What to know about abortion policy across the US heading into 2024

Abortion is going to be a major issue in the U.S. again in 2024, the second full year after the nation's top court ended a right to abortion and making it largely a state issue

FILE - A group from St. Michael the Archangel School in Findlay, Ohio, gathers during the Ohio March for Life rally at the Ohio State House in Columbus, Ohio, Oct. 6, 2023. Abortion is expected to be a major issue in 2024 for voters, courts and state lawmakers. (AP Photo/Carolyn Kaster, file)

Abortion is going to remain a major issue in politics, policy and the courts in the U.S. in 2024, even though most of the states that were expected to impose restrictions have already done so.

The abortion landscape has been in flux since the June 2022 U.S. Supreme Court ruling that overturned Roe v. Wade, which touched off a round of abortion policy changes and new litigation about them.

There are still looming ballot questions and court decisions. And lawmakers could tweak current abortion laws.

Here’s a look at what to know.

Since Roe was overturned, abortion-related questions have been on the ballot in seven states – and the abortion rights side has prevailed on all of them.

Legislatures in the East Coast blue states of Maryland and New York have already put questions on the November 2024 ballot to amend the state constitutions to include rights regarding reproductive health care .

Both states already allow abortion through viability, which is generally considered to be about 24 weeks gestational age.

While those are the only states where ballot questions are a sure thing, they’re possible in several others.

There are pushes to add constitutional rights to abortion in Minnesota, Montana, Nevada and Virginia, where it’s legal in most cases already; and in Arizona, Florida, Nebraska and South Dakota, where heavier restrictions are in place.

In Missouri, where abortion is banned throughout pregnancy, there are dueling ballot measures to expand abortion access. One would bar the government from banning it during the first 24 weeks of pregnancy. Another, from moderate Republicans, would make it legal but for fewer weeks.

In Colorado, where abortion is legal in most cases, there are pushes for ballot measures both to enshrine abortion rights and to roll them back.

Lawmakers in Iowa, where abortion restrictions have been put on hold by a court, are pushing for an amendment that would clear the way for a ban. There could be a similar effort in Pennsylvania, where abortion is legal until viability.

For nearly 50 years, abortion legal questions were waged mostly in federal courts.

But the U.S. Supreme Court finding that there’s no national right to abortion directed the latest generation of legal battles over abortion mostly to state court.

Some of the big issues that are yet to be decided:

Women in Idaho, Oklahoma, Tennessee and Texas are suing over being denied abortion while facing harrowing pregnancy complications. The Texas Supreme Court heard arguments in a similar case in November, and this month it denied a woman's request for an immediate abortion, finding that her life was not in danger, so she did qualify under the exceptions in state law.

The U.S. Supreme Court has agreed to take up the question of whether the U.S. Food and Drug Administration's approval of the abortion drug mifepristone was appropriate.

State courts are considering several challenges to abortion bans and restrictions, including in Iowa, Montana, Utah and Wyoming, where courts have blocked enforcement of the measures.

In Idaho, a federal judge in November blocked enforcement of the state's first-in-the-nation “abortion trafficking” ban while courts sort out the constitutionality of the measure.

Legislative sessions begin in January or February in most states, and there haven't been many abortion-related bills filed yet.

But activists on both sides anticipate that bills will emerge.

Inrgid Duran, the legislative director at National Right to Life, said other states could pursue provisions like Idaho's to make it illegal to transport a minor for an abortion without parental consent. Enforcement in Idaho is on hold.

She also said there could be more efforts to fund organizations, sometimes called crisis pregnancy centers, that seek to dissuade abortion, and more measures to clarify abortion definitions.

“The pro-life movement has faced challenges before and will continue to face challenges,” she said. “But it’s not going to deter us from continuing to do what is right by advocating for the vulnerable.”

Some conservative groups are also prioritizing providing more resources to support women during pregnancy and after birth, including with tax credits or grants to boost organizations that encourage women not to seek abortions.

Missouri lawmakers have introduced measures that would make it possible to file homicide charges against women who have abortions. Most major anti-abortion groups oppose that approach, which has been introduced in other states but never gained traction.

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Key Facts on Abortion in the United States

Usha Ranji , Karen Diep , and Alina Salganicoff Published: Nov 21, 2023

Note: This brief was updated on December 20, 2023 to incorporate new data on abortion statistics. On June 24, 2022, the Supreme Court issued a ruling in Dobbs v. Jackson Women’s Health Organization that overturned the constitutional right to abortion as well as the federal standards of abortion access, established by prior decisions in the cases Roe v. Wade and Planned Parenthood v. Casey . Prior to the Dobbs ruling, the federal standard was that abortions were permitted up to fetal viability. That federal standard has been eliminated, allowing states to set policies regarding the legality of abortions and establish limits. Access to and availability of abortions varies widely between states , with some states banning almost all abortions and some states protecting abortion access.

This issue brief answers some key questions about abortion in the United States and presents data collected before and new data that was published shortly after the overturn of Roe v. Wade .

What is abortion?

How safe are abortions, how often do abortions occur, who gets abortions, at what point in pregnancy do abortions occur, where do people get abortion care, how much do abortions cost, does private insurance or medicaid cover abortions, what are public opinions about abortion.

Abortion is the medical termination of a pregnancy. It is a common medical service that many women obtain at some point in their life. There are different types of abortion methods, which the National Academy of Sciences, Engineering, and Medicine (NASEM ) places in four categories:

  • Medication Abortion – Medication abortion, also known as medical abortion or abortion with pills, is a pregnancy termination protocol that involves taking oral medications. There are two widely accepted protocols for medication abortion. In the U.S., the most common protocol involves taking two different drugs, Mifepristone and Misoprostol. Typically, an individual using medication abortion takes Mifepristone first, followed by misoprostol 24-48 hours later. In the U.S., the Food and Drug Administration (FDA) has approved this protocol of medication abortion for use up to the first 70 days (10 weeks) of pregnancy, and its use has been rising for years. Another medication abortion protocol uses misoprostol alone . Patients can take 800 µg (4 pills) of misoprostol sublingually or vaginally every three hours for a total of 12 pills. The regimen is also recommended for up to 70 days (10 weeks) of pregnancy, but it is not currently approved by the FDA and is more commonly used in other countries.

Guttmacher Institute estimates that in 2020, medication was used for more than half (53%) of all abortions. While medication abortion has been available in the U.S. for more than 20 years, studies have found that many adults and women of reproductive age have not heard of medication abortion. Many have confused emergency contraception ( EC ) pills with medication abortion pills, but EC does not terminate a pregnancy. EC works by delaying or inhibiting ovulation and will not affect an established pregnancy.

  • Aspiration , a minimally invasive and commonly used gynecological procedure, is the most common form of procedural abortion. It can be used to conduct abortions up to 14-16 weeks of gestation. Aspiration is also commonly used in cases of early pregnancy loss (miscarriage).
  • Dilation and evacuation abortions (D&E) are usually performed after the 14th week of pregnancy. The cervix is dilated, and the pregnancy tissue is evacuated using forceps or suction.
  • Induction abortions are rare and conducted later in pregnancy. They involve the use of medications to induce labor and delivery of the fetus.

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Decades of research have shown that abortion is a very safe medical service.

Despite its strong safety profile, abortion is the most highly regulated medical service in the country and is now banned in several states. In addition to bans on abortion altogether and telehealth, many states impose other limitations on abortion that are not medically indicated, including waiting periods, ultrasound requirements, gestational age limits, and parental notification and consent requirements. These restrictions typically delay receipt of services.

  • NASEM completed an exhaustive review on the safety and effectiveness of abortion care and concluded that complications from abortion are rare and occur far less frequently than during childbirth.
  • NASEM also concluded that safety is enhanced when the abortion is performed earlier in the pregnancy. State level restrictions such as waiting periods, ultrasound requirements, and gestational limits that impede access and delay abortion provision likely make abortions less safe.
  • When medication abortion pills, which account for the majority of abortions, are administered at 9 weeks’ gestation or less, the pregnancy is terminated successfully 99.6% of the time, with a 0.4% risk of major complications, and an associated mortality rate of less than 0.001 percent (0.00064%).
  • Medication abortion pills can be provided in a clinical setting or via telehealth (without an in-person visit). Research has found that the provision of medication abortion via telehealth is as safe and effective as the provision of the pills at an in person visit.
  • Studies on procedural abortions, which include aspiration and D&E, have also found that they are very safe. Research on aspiration abortions, the most common procedural method, have found the rate of major complications of less than 1%.

There are three major data sources on abortion incidence and the characteristics of people who obtain abortions in the U.S: the Centers for Disease Control and Prevention (CDC), the Guttmacher Institute, and most recently, the Society of Family Planning’s (SFP) #WeCount project.

The federal CDC Abortion Surveillance System requests data from the central health agencies of the 50 states, DC, and New York City to document the number and characteristics of women obtaining abortions. Most states collect data from facilities where abortions are provided about the clinicians providing abortions, demographic characteristics of patients, gestational age, and type of abortion procedure. Reporting these data to the CDC is voluntary and not all states participate in the surveillance system. Notably, California, Maryland, and New Hampshire have not reported data on abortions to the CDC system for years. CDC publishes available data from the surveillance system annually.

Guttmacher Institute , an independent research and advocacy organization, is another major source of data on abortions in the U.S. Prior to the Dobbs ruling, Guttmacher conducted the Abortion Provider Census (APC) periodically which has provided data on abortion incidence, abortion facilities, and characteristics of abortion patients. Data from this Census are based primarily on questionnaires collected from all known facilities that provide abortion in the country, information obtained from state health departments, and Guttmacher estimates for a small portion of facilities. The most recent APC reports data from 2020.

The CDC and Guttmacher data differ in terms of methods, timeframe, and completeness, but both have shown similar trends in abortion rates over the past decade. One notable difference is that Guttmacher’s study includes continuous reporting from California, D.C., Maryland, and New Hampshire, which explains at least in part the higher number of abortions in their data.

Since the Dobbs ruling, the Guttmacher Institute has established the Monthly Abortion Provision Study to track abortion volume within the formal United States health care system. This ongoing effort collects data on and provides national and state-level estimates on procedural and medication abortions while also tracking the changes in abortion volume since 2020. The Monthly Abortion Provision Study was designed to complement Guttmacher’s APC along with other data collection efforts to allow for quick snapshots of the changing abortion landscape in the United States.

Society of Family Planning’s (SFP) #WeCount is another national reporting effort that measures changes in abortion access following the Dobbs ruling. The project reports on the number of abortions per month by state and includes data on abortions provided through clinics, private practices, hospitals, and virtual-only providers. The report does not include data on self-managed abortions that are performed without clinical supervision. The most recent #WeCount report analyzes data from April 2022 to data from June 2023, marking one full year of abortion data since Dobbs. The effort represents 83% of all providers known to #WeCount who agreed to participate in their research.

This KFF issue brief uses data from the CDC, Guttmacher, and SFP as well as other research organizations.

How has the abortion rate changed over time?

For most of the decade prior to the Dobbs ruling, there was a steady decline in abortion rates nationally, but there was a slight increase in the years just before the ruling.

In their most recent national data, Guttmacher Institute reported 930,160 abortions in 2020 and a rate of 14.4 per 1,000 women. CDC reported 622,108 abortions in 2021 and a rate of 11.6 abortions per 1,000 women (excludes CA, DC, MD, NH). Guttmacher’s study showed an upward trend in abortion from 2017 to 2020 whereas CDC’s report showed an increase in abortions from 2017 to 2021 except for a slight decrease in 2020.

While most attribute the long-term decline in abortion rates to increased use of more effective methods of contraception , several states had reduced access to low- or no-cost contraceptive care as a result of reductions in the Title X network under the Trump Administration, which may have contributed to the slight rise in abortions prior to the Dobbs ruling. Other factors that may have contributed to the increase could include greater coverage under Medicaid that subsequently made abortions more affordable in some states and broader financial support from abortion funds to help individuals pay for the costs of abortion care.

Even prior to the Dobbs ruling, abortion rates varied widely between states.

National averages can mask local and more granular differences. Lower state-level abortion rates do not reflect less need. Some of the variation has been due to the wide differences in state policies, with some states historically placing restrictions on abortion that make access and availability to nearly out of reach and, on the other side, some states enshrining protections in state Constitutions and legislation.

  • In 2020, the abortion rate (per 1,000 women ages 15-44) ranged from 0.1 in Missouri to 48.9 in the District of Columbia (DC). Trends also varied between states. While the national rate of abortion increased between 2017 and 2019, some states saw declines, with particularly sharp drops in states where heavy restrictions were put into place.

While the number of abortions in the U.S. dropped immediately following the Dobbs decision, new data show that the number of abortions increased overall one year following the ruling. However, the upswing obscures the declines in abortion care in states with bans.

SFP’s #WeCount estimates there were 2,200 cumulative more abortions in the year following Dobbs (July 2022 to June 2023) compared to the pre- Dobbs period (April 2022 and May 2022). Nationally, the number of abortions varied month-by-month, with the largest decrease observed in November 2022 (73,930 abortions; 8,185 fewer abortions than pre- Dobbs period ) and the largest increase in March 2023 (92,680 abortions; 10,565 more abortions than pre- Dobbs period). The states with the largest cumulative increases in the total number of abortions provided by a clinician during the 12-month period include Illinois, Florida, North Carolina, California, and New Mexico. States with abortion bans experienced the largest cumulative decreases in the number of abortions, including Texas, Georgia, Tennessee, and Louisiana (data varies by month in each state; data not shown).

States without abortion bans experienced an increase of abortions following the Dobbs ruling likely due to a combination of reasons: increased interstate travel for abortion access, expanded in-person and virtual/telehealth capacity to see patients, increased measures to protect and cover abortion care for residents and out-of-state patients, and potentially reduced abortion-related stigma as a result of community mobilization around abortion care.

However, the overall national increase in the number of abortions masks the absence and/or scarcity of abortion care in states with total abortion bans or severe restrictions. States with total bans experienced observed 94,930 fewer clinician-provided abortions a year following the ruling (data not shown). Note, this figure is an underestimate due several state policies that restricted abortion access during the pre- Dobbs period. These estimates do not include abortions that may have been performed through self-managed means.

Most of the information about people who receive abortions comes from data prior to the Dobbs ruling. In 2021, women across a range of age groups, socioeconomic status, and racial and ethnic backgrounds obtained abortions, but the majority were obtained by women who were in their twenties, low-income, and women of color.

  • Women in their twenties accounted for more than half (57%) of abortions. Nearly one-third (31%) were among women in their thirties and a small share were among women in their 40s (4%) and teens (8%).
  • Seven in ten abortion patients were of women of color. Black women comprised 42% of abortion recipients, White women 30% , Hispanic women 22%, and 7% women of other races/ethnicities.
  • Many women who sought abortions have children. More than six in 10 (61%) abortion patients in 2021 had at least one previous birth.

The vast majority (94%) of abortions occur during the first trimester of pregnancy according to data available from before the Dobbs decision.

Before the 2022 ruling in Dobbs, there was a federal constitutional right to abortion before the pregnancy is considered to be viable, that is, can survive outside of a pregnant person’s uterus. Viability is generally considered around 24 weeks of pregnancy. Most abortions, though, occur well before the point of fetal viability.

  • Data from 2021 found that more than four in ten (45%) abortions occurred by six weeks of gestation, a third (36%) occurred between seven and nine weeks, and 13% at 10-13 weeks. Just 7% of abortions occurred after the first trimester.
  • Prior to the decision in the Dobbs case, almost half of states (22) had enacted laws that ban abortion at a certain gestational age. Most of these limits are in the second trimester, but some are in the first trimester, well before fetal viability. Many of these laws were blocked because they violated the federal standard established by Roe v Wade. Some states have enacted laws banning abortions after fetal cardiac activity can be detected, or around 6 weeks of pregnancy, which is often before a person knows they are pregnant. In addition to banning abortion, states can now establish pre-viability gestational restrictions because the federal standard has been overturned.

Just over half of abortions were provided at clinics that specialize in abortion care in 2020. Others were provided at clinics that offer abortion care in addition to other family planning services.

Guttmacher Institute estimated that 96% of abortions were provided at clinics and just 4% were provided in doctors’ offices or hospitals in 2020. Most clinic-based abortions were provided at clinics that specialize in providing abortion care, but many were provided at clinics that offer a wide range of other sexual and reproductive health services like contraception and STI care. Most abortions are provided by physicians. However, in 19 states and D.C., Advanced Practice Clinicians (APCs) such as Nurse Practitioners and midwives may provide medication abortions. Conversely, 31 states prohibit clinicians other than physicians from providing abortion care.

Even prior to the ruling in Dobbs , access to abortion services was very uneven across the country though. The proliferation of restrictions in many states, particularly in the South, had greatly shrunk the availability of services in some areas. In the wake of overturning Roe v. Wade , these geographic disparities are likely to widen as more states ban abortion services altogether.

Telehealth has grown as a delivery mechanism for abortion services.

While procedural abortions must be provided in a clinical setting, medication abortion can be provided in a clinical setting or via telehealth. Access to medication abortion via telehealth had been limited for many years by a Food and Drug Administration (FDA) restriction that had permitted only certified clinicians to dispense mifepristone in a health care setting. The drug could not be mailed or picked up at a retail pharmacy. However, in December 2021, the FDA permanently revised its policy and no longer requires clinicians to dispense the drug in person. Additionally, in January 2023, the FDA finalized a change that allows retail pharmacies to dispense medication abortion pills to patients with a prescription.

While some states are regulating the use of mifepristone as an abortion method, the Biden Administration has asserted that the FDA has regulatory power over all drugs, including mifepristone. This could result in future legal action as the authority of the state to regulate health care will be pitted against the authority of the federal government to regulate drugs through the FDA will be contested.

  • In a telehealth abortion, the patient typically completes an online questionnaire to assess (1) confirmation of pregnancy, (2) gestational age and (3) blood type. If determined eligible by a remote clinician, the patient is mailed the medications. This model does not require an ultrasound for pregnancy dating if the patient has regular periods and is sure of the date of their last menstrual period (in line with  ACOG ’s guidelines for pregnancy dating). If the patient has irregular periods or is unsure how long they have been pregnant, they must obtain an ultrasound to confirm gestational age and rule out an ectopic pregnancy 3 and send in the images for review before receiving their medications. If the patient does not know their blood type or has Rh negative blood, the  provider  may prompt the patient to visit a nearby clinic for an injection to prevent adverse reactions between maternal and fetal blood ( RhoGAM ), The follow-up visit with a clinician can also happen via a telehealth visit.
  • However, even in some of the states that have not banned abortion altogether, telehealth may not be available. Many states had established restrictions prior to the Dobbs ruling that limit the use of telehealth abortions by either requiring abortion patients to take the pills at a physical clinic, require ultrasounds for all abortions, set their own policies regarding the dispensing of the medications used for abortion care, or directly ban the use of telehealth for abortion care. As of November 2022, of the 33 states that have not banned abortion, eight had at least one of these restrictions, effectively prohibiting telehealth for medication abortion.
  • Medication abortion has emerged as a major legal front in the battle over abortion access across the nation. Multiple cases have been filed in federal courts regarding aspects of the FDA’s regulation of medication abortion as well as the mailing of medications. One notable ongoing case is Alliance for Hippocratic Medicine v. FDA , where the plaintiffs are challenging the FDA’s authority and approval process for mifepristone. The plaintiffs also contend that an 1873 anti-obscenity law, the Comstock Act, prohibits the mailing of any medication used for abortion. In April 2023, a US Supreme Court ruling allowed current FDA rules to remain in effect as the case proceeds through the courts. This means that mifepristone remains available for medication abortion either in a clinic or via telehealth where state law permits.

