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Key facts about the abortion debate in America

The U.S. Supreme Court’s June 2022 ruling to overturn Roe v. Wade – the decision that had guaranteed a constitutional right to an abortion for nearly 50 years – has shifted the legal battle over abortion to the states, with some prohibiting the procedure and others moving to safeguard it.

As the nation’s post-Roe chapter begins, here are key facts about Americans’ views on abortion, based on two Pew Research Center polls: one conducted from June 25-July 4 , just after this year’s high court ruling, and one conducted in March , before an earlier leaked draft of the opinion became public.

This analysis primarily draws from two Pew Research Center surveys, one surveying 10,441 U.S. adults conducted March 7-13, 2022, and another surveying 6,174 U.S. adults conducted June 27-July 4, 2022. Here are the questions used for the March survey , along with responses, and the questions used for the survey from June and July , along with responses.

Everyone who took part in these surveys is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories.  Read more about the ATP’s methodology .

A majority of the U.S. public disapproves of the Supreme Court’s decision to overturn Roe. About six-in-ten adults (57%) disapprove of the court’s decision that the U.S. Constitution does not guarantee a right to abortion and that abortion laws can be set by states, including 43% who strongly disapprove, according to the summer survey. About four-in-ten (41%) approve, including 25% who strongly approve.

About eight-in-ten Democrats and Democratic-leaning independents (82%) disapprove of the court’s decision, including nearly two-thirds (66%) who strongly disapprove. Most Republicans and GOP leaners (70%) approve , including 48% who strongly approve.

Most women (62%) disapprove of the decision to end the federal right to an abortion. More than twice as many women strongly disapprove of the court’s decision (47%) as strongly approve of it (21%). Opinion among men is more divided: 52% disapprove (37% strongly), while 47% approve (28% strongly).

About six-in-ten Americans (62%) say abortion should be legal in all or most cases, according to the summer survey – little changed since the March survey conducted just before the ruling. That includes 29% of Americans who say it should be legal in all cases and 33% who say it should be legal in most cases. About a third of U.S. adults (36%) say abortion should be illegal in all (8%) or most (28%) cases.

Generally, Americans’ views of whether abortion should be legal remained relatively unchanged in the past few years , though support fluctuated somewhat in previous decades.

Relatively few Americans take an absolutist view on the legality of abortion – either supporting or opposing it at all times, regardless of circumstances. The March survey found that support or opposition to abortion varies substantially depending on such circumstances as when an abortion takes place during a pregnancy, whether the pregnancy is life-threatening or whether a baby would have severe health problems.

While Republicans’ and Democrats’ views on the legality of abortion have long differed, the 46 percentage point partisan gap today is considerably larger than it was in the recent past, according to the survey conducted after the court’s ruling. The wider gap has been largely driven by Democrats: Today, 84% of Democrats say abortion should be legal in all or most cases, up from 72% in 2016 and 63% in 2007. Republicans’ views have shown far less change over time: Currently, 38% of Republicans say abortion should be legal in all or most cases, nearly identical to the 39% who said this in 2007.

However, the partisan divisions over whether abortion should generally be legal tell only part of the story. According to the March survey, sizable shares of Democrats favor restrictions on abortion under certain circumstances, while majorities of Republicans favor abortion being legal in some situations , such as in cases of rape or when the pregnancy is life-threatening.

There are wide religious divides in views of whether abortion should be legal , the summer survey found. An overwhelming share of religiously unaffiliated adults (83%) say abortion should be legal in all or most cases, as do six-in-ten Catholics. Protestants are divided in their views: 48% say it should be legal in all or most cases, while 50% say it should be illegal in all or most cases. Majorities of Black Protestants (71%) and White non-evangelical Protestants (61%) take the position that abortion should be legal in all or most cases, while about three-quarters of White evangelicals (73%) say it should be illegal in all (20%) or most cases (53%).

In the March survey, 72% of White evangelicals said that the statement “human life begins at conception, so a fetus is a person with rights” reflected their views extremely or very well . That’s much greater than the share of White non-evangelical Protestants (32%), Black Protestants (38%) and Catholics (44%) who said the same. Overall, 38% of Americans said that statement matched their views extremely or very well.

Catholics, meanwhile, are divided along religious and political lines in their attitudes about abortion, according to the same survey. Catholics who attend Mass regularly are among the country’s strongest opponents of abortion being legal, and they are also more likely than those who attend less frequently to believe that life begins at conception and that a fetus has rights. Catholic Republicans, meanwhile, are far more conservative on a range of abortion questions than are Catholic Democrats.

Women (66%) are more likely than men (57%) to say abortion should be legal in most or all cases, according to the survey conducted after the court’s ruling.

More than half of U.S. adults – including 60% of women and 51% of men – said in March that women should have a greater say than men in setting abortion policy . Just 3% of U.S. adults said men should have more influence over abortion policy than women, with the remainder (39%) saying women and men should have equal say.

The March survey also found that by some measures, women report being closer to the abortion issue than men . For example, women were more likely than men to say they had given “a lot” of thought to issues around abortion prior to taking the survey (40% vs. 30%). They were also considerably more likely than men to say they personally knew someone (such as a close friend, family member or themselves) who had had an abortion (66% vs. 51%) – a gender gap that was evident across age groups, political parties and religious groups.

Relatively few Americans view the morality of abortion in stark terms , the March survey found. Overall, just 7% of all U.S. adults say having an abortion is morally acceptable in all cases, and 13% say it is morally wrong in all cases. A third say that having an abortion is morally wrong in most cases, while about a quarter (24%) say it is morally acceptable in most cases. An additional 21% do not consider having an abortion a moral issue.

Among Republicans, most (68%) say that having an abortion is morally wrong either in most (48%) or all cases (20%). Only about three-in-ten Democrats (29%) hold a similar view. Instead, about four-in-ten Democrats say having an abortion is morally  acceptable  in most (32%) or all (11%) cases, while an additional 28% say it is not a moral issue. 

White evangelical Protestants overwhelmingly say having an abortion is morally wrong in most (51%) or all cases (30%). A slim majority of Catholics (53%) also view having an 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%). Among religiously unaffiliated Americans, about three-quarters see having an abortion as morally acceptable (45%) or not a moral issue (32%).

• Religion & Abortion

Carrie Blazina is a former digital producer at Pew Research Center .

Cultural Issues and the 2024 Election

Support for legal abortion is widespread in many places, especially in europe, public opinion on abortion, americans overwhelmingly say access to ivf is a good thing, broad public support for legal abortion persists 2 years after dobbs, most popular.

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How the Right to Legal Abortion Changed the Arc of All Women’s Lives

I’ve never had an abortion. In this, I am like most American women. A frequently quoted statistic from a recent study by the Guttmacher Institute, which reports that one in four women will have an abortion before the age of forty-five, may strike you as high, but it means that a large majority of women never need to end a pregnancy. (Indeed, the abortion rate has been declining for decades, although it’s disputed how much of that decrease is due to better birth control, and wider use of it, and how much to restrictions that have made abortions much harder to get.) Now that the Supreme Court seems likely to overturn Roe v. Wade sometime in the next few years—Alabama has passed a near-total ban on abortion, and Ohio, Georgia, Kentucky, Mississippi, and Missouri have passed “heartbeat” bills that, in effect, ban abortion later than six weeks of pregnancy, and any of these laws, or similar ones, could prove the catalyst—I wonder if women who have never needed to undergo the procedure, and perhaps believe that they never will, realize the many ways that the legal right to abortion has undergirded their lives.

Legal abortion means that the law recognizes a woman as a person. It says that she belongs to herself. Most obviously, it means that a woman has a safe recourse if she becomes pregnant as a result of being raped. (Believe it or not, in some states, the law allows a rapist to sue for custody or visitation rights.) It means that doctors no longer need to deny treatment to pregnant women with certain serious conditions—cancer, heart disease, kidney disease—until after they’ve given birth, by which time their health may have deteriorated irretrievably. And it means that non-Catholic hospitals can treat a woman promptly if she is having a miscarriage. (If she goes to a Catholic hospital, she may have to wait until the embryo or fetus dies. In one hospital, in Ireland, such a delay led to the death of a woman named Savita Halappanavar, who contracted septicemia. Her case spurred a movement to repeal that country’s constitutional amendment banning abortion.)

The legalization of abortion, though, has had broader and more subtle effects than limiting damage in these grave but relatively uncommon scenarios. The revolutionary advances made in the social status of American women during the nineteen-seventies are generally attributed to the availability of oral contraception, which came on the market in 1960. But, according to a 2017 study by the economist Caitlin Knowles Myers, “The Power of Abortion Policy: Re-Examining the Effects of Young Women’s Access to Reproductive Control,” published in the Journal of Political Economy , the effects of the Pill were offset by the fact that more teens and women were having sex, and so birth-control failure affected more people. Complicating the conventional wisdom that oral contraception made sex risk-free for all, the Pill was also not easy for many women to get. Restrictive laws in some states barred it for unmarried women and for women under the age of twenty-one. The Roe decision, in 1973, afforded thousands upon thousands of teen-agers a chance to avoid early marriage and motherhood. Myers writes, “Policies governing access to the pill had little if any effect on the average probabilities of marrying and giving birth at a young age. In contrast, policy environments in which abortion was legal and readily accessible by young women are estimated to have caused a 34 percent reduction in first births, a 19 percent reduction in first marriages, and a 63 percent reduction in ‘shotgun marriages’ prior to age 19.”

Access to legal abortion, whether as a backup to birth control or not, meant that women, like men, could have a sexual life without risking their future. A woman could plan her life without having to consider that it could be derailed by a single sperm. She could dream bigger dreams. Under the old rules, inculcated from girlhood, if a woman got pregnant at a young age, she married her boyfriend; and, expecting early marriage and kids, she wouldn’t have invested too heavily in her education in any case, and she would have chosen work that she could drop in and out of as family demands required.

In 1970, the average age of first-time American mothers was younger than twenty-two. Today, more women postpone marriage until they are ready for it. (Early marriages are notoriously unstable, so, if you’re glad that the divorce rate is down, you can, in part, thank Roe.) Women can also postpone childbearing until they are prepared for it, which takes some serious doing in a country that lacks paid parental leave and affordable childcare, and where discrimination against pregnant women and mothers is still widespread. For all the hand-wringing about lower birth rates, most women— eighty-six per cent of them —still become mothers. They just do it later, and have fewer children.

Most women don’t enter fields that require years of graduate-school education, but all women have benefitted from having larger numbers of women in those fields. It was female lawyers, for example, who brought cases that opened up good blue-collar jobs to women. Without more women obtaining law degrees, would men still be shaping all our legislation? Without the large numbers of women who have entered the medical professions, would psychiatrists still be telling women that they suffered from penis envy and were masochistic by nature? Would women still routinely undergo unnecessary hysterectomies? Without increased numbers of women in academia, and without the new field of women’s studies, would children still be taught, as I was, that, a hundred years ago this month, Woodrow Wilson “gave” women the vote? There has been a revolution in every field, and the women in those fields have led it.

It is frequently pointed out that the states passing abortion restrictions and bans are states where women’s status remains particularly low. Take Alabama. According to one study , by almost every index—pay, workforce participation, percentage of single mothers living in poverty, mortality due to conditions such as heart disease and stroke—the state scores among the worst for women. Children don’t fare much better: according to U.S. News rankings , Alabama is the worst state for education. It also has one of the nation’s highest rates of infant mortality (only half the counties have even one ob-gyn), and it has refused to expand Medicaid, either through the Affordable Care Act or on its own. Only four women sit in Alabama’s thirty-five-member State Senate, and none of them voted for the ban. Maybe that’s why an amendment to the bill proposed by State Senator Linda Coleman-Madison was voted down. It would have provided prenatal care and medical care for a woman and child in cases where the new law prevents the woman from obtaining an abortion. Interestingly, the law allows in-vitro fertilization, a procedure that often results in the discarding of fertilized eggs. As Clyde Chambliss, the bill’s chief sponsor in the state senate, put it, “The egg in the lab doesn’t apply. It’s not in a woman. She’s not pregnant.” In other words, life only begins at conception if there’s a woman’s body to control.

Indifference to women and children isn’t an oversight. This is why calls for better sex education and wider access to birth control are non-starters, even though they have helped lower the rate of unwanted pregnancies, which is the cause of abortion. The point isn’t to prevent unwanted pregnancy. (States with strong anti-abortion laws have some of the highest rates of teen pregnancy in the country; Alabama is among them.) The point is to roll back modernity for women.

So, if women who have never had an abortion, and don’t expect to, think that the new restrictions and bans won’t affect them, they are wrong. The new laws will fall most heavily on poor women, disproportionately on women of color, who have the highest abortion rates and will be hard-pressed to travel to distant clinics.

But without legal, accessible abortion, the assumptions that have shaped all women’s lives in the past few decades—including that they, not a torn condom or a missed pill or a rapist, will decide what happens to their bodies and their futures—will change. Women and their daughters will have a harder time, and there will be plenty of people who will say that they were foolish to think that it could be otherwise.

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abortion , the expulsion of a fetus from the uterus before it has reached the stage of viability (in human beings, usually about the 20th week of gestation). An abortion may occur spontaneously, in which case it is also called a miscarriage , or it may be brought on purposefully, in which case it is often called an induced abortion.

Spontaneous abortions, or miscarriages, occur for many reasons, including disease, trauma, genetic defect, or biochemical incompatibility of mother and fetus. Occasionally a fetus dies in the uterus but fails to be expelled, a condition termed a missed abortion.

Induced abortions may be performed for reasons that fall into four general categories: to preserve the life or physical or mental well-being of the mother; to prevent the completion of a pregnancy that has resulted from rape or incest; to prevent the birth of a child with serious deformity, mental deficiency , or genetic abnormality; or to prevent a birth for social or economic reasons (such as the extreme youth of the pregnant female or the sorely strained resources of the family unit). By some definitions, abortions that are performed to preserve the well-being of the female or in cases of rape or incest are therapeutic, or justifiable, abortions.

Numerous medical techniques exist for performing abortions. During the first trimester (up to about 12 weeks after conception), endometrial aspiration , suction, or curettage may be used to remove the contents of the uterus. In endometrial aspiration, a thin flexible tube is inserted up the cervical canal (the neck of the womb) and then sucks out the lining of the uterus (the endometrium) by means of an electric pump.

In the related but slightly more onerous procedure known as dilatation and evacuation (also called suction curettage or vacuum curettage), the cervical canal is enlarged by the insertion of a series of metal dilators while the patient is under anesthesia , after which a rigid suction tube is inserted into the uterus to evacuate its contents. When, in place of suction, a thin metal tool called a curette is used to scrape (rather than vacuum out) the contents of the uterus, the procedure is called dilatation and curettage. When combined with dilatation, both evacuation and curettage can be used up to about the 16th week of pregnancy.

From 12 to 19 weeks the injection of a saline solution may be used to trigger uterine contractions; alternatively, the administration of prostaglandins by injection, suppository, or other method may be used to induce contractions, but these substances may cause severe side effects. Hysterotomy, the surgical removal of the uterine contents, may be used during the second trimester or later. In general, the more advanced the pregnancy, the greater the risk to the female of mortality or serious complications following an abortion.

In the late 20th century a new method of induced abortion was discovered that uses the drug RU-486 (mifepristone), an artificial steroid that is closely related to the contraceptive hormone norethnidrone. RU-486 works by blocking the action of the hormone progesterone, which is needed to support the development of a fertilized egg. When ingested within weeks of conception , RU-486 effectively triggers the menstrual cycle and flushes the fertilized egg out of the uterus. RU-486 is typically used in combination with another drug, misoprostol, which softens the cervix and induces uterine contractions. By 2020 the two-drug combination, commonly referred to as a “medication abortion” or the “abortion pill,” accounted for more than half of all abortions in the United States .

