Analysis Sexuality

Three on Getting to the Bottom of Things

Heather Corinna

Is anal sex really sex? What risk of pregnancy does it pose? And how do you assure consent for it from a partner and enagage in it in ways they're most likely to enjoy?

Published in partnership with Scarleteen
Ariana11 asks:

So my boyfriend of 9 months was asking me about anal sex. We only ever done oral sex, so when he brought up anal I was a little scared. We both decided to at least see if it could work. We were at his house and I got on my knees and he slowly went in. At first if hurt then it didn’t. All in all we only did this for about 7 seconds then we stopped. We were never intending to do anal for longer than 15 seconds. We were just going to do long enough to see what it would be like. After we stopped we sat on the bed and I asked him if this counted as sex. He said that it didn’t. (We are both virgins by the way…or maybe not?) I’m not sure if it counted. If it did then did I just lose my virginity?

Heather Corinna replies:

Virginity isn’t a term used in sexual health or defined medically, anatomically or by any one sexual activity. It’s a word some people use to determine when they or others have or have not had sex, based in either personal or cultural ideas or experiences of what they consider sex to be. I can’t tell you what your own cultural or personal ideas about sex are.

If virginity is a term you’re going to use, my best advice is to define it for yourself, not have or ask others to define it or sex for you. Your boyfriend, like anyone else, will have his own ideas and his own agendas in defining those things for you (like, for instance, knowing if he says anal sex is sex, you might get upset or be less inclined to do it with him). If he’s going to define it and use it as a term or value, he should only do so for himself, not for you. This is about you, about your own sexuality and sexual experiences, about your body and your use of terms.

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How people define sex varies, but I’m guessing that, probably just like with the oral sex you’re engaging in, anal sex was something at least one of you wanted to do based in sexual feelings or sexual curiosity: to see how it felt, to explore your sexuality together, to try to experience pleasure or to get off. If any or all of those things were true, my opinion is that it isn’t useful or sound to deny them, or to try and rationalize something that most likely was about sex as not being sexual. How long a given sexual activity lasts also isn’t a sound way of defining sex, especially since sometimes, that’s outside people’s control. Now, if you didn’t fully consent to this or were talked into it in any way, then it might not have been sex, and may have been sexual assault. But it doesn’t sound like that’s what went on here: you say you both made a choice to do this.

But what I want to make sure you know is that anal sex is absolutely a kind of sex as we define sex in sexual health and medicine, a kind of sex that also presents the same kinds of physical risks (and often emotional ones, too) as vaginal intercourse does.

The pregnancy risk is considerably lower with anal sex than with vaginal intercourse, since fluids from your partner‘s penis deposited into or around the anus isn’t a direct deposit into the vagina like with vaginal intercourse. However, given our pal gravity and the closeness of the anus to the vaginal opening, some risk is still present, especially if your partner ejaculates. The bigger issue, though, are sexually transmitted and other common infections, like bacterial infections. The risks for those with anal intercourse are higher than they are for vaginal intercourse, including the risk of HIV.

I know you said you’re both virgins, but if your boyfriend doesn’t define oral or anal sex as sex, and still considers himself not having had sex with those activities, chances are good that if he’s ever been with anyone else, he may have done those things, and may have been likely to do them without using protection. If he doesn’t think he’s had any sex yet, but has engaged in these kinds of sex, he’s probably also never been tested for sexually transmitted infections. So, while these activities will always pose some risk of infections, if your partner has done these things with anyone besides you, especially unprotected, your STI risks here could be high.

If you have been using condoms or other latex barriers for these kinds of sex, you have radically reduced those risks. However, you two will still want to add testing for infections to your healthcare roster now: condom use is only one part of safer sex. Testing, and treatment if and when anyone has or gets an STI, is the other super-important part. If you’re not sure where to do that, drop me a line and I can help you find that care near you.

When it comes to your body and your health, these things are sex, So, you’ll want to make sure you’re not denying that so much that you aren’t being as safe as you can be with them, which includes using condoms or other latex barriers, regular sexual healthcare, and, with any kind of intercourse, an additional method of birth control if you don’t feel okay about the level of protection condoms alone offer in preventing pregnancy.

