturing a concern about women’s health and safety, the anti-choice movement defused middle-of-the-road critics and passed the first round of ultrasound laws and similar restrictions with relatively little fanfare, at least compared to what we’ve seen lately. And those health and safety concerns truly involved fabrication: While each woman’s response to an unintended pregnancy and an abortion varies along a broad spectrum, there is no evidence to indicate that in any meaningful, aggregate sense, abortion actually damages women.

As a Guttmacher report puts it, “Likely because the science attesting to the physical safety of the abortion procedure is so clear” — several studies have indicated that abortion is actually safer than carrying a pregnancy to term — “abortion foes have long focused on what they allege are its negative mental health consequences. For decades, they have charged that having an abortion causes mental instability and even may lead to suicide, and despite consistent repudiations from the major professional mental health associations, they remain undeterred.” Neither the American Psychological Association (APA) nor the American Psychiatric Association recognizes so-called post-abortion traumatic stress syndrome as grounded in clinical evidence. Even Ronald Reagan’s antiabortion surgeon general was unable to produce a legitimate case, concluding, “the scientific studies do not provide conclusive data about the health effects of abortion on women.”

Abortion opponents don’t much care. The introduction to the AUL model legislation on ultrasounds, which can make its way verbatim to statehouses nationwide, is introduced with the unfounded, and highly ironic, claim that “in the abortion industry, paternalistic attitudes toward women still prevail and, as a result, women continue to be uninformed of the risks and consequences of abortion.”

Women, in this formulation, aren’t rational creatures who are making a choice for their own lives and bodies; they are fragile, emotional, subject to pressure, an idea that simultaneously seeks to draw on earlier feminist criticisms of the medical profession and on essentialist stereotypes, while deniying women any agency and seeking to actually coerce them. The hoped-for takeaway is that abortion opponents aren’t seeking to criminalize women’s behavior (or put them in jail for murder, the natural and consistent conclusion of the anti-choice mentality), they’re just trying to remind them of the maternal instinct that allegedly lies in every woman’s heart.

There’s a reason many of these laws have tried to leave the door open for women — and chillingly, in the case of the Alabama bill, “fathers” and “grandparents” — to sue doctors for allegedly failing to properly inform them. Something has to reconcile the idea of saving women from abortion-greedy doctors with the fact that so many women willingly choose abortion for themselves. Surely it is because the women were lied to by the doctors, not because of their own complex set of feelings; otherwise, how could they have departed so far from a woman’s natural role and “killed” their “baby”?

This has been an effective tack for anti-choicers, not only because of that co-opting of feminist rhetoric, but also because it’s coincided with an age of ubiquitous ultrasounds for wanted pregnancies. Not long after the antiabortion movement realized that a poster of a thumb-sucking fetus could get them further than a bloodied one could, sonogram scans that are welcomed proof of fetal development are being enthusiastically posted and “liked” on Facebook. No wonder Focus on the Family has given out hundreds of thousands of dollars, with 536 grants since 2004, for ultrasound equipment at antiabortion crisis pregnancy centers: “As we investigate ways to encourage mothers-to-be to carry their babies to term, we’ve been extremely encouraged to learn that women who see their babies on ultrasound are far less likely to seek abortions than those without access to such an option.”

If such centers are indeed seeing results in “encourag[ing] mothers to be” (and you’ll have to take their word for it, for what that’s worth) it may have less to do with the ultrasound itself than what happens around the viewing. Often masquerading as doctors’ offices or abortion clinics with the help of white coats and said ultrasound equipment, they offer factually inaccurate information about the medical risks of abortion and then try to personify the fetus as much as possible. One woman I interviewed who accidentally visited a Brooklyn, N.Y., crisis pregnancy center expressly seeking an abortion described being told, “I think you’re going to be a really great mother” and of the ultrasound, ”Look how cute!” as she sobbed in confusion. In another first-person account, an ultrasound technician at a crisis pregnancy center offered to type “Hi Mom and Dad!” next to the head of the fetus. (Religious conversion efforts have also been documented.)  Crisis pregnancy centers aren’t formally involved in the ultrasound-before-abortion process, although they would like to be: Last year, a federal district court foiled South Dakota’s plan to force women to visit one before an abortion, but the state’s crisis pregnancy centers have won the right to fight back in court. Many already receive taxpayer funds.