Whether and to what extent induced abortions should be permitted, encouraged, or severely repressed is a social issue that has divided theologians, philosophers, and legislators for centuries. Abortion was apparently a common and socially accepted method of family limitation in the Greco-Roman world. Although Christian theologians early and vehemently condemned abortion, the application of severe criminal sanctions to deter its practice became common only in the 19th century. In the 20th century such sanctions were modified in one way or another in various countries, beginning with the Soviet Union in 1920, with Scandinavian countries in the 1930s, and with Japan and several eastern European countries in the 1950s. In some countries the unavailability of birth control devices was a factor in the acceptance of abortion. In the late 20th century China used abortion on a large scale as part of its population control policy. In the early 21st century some jurisdictions with large Roman Catholic populations, such as Portugal and Mexico City , decriminalized abortion despite strong opposition from the church, while others, such as Nicaragua, increased restrictions on it.

A broad social movement for the relaxation or elimination of restrictions on abortion resulted in the passing of liberalized legislation in several states in the United States during the 1960s. The U.S. Supreme Court ruled in Roe v. Wade (1973) that unduly restrictive state regulation of abortion was unconstitutional, in effect legalizing abortion for any reason for women in the first three months of pregnancy. A countermovement for the restoration of strict control over the circumstances under which abortions might be permitted soon sprang up, and the issue became entangled in social and political conflict. In rulings in 1989 ( Webster v. Reproductive Health Services ) and 1992 ( Planned Parenthood v. Casey ), a more conservative Supreme Court upheld the legality of new state restrictions on abortion, though it proved unwilling to overturn Roe v. Wade itself. In 2007 the Court also upheld a federal ban on a rarely used abortion method known as intact dilation and evacuation. In a later ruling, Dobbs v. Jackson Women’s Health Organization (2022), the Court overturned both Roe and Casey , holding that there is no constitutional right to abortion. Following the Court’s decision in Dobbs , several states adopted new (or reinstated old) abortion restrictions or banned the procedure altogether.

In April 2023 a federal district court judge in Texas issued an order effectively invalidating the federal Food and Drug Administration ’s (FDA) approval of RU-486 in 2000. An approximately simultaneous order by a federal district court judge in Washington state prohibited the FDA from further limiting access to RU-486 in 17 states and the District of Columbia . Shortly after the two rulings, the U.S. Court of Appeals for the Fifth Circuit temporarily blocked the Texas judge’s finding that RU-486 had been improperly approved but declined to reverse his separate stays of measures that the FDA had taken since 2016 to make RU-486 accessible to more patients, including extending the period during which the drug could be used from 7 to 10 weeks of pregnancy and permitting the drug to be mailed to patients rather than administered at an in-person visit with a doctor. The administration of Pres. Joe Biden then submitted an emergency appeal to the Supreme Court, asking that it temporarily uphold the FDA’s approval of RU-486 and its measures since 2016 to make the drug more accessible. One week later the Supreme Court granted the administration’s request. In December 2023, following the Fifth Circuit’s decision in August upholding the district court’s invalidation of the FDA’s accessibility measures since 2016, the Supreme Court agreed to review the case, Food and Drug Administration v. Alliance for Hippocratic Medicine , the first major abortion-related case on its docket since Dobbs v. Jackson Women’s Health Organization . On June 13, 2024, the Court unanimously reversed and remanded the Fifth’s Circuit’s decision, holding that the original plaintiffs in the case—a group of pro-life medical associations and several individual doctors—lacked standing to sue .

The public debate of the abortion issue has demonstrated the enormous difficulties experienced by political institutions in grappling with the complex and ambiguous ethical problems raised by the question of abortion. Opponents of abortion, or of abortion for any reason other than to save the life of the mother, argue that there is no rational basis for distinguishing the fetus from a newborn infant; each is totally dependent and potentially a member of society, and each possesses a degree of humanity. Proponents of liberalized regulation of abortion hold that only a woman herself, rather than the state, has the right to manage her pregnancy and that the alternative to legal, medically supervised abortion is illegal and demonstrably dangerous, if not deadly, abortion.

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From Bioethics Briefings

• Abortion remains controversial.
• In recent years, several states, including Texas and Oklahoma, have passed abortion bans early in pregnancy.
• For nearly 50 years, there was a Constitutional right to abortion in the United States, established by the Supreme Court in Roe v. Wade in 1973
• The Supreme Court overturned Roe v. Wade in June 2022, eliminating the Constitutional right to abortion.
• A central ethical question in the abortion debate is over the moral status of the fetus.
• Opinions range from the belief that the fetus is a human being with full moral status and rights from conception to the belief that a fetus has no rights, even if it is human in a biological sense. Most Americans’ beliefs fall somewhere in the middle.
• Moral philosophers from various perspectives provide nuanced examinations of the abortion question that go beyond the standard political breakdowns.

Framing the Issue

Abortion has been one of the most divisive and emotionally charged issues in American politics. At one end of the debate are those who regard abortion as murder, a despicable and heinous crime. At the other end of the spectrum are those who regard any attempt to restrict abortion as an egregious violation of women’s rights to make their own decisions about their bodies and what is best for them and their families. Most Americans are somewhere in the middle.

A central philosophical question in the abortion debate concerns the moral status of the embryo and fetus. If the fetus is a person, with the same right to life as any human being who has been born, it would seem that very few, if any, abortions could be justified, because it is not morally permissible to kill children because they are unwanted or illegitimate or disabled. However, the morality of abortion is not settled so straightforwardly. Even if one accepts the argument that the fetus is a person, it does not automatically follow that it has a right to the use of the pregnant woman’s body. Thus, the morality of abortion depends not only on the moral status of the fetus, but also on whether the pregnant woman has an obligation to continue to gestate the fetus.

Ethical Considerations Around Abortion

Public opinion on abortion falls into three camps—conservative, liberal, and moderate (or gradualist)—each of which draws on both science and ethical thinking.

Conservative

Conservative opposition to abortion stems from the conviction that the fetus is a human being, with the same rights as any born human being, from the beginning of pregnancy onward. Some conservative groups—such as the Catholic Church—consider the fetus to be a human being with full moral rights even earlier than the beginning of pregnancy, which occurs when the embryo implants in the uterus. The Church regards the embryo as a full human being from conception (the conjoining of sperm and egg). This is because at conception the embryo receives its own unique genetic code, distinct from that of its mother or father. Therefore, Catholic doctrine regards conception, not implantation, as the beginning of the life of a human being.

Although conservatives concede that the fetus changes dramatically during gestation, they do not accept these changes as relevant to moral standing. Conservatives argue that there is no stage of development at which we can say, now we have a human being, whereas a day or a week or a month earlier we did not. Any attempt to place the onset of humanity at a particular moment—whether it be when brain waves appear, or when the fetus begins to look human, or when quickening, sentience, or viability occur —is bound to be arbitrary because all of these stages will occur if the fetus is allowed to grow and develop.

A secular antiabortion argument given by Don Marquis in 1989 differs from the traditional conservative view in that it is not based on the fetus’s being human, thus avoiding the charge of “speciesism.” Rather, Marquis argues that abortion is wrong for the same reason that killing anyone is wrong—namely, that killing deprives its victim of a valuable future, what he calls “a future like ours.” It is possible that some nonhumans (some animals or aliens) have a future like ours. If so, then killing them is also wrong.

This raises two questions about what it is to have a future like ours. First, what precisely is involved in this notion? Does it essentially belong to rational, future-oriented, plan-making beings? If so, then killing most nonhuman animals would not be wrong, but neither would killing those who are severely developmentally disabled. Second, at what point does the life of a being with a future like ours start? Marquis assumes that we are essentially human animals, so our lives start with the beginning of our organisms. But Jeff McMahan denies this, arguing that we are essentially embodied minds, and not human organisms. On McMahan’s view, our lives do not start until our organism becomes conscious, probably some time in the second trimester. Early abortion, on his view, does not kill someone with a future like ours, but rather prevents that individual from coming into existence – in much the way contraception does.

The pro-choice position on abortion is often referred to as the liberal view. Mary Anne Warren provides a classic statement of the liberal view. Warren does not dispute the conservative’s claim that the fetus is biologically human, but she denies that biological humanity is either necessary or sufficient for personhood and a right to life. She argues that basing moral standing on species membership is arbitrary, and maintains that it is the killing of persons , not humans, that is wrong. Indeed, Warren thinks that the conservative is guilty of a logical mistake: confusing biological humans and persons. Persons are beings with certain psychological traits, including sentience, consciousness, the capacity for rational thought, and the ability to use language. There may be some nonhuman persons (e.g., some animals, extraterrestrial aliens), and there may be biological humans that are not persons, including early gestation fetuses, who have no person-making characteristics. By the end of the second trimester, fetuses are probably sentient, but even late gestation fetuses are less personlike than most mammals who are not considered to be persons.

In 1971, Judith Thomson gave a completely different pro-choice argument from the classic liberal one, in which she maintained that even if the personhood of the fetus were granted, for the sake of the argument, this would not settle the morality of abortion because the fetus’s right to life does not necessarily give it a right to use the pregnant woman’s body. No one, Thomson says, has the right to use your body unless you give him permission—not even if he needs it for life itself. At least in the case of rape, the pregnant woman has not given the fetus the right to use her body. (Thus, Thomson’s argument, somewhat ironically for an article entitled “A Defense of Abortion,” provides those who are generally anti-choice with a rationale for making an exception in the case of rape, as do many pro-lifers—though not the Catholic Church.) Thomson maintains that whether a woman has a moral obligation to allow a fetus to remain in her body is a separate question from whether the fetus is a person with a right to life, and depends instead on the amount of sacrifice or burden it imposes on her.

In 2003, Margaret Little argued that while abortion is not murder, neither is it necessarily moral. A pregnant woman and her fetus are not strangers; she is biologically its mother which provides her with some reason to protect its life. However, she may have duties of care to others, such as her existing children, which would be more difficult to fulfill if she has another child. The typical abortion patient is already a mother, single, and low-income or poor. Although Little does not regard the fetus as a person, it is a “burgeoning human life,” and as such is worthy of respect. But abortion does not necessarily conflict with respect for human life. Many women regard bringing a child into the world when they are not able to care for it properly as itself disrespectful of human life.

The moderate, or gradualist, agrees with the classic liberal that an early fetus, much less a one-celled zygote, is not a person, but agrees with the conservative that the late-gestation fetus merits some moral concern because it is virtually identical to a born infant. Thus, the moderate thinks that early abortions are morally better than late ones and that the reasons for having one should be stronger as the pregnancy progresses. A reason that might justify an early abortion, such as not wanting to become a mother, would not justify an abortion in the seventh month to the moderate.

Fetal Development Timeline (pdf)

The Legal Perspective

In Roe v. Wade , the Supreme Court based its finding of a woman’s constitutional right to abortion prior to fetal viability on two factors: the legal status of the fetus and the woman’s right to privacy. Concluding that outside of abortion law, the unborn had never been treated as full legal persons, the Court then looked to see if there were any state interests compelling enough to override a woman’s right to make this momentous personal decision for herself. It decided that there were none at all in the first trimester of pregnancy. In the second trimester, the state’s interest in protecting maternal health allows for some restrictions, so long as these are actually related to maternal health and not the protection of the life of the fetus. The state’s interest in protecting potential life becomes “compelling,” and trumps the woman’s right to privacy only after the fetus becomes viable, which in 1973 was somewhere between 24 and 28 weeks. Today, some premature infants are being saved as early as 22 weeks. However, it appears that, absent development of an artificial placenta, 22 weeks represents an absolute lower limit on viability. After viability, states may prohibit abortion altogether if they choose, unless continuing the pregnancy would threaten the woman’s life or health.

Planned Parenthood of Southeastern Pennsylvania v. Casey (1992) pitted the Justices who wanted to reverse Roe against those who wished to preserve it. Neither side prevailed and the result was a compromise written by Justices O’Connor, Kennedy, and Souter. It upheld Roe’s central finding, that women have a constitutionally protected right to choose abortion, prior to viability, while rejecting the trimester framework. Casey held that the State’s profound interest in protecting potential life existed at all stages of pregnancy, not just after viability. States may enact procedures and rules reflecting its preference for childbirth over abortion, so long as these rules and procedures do not constitute an “undue burden” on the woman’s choice.

The Court interpreted the undue burden standard as permitting a requirement that required doctors to provide information about the abortion procedure, the relative risks of abortion and childbirth, embryonic and fetal development, and available resources should the woman choose to carry to term, provided the information given to the woman is truthful and not misleading. This qualification has not always been followed. In several states, doctors are required to tell women seeking abortions that having an abortion increases their risk of breast cancer. While not exactly a lie, this is certainly misleading. Having a full term pregnancy can reduce the risk of breast cancer, but having an abortion does not increase a woman’s risk of developing breast cancer. The Court also upheld a waiting period of 24 hours, as its intent is to make the abortion decision more informed and deliberate. Yet the actual effect of waiting periods is often to make abortion access much more difficult, especially in places where women have to travel long distances to find an abortion provider.

After attempts to overturn Roe failed, a new strategy of restricting abortions was developed. This strategy included outlawing particular methods of abortion, such as partial-birth abortion, imposing time limits based on claims of fetal sentience, and imposing restrictions on clinics and doctors who perform abortions in the name of protecting maternal health.

Fetal Sentience

In 2010, Nebraska banned all abortion after 20 weeks, on the ground that the fetus at that stage can feel pain. Subsequently, more than a third of states passed similar laws. In 2015, the Pain-Capable Unborn Child Protection Act passed the House of Representatives; the motion to consider the bill in the Senate was withdrawn. The bill prohibited a physician from performing an abortion after 20 weeks, except where necessary to save the life of a pregnant woman (excluding psychological or emotional conditions) or in cases of rape or incest against a minor.

Are 20-week old fetuses sentient? This claim is rejected by the American College of Obstetricians and Gynecologists, which says it knows of no legitimate scientific information that supports the claim that a 20-week old fetus can feel pain. Other researchers think that while we do not know when fetuses become sentient, it might occur as early as 17 weeks. Utah became the first state to require doctors to give anesthesia to women having an abortion at 20 weeks or later. The law, which went into effect in May 2016, would not apply to women having abortions needed to save their lives, or in cases of rape or incest. An obstetrician-gynecologist in Utah, who spends half of a Saturday each month in an abortion clinic, protested, “You’re asking me to invent a procedure that doesn’t have any research to back it up. You want me to experiment on my patients.”

Protecting Women’s Health

Casey allowed states to restrict abortions based on a concern for women’s health, so long as the restrictions did not impose an undue burden on the choice. A key issue raised by the Supreme Court case Whole Woman’s Health v. Hellerstedt, decided in 2016, was how judges should evaluate such health-justified restrictions. The case concerned a 2013 Texas law that required any physician performing an abortion to have admitting privileges at a hospital not further than 30 miles from the abortion facility, and required any abortion facility to meet the minimum standards for ambulatory surgical centers. The District Court said that the law was unconstitutional because of its impact on access to abortion in Texas. Many abortion facilities would be unable to meet these requirements and would be forced to close, thereby severely limiting access to abortion. Moreover, the law’s provisions were unnecessary to protect women’s health. Abortion is an extremely safe medical procedure with very low rates of complications and virtually no deaths. In fact, although childbirth is 14 times more likely than abortion to result in death, Texas law allows a midwife to oversee childbirth in the patient’s own home. Thus, the new law was a solution to which there was no problem.