I’m telling you these things for two reasons. For one, I want you to be sure to take care of yourself and your health; to avoid or reduce possible health risks or outcomes you don’t want or don’t feel ready for. I don’t know what your reasons are for choosing not to have vaginal intercourse, but if it’s about not taking risks of pregnancy or infections, you might want to reconsider engaging in anal sex and maybe oral sex, too, or at least make sure you’re protecting yourself soundly with condoms to reduce those risks.

But I also want to give you that information so you can inform your sexual choices from an emotional standpoint and one where you’re really in control of your sexuality and how you choose to share and express it. If you’re engaging in things that are at least clearly kinds of sex from a health viewpoint, and don’t feel okay about that emotionally, intellectually, in your relationship or based on whatever your unique ethics and values are, you might want to press pause for a while and think about all of this in regard to those things. Because if that’s the case, you’re probably not going to be feeling, or keep feeling, so great about these choices.

It sounds like you might want to talk with your boyfriend more about this too, sharing the information I just gave you, and maybe taking some time together to get some more sex education, either at this website, from your healthcare provider, from your parents, school, or other available resources.

Here are a few links that might be good places for you both to get started:

RB2392 asks:

I am inquiring about anal sex. My boyfriend and I (after a long discussion) decided since we were not having traditional intercourse that we would try anal to spice things up, so to say. We have been together since we were 14 (we have never even held hands or kissed anyone else) and have remained faithful, so my worries are not about STDs. I am more concerned about pregnancy. That’s why we are not having vaginal sex. When we have anal sex we will do everything we can to prevent an unwanted pregnancy. We have bought condoms, a water-based lubricant, and have talked everything over and have done a little research. My question I guess is what is the possibility that, even after all the precautions taken, I will get pregnant. I am looking for statistics. What percentage (if you can find it) of couples having careful anal sex still get pregnant? We both have always been a little too concerned about getting pregnant, and I am concerned the condom will break and the sperm will somehow manage to make its way into my vagina.

It sounds like you’re doing a great job with safer sex practices. That both radically reduces your risk of infections (including bacterial infections, which can happen even when people are monogamous and don’t have any STIs), and makes pregnancy highly unlikely.

Like I explained above, while we can’t say pregnancy isn’t a risk with anal sex, because a “splash” conception could occur, we can safely say it’s probably low risk. But so long as your partner is wearing condoms from start to finish (as in, not putting one on halfway through, or taking it off while you’re still having anal sex), a pregnancy occurring from this activity would be very, very unlikely. Always using lubricant like you have been not only helps protect delicate anal tissue, it helps keep condoms from breaking. If a condom is worn and used properly for all genital contact and doesn’t slip off or break, you can be sure that for that one given incident of anal sex with that proper use and lack of condom failure, a pregnancy is absolutely not going to occur.

I’m afraid I don’t have statistics to share about pregnancies from protected anal sex. I don’t know of and can’t find any studies done on that, which isn’t surprising. Most studies done on conception are about vaginal intercourse, since that’s how we know, without a doubt, pregnancy most often occurs. I can assure you, however, that if pregnancy was often occurring that way, those figures would be out there.

What I can share are a few other credible sources which discuss the risk of pregnancy from anal sex in general, if that helps you out. You can take a look here, here and here. You might also start looking into a secondary method of birth control if you want more protection than condoms offer and are having sex that involves a penis having contact with your genitals, which always will pose at least some risk of pregnancy, even with kinds of sex where that risk is low.

Just know that it’s always up to you to decide what you’re comfortable doing and what you’re not. So, if even what I said and what’s said in those links still leave you feeling worried and insecure, remember that it’s always okay to nix any kind of sex you don’t want or don’t feel comfortable with, even if it might seem to someone else (or even to you), like your discomfort or worry isn’t reasonable. I don’t think it’s fair to frame whatever level of concern you have about pregnancy as “too much.” Pregnancy is a huge deal, and when it’s not something we want, feel ready for, or think we can handle, it’s sound to be concerned about it. If and when we know we really don’t want it, really aren’t ready, and really couldn’t deal, it makes sense to be very concerned.

sexlover23 asks:

I’m a 20 year old woman in a relationship with a 19 year old guy, and one of my major fantasies is to anally penetrate him. When I first brought it up, he was interested because he knew I loved anal and he’d heard it felt really good for men. But then he tried to finger himself and it ended up immediately triggering diarrhea (sorry if this is tmi). Also, I like to touch and gently slap his ass, but he recently told me that he doesn’t like it.