Data from SFP’s October 2023 #WeCount report show that abortions provided by virtual-only clinics represent approximately 5% of all abortions post- Roe . The number of telehealth abortions increased 72% from a monthly average of 4,045 abortions in April and May 2022 to 6,950 abortions per month in the 12 months post- Dobbs . Nearly all of these abortions occurred in states that permit abortions.

Self-managed abortions are provided without a clinician visit.

Self-managed abortions typically involve obtaining medication abortion pills from an online pharmacy that will send the pills by mail or by purchasing the pills from a pharmacy in another country. This does not typically involve a direct consultation with a clinician either in person or via telehealth.

Research has found that prior to Dobbs , more than one in ten patients who obtained abortions at clinics had considered self-managing their abortions. This is likely to increase going forward since abortion care is not available in many states, and there have already been reports of people ordering pills from online markets outside the U.S. medical system. Tracking information on these online orders can help fill in gaps in abortion count estimates but can also be difficult. Some companies may not share data on purchases, and it would also be unclear whether patients take the abortion medication after receiving it in the mail.

The median costs of abortion services exceed $500.

Obtaining an abortion can be costly. On average, the costs are higher for abortions in the second trimester than in the first trimester. State restrictions can also raise the costs, as people may have to travel if abortions are prohibited or not available in their area. Many people pay for abortion services out of pocket, but some people can obtain assistance from local abortion funds.

  • In 2021, the median costs for people paying out of pocket in the first trimester were $568 for a medication abortion and $625 for a procedural abortion. The Federal Reserve estimates that nationally about one-third of people do not have $400 on hand for unexpected expenses. For low-income people, who are more likely to need abortion care, these costs are often unaffordable.
  • The costs of abortion are higher in the second trimester compared to the first, with median self-pay of $775. In the second trimester, more intensive procedures may be needed, more are likely to be conducted in a hospital setting (although still a minority), and local options are more limited in many communities that have fewer facilities. This results in additional nonmedical costs for transportation, childcare, lodging, and lost wages. nonmedical costs for transportation, childcare, lodging, and lost wages.
  • Abortion funds are independent organizations that help some people pay for the costs of abortion services. Most abortion funds are regional and have connections to clinics in their area. Funds vary, but they typically provide assistance with the costs of medical care, travel, and accommodations if needed. However, they do not reach all people seeking services, and many people are not able to afford the costs of obtaining an abortion because they cannot pay for the abortion itself or cover the costs of travel, lodging or missed work.

Insurance coverage for abortion services is heavily restricted in certain private insurance plans and public programs like Medicaid and Medicare.

Private insurance covers most women of reproductive age, and states have the responsibility to regulate fully insured private plans in their state, whereas the federal government regulates self-funded plans under the Employee Retirement Income Security Act (ERISA). States can choose whether abortion coverage is included or excluded in private plans that are not self-insured.

  • Prior to the Dobbs ruling, several states had enacted private plan restrictions and banned abortion coverage from ACA Marketplace plans. Currently, there are 11 states that have policies restricting abortion coverage in private plans and 26 that ban coverage in any Marketplace plans. Since the Dobbs ruling, some of these states have also banned the provision of abortion services altogether.
  • A handful of states ( 9 ), however, have enacted laws that require private plans to cover abortion.
  • The Medicaid program covers approximately one in five women of reproductive age and four in ten who are low-income. For decades, the Hyde Amendment has banned the use of federal funds for abortion in Medicaid and other public programs unless the pregnancy is a result of rape, incest, or it endangers the woman’s life.
  • States have the option to use state-only funds to cover abortions under other circumstances for women on Medicaid, which 16 states do currently. However, more than half (56% ) of women covered by Medicaid live in Hyde states.
  • According to a Guttmacher Institute survey of patients in the year prior to the Dobbs ruling, a quarter (26%) of abortion patients in the study used Medicaid to pay for abortion services, 11% used private insurance, and 60% paid out of pocket. People in states with more restrictive abortion policies were less likely to use Medicaid or private insurance and more likely to pay out of pocket compared to people living in less restrictive states.
  • Federal law also restricts abortion funding under the Indian Health Service, Medicare, and the Children’s Health Insurance Program. Over the years, language similar to that in the Hyde Amendment has been incorporated into a range of other federal programs that provide or pay for health services to women including: the military’s TRICARE program, federal prisons, the Peace Corps, and the Federal Employees Health Benefits Program.

National polls have consistently found that a majority of the public did not want to see Roe v . Wade overturned and that most people feel that abortion is a personal medical decision. The public also strongly opposes the criminalization of abortion both among people who get abortion and the clinicians who provide abortion services. Nearly three quarters of adults (74%) and 79% of reproductive age women say that obtaining an abortion should be a personal choice rather than regulated by law (data not shown). For example, two-thirds of the public are concerned that bans on abortion may lead to unnecessary health problems for people experiencing pregnancy complications.

Additional KFF resources:

Abortion in the US Dashboard

Access and Coverage of Abortion Services

Issue Brief: Abortion at SCOTUS: Dobbs v. Jackson Women’s Health

Issue Brief: State Actions to Protect and Expand Access to Abortion Services

Policy Watch: A Year After Dobbs: Policies Restricting Access to Abortion in States Even Where It’s Not Banned

Policy Watch: Employer Coverage of Travel Costs for Out-of-State Abortion

Issue Brief: Exclusion of Abortion Coverage from Employer-Sponsored Health Plans

Interactive: How State Policies Shape Access to Abortion Coverage

Medication Abortion

Issue Brief: Legal Challenges to the FDA Approval of Medication Abortion Pills

Infographic: The Availability and Use of Medication Abortion Care

Fact Sheet: The Availability and Use of Medication Abortion

Issue Brief: The Intersection of State and Federal Policies on Access to Medication Abortion Via Telehealth

Public Opinion on Abortion

Web Event: Americans’ Knowledge and Attitudes About Abortion Access and The Pending Supreme Court Ruling

KFF Health Tracking Poll: Early 2023 Update On Public Awareness On Abortion and Emergency Contraception

KFF Health Tracking Poll: Views on and Knowledge about Abortion in Wake of Leaked Supreme Court Opinion

Other Resources on Women’s Health

Interactive: State Profiles for Women’s Health

Interactive: State Health Facts on Women’s Health Indicators

Homepage: Women’s Health Policy

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  • The Availability and Use of Medication Abortion
  • State Actions to Protect and Expand Access to Abortion Services
  • Legal Challenges to State Abortion Bans Since the Dobbs Decision
  • Legal Challenges to the FDA Approval of Medication Abortion Pills
  • Employer Coverage of Travel Costs for Out-of-State Abortion
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What to know about abortion policy across the US heading into 2024

FILE - A group from St. Michael the Archangel School in Findlay, Ohio, gathers during the Ohio March for Life rally at the Ohio State House in Columbus, Ohio, Oct. 6, 2023. Abortion is expected to be a major issue in 2024 for voters, courts and state lawmakers. (AP Photo/Carolyn Kaster, file)

FILE - A group from St. Michael the Archangel School in Findlay, Ohio, gathers during the Ohio March for Life rally at the Ohio State House in Columbus, Ohio, Oct. 6, 2023. Abortion is expected to be a major issue in 2024 for voters, courts and state lawmakers. (AP Photo/Carolyn Kaster, file)

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Abortion is going to remain a major issue in politics, policy and the courts in the U.S. in 2024, even though most of the states that were expected to impose restrictions have already done so.

The abortion landscape has been in flux since the June 2022 U.S. Supreme Court ruling that overturned Roe v. Wade, which touched off a round of abortion policy changes and new litigation about them.

There are still looming ballot questions and court decisions. And lawmakers could tweak current abortion laws.

Here’s a look at what to know.

Wisconsin Assembly Speaker Robin Vos speaks during an interview with The Associated Press at the state Capitol in Madison, Wis., on Wednesday, Dec. 20, 2023. Vos said he hopes to let voters decide in a ballot question whether to shorten the length of time pregnant women can legally seek abortions in the state. (AP Photo/Harm Venhuizen)

ABORTION WILL BE ON THE BALLOT IN 2024

Since Roe was overturned, abortion-related questions have been on the ballot in seven states – and the abortion rights side has prevailed on all of them.

Legislatures in the East Coast blue states of Maryland and New York have already put questions on the November 2024 ballot to amend the state constitutions to include rights regarding reproductive health care.

Both states already allow abortion through viability, which is generally considered to be about 24 weeks gestational age.

While those are the only states where ballot questions are a sure thing, they’re possible in several others.

There are pushes to add constitutional rights to abortion in Minnesota, Montana, Nevada and Virginia , where it’s legal in most cases already; and in Arizona , Florida , Nebraska and South Dakota , where heavier restrictions are in place.

In Missouri , where abortion is banned throughout pregnancy, there are dueling ballot measures to expand abortion access. One would bar the government from banning it during the first 24 weeks of pregnancy. Another, from moderate Republicans, would make it legal but for fewer weeks.

In Colorado, where abortion is legal in most cases, there are pushes for ballot measures both to enshrine abortion rights and to roll them back.

Lawmakers in Iowa, where abortion restrictions have been put on hold by a court, are pushing for an amendment that would clear the way for a ban. There could be a similar effort in Pennsylvania, where abortion is legal until viability.

AND IT’S STILL IN THE COURTS

For nearly 50 years, abortion legal questions were waged mostly in federal courts.

But the U.S. Supreme Court finding that there’s no national right to abortion directed the latest generation of legal battles over abortion mostly to state court.

Some of the big issues that are yet to be decided:

Women in Idaho, Oklahoma, Tennessee and Texas are suing over being denied abortion while facing harrowing pregnancy complications. The Texas Supreme Court heard arguments in a similar case in November, and this month it denied a woman’s request for an immediate abortion , finding that her life was not in danger, so she did qualify under the exceptions in state law.

The U.S. Supreme Court has agreed to take up the question of whether the U.S. Food and Drug Administration’s approval of the abortion drug mifepristone was appropriate.

State courts are considering several challenges to abortion bans and restrictions, including in Iowa, Montana, Utah and Wyoming, where courts have blocked enforcement of the measures.

In Idaho, a federal judge in November blocked enforcement of the state’s first-in-the-nation “abortion trafficking” ban while courts sort out the constitutionality of the measure.

ABORTION COULD ALSO BE ON THE LEGISLATIVE AGENDA

Legislative sessions begin in January or February in most states, and there haven’t been many abortion-related bills filed yet.

But activists on both sides anticipate that bills will emerge.

Inrgid Duran, the legislative director at National Right to Life, said other states could pursue provisions like Idaho’s to make it illegal to transport a minor for an abortion without parental consent. Enforcement in Idaho is on hold .

She also said there could be more efforts to fund organizations, sometimes called crisis pregnancy centers, that seek to dissuade abortion, and more measures to clarify abortion definitions.

“The pro-life movement has faced challenges before and will continue to face challenges,” she said. “But it’s not going to deter us from continuing to do what is right by advocating for the vulnerable.”

Some conservative groups are also prioritizing providing more resources to support women during pregnancy and after birth, including with tax credits or grants to boost organizations that encourage women not to seek abortions.

Missouri lawmakers have introduced measures that would make it possible to file homicide charges against women who have abortions . Most major anti-abortion groups oppose that approach, which has been introduced in other states but never gained traction.

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Q&A: Access to Abortion is a Human Right

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Abortion rights activists protest outside of the U.S. Supreme Court on Capitol Hill in Washington, DC, Tuesday, June 21, 2022.

Access to safe and legal abortion is a matter of human rights, and its availability is the best way to protect autonomy and reduce maternal mortality and morbidity.

Is abortion a human rights issue?

Access to safe, legal abortion is a matter of human rights. Authoritative interpretations of international human rights law establish that denying women, girls, and other pregnant people access to abortion is a form of discrimination and jeopardizes a range of human rights. United Nations human rights treaty bodies regularly call for governments to decriminalize abortion in all cases and to ensure access to safe, legal abortion in certain circumstances at a minimum.

What are the human rights consequences of restricting or banning abortion access? 

Countries have obligations to respect, protect, and fulfill human rights, including those concerning sexual and reproductive health and autonomy. Where safe and legal abortion services are unreasonably restricted or not fully available, many other internationally protected human rights may be at risk, including rights to nondiscrimination and equality; to life, health, and information; to freedom from torture and cruel, inhuman and degrading treatment; to privacy and bodily autonomy and integrity; to decide the number and spacing of children; to liberty; to enjoy the benefits of scientific progress; and to freedom of conscience and religion.

These rights are set out the Universal Declaration of Human Rights, and protected in many international treaties, including the International Covenant on Economic, Social and Cultural Rights (ICESCR), the International Covenant on Civil and Political Rights (ICCPR), the Convention Against Torture (CAT), the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), and the Convention on the Rights of the Child (CRC), as well as in regional level treaties in Africa, the Americas, and Europe. 

For nearly two decades, Human Rights Watch has documented the human rights harm of restricted or banned access to abortion in countries around the world, including in the US , Ecuador , Argentina , Brazil , the Dominican Republic , and Ireland .  

What is the Human Rights Watch position on abortion?

Human Rights Watch believes that reproductive rights are human rights, including the right to access to abortion. States have the obligation to provide women, girls, and other pregnant people with access to safe and legal abortion as part of their core human rights responsibilities.

As Human Rights Watch has stated in amicus curiae briefs to high courts in countries around the world – from Brazil and Colombia to South Korea and most recently with partner organizations in the United States – international human rights law and relevant jurisprudence support the conclusion that decisions about abortion belong to a pregnant person alone, without interference or unreasonable restriction by the state or third parties.

Is the right to life at risk when access to abortion is restricted or banned?

Yes. Legal restrictions on abortion often result in more illegal abortions, which may also be unsafe and may drive higher maternal mortality and morbidity. As a result, lack of access to safe and legal abortion puts the lives of pregnant people at risk.

According to the World Health Organization (WHO), complications from pregnancy and childbirth are the leading cause of death for girls and young women ages 15 to 19, and children ages 10 to 14 have a higher risk of health complications and death from pregnancy than adults. WHO has also found that the removal of restrictions on abortion results in the reduction of maternal mortality .

The UN Human Rights Committee (HRC), which monitors states’ compliance with the ICCPR , has noted the relationship between restrictive abortion laws and threats to women’s and girls’ lives. It has explicitly clarified that states parties cannot regulate access to abortion in any way that requires pregnant people to resort to unsafe abortions, and that states must provide safe, legal, and effective access to abortion to prevent risk to the lives and health of pregnant people, and to ensure that they are not subject to substantial pain or suffering, most notably in cases where pregnancy is the result of rape or incest, or the pregnancy is not viable.

Do restrictive abortion policies reduce the rate of abortions?

Abortion restrictions do not prevent abortions. Research has shown that when abortion is banned or restricted, the number of abortions does not decrease. Abortions just move underground. This increases the risk both of unsafe procedures and that people will be reported to police or prosecuted for suspected abortions.

The rate of unsafe abortions is nearly 45 times higher in countries with highly restrictive abortion laws than in countries where abortion is legal and unrestricted.

Restrictive abortion policies push pregnant people seeking abortions, especially those living in poverty or rural areas , out of the healthcare system and into unsafe, unregulated settings. WHO has also stated that lack of access to safe, affordable, timely, and respectful abortion care, as well as the promotion of stigma associated with abortion, poses risks to abortion seekers’ physical and mental well-being throughout their lives.

Who will be most harmed from restrictions on access to abortion?

Not all pregnant people are likely to experience the human rights and health harm of restricting abortion equally. Young people and marginalized groups including Black, Indigenous, and other people of color, people living in economic poverty, and sexual and gender minorities are more likely to be harmed. The UN Human Rights Committee has held that lack of availability of reproductive health information and services, including abortion, undermines women’s right to nondiscrimination.

The UN Human Rights Committee, like the Committee on the Elimination on Discrimination Against Women, has also noted that restrictions on abortion result in the disproportionate practice of illegal, unsafe abortions by poor and rural women or women unable to travel outside a jurisdiction where abortion is banned.  The UN Committee on the Rights of the Child has also said that punitive abortion laws constitute a violation of children’s right to freedom from discrimination.

Even where abortion is technically legal, heavy restrictions can make it inaccessible to marginalized people. This forces pregnant people, particularly from marginalized groups, to look for unsafe and clandestine abortion opportunities and to risk criminal or civil penalties, even when their circumstances fall within what is legally permissible.

Moreover, the Committee on Economic, Social and Cultural Rights has said, “[a] wide range of laws, policies and practices undermine the autonomy and right to equality and non-discrimination in the full enjoyment of the right to sexual and reproductive health, for example criminalization of abortion or restrictive abortion laws.”  It has also noted that restrictions on abortion particularly affect women living in poverty or without or with less formal education. Similarly, six UN experts stressed in a 2015 joint news release that in El Salvador, “the total ban on abortion disproportionately affects women who are poor.”

What has the UN said about lack of access to and criminalization of abortion?

UN human rights treaty bodies, which monitor countries’ compliance with relevant treaties and that report or advise on human rights related to specific themes or countries, have consistently called for decriminalization of abortion and the full realization of sexual and reproductive rights, including access to safe, legal abortion.

Examples of statements from these mechanisms in relation to abortion include the following:

The CEDAW Committee, which monitors compliance with CEDAW, stated that:

Unsafe abortion is a leading cause of maternal mortality and morbidity. As such, States parties should legalize abortion at least in cases of rape, incest, threats to the life and/or health of the mother, or severe fetal impairment, as well as provide women with access to quality post-abortion care, especially in cases of complications resulting from unsafe abortions. States parties should also remove punitive measures for women who undergo abortion.

The committee has made similar recommendations to many governments while reviewing their compliance with the treaty. These recommendations typically call on governments to decriminalize abortion in all cases, legalize abortion in the circumstances noted above, and guarantee access.

The Human Rights Committee , which monitors states’ compliance with the ICCPR, has noted the relationship between restrictive abortion laws and threats to women’s and girls’ lives and has clarified the scope of States parties’ obligations to protect their right to life. In particular, “restrictions on the ability of women or girls to seek abortion must not, inter alia, jeopardize their lives.” The committee has frequently expressed concern about criminalization of abortion and has called for expanded access.

Like the CEDAW Committee, the Human Rights Committee , the Committee on Economic Social and Cultural Rights (which monitors the ICESCR), and the Committee against Torture , (which monitors CAT), have called the removal of penalties for abortion and for the implementation of measures to ensure safe, legal access to abortion. Where safe abortion is not available it can pose risks to mental health , including severe anguish and risk of suicide . The tie between mental health and restrictions in access to reproductive health is so clear that the UN Committee against Torture has expressed concern at the severe physical and mental anguish and distress experienced by women and girls due to abortion restrictions, and concluded that criminalization and inaccessibility of abortion can be incompatible with a government’s duty to uphold the right to freedom from torture and other cruel, inhuman or degrading treatment or punishment.

