The 30-second Obama ad titled “Troubled” has a female narrator saying, “Every woman who believes decisions about our bodies and our health care should be our own is troubled Mitt Romney supports overturning Roe v. Wade. Romney backed a law that outlaws all abortions, even in cases of rape and incest.”

In its headline, Fox News reports that the Romney campaign says the ad is false, pointing to, by way of evidence, the National Review op-ed Romney published last year entitled “My Pro-Life Pledge.” In the op-ed, Romney explains why he wouldn’t sign the Susan B. Anthony pledge, in part because it failed to include exceptions for rape, incest or to save the life of the mother.

But Romney has hardly stuck to that principle. Let’s look at the portion of the 2007 debate that the Obama campaign refers to in its ad. The question was, “If, hypothetically, Roe v. Wade was overturned, and the Congress passed a federal ban on all abortions, and it came to your desk, would you sign it?” Giuliani said he wouldn’t sign it because he would leave it up to the states.

Romney, of course, wasn’t nearly so straightforward. First, he repeated his opposition to Roe, and then he said, “I would welcome a circumstance where there was such a consensus in this country that we said, we don’t want to have abortion in this country at all, period. That would be wonderful. I’d be delighted.”

Pressed by Anderson Cooper to actually answer the question, Romney said, “Let me say it. I’d be delighted to sign that bill. But that’s not where we are. That’s not where America is today. Where America is is ready to overturn Roe v. Wade and return to the states that authority. But if the Congress got there, we had that kind of consensus in that country, terrific.”

But Romney also told Mike Huckabee that he would support a constitutional amendment saying life begins at conception, which pro-choicers took to mean he was endorsing Huckabee’s pet Personhood cause, but which the Personhood people themselves were wary of taking as a full endorsement.

In other words, he’s for states’ rights with regards to abortion, unless he isn’t. He’s for rape, incest and health exceptions, unless he’s not. (Such exceptions make no sense on their own terms – is it not murder if the woman didn’t choose to have sex? – but also happen to be a rough approximation of squishy American public opinion on abortion, loosely supporting certain restrictions while also opposing an outright ban.)

Though focusing on rape, incest and health exceptions isn’t particularly pro-choice either (it’s none of our business why a woman wants an abortion), these are not academic questions. Several U.S. states have passed bans on abortions after 20 weeks with no exceptions, in blatant violation of the Roe standard, and certain House Republicans have tried to get the same passed in the District of Columbia. They’re spoiling for a Supreme Court fight – one that will likely be decided by justices appointed by the next president.

By the way, there was another question in that 2007 CNN/YouTube debate that Mitt Romney, probably to his great relief, didn’t have to answer. (Ron Paul and Fred Thompson were saddled with it instead.) “In the event that abortion becomes illegal and a woman obtains an abortion anyway, what should she be charged with, and what should her punishment be? What about the doctor who performs the abortion?” Maybe it can be asked in the general election debates. We’ll see which Mitt Romney answers then.

Kristol briefly considers that this could (plausibly) mean that New Hampshire Sen. Kelly Ayotte or (less plausibly) New Mexico Gov. Susana Martinez are being at least considered, but that’s boring. But instead he zeroes in on a Park City campaign event in which Rice “seemed to impress Mitt Romney, who was standing beside her,” and argues that she “would complement Romney in terms of area of expertise, gender (obviously!), and life experience.” (Obviously! He doesn’t mention race.)

As Kristol columns go, this is particularly lacking in anything resembling convincing facts. Rice denied the speculation over a week ago in terms far more convincing than the usual coyness: “There is no way that I will do this because it’s really not me. I know my strengths and weaknesses.” Once again, Rice has never run for office and doesn’t have domestic experience, not to mention the fact that she’s nebulously pro-choice – a no-go for Romney in trying to reassure the social conservative base. But don’t worry, Kristol doesn’t really mean it: “Let me be clear: I’m not advocating the selection of Rice. I’m just reading the tea leaves, and the biggest tea leaf out there right now is Ann Romney’s comment. It makes sense to take Ann Romney seriously. Cherchez la femme!”