Whenever I bring up things like fingering him or rimming him, he tells me that he would be okay with it, but I’m starting to get uncomfortable. I still really want to penetrate him, but I’m wondering if he’s just telling me that he wants to do it because I want to. Consent is really important to me so I don’t want to make him do something he isn’t into. Does this sound like a situation where I should back off?

Also, if it turns out that being penetrated really is something he’s interested in, how can I make sure it’s a good experience for him? I’ve always loved anal and it’s always been relatively easy for me, so it’s hard for me to understand where he’s coming from. I’m especially worried about making sure that putting anything in his ass doesn’t make him evacuate his bowels again. Thanks.

Anal sex isn’t actually associated with losing bowel control, despite about 90 million urban myths to the contrary. What’s most likely is that your boyfriend already had or was getting a case of diarrhea and just unfortunately chose that day to also engage in exploring anal play.

Certainly, if someone has to have a bowel movement and is holding it in, they might go ahead and have that bowel movement during anal play. Sometimes exploring anal entry can also result in people feeling the urge to have a bowel movement, so if they had to go already, they might be more inclined to when they’re doing that exploration.

People with health conditions like IBS or Crohn’s Disease can find anal sex can trigger the release of their bowels. Not knowing how we was feeling at the time this happened, what, if any, health issues he has or had then (including a case of the runs that he just had the bad luck of having start that day), or even knowing if he emptied his bowels before anal play, it’s impossible for me to give any kind of final word on this. But on the whole, receptive anal sex play often teaches people how to have more control over the muscles of the anus and tones them, resulting in better bowel control, not a loss of control. So, in general, so long as someone isn’t ill, doesn’t have health conditions where bowel control is an issue, and empties their bowels beforehand, this really isn’t something they or you will need to worry about.

While feces isn’t stored in the rectum, it’s often lined with trace amounts of feces that tend to show up with anal sex, which, when mixed with lube, can look like a very watery, loose bowel movement. And on days when our stool is more soft than hard, more trace fecal matter tends to be in the rectum, so that’s all the more likely. That kind of discharge is very common, so that might be what he experienced, rather than diarrhea. If he wants to do his best to avoid that, he should know it’s not totally avoidable, but skipping out on anal play on days when his stools are looser can make it less likely.

However, since your partner did have some kind of fecal something-or-other happen, it’d be understandable if he felt worried about it. Many people have ooky feelings about feces, and don’t feel comfortable with it. So, you’ll have to talk to him about how he feels, and see if getting this information and more on the subject soothes his concerns and makes him feel okay about exploring this again soon or not. A member of our advisory board and my good friend Cory Silverberg has a piece on this over here which can fill you both in some more feces and anal sex. I think Cory’s comment there about people checking in to make sure they’re comfortable with the possibility of some kind of fecal matter is important. If your boyfriend isn’t, even if you are, best to hold off on this until or unless he feels okay about that.

Moving forward around consent, your desires and his. With anything where he’s told you he doesn’t like what you’re doing or isn’t okay with that? Those are the things you don’t do unless he puts them back on the table and asks for them himself. For instance, he told you he doesn’t like it when you slap his bottom. (You also said touch, but I’m assuming you mean in a specific way, since he’s saying he might be okay with things were you touch his bottom.) So, you’re going to stop doing that. With the things he says he would be okay with trying, you can just follow that response up by asking if he also wants to try them, not just for you, but also out of his own desire to do them, too. If he says no, then you know to back up. If he says yes, then you accept his yes. If we have every reason to believe a sexual partner is capable of giving full consent and expressing their own desires, then when they do, we always want to afford them the respect of taking them at their word.

Of course, if you ever find you still don’t feel comfortable doing something even with all of that, you always get to opt out or hold off because of your own discomfort, whatever it’s about. Just because you have a desire for something, and he shares it and consents, doesn’t automatically mean you’ll feel comfortable or choose to move forward, since our sexual choices can involve more factors than just those.

