women's abortion essay

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• Six out of 10 unintended pregnancies end in induced abortion.
• Abortion is a common health intervention. It is very safe when carried out using a method recommended by WHO, appropriate to the pregnancy duration and by someone with the necessary skills.
• However, around 45% of abortions are unsafe.
• Unsafe abortion is an important preventable cause of maternal deaths and morbidities. It can lead to physical and mental health complications and social and financial burdens for women, communities and health systems.
• Lack of access to safe, timely, affordable and respectful abortion care is a critical public health and human rights issue.

Around 73 million induced abortions take place worldwide each year. Six out of 10 (61%) of all unintended pregnancies, and 3 out of 10 (29%) of all pregnancies, end in induced abortion (1) .

Comprehensive abortion care is included in the list of essential health care services published by WHO in 2020. Abortion is a simple health care intervention that can be safely and effectively managed by a wide range of health workers using medication or a surgical procedure. In the first 12 weeks of pregnancy, a medical abortion can also be safely self-managed by the pregnant person outside of a health care facility (e.g. at home), in whole or in part. This requires that the woman has access to accurate information, quality medicines and support from a trained health worker (if she needs or wants it during the process).

Comprehensive abortion care includes the provision of information, abortion management and post-abortion care. It encompasses care related to miscarriage (spontaneous abortion and missed abortion), induced abortion (the deliberate interruption of an ongoing pregnancy by medical or surgical means), incomplete abortion as well as intrauterine fetal demise.

The information in this fact sheet focuses on care related to induced abortion.

Scope of the problem

When carried out using a method recommended by WHO appropriate to the pregnancy duration, and by someone with the necessary skills, abortion is a safe health care intervention (5).

However, when people with unintended pregnancies face barriers to attaining safe, timely, affordable, geographically reachable, respectful and non-discriminatory abortion care, they often resort to unsafe abortion. 1

Global estimates from 2010–2014 demonstrate that 45% of all induced abortions are unsafe. Of all unsafe abortions, one third were performed under the least safe conditions, i.e. by untrained persons using dangerous and invasive methods.  More than half of all these unsafe abortions occurred in Asia, most of them in south and central Asia. In Latin American and Africa, the majority (approximately 3 out of 4) of all abortions were unsafe. In Africa, nearly half of all abortions occurred under the least safe circumstances (3) .

Consequences of inaccessible quality abortion care

Lack of access to safe, affordable, timely and respectful abortion care, and the stigma associated with abortion, pose risks to women’s physical and mental well-being throughout the life-course.

Inaccessibility of quality abortion care risks violating a range of human rights of women and girls, including the right to life; the right to the highest attainable standard of physical and mental health; the right to benefit from scientific progress and its realization; the right to decide freely and responsibly on the number, spacing and timing of children; and the right to be free from torture, cruel, inhuman and degrading treatment and punishment.

One review from 2003–12, found that 4.7-13% of maternal deaths were linked to abortive pregnancy outcomes (4) but noted that maternal deaths due to abortion, and more specifically unsafe abortion, are often misclassified and underreported given the stigma. 

Deaths from safe abortion are negligible, <1/100 000 (5). On the other hand, in regions where unsafe abortions are common, the death rates are high, at > 200/100 000 abortions. Estimates from 2012 indicate that in developing countries alone, 7 million women per year were treated in hospital facilities for complications of unsafe abortion (6) .

Physical health risks associated with unsafe abortion include:

• incomplete abortion (failure to remove or expel all pregnancy tissue from the uterus);
• haemorrhage (heavy bleeding);
• uterine perforation (caused when the uterus is pierced by a sharp object); and
• damage to the genital tract and internal organs as a consequence of inserting dangerous objects into the vagina or anus.

Restrictive abortion regulation can cause distress and stigma, and risk constituting a violation of human rights of women and girls, including the right to privacy and the right to non-discrimination and equality, while also imposing financial burdens on women and girls. Regulations that force women to travel to attain legal care, or require mandatory counselling or waiting periods, lead to loss of income and other financial costs, and can make abortion inaccessible to women with low resources (6,8) .

Estimates from 2006 show that complications of unsafe abortions cost health systems in developing countries US$ 553 million per year for post-abortion treatments. In addition, households experienced US$ 922 million in loss of income due to long-term disability related to unsafe abortion (10) . Countries and health systems could make substantial monetary savings by providing greater access to modern contraception and quality induced abortion (8,9) .

Expanding quality abortion care

Evidence shows that restricting access to abortions does not reduce the number of abortions (1) ; however, it does affect whether the abortions that women and girls attain are safe and dignified. The proportion of unsafe abortions are significantly higher in countries with highly restrictive abortion laws than in countries with less restrictive laws (2) .

Barriers to accessing safe and respectful abortion include high costs, stigma for those seeking abortions and health care workers, and the refusal of health workers to provide an abortion based on personal conscience or religious belief. Access is further impeded by restrictive laws and requirements that are not medically justified, including criminalization of abortion, mandatory waiting periods, provision of biased information or counselling, third-party authorization and restrictions regarding the type of health care providers or facilities that can provide abortion services.

Multiple actions are needed at the legal, health system and community levels so that everyone who needs abortion care has access to it. The three cornerstones of an enabling environment for quality comprehensive abortion care are:

• respect for human rights, including a supportive framework of law and policy;
• the availability and accessibility of information; and
• a supportive, universally accessible, affordable and well functioning health system.

A well-functioning health system implies many factors, including:

• evidence-based policies;
• universal health coverage;
• the reliable supply of quality, affordable medical products and equipment;
• that an adequate number of health workers, of different types, provide abortion care at a reachable distance to patients; 
• the delivery of abortion care through a variety of approaches, e.g. care in health facilities, digital interventions and self-care approaches, allowing for choices depending on the values and preferences of the pregnant person, available resources, and the national and local context;
• that health workers are trained to provide safe and respectful abortion care, to support informed decision-making and to interpret laws and policies regulating abortion;
• that health workers are supported and protected from stigma; and
• provision of contraception to prevent unintended pregnancies.

Availability and accessibility of information implies:

• provision of evidence-based comprehensive sexuality education; and
• accurate, non-biased and evidence-based information on abortion and contraceptive methods.

WHO response

WHO provides global technical and policy guidance on the use of contraception to prevent unintended pregnancy, provision of information on abortion care, abortion management (including miscarriage, induced abortion, incomplete abortion and fetal death) and post-abortion care. In 2022, WHO published an updated, consolidated guideline on abortion care, including all WHO recommendations and best practice statements across three domains essential to the provision of abortion care: law and policy, clinical services and service delivery. 

WHO also maintains the Global Abortion Policies Database . This interactive online database contains comprehensive information on the abortion laws, policies, health standards and guidelines for all countries. 

Upon request, WHO provides technical support to countries to adapt sexual and reproductive health guidelines to specific contexts and strengthen national policies and programmes related to contraception and safe abortion care. A quality abortion care monitoring and evaluation framework is also in development.

WHO is a cosponsor of the HRP (UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction) , which carries out research on clinical care, abortion regulation, abortion stigma, as well as implementation research on community and health systems approaches to quality abortion care. It also monitors the global burden of unsafe abortion and its consequences.