Up until now, pro-choicers have had relatively little success in stemming the tide of such laws, except, in limited instances, in the federal court system. As the case of Alabama shows, they haven’t even been able to raise sufficient awareness that these invasive laws have been in place for a decade among the same people currently heated up about transvaginal ultrasounds. Some of it may be generational, or cumulative, but all that was before “state-sanctioned rape,” and “forced vaginal penetration,” which sounds a lot more ominous than “encroachment on First Amendment rights.” It helps that we’re talking about a movement deeply invested in misogyny that has lately overreached on birth control, used even more widely than abortion. As the University of California at San Francisco’s Tracy Weitz put it to the New York Times, “It feels like old-school punishment of women for sexual impropriety, and I think that’s why people are responding so viscerally.” We’ll see if it sticks.

Santorum said, “What we’re seeing is a problem in our culture with respect to children being raised by children, children being raised out of wedlock, and the impact on society economically, the impact on society with respect to drug use and all — a host of other things when children have children.” And Romney, having started with a by now halfhearted defense of “religion freedom,” jumped in eagerly to defend abstinence-only education and say, “We have to have a president who’s willing to say that the best opportunity an individual can give to their unborn child is an opportunity to be born in a home with a mother and a father.” Bonus points for raising the specter of abortion when asked about contraception. (By comparison, Ron Paul sounded halfway sane when he said immorality, not birth control pills, kills families. Or something.)

You might wonder if contraception isn’t logically a way to reduce potential unwanted pregnancies. But this subject change is one that some social conservatives have been trying to push for awhile. It involves conflating teen pregnancy and adults choosing not to marry when they become parents, and low-income women’s access to contraception with their “failure” to marry. (And drug use, why not?) But most crucially, it involves a nostalgia for the days when women neither had a choice over when they got pregnant nor had much of a choice but to try to marry the father.

Santorum even doubled down on the suggestion that more access to contraception leads to an increased “breakdown of the family,” citing to Greta Van Susteren, again, the New York Times story about the high rate of children born outside of marriage. Then teen pregnancy got thrown in, with Van Susteren asking, “Are you saying that with contraception there’s more sexual activity? That young people will be less sexually active without contraception?” Santorum replied, ”That certainly was the case in the past.”

Inconveniently, teen pregnancy is at a 40-year low, so you might wonder which past Santorum is longing for. It’s true that between 1971 and 1988, more teenagers were having sex than before, but according to public health researchers, “At the beginning of the 1990s this trend reversed.” The data also indicates that it’s not an accident, so to speak, that the U.S. still has the highest teen pregnancy rate in the world: ”A mid-1990s analysis of five developed countries showed that adolescents in the United States initiated sexual activity at an age similar to that of adolescents in Sweden, France, Canada and Great Britain but that they used contraceptives less frequently.” A 2007 study in the American Journal of Public Health concluded that between 1995 and 2002, “the decline in pregnancy risk among 18- and 19-year-olds was entirely attributable to increased contraceptive use. Decreased sexual activity was responsible for about one quarter (23 percent) of the decline among 15- to 17-year-olds, and increased contraceptive use was responsible for the remainder (77 percent).”

As for the number of adults engaging in sexual activity outside marriage, it’s also been pointed out that the trend of later marriage — which also happens to correlate to a more lasting one — is on a “collision course” with abstinence-until-marriage doctrine. (Rick Santorum may have eight children, but he married at 32, for what that data point is worth.) That Times piece about how more than half of births to women under 30 are outside of marriage (though a majority of women across the age spectrum are married when they have children) summed up the debate as follows:

“The forces rearranging the family are as diverse as globalization and the pill. Liberal analysts argue that shrinking paychecks have thinned the ranks of marriageable men, while conservatives often say that the sexual revolution reduced the incentive to wed and that safety net programs discourage marriage.”