The Fifth Circuit reversed the District Court decision. One of its more startling claims was that states are entitled to impose health-justified restrictions, which are not subject to judicial review. In a 5-3 decision, the Supreme Court roundly rejected this claim. Writing for the majority, Justice Breyer said, “. . . the Court, when determining the constitutionality of laws regulating abortion procedures, has placed considerable weight upon evidence and argument presented in judicial procedures.” In other words, states may not simply assert that the restrictions are necessary, but must have factual evidence to show that they are. Moreover, the Court has an independent constitutional duty to review factual findings where constitutional rights are at stake.

Despite new restrictions on abortion, the core principle of  Roe  and  Casey– that the right to abortion is protected by the Constitution — was upheld. But that was soon to change.

The Change in the Composition of the Supreme Court

Between 1991 and 2020, five Justices openly hostile to abortion (Clarence Thomas, Samuel Alito, Neil Gorsuch, Brett Kavanaugh, and Amy Barrett) were appointed to the Court, making the 6-3 decision to reverse Roe possible.

The change in the Court’s composition emboldened several states to pass abortion bans much earlier than viability. One of the most restrictive, signed into law by Texas Governor Greg Abbott in May  2021, prohibits abortions after a fetal heartbeat is detected, usually after six weeks of pregnancy. About a year later, Oklahoma adopted a similar restriction and made illegal abortion a felony punishable by up to 10 years in prison. A bill introduced in Louisiana (House Bill 813) in May 2022 allowed criminal charges for murder to be brought against those who perform or have abortions. Its sponsor, Republican Danny McCormick, justified the bill by saying, “it is actually very simple: Abortion is murder.” Louisiana Right to Life did not support the bill, since their policy is that “abortion-vulnerable women” should not be treated as criminals. The group also called the bill unnecessary since Louisiana already had a trigger law that would outlaw abortion, except when necessary to save the life of the mother, if Roe were overturned. An amended version of HB 813, which removed the language about charging women having abortions with murder and exempted birth control from being outlawed, did pass the House.

Overturning Roe and Casey

Dobbs v. Jackson Women’s Health (June 2022) .  The case concerned a Mississippi law banning all abortions after 15 weeks gestational age except in medical emergencies and in the case of severe fetal abnormality. Characterizing the decisions in Roe and Casey as “egregiously wrong,” the majority held that:

“. . . Roe and Casey must be overruled. The Constitution makes no reference to abortion, and no such right is implicitly protected by any constitutional provision, including the one on which the defenders of Roe and Casey now chiefly rely — the Due Process Clause of the Fourteenth Amendment. That provision has been held to guarantee some rights that are not mentioned in the Constitution, but any such right must be “deeply rooted in this Nation’s history and tradition” and “implicit in the concept of ordered liberty.”

With the overturning of Roe and Casey , the matter of abortion has been returned to the states. Most abortions are banned in 14 states, while protected by state law or constitution in 21 states. (For updates, see Kaiser Health News Abortion Policy Tracker .) Abortion providers and advocates have challenged abortion bans in many states as violating the state constitution or another state law.

In his concurrence, Chief Justice Roberts said that while he agreed with the majority’s conclusion to uphold Mississippi’s law, he would have preferred a narrower approach based on the principle of judicial restraint. Instead of “repudiating a constitutional right we have not only previously recognized, but also expressly reaffirmed applying the doctrine of stare decisis “, the Court could simply have rejected viability as the point at which the state’s interest in protecting potential life outweighed the woman’s right to terminate her pregnancy, and upheld Mississippi’s right to ban abortions after 15 weeks. The majority rejected this approach, in part because it “would only put off the day when we would be forced to confront the question we now decide. The turmoil wrought by Roe and Casey would be prolonged. It is far better–for this Court and the country–to face up to the real issue without further delay.”

Abortion After Dobbs

The claim that Dobbs will end the turmoil over abortion is dubious. Abortion rights activists have challenged trigger bans in a dozen states. Some have already been rejected by judges, but other cases continue. Most of the legal challenges nationwide seek to establish that state constitutions protect a right to abortion. President Biden has signed an executive order designed to ensure access to abortion medication and emergency contraception, leaving the details up to the secretary of health and human services.

Court cases have challenged the availability of medication abortion . Another issue likely to result in lawsuits is whether states can prevent their residents from traveling to other states to have abortions. Nor are legal battles necessarily limited to the states. Some anti-abortion activists are pushing for a federal ban on abortion, while some pro-choice advocates are pushing for a federal law to protect the right to abortion. Neither side has the 60 votes necessary, but that could change in the future.

The Supreme Court expressly noted that its opinion “is not based on any view about if and when prenatal life is entitled to any of the rights enjoyed after birth.” That leaves open the question whether states may confer legal personhood on embryos. May they punish women who have abortions under their homicide statutes, even executing them in death penalty states?

The extreme conservative position, taken by the official teachings of the Roman Catholic Church, regards even abortions necessary to save the life of the pregnant woman as illicit, since it is forbidden to kill one innocent human being in order to save the life of another. As of July 2022, all of the state anti-abortion laws and proposed laws make an exception for “medical emergencies,” but nothing in Dobbs requires states to make this exception. Moreover, the determination of what counts as a medical emergency can be extremely subjective. A pregnant woman may develop a condition that might be, but is not definitely, life-threatening. May a doctor perform an abortion in that case? Five women in Texas have filed a lawsuit saying that they were denied medically necessary abortions. Joined by two ob-gyns, they are seeking to clarify when abortion is permissible under state law.

Questions abound. How close to death must a woman be for doctors to act? Will doctors be willing to take the risk of possible jail time if they make a call that is later questioned?

Complications can arise in any pregnancy, but the inability to get an abortion for medical reasons is likely to impose particular burdens on pregnant patients with chronic illnesses and disabilities, including psychiatric conditions, diabetes, and heart conditions. Pregnancy may take years off their lives, but this would not be enough for them to get an abortion in states that provide an exemption only in the case of a “medical emergency” that “necessitate[s] the immediate performance or inducement of an abortion.”

Thus, Dobbs is likely to have a deleterious impact on the ability of doctors to care properly for their pregnant patients, as well as for some women who are not pregnant. The AMA condemned the decision as “an egregious allowance of government intrusion into the medical examination room, a direct attack on the practice of medicine and the patient-physician relationship, and a brazen violation of patients’ rights to evidence-based reproductive health services.” In the weeks after the Dobbs decision, there were reports of profound changes in other medical care, including for ectopic pregnancies and for women with lupus, which is treated with a medicine that can cause miscarriage.

There are no exceptions for pregnancies that result from rape or incest in Alabama, Arkansas, Florida, Kentucky, Louisiana, Missouri, Oklahoma, Ohio, South Dakota, Tennessee, or Texas. The rationale is that it is unjust to end a pregnancy because its father is a rapist. Those who favor exceptions for rape and incest regard it as equally unjust to force women to continue a pregnancy for which they have no responsibility.

The Impact of Dobbs Beyond Abortion

The loss of abortion rights is real and of great concern to many Americans, not only because of the impact this will have on the lives of women and their families, but also because a rejection of the constitutional right to privacy and substantive due process could have effects beyond abortion. On the face of it, the analysis in Dobbs applies to other rights that the Supreme Court has upheld, including the right of both married and unmarried couples to use contraceptives ( Griswold v. Connecticut , 1965, and Eisenstadt v. Baird , 1972), the right to marry a person of a different race ( Loving v. Virginia , 1967), the right to engage in private, consensual sexual acts ( Lawrence v. Texas , 2003), and the right to marry a person of the same sex ( Obergefell v. Hodges , 2015). None of these rights are mentioned in the Constitution, nor are they deeply rooted in this Nation’s history and tradition. This means, in the words of the dissenters (Breyer, Sotomayor, and Kagan) that “one of two things must be true. Either the majority does not really believe in its own reasoning. Or if it does, all rights that have no history stretching back to the mid-19th century are insecure. Either the mass of the majority’s opinion is hypocrisy, or additional constitutional rights are under threat. It is one or the other.”

The majority insisted that its decision “concerns the constitutional right to abortion and no other right. Nothing in this opinion should be understood to cast doubt on precedents that do not concern abortion.” But if other precedents fail the test for determining constitutional rights provided in Dobbs , why aren’t these cases also wrongly decided?

Same-Sex Marriage

In his separate concurring opinion, Justice Thomas forthrightly accepted this implication, saying, “in future cases, we should reconsider all of this Court’s substantive due process precedents, including Griswold , Lawrence , and Obergefell .” Thomas, unsurprisingly, did not mention Loving , perhaps because he assumes that discrimination based on race is prohibited by the Fourteenth Amendment’s guarantee of equal protection. The dissenters, however, note that the right to marry someone of a different race was not protected at the time of the adoption of the Fourteenth Amendment any more than the rights to abortion, contraception, to engage in private, consensual acts, or to marry a person of the same sex.

While anti-miscegenation laws are unlikely to garner much public support, the same may not be true for LGBTQ rights protected by Lawrence and Obergefell . Some far-right Republicans have expressed an interest in ending same-sex marriage . Texas Attorney General Ken Paxton has said that he would defend the state’s defunct sodomy law if the Supreme Court were to follow Thomas’s suggestion and revisit Lawrence .

Contraception, IVF

It seems unlikely that there would be much enthusiasm in the states for banning contraceptives in general, although some conservatives might favor rolling back the sexual revolution that stemmed from the Pill. Presumably, that would satisfy the rational-basis test that the Court identified as the standard for abortion restrictions or prohibition. Moreover, some forms of contraception, such as IUDs, that prevent a fertilized egg from implanting, might be prohibited under laws like Oklahoma’s that define persons as human beings from conception onwards.

IVF could also be adversely affected by Dobbs , because of the routine practice of discarding embryos. This occurs for two reasons. First, the creation of excess embryos enables fertility doctors to implant only one or two embryos per cycle, and to freeze the remainders for future use. This protects women from having to go through the onerous process of egg retrieval in future pregnancies. Freezing embryos has also facilitated single embryo transfer for good-prognosis patients, which has resulted in fewer twins and higher-multiple births, which are riskier for both mothers and babies than singleton births.

Second, it is now routine in IVF to test embryos for chromosomal defects and to discard affected embryos. This improves the chances for a successful pregnancy since embryos with chromosomal defects are less likely to implant and to miscarry. At this point, embryos created in labs are not explicitly targeted by state laws that ban abortion. Trigger laws in most states are aimed at preventing the termination of pregnancy, not regulating IVF embryos. That could change. A spokeswoman for Students for Life Action, a large national anti-abortion group, says that they are looking at IVF : “Protecting life from the very beginning is our ultimate goal, and in this new legal environment we are researching issues like IVF, especially considering a business model that, by design, ends most of the lives conceived in a lab.”  Ironically, laws intended to prevent the termination of pregnancies might deprive infertile couples from having a successful pregnancy.

On February 16, 2024, the Supreme Court of Alabama held that frozen embryos are children with respect to Alabama’s wrongful-death statutes. Some have claimed that this will disallow the discard of embryos by IVF clinics, but that is not obvious. Wrongful-death suits must demonstrate negligence, not simply causing death. Nevertheless, the implications of the court’s decision are unclear, creating anxiety among IVF providers and patients. The University of Alabama health system is pausing in vitro fertilization treatments while considering the implications of the court’s decision.

Care for Miscarrying Patients

Another area of concern is the medical care given to women with wanted pregnancies who miscarry. In what is known as a “missed miscarriage,” the fetus dies in the womb but is not expelled from the woman’s body. In an “incomplete miscarriage,” not all of the fetal tissue is expelled. These situations can cause infection that poses a threat to the woman’s life. The medical options are waiting and hoping that the woman miscarries naturally or intervening medically with either a surgical procedure (D&C) or abortion medication to remove the fetus or fetal tissue. Because these interventions are also used in abortion procedures, outlawing abortion could have a chilling effect on what doctors are willing to do.

In states with abortion bans, there are reports of doctors declining to perform any procedure that could be seen as an illegal abortion. In some cases, women have had to wait to miscarry, which could take weeks. Not only does this impose added emotional stress on women who have lost a wanted pregnancy, but it could even cost their lives. This happened in Ireland in 2012. Savita Halappanavar, 17 weeks pregnant, was admitted to hospital after a miscarriage was deemed inevitable. When she did not miscarry after her water broke, she discussed having a termination with the attending physician. This was denied because Irish law at the time forbade abortion if a heartbeat was still detectable. While they waited for the fetus’s heart to stop, Savita developed sepsis and died. The case was instrumental in getting abortion legalized in Ireland.

So far, no woman in the U.S. has died as a result of restrictive abortion laws, but some have come close. An ob-gyn in San Antonio, Tx., had to wait until the fetal heartbeat stopped to treat a miscarrying patient who had developed a dangerous womb infection. The delay caused complications which required her to have surgery, lose multiple liters of blood, and be put on a breathing machine. Texas law essentially requires doctors to commit malpractice.

Landmark cases like Quinlan (1976) and Cruzan (1990) relied on a constitutional right of privacy and substantive due process. The rejection by the Court of these principles could threaten well-established rights of patients to refuse life-saving care and to stipulate their wishes in that regard in advance directives.

At this point, it is impossible to predict all of the effects of overturning Roe and Casey . This much is clear: the battle over abortion rights is far from over.

Bonnie Steinbock , PhD, a Hastings Center fellow, is professor emeritus of philosophy at The University at Albany/State University of New York.

• Symposium: Seeking Reproductive Justice in the Next 50 Years. The Journal of Law, Medicine & Ethics, 51 (Fall 2023): 455.
• Linda Greenhouse and Reva Siegel, “Casey and the Clinic Closings: When ‘Protecting Health’ Obstructs Choice,” Yale Law Review 125 (2016): 1428-1531.
• Bonnie Steinbock, Life Before Birth: The Moral and Legal Status of Embryos and Fetuses, 2nd edition (Oxford University Press, 2011).
• Ronald Dworkin, “The Court and Abortion: Worse Than You Think,” New York Review of Books, May 31, 2007.
• Margaret Olivia Little, “The Morality of Abortion,” in Christopher Wellman and R.G. Frey, eds., A Companion to Applied Ethics (Blackwell Publishing, 2003).
• David Boonin, A Defense of Abortion (Cambridge University Press, 2002).
• Jeff McMahan, The Ethics of Killing: Problems at the Margins of Life (Oxford University Press, 2002).
• Susan Dwyer and Joel Feinberg, eds. The Problem of Abortion (Wadsworth Publishing Co., 1996).
• Sidney Callahan and Daniel Callahan, eds. Abortion: Understanding Differences (Plenum, 1984).
• Kristin Luker, Abortion and the Politics of Motherhood (University of California Press, 1984).
• Don Marquis, “Why Abortion Is Immoral,” Journal of Philosophy, April 1984.
• Donald H. Regan, "Rewriting Roe v. Wade." Michigan Law Review, August 1979.
• Mary Anne Warren, “On the Moral and Legal Status of Abortion,” The Monist, January 1973.
• Judith Thomson, “A Defense of Abortion,” Philosophy and Public Affairs, Winter 1971.
• Ethics and Abortion Resources from The Hastings Center
• Bonnie Steinbock, PhD Hastings Center Fellow and professor emeritus of philosophy at The University at Albany/State University of New York [email protected]
• Thomas H. Murray, PhD President Emeritus and Fellow, The Hastings Center [email protected]
• Maggie Little, BPhil, PhD Director, The Kennedy Institute of Ethics; Hastings Center Fellow [email protected]
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Four Ways Access to Abortion Improves Women’s Well-Being

Last month, the Supreme Court repealed Roe v. Wade , taking away a woman’s constitutional right to an abortion. Already, several states have used that ruling to enact state laws banning abortion. In some cases, receiving an abortion or providing one, even in cases of rape or incest, is a crime punishable by imprisonment or hefty fines.