1 An “unsafe abortion” is defined as a procedure for terminating a pregnancy performed by persons lacking the necessary information or skills or in an environment not in conformity with minimal medical standards, or both. The persons, skills and medical standards considered safe in the provision of abortion are different for medical and surgical abortion and by pregnancy duration. In using this definition, what is considered ‘safe’ or unsafe needs to be interpreted in line with the most current WHO technical and policy guidance (2).

(1) Bearak J, Popinchalk A, Ganatra B, Moller A-B, Tunçalp Ö, Beavin C et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Glob Health. 2020 Sep; 8(9):e1152-e1161. doi: 10.1016/S2214-109X(20)30315-6. 

(2) Ganatra B, Tunçalp Ö, Johnston H, Johnson BR, Gülmezoglu A, Temmerman M. From concept to measurement: Operationalizing WHO's definition of unsafe abortion. Bull World Health Organ 2014;92:155; 10.2471/BLT.14.136333.

(3) Ganatra B, Gerdts C, Rossier C, Johnson Jr B R, Tuncalp Ö, Assifi A et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. The Lancet. 2017 Sep.

(4) Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun; 2(6):e323-33.

(5) Raymond EG, Grimes DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol. 2012 Feb;119(2 Pt 1):215-9. doi: 10.1097/AOG.0b013e31823fe923. PMID: 22270271.

(6) Singh S, Maddow-Zimet I. Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. BJOG 2015; published online Aug 19. DOI:10.1111/1471-0528.13552.

(7) Coast E, Lattof SR, Meulen Rodgers YV, Moore B, Poss C. The microeconomics of abortion: A scoping review and analysis of the economic consequences for abortion care-seekers. PLoS One. 2021 Jun 9;16(6):e0252005. doi: 10.1371/journal.pone.0252005. PMID: 34106927; PMCID: PMC8189560.

(8) Lattof SR, Coast E, Rodgers YVM, Moore B, Poss C. The mesoeconomics of abortion: A scoping review and analysis of the economic effects of abortion on health systems. PLoS One. 2020 Nov 4;15(11):e0237227. doi: 10.1371/journal.pone.0237227. PMID: 33147223; PMCID: PMC7641432.

(9) Rodgers YVM, Coast E, Lattof SR, Poss C, Moore B. The macroeconomics of abortion: A scoping review and analysis of the costs and outcomes. PLoS One. 2021 May 6;16(5):e0250692. doi: 10.1371/journal.pone.0250692. PMID: 33956826; PMCID: PMC8101771.

(10). Vlassoff et al. Economic impact of unsafe abortion-related morbidity and mortality: evidence and estimation challenges. Brighton, Institute of Development Studies, 2008 (IDS Research Reports 59).

• Abortion care guideline
• Classification of abortions by safety: article in The Lancet
• Quality of care
• Maintaining essential health services during the COVID-19 outbreak
• Sexual and reproductive health and research including the Special Programme HRP

Global Abortion Policies Database

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Pro-Choice Does Not Mean Pro-Abortion: An Argument for Abortion Rights Featuring the Rev. Carlton Veazey

Since the Supreme Court’s historic 1973 decision in Roe v. Wade , the issue of a woman’s right to an abortion has fostered one of the most contentious moral and political debates in America. Opponents of abortion rights argue that life begins at conception – making abortion tantamount to homicide. Abortion rights advocates, in contrast, maintain that women have a right to decide what happens to their bodies – sometimes without any restrictions.

To explore the case for abortion rights, the Pew Forum turns to the Rev. Carlton W. Veazey, who for more than a decade has been president of the Religious Coalition for Reproductive Choice. Based in Washington, D.C., the coalition advocates for reproductive choice and religious freedom on behalf of about 40 religious groups and organizations. Prior to joining the coalition, Veazey spent 33 years as a pastor at Zion Baptist Church in Washington, D.C.

A counterargument explaining the case against abortion rights is made by the Rev. J. Daniel Mindling, professor of moral theology at Mount St. Mary’s Seminary.

Featuring: The Rev. Carlton W. Veazey, President, Religious Coalition for Reproductive Choice

Interviewer: David Masci, Senior Research Fellow, Pew Forum on Religion & Public Life

Question & Answer

Can you explain how your Christian faith informs your views in support of abortion rights?

I grew up in a Christian home. My father was a Baptist minister for many years in Memphis, Tenn. One of the things that he instilled in me – I used to hear it so much – was free will, free will, free will. It was ingrained in me that you have the ability to make choices. You have the ability to decide what you want to do. You are responsible for your decisions, but God has given you that responsibility, that option to make decisions.

I had firsthand experience of seeing black women and poor women being disproportionately impacted by the fact that they had no choices about an unintended pregnancy, even if it would damage their health or cause great hardship in their family. And I remember some of them being maimed in back-alley abortions; some of them died. There was no legal choice before Roe v. Wade .

But in this day and time, we have a clearer understanding that men and women are moral agents and equipped to make decisions about even the most difficult and complex matters. We must ensure a woman can determine when and whether to have children according to her own conscience and religious beliefs and without governmental interference or coercion. We must also ensure that women have the resources to have a healthy, safe pregnancy, if that is their decision, and that women and families have the resources to raise a child with security.

The right to choose has changed and expanded over the years since Roe v. Wade . We now speak of reproductive justice – and that includes comprehensive sex education, family planning and contraception, adequate medical care, a safe environment, the ability to continue a pregnancy and the resources that make that choice possible. That is my moral framework.

You talk about free will, and as a Christian you believe in free will. But you also said that God gave us free will and gave us the opportunity to make right and wrong choices. Why do you believe that abortion can, at least in some instances, be the right choice?

Dan Maguire, a former Jesuit priest and professor of moral theology and ethics at Marquette University, says that to have a child can be a sacred choice, but to not have a child can also be a sacred choice.

And these choices revolve around circumstances and issues – like whether a person is old enough to care for a child or whether a woman already has more children than she can care for. Also, remember that medical circumstances are the reason many women have an abortion – for example, if they are having chemotherapy for cancer or have a life-threatening chronic illness – and most later-term abortions occur because of fetal abnormalities that will result in stillbirth or the death of the child. These are difficult decisions; they’re moral decisions, sometimes requiring a woman to decide if she will risk her life for a pregnancy.

Abortion is a very serious decision and each decision depends on circumstances. That’s why I tell people: I am not pro-abortion, I am pro-choice. And that’s an important distinction.

You’ve talked about the right of a woman to make a choice. Does the fetus have any rights?

First, let me say that the religious, pro-choice position is based on respect for human life, including potential life and existing life.

But I do not believe that life as we know it starts at conception. I am troubled by the implications of a fetus having legal rights because that could pit the fetus against the woman carrying the fetus; for example, if the woman needed a medical procedure, the law could require the fetus to be considered separately and equally.

From a religious perspective, it’s more important to consider the moral issues involved in making a decision about abortion. Also, it’s important to remember that religious traditions have very different ideas about the status of the fetus. Roman Catholic doctrine regards a fertilized egg as a human being. Judaism holds that life begins with the first breath.