You clearly have a great awareness of how big your desire is for this kind of play, and are also very attentive and mindful about consent and your partner’s own desires. So, I’m personally not worried about you being so into your own wants that you dismiss your partner and do things you want, but he doesn’t. It’s lack of that kind of awareness, thoughtfulness and care that tends to drive sex without full consent.

But since you say you don’t understand where he’s coming from because of what you enjoy yourself, it might help to just remember how very different all of our sexual experiences and body sensations can be. Something that feels great to me might feel terrible or like no big whoop to you, or vice-versa. We don’t really need to understand all of the whys of those differences, so much as we need to always remember they exist and that we need to make room for them. If we’re going to try something again that didn’t feel great to a partner before, that’s when the whys come into bigger play. What we can do then is to ask a lot of questions to try and get to the bottom of it (I’d love to say no pun intended, but I think we all know by now I intend them), and be sure to continue asking how things feel during whatever that activity is, too. It also never hurts to remind our sexual partners that we’re always down with stopping any sexual activity any time they want us to, for any reason.

So, whatever it is with this you both want to move forward with, how do you make sure it’s as good an experience as possible? For starters, you engage all the basics it sounds like you already know. You assure you have enthusiastic consent and a good foundation for it, and you do check-ins for continued consent throughout sex, just like is ideal with any kind of sex, with any kind of partner.

Some basics specific to anal sex going well? Lube. Lots and lots of lube. A roman bath of lube. Thicker or silicone-based lubes can tend to work better for anal sex than thin, water-based lubes. Always go slow and gradual. Patience, caterpillar. In other words, external rubbing with a fingertip before entry with one; one finger before two. You get the drill. If you’re using fingers or toys, cover them with something latex, be it a glove, finger cot or condom: anal tissue is delicate, and it’s super-easy to wind up with tiny tears, even a hard stool can cause fissures. A teeny edge of a toy that didn’t get quite sanded, or even a hangnail on your finger could abrade his butt: latex barriers help prevent those kinds of owies. And I feel like you already know this, but as is the case with any kind of sex we know we are super-duper into and excited about, making sure we’re not getting SO into it that we space out on where our partner is at is smart. Again, checking in verbally often is a good practice.

For more information on anal sex, you could pick up a copy of Jack Morin’s Anal Pleasure and Health which pretty much remains the bible on all things booty, including anal sex and eroticism. Even just taking a look at a shorter piece on anal sex from Dr. Morin here will give you a lot of good information to start with. Additionally, you might find Let’s Get Metaphysical: The Etiquette of Entry, a piece here on sex with any kind of entry into someone’s body gives you some good food for thought and perhaps some new things to talk about together, too.

Analysis Law and Policy

Indiana Court of Appeals Tosses Patel Feticide Conviction, Still Defers to Junk Science

Jessica Mason Pieklo

The Indiana Court of Appeals ruled patients cannot be prosecuted for self-inducing an abortion under the feticide statute, but left open the possibility other criminal charges could apply.

The Indiana Court of Appeals on Friday vacated the feticide conviction of Purvi Patel, an Indiana woman who faced 20 years in prison for what state attorneys argued was a self-induced abortion. The good news is the court decided Patel and others in the state could not be charged and convicted for feticide after experiencing failed pregnancies. The bad news is that the court still deferred to junk science at trial that claimed Patel’s fetus was on the cusp of viability and had taken a breath outside the womb, and largely upheld Patel’s conviction of felony neglect of a dependent. This leaves the door open for similar prosecutions in the state in the future.

As Rewire previously reported, “In July 2013 … Purvi Patel sought treatment at a hospital emergency room for heavy vaginal bleeding, telling doctors she’d had a miscarriage. That set off a chain of events, which eventually led to a jury convicting Patel of one count of feticide and one count of felony neglect of a dependent in February 2015.”

To charge Patel with feticide under Indiana’s law, the state at trial was required to prove she “knowingly or intentionally” terminated her pregnancy “with an intention other than to produce a live birth or to remove a dead fetus.”