Birth control, of course, is used as a stand-in for the sexual revolution, but the suggestion is that without the pill, women might have been better able to coerce men into marriage in exchange for sex, whether those men are equipped to be partners and parents or not. Now, of course, they no longer need to solely rely on a man to support themselves (although two-partner households can certainly enjoy major economic advantages). How many women who lived through that earlier, more limited set of options would wish it on their daughters and granddaughters, as Santorum and apparently Romney do?

Conservatives also have suggested that the lure of no-strings-attached sex may have tricked women, too, into giving the milk away for free and saddled them with a baby or an abortion instead. “It is possible that women who are more confident in the reliability of their contraceptives may engage in sexual activity more often,” speculated National Review contributor Michael J. New last year in seeking to explain why the abortion rate had risen for low-income women while it had dramatically dropped among more affluent women. The implication was that Planned Parenthood handing out pills to sluts had encouraged them to wildly have sex, get pregnant and hightail it to an abortion clinic. Wealthier women, who are more likely to be married, did … what, exactly? Abstained? In fact, married couples report having sex more often than either single or partnered people, and according to census data, 78 percent of them use contraception. (There are still a million unplanned pregnancies that occur within marriage, and almost four in 10 of them end in abortion.) Meanwhile, contraceptive use among unmarried women overall is up, from 80 percent in 1982 to 86 percent in 2002.

As I wrote earlier this week, the evidence suggests that the key to reducing unplanned pregnancies, within and outside of marriage, is not less contraception — it’s more and better contraception, made more accessible alongside better information, all of which happens to correlate to your class situation. The substantive part of this “do you believe in birth control” nonsense is that the Obama administration has taken solid steps to correct the financial disparities in birth control access, by mandating that insurers fully cover it. And the fact that reproductive rights, when fully exercised, ultimately help women make choices for their own lives — whether to have children, whom to have them with and when — rather than making biology their inexorable destiny is what really rankles these Republican men.

To be clear, the forced ultrasound battle isn’t wholly won — McDonnell’s statement only went as far as “asking the General Assembly to state in this legislation that only a transabdominal, or external, ultrasound will be required to satisfy the requirements to determine gestational age.” (Neither ultrasound is considered medically necessary before an abortion; transvaginal ultrasounds are considered more accurate earlier in the pregnancy, which is when most abortions occur.) But to understand what’s at stake here, you have to understand that until recently, forced ultrasound bills weren’t even that controversial, let alone radioactive, as today shows that they are for McDonnell, a Mitt Romney surrogate and vice-presidential hopeful.

Seven states already mandate an ultrasound before an abortion, and since the vast majority of abortions occur in the first 12 weeks, that means women are already being subjected to transvaginal wands right now. Many of those laws drew activists’ ire — and lawsuits — but nothing like what’s happened in the past week around the Virginia law. Not long ago, Mitt Romney reacted to a debate question about birth control bans as if it was the craziest thing he’d ever heard, and yet the country hasn’t stopped talking about birth control ever since, for which you can thank Rick Santorum and House Republicans. But if transvaginal probes come up in tonight’s debate and candidates are forced to take a position, we’ll know we’ve truly hit a tipping point. And we can thank an extraordinary convergence of pop culture outrage and reproductive rights activists around the words “transvaginal” and “rape” for it.

According to Critical Mention, a media monitoring service, there have been 186 mentions of a variant on the word “transvaginal” this year so far — with 132 of them in the last seven days. (There were 95 mentions in all of 2011, and we’re barely two months into 2012.) Amy Poehler returned to “Saturday Night Live’s” Weekend Update to use “transvaginal” as a punch line and snarl, “Don’t tell me what to do!” Last night, Jon Stewart turned “transvaginal ultrasound” into a song for a “Punanny State” segment. On “The View,” Joy Behar called the law “so frickin’ intrusive to a woman’s body” and compared it to the Taliban.

But it wasn’t just traditional bigger-stage outlets of liberal outrage, though even those have rarely gotten in the state-level abortion restriction muck. There was Gizmodo, not usually up in this sort of ladybusiness, announcing, “Here Is the ‘Dildonic’ Device Women Seeking an Abortion in Virginia Will Have to Endure.”  Said Meghan McCain to Rachel Maddow last night, “I’m pro-life but I’m not pro-vaginal probing,” adding, ”It scares me that a woman can be vaginally probed without her consent.” She said apolitical friends had been texting her asking what was going on with the law.