What about at the very end of a woman’s pregnancy? Does a fetus acquire rights after the point of viability, when it can survive outside the womb? Or let me ask it another way: Assuming a woman is healthy and her fetus is healthy, should the woman be able to terminate her pregnancy until the end of her pregnancy?

There’s an assumption that a woman would end a viable pregnancy carelessly or without a reason. The facts don’t bear this out. Most abortions are performed in the first 12 weeks of pregnancy. Late abortions are virtually always performed for the most serious medical and health reasons, including saving the woman’s life.

But what if such a case came before you? If you were that woman’s pastor, what would you say?

I would talk to her in a helpful, positive, respectful way and help her discuss what was troubling her. I would suggest alternatives such as adoption.

Let me shift gears a little bit. Many Americans have said they favor a compromise, or reaching a middle-ground policy, on abortion. Do you sympathize with this desire and do you think that both sides should compromise to end this rancorous debate?

I have been to more middle-ground and common-ground meetings than I can remember and I’ve never been to one where we walked out with any decision.

That being said, I think that we all should agree that abortion should be rare. How do we do that? We do that by providing comprehensive sex education in schools and in religious congregations and by ensuring that there is accurate information about contraception and that contraception is available. Unfortunately, the U.S. Congress has not been willing to pass a bill to fund comprehensive sex education, but they are willing to put a lot of money into failed and harmful abstinence-only programs that often rely on scare tactics and inaccurate information.

Former Surgeon General David Satcher has shown that abstinence-only programs do not work and that we should provide young people with the information to protect themselves. Education that stresses abstinence and provides accurate information about contraception will reduce the abortion rate. That is the ground that I stand on. I would say that here is a way we can work together to reduce the need for abortions.

Abortion has become central to what many people call the “culture wars.” Some consider it to be the most contentious moral issue in America today. Why do many Catholics, evangelical Christians and other people of faith disagree with you?

I was raised to respect differing views so the rigid views against abortion are hard for me to understand. I will often tell someone on the other side, “I respect you. I may disagree with your theological perspective, but I respect your views. But I think it’s totally arrogant for you to tell me that I need to believe what you believe.” It’s not that I think we should not try to win each other over. But we have to respect people’s different religious beliefs.

But what about people who believe that life begins at conception and that terminating a pregnancy is murder? For them, it may not just be about respecting or tolerating each other’s viewpoints; they believe this is an issue of life or death. What do you say to people who make that kind of argument?

I would say that they have a right to their beliefs, as do I. I would try to explain that my views are grounded in my religion, as are theirs. I believe that we must ensure that women are treated with dignity and respect and that women are able to follow the dictates of their conscience – and that includes their reproductive decisions. Ultimately, it is the government’s responsibility to ensure that women have the ability to make decisions of conscience and have access to reproductive health services.

Some in the anti-abortion camp contend that the existence of legalized abortion is a sign of the self-centeredness and selfishness of our age. Is there any validity to this view?

Although abortion is a very difficult decision, it can be the most responsible decision a person can make when faced with an unintended pregnancy or a pregnancy that will have serious health consequences.

Depending on the circumstances, it might be selfish to bring a child into the world. You know, a lot of people say, “You must bring this child into the world.” They are 100 percent supportive while the child is in the womb. As soon as the child is born, they abort the child in other ways. They abort a child through lack of health care, lack of education, lack of housing, and through poverty, which can drive a child into drugs or the criminal justice system.

So is it selfish to bring children into the world and not care for them? I think the other side can be very selfish by neglecting the children we have already. For all practical purposes, children whom we are neglecting are being aborted.

This transcript has been edited for clarity, spelling and grammar.

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Understanding why women seek abortions in the US

M antonia biggs.

1 Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California, USA

Heather Gould

Diana greene foster.

The current political climate with regards to abortion in the US, along with the economic recession may be affecting women’s reasons for seeking abortion, warranting a new investigation into the reasons why women seek abortion.

Data for this study were drawn from baseline quantitative and qualitative data from the Turnaway Study , an ongoing, five-year, longitudinal study evaluating the health and socioeconomic consequences of receiving or being denied an abortion in the US. While the study has followed women for over two full years, it relies on the baseline data which were collected from 2008 through the end of 2010. The sample included 954 women from 30 abortion facilities across the US who responded to two open ended questions regarding the reasons why they wanted to terminate their pregnancy approximately one week after seeking an abortion.

Women’s reasons for seeking an abortion fell into 11 broad themes. The predominant themes identified as reasons for seeking abortion included financial reasons (40%), timing (36%), partner related reasons (31%), and the need to focus on other children (29%). Most women reported multiple reasons for seeking an abortion crossing over several themes (64%). Using mixed effects multivariate logistic regression analyses, we identified the social and demographic predictors of the predominant themes women gave for seeking an abortion.

Conclusions

Study findings demonstrate that the reasons women seek abortion are complex and interrelated, similar to those found in previous studies. While some women stated only one factor that contributed to their desire to terminate their pregnancies, others pointed to a myriad of factors that, cumulatively, resulted in their seeking abortion. As indicated by the differences we observed among women’s reasons by individual characteristics, women seek abortion for reasons related to their circumstances, including their socioeconomic status, age, health, parity and marital status. It is important that policy makers consider women’s motivations for choosing abortion, as decisions to support or oppose such legislation could have profound effects on the health, socioeconomic outcomes and life trajectories of women facing unwanted pregnancies.

While the topic of abortion has long been the subject of fierce public and policy debate in the United States, an understanding of why women seek abortion has been largely missing from the discussion [ 1 ]. In an effort to maintain privacy, adhere to perceived social norms, and shield themselves from stigma, the majority of American women who have had abortions— approximately 1.21 million women per year [ 2 ]– do not publicly disclose their abortion experiences or engage in policy discussions as a represented group [ 3 - 5 ].

A review of several international and a handful of US qualitative and quantitative articles considered reasons for abortion among women in 26 “high-income” countries [ 6 ]. Of these, four studies (two primarily quantitative, one primarily qualitative and one that used mixed methods) were conducted in the US [ 7 - 10 ]. This review found that, despite methodological differences among the studies, a consistent picture of women’s reasons for abortion emerged, that could be encapsulated in three categories: 1) “Women-focused” reasons, such as those related to timing, the woman’s physical or mental health, or completed family size; 2) “Other-focused” reasons, such as those related to the intimate partner, the potential child, existing children, or the influences of other people, and 3) “Material” reasons, such as financial and housing limitations. These categories were not mutually exclusive; women in nearly all of the studies reported multiple reasons for their abortion.