I’ll give Kristol this: It does make sense to take Ann Romney seriously if you take seriously her husband’s campaign trail assumption that she’s his pipeline to the hearts and minds of women everywhere. (On the other hand, Ann Romney also said of Mitt, “There’s a wild and crazy man inside there.”)

The problem with all this – besides incredibly bored people struggling to entertain themselves in July with rank speculation – is that because John McCain once made a pandering, ill-thought-out decision, all Republican women are tarred with the same brush.  Or, as the Week put it in its roundup, “Some worry that Mitt could repeat the mistakes John McCain made in 2008.” To be clear, Mitt Romney choosing a woman over the handful of men he clearly favors would be pandering, but it wouldn’t be a mistake if she happened to be the best person for the (mostly non-substantive) job.

This is the same essentialism that says that Ann Romney, who has no relevant background besides being born female, is a fast-track to the female vote. And it’s the same inability to see women as human beings on their own terms, a self-fulfilling prophecy that says that even the most qualified Republican woman will be nothing but Palin redux. Talk about one step forward, two steps back.

But what both will mean in practice is very much an open question.

“I don’t expect that overnight, providers everywhere are going to be providing lifesaving abortions,” says Charlotte Smith, director of policy at Ipas, which advocates for safe abortion worldwide and is providing technical support to the government’s transition. “I imagine that as in any place that has over 150 years of a very restrictive abortion law, it’s going to take a lot of providers a lot of time to feel that they would be protected,” even if they support abortion rights. Still, Smith says,  “It’s kind of amazing progress if you look at where Kenya has come from.”

Getting the constitutional language alone didn’t come easily. After both Obama and Biden lent their support to constitutional reform, Republican Rep. Chris Smith declared, “This is an administration that is very aggressive in promoting the killing of unborn children and the wounding of their mothers by way of abortion worldwide.” Smith and his American conservative allies charged that U.S. funds marked for civic education around constitutional review were actually illegally advocating for abortion rights and intimidating opponents. The U.S. embassy in Nairobi was unequivocal: “These claims are categorically false, and those making such allegations are lying.” Jay Sekulow’s American Center for Law and Justice, a key architect for the conservative legal revolution, even opened an office in Kenya that year. By way of compromise, the final constitution also included language about life beginning at conception, but church leaders urged Kenyans to vote no anyway.

“A lot of the talking points said by the Kenyan judges and the politicians came straight from the Republicans,” Dr. Joachim Osur, the director for Ipas’ Africa Alliance programs, told me, adding, “Some of them were saying that women in the streets would be forced to have an abortion even if they didn’t want to.”

Kenyans I spoke to around the country remain annoyed at the hijacking of the constitutional review process, which emerged as a way of healing after a violent political crisis that killed over a thousand people and displaced hundreds of thousands. Osur went so far as to suggest that abortion was a poison pill, an attempt by vested interests against land reform to take the whole thing down.

“There were a lot of people who did not want change to happen in Kenya,” he says.

He and other reproductive health advocates would have preferred to go through an act of parliament rather than the constitution, but they fought the battle that came to them, with the support of some of the major medical leadership in the country. They, after all, were the ones who had to deal with the women who had “backstreet abortions,” who harmed themselves, who overdosed on quinine intended for malaria patients or on herbal concoctions.

“We medics, we advocate for safe abortion,” Eunice Wanjiku, the nurse in charge at the clinic where I met those four women, told me. On the other hand, she came up with what seemed like a pretext to get as far away as possible from everyone else to tell me that.

And the controversy amounted to a national conversation of sorts. “What this whole fiasco brought about is that for the first time, people discussed the issue of abortion openly,” Osur said. “It helped reduce the stigma around it.”

It was an issue of acute timeliness in a country where 488 mothers die for every 100,000 live births and where unmet need for family planning is estimated at 26 percent for adult women, according to health ministry figures. Dr. Bashir Issak, director of reproductive health at the Ministry of Health, suggested in an interview that in recent years, family planning in general had been sidelined by vertical funding focusing on HIV/AIDS. (The Gates Foundation, which funded the International Reporting Project trip that brought me to Kenya, is on a big push to make family planning a major part of the developing world agenda, including with an international summit in London next week, though the foundation does not take a position on or fund abortion-related activities.)