According to the Indiana Court of Appeals, attorneys for the State of Indiana failed to show the legislature had originally passed the feticide statute with the intention of criminally charging patients like Patel for terminating their own pregnancies. Patel’s case, the court said, marked an “abrupt departure” from the normal course of prosecutions under the statute.

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“This is the first case that we are aware of in which the State has used the feticide statute to prosecute a pregnant woman (or anyone else) for performing an illegal abortion, as that term is commonly understood,” the decision reads. “[T]he wording of the statute as a whole indicate[s] that the legislature intended for any criminal liability to be imposed on medical personnel, not on women who perform their own abortions,” the court continued.

“[W]e conclude that the legislature never intended the feticide statute to apply to pregnant women in the first place,” it said.

This is an important holding, because Patel was not actually the first woman Indiana prosecutors tried to jail for a failed pregnancy outcome. In 2011, state prosecutors brought an attempted feticide charge against Bei Bei Shuai, a pregnant Chinese woman suffering from depression who tried to commit suicide. She survived, but the fetus did not.

Shuai was held in prison for a year until a plea agreement was reached in her case.

The Indiana Court of Appeals did not throw out Patel’s conviction entirely, though. Instead, it vacated Patel’s second charge of Class A felony conviction of neglect of a dependent, ruling Patel should have been charged and convicted of a lower Class D felony. The court remanded the case back to the trial court with instructions to enter judgment against Patel for conviction of a Class D felony neglect of a dependent, and to re-sentence Patel accordingly to that drop in classification.

A Class D felony conviction in Indiana carries with it a sentence of six months to three years.

To support Patel’s second charge of felony neglect at trial, prosecutors needed to show that Patel took abortifacients; that she delivered a viable fetus; that said viable fetus was, in fact, born alive; and that Patel abandoned the fetus. According to the Indiana Court of Appeals, the state got close, but not all the way, to meeting this burden.

According to the Indiana Court of Appeals, the state had presented enough evidence to establish “that the baby took at least one breath and that its heart was beating after delivery and continued to beat until all of its blood had drained out of its body.”

Therefore, the Court of Appeals concluded, it was reasonable for the jury to infer that Patel knowingly neglected the fetus after delivery by failing to provide medical care after its birth. The remaining question, according to the court, was what degree of a felony Patel should have been charged with and convicted of.

That is where the State of Indiana fell short on its neglect of a dependent conviction, the court said. Attorneys had failed to sufficiently show that any medical care Patel could have provided would have resulted in the fetus surviving after birth. Without that evidence, the Indiana Court of Appeals concluded, state attorneys could not support a Class A conviction. The evidence they presented, though, could support a Class D felony conviction, the court said.

In other words, the Indiana Court of Appeals told prosecutors in the state, make sure your medical experts offer more specific testimony next time you bring a charge like the one at issue in Patel’s case.

The decision is a mixed win for reproductive rights and justice advocates. The ruling from the court that the feticide statute cannot be used to prosecute patients for terminating their own pregnancy is an important victory, especially in a state that has sought not just to curb access to abortion, but to eradicate family planning and reproductive health services almost entirely. Friday’s decision made it clear to prosecutors that they cannot rely on the state’s feticide statute to punish patients who turn to desperate measures to end their pregnancies. This is a critical pushback against the full-scale erosion of reproductive rights and autonomy in the state.

But the fact remains that at both trial and appeal, the court and jury largely accepted the conclusions of the state’s medical experts that Patel delivered a live baby that, at least for a moment, was capable of survival outside the womb. And that is troubling. The state’s experts offered these conclusions, despite existing contradictions on key points of evidence such as the gestational age of the fetus—and thus if it was viable—and whether or not the fetus displayed evidence of life when it was born.

Patel’s attorneys tried, unsuccessfully, to rebut those conclusions. For example, the state’s medical expert used the “lung float test,” also known as the hydrostatic test, to conclude Patel’s fetus had taken a breath outside the womb. The test, developed in the 17th century, posits that if a fetus’ lungs are removed and placed in a container of liquid and the lungs float, it means the fetus drew at least one breath of air before dying. If the lungs sink, the theory holds, the fetus did not take a breath.