The largest of the US studies included in the review, by Finer and colleagues [ 9 ], utilized data from a structured survey conducted in 2004 with 1,209 abortion patients across the US, as well as open-ended, in-depth interviews conducted with 38 patients from four facilities, nearly half of whom were in their second trimester of pregnancy. Quantitative data from this study were compared to survey data collected from nationally representative samples in 1987 [ 11 , 12 ] and 2000 [ 13 ]. The most commonly reported reasons for abortion in 2004 (selected from a researcher-generated list of possible reasons with write-in options for other reasons) were largely similar to those found in the 1987 study [ 11 ]. The top three reason categories cited in both studies were: 1) “Having a baby would dramatically change my life” (i.e., interfere with education, employment and ability to take care of existing children and other dependents) (74% in 2004 and 78% in 1987), 2) “I can’t afford a baby now” (e.g., unmarried, student, can’t afford childcare or basic needs) (73% in 2004 and 69% in 1987), and 3) “I don’t want to be a single mother or am having relationship problems” (48% in 2004 and 52% in 1987). A sizeable proportion of women in 2004 and 1987 also reported having completed their childbearing (38% and 28%), not being ready for a/another child (32% and 36%), and not wanting people to know they had sex or became pregnant (25% and 33%). Considering all of the reasons women reported, the authors observed that the reasons described by the majority of women (74%) signaled a sense of emotional and financial responsibility to individuals other than themselves, including existing or future children, and were multi-dimensional. Greater weeks of gestation were found to be related with citing concerns about fetal health as reasons for abortion. The authors did not examine associations between weeks of gestation with some of the other more frequently mentioned reasons for abortion.

While the US abortion rate appears to have stabilized after a national decline, this decline has been slower among low-income women and in certain states, suggesting possible disparities in access to effective contraceptive methods and/or economic challenges preventing women from feeling they are able to care for a child [ 2 , 13 ]. According to national estimates for 2005 and 2008, changes in the abortion rate varied by region, with the South and West seeing small declines, and the Northwest and Midwest seeing no change over that period [ 2 ].

Furthermore, the changing political climate and increasing restrictive legislation with regards to abortion in this country [ 14 ], in conjunction with the economic recession, may be affecting women’s reasons for seeking abortion, warranting a fresh investigation into these issues. This study builds upon and extends the small body of literature that documents US women’s reasons for abortion [ 6 ]. While two other papers using data from the Turnaway Study (see below) describe how women who indicate partner related reasons or reasons related to their own alcohol, tobacco and/or drug use, differ from those who do not mention these reasons [ 15 , 16 ] this study presents all of the reasons women from the Turnaway Study gave for seeking abortion, as described in their own words.

Ethics statement

This study was approved by the University of California, San Francisco, Committee on Human Research. Written and oral consent was obtained from all participants.

Study design

Data for this study were drawn from baseline quantitative and qualitative data from the Turnaway Study, an ongoing, five-year, longitudinal study evaluating the health and socioeconomic consequences of receiving or being denied an abortion in the US. While the study has followed women for two full years, this analysis relies on the baseline data which were collected from 2008 through the end of 2011. The study design, recruitment and research methods and some findings from this study have been published elsewhere [ 15 , 17 - 19 ]. This study overcomes several limitations of previous studies on this topic. Most importantly, we interviewed a large sample of both adult and adolescent women, including many women who sought abortions at later gestations of pregnancy. We asked women about their reasons for abortion using an open-ended question, rather than relying on a checklist of researcher-generated reasons.

This paper draws on baseline data from interviews conducted one week after receiving or being denied an abortion at the recruitment facility.

Recruitment

Women seeking abortion care at 30 US facilities (abortion clinics, other clinics and hospitals) between January 2008 and December 2010 were recruited to participate in the study. Facilities were identified using the National Abortion Federation membership directory, as well as through professional contacts in the abortion research community. While the gestational limits of the recruitment facilities varied (from 10 weeks to the end of the second trimester), they each had the latest gestational limit for providing abortion of any facility within 150 miles. These sites were selected because we thought that women denied an abortion would be unlikely to get one elsewhere. The facilities performed an average of 2,400 abortions annually (range 440–8,000) and were located in 21 states throughout the US representing every US region [ 17 ].

Abortion patients were eligible to participate in the study if they were English- or Spanish-speaking, aged 15 years or older, had no fetal diagnoses or demise, and were within the gestational age range of one of three study groups. At each facility, a designated point person was trained by Turnaway study researchers to oversee and conduct site recruitment activities. After assessing potential participants’ eligibility based on their age, language and gestational age, the facility point person or facility staff briefly informed potential participants about the study. Participants were usually approached in a private exam room after receiving an ultrasound and were told that the purpose of the study was to learn more about how unintended pregnancy affects women’s lives. Participants who expressed willingness to learn more about the study were led to a private location within the clinic, where they were given additional study information, the informed consent documents, and human subjects’ Bill of Rights a .

Facility staff then connected interested prospective participants to Turnaway study researchers by telephone. Facility staff dialed and introduced participant by first name then passed the phone to the woman to speak with the interviewer. During the recruitment call, research staff explained the study in greater detail, screened for eligibility and obtained informed consent. After verbally agreeing to participate, each woman signed a written consent form, which was faxed by facility staff to a private, dedicated fax machine in the UCSF Project Director’s office. Parental consent was obtained from women under the age of 18 living in states where parental notification or consent for an abortion is required. In states without parental involvement laws, women under the age of 18 were screened for their ability to understand the risks and benefits of the study and, those who were determined to be able provided informed consent on their own behalf. For all patients who completed the recruitment call and consented to enroll, Turnaway study researchers scheduled their first telephone interview to take place eight days later. These baseline interviews lasted approximately 40 minutes. The study is ongoing, with follow-up phone interviews being conducted every six months for five years.

All interviewers were female, fluent in English and/or Spanish, and experienced in reproductive health research and interviewing techniques. The interviewer training covered general interviewing guidelines, handling sensitive issues, confidentiality, data collection protocols, question-by-question reviews of both English and Spanish versions of the interview guide, role playing, and record-keeping. During the data collection period, research staff worked closely with the interviewers to ensure data quality. Quality assurance strategies included making sure that interviewers understood the meaning of every question, how to ask the question and how to record answers, observation of live interviews, monitoring the data for missing values, and periodic inter-rater reliability tests. All data from the interviews were entered manually. The interviewers simultaneously collected and entered data into a password-protected, computer database using CASES (Computer Assisted Survey Execution System). Qualitative responses in Spanish were translated to English by bilingual research staff. Women were mailed a $50 gift card for a major retail store after completing each interview.

Participants

Overall, 37.5% of eligible women agreed to complete semi-annual telephone interviews for a period of five years. For the purposes of the larger study, participants were recruited into three distinct study groups: women who were denied an abortion because they were just over the pregnancy gestational age limit for the clinic (n=231), women who received an abortion and were just under the gestational age limit (n=452), and women who received a first trimester procedure (n=273). For the purposes of this analysis, all three groups are combined and analyzed by gestational age.

The structured interview guide included questions on participant socio-demographic characteristics, experiences becoming pregnant, pregnancy planning, and the abortion decision-making process. The interview guide and study protocols were all first pilot tested among 64 women receiving or being denied an abortion at a local abortion facility.

Demographic characteristics

We examine age, race/ethnicity (White, Black, Hispanic/Latina and other), education (more than high school versus high school graduation or less than high school), whether they received public assistance (i.e. Women Infant and Children (WIC), food stamps, disability payments, or Temporary Assistance for Needy Families (TANF)) in the past month and employment status (part/full time versus not employed).