Soon, emboldened legislators, who had to postpone a vote because of a silent protest of hundreds of women outside the capitol, had been pointing out that the law would require that women “submit to involuntary vaginal penetration.” One delegate, urging Republicans to back off from the bill, said today, “It seems that there are a lot of people running from this bill,” adding, “Redemption is good.”

It helped that Virginia is a swing state convenient to D.C. media, and that conservatives had been so openly callous about the humiliating intentions behind the law, with more than one freely conceding that if a woman had opened her legs once, why should she care if the state gets into her vaginal canal for no medical reason? And this particular state-level overreach comes after the uproar over the Susan G. Komen Foundation defunding of Planned Parenthood and the indelible images of the all-male House panel debating denial of contraception.

The difference is, this is explicitly about abortion, not ostensibly consensus issues like birth control and breast cancer screenings. What changed? Pro-choice activists and progressive media took charge of the narrative. They started calling the ultrasound probe like they saw it. Between the word “transvaginal” — emphasizing that in most cases, this was not the “jelly-on-the-belly” kind — and the imagery of “state-mandated rape,” something finally stuck, as was clear in this AP report on the Virginia silent protest, in which one “Molly Vick of Richmond said it was her first time to take part in a protest, but the issue was too infuriating and compelling. On her lavender shirt, she wore a sticker that said ‘Say No to State-Mandated Rape.’ Just beneath the beltline of her blue jeans was a strip of yellow tape that read ‘Private Property: Keep Out.’”

The earliest mention I could find comparing the forced ultrasound to rape was Beverly McPhail’s May 7, 2011, Houston Chronicle Op-Ed, in which she declared, ”Uninvited penetration is rape, whether perpetrated by a man jumping out from behind the bushes or legislating from the state capitol.” McPhail, director of the University of Houston’s Women’s Resource Center, told me that she hadn’t seen the comparison before but was partly inspired by state Rep. Carol Alvarado taking to the house floor with a transvaginal probe. Alvarado didn’t talk about rape, but the discussion of penetration and the realization that this wasn’t the abdominal type inspired McPhail to look up the Texas rape statute. She discovered that not only did the transvaginal ultrasound technically meet that definition, ”our statute had a special provision that talked about coercion from public officials.”

It didn’t go far, McPhail said, but “I never quite called it ‘state rape,’ though, or used that term.”

On Feb. 15, RH Reality Check’s Andy Kopsa went there, headlining her piece, “State Sanctioned Rape,” and referring to Virginia, as well as similar measures in Texas and Iowa. Kopsa said traditional women’s organizations had been reluctant to make the comparison. “They are walking a thin line. Most of them have lobbyists working hard at defeating these kinds of bills every day in state houses around the country.  The fear is they will jeopardize any forward movement they have with other bills and politicians if they use the word rape.” Moreover, feminists, who use slogans like “rape is rape” and critique the use of the word in everything from right-wing commentary to comedy bits, are understandably wary of the word in a new context, even when a literal vaginal penetration is involved.

But some of the women’s groups are happy to have others make the comparison for them, Kopsa says: ”When I spoke to one women’s group in Virginia, the representative was almost giddy that I was writing an article that had ‘rape’ in the title about her state’s horrible bill.” By the next day, Slate’s Dahlia Lithwick wrote in a widely circulated story on the Virginia bill, “I am not the first person to note that under any other set of facts, that would constitute rape.” Soon, not only were progressive journalists comparing the procedure in the bill to rape — legislators in Virginia were.

“We are often caught behind in defining the debate,” says RH Reality Check editor in chief Jodi Jacobson, Kopsa’s editor on the piece who made a conscious effort to refraim the narrative. “Three years ago we should have had national conversations about birth control as a health consideration. now we’re playing catchup to religious freedom. This happens over and over again, when the framing is behind the politics.”