Though people may argue over whether this ruling is sound or not, it likely spells disaster for women’s health and well-being. That’s because research suggests women who have the right to choose whether or not to give birth are happier, healthier, and more economically stable than those who don’t. And their children benefit, too, by having a mother who can afford to nurture and provide for them better.

How do we know this? Mostly from data coming out of the “ Turnaway Study ”—a long-term, prospective study that followed hundreds of women seeking abortions at different clinics around the country who were either given an abortion or denied one (because of gestation limits for an abortion). By comparing the well-being of these women—who except for receiving an abortion or not were very similar to one another—researchers could more accurately assess the impacts of losing abortion rights.

Here are some of the findings from that important study (and others) about the benefits of receiving an abortion when you want one.


1. Better mental health


Many women are made to feel guilty about seeking an abortion; at times, the circumstances surrounding their choice can involve stress and negative emotions. Does getting the abortion hurt their mental health? Not in most cases. In general, women who get a desired abortion tend to have better mental health—even in the short term—than their peers who are denied one.


In one study , researchers compared women who received an abortion to those who were turned away and found that they had less anxiety, higher self-esteem, and greater life satisfaction one week post-abortion. As time went on, the two groups converged and both fared similarly in terms of their psychological well-being. But it’s clear that getting an abortion had no ill effects, and provided some short-term advantages, for a woman’s mental health.

In another study , researchers looked at the psychological well-being of first-time parents and found no evidence that having had an abortion negatively impacted a woman’s mental health or that it affected her sense of efficacy in raising her children. On the other hand, women who gave birth to an unwanted child (before Roe v. Wade allowed women to have legal abortions) were shown to be more depressed in middle age than women who’d had a wanted childbirth, planned or otherwise.

Of course, that’s not to say that women never suffer emotionally when having an abortion. Someone who really wants to be a mother, but is making the decision to end her pregnancy for economic or health reasons, would likely feel grief.

However, the research to date shows that there is no inherent psychological downside of getting an abortion if you want one—while the opposite may be true for being denied one. That is why the American Psychological Association issued a statement against the court’s ruling.

2. Better physical health

While some have argued that abortions have health risks, those pale in comparison to giving birth. Legal, medically supervised abortions are relatively safe for women. If we don’t keep them that way, women may seek to abort unwanted pregnancies on their own, putting themselves at greater risk for health complications.

One study found that women who wanted an abortion and were able to get one had better overall health five years later than a comparison group of women who were denied an abortion. About 20% of them reported that their health was only fair or poor compared to 27% of women giving birth, and they had fewer chronic headaches, migraines, and joint pain, too. As demographers estimate , a ban on abortions will likely have dire consequences for a large number of women, with the poor and less educated suffering most.

3. More economic stability and less poverty

The two most common reasons women choose to get an abortion are economic instability (they can’t afford to care for a child right now) and poor timing (it might interfere with their educational or career goals). Given that, it makes sense that women who can get an abortion may have better incomes and more stability in their lives. Research bears this out.

As one study showed, having a child later in adulthood substantially increases earned wages for women, especially if they’re college-educated. But the ability of a woman to choose to delay motherhood is affected by whether or not she can obtain an abortion if she wants one, obviously—which suggests that women who have access to abortions also have an economic advantage.

Greater Good Resources for Women’s Well-Being

Articles that aim to help women take care of themselves and each other, make a living, raise children, and work for equality.

The negative effects of not having reproductive freedom were supported by a study published by the National Bureau of Economic Research. In the study, researchers found that “women who were denied an abortion experience a large increase in financial distress that is sustained for several years.” Some of the economic fallout of being denied an abortion included an increased risk of lingering debt, evictions, bankruptcies, and poor credit ratings.

This means women who received an abortion fared better economically and were better able to stay out of poverty, not only helping themselves, but their other children , as well.

4. Women with access to abortions have healthier children

When a woman has access to an abortion for an unwanted pregnancy, she is better able to care for the other children she has (or eventually has).

In one study published in JAMA Pediatrics , researchers compared babies born to a woman denied an abortion (called an “index” baby) to babies born to a woman after she was able to procure an abortion for an earlier pregnancy (“subsequent” babies). Findings showed that mothers were less able to bond with index children than with subsequent children.

In addition, studies found that the existing children of a woman seeking an abortion fared better developmentally six months to 4.5 years later if the woman was given (versus denied) an abortion. This means that the children living with a less-stressed mother demonstrated some combination of better fine motor, gross motor, receptive language, expressive language, self-soothing, and social-emotional skills than children born to a woman denied an abortion. The children were also less likely to live below the poverty line.

Of course, some of these benefits of having access to abortion would be even more pronounced if we lived in a country where there was support for a woman’s right to choose their own reproductive destiny. When countries have better access to abortion, maternal deaths decline , which certainly benefits those women’s children, while abortion rates do not change much (or may even be higher) if abortion is illegal.

If the United States truly wants to protect women and their children, research suggests that they should look to countries whose governments provide universal social welfare programs that benefit families—things like free, widely available prenatal care, health care, parental leave, and child care for working mothers, regardless of their ability to pay. If we had similar policies here, it might not only help those children who are wanted, but also help those who aren’t.

About the Author

Jill Suttie

Jill Suttie, Psy.D. , is Greater Good ’s former book review editor and now serves as a staff writer and contributing editor for the magazine. She received her doctorate of psychology from the University of San Francisco in 1998 and was a psychologist in private practice before coming to Greater Good .

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Can you explain what "pro-choice" and "pro-life" means? 

May 2, 2024 2 min read

By Holly @ Planned Parenthood

Someone asked us:  Can you explain what pro-choice means and pro-life means? When my family talks about abortion I think they’re saying “pro-choice” and “pro-life” wrong, but I’m not sure. 

Many years ago, "pro-life" and "pro-choice" were terms people came up with to describe themselves as being against abortion access and for abortion access. And you may hear these outdated labels still used today. But neither accurately describes those who oppose abortion, or people who believe that decisions about abortion should be made by the person who is actually pregnant — not the government.

Generally, people who identified as “pro-choice” believed that people have the right to control their own bodies, and everyone should be able to decide when and whether to have children. 

People who want abortion to be illegal and inaccessible are often called “pro-life.” The truth is, a majority of Americans believe abortion should be legal and accessible, and that politicians shouldn’t make other people’s personal health care decisions. There are plenty of people in that majority who feel abortion wouldn’t be the right decision for them personally, but do not want to stop others from making a different decision.

“Pro-choice” and “pro-life” labels don’t reflect the complexity of how most people actually think and feel about abortion. Some people and organizations, including Planned Parenthood, don’t use these terms anymore.

Planned Parenthood believes that decisions about whether to choose adoption, end a pregnancy, or parent should be made by a pregnant person with the counsel of their family, their faith, and their nurse or doctor. Politicians should not be involved in anyone’s personal medical decisions about their reproductive health or pregnancy.

Tags: Abortion , Reproductive Rights , anti choice , pro-choice , pro-life

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Ask the expert: 10 questions on safe abortion care

How safe is abortion? 

Abortion, using the recommended methods, is a very safe procedure. It can happen as an outpatient procedure, or it can be done with medications or tablets. These tablets, Misoprostol and Mifepristone, are actually on the WHO’s core essential medicine list. When these tablets became known as a way to induce abortion decades ago, the medical community was cautious, and they were often provided in hospitalized settings, but the evidence has accumulated so much over the years that we now know that these can be safely provided by a wide range of health workers, not just OB GYN doctors, but general physicians, nurses, midwives, and, in some situations in early pregnancy, by nonclinical providers as well. 

When we use these tablets, the abortion happens over a course of a few hours or few days. In the first 12 weeks of pregnancy, this process can be self-managed.  

In some cases this can be done through telemedicine, so that the woman and health worker can interact remotely to have initial conversations, and determine eligibility. Then the medicines can be either sent to her through the post or through arrangement at a nearby health facility. Then, there remains a channel of communication between the health worker and the woman. 

How can people avoid misinformation about abortion? 

WHO is a good place to start to get evidence based information on the aspects of care and abortion care. And I would encourage readers to visit the WHO health topic page to learn about the evidence. But of course, it's also important for individuals to have accurate information about their local context and what their rights are, what the accessibility to services are and what the potential risks are of seeking care within their context. So, of course, it's important to also find a respected and trusted source, perhaps a professional association.  

It's difficult in this age of social media to be able to separate real and fake information. And I think it's important that everybody takes a second look at information that they might see circulating in social media channels, double check on the evidence or the credibility of the source, and also be very careful about not perpetuating or sending out information that they are not sure of because fake information can cost lives. 

Do restrictions on abortion reduce abortion rates? 

The science and the evidence show us that restricting abortion does not reduce abortion rates. There is a trend, though, in countries with more restrictive laws, there are more unintended pregnancies that end in abortion. Furthermore, we find that unsafe abortion is significantly higher in the groups of countries where the laws are most restrictive. In fact, we see that in countries where laws are relatively liberal, most abortions, about nine and 10 occur in safe circumstances. But if you go to the other extreme of the most restrictive group of countries, only about one in four can be considered to be safe. 

What works to improve outcomes? 

A combination of policies and access prevent unsafe abortion and promote the health of women and communities. These include: 

• Liberal abortion laws 
• Access to a range of sexual reproductive and health services including access to contraception and family planning 
• Gender equality  
• Policies and practices to help support women in their lives, livelihoods and their reproductive decisions.

What are some of the barriers to abortion, even where they are legally permitted? 

Even when the law allows abortion on certain grounds and certain conditions, the same countries have laws that also make it criminal. If you provide abortion outside those defined grounds three out of four countries actually have criminal penalties for women who are seeking abortion care. 

There are so many aspects that are written into the law that stand in the way of actually being able to access care, including proving rape, requiring the approval of medical boards or judicial committees ,and mandatory waiting periods. It can also be a challenge to find a healthcare provider willing to provide abortion care free of stigma, free of disrespect, free of abuse.  

What are the equity issues that arise in access to abortion care? 

We know that access issues are even at the best of times, not equitable. So the minute you add in barriers and restrictions that come in through law and other places, we know that some women and some girls and some individuals will suffer more than others. 

The specifics of who gets discriminated may vary in different contexts and in different countries. It may be people living in vulnerable situations. It may be because of color, race, ethnicity, or multiple factors working together that make it harder over and above the difficulties and the stigma related to abortion care to actually access care.  

What can be done to improve access? 

Luckily, there are only about 20 countries in the world where there is absolutely no indication for a lawful abortion, but even within these contexts care for complications and post-abortion care is perfectly possible. And in all other countries, there are at least some indications under which abortion is legal. So, I think the first step is really to examine whether or not we are making the healthcare services available that we can even within the current legal and regulatory frameworks.  

We find very often care that is not evidence based. We find that the appropriate medicines may not be registered in the essential medicine lists. Providers might not be trained and national guidelines, for example, may not be in tune with the latest evidence as put out by WHO or other professional societies. There is so much progress to be made by starting with what we can within the context of the country.  

Where does family planning advice come into abortion care? 

Family planning and contraception is an essential part of sexual and reproductive healthcare services, but it’s not the only part. It's all along a continuum. We don’t see abortion as being distinct or unique. There are about 121 million unintended pregnancies in the world every year. About six out of 10 women who are pregnant and don’t want to be end the pregnancy through an induced abortion. Now, clearly, if there are women who are not wanting to be pregnant at a particular time, then it's important that we provide them with the access to affordable contraception and declining rates of unintended pregnancy will also have an effect on abortion rates. 

But we also have to realize that unintended pregnancy is one of the drivers for abortion, but there are many other reasons. I think there are as many reasons as there are individuals seeking care, and there is really no other option, but to have all of these services exist in tandem so that we can meet the needs of individuals.  

How do human rights factor into abortion and sexual and reproductive health? 

WHO’s definition of health is not just the absence of disease, but a complete sense of health and wellbeing. It is a rights issue. You can't separate health and rights because they're two sides of the same coin, one interacts with the other. You cannot have health without respecting the rights of the individuals seeking that healthcare. And then when you are respectful of the rights of individuals, then it becomes a no brainer that ensuring access to healthcare for these individuals is important as well.  

What should guide policies and service delivery? 

We should let the evidence guide us, and center all of our policies and our recommendations and work on the needs of women, girls, individuals seeking care. This comes out clearly in the WHO abortion care guideline. 

Additionally, lately, we have seen so many people sharing their experiences of how abortion care transformed their lives. Many individuals are speaking up when they've never spoken up before for fear of the stigma that this issue still carries. I'm seeing so many stories also by healthcare providers who are speaking to their challenges in providing care when it's not always easy because of the circumstances around laws and access.  

It's really important that these experiences are used as pieces of evidence as important as the big data and numbers, and that we centralize our decision-making in terms of listening and supporting the real people whose lives are affected by these healthcare decisions.  

Abortion Access

The u.s. supreme court has ended the federal constitutional right to abortion — handing our power to control our own bodies to politicians., take action: bans off our bodies.

Politicians opposed to abortion rights have made it clear that their ultimate goal is to ban abortion nationwide. Join the fight for our right to make decisions about our bodies, lives, and futures!

3 Facts on Abortion

Abortion is health care.

No one is free unless they control their own body. Abortion is an essential part of sexual and reproductive health care. Both in-clinic and medication abortions are very safe.

Abortion Is Common

Nearly a fourth of women in America will have an abortion by age 45. Abortion has been practiced for thousands of years in cultures throughout the world.

Abortion Is a Basic Right

The ability to control your own personal medical decisions, including whether to end a pregnancy, is a fundamental human right. Restricting abortion access is dangerous and inhumane. 

You should have the right to control your own body.

And yet, on June 24, 2022, the Supreme Court overturned Roe v. Wade — the case that had recognized the federal constitutional right to abortion in 1973. The Supreme Court’s new ruling means that we have lost federal constitutional protection for abortion.

This devastating decision turns back the clock on reproductive rights 50 years. It gives politicians the authority to make decisions for you. And it lets them control what your future will look like.

Now, abortion bans will spread across much of the country.

But the abortion rights movement is strong, and we’re not backing down. Planned Parenthood Action Fund is fighting even harder for the rights of all people — and generations to come — to live the life they choose. We just need one thing: your support.

Join us in the fight for our right to make decisions about our bodies, lives, and futures!

Roe v. Wade

• Roe v. Wade: What We've Lost
• Roe v. Wade: Behind the Case

Abortion in U.S. History

Abortion's Deep Roots in America’s History

Abortion Law Historical Timeline: 1850 to Today

The Supreme Court has overturned Roe v. Wade , the case that had recognized the constitutional right to abortion for 49 years.

Here’s what that means.

What Happened

The U.S. Supreme Court is now dominated by justices hostile to our freedom — and in June 2022, the court took away our federal constitutional right to abortion. This ruling robbed us of our power to make personal decisions about our own bodies, and gave that control to politicians.

This decision overturns nearly 50 years of precedent. And it goes against the will of the American people, 80% of whom believe that abortion should be legal.

What’s Next

Abortion bans have already taken effect in some states. In others, the Supreme Court’s outrageous decision is fueling efforts by narrow-minded politicians to ban abortion soon.

Abortion bans can trap people into inhumane situations, forcing them to remain pregnant or — if they have the resources — to travel hundreds or thousands of miles for a legal abortion.