Pregnancy-related characteristics

We also considered parity, and gestational age at recruitment (13 weeks or less, 14 to 19 weeks, and 20 weeks or more). Pregnancy intentions were measured with the London Measure of Unplanned Pregnancy. The London Measure is a validated measure of pregnancy intentions that assesses contraceptive use, intentions to become pregnant, extent to which women wanted to become pregnant and partner interest in becoming pregnant in the month before becoming pregnant as well as changes women may have made in preparation for pregnancy and women’s perceptions of the timing of the pregnancy [ 20 ]. It is a continuous scale ranging from 1–12, with 0–3 indicating unplanned pregnancies, 4–9 ambivalent pregnancies and 10–12 planned pregnancies.

Health care and health

“ Has healthcare provider” was a dichotomous variable defined as having a doctor or nurse practitioner one usually goes to when sick or wanting health advice. Self-rated health is a dichotomous variable of rating health prior to pregnancy as good or very good versus fair, poor or very poor. History of depression or anxiety diagnosis is a dichotomous variable indicating whether the participant has ever been told by a health professional if she suffers from a major depressive or anxiety disorder.

Reasons for abortion

All participants were asked two open-ended questions about their reasons for seeking an abortion. The first question asked “What are the reasons that you decided to have an abortion?” followed by a prompt asking for any other reasons until the respondent says that is all. The second questions asked “What would you say was the main reason you decided to have an abortion?” Generally participants were not able to narrow their answers to one reason and sometimes even gave additional reasons to this last question making it difficult to discern a “main” reason. Therefore, the answers to both questions were combined to identify all reasons given by respondents for seeking abortion.

Data analysis

Qualitative analysis.

The analytic team was comprised of two of the study authors. A non-hierarchical list of themes was generated and agreed upon by both researchers after reviewing an initial 100 responses. The next set of 100 responses was coded using the agreed upon themes and were revised iteratively, as appropriate. The list of themes was finalized after review of all responses. Once the final set of themes was generated, both researchers recoded all the responses until reaching consensus on all items. Occasionally the underlying reasons that motivated a particular response were not evident. For example some women may have responded that they sought abortion due to “bad timing”, which may have been due to a number of factors (e.g. being financially unprepared or not having found the right partner) but unless these underlying reasons were explicitly stated, her reason was coded only as “bad timing.” Often the reasons were interrelated with other reasons, (e.g. “bad timing because I’m unemployed”) in which case the response was coded under all themes mentioned (e.g. “bad timing” and “unemployed”). Respondents could also be coded under multiple subthemes within an overarching theme (e.g. “unemployed and don’t want government assistance.” All coding was done in Excel.

Quantitative analysis

Once all of the codes were finalized, the reasons for abortion were analyzed quantitatively using Stata Version 12. Multivariable mixed effects logistic regression was used to assess the characteristics associated with having higher odds of reporting each of the major themes as a reason for seeking abortion. Continuous predictors included age, pregnancy intentions and parity. Dichotomous predictors included high school education and above (yes/no), employed (yes/no), has health care provider (yes/no), history of depression or anxiety (yes/no), and rates health as good/very good (yes/no). Additional categorical predictors included a four-part race variable, a three-part marital status variable, and a three-part gestational age variable. Our quantitative analysis approach accounted for clustering by recruitment site.

Description of the sample

Two women did not answer either question on reason for seeking an abortion, leaving a final sample of 954. A description of study participants is presented in Table  1 . Approximate 37% of participants were white, 36% between the ages of 20 and 24 (36%), and 38% were nulliparous. The majority were single and never married (79%), had less than a high school education (53%) and enough money to meet basic living needs (60%).

Participant characteristics (n=954)

a This age category includes one participant aged 14 who was recruited early in the study before the minimum enrollment age was changed to 15.

Women gave a wide range of responses to explain why they had chosen abortion. The reasons were comprised of 35 themes which were categorized under a final set of 11 overarching themes (Table  2 ). While most women gave reasons that fell under one (36%) or two (29%) themes, 13% mentioned four or more themes. Many women reported multiple reasons for seeking an abortion crossing over several themes. As one 21 year-old woman describes, “ This is how I described it [my reasons for abortion] to my doctor 'social, economic’, I had a whole list, I don’t feel like I could raise a child right now and give the child what it deserves. ”A 19-year old explains “[There are] so many of them [reasons]. I already have one baby, money wise, my relationship with the father of my first baby, relationship with my mom, school. ” A 27-year old enumerates the reasons that brought her to the decision to have an abortion “ My relationship is newer and we wanted to wait. I don’t have a job, I have some debt, I want to finish school and I honestly am not in the physical shape that I would want to be to start out a pregnancy .”

Major themes and reasons women gave for seeking abortion (n=954)

Note: Respondents gave reasons under multiple themes and subthemes.

Financial reasons

A financial reason (40%) was the most frequently mentioned theme. Six percent of women mentioned this as their only reason for seeking abortion. Most women (38%) cited general financial concerns which included responses such as “ financial problems ,” “ don’t have the means ,” “It all boils down to money ” and “ can’t afford to support a child .” As one unemployed 42-year-old woman with a monthly household income of a little over $1,000 describes “[It was] all financial, me not having a job, living off death benefits, dealing with my 14 year old son. I didn't have money to buy a baby spoon. ”

A small proportion of women (4%) stated that lack of employment or underemployment was a reason for seeking an abortion. A 28-year old college educated woman, receiving $1,750 a month in government assistance, looking for work, and living alone with her two children while her husband was away in the Air Force explains “ [My husband and I] haven't had jobs in awhile and I don't want to go back to living with other people. If we had another child it would be undue burden on our financial situation. ” Six (0.6%) women stated that their lack of insurance and/or inability to get government assistance contributed to their desire to terminate their pregnancies.

“I’m unemployed, no health insurance, and could not qualify for any government-assisted aid, and even if my fiancé decided to hurry up and get married, I still wouldn't have been covered under his health insurance for that.”-- 32-year-old, in school full-time.

Four respondents (0.4%) said that their desire to have an abortion stemmed from their inability to provide for the child without relying on government assistance. “I don't have enough money to support a child and I don't want to have to get support from the government. ”

Not the right time for a baby

Over one third (36%) of respondents stated reasons related to timing. Many women (34%) used phrasing such as “ I wasn’t ready ”, and “ wasn’t the right time. ” A 21-year old pointed to a number of reasons why she felt the timing of her pregnancy was wrong “ Mainly I didn't feel like I was ready yet - didn't feel financially, emotionally ready. Due date was at the same time as my externship at school. Entering the workforce with a newborn would be difficult - I just wasn't ready yet .” A small proportion of women described not having enough time or feeling too busy to have a baby (2%). A 25-year old looking for work, already raising a child, and who reported “rarely” having enough money to meet her basic living needs explains how she has “ So many things going on now-physically,emotionally, financially, pretty busy and can't handle anymore right now. ” Similarly, a 19-year old describes how she “ didn't have time to go to the doctor to make sure everything is OK like I wanted to. So busy with school and work I felt it [having an abortion] would be the right thing to do until I really have time to have one [a child]. ” Fewwomen described being too old to have a baby (2%). A 43-year old illustrates how timing and her age are the primary reasons for seeking abortion “ Because I'm too old to have a child. It's like starting over and my nerves are bad. My son…he's going to be 2b0 next month and I don't want to start over. It's just bad timing .”