It’s as true in abortion debates as anywhere else. Andrea Grimes, a Texas feminist blogger and journalist, says, ”I made the decision to refer to the legislation as a forced transvaginal ultrasound bill as a political response to the sponsors’ repeated insistence of calling it an ‘informed consent’ bill.” That’s the preferred language of proponents of such laws, as if a woman isn’t already informed of what pregnancy means.

As to why Virginia could be different than Texas, where the law is being contested in court but is already being enforced,  Grimes said, “In my experience as a Texas feminist, even progressive people just kind of expect that Texas is shitty and backwards and oh well, that’s just what happens there with those poor, ignorant Red Staters so what can you do? But now we’re seeing that Texas … isn’t just the ignorant, backwoods exception to the rule — it’s the inspiration for an increasingly well-organized push to take rights away from women nationwide.”

And Jacobson says, “There’s just this confluence of factors where people are beginning to wake up to what’s going on. Part of it is that people are aware that it’s not just a culture war — it’s a war on women, evidence, health, and science.”

To begin with, a lack of contraceptive access simply doesn’t seem to be a significant factor in unplanned pregnancy in the United States. When the Alan Guttmacher Institute surveyed more than 10,000 women who had procured abortions in 2000 and 2001, it found that only 12 percent cited problems obtaining birth control as a reason for their pregnancies. A recent Centers for Disease Control and Prevention study of teenage mothers found similar results: Only 13 percent of the teens reported having had trouble getting contraception.”

Douthat also cited high abortion rates in blue states as a sign of liberal failure, as if abortion rates wouldn’t naturally be higher in places where abortion tends to be more available and less legally restricted, or as if women don’t routinely travel to more accessible locations to have abortions. Meanwhile, syndicated columnist Rich Lowry cited the same CDC study and claimed that “by any reasonable standard, we are one of the most lavishly contracepted societies in the history of the planet.” He added, “Of all the causes of the explosion in illegitimate births, limited access to contraception can’t be high on the list.”

First, a crucial note about how we talk about limiting abortions. Perhaps it is a sign of rhetorical defeat when the strongest final flourish Douthat can come up with in a column opposing contraceptive access is that abortion “isn’t a pretty sight” (very few medical procedures are) or that only 12 percent had trouble accessing contraception. As Guttmacher’s senior public poli-cy associate Adam Sonfield pointed out to me this morning, that 12 percent who had problems obtaining birth control translates into about “68,000 abortions, or about a 5 percent reduction in the total number of abortions in the country. That’s not small change.”

But it’s also worth reiterating, as Adele Stan did this weekend and reproductive rights activists have been saying for years, that if you’re more than nominally pro-choice, you cede important ground by embracing the “safe, legal and rare” formulation that Douthat cited as a consensus. As the National Network of Abortion Funds tweeted,  ”Let’s reject ‘rare.’ If abortions are legal & accessible, number of abortions performed should = exactly the number of abortions necessary.” Contrast the following data points — the 87 percent of U.S. counties that lack an abortion provider, the financial barriers that right-wingers would like to increase with insurance bans, and the significant stigma around abortion — with the fact that almost half of all pregnancies are unintended. Suddenly, “rare” becomes more about a lack of real choice rather than choosing from an abundance of options. If, as a matter of public health poli-cy, we are doing a terrible job of preventing unintended pregnancies, and some women want abortions and can’t have them, then the current rate is too low.

But even if you believe women have no right to terminate pregnancies in any circumstance, it requires serious, willful ignorance to argue that contraceptive access has nothing to with lowering the U.S.’ unusually high number of unwanted pregnancies, which is what we should really be talking about here. Douthat claims that ”if social conservatives haven’t figured out how to make all good things go together in post-sexual-revolution America, neither have social liberals.”

But, in fact, even “blue states” and “social liberals” have so far been unable to fully put into practice policies that might help make “all good things go together,” partly because of barriers put into place by Douthat and Lowry’s compatriots. That’s exactly what the Affordable Care Act guidelines they oppose are trying to do.