Meanwhile, eight years of the Bush administration’s enforcement of the global gag rule – prohibiting U.S. funding to any organization that so much as discusses safe abortion, and defunding the U.N. Population Fund (UNFPA) – had a chilling effect on contraceptive access, as family planning clinics across the country closed and preemptively zealous enforcement led to birth control shortages. A Stanford study last year crunched the numbers and found data to support what health professionals on the ground told me several times: The illegal abortion rate in countries like Kenya rose as a result of Republican policies.

Even though the Obama administration has lifted the global gag rule and restored UNFPA funding, groups that get U.S. funding are still hamstrung by the Helms Amendment and the Siljander Amendment, which respectively prevent the funding of abortion or the funding of advocacy for safe abortion. In practice, this can lead to some contortion.

Take Kisumu Medical and Education Trust, which I visited recently. It was ineligible for U.S. funding under the Bush administration because it works on comprehensive reproductive healthcare – from adolescent health to advocating for safe abortion access to caring for women who have had unsafe abortions. Under Obama, they’ve gotten a U.S. government grant to improve the services of 650 healthcare providers when it comes to infectious diseases like malaria and HIV. “But we are not allowed to spend any of this money on anything related to post-abortion care or abortion,” said  director of programs Sam Owoko. “You have to separate the room where you’re doing post-abortion care and the room where you’re doing everything else,” and, he said, even have a separate set of tools, no easy task when resources are already so scarce.

Frustrated reproductive health professionals have pointed out that the same commodities USAID won’t fund because they can be used for elective abortion – manual vacuum aspirators, Misoprostol — are the ones recommended for lifesaving post-abortion care or postpartum hemorrhage. Every year, roughly 20,000 women are treated in public hospitals for abortion-related complications – as health professionals are required to under Kenyan law — and that doesn’t count the ones who go to private facilities or who never make it to a hospital.

Some of those MVAs and pills are, of course, already quietly being used for safer abortion in remote clinics around Kenya, as was quite plain on my visits to health facilities. Some of these providers are simply opportunists, like the high-earning illegal abortion provider in a Nairobi slum visited by two of my colleagues on the trip. (He enforces his own informal restrictions that sound a lot like laws that have been passed or attempted in the U.S.: no married women without permission from their husbands, and no schoolgirls without permission from their parents.)

Others clearly feel as Osur does: “I do not think it is morally right to wait for women to start the abortion at home and wait for them to start bleeding so you can finish the job at the clinic. I don’t see any morality in that.”

Mississippi House Bill 1390, requiring that abortion providers have admitting privileges at hospitals, was specifically passed to target JWHO’s out-of-state doctors. It is unsurprisingly difficult to find a Mississippi-based doctor willing to deal with the sustained harassment on his or her doorstep, though JWHO’s clinic director told me when I was there in October that she knows several local pro-choice doctors who have at least considered it. The situation is sufficiently dire that one of the doctors who does fly in to Jackson is referred to in the complaint as John Doe MD out of concern for his safety.

If there’s any doubt that this is a regulation set up for the abortion clinic to fail, one of the hospitals didn’t even bother to send the doctors an application for admitting privileges, despite two months of requests. For its part, the clinic, backed by the Center for Reproductive Rights, has argued that the law is seeking to bar women from their constitutional right to an abortion.

That is transparently the intent, though — as any honest person in a country that has actually banned abortion will tell you — it’s rarely the effect. According to a 2011 Guttmacher analysis, Mississippi has the highest rate of unintended pregnancy in the nation and among the worst abortion access in the country. (Both Dakotas also have only one provider). In a Mississippi without an abortion clinic, the women with means can go to Memphis, New Orleans or Little Rock – many already do.

So it goes with many abortion restrictions. Mississippi was on the vanguard of a now-commonplace abortion restriction: It enacted a 24-hour waiting period in 1992. In the four years that followed, the overall abortion rate declined (as it did, dramatically, nationwide), but second-trimester abortions increased overall.

As for what will happen to the ones who can’t leave the state if the bill shuts down JWHO once and for all, the authors of the bill have already been quite open about how they feel about them. The bill’s sponsor, State representative Sam Mims, recently told Reuters that the prospect of unsafe abortion left him “not at all worried … My hope is that the women that are making these choices will now choose life, that they will realize that life begins at conception.”