Partner-related reasons

Nearly one third (31%) of respondents gave partner-related reasons for seeking an abortion. Six percent mentioned partners as their only reason for seeking abortion. Partner related reasons included not having a “good” or stable relationship with the father of the baby (9%), wanting to be married first (8%), not having a supportive partner (8%), being with the “wrong guy” (6%), having a partner who does not want the baby (3%), and having an abusive partner (3%). For a more extensive analysis of partner-related reasons for seeking an abortion see Chibber et al. [ 17 ].

Need to focus on other children

The need to focus on other children was a common theme, mentioned by 29% of women. Six percent of women mentioned only this theme. The majority of these reasons (67%) were related to feeling overextended with current children “ I already had 2 kids and it would be really overwhelming. It's kind of hard to raise 2 kids by yourself ,” that the pregnancy was too soon after a previous child “ I have a 3-month-old already. If I had had that baby, he wouldn't even be one [year old by the time the baby came] ”, or simply not wanting any more children “I just felt inadequate-I have a teenager and 2 pre-teens and I couldn't see starting over again.” A small proportion (5%) of women felt that having a baby at this time would have an adverse impact on her other children. “I already have 5 kids; their quality of life would go down if I had another. ” A 31-year-old with three children spoke of the need to focus on her sick child as a reason for seeking abortion “My son was diagnosed with cancer. His treatment requires driving 10 hours and now we found out we need to go to New York for some of his treatment. The stress of that and that he relies on me. ”

A new baby would interfere with future opportunities

One in five women (20%) reported that they chose abortion because they felt a baby at this time would interfere with their future goals and opportunities in general (5%) or, more specifically, with school (14%) or career plans (7%). Usually the reasons were related to the perceived difficulty of continuing to advance educational or career goals while raising a baby: “I didn't think I'd be able to support a baby and go to college and have a job. ” states an 18-year old respondent in high school. A 21-year-old woman in college with no children explains that she “ Still want[s] to be able to do things like have a good job, finish school, and be stable. ” Similarly , a 26-year old desiring to go back to college explains “ I wanted to finish school. I'd been waiting a while to get into the bachelor's program and I finally got it. ” Another woman explains “ I feel like I need to put myself first and get through college and support myself. ” As a 21-one-year old seeking a college degree points out, “I’m trying to graduate from college and I’m going to cooking school in August and I have a lot of things going for me and I can’t take care of a kid by myself .” Others spoke to the inability to take time off work to raise the child.” A 21-one-year old holding two part-time jobs and raising two children states: “I wouldn't be able to take the time off work. My work doesn't offer maternity leave and I have to work [to afford to live] here. If I took time off I would lose my job so there's just no way.”

Some women, particularly younger women, expressed the feeling that having a baby at this time would negatively impact multiple aspects of their future lives.

“It is hard to get in school. If I had the baby it would be tough to do school work, thinking about my future. I know that I wouldn't be able to do what I want to do. I still want to be free and have my youth. I don't want to have it all gone because of one experience. I still want to study abroad. I don't want to ruin that.” -- 20-year-old in college with no children

Not emotionally or mentally prepared

Nineteen percent of respondents (19%) described feeling emotionally or mentally unprepared to raise a child at this time. Respondents in this category were characterized by a feeling of exasperation and an inability to continue the pregnancy— “I can't go through it” , “ I just felt inadequate ”— or feeling a lack of mental strength to have the baby— “[I am] not mentally stable to take that on”, “emotionally, I couldn't take care of another baby, ” and “I couldn’t handle it.” A 19-year old mother reporting a history of depression and physical abuse describes seeking an abortion because, “ I have a lot of problems-serious problems and so I'm not prepared for another baby. ” Another woman explained her rationale for seeking abortion, “ I would say a mental reason, in the sense that it would really be a burden because then I would have to watch three, my hands are already full.”

Health-related reasons

Twelve percent of respondents (12%) mentioned health-related reasons ranging from concern for her own health (6%), health of the fetus (5%), drug, tobacco, or alcohol use (5%), and/or non-illicit prescription drug or birth control use (1%). Maternal health concerns included physical health issues that would be exacerbated by the pregnancy or due to the pregnancy itself, “ My bad back and diabetes, I don't think the baby would have been healthy. I don't think I would have been able to carry it to term” as well as mental health concerns. Five percent of women (5%) chose abortion because they were concerned about the effects of their drug and/or alcohol use on the health of the fetus or on their ability to raise the child. For a more extensive analysis of substance use as reasons for seeking an abortion see Roberts et al. [ 16 ]. Other women (5%) voiced concern for the health of the fetus because they had been using contraceptives (n=4), psychotropic drugs (n=3) or medications (such as antibiotics, blood thinners, and narcotics) to treat other health conditions (n=7). As one woman explains, she and her partner chose abortion “ because I had been doing drinking and the medication I’m on for bipolar disorder is known to cause birth defects and we decided it’s akin to child abuse if you know you’re bringing your child into the world with a higher risk for things. ”

Want a better life for the baby than she could provide

Twelve percent of women gave reasons for choosing abortion related to their desire to give the child a better life than she could provide. Responses related to generally wanting to give the child a better life (7%) were characterized by a concern for the child “I'm afraid my kid will be suffering in this world” and “ wouldn't have been good for me or the child,” or a feeling of inadequacy to parent the child: “I can't take care of a kid because I can barely take care of myself and I don't want to bring a child into the world when I'm unmarried and not ready. ” As reflected in this previous quote, sometimes statements stemmed from a desire for the baby to have a father, or the feeling that the father of the baby was not suitable. “I didn't want to do it by myself. I couldn't and the man was abusive and horrible… I didn't want my kid to grow up with a father like that (knowing his father had left). ” For one woman, the decision to terminate her pregnancy was a moral one. “I've been unemployed it’s not a decision I can face morally without being able to raise it properly. An abortion was the best option. ”

Approximately 5% of respondents explained that their living or housing context was not suitable for a baby and mentioned this as one of the reasons they chose abortion. According to a 22-year old who described herself as being unable to work, on welfare, and rarely having enough money to meet basic living needs: “My mom pays my rent for me and where I live I can't have kids. I can't get anyone to rent to me because I have had an eviction and haven't had a steady job. ”

While never mentioned as the only reason for choosing abortion, 13 respondents said that lack of help to care for the baby was one reason they chose abortion. Responses included “I wouldn't have a babysitter for school,” “family isn't close by to help”, and “My grandma passed away and she was the one who was going to help.” Another subcategory of this theme included choosing abortion because of the desire not to repeat their childhood (n=5). An 18-year old who frequently smoked marijuana explained that she chose abortion “Because I did do drugs and my mom used drugs with me and my sister and I swore to myself I wouldn't bring a child into this world like that. ” Another respondent in her teens and who had a history of physical and sexual abuse and neglect remarked “my childhood was less than awesome, if I do have a child I want to give it the best possible life that I can and I am not in a place to do that right now. ”

Lack of maturity or independence

Less than 7% of women explained that their reliance on others or lack of maturity was a reason for choosing abortion. Some women felt they were too young (5%), unable to take care of themselves (1%), or too reliant on others to raise this baby (1%). “I'm not grown up enough to take care of another person. I can't take care of myself yet, let alone another person. I wouldn't want to bring a baby into this world with parents who aren't ready to be parents. ”