Similarly, the UN Committee on the Rights of the Child has urged states to “decriminalize abortion to ensure that girls have access to safe abortion and post-abortion services, review legislation with a view to guaranteeing the best interests of pregnant adolescents and ensure that their views are always heard and respected in abortion-related decisions.” In many individual state reviews of treaty compliance, called concluding observations, the committee explicitly called for decriminalization of abortion “in all circumstances.”

The UN special rapporteur on the right to health has said that criminal laws penalizing and restricting induced abortion are “impermissible barriers to the realization of women’s right to health and must be eliminated.”

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what is the conclusion about abortion

Abortion: What it is and why people disagree whether it should be legal

And why you’re hearing so much about it right now.

⭐️HERE’S WHAT YOU NEED TO KNOW⭐️

  • A U.S. Supreme Court ruling has determined that states will get to decide how abortions are regulated.
  • An abortion is a medical procedure that ends a pregnancy.
  • This means in some American states, abortions will become illegal.
  • Abortion is legal in Canada and not affected by the U.S. decision.
  • Some people agree with this decision, but others say abortion should be a universal right for all who want it.
  • Keep reading to understand the anti-abortion/pro-choice debate. ⬇️ ⬇️ ⬇️

On June 24, the U.S. Supreme Court overturned a historic decision called Roe v. Wade.

The court’s new ruling limits a person’s right to have an abortion in the United States.

It’s expected to lead to abortion restrictions or outright bans in at least 13 U.S. states.

If you want to know more about the decision, read this article:

  • Roe v. Wade was overturned. What does that mean?

If you want to know what an abortion is and why people disagree whether or not it should be allowed, keep reading.

Words we use in this article:  Abortion: An abortion is a medical procedure that ends a pregnancy. Depending on the situation, it can either be done by prescribed medication or as a surgical procedure in a clinic or hospital by a doctor.  Conception: Conception is when a male sperm cell fertilizes a female egg, or ovum, and a person becomes pregnant.  Fetus: A fertilized egg is called a zygote, which eventually becomes a fetus at approximately nine weeks and continues to develop until birth.

Why are there different views on abortion?

Abortion can be controversial because not everyone agrees who should decide whether or not to end a pregnancy: the individual who is pregnant or the government.

Bernard Dickens, professor emeritus of health law and policy at the University of Toronto, has been studying the history of abortion and the laws relating to it for 50 years.

He says for some people who are pro-choice and support the right to abortion, the fact that the fetus is inside the individual's body means that they get to decide what happens to it.

what is the conclusion about abortion

Those who are anti-abortion oppose the decision to end a pregnancy with abortion and believe that the fetus is considered a person long before birth.

“From a religious or moral perspective, some people say that life begins earlier than birth, life begins at conception, when a woman becomes pregnant,” Dickens said.

Because those who are anti-abortion see the fetus as a living being, they believe that abortion is ending a life, and that the government should intervene to protect that life.

what is the conclusion about abortion

When do abortions happen?

In the U.S., federal statistics suggest that 94 per cent of abortions are performed at or before 13 weeks of pregnancy, which lasts about 40 weeks, or nine months.

Roughly 99 per cent of abortions are performed before 21 weeks of pregnancy (about four and a half months).

In Canada, the statistics are very similar.

Few health care providers in Canada or the U.S. perform abortions after 24 weeks (about five and a half months), unless the life of the person who is pregnant is at risk, if the fetus has serious complications, or in cases where a person has become pregnant as a result of a sexual assault.

pregnancy month by month, images of developing fetus in womb, week 1 microscopic cell, week 8 roughly the size of a quarter, week 12 rougly the size of a tennis ball, week 13 in the US 94% or abortions are performed at or before this point

Why do people have abortions?

According to Dickens, numerous factors can influence a person’s decision to have an abortion in the United States, including financial, medical and personal.

One of the common reasons is socioeconomic. In other words, some of the people who have had abortions said they couldn't afford to raise a child or add another child to their family.

According to a study done in 2014 by the Guttmacher Institute, a not-for-profit research organization that studies reproductive health:

  • 59 per cent of people in the U.S. who chose abortions already have kids.
  • 75 per cent of people who had had abortions lived below the poverty line of $15,730 US for a family of two. 

OK, now that you understand the background and you want to learn more about what led to the decision in the United States, read this article .

Have more questions? Want to tell us how we’re doing? Use the “send us feedback” link below. ⬇️⬇️⬇️

With files from The Associated Press

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2. social and moral considerations on abortion.

Relatively few Americans view the morality of abortion in stark terms: Overall, just 7% of all U.S. adults say abortion is morally acceptable in all cases, and 13% say it is morally wrong in all cases. A third say that abortion is morally wrong in  most  cases, while about a quarter (24%) say it is morally acceptable most of the time. About an additional one-in-five do not consider abortion a moral issue.

A chart showing wide religious and partisan differences in views of the morality of abortion

There are wide differences on this question by political party and religious affiliation. Among Republicans and independents who lean toward the Republican Party, most say that abortion is morally wrong either in most (48%) or all cases (20%). Among Democrats and Democratic leaners, meanwhile, only about three-in-ten (29%) hold a similar view. About four-in-ten Democrats say abortion is morally  acceptable  in most (32%) or all (11%) cases, while an additional 28% say abortion is not a moral issue. 

White evangelical Protestants overwhelmingly say abortion is morally wrong in most (51%) or all cases (30%). A slim majority of Catholics (53%) also view abortion as morally wrong, but many also say it is morally acceptable in most (24%) or all cases (4%), or that it is not a moral issue (17%). And among religiously unaffiliated Americans, about three-quarters see abortion as morally acceptable (45%) or not a moral issue (32%).

There is strong alignment between people’s views of whether abortion is morally wrong and whether it should be illegal. For example, among U.S. adults who take the view that abortion should be illegal in all cases without exception, fully 86% also say abortion is always morally wrong. The prevailing view among adults who say abortion should be legal in all circumstances is that abortion is not a moral issue (44%), though notable shares of this group also say it is morally acceptable in all (27%) or most (22%) cases. 

Most Americans who say abortion should be illegal with some exceptions take the view that abortion is morally wrong in  most  cases (69%). Those who say abortion should be legal with some exceptions are somewhat more conflicted, with 43% deeming abortion morally acceptable in most cases and 26% saying it is morally wrong in most cases; an additional 24% say it is not a moral issue. 

The survey also asked respondents who said abortion is morally wrong in at least some cases whether there are situations where abortion should still be legal  despite  being morally wrong. Roughly half of U.S. adults (48%) say that there are, in fact, situations where abortion is morally wrong but should still be legal, while just 22% say that whenever abortion is morally wrong, it should also be illegal. An additional 28% either said abortion is morally acceptable in all cases or not a moral issue, and thus did not receive the follow-up question.

Across both political parties and all major Christian subgroups – including Republicans and White evangelicals – there are substantially more people who say that there are situations where abortion should still be  legal  despite being morally wrong than there are who say that abortion should always be  illegal  when it is morally wrong.

A chart showing roughly half of Americans say there are situations where abortion is morally wrong, but should still be legal

Public views of what would change the number of abortions in the U.S.

Americans more likely to say additional support for women would reduce the number of abortions than say the same about stricter laws

Asked about the impact a number of policy changes would have on the number of abortions in the U.S., nearly two-thirds of Americans (65%) say “more support for women during pregnancy, such as financial assistance or employment protections” would reduce the number of abortions in the U.S. Six-in-ten say the same about expanding sex education and similar shares say more support for parents (58%), making it easier to place children for adoption in good homes (57%) and passing stricter abortion laws (57%) would have this effect. 

While about three-quarters of White evangelical Protestants (74%) say passing stricter abortion laws would reduce the number of abortions in the U.S., about half of religiously unaffiliated Americans (48%) hold this view. Similarly, Republicans are more likely than Democrats to say this (67% vs. 49%, respectively). By contrast, while about seven-in-ten unaffiliated adults (69%) say expanding sex education would reduce the number of abortions in the U.S., only about half of White evangelicals (48%) say this. Democrats also are substantially more likely than Republicans to hold this view (70% vs. 50%). 

Democrats are somewhat more likely than Republicans to say support for parents – such as paid family leave or more child care options – would reduce the number of abortions in the country (64% vs. 53%, respectively), while Republicans are more likely than Democrats to say making adoption into good homes easier would reduce abortions (64% vs. 52%).

Majorities across both parties and other subgroups analyzed in this report say that more support for women during pregnancy would reduce the number of abortions in America.

A chart showing Republicans more likely than Democrats to say passing stricter abortion laws would reduce number of abortions in the United States

A majority of Americans say women should have more say in setting abortion policy in the U.S.

A chart showing seven-in-ten Democrats say women should have more say than men in setting abortion policy in the U.S.

More than half of U.S. adults (56%) say women should have more say than men when it comes to setting policies around abortion in this country – including 42% who say women should have “a lot” more say. About four-in-ten (39%) say men and women should have equal say in abortion policies, and 3% say men should have more say than women. 

Six-in-ten women and about half of men (51%) say that women should have more say on this policy issue. 

Democrats are much more likely than Republicans to say women should have more say than men in setting abortion policy (70% vs. 41%). Similar shares of Protestants (48%) and Catholics (51%) say women should have more say than men on this issue, while the share of religiously unaffiliated Americans who say this is much higher (70%).

How do certain arguments about abortion resonate with Americans?

Seeking to gauge Americans’ reactions to several common arguments related to abortion, the survey presented respondents with six statements and asked them to rate how well each statement reflects their views on a five-point scale ranging from “extremely well” to “not at all well.” 

About half of U.S. adults say if legal abortions are too hard to get, women will seek out unsafe ones

The list included three statements sometimes cited by individuals wishing to protect a right to abortion: “The decision about whether to have an abortion should belong solely to the pregnant woman,” “If legal abortions are too hard to get, then women will seek out unsafe abortions from unlicensed providers,” and “If legal abortions are too hard to get, then it will be more difficult for women to get ahead in society.” The first two of these resonate with the greatest number of Americans, with about half (53%) saying each describes their views “extremely” or “very” well. In other words, among the statements presented in the survey, U.S. adults are most likely to say that women alone should decide whether to have an abortion, and that making abortion illegal will lead women into unsafe situations.

The three other statements are similar to arguments sometimes made by those who wish to restrict access to abortions: “Human life begins at conception, so a fetus is a person with rights,” “If legal abortions are too easy to get, then people won’t be as careful with sex and contraception,” and “If legal abortions are too easy to get, then some pregnant women will be pressured into having an abortion even when they don’t want to.” 

Fewer than half of Americans say each of these statements describes their views extremely or very well. Nearly four-in-ten endorse the notion that “human life begins at conception, so a fetus is a person with rights” (26% say this describes their views extremely well, 12% very well), while about a third say that “if legal abortions are too easy to get, then people won’t be as careful with sex and contraception” (20% extremely well, 15% very well).

When it comes to statements cited by proponents of abortion rights, Democrats are much more likely than Republicans to identify with all three of these statements, as are religiously unaffiliated Americans compared with Catholics and Protestants. Women also are more likely than men to express these views – and especially more likely to say that decisions about abortion should fall solely to pregnant women and that restrictions on abortion will put women in unsafe situations. Younger adults under 30 are particularly likely to express the view that if legal abortions are too hard to get, then it will be difficult for women to get ahead in society.

A chart showing most Democrats say decisions about abortion should fall solely to pregnant women

In the case of the three statements sometimes cited by opponents of abortion, the patterns generally go in the opposite direction. Republicans are more likely than Democrats to say each statement reflects their views “extremely” or “very” well, as are Protestants (especially White evangelical Protestants) and Catholics compared with the religiously unaffiliated. In addition, older Americans are more likely than young adults to say that human life begins at conception and that easy access to abortion encourages unsafe sex.

Gender differences on these questions, however, are muted. In fact, women are just as likely as men to say that human life begins at conception, so a fetus is a person with rights (39% and 38%, respectively).

A chart showing nearly three-quarters of White evangelicals say human life begins at conception

Analyzing certain statements together allows for an examination of the extent to which individuals can simultaneously hold two views that may seem to some as in conflict. For instance, overall, one-in-three U.S. adults say that  both  the statement “the decision about whether to have an abortion should belong solely to the pregnant woman” and the statement “human life begins at conception, so the fetus is a person with rights” reflect their own views at least somewhat well. This includes 12% of adults who say both statements reflect their views “extremely” or “very” well. 

Republicans are slightly more likely than Democrats to say both statements reflect their own views at least somewhat well (36% vs. 30%), although Republicans are much more likely to say  only  the statement about the fetus being a person with rights reflects their views at least somewhat well (39% vs. 9%) and Democrats are much more likely to say  only  the statement about the decision to have an abortion belonging solely to the pregnant woman reflects their views at least somewhat well (55% vs. 19%).

Additionally, those who take the stance that abortion should be legal in all cases with no exceptions are overwhelmingly likely (76%) to say only the statement about the decision belonging solely to the pregnant woman reflects their views extremely, very or somewhat well, while a nearly identical share (73%) of those who say abortion should be  illegal  in all cases with no exceptions say only the statement about human life beginning at conception reflects their views at least somewhat well.

A chart showing one-third of U.S. adults say both that abortion decision belongs solely to the pregnant woman, and that life begins at conception and fetuses have rights

In their own words: How Americans feel about abortion 

A chart showing Americans express a range of strong emotions when asked to describe feelings on abortion

When asked to describe whether they had any other additional views or feelings about abortion, adults shared a range of strong or complex views about the topic. In many cases, Americans reiterated their strong support – or opposition to – abortion in the U.S. Others reflected on how difficult or nuanced the issue was, offering emotional responses or personal experiences to one of two open-ended questions asked on the survey. 

One open-ended question asked respondents if they wanted to share any other views or feelings about abortion overall. The other open-ended question asked respondents about their feelings or views regarding abortion restrictions. The responses to both questions were similar. 

Overall, about three-in-ten adults offered a response to either of the open-ended questions. There was little difference in the likelihood to respond by party, religion or gender, though people who say they have given a “lot” of thought to the issue were more likely to respond than people who have not. 

Of those who did offer additional comments, about a third of respondents said something in support of legal abortion. By far the most common sentiment expressed was that the decision to have an abortion should be solely a personal decision, or a decision made jointly with a woman and her health care provider, with some saying simply that it “should be between a woman and her doctor.” Others made a more general point, such as one woman who said, “A woman’s body and health should not be subject to legislation.” 

About one-in-five of the people who responded to the question expressed disapproval of abortion – the most common reason being a belief that a fetus is a person or that abortion is murder. As one woman said, “It is my belief that life begins at conception and as much as is humanly possible, we as a society need to support, protect and defend each one of those little lives.” Others in this group pointed to the fact that they felt abortion was too often used as a form of birth control. For example, one man said, “Abortions are too easy to obtain these days. It seems more women are using it as a way of birth control.” 

About a quarter of respondents who opted to answer one of the open-ended questions said that their views about abortion were complex; many described having mixed feelings about the issue or otherwise expressed sympathy for both sides of the issue. One woman said, “I am personally opposed to abortion in most cases, but I think it would be detrimental to society to make it illegal. I was alive before the pill and before legal abortions. Many women died.” And one man said, “While I might feel abortion may be wrong in some cases, it is never my place as a man to tell a woman what to do with her body.” 

The remaining responses were either not related to the topic or were difficult to interpret.

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About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

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What Is an Abortion?

Julie Lynn Marks

An abortion involves using surgery or taking medicines to end a pregnancy. It’s also sometimes referred to as termination of pregnancy, per  MedlinePlus .

According to  Planned Parenthood , about 1 in every 4 people who can get pregnant in the United States will have an abortion by the time they’re 45 years old.

Why Is an Abortion Performed?

The reasons for having an abortion vary, but according to the  Mayo Clinic , someone might choose this option if:

  • They didn’t intend to get pregnant ( Research shows half of people seeking abortion report using birth control in the month before they became pregnant.)
  • They no longer want to be pregnant
  • They have a medical condition that makes pregnancy life-threatening
  • The fetus has a serious medical condition
  • They require medical assistance to induce delivery of nonviable fetal tissue after miscarriage or stillbirth (While medical providers would not use the term “abortion” in these scenarios because the pregnancy has already ended, the medications and procedures are the same. However, ongoing abortion restrictions at the state level could prevent women from obtaining this medically necessary care.)

In a study published in the medical journal BMC Women’s Health , researchers analyzed a sample of 954 women from 30 abortion facilities across the United States. They found that women cited many reasons for choosing an abortion, including the following:

  • Not being financially prepared
  • Partner-related issues
  • The desire to focus on the children they already had
  • Concern that the pregnancy would interfere with future opportunities
  • Not being emotionally prepared
  • Health-related reasons
  • Believing the child deserved a better life
  • Not being independent or mature enough
  • Influences from family or friends

Most of the women studied reported multiple reasons for choosing to terminate their pregnancy. The authors of the paper concluded that a woman’s decision to seek an abortion is influenced by various factors, such as age, health, socioeconomic status, parity, and marital status.

Abortion Legal Barriers

On Jun 24, 2022, the U.S. Supreme Court overturned the decision Roe v. Wade (PDF), which had protected the federal right to abortion for nearly 50 years. As a result, the ability to access abortion is now determined at the state level. State laws can change frequently, but the Guttmacher Institute, a nonprofit organization that supports abortion rights, maintains a database where you can confirm the legal status of abortion in your state.

RELATED: How to Find Trustworthy Abortion, Emergency Contraception, and Birth Control Resources

What Are the Types of Abortion?

There are different ways to perform an abortion. Your healthcare provider might recommend a type based on your personal choices, how far along you are in your pregnancy, or other circumstances, notes  UCSF Health .

Medication Abortion

A medication abortion , sometimes referred to as a medical abortion, involves taking medications to end your pregnancy.

This type of abortion is typically only an option up until 11 weeks from your last menstrual period, per  Planned Parenthood . However, some insurance companies won’t cover a medication abortion after seven weeks of pregnancy, notes  UCSF .

A medication abortion is about 95 percent effective at helping someone completely pass a pregnancy without surgery.

The most common medications given for a medication abortion are mifepristone (Mifeprex, RU-486) and misoprostol (Cytotec) . Mifepristone blocks the action of the hormone progesterone , which is important for pregnancy. Misoprostol prompts the uterus to contract and empty.

A healthcare provider will give you these medicines at a health clinic. You may take them at the facility or at home, depending on your state laws and your provider’s policies.

You will need to see your provider at least two times: once before taking the medicines and once after you’ve completed the treatment to confirm that the abortion worked.

Medication abortions can take up to 24 hours to complete.

A medication abortion is different than emergency contraception , of which the most common is known as the “morning after pill.” Emergency contraception is used to prevent pregnancy, while a medication abortion is used to terminate a pregnancy.

Surgical Abortion

A surgical abortion, or an “in-clinic abortion,” is a procedure that’s done to remove the pregnancy tissue from a person’s womb (uterus), per  MedlinePlus .

According to  Planned Parenthood , the two types of surgical abortions are:

  • Suction Abortion (Vacuum Aspiration) With this technique, gentle suction is used to empty the uterus. A suction abortion can be performed until about 14 to 16 weeks after your last period. This is the most common type of in-clinic abortion.
  • Dilation and Evacuation (D&E) Abortion A D&E involves using suction and surgical instruments to empty a woman’s uterus. Doctors may recommend this type of procedure if it’s been 16 weeks or longer since your last period.