It’s an elegant pronouncement, one that combines a farcical conception of “choice” and an utter contempt for women’s decision-making capabilities – women, many of whom are already mothers, that need Mims’s intervention for them to know what’s happening in their own uteruses.

But it was Mims’s colleague Bubba Carpenter who in May made the implicit sadism most infamously clear. Several [sic]s should be applied to this statement: “Literally, we stopped abortion in the state of Mississippi, legally.”

Then he said, “And of course, there you have the other side. They’re like, ‘Well, the poor pitiful women that can’t afford to go out of state are just going to start doing them at home with a coat hanger.’ That’s what we’ve heard over and over and over. But hey, you have to have moral values. You have to start somewhere, and that’s what we’ve decided to do. This became law and the governor signed it, and I think for one time, we were first in the nation in the state of Mississippi.” At least he was honest.

Only 43 percent of births in Kenya happen in a health facility (for reference, in 2009, 98.9 percent of births in the U.S. took place in a hospital). Meanwhile, Kenya’s last two demographic surveys, in 2003 and 2008, show a maternal mortality rate that is either stagnant or slightly worsening — most recently, 488 maternal deaths for every 100,000 births. The two statistics are intricately linked: Among the women who can even access health facilities, usually in cities, cost is a barrier, one that mounts if you can’t immediately pay and are detained. So is fear of mistreatment or dangerous conditions, particularly for those going to public facilities like Pumwani, which is currently run by the city council of Nairobi. Anyone who can afford it goes to a private birthing center or hospital.

Reports of abuses and detention at Pumwani are by now cyclical in Kenyan media, ranging from unsafe conditions, mistreatment at the hands of medical staff, and even rampant trafficking of babies. In 2004, a UK-based pastor, Gilbert Deya, was accused of having stolen five Kenyan babies, at least one of them from Pumwani, and allegedly convinced infertile women they were “miracle babies.” (Last fall, Britain agreed to extradite him to Kenya.) In May 2009, according to the Guardian, “a local television station used a hidden camera to show how 44 new mothers were being held in a locked room at the Kenyatta National hospital.”

But justice is slow, and no one I spoke to, whether frequent patient or reproductive health advocate, believed anything had changed after a government task force report issued in August 2011. Maimuna is one of several women working with the attorneys at the Center for Reproductive Rights’ Nairobi office in hopes of building a case; the 2010 Kenyan constitution enumerates a right to health and to be free from degrading treatment.

Though Pumwani has a special infamy as the largest maternity hospital in the country, it’s not alone, according to a 2007 report by the Federation of Women Lawyers-Kenya and the Center for Reproductive Rights. Detention of postpartum women has been well-documented at Kenyatta National Hospital, one of the largest hospitals in the region, as has disrespectful or downright dangerous treatment of birthing mothers, across the country. One woman, referred to as Regina in the 2007 report, said of the operating room at Siaya Medical District Hospital, “I remember I was the only one who came from the theatre alive … In fact, you would come from the theatre and hear nurses say, ‘We know no patient of [the doctor] survives.’” After her cesarean, according to the report, Regina discovered a rusty blade had been left in her uterus.

Margaret A., 35, has delivered four out of her five children at Pumwani, including a breech birth requiring a cesarean in November 2010. When she didn’t have the deposit to be admitted, she told Salon, she was told to lie on the floor and wait. Eventually, she says, a female doctor took pity on her. A day after her cesarean, she says the staff forced her to get out of bed and sleep on the floor, all the time berating her — “Why do you open your legs and give birth every time?” She suffered a bladder rupture, for which she needed further surgery.

“You feel like you’re not a Kenyan,” says Margaret. “You’re like a refugee.”

Both Margaret and Maimuna saw plenty to lead them to believe that at Pumwani, baby-trafficking isn’t a thing of the past. Maimuna said she was passing through that ground-floor ward on her way to do laundry with other mothers when she heard a woman screaming that she was being shown a dead baby boy when she’d given birth to a girl. “Both the dead babies that day were boys,” Maimuna told me – she knew, because everyone sees them.