Not surprisingly, medical forensics has advanced since the 17th century, and medical researchers widely question the hydrostatic test’s reliability. Yet this is the only medical evidence the state presented of live birth.

Ultimately, the fact that the jury decided to accept the conclusions of the state’s experts over Patel’s is itself not shocking. Weighing the evidence and coming to a conclusion of guilt or innocence based on that evidence is what juries do. But it does suggest that when women of color are dragged before a court for a failed pregnancy, they will rarely, if ever, get the benefit of the doubt.

The jurors could have just as easily believed the evidence put forward by Patel’s attorneys that gestational age, and thus viability, was in doubt, but they didn’t. The jurors could have just as easily concluded the state’s medical testimony that the fetus took “at least one breath” was not sufficient to support convicting Patel of a felony and sending her to prison for 20 years. But they didn’t.

Why was the State of Indiana so intent on criminally prosecuting Patel, despite the many glaring weaknesses in the case against her? Why were the jurors so willing to take the State of Indiana’s word over Patel’s when presented with those weaknesses? And why did it take them less than five hours to convict her?

Patel was ordered in March to serve 20 years in prison for her conviction. Friday’s decision upends that; Patel now faces a sentence of six months to three years. She’s been in jail serving her 20 year sentence since February 2015 while her appeal moved forward. If there’s real justice in this case, Patel will be released immediately.

Culture & Conversation Abortion

With Buffer Zones and Decline of ‘Rescues’ Came Anti-Choice Legal Boom, Book Argues

Eleanor J. Bader

University of Denver's Joshua Wilson argues that prosecutions of abortion-clinic protesters and the decline of "rescue" groups in the 1980s and 1990s boosted conservative anti-abortion legal activism nationwide.

There is nothing startling or even new in University of Denver Professor Joshua C. Wilson’s The New States of Abortion Politics (Stanford University Press). But the concise volume—just 99 pages of text—pulls together several recent trends among abortion opponents and offers a clear assessment of where that movement is going.

As Wilson sees it, anti-choice activists have moved from the streets, sidewalks, and driveways surrounding clinics to the courts. This, he argues, represents not only a change of agitational location but also a strategic shift. Like many other scholars and advocates, Wilson interprets this as a move away from pushing for the complete reversal of Roe v. Wade and toward a more incremental, state-by-state winnowing of access to reproductive health care. Furthermore, he points out that it is no coincidence that this maneuver took root in the country’s most socially conservative regions—the South and Midwest—before expanding outward.

Wilson credits two factors with provoking this metamorphosis. The first was congressional passage of the Freedom of Access to Clinic Entrances (FACE) Act in 1994, legislation that imposed penalties on protesters who blocked patients and staff from entering or leaving reproductive health facilities. FACE led to the establishment of protest-free buffer zones at freestanding clinics, something anti-choicers saw as an infringement on their right to speak freely.

Not surprisingly, reproductive rights activists—especially those who became active in the 1980s and early 1990s as a response to blockades, butyric acid attacks, and various forms of property damage at abortion clinics—saw the zones as imperative. In their experiences, buffer zones were the only way to ensure that patients and staff could enter or leave a facility without being harassed or menaced.

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The second factor, Wilson writes, involved the reduced ranks of the so-called “rescue” movement, a fundamentalist effort led by the Lambs of Christ, Operation Rescue, Operation Save America, and Priests for Life. While these groups are former shadows of themselves, the end of the rescue era did not end anti-choice activism. Clinics continue to be picketed, and clinicians are still menaced. In fact, local protesters and groups such as 40 Days for Life and the Center for Medical Progress (which has exclusively targeted Planned Parenthood) negatively affect access to care. Unfortunately, Wilson does not tackle these updated forms of harassment and intimidation—or mention that some of the same players are involved, albeit in different roles.

Instead, he argues the two threads—FACE and the demise of most large-scale clinic protests—are thoroughly intertwined. Wilson accurately reports that the rescue movement of the late 1980s and early 1990s resulted in hundreds of arrests as well as fines and jail sentences for clinic blockaders. This, he writes, opened the door to right-wing Christian attorneys eager to make a name for themselves by representing arrested and incarcerated activists.