But politicians who oppose abortion won’t stop with state bans. They ultimately want to ban abortion nationwide and make safe, legal abortion completely impossible.

What We’re Doing

We are outraged and ready to fight like hell.

No judge, no politician, no law should ever block your personal medical decisions or set the course for your life. Abortion access should not be based on your ZIP code, income level, or immigration status.

Types of State Restrictions on Abortion

"Personhood," insurance bans, waiting periods, biased counseling, and more

What are TRAP Laws?

Federal and State Bans and Restrictions on Abortion

• Hyde Amendment
• 20-Week Bans

Where Is Abortion Accessible?

Look up your state to find current abortion laws — and learn how your access to abortion may have changed now that the Supreme Court has overturned Roe v. Wade .

How We Got Here

Abortion bans began in America in the late 1800s and early 1900s, when men in power sought to strategically control the country’s women and reproduction. State bans caused abortion care to go underground. But advocates for the right to access abortion fought back. And in 1973, the U.S. Supreme Court recognized abortion as a constitutional right in its Roe v. Wade decision. 

In the decades since, abortion opponents stacked federal courts with anti-abortion judges ; passed abortion bans ; spread deceptions ; imposed arbitrary restrictions ; and waged one legal battle after another. Now, they have reversed Roe v. Wade .

Abortion Bans Harm People of Color

Abortion bans are a product of the historic and systemic barriers to health care that too many communities face every day.  

America’s legacy of racism and discrimination has already blocked access to care and opportunity — generation after generation — for Black, Latino, Indigenous, and other people of color. Abortion bans harm them the most.

Abortion bans and restrictions also fall hard on people with low incomes , for whom the cost of transportation, childcare, and time off work often conspire to put abortion out of reach — even where it is legal.

Blogs About Abortion

Outrage: u.s. supreme court takes away federal constitutional right to abortion.

On June 24, the U.S. Supreme Court overturned Roe v. Wade — throwing out the 1973 decision that recognized abortion as a constitutional right, and handing politicians across the country the power to make decisions about our bodies, our lives, and our futures.

Anti-abortion Members of Congress Proposing Nationwide Six-Week Ban

The Supreme Court plans to end the constitutional right to abortion — taking away our power to control our own bodies — and politicians aim to outlaw abortion across the United States, no matter where you live. We're fighting back.

Abortion Bans and Restrictions Mount in States Across the Country Just 2 Months Into 2022

Emboldened by a Supreme Court decision that could end the constitutional right to abortion this spring, politicians opposed to abortion rights have wasted no time advancing laws to harshly restrict abortion or ban it entirely. 

Planned Parenthood health centers are proud to continue providing safe, legal abortion.

No matter what, Planned Parenthood believes you deserve accurate information and access to the full range of reproductive health care services — including safe, legal abortion — so you can make your own, fully informed health-care decisions.

Abortion Access: Timeline of Attacks 2009–2022

Here are key attacks on abortion providers and abortion rights in the past decade.

See the full timeline

2009: Dr. George Tiller, an abortion provider, is assassinated while attending church in Kansas

2010 : Swept up by hostility to health-care legislation, anti-abortion politicians win elections to Congress and state legislatures — and then use gerrymandering and voting restrictions to entrench themselves in office.

2011 : Thirty-six states enact a then-record 92 new abortion restrictions .

2012 : Nineteen states enact 43 new abortion restrictions .

2013 : Ignoring mass protests, anti-abortion Texas politicians enact sweeping abortion restrictions . In the following three years, half of Texas's approximately 40 abortion providers close , leaving many people to travel hundreds of miles or cross states lines to get an abortion

2014 : Fifteen states enact 26 new abortion restrictions , including two bans on abortion at 20 weeks of pregnancy — bringing the total of states enacting 20-week abortion bans to 13 .

2015 : Anti-abortion extremists linked to the group that killed Dr. Tiller release misleading, deceptive smear videos to demonize abortion providers and smear Planned Parenthood.

2016 : Anti-abortion Justice Antonin Scalia dies, setting up a fight for the future of the U.S. Supreme Court.  In an unprecedented step, anti-abortion Senate Majority Leader Mitch McConnell refuses to start the confirmation process to fill the vacancy. Then, despite running close to 3 million votes behind his opponent, Donald Trump wins enough electoral votes to become president-elect.

2017 : Trump attacks abortion access — and swiftly moves on his promise to name judges who would “automatically” overturn Roe v. Wade .

2018 : Trump appoints — and the Senate confirms — a second anti-abortion Supreme Court justice, Brett Kavanaugh.

2019:  The Trump-Pence administration issues a   Title X gag rule  in an attempt to ban providers in the  Title X program  from telling millions of patients  how they can safely and legally access abortion  — and “defund” Planned Parenthood health centers by making it impossible for Title X patients to obtain birth control there.

Some anti-abortion politicians seized on the COVID-19 pandemic to try to impose abortion bans.  See the timeline of the new coronavirus-based abortion bans and our fight against them.

Supreme Court Justice Ruth Bader Ginsburg dies, and the U.S. Senate majority rushes to confirm Justice Amy Coney Barrett as Ginsburg’s replacement.

In one of the most extreme abortion bans this country has ever seen, politicians, neighbors, and even complete strangers can sue anyone who helps a person access an abortion in Texas after six weeks.

Other states follow Texas’s lead by introducing “copycat” legislation.

​​​​​​​ Abortion restrictions mount across the country, including restrictions on medication abortion . Unprecedented abortion bans become law in Florida , Oklahoma , Arizona , and Idaho .

The U.S. Supreme Court overturns Roe v. Wade , opening the floodgates for more states to ban abortion.

Related Content

77% of Americans Want Abortion to Remain Safe and Legal

What You Need to Know About Trump’s Lies About Abortions Later in Pregnancy

Don’t Call 6-Week Abortion Bans “Heartbeat” Bills. Here’s Why.

What You Need to Know About the Wave of Unconstitutional Abortion Bans in the States

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Abortion Law and Policy Around the World

Marge berer.

International coordinator of the International Campaign for Women’s Right to Safe Abortion, London, UK, and was the editor of Reproductive Health Matters , which she founded, from 1993 to 2015.

The aim of this paper is to provide a panoramic view of laws and policies on abortion around the world, giving a range of country-based examples. It shows that the plethora of convoluted laws and restrictions surrounding abortion do not make any legal or public health sense. What makes abortion safe is simple and irrefutable—when it is available on the woman’s request and is universally affordable and accessible. From this perspective, few existing laws are fit for purpose. However, the road to law reform is long and difficult. In order to achieve the right to safe abortion, advocates will need to study the political, health system, legal, juridical, and socio-cultural realities surrounding existing law and policy in their countries, and decide what kind of law they want (if any). The biggest challenge is to determine what is possible to achieve, build a critical mass of support, and work together with legal experts, parliamentarians, health professionals, and women themselves to change the law—so that everyone with an unwanted pregnancy who seeks an abortion can have it, as early as possible and as late as necessary.

Toward a definition of decriminalization of abortion

In simple terms, the decriminalization of abortion means removing specific criminal sanctions against abortion from the law, and changing the law and related policies and regulations to achieve the following:

• not punishing anyone for providing safe abortion,
• not punishing anyone for having an abortion,
• not involving the police in investigating or prosecuting safe abortion provision or practice,
• not involving the courts in deciding whether to allow an abortion, and
• treating abortion like every other form of health care—that is, using best practice in service delivery, the training of providers, and the development and application of evidence-based guidelines, and applying existing law to deal with any dangerous or negligent practices.

Some history

Abortion was legally restricted in almost every country by the end of the nineteenth century. The most important sources of such laws were the imperial countries of Europe—Britain, France, Portugal, Spain, and Italy—who imposed their own laws forbidding abortion on their colonies.

According to the United Nations Population Division’s comprehensive website on abortion laws, legal systems under which abortion is legally restricted fall into three main categories, developed mostly during the period of colonialism from the sixteenth century onward:

• common law: the UK and most of its former colonies—Australia, Bangladesh, Canada, India, Ireland, Malaysia, New Zealand, Pakistan, Singapore, the United States, and the Anglophone countries of Africa, the Caribbean, and Oceania;
• civil law: most of the rest of Europe, including Belgium, France, Portugal, Spain, and their former colonies, Turkey and Japan, most of Latin America, non-Anglophone sub-Saharan Africa, and the former Soviet republics of Central and Western Asia. In addition, the laws of several North African and Middle Eastern countries have been influenced by French civil law; and
• Islamic law: the countries of North Africa and Western Asia and others with predominantly Muslim populations, and having an influence on personal law, for example, Bangladesh, Indonesia, Malaysia, and Pakistan. 1

Historically, restrictions on abortion were introduced for three main reasons:

• Abortion was dangerous and abortionists were killing a lot of women. Hence, the laws had a public health intention to protect women—who nevertheless sought abortions and risked their lives in doing so, as they still do today if they have no other choice.
• Abortion was considered a sin or a form of transgression of morality, and the laws were intended to punish and act as a deterrent.
• Abortion was restricted to protect fetal life in some or all circumstances.

Since abortion methods have become safe, laws against abortion make sense only for punitive and deterrent purposes, or to protect fetal life over that of women’s lives. While some prosecutions for unsafe abortions that cause injury or death still take place, far more often existing laws are being used against those having and providing safe abortions outside the law today. Ironically, it is restrictive abortion laws—leftovers from another age—that are responsible for the deaths and millions of injuries to women who cannot afford to pay for a safe illegal abortion.

This paper provides a panoramic view of current laws and policies on abortion in order to show that, from a global perspective, few of these laws makes any legal or public health sense. The fact is that the more restrictive the law, the more it is flouted, within and across borders. Whatever has led to the current impasse in law reform for women’s benefit—whether it is called stigma, misogyny, religion, morality, or political cowardice—few, if any, existing laws on abortion are fit for purpose.

Efforts to reform abortion law and practice since 1900

The first country to reform its abortion law was the Soviet Union, spurred by feminist Alexandra Kollantai, through a decree on women’s health care in October 1920. 2 Since then, progressive abortion law reform (the kind that benefits women) has been justified on public health and human rights grounds, to promote smaller families for population and environmental reasons, and because women’s education and improved socioeconomic status have created alternatives to childbearing. Perhaps most importantly, controlling fertility has become both technically feasible and acceptable in almost all cultures today. Yet despite 100 years of campaigning for safe abortion, the use of contraception has been completely decriminalized while abortion has not.

Abortion is one of the safest medical procedures if done following the World Health Organization’s (WHO) guidance. 3 But it is also the cause of at least one in six maternal deaths from complications when it is unsafe. 4 In 2004, research by WHO based on estimates and data from all countries showed that the broader the legal grounds for abortion, the fewer deaths there are from unsafe abortions. 5 In fact, the research found that there are only six main grounds for allowing abortion apply in most countries:

• ground 1 – risk to life
• ground 2 – rape or sexual abuse
• ground 3 – serious fetal anomaly
• ground 4 – risk to physical and sometimes mental health
• ground 5 – social and economic reasons
• ground 6 – on request

With each additional ground, moving from ground 1 to 6, the findings show that the number of deaths falls. Countries with almost no deaths from unsafe abortion are those that allow abortion on request without restriction.

This is proof that that the best way to consign unsafe abortion to history is by removing all legal restrictions and providing universal access to safe abortion. But the question remains, how do we get from where things are now to where they could (and should) be?

Attempts to move from almost total criminalization to partial (let alone total) decriminalization of abortion have been slow and fraught with difficulties. Why? Because the best way to control women’s lives is through (the risk of) pregnancy. The traditional belief that women should accept “all the children God gives,” the recent glorification of the fetus as having more value than the woman it is dependent on, and male-dominated culture are all used extremely effectively to justify criminal restrictions. Nevertheless, the need for abortion is one of the defining experiences of having a uterus.

Globally, 25% of pregnancies ended in induced abortion in 2010–2014, including in countries with high rates of contraceptive prevalence. 6 Increasingly, thanks to years of effective campaigning, more and more women are defending the need for abortion, as well as the right to a safe abortion—and access to it if and when they need it. Moreover, a growing number of governments, in both the Global North and more recently the Global South, have begun to acknowledge that preventing unsafe abortions is part of their commitment to reducing avoidable maternal deaths and their obligations under international human rights law.

While some people still wish that this could be achieved through a higher prevalence of contraceptive use or post-abortion care alone, the facts are against it. Those facts include both the occurrence of contraceptive failure among those who do use a method and the failure to use contraception, both of which are common events and sexual behaviors.

The role of international human rights bodies in calling for law reform

A new layer of involvement in advocacy for safe abortion, based on an analysis of how existing laws affect women and girls and whether they meet international human rights standards, has emerged in recent years. United Nations human rights bodies—including the Human Rights Committee, the Committee on the Elimination of Discrimination against Women, the Committee on Economic, Social and Political Rights, the Working Group on discrimination against women in law and practice, and the Special Rapporteurs on the right to the highest attainable standard of health, the rights of women in Africa, and torture—have played an increasingly visible role in calling for progressive abortion law reform. 7

Regional bodies such as the Inter-American Court of Human Rights, the European Court of Human Rights, and the African Commission on Human and Peoples’ Rights (ACHPR) have been very active in this regard as well. The ACHPR called in January 2016 for the decriminalization of abortion across Africa, in line with the Maputo Protocol, and renewed that call in January 2017, making waves across the region. 8

Legalize or decriminalize: What’s in a word?

Interestingly, no human rights body has gone so far as to call for abortion to be permitted at the request of the woman, yet many have called for abortion to be decriminalized. This raises the question of what is understood in different quarters by the term “decriminalization.”

For many years, the abortion rights movement internationally has called for “safe, legal abortion.” More recently, calls for the “decriminalization of abortion” have also emerged. Do these mean the same thing? In simplistic terms, they might be differentiated like this: legalizing abortion means keeping abortion in the law in some form by identifying the grounds on which it is allowed, while decriminalizing abortion means removing criminal sanctions against abortion altogether.

In that sense, abortion is legal on one or more grounds (mostly as exceptions to the law) in all but a few countries today, while Canada stands out as the only country to date that, through a Supreme Court decision in 1988, effectively decriminalized abortion altogether. 9 No other country, no matter how liberal its law reform, has been willing to take abortion completely out of the law that delimits it.

However, this distinction is often not what is meant. Instead, the two terms are used interchangeably—that is, abortion may be legalized or decriminalized on some or all grounds. No one is likely to be able to change this lack of differentiation in terminology. Nevertheless, it is crucial when recommending abortion law reform to be clear what exactly is and is not intended. I will come back to this later in the paper, after exploring the complexity of the changes being called for, no matter which of the two terms is used.

The law on abortion in countries today

Criminal restrictions on the practice of abortion are contained in statute law—in other words, laws passed by legislatures, sometimes as part of criminal or penal codes, which consolidate a group of criminal statutes. In the UK, for example, abortion was criminalized in sections 58 and 59 of the Offences against the Person Act of 1861, with one aspect further defined in the Infant Life Preservation Act of 1929, and then allowed on certain grounds and conditions in Great Britain (but not Northern Ireland) in the 1967 Abortion Act, which was then amended further in the Human Fertilisation and Embryology Act of 1990. In the 1967 Abortion Act, legal grounds for abortion are set out as exceptions to the criminal law, yet the 1861 act is still in force and still being used to prosecute illegal abortions today. 10

Ireland, formerly a part of the UK, was also subject to the 1861 Offences against the Person Act and revoked sections 58–59 only in the Protection of Life during Pregnancy Act of 2013, which imposed its own almost total criminalization of abortion. 11 Sierra Leone, a former British colony, also revoked the 1861 Offences against the Person Act in the Safe Abortion Act, passed in December 2015 and again a second time unanimously in February 2016. That act allows abortion on request during the first 12 weeks of pregnancy, and until week 24 in cases of rape, incest, or risk to health of the fetus or the woman or girl, but it was not finally signed into law. 12

At the end of the twentieth century, abortion was legally permitted to save the life of the woman in 98% of the world’s countries. 13 The proportion of countries allowing abortion on other grounds was as follows: to preserve the woman’s physical health (63%); to preserve the woman’s mental health (62%); in case of rape, sexual abuse, or incest (43%); fetal anomaly or impairment (39%); economic or social reasons (33%); and on request (27%).