Most in-clinic abortion procedures take about 5 to 10 minutes.

Surgical abortions are usually very successful. According to Planned Parenthood, they work more than 99 out of every 100 times.

Abortion Later in Pregnancy

Abortions occurring at or after 21 weeks of pregnancy are extremely uncommon, per the  Kaiser Family Foundation , accounting for only about 1 percent of abortions in the United States. Abortions at this stage of pregnancy are sometimes called “late-term abortions,” although this is a nonmedical term that many healthcare providers take issue with.

What are the Benefits of an Abortion and Risks of Being Denied One?

A landmark report called “ The Turnaway Study ” conducted interviews with almost 1,000 women who were seeking abortions. Some were able to get an abortion, while the rest were turned away because they had surpassed their state’s gestational limit. By following up with these individuals multiple times over five years, the study authors were able to compare the physical, emotional, and social outcomes of receiving a wanted abortion versus being denied one.

For people who were able to receive an abortion, the benefits they experienced compared with those who were forced to carry their pregnancy to term included:

  • Better Health and Less Chronic Pain Women who were denied an abortion and gave birth experienced more life-threatening complications like eclampsia and postpartum hemorrhage. They also reported more chronic headaches or migraine , joint pain, and gestational hypertension compared with people who were able to get a wanted abortion.
  • Better Short-Term Mental Health Those who were denied an abortion reported increased anxiety and stress and decreased self-esteem soon after the procedure was denied. About six months to a year after receiving or being denied an abortion, all women reported similar levels of mental health and well-being.
  • Better Economic Security People who were denied an abortion were 4 times more likely to fall below the federal poverty level than those who were able to get an abortion. Women forced to carry a pregnancy to term were also 3 times as likely to be unemployed, and also reported more debt, lower credit scores, and more financial insecurity for multiple years after giving birth.
  • More Likely to Graduate With an Advanced Degree Women denied abortion had similar odds of graduating or dropping out of school compared with those who did get an abortion, but those who got one were more likely to graduate with an advanced degree.
  • Better Outcomes for Their Existing Children The already existing children of women forced to carry a pregnancy to term were over 3 times as likely to live in poverty, and less likely to achieve developmental milestones compared with the existing children of people who were able to get an abortion.

What Are the Complications and Risks of an Abortion?

Legal abortions are considered safe, with very few lasting risks. According to the  National Academy of Sciences , pregnant people are nearly 13 times more likely to die in childbirth than to die from receiving an abortion. Between 1988 and 2010, only 0.7 deaths occurred for every 100,000 abortions, versus 8.8 deaths out of every 100,000 births.

Childbirth is riskier for minorities as well. Black women are 3 times more likely to die in childbirth than white women in the United States, according to the  Centers for Disease Control and Prevention (CDC) , and elevated risks for Native Americans and Alaska Natives follow close behind.

Studies  show that early abortions without complications do not affect a woman’s future fertility . Additionally, having an abortion won’t cause pregnancy issues such as birth defects, miscarriage , premature birth, ectopic pregnancy , or infant death down the road, notes  Planned Parenthood .

The short-term complications you might experience will depend on the type of abortion you have.

Medication Abortion Risks

According to  Mayo Clinic , some short-term physical complications of a medication abortion include:

  • Heavy or prolonged bleeding
  • An incomplete or unsuccessful abortion (which means you may need to have a surgical abortion)

Between 3 and 5 percent of women will need to have a surgical abortion because of persistent or excessive bleeding, continued pregnancy, or their own preferences.

If abortion is illegal in your state, you could face prosecution for completing a medication abortion. Although so far instances of such prosecution have been rare, experts predict they will increase in a post- Roe environment, according to  NPR .

In the unlikely case that you have complications from medication abortion that require medical attention, you do not have to tell your healthcare provider you took abortion pills — there is no way for them to tell the difference between a spontaneous miscarraige and one induced with medication, according to the abortion nonprofit  Women Help Women .

Surgical Abortion Risks

Rare complications of a surgical abortion may include:

  • Very heavy bleeding
  • Pregnancy tissue left in your uterus
  • Injury to your cervix, uterus, or other organs
  • An allergic reaction to medications

Additionally, there’s a small chance the abortion won’t work, and your pregnancy doesn’t end. You might need another procedure if this happens, notes  Planned Parenthood .

How to Prepare for an Abortion

Before a medical or surgical abortion, your provider may perform a urine test, a physical exam, or a blood test . Additionally, you may need to have an ultrasound to confirm how far along you are in your pregnancy and to rule out ectopic pregnancy .

Your healthcare provider will explain how the medicines or procedure will work, the side effects, and the risks.

If you’re having a surgical abortion, you might need the following before your procedure, according to  UCSF Health :

  • Oral pain medicines, such as Vicodin , Valium , and ibuprofen
  • Medicines to soften your cervix, such as misoprostol
  • Dilating sticks that are placed in your cervix, such as laminaria or Dilapan
  • Antibiotics to help prevent infections
  • Sedation drugs

The medicines you require and when you receive them will depend on how far along you are in your pregnancy and the type of abortion you’re having, notes UCSF Health.

If you take Vicodin , Valium , or other sedation medicines, you’ll need to arrange for someone to take you home from the clinic.

Finding a Provider and Clinic

You should know that healthcare providers aren’t required to perform elective abortions, and different states have certain legal requirements, waiting periods, or age restrictions when it comes to abortions, if they’re legal at all. These laws might make it challenging to find a provider or clinic.

Planned Parenthood offers resources for finding clinics and health centers in your area.

Costs and Insurance Coverage

Planning for the cost of an abortion can be challenging for some people. While prices vary, an abortion in the first trimester can run up to $1,500, notes  Planned Parenthood . A second trimester abortion usually costs more .

Some insurance plans cover abortions, but others don’t. Check your policy before scheduling your appointment. If your procedure is not covered, you might be able to work out a self-payment option with the clinic.

Community health clinics are often a good option for low-cost care. The centers are funded by the federal government and are usually located in areas with fewer doctors. According to the  Health Resources and Services Administration (HRSA) , these federally qualified health centers in underserved areas must provide care on a sliding scale based on your ability to pay.

Additionally, your local Planned Parenthood health center may be able to provide you with other options or resources for financial assistance.

How Is an Abortion Performed?

The process will depend on the type of abortion you have.

An abortion feels different for everyone. Some women report intense pain, while others describe it as slight discomfort. Your doctors and nurses will try to make your abortion as comfortable as possible, notes  Planned Parenthood .

For a medication abortion, your provider will give you one tablet of mifepristone that you usually take in the clinic, according to  Mayo Clinic , although some states allow telehealth for first trimester medication abortions

Then, hours or days later, you’ll be instructed to take misoprostol, usually at home. Your provider may also give you antibiotics to prevent an infection.

About a week later, you’ll meet with your provider to make sure the abortion is complete.

Suction Abortion

If you’re having a suction abortion, according to  Planned Parenthood , a healthcare professional will first examine your uterus and use a speculum to see inside your vagina . Then, they will:

  • Inject numbing medication into your cervix
  • Stretch the opening of your cervix with dilating rods
  • Insert a thin tube into your uterus
  • Use a small suction device or machine to remove the pregnancy tissue out of your uterus

Additionally, the doctor may use a tool to remove any tissue that’s still left in your uterus or to confirm that your uterus is completely empty.

After the suction abortion is over, you’ll stay in a recovery area for about an hour or until you feel well enough to go home.

While the procedure itself only takes about 10 minutes, your appointment will be longer due to prep and recovery time.

D&E Abortion

You’ll probably be sedated for a D&E procedure.

First, your doctor will prepare your cervix with medicines that help open it. Dilator sticks (laminaria) are often given a few hours or a day before a D&E.

To begin the procedure, a healthcare provider will look at your uterus and examine inside your vagina with a speculum. Then, they will:

  • Inject a numbing medication into your cervix
  • Use surgical instruments along with a suction device to remove the pregnancy tissue from your uterus

The procedure typically takes about 10 to 20 minutes, but your appointment will be longer due to the prep and recovery time.

You’ll wait in a recovery room for up to an hour or until you feel well enough to leave.

How Long Does It Take to Recover From an Abortion?

Most people heal quickly after an abortion, but your recovery might depend on the type of abortion you had and how far along you were in your pregnancy.

Recovery After Medication Abortion

If you have a medication abortion, you should plan to rest on the day you take your second medicine. You might feel tired for a couple of days after this dose, notes  Planned Parenthood .

You can usually resume most normal tasks, such as going to work or driving, the next day. However, don’t perform any strenuous activities, such as heavy exercise, for several days.

You might bleed or spot sporadically for several weeks after your medication abortion.

Follow your provider’s instructions carefully. Let them know if you experience nausea, vomiting, diarrhea, or a fever for more than 24 hours after taking misoprostol.

You can have sex as soon as you feel ready (but again, it's important to use contraception if you want to avoid pregnancy).

Your normal periods should resume four to eight weeks after the abortion, but this will depend on your birth control method .

Recovery After Surgical Abortion

The day after a surgical abortion, you can usually resume regular activities, such as driving and working, if you feel up to it. You can also have sex as soon as you feel well enough, though be sure to use reliable contraception if you wish to prevent pregnancy, notes Planned Parenthood.

You’ll probably experience some cramping or bleeding. Pain medicines, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) , can help with the discomfort.

You might bleed or spot for several weeks, but some people don’t bleed at all. Your healthcare provider may recommend that you use pads, so you can keep track of how much you bleed.

You should get a normal period about four to eight weeks after your procedure, but this might vary if you use certain birth control methods .

Be sure to follow all your doctor’s instructions after your procedure. Call your provider right away if you:

  • Soak through two pads per hour for two hours
  • Have pain or cramps that don’t get better with medicine
  • Have a fever of 100.4 degrees F or higher

Abortion Resources

If you’re considering an abortion, you’re not alone. Many resources are available to help you through the process. Here are some of Everyday Health’s favorites:

Abortion Finder

AbortionFinder.org features more than 750 health centers and offers a comprehensive directory of trusted and verified abortion service providers in the United States. You can also find information about how the laws in your state may affect your ability to get an abortion.

The Guttmacher Institute

The Guttmacher Institute is a nonprofit organization supporting abortion rights. It maintains an up-to-date database of the legality of abortion in all 50 states and the District of Columbia, in addition to other abortion information resources.

Planned Parenthood

Planned Parenthood is a nonprofit organization that delivers vital reproductive healthcare, sex education, and information to millions of people around the world. On their site, you can search for clinics in your area and even chat with a health educator who can answer any questions or concerns you have about your pregnancy options.

National Abortion Federation (NAF)

The mission of the NAF is to unite, represent, serve, and support abortion providers in delivering patient-centered, evidence-based care. Their toll-free hotline provides callers with abortion referrals and financial assistance services. You can also locate a provider in your area right on their website.

National Network of Abortion Funds (NNAF)

The NNAF aims to remove financial and logistical barriers to abortion access. They help connect people seeking an abortion with organizations that can assist with the costs of having one.

Resources to Avoid: Crisis Pregnancy Centers

In every state there are clinics sometimes called “crisis pregnancy centers” or “pregnancy resource centers” that present themselves as abortion clinics or healthcare facilities, and that specifically target people looking for information on abortion, according to  Planned Parenthood .

These clinics do not present the full range of options when it comes to making a decision about an unwanted pregnancy. Oftentimes, they even intentionally mislead people seeking information, for example by telling them the lie that abortion can cause infertility. Resources like the Crisis Pregnancy Center Map and Expose Fake Clinics have searchable lists of predatory crisis pregnancy centers that you can use to make sure the clinic you select is reputable.

Next Steps and Recommendations

Most women can start on hormonal or nonhormonal birth control immediately after having an abortion.

Some options include:

  • The pill (available in a variety of formulations)
  • A progesterone implant (Nexplanon)
  • Intrauterine devices (IUDs), with or without hormones
  • A progesterone shot (Depo-Provera)

In cases of surgical abortion, providers can insert an IUD in your uterus at the same time you undergo the procedure.

If you’re interested in a birth control method, your provider can walk you through your options.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

  • Abortion. MedlinePlus . April 22, 2021.
  • What Facts About Abortion Do I Need to Know? Planned Parenthood .
  • Medical Abortion. Mayo Clinic . May 14, 2020.
  • Jones RK. Reported Contraceptive Use in the Month of Becoming Pregnant Among U.S. Abortion Patients in 2000 and 2014. Contraception . April 2018.
  • Rubin R. How Abortion Bans Could Affect Care for Miscarriage and Infertility. JAMA . June 28, 2022.
  • Management of Stillbirth. American College of Obstetricians and Gynecologists . March 2020.
  • Biggs MA, Gould H, Foster DG. Understanding Why Women Seek Abortions in the US. BMC Women’s Health . July 5, 2013.
  • Interactive Map: US Abortion Policies and Access After Roe. Guttmacher Institute .
  • Dobbs, State Health Officer of the Mississippi Department of Health, Et al. v. Jackson Women’s Health Organization Et al. Supreme Court of the United States .
  • Medical Versus Surgical Abortion. UCSF Health .
  • The Abortion Pill. Planned Parenthood .
  • Abortion — Surgical. MedlinePlus . October 8. 2021.
  • In-Clinic Abortion. Planned Parenthood .
  • Medical Abortion. UCSF Health .
  • How Safe Is an In-Clinic Abortion? Planned Parenthood .
  • Surgical Abortion (Second Trimester). UCSF Health .
  • Surgical Abortion (First Trimester). UCSF Health .
  • Abortions Later in Pregnancy. Kaiser Family Foundation . December 5, 2019.
  • The Turnaway Study. Advancing New Standards in Reproductive Health (ANRISH) .
  • The Safety and Quality of Abortion Care in the United States. National Academies of Science . 2018.
  • Working Together to Reduce Black Maternal Mortality. Centers for Disease Control and Prevention . April 6, 2022.
  • Losing a Pregnancy Could Land You in Jail in Post-Roe America. NPR . July 3, 2022.
  • Will a Doctor Be Able to Tell if You've Taken Abortion Pills? Women Help Women . Sept. 23, 2019.
  • How Do I Get an In-Clinic Abortion? Planned Parenthood .
  • How Much Does an Abortion Cost? Planned Parenthood .
  • Federally Qualified Health Centers. Health Resources and Services Administration . May 2018.
  • Find a Health Center. Planned Parenthood .
  • What Happens During an In-Clinic Abortion? Planned Parenthood .
  • What Can I Expect After Having an In-Clinic Abortion? Planned Parenthood .
  • What Can I Expect After I Take the Abortion Pill? Planned Parenthood .

What is an abortion?

Here's a look at the science behind the early termination of a pregnancy.

Abortion rights demonstrators gather near the Washington Monument during a nationwide rally in support of abortion rights in Washington, D.C., on May 14, 2022.

How are abortions induced?

Are abortions safe, what happens after an abortion, who gets abortions, history of abortion in the us, where is abortion legal in the us, additional resources.

An abortion is the early termination of a pregnancy, which can happen spontaneously, as in the case of a miscarriage, or can happen when the pregnancy is ended by medical or surgical means. In these latter cases, the abortion method depends on the stage of pregnancy , among other factors.

On June 24, 2022, the Supreme Court overturned Roe v. Wade and thus eliminated the constitutional right to abortion in the US. 

There are a few different ways an abortion can be induced, depending on how far along the pregnancy is and whether the pregnancy is inside or outside the uterus, said Dr. Deborah Powell, a professor of laboratory medicine and pathology at the University of Minnesota and member of the National Academies' Committee on Reproductive Health Services: Assessing the Safety and Quality of Abortion Care in the U.S.

The majority of abortions occur within the first trimester, meaning the first 12 weeks of pregnancy, or very soon after, Powell said.

The methods are as follows, according to a 2018 report on the safety of abortion care in the United States, authored by the National Academies' Committee on Reproductive Health Services: 

  • Medication abortion, or "medical" abortion: This method is FDA approved for pregnancies up to 10 weeks' gestation and involves two medications that are taken 24 to 48 hours apart. The first pill is mifepristone, which blocks the production of progesterone, an important hormone for maintaining pregnancy. The second pill is misoprostol, which induces uterine contractions that empty the uterus. (Note that, in some cases, misoprostol may be prescribed on its own, according to the World Health Organization , WHO.
  • Aspiration abortion (also referred to as surgical abortion, suction curettage, or dilation and curettage (D&C)): Aspiration is the most common abortion method used in the U.S., accounting for about 68% of abortions in 2013, and it can be used up to 16 weeks' gestation. This procedure involves dilating the cervix so that a hollow curette, or tube can be inserted into the uterus. At the other end of the tube, a hand-held syringe or an electric device is applied to create suction and empty the uterus. The procedure generally takes less than 10 minutes. 
  • Dilation and evacuation (D&E): This type of abortion is usually performed after 14 weeks' gestation and involves dilation of the cervix followed by suction and/or forceps extraction to empty the uterus.
  • Induction abortion (also referred to as "medical" abortion): This method involves the use of medications to induce labor and delivery of the fetus. The most effective regimens use higher doses of the same medications used for medical abortions done earlier in pregnancy: mifepristone and misoprostol.

"Abortions are very safe," Powell told Live Science. "Abortions are as safe as, if not safer than, a normal pregnancy that goes to term." 

Generally, all methods are expected to cause vaginal bleeding during and after the abortion, according to the National Academies' 2018 report. 

—Abortion laws by state: https://reproductiverights.org/maps/abortion-laws-by-state/

—For questions about legal rights and self-managed abortion: www.reprolegalhelpline.org  

—To find an abortion clinic in the US: www.ineedanA.com

—Miscarriage & Abortion Hotline operated by doctors who can offer expert medical advice: Available online or at 833-246-2632

—To find practical support accessing abortion: www.apiarycollective.org  

A medication abortion will often cause heavy cramping and abdominal pain, similar to the pain felt during a miscarriage, and the method may cause the patient to pass blood clots and have what seems like an extremely heavy period that can last for up to two weeks, Powell said. Over the counter anti-inflammatory medications can help relieve the pain. 

Complications due to any kind of abortion are extremely rare, occurring in less than a fraction of a percent of patients in most cases, according to the report. The risk of complications increases slightly with the duration of the pregnancy. 

"Abortions that are done very late in pregnancy are very infrequent and are usually done by physicians," Powell said. Late pregnancy abortions may be done because of an underlying medical condition in the pregnant patient or the fetus that puts them at risk of complications should the pregnancy continue, "but the abortion procedure itself is not unsafe," she said. 

The only time abortions may be considered unsafe is when they are performed in non-health care settings by people who are not medical professionals or trained health care providers, Powell explained. In these situations, there is a risk of serious and harmful infection if the attempt to remove a pregnancy is performed with non-sterile instruments or in a non-sterile environment. 

Based on a thorough review of the scientific literature and studies from around the world, researchers of the 2018 report agreed that abortion does not appear to have a negative impact on future fertility or the risk of future pregnancy complications, preterm births or breast cancer development. Abortions don't pose a significant risk to patients' mental health, either, the report authors concluded. 

Objective, controlled studies of pregnancies and abortions in clinical settings similar to those found in the United States have found that abortions have no effect on future fertility. 