But the lawyers’ efforts did not stop there. Instead, they set their sights on FACE and challenged the statute on First Amendment grounds. As Wilson reports, for almost two decades, a loosely connected group of litigators and activists worked diligently to challenge the buffer zones’ legitimacy. Their efforts finally paid off in 2014, when the U.S. Supreme Court found that “protection against unwelcome speech cannot justify restrictions on the use of public streets and sidewalks.” In short, the decision in McCullen v. Coakley found that clinics could no longer ask the courts for blanket prohibitions on picketing outside their doors—even when they anticipated prayer vigils, demonstrations, or other disruptions. They had to wait until something happened.

This, of course, was bad news for people in need of abortions and other reproductive health services, and good news for the anti-choice activists and the lawyers who represented them. Indeed, the McCullen case was an enormous win for the conservative Christian legal community, which by the early 2000s had developed into a network united by opposition to abortion and LGBTQ rights.

The New States of Abortion Politics zeroes in on one of these legal groups: the well-heeled and virulently anti-choice Alliance Defending Freedom, previously known as the Alliance Defense Fund. It’s a chilling portrait.

According to Wilson, ADF’s budget was $40 million in 2012, a quarter of which came from the National Christian Foundation, an Alpharetta, Georgia, entity that claims to have distributed $6 billion in grants to right-wing Christian organizing efforts since 1982.

By any measure, ADF has been effective in promoting its multipronged agenda: “religious liberty, the sanctity of life, and marriage and the family.” In practical terms, this means opposing LGBTQ inclusion, abortion, marriage equality, and the right to determine one’s gender identity for oneself.

The group’s tentacles run deep. In addition to a staff of 51 full-time lawyers and hundreds of volunteers, a network of approximately 3,000 “allied attorneys” work in all 50 states to boost ADF’s agenda. Allies are required to sign a statement affirming their commitment to the Trinitarian Statement of Faith, a hallmark of fundamentalist Christianity that rests on a literal interpretation of biblical scripture. They also have to commit to providing 450 hours of pro bono legal work over three years to promote ADF’s interests—no matter their day job or other obligations. Unlike the American Bar Association, which encourages lawyers to provide free legal representation to poor clients, ADF’s allied attorneys steer clear of the indigent and instead focus exclusively on sexuality, reproduction, and social conservatism.

What’s more, by collaborating with other like-minded outfits—among them, Liberty Counsel and the American Center for Law and Justice—ADF provides conservative Christian lawyers with an opportunity to team up on both local and national cases. Periodic trainings—online as well as in-person ones—offer additional chances for skill development and schmoozing. Lastly, thanks to Americans United for Life, model legislation and sample legal briefs give ADF’s other allies an easy way to plug in and introduce ready-made bills to slowly but surely chip away at abortion, contraceptive access, and LGBTQ equality.

The upshot has been dramatic. Despite the recent Supreme Court win in Whole Woman’s Health v. Hellerstedt, the number of anti-choice measures passed by statehouses across the country has ramped up since 2011. Restrictions—ranging from parental consent provisions to mandatory ultrasound bills and expanded waiting periods for people seeking abortions—have been imposed. Needless to say, the situation is unlikely to improve appreciably for the foreseeable future. What’s more, the same people who oppose abortion have unleashed a backlash to marriage equality as well as anti-discrimination protections for the trans community, and their howls of disapproval have hit a fever pitch.

The end result, Wilson notes, is that the United States now has “an inconstant localized patchwork of rules” governing abortion; some counties persist in denying marriage licenses to LGBTQ couples, making homophobic public servants martyrs in some quarters. As for reproductive health care, it all depends on where one lives: By virtue of location, some people have relatively easy access to medical providers while others have to travel hundreds of miles and take multiple days off from work to end an unwanted pregnancy. Needless to say, this is highly pleasing to ADF’s attorneys and has served to bolster their fundraising efforts. After all, nothing brings in money faster than demonstrable success.

The New States of Abortion Politics is a sobering reminder of the gains won by the anti-choice movement. And while Wilson does not tip his hand to indicate his reaction to this or other conservative victories—he is merely the reporter—it is hard to read the volume as anything short of a call for renewed activism in support of reproductive rights, both in the courts and in the streets.