Influences from friends and/or family

Around 5% of women described a concern for, or influences from family or friends as a reason for seeking abortion. Two percent feared that having a baby would negatively impact their family or friends “It would have been a strain on my family ” and a similar proportion (2%) didn’t want others to know about their pregnancy or feared judgment or reaction from others. A 19-year old explains that the reason she chose abortion was because “I was scared to go to my parents .” Another woman feared what the family would think about her having a biracial child. A small minority reported influences or pressure from family or friends (n=11) as a reason for seeking abortion. “Because my mother convinced me to get one, ” explains one 17-year old. A 23-year old describes her rationale for seeking abortion “because my dad thinks I should finish school first, not financially ready for a baby, gonna have to move out when I have the baby. ” Similarly, a 25-year old explained that she wanted an abortion because of, “the negative feedback I was getting from my family. ”

Don’t want a baby or place baby for adoption

Four percent (4%) of women gave reasons falling under the theme not wanting a baby or not wanting to place a baby for adoption. Three percent (3%) explained succinctly that they do not want a baby or don’t want children “I just didn't want any kids”, “It [a baby] is something I just didn't want.” A small number (n=7) mentioned adoption was not an option for them. As one 25-year old describes “We are not really sure if we ever want kids. I don't think that I would be strong enough to give it up for adoption. ” Another respondent states that “adoption isn't an option for me-so it was kind of a no brainer decision. ”

Other reasons

Eleven women (1%) gave other reasons for seeking abortion that didn’t easily fall into one of the major themes, including going through legal issues (n=3) and fear of giving birth (n=2).

Factors related to reasons for abortion

Using mixed effects multivariate logistic regression analyses, we examined the social and demographic predictors of the predominant themes women gave for seeking an abortion (Table  3 ). Significant predictors of reporting financial reasons for seeking an abortion included marital status, education level, and not having enough money to meet basic living needs. Women who gave financial reasons for seeking an abortion were more likely to have a higher level of education [Odds Ratio (OR) 1.41, 95% Confidence Interval (CI), 1.05-1.90], less likely to be separated, divorced or widowed (OR, 0.54, CI, 0.34-0.86) than to be single/never married, and less likely to have enough money to meet basic needs (OR 0.54 CI, 0.41-0.72). Approximately 82% of women who reported this as a reason were single/never married.

Multivariate mixed effects logistic analyses predicting reasons for abortion

*p<.05; **p<.01; ***p<.001; OR Odds Ratios; CI=95% Confidence Intervals.

Women who reported reasons related to the need to focus on other children now were significantly more likely to have a lower pregnancy intentions score (OR 0.79, CI 0.71-0.88), and, to have a greater number of children (OR 2.31, CI 1.97-2.72). All women who reported this as a reason had one or more children.

Women who reported that this is not the right time for a baby as a reason for seeking abortion had a lower pregnancy intentions score (OR 0.86, CI 0.78-0.94) and lower parity (OR 0.71, CI 0.61-0.82). Over half (51%) of women who reported this as a reason had no children.

Women who gave partner related reasons were significantly more likely to be African American (OR 0.66, CI 0.45-0.99) and to have higher parity (OR, 0.78, CI 0.67-0.90). Older women (OR 1.03, 1.0-1.07), women who were separated, divorced or widowed (OR 2.22, CI 1.40-3.53), and women with higher pregnancy intention scores (OR 1.11, CI 1.01-1.21), had increased odds of giving partner related reasons.

Women who chose abortion because they felt having a baby would interfere with her future plans were more likely to be younger (OR 0.94, CI 0.90-0.98), to have more than a high school education (OR 2.43, CI 1.66-3.56), self-rated good health (OR 1.81, CI 1.08-3.04), and lower scores on the pregnancy intentions scale (OR 0.89, CI 0.80-0.99). Among those who reported this as a reason, over half (52%) were in college or getting their Associates or technical degree.

Predictors of reporting being emotionally or mentally unprepared as a reason for seeking abortion included race/ethnicity and having enough money to meet basic living needs. Women who were African American (OR 0.47, CI 0.29-0.75) were less likely than white women to report this as a reason. Women who reported having sufficient money to meet basic needs (OR 0.55, CI 0.38-0.78) were at a reduced odds of reporting this as a reason for seeking abortion.

Women with a history of depression or anxiety (OR 3.29, CI 2.07-5.23) had sharply elevated odds of mentioning physical or mental health factors as reasons for seeking abortion. Women who rated their health as good (OR 0.61, CI 0.37-0.99) and were employed (OR 0.50, CI 0.32-0.80) had reduced odds of mentioning physical or mental health reasons for seeking abortion.

Women who chose abortion because they wanted to give the baby a better life than they could provide were significantly more likely to have more than a high school education (OR 1.61, CI 1.0-2.5), have lower parity (OR 0.65, CI 0.5-0.8), and to lack a usual health care provider (OR 0.63, CI 0.4-1.0). Over half of women who gave this as a reason were nulliparous (55%).

Women who gave lack of independence or immaturity as a reason for seeking abortion were more likely to be younger (OR 0.83, CI 0.7-0.9) and lower parity (OR 0.38, CI 0.2-0.7). All women who gave this reason were under age 31, 48% were in their teens and 83% were nulliparous. Marital status was excluded in the model because of problems with collinearity with the outcome. Nearly all (97%) women who gave this as a reason were single/never married.

Reporting influences from friends and family as a reason for seeking abortion was significantly predicted by age and pregnancy intentions. Women who report this reason were more likely to be younger (OR 0.87, CI 0.8-1.0) and to have a higher pregnancy intentions score (OR 1.20, CI 1.0-1.4). Over three quarters (85%) of women who gave this as a reason were ages 24 and under. Their average pregnancy intentions score was higher when compared to women giving other reasons (3.2 vs. 2.7, p=.03).

The two significant predictors of “don’t want a baby or place baby for adoption” were lower parity (OR 0.67, CI 0.46-0.96) and a lower pregnancy intentions score (OR 0.77, CI 0.60-0.99). Over two thirds (68%) who reported this reason were nulliparous.

The findings from this study demonstrate that the reasons women seek abortion are complex and interrelated. Unlike other studies [ 6 ], this study asked women entirely open-ended questions regarding the reasons they sought to terminate their pregnancies, ensuring that all women’s reasons could be fully captured. This methodology enabled us to get a wide range of responses that otherwise would not have been gathered. While some women stated only one factor that contributed to their desire to terminate their pregnancies, others pointed to a myriad of factors that, cumulatively, resulted in their seeking an abortion.