The authors of the 2018 report also found no associations between abortions and future pregnancy complications, including stillbirth, ectopic pregnancies (pregnancy that occurs outside the uterus) or gestational hypertension (high blood pressure in pregnancy). A 2014 study published in BJOG : An International Journal of Obstetrics and Gynecology reported that the risk of hemorrhaging during a vaginal delivery was slightly higher among women who had a prior medication abortion (but not other kinds of abortion) compared with women in their first pregnancy. However, the medical reason for this heightened risk remains unclear and other studies have yet to back up the finding, according to the 2018 report. 

There is also no association between abortions and future preterm births, no matter when in gestation the abortion occurred or how many abortions the person has had in the past. That said, a 2017 study published in the journal Obstetrics & Gynecology found evidence that becoming pregnant shortly after any abortion — within less than 6 months — was associated with a slightly increased risk of preterm birth (about 1.5% higher), based on the medical records of nearly 20,000 Finnish women. However, it's unclear if the association was causal or due to other maternal factors, such as obesity or gestational diabetes. 

Presumably, women who undergo abortions because of fetal abnormalities or other medical complications are likely to carry more emotional burden than women who abort unwanted pregnancies. Studies have found that the rate of mental health problems for women with an unwanted pregnancy were the same whether they had an abortion or gave birth, the 2018 report concluded. 

Several leading health care organizations, including the American College of Obstetricians and Gynecologists and the WHO, have issued guidelines on what preabortion and postabortion care should look like, as described in the National Academies' 2018 report. 

The organizations agree that patients should receive individualized, sensitive communication and comprehensive education about the risks and benefits of available abortion options and how each procedure is performed. Health care providers should also confirm with patients that the decision is voluntary and provide support for a patient's emotional needs before and after the procedure. This care should include counseling on appropriate postabortion contraception options. 

Approximately 862,320 abortions were performed in 2017 in the United States, down 7% from 926,190 in 2014, according to the Guttmacher Institute , a nonprofit research and policy organization focused on reproductive health and rights. That's a rate of about 1.35% of women ages 15 to 44 — the lowest rate ever in the U.S.

The most recent demographic data on abortions is from the Guttmacher Institute's 2014 nationwide survey. The survey found that the majority of abortion patients in the U.S. were between the ages of 20 and 29, heterosexual, white, had given birth at least once before and were had an income below the federal poverty level. Just over half of abortion patients (51%) were using contraceptive methods when they became pregnant. 

Although data suggests that the majority of abortions performed in the U.S. are due to unwanted pregnancies, some abortions occur because of medical complications that cause the fetus to become unviable or present a serious health risk for the pregnant person. The exact number of abortions that occur for such reasons is unclear, but it happens frequently enough that many health care providers are concerned that their patients' lives could be put at serious risk should abortions become illegal, Powell said. 

For example, she said, an ectopic pregnancy, or pregnancy occurring outside the uterus (most often in a fallopian tube), is rare but would undoubtedly cause severe and even life-threatening complications for the pregnant person if the pregnancy is not terminated. 

Ectopic pregnancies are just one example of many potential reasons why an abortion may be medically necessary for the health of the pregnant patient, and it would be impossible to create legislation that acknowledges all those scenarios, Powell said. In short, "abortion is health care," she said, “and should be supervised by health care providers."

On June 24, 2022, the U.S. Supreme Court overturned Roe V. Wade, thus eliminating the constitutional right to abortion that was established in the country in 1973. This means that states can now set their own abortion laws.

The original 1973 court case was initially raised to challenge a Texas law that banned all abortions except in the case that the pregnancy was deemed life-threatening to the patient. Although the U.S Supreme Court's ruling establishing a constitutional right to abortion across the nation, it still allowed states to impose regulations on abortions in the second trimester and prohibit procedure in the third trimester, under certain circumstances.

Read more about Roe V. Wade and the history of abortion here at Live Science.

Abortion is legal in the following states:

  • California 
  • Minnesota 
  • Illinois 
  • New Jersey 
  • Connecticut
  • Alaska 
  • Delaware 
  • Kansas 
  • Massachusetts
  • New Hampshire
  • Rhode Island

Abortion is illegal in the following states:

  • South Dakota
  • Missouri 
  • Mississippi 

In other states, abortion is soon-to-be banned or under serious threat. Discover abortion laws by state at the Center for Reproductive Rights .

Editor's note: This new article was published on August 3, 2022 by Live Science contributor Alice Ball following the Supreme Court's decision to overturn  Roe v. Wade  on June 24, 2022. This decision eliminated the constitutional right to abortion that was established by the 1973 court case and later affirmed by a 1992 case called Planned Parenthood of Southeastern Pennsylvania v. Casey.

Wired has put together a guide with resources for navigating abortions and abortion questions.

To learn more about the science and history of abortion rights, check out this Scientific American page for a curated selection of several opinion and features articles.

The Guttmacher Institute has statistics and other information about abortions in the U.S., including  information on rates, safety, demographics, insurance, laws and more.

Sign up for the Live Science daily newsletter now

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Kimberly Hickok

Kimberly has a bachelor's degree in marine biology from Texas A&M University, a master's degree in biology from Southeastern Louisiana University and a graduate certificate in science communication from the University of California, Santa Cruz. She is a former reference editor for Live Science and Space.com. Her work has appeared in Inside Science, News from Science, the San Jose Mercury and others. Her favorite stories include those about animals and obscurities. A Texas native, Kim now lives in a California redwood forest. 

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A black-and-white photo of a woman, Sherri Chessen, holding one of her young children.

A Forgotten Chapter of Abortion History Repeats Itself

Sherri Chessen with one of her children. Credit... Arizona Republic, via USA Today Network

Supported by

Linda Greenhouse

By Linda Greenhouse

Ms. Greenhouse, the recipient of a 1998 Pulitzer Prize, reported on the Supreme Court for The Times from 1978 to 2008 and was a contributing Opinion writer from 2009 to 2021.

  • Dec. 22, 2023

Much of the country no doubt watched in amazement last week as a woman with a doomed pregnancy was forced to flee her home state, Texas, to get the abortion her doctors deemed necessary to protect her future ability to bear children. Could this really be happening in the United States in 2023?

But then, should anyone who has followed the recent dystopian course of abortion in America have been surprised? After all, on the other side of the half-century during which abortion was a constitutional right, something eerily similar had happened in an episode that shocked the country when abortion was a subject not discussed in polite society.

It was 1962, and Sherri Chessen Finkbine, a 29-year-old mother of four and host of a popular children’s television program in Phoenix, was pregnant again. Suffering from morning sickness, she tried some pills, marketed in Europe as a sleeping aid, that her husband had brought back from a trip to London. Only after having taken multiple doses did she read about an outbreak in Europe of devastating birth defects in babies born to women who had used a drug called thalidomide. Her doctor confirmed that thalidomide was what she had taken.

The doctor recommended a “therapeutic” abortion and arranged for one to be performed quietly at a Phoenix hospital. Ms. Chessen — the media called her by her husband’s last name, Finkbine, but she had always preferred Chessen — felt obliged to warn other women who might unknowingly be facing the same situation. She talked to The Arizona Republic’s medical editor, who granted her anonymity. But her name became known, and in part because of her prominence — she was “Miss Sherri” of the popular “Romper Room — the story exploded. The hospital declined to go ahead with the scheduled procedure and, with abortion illegal in every state, there was no place in the country she could go.

She and her husband, a public-school teacher, went to Sweden for the abortion. By that time, she was 13 weeks pregnant. When they got back to Phoenix, she lost her job, and her husband was suspended from his teaching post.

A black-and-white photo of a woman, Sheri Chessen, and her husband walking down stairs from a plane onto tarmac on their way to obtain an abortion.

Ms. Chessen’s trauma 61 years ago was even more jarring than Kate Cox’s was this month, because a subject largely hidden from public view was suddenly national news. I still remember, as a 15-year-old, being mesmerized by Life magazine’s extended account that covered not only Ms. Chessen’s experience but the abortion issue itself; included in the coverage were wrenching photographs of surviving “thalidomide babies” missing arms or legs or both.

Her story brought the once forbidden topic into the country’s living rooms in the most sympathetic light imaginable. “Her wholesome image clashed so dramatically with the public’s concept of abortion — the lawless choice of wayward women — that her decision to go through with the procedure sparked a heated national debate,” Jennifer Vanderbes writes in a new book, “Wonder Drug: The Secret History of Thalidomide in America and Its Hidden Victims.”

Although Ms. Chessen received plenty of hate mail, along with condemnation by the Vatican, a Gallup poll found that a majority of Americans thought she had made the right decision. It’s possible to see the episode as a spark that helped ignite the abortion reform movement that culminated in Roe v. Wade 11 years later. “Here is a need for common sense,” The Tulsa Tribune wrote in an editorial.

I first got in touch with Ms. Chessen in 2009, when Reva Siegel, a law professor at Yale, and I were compiling material for a documentary history of how abortion was discussed and debated before the 1973 decision. In an archive at the Schlesinger Library at the Radcliffe Institute for Advanced Study, I found the text of a talk Ms. Chessen gave in 1966 about her experience.

“We tried so desperately to do what was right, yet thousands of people sought to judge for us,” she said in her talk.

Holding the document in my hands, I felt a sense of wonder that such a thing could have happened in my lifetime and relief that it would never happen to another woman. I found a phone number and called Ms. Chessen to get permission to reprint the talk. We included the text in our book, “Before Roe v. Wade.”

Sherri Chessen is now 91 years old. After her abortion, she went on to have a fifth child, a daughter named Kristin Atwell Ford, an award-winning filmmaker who is making a documentary about her mother. In later years, Ms. Chessen wrote and published children’s books. She lives on her own in Southern California. When I called her the other day, it was as if she had been waiting to be asked how she felt about the replay of the long-ago chapter of her long life.

“I’m losing my patience!” she exclaimed. “I have a newfound fire that wants to clobber all those idiots. When will they ever learn?”

Is “never” the inevitable answer? When I talk to student groups and others about the history of abortion, I’m no longer surprised to find how few have ever heard of Sherri Chessen and her flight to Sweden. That is unfortunate, because her story provides essential context for understanding what Texas — its politicians and its judges — did to Kate Cox this month. Those of us who are old enough to remember Sherri Chessen’s story, and who assumed it could never happen again, have now seen it happen, on our watch. If her experience lit a spark in 1962, Kate Cox’s experience should ignite a fire in 2024.

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Linda Greenhouse, the winner of a 1998 Pulitzer Prize, reported on the Supreme Court for The Times from 1978 to 2008. She is the author of “Justice on the Brink: The Death of Ruth Bader Ginsburg, the Rise of Amy Coney Barrett, and Twelve Months That Transformed the Supreme Court.”

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National Academies Press: OpenBook

The Safety and Quality of Abortion Care in the United States (2018)

Chapter: 5 conclusions, 5 conclusions.

This report provides a comprehensive review of the state of the science on the safety and quality of abortion services in the United States. The committee was charged with answering eight specific research questions. This chapter presents the committee’s conclusions by responding individually to each question. The research findings that are the basis for these conclusions are presented in the previous chapters. The committee was also asked to offer recommendations regarding the eight questions. However, the committee decided that its conclusions regarding the safety and quality of U.S. abortion care responded comprehensively to the scope of this study. Therefore, the committee does not offer recommendations for specific actions to be taken by policy makers, health care providers, and others.

1. What types of legal abortion services are available in the United States? What is the evidence regarding which services are appropriate under different clinical circumstances (e.g., based on patient medical conditions such as previous cesarean section, obesity, gestational age)?

Four legal abortion methods—medication, 1 aspiration, dilation and evacuation (D&E), and induction—are used in the United States. Length of gestation—measured as the amount of time since the first day of the last

___________________

1 The terms “medication abortion” and “medical abortion” are used interchangeably in the literature. This report uses “medication abortion” to describe the U.S. Food and Drug Administration (FDA)-approved prescription drug regimen used up to 10 weeks’ gestation.

menstrual period—is the primary factor in deciding what abortion procedure is the most appropriate. Both medication and aspiration abortions are used up to 10 weeks’ gestation. Aspiration procedures may be used up to 14 to 16 weeks’ gestation.

Mifepristone, sold under the brand name Mifeprex, is the only medication specifically approved by the FDA for use in medication abortion. The drug’s distribution has been restricted under the requirements of the FDA Risk Evaluation and Mitigation Strategy program since 2011—it may be dispensed only to patients in clinics, hospitals, or medical offices under the supervision of a certified prescriber. To become a certified prescriber, eligible clinicians must register with the drug’s distributor, Danco Laboratories, and meet certain requirements. Retail pharmacies are prohibited from distributing the drug.

When abortion by aspiration is no longer feasible, D&E and induction methods are used. D&E is the superior method; in comparison, inductions are more painful for women, take significantly more time, and are more costly. However, D&Es are not always available to women. The procedure is illegal in Mississippi 2 and West Virginia 3 (both states allow exceptions in cases of life endangerment or severe physical health risk to the woman). Elsewhere, access to the procedure is limited because many obstetrician/gynecologists (OB/GYNs) and other physicians lack the requisite training to perform D&Es. Physicians’ access to D&E training is very limited or nonexistent in many areas of the country.

Few women are medically ineligible for abortion. There are, however, specific contraindications to using mifepristone for a medication abortion or induction. The drug should not be used for women with confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass; an intrauterine device in place; chronic adrenal failure; concurrent long-term systemic corticosteroid therapy; hemorrhagic disorders or concurrent anticoagulant therapy; allergy to mifepristone, misoprostol, or other prostaglandins; or inherited porphyrias.

Obesity is not a risk factor for women who undergo medication or aspiration abortions (including with the use of moderate intravenous sedation). Research on the association between obesity and complications during a D&E abortion is less certain—particularly for women with Class III obesity (body mass index ≥40) after 14 weeks’ gestation.

A history of a prior cesarean delivery is not a risk factor for women undergoing medication or aspiration abortions, but it may be associated

2 Mississippi Unborn Child Protection from Dismemberment Abortion Act, Mississippi HB 519, Reg. Sess. 2015–2016 (2016).

3 Unborn Child Protection from Dismemberment Abortion Act, West Virginia SB 10, Reg. Sess. 2015–2016 (2016).

with an increased risk of complications during D&E abortions, particularly for women with multiple cesarean deliveries. Because induction abortions are so rare, it is difficult to determine definitively whether a prior cesarean delivery increases the risk of complications. The available research suggests no association.

2. What is the evidence on the physical and mental health risks of these different abortion interventions?

Abortion has been investigated for its potential long-term effects on future childbearing and pregnancy outcomes, risk of breast cancer, mental health disorders, and premature death. The committee found that much of the published literature on these topics does not meet scientific standards for rigorous, unbiased research. Reliable research uses documented records of a prior abortion, analyzes comparable study and control groups, and controls for confounding variables shown to affect the outcome of interest.

Physical health effects The committee identified high-quality research on numerous outcomes of interest and concludes that having an abortion does not increase a woman’s risk of secondary infertility, pregnancy-related hypertensive disorders, abnormal placentation (after a D&E abortion), preterm birth, or breast cancer. Although rare, the risk of very preterm birth (<28 weeks’ gestation) in a woman’s first birth was found to be associated with having two or more prior aspiration abortions compared with first births among women with no abortion history; the risk appears to be associated with the number of prior abortions. Preterm birth is associated with pregnancy spacing after an abortion: it is more likely if the interval between abortion and conception is less than 6 months (this is also true of pregnancy spacing in general). The committee did not find well-designed research on abortion’s association with future ectopic pregnancy, miscarriage or stillbirth, or long-term mortality. Findings on hemorrhage during a subsequent pregnancy are inconclusive.

Mental health effects The committee identified a wide array of research on whether abortion increases women’s risk of depression, anxiety, and/or posttraumatic stress disorder and concludes that having an abortion does not increase a woman’s risk of these mental health disorders.

3. What is the evidence on the safety and quality of medical and surgical abortion care?

Safety The clinical evidence clearly shows that legal abortions in the United States—whether by medication, aspiration, D&E, or induction—are

safe and effective. Serious complications are rare. But the risk of a serious complication increases with weeks’ gestation. As the number of weeks increases, the invasiveness of the required procedure and the need for deeper levels of sedation also increase.

Quality Health care quality is a multidimensional concept. Six attributes of health care quality—safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity—were central to the committee’s review of the quality of abortion care. Table 5-1 details the committee’s conclusions regarding each of these quality attributes. Overall, the committee concludes that the quality of abortion care depends to a great extent on where women live. In many parts of the country, state regulations have created barriers to optimizing each dimension of quality care. The quality of care is optimal when the care is based on current evidence and when trained clinicians are available to provide abortion services.

4. What is the evidence on the minimum characteristics of clinical facilities necessary to effectively and safely provide the different types of abortion interventions?

Most abortions can be provided safely in office-based settings. No special equipment or emergency arrangements are required for medication abortions. For other abortion methods, the minimum facility characteristics depend on the level of sedation that is used. Aspiration abortions are performed safely in office and clinic settings. If moderate sedation is used, the facility should have emergency resuscitation equipment and an emergency transfer plan, as well as equipment to monitor oxygen saturation, heart rate, and blood pressure. For D&Es that involve deep sedation or general anesthesia, the facility should be similarly equipped and also have equipment to provide general anesthesia and monitor ventilation.

Women with severe systemic disease require special measures if they desire or need deep sedation or general anesthesia. These women require further clinical assessment and should have their abortion in an accredited ambulatory surgery center or hospital.

5. What is the evidence on what clinical skills are necessary for health care providers to safely perform the various components of abortion care, including pregnancy determination, counseling, gestational age assessment, medication dispensing, procedure performance, patient monitoring, and follow-up assessment and care?

Required skills All abortion procedures require competent providers skilled in patient preparation (education, counseling, and informed consent);

TABLE 5-1 Does Abortion Care in the United States Meet the Six Attributes of Quality Health Care?

a These attributes of quality health care were first proposed by the Institute of Medicine’s Committee on Quality of Health Care in America in the 2001 report Crossing the Quality Chasm: A New Health System for the 21st Century.

b Elsewhere in this report, effectiveness refers to the successful completion of the abortion without the need for a follow-up aspiration.

clinical assessment (confirming intrauterine pregnancy, determining gestation, taking a relevant medical history, and physical examination); pain management; identification and management of expected side effects and serious complications; and contraceptive counseling and provision. To provide medication abortions, the clinician should be skilled in all these areas. To provide aspiration abortions, the clinician should also be skilled in the technical aspects of an aspiration procedure. To provide D&E abortions, the clinician needs the relevant surgical expertise and sufficient caseload to maintain the requisite surgical skills. To provide induction abortions, the clinician requires the skills needed for managing labor and delivery.

Clinicians that have the necessary competencies Both trained physicians (OB/GYNs, family medicine physicians, and other physicians) and advanced practice clinicians (APCs) (physician assistants, certified nurse-midwives, and nurse practitioners) can provide medication and aspiration abortions safely and effectively. OB/GYNs, family medicine physicians, and other physicians with appropriate training and experience can perform D&E abortions. Induction abortions can be provided by clinicians (OB/GYNs,

family medicine physicians, and certified nurse-midwives) with training in managing labor and delivery.

The extensive body of research documenting the safety of abortion care in the United States reflects the outcomes of abortions provided by thousands of individual clinicians. The use of sedation and anesthesia may require special expertise. If moderate sedation is used, it is essential to have a nurse or other qualified clinical staff—in addition to the person performing the abortion—available to monitor the patient, as is the case for any other medical procedure. Deep sedation and general anesthesia require the expertise of an anesthesiologist or certified registered nurse anesthetist to ensure patient safety.