The number of countries in 2002 that permitted each of these grounds varied greatly by region. Thus, abortion was permitted upon request in 65% of developed countries but only 14% of developing countries, and for economic and social reasons in 75% of developed countries but only 19% of developing countries. 14 Some countries permit additional grounds for abortion, such as if the woman has HIV, is under the age of 16 or over the age of 40, is not married, or has many children. A few also allow it to protect existing children or because of contraceptive failure. 15

These percentages, published in 2002, are out of date, but they have not changed dramatically. In late 2017, research updating the world’s laws on abortion and adding new information about related policies, conducted under the aegis of the Department of Reproductive Health and Research/Human Reproductive Programme at WHO, will be incorporated into the United Nations Population Division’s website. 16

Regulating abortion

There is much more to this story, however. In addition to statute law, other ways to liberalize, restrict, or regulate access to abortion, which also have legal standing, include the following:

• national constitutions in at least 20 countries, such as the Eighth Amendment to the Constitution (1983) in Ireland;
• supreme court decisions, such as in the United States (1973, 2016), Canada (1988), Colombia (2006), and Brazil (2012), as well as higher court decisions, such as in India (2016, 2017) allowing individual women abortions beyond the 20-week upper limit;
• customary or religious law, such as interpretations of Muslim law that allow abortion up to 120 days in Tunisia and the United Arab Emirates but do not allow abortion at all in other majority Muslim countries;
• regulations that require confidentiality on the part of health professionals on the one hand, but on the other hand require health professionals to report a criminal act they may learn of, for example, while providing treatment for complications of unsafe abortion;
• medical ethical codes, which, for example, allow or disallow conscientious objection; and
• clinical and other regulatory standards and guidelines governing the provision of abortion, such as reporting guidelines, disciplinary procedures, parental or spousal consent, and restrictions on which health professionals may provide abortions and where, who may approve an abortion, and which methods may be used—as adjuncts to (though not always formally part of) the law.

Reed Boland has found that the distinction between laws and regulations governing abortion is not always clear and that some countries, usually those where abortion laws are highly restrictive, have issued no regulations at all. In the most complex cases, there are multiple texts over many years which may contain conflicting provisions and obscure and outdated language. The upshot may be that no one is sure when abortion is actually allowed and when it isn’t, which may serve to stop it being provided safely and openly at all. 17

Uganda is a case in point. According to a recently published paper by Amanda Cleeve et al., Uganda’s Constitution and Penal Code conflict with each other, leading to ambiguous interpretations and lack of awareness of the fact that abortion is legal to protect women’s health and life. Moreover, while Uganda has a national reproductive health policy, it is not supported in law and is not being implemented. In 2015, in order to clarify this situation, the minister of health and other stakeholders developed Standards and Evidence-based Guidelines on the Prevention of Unsafe Abortion . These included details of who can provide abortions, and where and how, and assigned health service responsibilities, such as level of care and post-abortion care. However, the guidelines were withdrawn in January 2016 due to religious and political opposition. 18

Post-abortion care to treat the consequences of unsafe abortions has been instituted since it was approved in the International Conference on Population and Development’s Programme of Action in 1994, in countries where there was little or no prospect of law reform, as a stopgap measure, to save lives. But this has not been a success in African countries such as Tanzania, where, under the 1981 Revised Penal Code, it remains unclear whether abortion is legal to preserve a woman’s physical or mental health or her life, and where 16% of maternal deaths are still due to unsafe abortions. 19 Although the government has tried to expand the availability of post-abortion care, a 2015 study found that “significant gaps still existed and most women were not receiving the care they needed.” 20 In early 2016, according to a CCTV-Africa report, the newly appointed prime minister, in tandem with the president, threatened to dismiss and possibly imprison doctors performing illegal abortions following recent reports of doctors in both public and private hospitals accepting payments for doing abortions and a reported increase in cases of complications. 21

Sometimes, other laws unrelated to abortion create barriers. In Morocco, the abortion law was established in 1920 when Morocco was a French protectorate. In May 2015, following a public debate arising from reports of women’s deaths from unsafe abortion, a reform process to expand legal protections was initiated by a directive of the king. According to the Moroccan Family Planning Association, despite a consensus that abortion should be permitted within the first three months if the woman’s physical and mental health is in danger, and in cases of rape, incest, or congenital malformation, unmarried women would be excluded because it is illegal to have sex outside marriage. 22

In India, a very liberal abortion law for its day was passed in 1971, but it has been poorly and unevenly implemented, such that high rates of morbidity and mortality persist to this day. 23 Even 15 years ago, the process for clinic registration as an approved abortion provider was arduous, limiting the number of clinics. 24 Moreover, two other laws have led to restrictions on abortion access: the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, which forbids ultrasound for purposes of sex determination and has led to restrictions on all second-trimester abortion provision, and the Protection of Children from Sexual Offences Act, which requires reporting of underage sex, so that minors who become pregnant cannot feel safe if they seek an abortion. 25

Restricting abortion without changing the law

Decent laws and policies can be sabotaged and access to abortion can be restricted without amending the law itself, but instead through policies pressuring women to have more children, public denunciation of abortion by political and religious leaders, or restricting access to services. Bureaucratic obstacles may be placed in women’s paths, such as requiring unnecessary medical tests, counselling even if women feel no need for it, having to get one or more doctors’ signatures, having to wait between making an appointment and having an abortion, or having to obtain consent from a partner, parent(s) or guardian, or even a judge.

In Turkey, for example, in 1983, in response to population growth, the government passed a law allowing fertility regulation, termination of pregnancy on request up to 10 weeks after conception, and sterilization. A married woman seeking an abortion was required only to obtain her husband’s permission or submit a formal statement of assumption of all responsibility prior to the procedure. 26 In recent years, however, President Erdogan has taken a pronatalist stance and urged Turkish couples to have at least three children. Since 2012, he has been calling abortion murder, expressing opposition to the provision of abortion services and threatening to restrict the law. Women protested against these threats in such large numbers in 2012 that to date there have been no changes to the law itself. But administrative changes were made in order to make the procedure for booking an appointment for an abortion—which is still primarily provided by gynecologists in hospitals—more difficult.

These changes have made it nearly impossible to obtain an abortion in a state hospital; indeed, some state hospitals have stopped providing abortions altogether. Although comparative data are not available, a 2016 study found that of 431 state hospitals with departments of obstetrics and gynecology, only 7.8% provided abortions without restriction as to reason, 78% provided abortions only if there was a medical necessity, and 11.8% did not provide abortions at all. Of the 58 teaching and research hospitals with departments of obstetrics and gynecology, only 17.3% provided abortion services without restriction as to reason, 71.1% only if there was a medical necessity, and 11.4% not at all. Overall, 53 of 81 provinces in Turkey did not have a state hospital that provided abortions without restriction as to reason, although this is permitted under the law. 27

Thus, the availability of safe abortion depends not only on permissive legislation but also on a permissive environment, political support, and the ability and willingness of health services and health professionals to make abortion available. In contrast to Turkey, Ethiopia is an example of the success of that support.

Law reform for the better—slowly but surely

In 2005, Ethiopia liberalized its abortion law. Previously, abortion was allowed only to save the life of the woman or protect her physical health. The current law allows abortion in cases of rape, incest, or fetal impairment, as well as if the life or physical health of the woman is in danger, if she has a physical or mental disability, or if she is a minor who is physically or mentally unprepared for childbirth. 28 This is a liberal law for sub-Saharan Africa, but for a long time, little was known about the extent of its implementation. In 2006, the government published national standards and guidelines on safe abortion that permitted the use of misoprostol, with or without mifepristone, in accordance with WHO guidance. A nationwide study in 2008 by the Guttmacher Institute estimated that within a few years, 27% of abortions were legal, though most abortions were still unsafe.

A 2011 study by Jemila Abdi and Mulugeta Gebremariam found that Ethiopian health care providers’ reasons for not providing abortions were mainly personal or due to lack of permission from an employer or the unavailability of services at their facility. Only 27% felt comfortable working at a site where abortion was provided. Reasons for not being comfortable were mainly religious, but also included personal values and a lack of training. Although 29% thought it should be a woman’s choice to have an abortion, 55% disagreed. The study also uncovered a lack of medical equipment and trained personnel, and bureaucratic problems at clinical sites. 29

Even so, major efforts were and are still being made to improve access at the primary level by constructing more health centers and training more mid-level providers. Between 2008 and 2014, the proportion of abortions provided in health facilities almost doubled. In 2014, almost three-fourths of facilities that could potentially provide abortions or post-abortion care did so, including 67% of the 2,600 public health centers nationwide, 80% of the 1,300 private or nongovernmental facilities, and 98% of the 120 public hospitals. The proportion of all abortion-related services provided by mid-level health workers increased from 48% in 2008 to 83% in 2014. While a substantial number of abortions continue to occur outside of health facilities, the proportion is falling, showing that change is possible but also that it takes time. 30

In recent decades in Latin America, a combination of legal reforms, court rulings, and public health guidelines have improved access to safe abortion for women. 31 These include allowing abortion on request in the first trimester of pregnancy, as in Mexico City (since 2007), and in Uruguay (since 2012). In Argentina, Bolivia, Brazil, Colombia, and Costa Rica, higher courts have been instrumental in interpreting the constitutionality and scope of specific grounds for abortion, though their judgments are not always implemented. In countries such as Peru, guidelines issued by hospitals or by governments at federal or state levels govern the enforcement of permitted grounds. 32 Additional steps needed constitute a huge task, as Ethiopia has shown—training providers and ensuring that services provide legal abortions, as well as informing women that these changes are taking place and that services are available.

Self-use of medical abortion in the absence of law and policy reform

In other Latin American countries, abortion laws have remained highly restrictive in spite of campaigns for women’s sexual and reproductive rights and human rights for more than 30 years. As a result, and thanks to the advent of new technology, women have begun to take matters into their own hands. An uncounted number of women, probably in the millions, has been obtaining and using misoprostol to self-induce abortion (widely available for gastric ulcers) from a range of sources—pharmacies, websites, black market—since its abortifacient effectiveness was first discovered in the late 1980s. This practice, begun in Brazil, has spread to many other countries and regions. In response, legal restrictions and regulations on access to medical abortion pills have been imposed by countries such as Brazil and Egypt in an effort to stop the unstoppable.

Moreover, in the past decade, feminist groups have set up safe abortion information hotlines in at least 20 countries, and health professionals are providing information and access to abortion pills via telemedicine, including Women Help Women, Women on Web, safe2choose, the Tabbot Foundation in Australia, and TelAbortion in the United States. 33

In Uruguay, which has hospital-based outpatient abortion care, Lilian Abracinskas, executive director of Mujer y Salud en Uruguay, said in a recent interview, “ In Uruguay, we don’t have doctors who do abortions. Abortion with pills is the only way and it isn’t possible to choose another method, such as manual vacuum aspiration. Health professionals are willing to be involved before and after, but not in the abortion.” 34 Thus, abortion service delivery has been reduced to providing information, prescribing pills, and conducting a follow-up appointment if the woman has concerns. It can be that simple (although it does restrict access to aspiration and surgical methods).

Abortion law as a political football and a weapon against women

While the overall trend globally is toward more progressive laws, some countries where the rightwing has taken power have gone backward. In Chile, from 1931 to 1989, the law allowed abortion on therapeutic grounds, described in the Penal Code as “termination of a pregnancy before the fetus becomes viable for the purpose of saving the mother’s life or safeguarding her health.” Pinochet, the dictator who overthrew the Allende government, banned abortion in 1989 as he left office, leaving no legal grounds at all. 35 It took until 2016 for Michelle Bachelet’s government, during her second term in office, to introduce a bill permitting three grounds for legal abortion—to save the woman’s life, in cases of rape or sexual abuse, and in cases of fatal fetal anomaly—which are more narrow than what was in place between 1931 and 1989 but are the best that its supporters think they can achieve today. 36

In Russia, the law has gone back and forth between permissive and restrictive with every change of political head of state. Stalin made abortion illegal when he took over from Lenin, and then after 1945, abortion was again permitted on broad grounds across the Soviet Union and in its satellite countries in Eastern Europe and West Asia, while under Vladimir Putin a long list of restrictions has been imposed, greatly reducing the number of grounds on which abortion is permitted. In January 2016, a bill aiming to “rule out the uncontrolled use of pharmaceutical drugs destined for termination of pregnancy” was tabled in parliament. It would have banned retail sales and limited the list of organizations permitted to buy medical abortion pills wholesale. It would also have banned abortions in private clinics and removed payment for them from state insurance policies. And it would not have allowed abortions to be covered by state health care unless the pregnancy threatened the woman’s life. The bill was withdrawn after strong public protest that was coordinated by the Russian Association for Population and Development; however, attempts at further restriction are likely to continue. 37

In a number of Central and Eastern European countries, the backlash against communist rule and the increasing influence of conservative religious figures has led to regular attempts to undermine permissive abortion laws. Poland has had the worst of it. In 1993, a liberal law was replaced by a very restrictive law that removed “difficult living conditions” as a legal ground for abortion, leaving only three grounds: serious threat to the life or health of the pregnant woman, as attested by two physicians; cases of rape or incest if confirmed by a prosecutor; and cases in which antenatal tests, confirmed by two physicians, demonstrated that the fetus was seriously and irreversibly damaged. 38 This law, in spite of an attempt to ban all abortions in 2016, remains in place due to months of national action by women’s groups, including a national women’s strike on October 3, 2016. However, in November 2016, the government approved a regulation offering pregnant women carrying a seriously disabled or unviable fetus a one-time payment of €1,000 to carry the pregnancy to term, even if the baby would be born dead or die soon after delivery. The package includes access to hospice and medical care, psychological counselling, baptism or a blessing and burial, and a person who will act as an “assistant to the family” and coordinate the support. The purported aim was to reduce the number of legal abortions on grounds of fetal anomaly. 39 This horrendous proposal, nasty anti-abortion propaganda, and systematic pressure on hospitals in Poland to stop doing abortions on medical grounds exemplify the right-wing extremism of the anti-abortion movement today, whose epicenter is in the United States and whose war on women sometimes feels relentless. 40

But this is not stopping women from having abortions.