Margaret recalled that when she was last admitted, a woman was told her baby had died, but when her husband demanded to see the baby’s body, its skin was peeling, indicating a much older corpse. She said she knew of single mothers who have been offered by nurses 50,000 shillings (about $600) in exchange for their babies. (Dr. Omondi Kumba did not respond to follow-up questions regarding baby trafficking.)

Detaining women and babies for failing to pay medical bills compounds the fact that the hospital is notoriously understaffed; when I visited Pumwani last week as part of a group of journalists brought to Kenya by the International Reporting Project, the doctor in charge, Omondi Kumba, told us that there are 180 nurses on staff where 250 are needed. And, he complained, the Nairobi city government doesn’t give them the necessary funding.

At Pumwani, the sticker price is 6,000 shillings ($71) for cesarean and 3,000 shillings ($35) for a normal birth, far less than other hospitals. (The cost-sharing in Kenyan hospitals was first implemented per World Bank recommendations in 1989. While the World Bank has backed away from the model, out-of-pocket contributions are the norm in Kenya even when certain services, such as contraceptives, are officially supposed to be free.) But the cheap upfront cost is deceptive, Maimuna points out: “Pumwani is the cheapest one and it is the expensive one.” In practice, even women who aren’t detained pay far more: They have to pay, item by item, for basic medical supplies, from gloves and syringes to disinfectant – or potentially go without. It’s up to a social worker to decide whether a woman has the ability to pay or should have a waiver; Kumba said about a million shillings get waived annually, not much solace to the women who are detained. Many of them get out when a charity decides to bail out all the women or a politician gets involved; the coming months — election season — are expected to be good for women who can’t pay their medical bills.

When I went to Pumwani, I had no idea we were walking through Kenya’s most notorious hospital. I can say that the staff’s responses to our questions as we were shuffled in and out were at best shifty and that very little effort was made to accord the women any privacy in our presence. We were reluctantly herded through a narrow passageway of mostly nude women breast-feeding their preemies in a heated unit and then led by a doctor through an examination room that was in use, with a clothed woman curled up, her face to the wall. (Kumba had told us several times not to put photos of the “naked women” on the Internet, and I still don’t know if he was joking. I didn’t take any photographs of the women at Pumwani.)

I did know enough by then to ask about detention of pregnant women, though I now wish I’d known more. Kumba said, sounding regretful, that detention of pregnant women is against the law and doesn’t happen. A few minutes later, I asked the nurse leading our tour where the detained women were, were they together or separate from the paying customers, and she paused for a minute and said that no, they were all together. Kumba didn’t respond to follow-up questions by email.

Several people who have watched the near-annual scandals at the hospital hope that a pending reorganization that could put Pumwani under new county control could make a difference. In the meantime, all the laws and task forces in the world don’t seem to have done much for women like Maimuna.

“It hasn’t changed anything,” she said. “Pumwani doesn’t change.”

What we did learn is that Sarah Obama has views that aren’t terribly surprising for a 90-year-old Kenyan woman who lived a fairly traditional Luo life until the cameras showed up. She opposes family planning and abortion — because babies are a gift from God. She thinks women shouldn’t be able to inherit property, though when asked what advice she would give to a young girl, she stressed education. Asked about efforts to get men to fight domestic violence, she replied that women should be beaten if they’re disobedient to their husbands. In case you’re wondering, her dowry when she married Barack Obama’s grandfather was 12 cows.

Also, she said life was better under colonialism: less of a mess. Nobody tell Newt Gingrich.

Wandering around the compound are a turkey, several sheep, cows and rabbits. While Mrs. Obama was being asked whom she would favor in Kenya’s next elections, I suddenly noticed that two of the rabbits were busily copulating just to the right of us.

I said, “Some people want to believe that the president was born in Kenya. Have these people ever bothered you or asked for his birth certificate?”

Mrs. Obama looked concerned, started to protest. But it turned out it was because the rabbits, post-coitus, had started to run away via a security guard’s carelessly ajar gate.

I repeated my question and it was translated. Mrs. Obama wrinkled up her face. Then the interpreter jumped in: “She says, ‘But Barack Obama wasn’t born in Kenya.’” That should settle it.