6. What safeguards are necessary to manage medical emergencies arising from abortion interventions?

The key safeguards—for abortions and all outpatient procedures—are whether the facility has the appropriate equipment, personnel, and emergency transfer plan to address any complications that might occur. No special equipment or emergency arrangements are required for medication abortions; however, clinics should provide a 24-hour clinician-staffed telephone line and have a plan to provide emergency care to patients after hours. If moderate sedation is used during an aspiration abortion, the facility should have emergency resuscitation equipment and an emergency transfer plan, as well as equipment to monitor oxygen saturation, heart rate, and blood pressure. D&Es that involve deep sedation or general anesthesia should be provided in similarly equipped facilities that also have equipment to monitor ventilation.

The committee found no evidence indicating that clinicians that perform abortions require hospital privileges to ensure a safe outcome for the patient. Providers should, however, be able to provide or arrange for patient access or transfer to medical facilities equipped to provide blood transfusions, surgical intervention, and resuscitation, if necessary.

7. What is the evidence on the safe provision of pain management for abortion care?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended to reduce the discomfort of pain and cramping during a medication abortion. Some women still report high levels of pain, and researchers are exploring new ways to provide prophylactic pain management for medication abortion. The pharmaceutical options for pain management during aspiration, D&E, and induction abortions range from local anesthesia, to minimal sedation/anxiolysis, to moderate sedation/analgesia, to deep sedation/

analgesia, to general anesthesia. Along this continuum, the physiological effects of sedation have increasing clinical implications and, depending on the depth of sedation, may require special equipment and personnel to ensure the patient’s safety. The greatest risk of using sedative agents is respiratory depression. The vast majority of abortion patients are healthy and medically eligible for all levels of sedation in office-based settings. As noted above (see Questions 4 and 6), if sedation is used, the facility should be appropriately equipped and staffed.

8. What are the research gaps associated with the provision of safe, high-quality care from pre- to postabortion?

The committee’s overarching task was to assess the safety and quality of abortion care in the United States. As noted in the introduction to this chapter, the committee decided that its findings and conclusions fully respond to this charge. The committee concludes that legal abortions are safe and effective. Safety and quality are optimized when the abortion is performed as early in pregnancy as possible. Quality requires that care be respectful of individual patient preferences, needs, and values so that patient values guide all clinical decisions.

The committee did not identify gaps in research that raise concerns about these conclusions and does not offer recommendations for specific actions to be taken by policy makers, health care providers, and others.

The following are the committee’s observations about questions that merit further investigation.

Limitation of Mifepristone distribution As noted above, mifepristone, sold under the brand name Mifeprex, is the only medication approved by the FDA for use in medication abortion. Extensive clinical research has demonstrated its safety and effectiveness using the FDA-recommended regimen. Furthermore, few women have contraindications to medication abortion. Nevertheless, as noted earlier, the FDA REMS restricts the distribution of mifepristone. Research is needed on how the limited distribution of mifepristone under the REMS process impacts dimensions of quality, including timeliness, patient-centeredness, and equity. In addition, little is known about pharmacist and patient perspectives on pharmacy dispensing of mifepristone and the potential for direct-to-patient models through telemedicine.

Pain management There is insufficient evidence to identify the optimal approach to minimizing the pain women experience during an aspiration procedure without sedation. Paracervical blocks are effective in decreasing procedural pain, but the administration of the block itself is painful, and

even with the block, women report experiencing moderate to significant pain. More research is needed to learn how best to reduce the pain women experience during abortion procedures.

Research on prophylactic pain management for women undergoing medication abortions is also needed. Although NSAIDs reduce the pain of cramping, women still report high levels of pain.

Availability of providers APCs can provide medication and aspiration abortions safely and effectively, but the committee did not find research assessing whether APCs can also be trained to perform D&Es.

Addressing the needs of women of lower income Women who have abortions are disproportionately poor and at risk for interpersonal and other types of violence. Yet little is known about the extent to which they receive needed social and psychological supports when seeking abortion care or how best to meet those needs. More research is needed to assess the need for support services and to define best clinical practice for providing those services.

Abortion is a legal medical procedure that has been provided to millions of American women. Since the Institute of Medicine first reviewed the health implications of national legalized abortion in 1975, there has been a plethora of related scientific research, including well-designed randomized clinical trials, systematic reviews, and epidemiological studies examining abortion care. This research has focused on examining the relative safety of abortion methods and the appropriateness of methods for different clinical circumstances. With this growing body of research, earlier abortion methods have been refined, discontinued, and new approaches have been developed.

The Safety and Quality of Abortion Care in the United States offers a comprehensive review of the current state of the science related to the provision of safe, high-quality abortion services in the United States. This report considers 8 research questions and presents conclusions, including gaps in research.

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History and scientific background on the economics of abortion

Brittany moore.

1 Ipas, Chapel Hill, North Carolina, United States of America

Yana van der Meulen Rodgers

2 Department of Labor Studies and Employment Relations, Department of Women’s and Gender Studies, Rutgers University, Piscataway, New Jersey, United States of America

Ernestina Coast

3 Department of International Development, London School of Economics and Political Science, London, United Kingdom

Samantha R. Lattof

Associated data.

All related data for this collection can be found in the related study protocol ( http://dx.doi.org/10.1136/bmjopen-2019-029939 ) and the related collection manuscripts: - Microeconomics of abortion ( https://doi.org/10.1371/journal.pone.0252005 ) - Mesoeconomics of abortion ( https://doi.org/10.1371/journal.pone.0237227 ) - Macroeconomics of abortion ( https://doi.org/10.1371/journal.pone.0250692 ) - Economics of abortion and its links with stigma ( https://doi.org/10.1371/journal.pone.0246238 ).

Approximately one quarter of all pregnancies globally end in abortion, making it one of the most common gynecological practices worldwide. Despite the high incidence of abortion around the globe, the synthesis of known economic outcomes of abortion care and policies is lacking. Using data from a systematic scoping review, we synthesized the literature on the economics of abortion at the microeconomic, mesoeconomic, and mesoeconomic levels and presented the results in a collection of studies. This article describes the history and scientific background for collection, presents the scoping review framework, and discusses the value of this knowledge base.

Methods and findings

We conducted a scoping review using the PRISMA extension for Scoping Reviews. Studies reporting on qualitative and/or quantitative data from any world region were considered. For inclusion, studies must have examined one of the following outcomes: costs, impacts, benefits, and/or value of abortion-related care or policies. Our searches yielded 19,653 unique items, of which 365 items were included in our final inventory. Studies most often reported costs (n = 262), followed by impacts (n = 140), benefits (n = 58), and values (n = 40). Approximately one quarter (89/365) of studies contained information on the secondary outcome on stigma. Economic factors can lead to a delay in abortion care-seeking and can restrict health systems from adequately meeting the demand for abortion services. Provision of post-abortion care (PAC) services requires more resources then safe abortion services. Lack of insurance or public funding for abortion services can increase the cost of services and the overall economic impact on individuals both seeking and providing care.

Conclusions

Consistent economic themes emerge from research on abortion, though evidence gaps remain that need to be addressed through more standardized methods and consideration to framing of abortion issues in economics terms. Given the highly charged political nature of abortion around the world, it is imperative that researchers continue to build the evidence base on economic outcomes of abortion services and regulations.

Introduction

Approximately 73.3 million induced abortions occur annually [ 1 ], and approximately half of those are unsafe [ 2 ]. Globally, abortion rates have fallen somewhat over time, from 40 to 39 abortions per 1000 women of reproductive age between 1990–1994 and 2015–2019. Most of this decline occurred in developed countries. Despite the overall decline in abortion rates, the absolute number of abortions considered unsafe (according to standards set by the World Health Organization) has remained high, with close to 7 million women in developing countries receiving treatment for abortion complications. In Latin America and Sub-Saharan Africa alone, where abortion access is highly restricted, three quarters of all abortions are unsafe [ 3 ].

These numbers clearly demonstrate the stark differences in access to safe abortion services around the world. Individuals seeking abortion services can face considerable barriers to care, including (but not limited to) long travel distances to facilities, stigma, lack of partner or family support, and limited economic resources. As seen more recently, the COVID-19 pandemic has exacerbated many of the existing socio-economic inequalities, including the disproportionate burdens of poverty and violence on women. Recent estimates by the Guttmacher Institute predict an enormous impact of pandemic-related challenges on reproductive outcomes, including 15 million additional unintended pregnancies and three million additional unsafe abortions globally [ 4 ]. COVID-19’s introduction into a landscape of abortion restrictions in many countries has intensified the barriers that providers and communities already face, with disproportionate impacts on low-income abortion seekers. At the same time, the pandemic has forced abortion providers to think of novel ways to service patients that allow for social distancing, protection of workers and patients, and adherence to the regional restrictions on abortion care.

Abortion care is changing [ 5 ], whether due to the increased use of pharmaceuticals to induce abortion [ 6 ] or the increased access and use of telehealth. At the same time, national laws, protocols, and funding provisions have shifted in various directions to either support or restrict access to care [ 7 ]. Despite the attention given to abortion access and abortion laws by governments, the media, and civil society, the economic outcomes of abortion services and abortion policies are poorly documented [ 8 ]. Policymakers and advocates have access to relatively little systematic evidence on the economic outcomes of abortion [ 9 ]. Clear, synthesized economic information on the economic outcomes of abortion services and policies can be a useful source of information to aid in decision-making for governments, policymakers, advocates, and other key stakeholders. Much of the existing information at hand consists of direct costs of abortion care services while fewer studies consider the indirect costs and economic impact of seeking abortion care or the far-reaching economic outcomes of abortion policies on the individual, community, and national level. Although some of these outcomes, such as lost wages over time and missed educational opportunities, may not be easily measured, they are still highly relevant to making fully informed decisions on abortion care and policies.

To address these critical gaps, we conducted an extensive scoping review that systematically scoped existing social science literature on the economics of abortion, specifically the impact of abortion care (including un/safe abortion and post-abortion care) and abortion policies on economic outcomes. Our review synthesizes the evidence base and identifies evidence gaps on the costs, impacts, and benefits of abortion to stakeholders at three different economic levels: microeconomic (abortion seekers and their households) [ 10 ], mesoeconomic (communities and health systems) [ 11 ], and macroeconomic (societies and nation states) [ 12 ]. Detailed results from these three analyses as well as the links between the economics of abortion and stigma are presented in separate companion articles [ 10 – 13 ]. The objective of this article is to introduce the collection by discussing the relevant history and scientific background on the economics of abortion, the framework of our systematic review, and how this collection could benefit the field.

History and scientific background

Abortion practices and laws restricting them have existed for centuries. Although people from around the world have been regulating their fertility through various means, the Egyptians were the first to document various abortion techniques around 1550 BCE [ 14 ]. These techniques were predominantly non-surgical and centered around the use of herbs. By the early 1800s, abortion practices had modernized and included surgical procedures with appropriate sanitation and anesthesia. Laws that criminalized abortion also appeared during this period, which in various countries could be punishable by the death penalty. The United States was not far behind in passing anti-abortion legislation, but the punishment was generally less severe [ 15 ]. By the mid-1800s, abortions were being performed fairly frequently in countries around the globe, and this remains true through the current period.

Despite this historical precedent and global prevalence, abortion seekers still have very different experiences with abortion around the world. Pregnant people in higher-income economies generally have greater access to safe abortions, while pregnant people in lower-income countries experience greater health risks in getting abortions due to greater resource-based obstacles to care (i.e., funds to reach point of access), less equipped healthcare infrastructure as well as abortion laws that restrict access to safe abortions [ 1 ]. Abortion laws have a long history that has often been shaped by deeply entrenched religious views, political ideologies, and patriarchal structures. These ideologies in turn are closely intertwined with stigmas around abortion in which women who seek one are viewed as straying from feminine ideals that include women’s natural fecundity, the irrevocability of their roles as mothers, and their instinctive nurturance of those who need care [ 16 ].

Abortion stigma can contribute to the creation and perpetuation of restrictive abortion legislation, which can have the likely unintended consequence of increasing, rather than decreasing, abortion rates. There is no definitive evidence that legal restrictions on abortions result in fewer abortions. In fact, findings in Sedgh et al . [ 17 ] show no association between abortion rates across countries and the legal status of abortion in those countries. If anything, countries with more restrictive abortion policies have more unsafe abortions, and countries that legalize abortions see a shift from clandestine, unsafe abortions to legal, safe abortions without an increase in overall abortion rates. Legalizing abortion is seen by a growing number of multilateral agencies, non-governmental organizations, scholars, and advocates as a necessary step toward reducing unsafe abortions and improving women’s reproductive health. Yet despite this authoritative shared view that access to safe, legal abortion is a fundamental right for women, more than 60 countries still ban abortion completely or only permit it to save the woman’s life.

The widespread dissemination of information through the internet has helped to destigmatize both abortion and contraception, and it has provided healthcare practitioners and women with clinical information about fertility control and safe abortion procedures, including abortion pills, otherwise known as medical abortion [ 18 ]. The World Health Organization approved the combination of mifepristone and misoprostol pills to induce abortion in the first twelve weeks of pregnancy and it placed the drugs on its list of essential medicines in 2005. However, availability and access to misoprostol and mifepristone is shaped by contextual health systems and regulatory frameworks. This accounts for the wide variation in access, availability and costs across geographies, legalities and social contexts [ 19 ]. The use of these drugs to perform medical abortions is still not a widely available option in lower-income countries. High prices and restrictive regulations, especially in the case of mifepristone, has been one of the limiting factors in the widespread use of medical abortions. Inequalities in access to both medications at affordable costs is also shaped by the global variations in essential medicines lists, with only 50 of 158 countries analyzed in the Global Abortion Policies Database including both misoprostol and mifepristone, not necessarily for abortion-related care [ 20 ]. By 2011, misoprostol was approved in over 80 countries, mostly for the prevention and treatment of gastric ulcers. However, mifepristone was only approved explicitly for abortion in 45 countries, mostly higher-income countries [ 21 ].

Considering the evidence, it is clear that there is a broad range of economic impacts and outcomes related to abortion access. However, despite the high incidence of abortion around the globe, we lack synthesis of the known economic costs and outcomes–at a variety of scales–of abortion care and abortion policies. Hence the economic consequences of abortion and policies affecting abortion provision are poorly understood. This evidence gap motivated our scoping review, the framework for which is discussed in the next section.

Framework of the scoping review

Our study reviews existing evidence on the economics of abortion and conceptualizes important issues around abortion, especially the costs, benefits, and impacts of abortion. The analysis synthesizes the evidence base and identifies evidence gaps on the costs and benefits of abortion to stakeholders at three different economic levels: micro (abortion seekers and their households), meso (communities and health systems) and macro (societies and nation states).

At the micro-level, we provide a comprehensive examination of individual’s decision making around contraceptive use, fertility, and abortion. The framework is based on a set of economics tools related to costs and benefits that model preferences and behaviors around fertility and abortion. At the meso-level, we consider the costs and benefits of abortion services in the context in which they take place, particularly communities and medical systems. Finally, at the macro-level, the project explores how access to abortion services and changes in abortion laws affect broad aggregates such as women’s labor supply, educational attainment, indicators of societal wellbeing such as crime, and overall gross domestic product (GDP).

Our scoping review of the economics of abortion is based on micro foundations and particularly, on an economic model of fertility that includes the cost of contraception and abortion [ 8 , 22 ]. We use the following production function to represent the determinants of fertility:

In this equation, a person’s actual fertility depends on the use of two methods to control fertility: contraceptive methods C and induced abortion A . Actual fertility also depends on an idiosyncratic element represented by the term ε, which includes both random chance and natural fecundity (assumed to be a given and not changeable by the person’s actions). These two methods of birth control each have an inverse relationship with fertility. The use of contraceptives and induced abortion both depend on the pecuniary and time costs of accessing them, while ignoring either method is assumed to be free and to involve no time costs. Both options also involve “utility costs,” which encompass social, religious, philosophical, and institutional factors related to birth control and abortion. The key decision in this model is for a person to choose the appropriate levels of C and/or A that will prevent actual fertility F from exceeding desired fertility F* , subject to the constraints the person faces regarding the monetary, time, and utility costs of both methods.

As one example of a utility cost that could influence an individual’s decision making about fertility, a person might live in a country in which abortion is very common and socially accepted because historically modern methods of contraception were less available. In contrast, someone could live in a country in which abortion is illegal and highly stigmatized. An abortion seeker might live in a country where they can buy abortion pills on the black market or through the internet. An abortion seeker might live in a country with a shortage of trained medical personnel and sterile facilities, making it difficult to get a safe abortion. What might happen if the cost of contraception or abortion rises? This model traces the effect of such an increase, which could feasibly arise should local healthcare providers experience funding cuts or an increase in the price of supplies. These changes are expected to impact individuals’ contraceptive usage, abortion, and actual fertility in ways that vary by their ability to absorb the higher costs, as well as the norms, beliefs, and institutional constraints associated with fertility control. Such changes may also increase the time that people need to find a reproductive healthcare provider. The extent to which individuals re-optimize their decisions around C and A depends not only on their ability to pay for C and A but also on the utility costs of these reproductive healthcare services and the form of the production function ( f ).

At the microeconomic level, this framework bolsters our focus on the financial cost of an abortion in the scoping review. Because the production function terms each include “utility costs”, our scoping review also focused on terms closely related to factors affecting the utility costs of abortion, and especially the economic impact, benefits, and values. At the mesoeconomic level, we aggregate up from these micro foundations to the level of communities and health systems. In particular, the provision of abortion care services requires financial and physical resources on the part of health facilities, and health providers have incentives to minimize their costs while maintaining or even improving the quality of abortion care services. At the macroeconomic level, we aggregate up from the micro model to the level of societies and nation states. People’s decision making around their fertility has direct repercussions for outcomes such as their education and employment, which in turn can affect macroeconomic aggregates such as labor supply and even GDP growth. More broadly, institutional factors associated with the model’s “utility costs” include government policies around the legality of abortion as well as public sector financing of abortion services. National laws around abortion are thus another important dimension of the model that can impact individual abortion seekers at the micro level, medical systems at the meso level, and human capital outcomes at the macro level.

It is critical to think of and beyond the direct costs of abortion services and individual economic burden of abortion policies to include the individual, family, community, health systems, national, and international level economic impacts. Rarely does the restrictive impact of an abortion policy take place in a vacuum nor does the cost of an abortion service only impact one day out of an individual’s life. To further define the economic outcomes of abortion services, our scoping review addresses current knowledge on the economics of abortion as well as the evidence gaps. This work articulates the costs, benefits, and value of abortion to women, households, communities, health systems, and societies with a traditional economic lens. It will also define and enumerate the non-traditional economic value, opportunity costs, and beneficiaries of abortion.

As abortion-related decisions and policies have their own unique economic implications, it is important to capture the full range of cost and health impacts of the services as well as the intangible factors not typically articulated as part of the direct economic impact of abortion, which may include: the impact of social exclusion, the educational and professional opportunities lost to women due to unintended pregnancy, the costs and economic impact of being denied abortion services, and longer term social and health effects of unsafe abortion. Traditional economic approaches tend to look at costs from the payer perspective and benefits from the user perspective. This systematic review seeks to broaden this lens for a full, comprehensive look at the beneficiaries beyond direct users and the health systems to include the implications of discrimination and stigma associated with abortion.