Keeping laws and policies that benefit women in clear sight

Cuba was the first country in Latin America and the Caribbean to reform its abortion law in favor of women, with a law that remains unique. Since 1965, abortion has been available on request up to the tenth week of pregnancy through the national health system. The Penal Code, adopted in 1979, says that an abortion is considered illegal only if it is without the consent of the pregnant woman, is unsafe, or is provided for profit. 41

In Japan, the law allowing abortion, enacted in 1948, was initially based on eugenics but was a liberal law in practice. Under this law, abortion became the primary mode of birth control in the country. The law was reformed in 1996 to omit all references to eugenics. Abortion is now permitted to protect health, which includes socioeconomic reasons, and in cases of sexual offenses. Abortion was and remains the main form of fertility control. The great majority of abortions fall under the health protection indication. Nearly all abortions are in the first trimester. 42

In recent years in some countries, laws to legalize abortion are found in public health statutes, court decisions, and policies and regulations on sexual and reproductive health care, rather than as part of the criminal law. Uruguay’s 2012 law is an example of public health legislation that sets out procedures and health care standards for the provision of abortion services. 43

In December 2014, the parliament of Luxembourg voted to remove abortion from the Penal Code up to 12 weeks of pregnancy and said that the woman no longer had to show she was “in distress” due to her pregnancy. Regulations on who can provide abortions were also revised. 44 In France, in 2014, 2015, and 2016, the 1975 Veil Law was reformed to increase access to abortion and reduce barriers. Women no longer have to be in a “state of distress” in France either, but need only request an abortion. The required seven-day “reflection period” between the request for an abortion and the abortion itself was also dropped. Most recently, midwives are now permitted to provide medical abortion, and the costs for all abortions are now reimbursed. 45

Sweden’s law is among the most liberal, though abortion is not entirely decriminalized. The Swedish law was amended in 1938, 1946, 1963, 1975, 1995, 2007, and 2008. Abortion is available on request up to 18 weeks. After that, permission from the National Board of Health and Welfare is required and may not be granted if the fetus is viable. Appeal is not permitted. Regulations govern who provides abortions and where. Any person not authorized to practice medicine who performs an abortion on another person can be fined or imprisoned for up to a year. Abortion is subsidized by the government; 95% of abortions take place before 12 weeks, and almost none after 18 weeks. Most are medical abortions. 46

In Australia, each state and the Capital Territory have a different law, ranging from very liberal to very restrictive; several are in the process of change. 47 In the United States in 1973, the Supreme Court held that criminalizing abortion violated a woman’s right to privacy and said that abortion should be a decision between a woman and her doctor. However, the court also held that US states have an interest in ensuring the safety and well-being of pregnant women, as well as the potential of human life. This opened a door to restrictions that become greater as pregnancy progresses, opening a Pandora’s box for states to impose restrictions that are tying up state and federal courts to this day:

• first trimester: a state cannot regulate abortion beyond requiring that the procedure be performed by a licensed doctor in medically safe conditions;
• second trimester: a state may regulate abortion if the regulations are reasonably related to the health of the pregnant woman; and
• third trimester: the state’s interest in protecting the potential human life outweighs the woman’s right to privacy, and the state may prohibit abortions unless abortion is necessary to save her life or health. 48

It is impossible not to think that no law is the best law when it comes to abortion, which brings us back to Canada, where abortion has not been restricted since 1988 and is available on request with no stipulations as to who must provide it or where. 49 Although abortion is not easily accessible in remote areas, and Canada was exceedingly slow to approve mifepristone, 50 opposition to abortion has never developed a foothold. The benefits for women of having no law are crystal clear. 51

Legalization or decriminalization: Closing the circle

Although recent calls for the decriminalization of abortion by human rights bodies, politicians, and some feminist groups aim to decriminalize only certain grounds and conditions related to abortion, these are far better than nothing. Thus, in Chile, El Salvador, Honduras, and Peru, where abortion is severely legally restricted, calls to “decriminalize abortion” include only three to four grounds—to protect the life and health of the woman, in cases of severe or fatal fetal anomalies, and as a result of rape or sexual abuse. While the great majority of abortions are not for these reasons, they are the only grounds that stand a chance of achieving majority approval through law reform in settings where “everything” is simply not in the cards.

In Africa, the Maputo Protocol is legally binding on the 49 states that have ratified it. The 2016 call by the ACHPR for the decriminalization of abortion across Africa is based on the Maputo Protocol, which calls for safe abortion to be authorized by states “in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the fetus.” 52 However, in January 2017, at the African Leaders’ Summit on Safe and Legal Abortion, the ACHPR went further, calling for safe, legal abortion as a human right, which by any definition surely exceeds the Maputo Protocol’s boundaries. 53

At bottom, the extent of decriminalization aimed for is a choice between the ideal and the practicable, and reflects the extent to which abortion is seen as a bona fide form of health care—not just by advocates for the right to safe abortion but also by politicians, health professionals, the media, and the public. The fact that abortion is still legally restricted in almost all countries is not just a historical legacy but indicative of the continuing ambivalence and negativity about abortion in most societies, no matter how old or where the law originally came from.

Some abortion rights supporters seem to have an underlying fear that without leaving something in the criminal law, “bad things” may start to happen. Canada proves this is not the case. Granted, not everywhere is Canada. But there are general criminal laws that allow the punishment of wrongdoing—such as forcing a woman to have an abortion against her will, giving her medical abortion pills without her knowledge, or causing injury or death through a dangerous procedure. These are laws against grievous bodily harm, assault, or manslaughter, which can be applied without the need for a criminal statute on abortion.

Changing the law to benefit women

Successfully changing the law on abortion is the work of years. Advocates do not get a lot of chances to change the law and need to decide what they want to end up with before campaigning for it, with the confidence that whatever they propose has a chance of being implemented. Another chance may not come again soon.

Allies are crucial. Most important are parliamentarians, health professionals, legal experts, women’s groups and organizations, human rights groups, family planning supporters—and above all, women themselves. Achieving a critical mass of support among all these groups is key to successful law reform, as is defeating the opposition, which can have an influence beyond its numbers.

Those unable to contemplate no law at all must confront the fact that each legal ground for abortion may be interpreted liberally or narrowly, and thereby implemented differently in different settings, or may not be implemented at all. The challenge is to define which abortions should remain criminal and what the punishment should be. Even if only some grounds would be considered acceptable, the question of who decides and on what basis remains when reforming existing law.

Wording becomes critical to supporting good practice. For example, grounds which are based on risk are particularly tricky. The definition of “risk” is itself complex, and the extent of risk may be hedged with uncertainty. Risk to the woman’s life, health, or mental health and risk of serious fetal anomaly have been subjected to challenge and disagreement among professionals. As Christian Fiala, head of the Gynmed Ambulatorium in Austria, has noted, “There is only one way to be sure a woman’s life is at risk, that is—after she dies.” 54

Reed Boland explores the importance of wording in depth with regard to the health ground for abortion:

The wording of [the health] indication varies greatly from country to country, particularly given the range of languages and legal traditions involved. Sometimes … there must be a risk to health. Great Britain’s law, for example … allows abortion where “continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman …” Sometimes … there must be a danger to health. Burkina Faso’s Penal Code permits abortions when “continuation of the pregnancy … endangers the health of the woman …” And in some countries there must only be medical or health reasons. In Vanuatu, there must be “good medical reasons”, in Djibouti “therapeutic reasons”, and in Pakistan a requirement of “necessary treatment”. These concepts are not necessarily the same. 55

Legislating on second-trimester abortions presents particular difficulties. Many laws say little or nothing about second-trimester abortions, which has a proscriptive effect. Second-trimester abortions constitute an estimated 10–15% of abortions globally, but as many as 25% in India and South Africa due to poor access to services. When they are unsafe, they account for a large proportion of hospital admissions for treatment of complications and are responsible for a disproportionate number of deaths. Hence, the law should protect second-trimester abortions assiduously. Yet social disapproval of these abortions can run high, and laws tend to be increasingly restrictive as pregnancy progresses, even laws that are liberal with regard to the first trimester. The mistaken belief that second-trimester abortions can be legislated away persists, despite the facts. 56

Restrictive abortion laws are being broken on a daily basis by millions of women and numerous abortion providers. Even in countries where the law is less restrictive, research shows that the letter of the law is being stretched in all sorts of ways to accommodate women’s needs. Yet opposition and a stubborn unwillingness to act continue to hamper efforts to meet women’s need for abortion without restrictions.

Conclusions

It should be clear that the plethora of convoluted laws and restrictions on abortion do not make any legal or public health sense. What makes abortion safe is simple and irrefutable—when it is available on the woman’s request and universally affordable and accessible. From this perspective, few existing laws are fit for purpose but merely repeat every possible permutation of the self-same restrictions.

The aim of this paper was not to provide answers or roadmaps, because in every country prevailing conditions must be taken into account. The aim was to motivate transformative thinking about whether any criminal law on abortion is necessary. Treating abortion as essential health care is a major step forward, and where the national setting insists on some sort of law, advocates could draft the simplest, most supportive law possible, placing first-trimester abortion care at the primary and community level, ensuring second-trimester services, involving mid-level providers, increasing women’s awareness of services and the law, aiming for universal access, integrating WHO-approved methods, and addressing social attitudes to reduce opposition. Space did not permit me to raise the issues of cost and public versus private services, but they are two major aspects that deserve priority consideration.

If it were up to me, all criminal sanctions against abortion would be revoked, making abortion available at the request of the only person who counts—the one who is pregnant. And as with all pregnancy care, abortion would be free at the point of care and universally accessible from very early on in pregnancy.

Canada has proved that no criminal law is feasible and acceptable. Sweden has proved that abortions after 18 weeks can effectively disappear with very good services, and WHO has shown that first-trimester abortions can be provided safely and effectively at the primary and community level by trained mid-level providers and provision of medical abortion pills by trained pharmacy workers. Finally, web- and phone-based telemedicine services are showing that clinic-based services are not required to provide medical abortion pills safely and effectively.

But to achieve these goals, or something close to them, it takes a strong and active national coalition, a critical mass of support, and—with luck and knowing what the goalposts are—less than 100 years of campaigning to make change happen on the ground.

Acknowledgments

This paper began as a presentation on the decriminalization of abortion at the FIAPAC Conference in Lisbon on October 13, 2016. I would like to thank the following individuals for information presented there that enriched this paper: Angela Dawson (information on Australia), Hamida Nkata (information on Tanzania), S. Sinan Ozalp (information on Turkey), Emily McLean (information on Ethiopia), Amanda Cleeve (information on Uganda), Joyce Arthur (information on Canada), and Amanda Huber (information on Laos). Much of the recent country-based information here was gleaned during my editing of the International Campaign for Women’s Right to Safe Abortion newsletter. 57 Many thanks to Sally Sheldon and Kinga Jelinska for helpful comments on a previous draft. Any errors are my own.

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Supreme Court rejects bid to restrict access to abortion pill

In a blow for anti-abortion advocates, the  Supreme Court  on Thursday rejected a challenge to the abortion pill mifepristone , meaning the commonly used drug can remain widely available.

The court  found unanimously  that the group of anti-abortion doctors who questioned the Food and Drug Administration’s decisions making it easier to access the pill did not have legal standing to sue. 

President Joe Biden said in a statement that while the ruling means the pill can remain easily accessible, “the fight for reproductive freedom continues” in the aftermath of the Supreme Court’s ruling two years ago that overturned abortion rights landmark Roe v. Wade.

“It does not change the fact that the right for a woman to get the treatment she needs is imperiled if not impossible in many states,” he added.

Justice Brett Kavanaugh, writing for the court, wrote that while plaintiffs have “sincere legal, moral, ideological, and policy objections to elective abortion and to FDA’s relaxed regulation of mifepristone,” that does not mean they have a federal case.

The plaintiffs failed to show they had suffered any injury, meaning that “the federal courts are the wrong forum for addressing the plaintiffs’ concerns about FDA’s actions,” he added.

“The plaintiffs may present their concerns and objections to the president and FDA in the regulatory process or to Congress and the president in the legislative process,” Kavanaugh wrote. “And they may also express their views about abortion and mifepristone to fellow citizens, including in the political and electoral processes.”

The legal challenge was brought by doctors and other medical professionals represented by the conservative Christian legal group Alliance Defending Freedom.

“We are disappointed that the Supreme Court did not reach the merits of the FDA’s lawless removal of commonsense safety standards for abortion drugs,” said Erin Hawley, one of the group’s lawyers. She told reporters she is hopeful the underlying lawsuit can continue because three states — Idaho, Missouri and Kansas — have brought their own claims and have different arguments for standing.

By throwing out the case on such grounds, the court avoided reaching a decision on the legal merits of whether the FDA acted lawfully in lifting various restrictions, including one making the drug obtainable via mail, meaning the same issues could yet return to the court in another case.

Another regulatory decision left in place means women can still obtain the pill within 10 weeks of gestation instead of seven. 

Likewise a decision to allow health care providers other than physicians to dispense the pill will remain in effect.

The court’s decision to roll back abortion rights two years ago led to a wave of new abortion restrictions in conservative states.

Then, the court suggested it was removing itself from the political debate over abortion, but with litigation continuing to rage over abortion access, the justices are continuing to play a pivotal role. 

Abortion rights supporters welcomed the ruling, with Nancy Northup, president of the Center for Reproductive Rights, saying she was relieved at the outcome but angered about the case lingering in the court system so long.

“Thank goodness the Supreme Court rejected this unwarranted attempt to curtail access to medication abortion, but the fact remains that this meritless case should never have gotten this far,” she said in a statement.

Danco Laboratories, manufacturer of Mifeprex, the brand version of mifepristone, praised the ruling too, saying it was good for the drug approval process writ large.

In rejecting the challenge, the court “maintained the stability of the FDA drug approval process, which is based on the agency’s expertise and on which patients, health care providers and the U.S. pharmaceutical industry rely,” company spokeswoman Abigail Long said.

Anti-abortion groups expressed disappointment, saying that the ruling highlighted the importance of this year’s election in which Democrat Biden, who has pledged to defend abortion rights, faces off against Republican Donald Trump, who has the strong backing of conservatives who oppose abortion.

“Joe Biden and the Democrats are hell-bent on forcing abortion on demand any time for any reason, including DIY mail-order abortions, on every state in the country,” Marjorie Dannenfeiser, president of SBA Pro-Life America, said.

If Trump were to win the election, his appointees to the FDA would be a position to impose new restrictions on mifepristone. Biden’s campaign manager, Julie Chavez-Rodriguez, alluded to the possibility in a call with reporters after the ruling. Calling the case “one tactic in a broader, relentless strategy” by anti-abortion activists, Chavez-Rodriguez said if Trump is elected, his advisers and allies would try to ban abortion nationwide “without the help of Congress or the court,” and also restrict access to contraception — a threat, she said, to blue as well as red states.

The mifepristone dispute is not the only abortion case currently before the court. It is also due to decide whether  Idaho’s strict abortion ban  prevents doctors in emergency rooms from performing abortions when a pregnant woman is facing dangerous complications.

Mifepristone is used as part of a two-drug FDA-approved regimen that is now the most common form of abortion in the United States.

Abortion is effectively banned altogether in 14 states, according to the Guttmacher Institute, a research group that backs abortion rights.

The FDA had the backing of the pharmaceutical industry, which has warned that any second-guessing of the approval process by untrained federal judges could  cause chaos and deter innovation.

Last year, Texas-based U.S. District Judge Matthew Kacsmaryk issued a sweeping ruling that completely invalidated the FDA’s approval of the pill, leading to panic among abortion-rights activists that it would be banned nationwide.

The Supreme Court last April put that ruling on hold, meaning the pill remained widely available while litigation continued.

The New Orleans-based 5th U.S. Circuit Court of Appeals in August then narrowed Kacsmaryk’s decision but left in place his conclusion that the FDA’s move to lift restrictions starting in 2016 was unlawful.

Both sides appealed to the Supreme Court. The court in December took up the Biden administration’s appeal in defense of the later FDA decisions, but it opted against hearing the challenge to the original approval of mifepristone in 2000. 

The Supreme Court focused solely on the later FDA action, including the initial 2021 decision that made the drug available by mail, which was finalized last year.

This article first appeared on NBCNews.com .

Lawrence Hurley covers the Supreme Court for NBC News Digital.

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Legalized Abortion and the Public Health: Report of a Study (1975)

Chapter: summary and conclusions.