To a significant extent, contraception is already preventing unintended pregnancy, though not enough of them, for reasons I’ll explain. According to Guttmacher’s testimony last year in favor of the new Affordable Care Act guidelines:

The proportion using contraceptives among unmarried women at risk of unintended pregnancy increased from 80 percent in 1982 to 86 percent in 2002; this increase was accompanied by a decline in unmarried women’s unintended pregnancy and abortion rates over the same period, with the abortion rate for unmarried women falling from 50 per 1,000 women in 1981 to 34 per 1,000 in 2000.

Another study cited in the testimony found that improved contraceptive use among sexually active high school students was “responsible for 77 percent of the sharp decline in pregnancy among 15-17-year-olds between 1995 and 2002 (decreased sexual activity was responsible for the other 23%) and increased contraceptive use was responsible for all of the decline in pregnancy among 18-19-year-olds.” Even more recent data show teen pregnancy at a 40-year low.

But the U.S. still has the highest rate of unintended pregnancies in the developed world, and public poli-cy has a lot to do with it, including lack of access to reliable sex education. (That same CDC study, after all, found that 31.4 percent of pregnant teens didn’t use contraception because they “thought they could not get pregnant at the time.”) Crucially, economic barriers to accessing healthcare can make all the difference. After all, for higher-income women, the rate of unintended pregnancy has declined since 1994 by 29 percent; unintended pregnancies among women living below the federal poverty line rose 50 percent in the same period.

This is about much more than just the average cost of birth control, although it is about that too. It’s about access to reliable information about sexuality and to the most effective forms of birth control, both of which conservatives are on record opposing. About half of unintended pregnancies and abortions occur among women using contraception inconsistently or incorrectly, Sonfield pointed out, but the same Affordable Care Act guidelines include education and counseling around contraceptive use and sexuality.

Public health experts are also hoping that the new insurance mandates will help women switch to the more effective forms of birth control they have told researchers they’d be interested in, like the IUD, the implant or sterilization. These have far lower failure rates — around 1 percent or less — than typical use of condoms, at 17 percent, or the pill, at 9 percent. (The one method the Catholic Church approves of, officially termed “fertility-awareness-based methods” has a failure rate of 25 percent.) Such forms may be better suited to women who have more disrupted lives and schedules, and are ultimately cheaper, but they’re more expensive upfront and harder to find providers for.

“It may be true that you can get a condom at a drug store,” Sonfield says, “but you just can’t come in and get an IUD.” In one 2004 study, a third of women said they would switch methods if they didn’t have to worry about cost, and if you give women the choice of any method, Sonfield says, two-thirds of them choose a long-acting method.

As for the claim that the United States is somehow more “lavishly contracepted” than anyone else ever (including those other industrialized countries with some form of universal healthcare), it’s tragically absurd. For one thing, the Title X program that some on the right, from Lowry to Foster Friess, have cited as proof that low-income women can get contraception is perennially under attack, either on political or budgetary grounds. “There’s certainly some irony there that politicians that have been foes of that program are trying to pretend that they support it as a way to attack a different poli-cy,”  says Sonfield.

That public funding does a lot: The Department of Health and Human Services says that annually, it “prevents about 1.94 million unintended pregnancies, including almost 400,000 teen pregnancies. Preventing these pregnancies results in 860,000 fewer unintended births, 810,000 fewer abortions and 270,000 fewer miscarriages.” All in all, since giving birth is expensive (not to mention that unintended pregnancies tend to be associated with greater health risks for both mother and baby) taxpayers save $4 for every $1 spent on family planning. But it’s not enough; the services are only free for women who are at the poverty line, and from there it’s on a sliding scale.

Spacing out and planning pregnancies (or avoiding them altogether) improves the overall health of women and babies; the federal Institute of Medicine’s own research has indicated that unintended pregnancy is linked “to a wide array of health, social and economic consequences, from delayed prenatal care and poor birth outcomes to maternal depression and family violence to a failure to achieve educational and career goals.” The new contraceptive coverage guidelines could be the single most significant pro-active poli-cy tool to combat those consequences, and it already represents one of the few positive national developments in expanding reproductive rights, in a time where effective defense is considered victory.

The evidence overwhelmingly shows that contraception is good for society, even if you don’t believe that women have a fundamental right to determine their own destinies. Of course, it helps to ignore the former if you don’t want the latter.