Ultimately, a scoping review on the evidence for the value, impact, and costs of abortion will help the field better understand our current programmatic functions. It would also be a valuable tool to make the case for how abortion is prioritized and addressed as a public health issue by governments and donors, and to help to inform our strategic priorities for future interventions.

Economics of abortion: The collection

We took a systematic approach to finding evidence on the economics of abortion by conducting a scoping review of relevant literature. We developed a protocol [ 23 ] following the Preferred Reporting Items for Systematic review and Meta Analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR) and reporting guidelines [ 24 ] to ensure our review was manageable, transparent, and reproducible. Since we were interested in analyzing the available, known evidence on the economic outcomes of abortion care and abortion policies, and we expected to locate a broad and diverse body of evidence on this topic [ 25 ], we chose to conduct a scoping review instead of a systematic review.

The scoping review considered any peer-reviewed journal article on induced abortion and/or post-abortion care from any world region [ 23 ]. Items also must have been published in English, French, Spanish, Dutch, or German from 1 September 1994 to 15 January 2019. The beginning point marks the start of the International Conference on Population and Development in Cairo, Egypt. This is an important date due to the resulting changes in the global discourse following this conference, shifting from a focus mostly on family planning to a broader continuum of care around sexual and reproductive health and rights.

The articles in this scoping review must have qualitative and/or quantitative data on abortion care or abortion policies at the microeconomic, mesoeconomic, or macroeconomic levels. The articles also must have included information on at least one of the following four types of economic outcomes: financial cost (cost of receiving or providing abortion care or financial costs resulting from abortion policies); impact (the effect or influence of abortion care or abortion policies); benefit (advantages or profits gained from receiving or providing abortion care or implementing abortion policies); and value (the importance, worth, welfare gains, or utility of receiving or providing abortion care or implementing abortion policies) [ 23 ]. Additional details on the inclusion and exclusion criteria for this scoping review, testing the search terms, and the process to extract the data can be found in the published scoping review protocol [ 23 ].

Findings in the economics of abortion collection are reported using a systematic narrative synthesis framework in which the results are presented narratively and organized thematically, supplemented with tables of descriptive statistics on included studies and their outcomes. In nearly all of the studies that we reviewed, authors tend to refer to study participants as ‘women’ or ‘girls’. We have used inclusive and/or gender-neutral language in our own writing in an effort to be more inclusive of transgender and nonbinary individuals. However, in the methods and results sections of the articles in the economics of abortion collection, we used language that is reflective of the terminology used by authors to describe study participants in the referenced articles.

Composition of articles in the collection

At the microeconomic level, we synthesized data from 230 studies on abortion care and policies [ 10 ]. Individual-level costs of abortion-related care around the globe have implications for the timing and type of care sought. To pay for abortion services, some people can forgo other expenditures or be pushed further into poverty and/or debt. Economic factors influence the time it takes to reach and/or receive abortion services and can lead to significant delays in care-seeking, which in turn impact the type of care sought, the gestational age at which care is obtained, and the cost of service.

At the mesoeconomic level, we synthesized data from 150 studies on abortion care and policies [ 11 ]. The evidence most frequently examines abortion costs to health systems and health facilities, particularly in high-income countries. The provision of post-abortion care services requires a disproportionate amount of financial and physical resources. Health facilities and health systems can realize financial savings while maintaining or even improving quality of abortion care services. Analyzing and comparing the costs of providing abortion services globally can be challenging due to variation across studies in identifying components of care and documenting costs.

At the macroeconomic level, we synthesized data from 158 studies on abortion care and policies, with much of the evidence focused on costs at the national level [ 12 ]. Public sector coverage of abortion costs is limited and inconsistent around the world. Evidence shows that removing restrictive abortion laws can have positive effects for education and labor, though the political economy around abortion legislation and its impacts are complicated and controversial.

In this collection, we also sought to better understand the intersections between abortion stigma and economic outcomes [ 13 ]. Out of the 89 articles with abortion stigma data, only 32 studies included stigma findings directly tied to the primary economic outcomes. In the remaining articles, stigma is mentioned in terms of its effects on the context or research methods but is less directly related to the primary economic outcomes. Abortion stigma can serve as a barrier to prevent individuals from obtaining correct information regarding abortion services and laws, leading to unnecessary increases in costs of care and significant delays. Cost of abortion services can be substantial, and individuals who are unable to disclose to and/or rely on their social support network are less likely to have adequate financial resources to access abortion services.

The onset of a global pandemic into a restrictive abortion environment in many countries around the globe makes it vital to conduct research on novel approaches and access to abortion care that will meet the needs of individuals facing different structural barriers, political obstacles, and socioeconomic backgrounds as they attempt to manage their fertility. COVID-19 has also forced abortion providers to devise new ways to manage healthcare with the implementation of protocols, including telemedicine, that satisfy the constraints of legislative restrictions and the social realities of the COVID-19 pandemic. Hence there is a clear need for more research on people’s needs for abortion services, the best potential methods of providing abortion services in this landscape of constraints, and the systems needed to help people access abortion without shame. However, this research cannot be done in a vacuum, making it all the more important to have a readily available body of knowledge on the economic costs and outcomes of abortion services and policies from the past few decades.

Although relatively few studies are defined explicitly by their authors or their methodology as “economic” studies, our review shows that there is a wealth of economically relevant information that can be gleaned from the evidence base. For example, whilst very little evidence uses the language of economic values and benefits of abortion, it is possible to infer micro-level values and benefits of abortion-related care by examining people’s reasons for abortion. These reasons are rarely singular; abortion-related decision-making is often the result of a complex interplay of factors (wealth, education, status, education, relationship). Moreover, the interplays between economics and delays to abortion-related care are striking. Across diverse contexts and populations, economic factors influence delays to abortion-related decision-making, attempts to seek care and the receipt of care. By unpacking the points at which economic factors introduce or compound delays to abortion-related care, greater insight into the points at which information and services might be better designed to reduce delays can be achieved. By further unpacking the intersectionality of these economic factors, we can better understand the ways in which health systems and contexts reproduce injustices and inequities.

Acknowledgments

We wish to thank Elaine Zundl (EZ), Lisbeth Gall (LG), and Joe Strong (JS) for their assistance with screening and data extraction.

Funding Statement

This work was supported by the Netherlands Ministry of Foreign Affairs, activity number 28438. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data Availability

Important conclusions from abortion studies

  • PMID: 12287992

In general, it can be concluded that the initiative on the determinants and consequences of induced abortion has shown some important patterns. For example, induced abortion is not restricted to adolescents but occurs also within marriage to limit family size. Induced abortion is prevalent both where family planning services are available and contraceptive prevalence is high as well as where family planning is not common, but for different reasons. In the former, motivation to limit family size is high and women would use any option if contraception fails or an unwanted pregnancy occurs. In the latter case, induced abortion forms part of a mix of incipient fertility regulation alternatives, most of which are traditional and of little effectiveness but including some use or improper use of modern methods. Few abortion seekers, and among them even fewer adolescents, were using a modern contraceptive at the time the pregnancy started. High use of traditional methods in some countries leads to abortion as women/couples fail to follow proper instructions with regards to the safe period. Unsafe clandestine abortions are more likely to be sought by poorer women and by adolescents. The findings of this research are increasingly being used to question the legal status of abortion in countries where the law is restrictive, or to strengthen family planning efforts in order to reduce abortion incidence.

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What are the different reasons to have an abortion?

what is the conclusion about abortion

People have abortions for many reasons. Some end a pregnancy because of health concerns or fetal anomalies, and others may choose to terminate an unintended pregnancy.

The term “unintended pregnancy” does not always explain the reasons and personal circumstances behind a person’s decision to have an abortion. Often, people who have had an abortion feel too judged to discuss their reasons or feelings afterward.

People may choose to end a pregnancy for a range of reasons, and there is no invalid reason to have an abortion. Pregnant individuals should not feel judged or unsafe when making their decision.

This article discusses the reasons a person may have an abortion. It also examines why some people have later-term abortions and how they access abortion services.

On June 24, 2022, the Supreme Court of the United States overturned Roe v. Wade, the landmark 1973 ruling that secured a person’s constitutional right to an abortion.

This means that individual states are now able to decide their own abortion laws. As a result, many states will ban or severely restrict abortion access.

The information in this article was accurate and up to date at the time of publication, but the facts may have changed since. Anyone looking to learn more about their legal rights can message the Repro Legal Helpline via a secure online form or call 844-868-2812.

Reasons for abortions

An image of the U.S. supreme court.

All reasons for abortion are valid, and the decision to end a pregnancy is very personal. According to the Centers for Disease Control and Prevention (CDC), 620,327 reported abortions took place in the United States in 2020, and 93.1% occurred in the first trimester — at 13 weeks’ gestation or earlier.

A 2013 study analyzed the reasons people seek abortions in the U.S. and found many factors. Most people gave reasons that fell under one or two of the below themes, but some gave four or more reasons.

Financial circumstances

Around 40% of people in the study mentioned a financial reason for needing an abortion. Most of them had general financial concerns or said they could not afford to support a child.

Around 4% said a lack of employment contributed to their decision, and 0.6% said they terminated their pregnancies because of a lack of insurance or government assistance.

More than one-third (36%) of study participants cited reasons relating to timing. Some felt they were not emotionally or financially ready to have a baby, while others felt they were too old to have a child.

Partner-related reasons

Almost one-third (31%) of study respondents gave reasons relating to their partner.

For example, some individuals said they did not have a good or stable relationship with their partner or that their partner was unsupportive. Around 8% wanted to get married before having children. Others mentioned that they had a partner who was abusive or who did not want the baby.

If you or someone you know is in immediate danger of domestic violence, call 911 or otherwise seek emergency help. Anyone who needs advice or support can contact the National Domestic Violence Hotline 24/7 via:

  • phone, at 800-799-7233
  • live chat, at thehotline.org
  • text, by texting LOVEIS to 22522

Many other resources are available, including helplines, in-person support, and temporary housing. People can find local resources and others classified by demographics, such as support specifically for People of Color, here:

  • The Office on Women’s Health
  • The National Coalition Against Domestic Violence

Other responsibilities

Around 29% of people mentioned that they needed to focus on their other children. They said they already felt overextended with their current children and would be overwhelmed by having another. A small percentage of people thought that having a baby would adversely affect their other children and quality of life.

Additionally, about 20% of people reported having an abortion because the timing would interfere with their future opportunities and goals. They felt they could not continue their education or advance their careers while raising a baby.

Emotions and mental health

Around 19% of people in the study expressed that they were emotionally or mentally unprepared for a child. They mentioned not having the mental capacity to have a baby or not feeling mentally stable enough to raise a child.

Other health-related reasons

Approximately 12% of individuals mentioned the following health-related reasons for having an abortion:

  • concerns for their health
  • concerns for the health of the fetus
  • drug, tobacco, or alcohol use
  • non-illicit prescription drug or birth control use
  • worsening of existing health issues, such as back pain and diabetes
  • mental health concerns
  • the effect of medications for existing health conditions on the fetus

Inability to provide for a baby

Some people — around 12% — chose abortion because of their desire for a better life for the child than they could provide. They mentioned feeling inadequate and unable to care for themselves or a child.

Other people said their housing situation was unsuitable for a baby.

Not independent or mature enough for a baby

Just under 7% of people reported a lack of maturity or said they had to rely on other people. Some explained that they felt they were too young for a baby and were unprepared for parenthood.

Influences from family and friends

About 5% of people described influences from family and friends as a reason they chose abortion. They worried that a child would be a strain on their family or that they would experience judgment from others.

Some people had an abortion because they were too scared to tell their parents about their pregnancy, while a small proportion had pressure from family to end their pregnancy.

Why may people have later-term abortions?

People sometimes call abortions that take place during the second trimester (weeks 14–27) and third trimester (weeks 28 onwards) “late-term abortions,” but this term is medically inaccurate . According to the CDC , in 2020, around 5.8% of reported abortions took place in weeks 14–20 of pregnancy, and 0.9% occurred in week 21 or later.

Reasons for abortions in the second or third trimester are similar to those in the first trimester. According to the Kaiser Family Foundation (KFF) , people may have abortions later in pregnancy for the following reasons:

Nonmedical reasons

Nonmedical reasons people have abortions later in pregnancy include:

  • not knowing they were pregnant until later in the pregnancy
  • a lack of information about access to abortion care
  • transportation difficulties
  • a lack of insurance coverage
  • difficulty raising money to pay for the procedure

Fetal anomalies

Individuals may have abortions later in pregnancy because of the health of the fetus. Although tests can detect many genetic fetal anomalies early in pregnancy, structural anomalies are not usually apparent until a fetal anatomy scan at 20 weeks. This scan provides ultrasound imaging of the developing organs.

Some of these anomalies can be fatal, meaning the fetus will die shortly before or after birth. In these circumstances, people may make the difficult decision to terminate a desired pregnancy rather than continue.

Life threatening risk

Some people have life threatening health conditions that arise later in pregnancy. In these situations, a person may decide to end a pregnancy to preserve their own life.

Life threatening conditions may include:

  • severe preeclampsia
  • cancer requiring immediate treatment
  • intrauterine infection with premature amniotic sac rupture

Why legal abortion matters

Since the Supreme Court overturned Roe v. Wade on June 24, 2022, restrictions on accessing abortion care have increased significantly. Preventing people from accessing safe abortions performed by trained healthcare professionals in sanitary conditions does not change their reasons for needing one and does not reduce the number of abortions.

However, it may force them to seek out unsafe procedures performed by people without the necessary skills and in environments that do not conform to medical standards.

According to the World Health Organization (WHO), around 73 million abortions occur annually worldwide. Almost 33 million of these are unsafe, and of all unsafe abortions, one-third use invasive methods or involve untrained people.

The WHO says unsafe abortion is a leading preventable cause of maternal deaths.

Unsafe abortions can result in physical and mental health complications and financial and social burdens. According to one published estimate , banning abortion in the U.S. could lead to a 21% increase in the total deaths relating to pregnancy and a 33% increase among Black females.

How to access abortion services

Although there are many restrictions on abortion access, people can use a resource called Abortion Finder from the National Abortion Federation to find in-person and virtual abortion services.

Learn more about family planning and abortion care in abortion-restricted states.

People may have an abortion for several reasons, including lack of finances, timing, partner-related reasons, and more. Most abortions take place within the first 13 weeks of pregnancy. However, some people may need abortions later in pregnancy to preserve their health or the health of the fetus.

Criminalizing abortion does not tend to stop people from having abortions, but it does increase complications and deaths. To ensure their safety and protect their dignity, it is crucial that people have access to safe abortions performed by trained professionals in sanitary conditions.

Last medically reviewed on December 23, 2022

  • Pregnancy / Obstetrics
  • Women's Health / Gynecology

How we reviewed this article:

  • Abortion [Fact sheet]. (2021). https://www.who.int/news-room/fact-sheets/detail/abortion
  • Abortions later in pregnancy. (2019). https://www.kff.org/womens-health-policy/fact-sheet/abortions-later-in-pregnancy
  • Biggs, M. A., et al . (2013). Understanding why women seek abortions in the US. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-13-29
  • Kortsmit, K., et al . (2022). Abortion surveillance — United States, 2020. https://www.cdc.gov/mmwr/volumes/71/ss/ss7110a1.htm?s_cid=ss7110a1_w
  • Stevenson, A. J. (2021). The pregnancy-related mortality impact of a total abortion ban in the United States: A research note on increased deaths due to remaining pregnant. https://read.dukeupress.edu/demography/article/58/6/2019/265968/The-Pregnancy-Related-Mortality-Impact-of-a-Total

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Reproductive rights in America

5 things to know about the latest abortion case in texas.

Selena Simmons-Duffin

Selena Simmons-Duffin

Diane Webber

what is the conclusion about abortion

Michel Martin

what is the conclusion about abortion

Center for Reproductive Rights attorney Molly Duane speaks before the Texas Supreme Court in Austin on Nov. 28. The court ruled in a different abortion case on Monday. Suzanne Cordeiro/AFP via Getty Images hide caption

Center for Reproductive Rights attorney Molly Duane speaks before the Texas Supreme Court in Austin on Nov. 28. The court ruled in a different abortion case on Monday.

On Monday, Texas' state Supreme Court issued an opinion with broad repercussions when it ruled against Kate Cox's petition to have a health-preserving abortion in her state. It did so even though Cox had already made the decision to leave Texas for an abortion because she felt she couldn't wait any longer.

There's a lot to unpack in that opinion and the other legal challenge to the three overlapping abortion bans in Texas. Here are five things to know about the case.

1. Who is Kate Cox and what happened to her?

Kate Cox, 31, lives in the Dallas area with her husband and two young kids. About 20 weeks into her third pregnancy, she learned her fetus has Trisomy 18, a genetic condition with slim to no chance of survival. She'd also suffered cramping and other symptoms, severe enough to send her to the emergency room multiple times in a two week period.

Cox believed she was a good candidate for the narrow exception to the three overlapping abortion bans in Texas. That exception says abortion is allowed when the mother's life is threatened or when a pregnancy "poses a serious risk of substantial impairment of a major bodily function."

Her lawyers and her doctor argued that her future fertility was at risk. Does it count as a "major bodily function"? Would Cox, her husband and her doctor be safe from enforcement of the serious penalties if she had the abortion? That's what the Center for Reproductive Rights asked the court when it filed an emergency petition on Cox's behalf, requesting the abortion bans' penalties be suspended for Cox, her husband, and her doctor, so she could have a legal abortion in Texas.

what is the conclusion about abortion

Kate Cox left Texas to end her pregnancy. Her fetus had Trisomy 18, and she had other health conditions that threaten her future fertility. Cox family hide caption

Kate Cox left Texas to end her pregnancy. Her fetus had Trisomy 18, and she had other health conditions that threaten her future fertility.

Although a district court judge granted the request , Texas Attorney General Ken Paxton immediately appealed it to the Texas Supreme Court. He also sent a warning letter, shared on social media , to the three hospitals where Cox might have had the procedure saying they would face penalties despite the lower court's permission. That was last Thursday. On Friday, the Texas Supreme court put a temporary hold on that ruling, pending review.

On Monday, Cox made the decision to leave the state to get the procedure. A few hours later, the Texas Supreme Court ruled against her and sided with Paxton.

2. Leaving Texas for an abortion is a legal option

Many who read the headlines that Kate Cox was fleeing the state to get an abortion thought that was against the law.

Texans can and do legally leave the state to get abortions , if they have the financial means. Many thousands of Texans drive hundreds of miles across the huge state or fly to states that allow abortions. Some Texas counties are trying to outlaw traveling through them for abortions , but it is not clear how those laws would be enforced.

How many miles do you have to travel to get abortion care? One professor maps it

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How many miles do you have to travel to get abortion care one professor maps it.

Cox did not want to travel, as she wrote in an op-ed in the Dallas Morning News last week: "I am a Texan. Why should I or any other woman have to drive or fly hundreds of miles to do what we feel is best for ourselves and our families, to determine our own futures?"

Pregnant patients in Texas who can't afford to travel for abortions can either continue to carry the pregnancy , or wait until they become sick enough to qualify for the medical exception.