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SUMMARY AND CONCLUSIONS The legal status of abortion in the United States became a heightened national issue with the January 1973 rulings by the Supreme Court that severely limited states' rights to control the procedure. The Court's decisions on the historic cases of Roe v. Wade and Doe v. Bolton precluded any state interference with the doctor-patient decision on abortion during the first trimester (three months) of pregnancy. During the second trimester, a state could intervene only to the extent of insisting on safe medical practices "reasonably related to maternal health." And for approximately the final trimester of a pregnancy—what the Court called "the state subsequent to viability" of a fetus—a state could forbid abortion unless medical judgment found it necessary "for the preservation of the life or health of the mother." The rulings crystallized opposition to abortion, led to the intro- duction of national and state legislation to curtail or prohibit it, and generated political pressures for a national debate on the issue. Against this background of concerns about abortion, the Institute of Medicine in 1974 called together a committee to review the existing evidence on the relationship between legalized abortion and the health of the public. The study group was asked to examine the medical risks to women who obtained legal abortions, and to document changes in the risks as legal abortion became more available. Although there have been other publications on particular relationships between abortion and health, the Institute's study is an attempt to enlist scholars, researchers, health practitioners, and concerned lay persons in a more comprehensive analysis of the available medical information on the subject. Ethical issues of abortion are not discussed in this analysis, nor are questions concerning the fetus in abortion. The study group recog- nizes that this approach implies an ethical position with which some may disagree. The emphasis of the study is on the health effects of abortion, not on the alternatives to abortion.

Abortion legislation and practices are important factors in the relationship between abortion and health status. In order to examine legislation and court decisions that have affected the availability of legal abortion in the U.S., the study group classified the laws and practices into three categories: restrictive conditions, under which abortion is prohibited or permitted only to save the pregnant woman's life; moderately restrictive conditions, under which abortion is per- mitted with approval by several physicians, in a wider range of circumstances to preserve the woman's physical or mental health, prevent the birth of a child with severe genetic or congenital defects, or terminate a pregnancy caused by rape or incest; and non-restrictive conditions, under which abortion essentially is available according to the terms of the Supreme Court ruling. Before 1967, all abortion laws in the United States could be classified as restrictive. Easing of restrictions began in 1967 with Colorado, and soon thereafter 12 other states also adopted moderately restrictive legislation to expand the conditions under which therapeutic abortion could be obtained. In 1970, four states (Alaska, Hawaii, New York, and Washington) removed nearly all legal controls on abortion. Non-restrictive conditions have theoretically existed throughout all fifty states since January 22, 1973, the date of the Supreme Court decision. There is evidence that substantial numbers of illegal abortions were obtained in the U.S. when restrictive laws were in force. Although some of the illegal abortions were performed covertly by physicians in medical settings, many were conducted in unsanitary surroundings by unskilled operators or were self-induced. In this report, "illegal abortion" generally refers to those performed by a non-physician or the woman herself. The medical risks associated with the last two types of illegal abortions are patently greater than with the first. A recent analysis of data from the first year of New York's non- restrictive abortion legislation indicates that approximately 70 percent of the abortions obtained legally in New York City would otherwise have been obtained illegally. Replacement of legal for illegal abortions also is reflected in the substantial decline in the number of reported complications and deaths due to other-than-legal abortions since non- restrictive practices began to be implemented in the United States. The number of all known abortion-related deaths declined from 128 in 1970 to 47 in 1973; those deaths specifically attributed to other-than-legal abortions (i.e., both illegal and spontaneous) dropped from 111 to 25 during the same period, with much of that decline attributed to a reduced incidence of illegal abortions. Increased use of effective con- traception may also have played a role in the decline of abortion-related deaths. Methods most frequently used in the United States to induce abortion during the first trimester of pregnancy are suction (vacuum aspiration) or dilatation and curettage (D&C). Abortions in the second trimester are usually performed by replacing part of the amniotic fluid that surrounds

the fetus with a concentrated salt solution (saline abortion), which usually induces labor 24 to 48 hours later. Other second trimester methods are hysterotomy, a surgical entry into the uterus; hysterectomy, which is the removal of the uterus; and, recently, the injection into the uterine cavity of a prostaglandin, a substance that causes muscular contractions that expel the fetus. Statistics on legal abortion are collected for the U.S. government by the Center for Disease Control. CDC's most recent nationwide data are for 1973, the year of the Supreme Court decision. Some of those figures are: — The 615,800 legal abortions reported in 1973 were an increase of approximately 29,000 over the number reported in 1972. These probably are underestimates of the actual number of abortions performed because some states have not yet developed adequate abortion reporting systems. — The abortion ratio (number of abortions per 1,000 live births) increased from 180 in 1972 to 195 in 1973. — More than four out of five abortions were performed in the first trimester, most often by suction or D&C. — Approximately 25 percent of the reported 1973 abortions were obtained outside the woman's home state. In 1972, before the Supreme Court decision, 44 percent of the reported abortions had been obtained outside the home state of the patient, primarily in New York and the District of Columbia. — Approximately one-third of the women obtaining abortions were less than 20 years old, another third were between 20 and 25, and the remaining third over 25 years of age. — In all states where data were available, about 25 percent of the women obtaining abortions were married. — White women obtained 68 percent of all reported abortions, but non-white women had abortion ratios about one-third greater than white women. In 1972, non-white women had abortion rates (abortions per 1,000 women of reproductive age) about twice those of whites in three states from which data were available to analyze. A national survey of hospitals, clinics, and physicians conducted in 1974 by The Alan Guttmacher Institute furnished data on the number of abortions performed in the U.S. during 1973, itemized by state and type of provider. A total of 745,400 abortions were reported in the survey, a figure higher than the 615,800 abortions reported in 1973 to CDC. The Guttmacher Institute obtains its data from providers of health services, while CDC gets most of its data from state health departments.

Risks of medical complications associated with legal abortions are difficult to evaluate because of problems of definition and subjective physician judgment. Available information from 66 centers is provided by the Joint Program for the Study of Abortion, undertaken by The Population Council in 1970-1971. The JPSA study surveyed almost 73,000 legal abortions. It used a restricted definition of major complications, which included unintended major surgery, one or more blood transfusions, three or more days of fever, and several other categories involving prolonged illness or permanent impairment. Although this study also collected data on minor complica- tions, such as one day of fever post-operatively, the data on major com- plications are probably more significant. The major complication rates published by the JPSA study and summarized below relate to women who had abortions in local facilities and from whom follow-up information was obtained. — Complications in women not obtaining concurrent sterilization and with no pre-existing medical problems (e.g., diabetes, heart disease, or gynecological problems) occurred 0.6 times per 100 abortions in the first trimester and 2.1 per 100 in the second trimester. — Complications in women not obtaining concurrent sterilization, but having pre-existing problems, occurred 2.0 times per 100 in the first trimester and 6.7 in the second. — Complications in women obtaining concurrent sterilization and not having pre-existing problems occurred 7.2 times per 100 in the first trimester and 8.0 in the second. — Women with both concurrent sterilization and pre-existing problems experienced complications approximately 17 times per 100 abortions regardless of trimester. The relatively high complication rates associated with sterilization in the JPSA study would probably be lower today because new sterilization techniques require minimal surgery and carry lower rates of complications. The frequency of medical complications due to illegal abortions cannot be calculated precisely, but the trend in these complications can be estimated from the number of hospital admissions due to septic and incomplete abortion—two adverse consequences of the illegal procedure.

The number of such admissions in New York City's municipal hospitals declined from 6,524 in 1969 to 3,253 in 1973; most restrictions on legal abortion in New York City were lifted in July of 1970. In Los Angeles, the number of reported hospital admissions for septic abortions declined from 559 in 1969 to 119 in 1971. Other factors, such as an increased use of effective contraception and a decreasing rate of unwanted pregnancies may have contributed to these declines, but it is probable that the introduction of less restrictive abortion legislation was a major factor. There has not been enough experience with legal abortion in the U.S. for conclusions to be drawn about long-term complications, particularly for women obtaining repeated legal abortions. Some studies from abroad suggest that long-term complications may include prematurity, miscarriage, or ectopic pregnancies in future pregnancies, or infertility. But research findings from countries having long experience with legal abortion are inconsistent among studies and the relevance of these data to the U.S. is not known; methods of abortion, medical services, and socio-economic characteristics vary from one country to another. Risks of maternal death associated with legal abortion are low—1.7 deaths per 100,000 first trimester procedures in 1972 and 1973—and less than the risks associated with illegal abortion, full-term pregnancy, and most surgical procedures. The 1973 mortality rate for a full-term pregnancy was 14 deaths per 100,000 live vaginal deliveries; the 1969 rate for cesarean sections was 111 deaths per 100,000 deliveries. For second trimester abortions, the combined 1972-73 mortality ratio was 12.2 deaths per 100,000 abortions. (For comparison, the surgical removal of the tonsils and adenoids had a mortality risk of five deaths per 100,000 operations in 1969). When the mortality risk of legal abortion is examined by length of gestation it becomes apparent that the mortality risks increase not only from the first to the second trimester, but also by each week of ges- tation. For example, during 1972-73, the mortality ratio for legal abortions performed at eight weeks or less was 0.5, and for those performed between nine and 10 weeks was 1.7 deaths per 100,000 legal abortions. At 11 to 12 weeks the mortality ratio increased to 4.2 deaths, and by 16 to 20 weeks, the ratio was more than 17 deaths per 100,000 abortions. Hysterotomy and hysterectomy, methods performed infrequently in both trimesters, had a combined mortality ratio of 61.3 deaths per 100,000 procedures. Some data on the mortality associated with illegal abortion are avail- lable from the National Center for Health Statistics (NCHS) and from CDC. In 1961 there were 320 abortion-related deaths reported in the U.S., most of them presumed by the medical profession to be from illegal abortion. By 1973, total reported deaths had declined to 47, of which 16 were specifi- cally attributed to illegal abortions. There has been a steady decline in the mortality rates (number of deaths per 100,000 women aged 15-44) associated with other-than-legal abortion for both white and non-white women, but in 1973 the mortality rate for non-white women (0.29) was almost ten times greater than that reported for white women (0.03).

Psychological effects of legal abortion are difficult to evaluate for reasons that include lack of information on pre-abortion psychological status, ambiguous terminology, and the absence of standardized measurements. The cumulative evidence in recent years indicates that although it may be a stressful experience, abortion is not associated with any detectable increase in the incidence of mental illness. The depression or guilt feelings reported by some women following abortion are generally described as mild and temporary. This experience, however, does not necessarily apply to women with a previous history of psychiatric illness; for them, abortion may be followed by continued or aggravated mental illness. The JPSA survey led to an estimate of the incidence of post-abortion psychosis ranging from 0.2 to 0.4 per 1,000 legal abortions. This is lower than the post-partum psychosis rate of one to two per 1,000 deliveries in the United States. Psychological factors also bear on whether a woman obtains a first or second-trimester abortion. Two studies in particular suggest that women who delay abortion into the later period may have more feelings of ambiva- lence, denial of the pregnancy, or objection on religious grounds, than those obtaining abortions in the first trimester. It is also apparent, however, that some second-trimester abortions result from procedural delays, difficulties in obtaining a pregnancy test, locating appropriate counseling, or arranging and financing the procedure. Diagnosis of severe defects of a fetus well before birth has greatly advanced in the past decade. Developments in the techniques of amniocen- tesis and cell culture have enabled a number of genetic defects and other congenital disorders to be detected in the second trimester of pregnancy. Prenatal diagnosis and the opportunity to terminate an affected pregnancy by a legal abortion may help many women who would have refrained from becoming pregnant or might have given birth to an abnormal child, to bear children unaffected by the disease they fear. Abortion, with or with- out prenatal diagnosis, also can be used in instances where there is reasonable risk that the fetus may be affected by birth defects from non-genetic causes, such as those caused by exposure of the woman to rubella virus infection or x-rays, or by her ingestion of drugs known to damage the fetus. Almost 60 inherited metabolic disorders, such as Tay-Sachs disease, potentially can be diagnosed before birth. More than 20 of these diseases already have been diagnosed with reasonaable accuracy by means of amniocentesis and other procedures. The techniques also can be used to identify a fetus with abnormal chromosomes, as in Down's syndrome (mongolism), and to discriminate between male and female fetuses, which in such diseases as hemophilia would allow determination of whether the fetus was at risk of being affected or simply at risk of being a hereditary carrier of the disorder.

In North America, amniocentesis was performed in more than 6,000 second-trimester pregnancies between 1967 and 1974. The diagnostic accuracy was close to 100 percent and complication rates were about two percent. Less than 10 percent of the diagnoses disclosed an affected fetus, meaning that the great majority of parents at risk averted an unnecessary abortion and were able to carry an unaffected child to term. There are many limitations to the use of prenatal diagnosis, especially for mass screening purposes. Amniocentesis is a fairly expensive procedure, and relatively few medical personnel are qualified to administer it and carry out the necessary diagnostic tests. Only a small number of genetic disorders can now be identified by means of amniocentesis and many couples still have no way to determine whether or not they are to be the parents of a child with genetic defects. Nevertheless, the avail- ability of a legal abortion expands the options available to a woman who faces a known risk of having an affected child. Abortion as a substitute for contraception is one possibility raised by the adoption of non-restrictive abortion laws. Limited data do not allow definitive conclusions, but they suggest that the introduction of non-restrictive abortion laws in the U.S. has not lead to any documented decline in demand for contraceptive services. Among women who sought abortion and who had previously not used contraception or had used it poorly, there is some evidence that they may have begun to practice contraception because contraceptives were made available to them at the time of their abortion. The health aspects of this issue bear on the higher mortality and mor- bidity associated with abortion as compared with contraceptive use, and on the possibility that if women rely on abortion rather than contraception they may have repeated abortions, for which the risk of long-term compli- cations is not known. The incidence of repeated legal abortions is little known because legal abortion has only been widely available in the U.S. for a few years. Data from New York City indicate that during the first two years of non-restrictive laws 2.45 percent of the abortions obtained by residents were repeat procedures. If those two years are divided into six-month periods, repeated legal abortions as a percent of the total rose from 0.01 percent in the first period to 6.02 percent in the last. Part of this increase is attributable to a statistical fact: the longer non-restrictive laws are in effect, the greater the number of women eligible to have repeated legal abortions. Perhaps, too, the reporting system has improved. In any case, some low incidence of repeated abortions is to be expected because none of the current contraceptive methods is completely failureproof, nor are they likely to be used with maximum care on all occasions.

8 A recent study has suggested that one additional factor contributing to the incidence of repeated abortions is that abortion facilities may not routinely provide contraceptive services at the time of the procedure. This is of concern because of recent evidence that ovulation usually oc- curs within five weeks and perhaps as early as 10 days after an abortion. The conclusions of the study group: — Many women will seek to terminate an unwanted pregnancy by abortion whether it is legal or not. Although the mortality and morbidity . associated with illegal abortion cannot be fully measured, they are clearly greater than the risks associated with legal abortion. Evidence suggests that legislation and practices that permit women to obtain abortions in proper medical surroundings will lead to fewer deaths and a lower rate of medical complications than restrictive legislation and practices. —• The substantial differences between the mortality and morbidity associated with legal abortion in the first and second trimesters suggest that laws, medical practices, and educational programs should enable and encourage women who have chosen abortion to obtain it in the first three months of pregnancy. — More research is needed on the consequences of abortion on health status. Of highest priority are investigations of long-term medical complications, particularly after multiple abortions the effects of abortion and denied abortion on the mental health and social welfare of individuals and families the factors of motivation, behavior, and access associated with contraceptive use and the choice of abortion.

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