The Center for Reproductive Rights says Cox felt she couldn't wait any longer for the Texas Supreme Court to decide her fate, fearing that her chance to have future children was in jeopardy, so she decided to travel to a state where abortion is legal. Her attorneys are not disclosing where Cox traveled to receive care.

3. It's about one abortion, but the implications are far wider

Although the Texas high court knew Cox was leaving the state, it didn't dismiss the case. Its seven-page opinion puts responsibility for these highly consequential choices on doctors.

The all-Republican court writes that the Texas legislature "has delegated to the medical – rather than the legal – profession the decision about when a woman's medical circumstances warrant this exception."

The decision notes that Cox has a very complicated pregnancy and "tragic diagnosis." Despite this, the court goes on to say, "Some difficulties in pregnancy, however, even serious ones, do not pose the heightened risks to the mother the exception encompasses." And it concludes by granting Paxton's request to throw out the lower court's ruling that would have allowed Cox to have an abortion legally in Texas.

"I think any regular person can look at her case and say, 'Well, surely Kate should qualify'" for an abortion, Cox's lawyer, Molly Duane of the Center for Reproductive Rights, told NPR's Morning Edition .

Yet, Duane points out, Cox was not "sick enough" in the Texas justices' eyes. "That should be truly chilling because it means, I think, that the exception doesn't exist at all." Duane added, "My question is, if she doesn't [qualify], who does?"

Anti-abortion rights groups in Texas cheered the high court's decision. "We are grateful that the Texas Supreme Court affirmed the protections in Texas law for the unborn baby in this case," wrote Amy O'Donnell of Texas Alliance for Life. In a previous statement , the group said the Center for Reproductive Rights was using Cox's case to "chisel away" at Texas's abortion laws.

4. Texas doctors face malpractice on one side, felony charges on the other

In court and in legal filings, Paxton's office has repeatedly argued that women with life-threatening pregnancies who did not get appropriate care in Texas can and should sue their doctors for malpractice.

At the same time, all of Texas's abortion laws target doctors who perform abortions with penalties. Doctors face life in prison, fines of $100,000 and loss of their medical license.

Doctors who want to defy abortion laws say it's too risky

Doctors who want to defy abortion laws say it's too risky

Paxton has not responded to repeated requests from NPR for explanations on how the overlapping abortion bans are being enforced.

"In the two years that these abortion bans have been in effect in Texas, the attorney general and officials for the state have remained eerily silent. They have refused to tell anyone what the exception means," Duane says.

People who help women get abortions can also be held liable under one of those three laws, S.B. 8 , which says anyone can sue a person for helping someone get an abortion. A person who drives their wife to the hospital for an illegal abortion in Texas could be sued by anyone anywhere. This is why Kate's husband Justin Cox was also named in the petition – Duane says it was to protect him against this provision of S.B. 8.

5. Three laws, zero clarity

With three different laws governing abortion in Texas, confusion reigns. For instance, Texas has a so-called "heartbeat law." In other states, those laws mean abortion is legal up until cardiac activity can be detected, usually around six weeks gestation. But Texas also has a law banning all abortions, from conception. It supersedes the six-week-ban in early pregnancy.

Part of what the Center for Reproductive Rights is seeking in both this case and its pending case against the state, Zurawski v. Texas , is clarity.

Even abortion rights opponents and the lawmaker who authored S.B. 8 have asked for this kind of guidance.

And the Texas Supreme Court justices also wrote that doctors could use help understanding how to apply the exception in real life circumstances.

"The courts cannot go further by entering into the medical-judgment arena," they wrote. "The Texas Medical Board, however, can do more to provide guidance in response to any confusion that currently prevails."

The Texas Medical Board has told NPR it will not comment on pending litigation. Paxton's office did not respond to NPR's multiple requests for an interview. Neither entity has provided guidance to doctors or hospitals that has been shared publicly.

  • molly duane
  • Texas abortion law
  • Texas Attorney General Ken Paxton
  • Center for Reproductive Rights
  • Abortion rights

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Humanities LibreTexts

5.1: Arguments Against Abortion

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  • Page ID 35918

  • Nathan Nobis & Kristina Grob
  • Morehouse College & University of South Carolina Sumter via Open Philosophy Press

We will begin with arguments for the conclusion that abortion is generally wrong , perhaps nearly always wrong . These can be seen as reasons to believe fetuses have the “right to life” or are otherwise seriously wrong to kill.

5.1.1 Fetuses are human

First, there is the claim that fetuses are “human” and so abortion is wrong. People sometimes debate whether fetuses are human , but fetuses found in (human) women clearly are biologically human : they aren’t cats or dogs. And so we have this argument, with a clearly true first premise:

Fetuses are biologically human.

All things that are biologically human are wrong to kill.

Therefore, fetuses are wrong to kill.

The second premise, however, is false, as easy counterexamples show. Consider some random living biologically human cells or tissues in a petri dish. It wouldn’t be wrong at all to wash those cells or tissues down the drain, killing them; scratching yourself or shaving might kill some biologically human skin cells, but that’s not wrong; a tumor might be biologically human, but not wrong to kill. So just because something is biologically human, that does not at all mean it’s wrong to kill that thing. We saw this same point about what’s merely biologically alive.

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This suggests a deficiency in some common understandings of the important idea of “human rights.” “Human rights” are sometimes described as rights someone has just because they are human or simply in virtue of being human .

But the human cells in the petri dish above don’t have “human rights” and a human heart wouldn’t have “human rights” either. Many examples would make it clear that merely being biologically human doesn’t give something human rights. And many human rights advocates do not think that abortion is wrong, despite recognizing that (human) fetuses are biologically human.

The problem about what is often said about human rights is that people often do not think about what makes human beings have rights or why we have them, when we have them. The common explanation, that we have (human) rights just because we are (biologically) human , is incorrect, as the above discussion makes clear. This misunderstanding of the basis or foundation of human rights is problematic because it leads to a widespread, misplaced fixation on whether fetuses are merely biologically “human” and the mistaken thought that if they are, they have “human rights.” To address this problem, we need to identify better, more fundamental, explanations why we have rights, or why killing us is generally wrong, and see how those explanations might apply to fetuses, as we are doing here.

It might be that when people appeal to the importance and value of being “human,” the concern isn’t our biology itself, but the psychological characteristics that many human beings have: consciousness, awareness, feelings and so on. We will discuss this different meaning of “human” below. This meaning of “human” might be better expressed as conscious being , or “person,” or human person. This might be what people have in mind when they argue that fetuses aren’t even “human.”

Human rights are vitally important, and we would do better if we spoke in terms of “conscious-being rights” or “person-rights,” not “human rights.” This more accurate and informed understanding and terminology would help address human rights issues in general, and help us better think through ethical questions about biologically human embryos and fetuses.

5.1.2 Fetuses are human beings

Some respond to the arguments above—against the significance of being merely biologically human—by observing that fetuses aren’t just mere human cells, but are organized in ways that make them beings or organisms . (A kidney is part of a “being,” but the “being” is the whole organism.) That suggests this argument:

Fetuses are human beings or organisms .

All human beings or organisms are wrong to kill.

Therefore, fetuses are wrong to kill, so abortion is wrong.

The first premise is true: fetuses are dependent beings, but dependent beings are still beings.

The second premise, however, is the challenge, in terms of providing good reasons to accept it. Clearly many human beings or organisms are wrong to kill, or wrong to kill unless there’s a good reason that would justify that killing, e.g., self-defense. (This is often described by philosophers as us being prima facie wrong to kill, in contrast to absolutely or necessarily wrong to kill.) Why is this though? What makes us wrong to kill? And do these answers suggest that all human beings or organisms are wrong to kill?

Above it was argued that we are wrong to kill because we are conscious and feeling: we are aware of the world, have feelings and our perspectives can go better or worse for us —we can be harmed— and that’s what makes killing us wrong. It may also sometimes be not wrong to let us die, and perhaps even kill us, if we come to completely and permanently lacking consciousness, say from major brain damage or a coma, since we can’t be harmed by death anymore: we might even be described as dead in the sense of being “brain dead.” 10

So, on this explanation, human beings are wrong to kill, when they are wrong to kill, not because they are human beings (a circular explanation), but because we have psychological, mental or emotional characteristics like these. This explains why we have rights in a simple, common-sense way: it also simply explains why rocks, microorganisms and plants don’t have rights. The challenge then is explaining why fetuses that have never been conscious or had any feeling or awareness would be wrong to kill. How then can the second premise above, general to all human organisms, be supported, especially when applied to early fetuses?

One common attempt is to argue that early fetuses are wrong to kill because there is continuous development from fetuses to us, and since we are wrong to kill now , fetuses are also wrong to kill, since we’ve been the “same being” all along. 11 But this can’t be good reasoning, since we have many physical, cognitive, emotional and moral characteristics now that we lacked as fetuses (and as children). So even if we are the “same being” over time, even if we were once early fetuses, that doesn’t show that fetuses have the moral rights that babies, children and adults have: we, our bodies and our rights sometimes change.

A second attempt proposes that rights are essential to human organisms: they have them whenever they exist. This perspective sees having rights, or the characteristics that make someone have rights, as essential to living human organisms. The claim is that “having rights” is an essential property of human beings or organisms, and so whenever there’s a living human organism, there’s someone with rights, even if that organism totally lacks consciousness, like an early fetus. (In contrast, the proposal we advocate for about what makes us have rights understands rights as “accidental” to our bodies but “essential” to our minds or awareness, since our bodies haven’t always “contained” a conscious being, so to speak.)

Such a view supports the premise above; maybe it just is that premise above. But why believe that rights are essential to human organisms? Some argue this is because of what “kind” of beings we are, which is often presumed to be “rational beings.” The reasoning seems to be this: first, that rights come from being a rational being: this is part of our “nature.” Second, that all human organisms, including fetuses, are the “kind” of being that is a “rational being,” so every being of the “kind” rational being has rights. 12

In response, this explanation might seem question-begging: it might amount to just asserting that all human beings have rights. This explanation is, at least, abstract. It seems to involve some categorization and a claim that everyone who is in a certain category has some of the same moral characteristics that others in that category have, but because of a characteristic (actual rationality) that only these others have: so, these others profoundly define what everyone else is . If this makes sense, why not also categorize us all as not rational beings , if we are the same kind of beings as fetuses that are actually not rational?

This explanation might seem to involve thinking that rights somehow “trickle down” from later rationality to our embryonic origins, and so what we have later we also have earlier , because we are the same being or the same “kind” of being. But this idea is, in general, doubtful: we are now responsible beings, in part because we are rational beings, but fetuses aren’t responsible for anything. And we are now able to engage in moral reasoning since we are rational beings, but fetuses don’t have the “rights” that uniquely depend on moral reasoning abilities. So that an individual is a member of some general group or kind doesn’t tell us much about their rights: that depends on the actual details about that individual, beyond their being members of a group or kind.

To make this more concrete, return to the permanently comatose individuals mentioned above: are we the same kind of beings, of the same “essence,” as these human beings? If so, then it seems that some human beings can be not wrong to let die or kill, when they have lost consciousness. Therefore, perhaps some other human beings, like early fetuses, are also not wrong to kill before they have gained consciousness . And if we are not the same “kind” of beings, or have different essences, then perhaps we also aren’t the same kind of beings as fetuses either.

Similar questions arise concerning anencephalic babies, tragically born without most of their brains: are they the same “kind” of beings as “regular” babies or us? If so, then—since such babies are arguably morally permissible to let die, even when they could be kept alive, since being alive does them no good—then being of our “kind” doesn’t mean the individual has the same rights as us, since letting us die would be wrong. But if such babies are a different “kind” of beings than us, then pre-conscious fetuses might be of a relevantly different kind also.

So, in general, this proposal that early fetuses essentially have rights is suspect, if we evaluate the reasons given in its support. Even if fetuses and us are the same “kind” of beings (which perhaps we are not!) that doesn’t immediately tell us what rights fetuses would have, if any. And we might even reasonably think that, despite our being the same kind of beings as fetuses (e.g., the same kind of biology), we are also importantly different kinds of beings (e.g., one kind with a mental life and another kind which has never had it). This photograph of a 6-week old fetus might help bring out the ambiguity in what kinds of beings we all are:

image8.png

In sum, the abstract view that all human organisms have rights essentially needs to be plausibly explained and defended. We need to understand how it really works. We need to be shown why it’s a better explanation, all things considered, than a consciousness and feelings-based theory of rights that simply explains why we, and babies, have rights, why racism, sexism and other forms of clearly wrongful discrimination are wrong, and , importantly, how we might lose rights in irreversible coma cases (if people always retained the right to life in these circumstances, presumably, it would be wrong to let anyone die), and more.

5.1.3 Fetuses are persons

Finally, we get to what some see as the core issue here, namely whether fetuses are persons , and an argument like this:

Fetuses are persons, perhaps from conception.

Persons have the right to life and are wrong to kill.

So, abortion is wrong, as it involves killing persons.

The second premise seems very plausible, but there are some important complications about it that will be discussed later. So let’s focus on the idea of personhood and whether any fetuses are persons. What is it to be a person ? One answer that everyone can agree on is that persons are beings with rights and value . That’s a fine answer, but it takes us back to the initial question: OK, who or what has the rights and value of persons? What makes someone or something a person?

Answers here are often merely asserted , but these answers need to be tested: definitions can be judged in terms of whether they fit how a word is used. We might begin by thinking about what makes us persons. Consider this:

We are persons now. Either we will always be persons or we will cease being persons. If we will cease to be persons, what can end our personhood? If we will always be persons, how could that be?

Both options yield insight into personhood. Many people think that their personhood ends at death or if they were to go into a permanent coma: their body is (biologically) alive but the person is gone: that is why other people are sad. And if we continue to exist after the death of our bodies, as some religions maintain, what continues to exist? The person , perhaps even without a body, some think! Both responses suggest that personhood is defined by a rough and vague set of psychological or mental, rational and emotional characteristics: consciousness, knowledge, memories, and ways of communicating, all psychologically unified by a unique personality.

A second activity supports this understanding:

Make a list of things that are definitely not persons . Make a list of individuals who definitely are persons . Make a list of imaginary or fictional personified beings which, if existed, would be persons: these beings that fit or display the concept of person, even if they don’t exist. What explains the patterns of the lists?

Rocks, carrots, cups and dead gnats are clearly not persons. We are persons. Science fiction gives us ideas of personified beings: to give something the traits of a person is to indicate what the traits of persons are, so personified beings give insights into what it is to be a person. Even though the non-human characters from, say, Star Wars don’t exist, they fit the concept of person: we could befriend them, work with them, and so on, and we could only do that with persons. A common idea of God is that of an immaterial person who has exceptional power, knowledge, and goodness: you couldn’t pray to a rock and hope that rock would respond: you could only pray to a person. Are conscious and feeling animals, like chimpanzees, dolphins, cats, dogs, chickens, pigs, and cows more relevantly like us, as persons, or are they more like rocks and cabbages, non-persons? Conscious and feeling animals seem to be closer to persons than not. 13 So, this classificatory and explanatory activity further supports a psychological understanding of personhood: persons are, at root, conscious, aware and feeling beings.

Concerning abortion, early fetuses would not be persons on this account: they are not yet conscious or aware since their brains and nervous systems are either non-existent or insufficiently developed. Consciousness emerges in fetuses much later in pregnancy, likely after the first trimester or a bit beyond. This is after when most abortions occur. Most abortions, then, do not involve killing a person , since the fetus has not developed the characteristics for personhood. We will briefly discuss later abortions, that potentially affect fetuses who are persons or close to it, below.

It is perhaps worthwhile to notice though that if someone believed that fetuses are persons and thought this makes abortion wrong, it’s unclear how they could coherently believe that a pregnancy resulting from rape or incest could permissibly be ended by an abortion. Some who oppose abortion argue that, since you are a person, it would be wrong to kill you now even if you were conceived because of a rape, and so it’s wrong to kill any fetus who is a person, even if they exist because of a rape: whether someone is a person or not doesn’t depend on their origins: it would make no sense to think that, for two otherwise identical fetuses, one is a person but the other isn’t, because that one was conceived by rape. Therefore, those who accept a “personhood argument” against abortion, yet think that abortions in cases of rape are acceptable, seem to have an inconsistent view.

5.1.4 Fetuses are potential persons

If fetuses aren’t persons, they are at least potential persons, meaning they could and would become persons. This is true. This, however, doesn’t mean that they currently have the rights of persons because, in general, potential things of a kind don’t have the rights of actual things of that kind : potential doctors, lawyers, judges, presidents, voters, veterans, adults, parents, spouses, graduates, moral reasoners and more don’t have the rights of actual individuals of those kinds.

Some respond that potential gives the right to at least try to become something. But that trying sometimes involves the cooperation of others: if your friend is a potential medical student, but only if you tutor her for many hours a day, are you obligated to tutor her? If my child is a potential NASCAR champion, am I obligated to buy her a race car to practice? ‘No’ to both and so it is unclear that a pregnant woman would be obligated to provide what’s necessary to bring about a fetus’s potential. (More on that below, concerning the what obligations the right to life imposes on others, in terms of obligations to assist other people.)

5.1.5 Abortion prevents fetuses from experiencing their valuable futures

The argument against abortion that is likely most-discussed by philosophers comes from philosopher Don Marquis. 14 He argues that it is wrong to kill us, typical adults and children, because it deprives us from experiencing our (expected to be) valuable futures, which is a great loss to us . He argues that since fetuses also have valuable futures (“futures like ours” he calls them), they are also wrong to kill. His argument has much to recommend it, but there are reasons to doubt it as well.

First, fetuses don’t seem to have futures like our futures , since—as they are pre-conscious—they are entirely psychologically disconnected from any future experiences: there is no (even broken) chain of experiences from the fetus to that future person’s experiences. Babies are, at least, aware of the current moment, which leads to the next moment; children and adults think about and plan for their futures, but fetuses cannot do these things, being completely unconscious and without a mind.

Second, this fact might even mean that the early fetus doesn’t literally have a future: if your future couldn’t include you being a merely physical, non-conscious object (e.g., you couldn’t be a corpse: if there’s a corpse, you are gone), then non-conscious physical objects, like a fetus, couldn’t literally be a future person. 15 If this is correct, early fetuses don’t even have futures, much less futures like ours. Something would have a future, like ours, only when there is someone there to be psychologically connected to that future: that someone arrives later in pregnancy, after when most abortions occur.

A third objection is more abstract and depends on the “metaphysics” of objects. It begins with the observation that there are single objects with parts with space between them . Indeed almost every object is like this, if you could look close enough: it’s not just single dinette sets, since there is literally some space between the parts of most physical objects. From this, it follows that there seem to be single objects such as an-egg-and-the-sperm-that-would-fertilize-it . And these would also seem to have a future of value, given how Marquis describes this concept. (It should be made clear that sperm and eggs alone do not have futures of value, and Marquis does not claim they do: this is not the objection here). The problem is that contraception, even by abstinence , prevents that thing’s future of value from materializing, and so seems to be wrong when we use Marquis’s reasoning. Since contraception is not wrong, but his general premise suggests that it is , it seems that preventing something from experiencing its valuable future isn’t always wrong and so Marquis’s argument appears to be unsound. 16

In sum, these are some of the most influential arguments against abortion. Our discussion was brief, but these arguments do not appear to be successful: they do not show that abortion is wrong, much less make it clear and obvious that abortion is wrong.

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