As indicated by the differences we observed among women’s reasons by individual characteristics, women seek abortion due to their unique circumstances, including their socioeconomic status, age, health, parity and marital status. Even with changes in the climate surrounding abortion and the shifting demographics of the women having abortions, the predominant reasons women gave for seeking abortion reflected those of previous studies [ 6 ]. Reasons related to timing, partners, and concerns for the ability to support the child and other dependents financially and emotionally were the most common reasons women gave for seeking an abortion, suggesting that abortion is often a decision driven by women’s concerns for current and future children, family, as well as existing commitments and responsibilities. Some women held the belief that her unborn child deserves to be raised under better circumstances than she can provide at this time; in an environment where the child is financially secure and part of a stable and loving family. This intersection between abortion and motherhood is described qualitatively in a study by Jones and colleagues where women indicate that their abortion decisions are influenced by the idea that children deserve “ideal conditions of motherhood” [ 21 ]. Some women also seem to have internalized gendered norms that value women as self-denying and always thinking in the best interest of her children, over making self-interested decisions. Experiences of stigma, fear of experiencing stigma, or internalized stigma around her abortion may have prompted women to give more socially desirable responses to make her appear or feel selfless, to justify her abortion decision. Other studies have reported abortion-seeking women’s fear of being judged as having made a selfish decision [ 22 ]. At the same time, some of the women seeking abortion in this study were aiming to secure themselves a better life and future- chances for a better job and a good education. These women may be more stigmatized than the former since they don’t fall into a discourse of the selfless and all-sacrificing woman. In an effort not to further contribute to the abortion stigma in our culture, we must be careful not to use women’s reasons for abortion as a way to rationalize or justify their abortions, but rather to better understand their experiences [ 23 ].

Denying women an abortion, which occurred among one quarter of the women interviewed in this study, may have a significant negative impact on her health, her existing children and other family members, and her future. Policies that restrict access to abortion must acknowledge that such women will need added support (e.g. financial, emotional, educational, health care, vocational support) to appropriately care for their children, other children, and themselves. In some cases, where women are struggling with abuse or health issues, continuing an unwanted pregnancy to term may be associated with even greater than normal risks of childbirth.

This study should be viewed in light of its limitations. Fewer than 40% of women who were eligible and approached agreed to participate. Many women may have been deterred from enrolling because participation required bi-annual interviews for a period of 5 years. Nonetheless, our sample demographics, with the exception of our overrepresentation of women beyond the first trimester, closely mirror the national estimates of women seeking abortion in the US, suggesting that our results are generalizable [ 24 , 25 ]. The greater proportion of women in our sample seeking abortions at later gestational ages and without fetal anomalies allows us to make inferences about a previously understudied group. Gestational age at the time of the interview was unrelated to any of the major themes mentioned. Other studies have found that late gestational age was an important predictor of termination because of concerns about the health of the fetus [ 9 ]. In this study, we have excluded women seeking abortion for fetal anomaly and found that seeking a later abortion was unrelated to women’s reasons for seeking an abortion. Thus, among women without fetal anomalies, reasons for seeking abortion are not different whether women sought abortion early or late in pregnancy. This suggests that factors other than the reasons for desiring an abortion play a role in seeking later abortions.

A small number of women stated that concern for the fetus while using contraception or other medications was a reason for seeking abortion pointing to an area for intervention. The general consensus in the literature is that birth control use during pregnancy is unlikely to have negative consequences for the development of the fetus [ 26 - 29 ]. A better understanding of the potential impact of the contraceptive methods and other medications on a developing fetus can help women be better informed when deciding whether nor not to have an abortion.

Laws requiring waiting periods, mandated counseling, and parental involvement for adolescents are motivated in part by a desire to protect women from making uninformed decisions and from being coerced into having an abortion. Prior research suggests that, women who feel the abortion decision is not completely their own have more difficulty coping following an abortion [ 30 ]. Our study, like most studies of women seeking abortions [ 9 ], finds that few women report pressure from others as a reason for seeking abortion. About 1% of women in this study described being influenced by others to have an abortion. Our study design, however, did not allow us to assess the level of pressure women experienced. The pressure women felt may have varied in degree from statements of a mild lack of support for continuing a pregnancy to strong and specific statements about a lack of future emotional or financial support for the pregnancy or potential child. While these women’s pregnancy intention scores are somewhat higher than those who gave other reasons for abortion, their scores were still in the unintended/ambivalent range. Health care providers should continue to assess and confirm that women are able to make their own decision about whether or not to continue or end a pregnancy. Women who experience pressure may benefit from additional emotional support if they choose to proceed with abortion.

In recent years, politicians, advocacy organizations and the media have extensively debated issues related to the funding, provision, utilization, and morality of abortion, and legislation restricting abortion access has increased dramatically. The Guttmacher Institute documented that 92 new provisions restricting abortion were enacted in 2011, almost three times the previous record of 34 provisions enacted six years earlier [ 31 ]. Despite the proliferation of proposed legislation that would restrict access to abortion, the public discourse concerning why women seek abortions has been limited. It is important that policy makers consider women’s motivations for choosing abortion, as decisions to support or oppose such legislation could have profound effects on the health, socioeconomic outcomes and life trajectories of women facing unwanted pregnancies.

As found in previous literature, the findings from this study demonstrate that women are motivated to seek abortion for a wide range of reasons that are driven by their unique circumstances and stage of life. Women expressed lacking the financial, emotional, and physical resources to adequately provide for a/another child, yet many were denied access to a wanted abortion. Supporters of policies that continue to further restrict women’s access to abortion need to recognize the potential impact on the financial, emotional, and physical well-being of these women and their families. Women who carry an unwanted pregnancy to term because they are denied access to a wanted abortion may require financial assistance, support handling an abusive partner, access to mental health services prenatal care and, potentially, specialized health care for high risk pregnancies. By better understanding women’s decisions when faced with an unintended pregnancy and destigmatizing abortion seeking we can better support women’s reproductive decisions and provide them with the resources they may need.

a Bill of Rights can be downloaded at: http://www.research.ucsf.edu/chr/Guide/chrB_BoR.asp .

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MAB’s role in this paper included conceptualizing the analyses for this paper, leading the quantitative and qualitative analyses and drafting the manuscript. HG was responsible for reviewing the literature, assisting in the qualitative coding, and drafting and editing the manuscript. DGF conceptualized and led the overall Turnaway study design and assisted in drafting and editing the manuscript. All authors approved the final manuscript.

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1472-6874/13/29/prepub

Acknowledgements

The authors thank Tracy Weitz for reviewing parts of the manuscript; Rana Barar and Sandy Stonesifer for study coordination and management; Janine Carpenter, Undine Darney, Ivette Gomez, Selena Phipps, Claire Schreiber and Danielle Sinkford for conducting interviews; Michaela Ferrari and Elisette Weiss for project support; Jay Fraser and John Neuhaus for statistical and database assistance and all the participating providers for their assistance with recruitment. This study was supported by research and institutional grants from the Wallace Alexander Gerbode Foundation, the David and Lucile Packard Foundation, the William and Flora Hewlett Foundation and an anonymous foundation.

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Abortion - List of Free Essay Examples And Topic Ideas

Abortion is a highly contentious issue with significant moral, legal, and social implications. Essays on abortion could explore the various aspects of the debate including the ethical dimensions, the legal frameworks governing abortion, and the social attitudes surrounding it. They might delve into historical changes in public opinion, the different arguments presented by pro-life and pro-choice advocates, and the impact of legal rulings on the accessibility and safety of abortion services. Discussions could also explore the intersection of abortion with issues like gender equality, religious freedom, and medical ethics. We have collected a large number of free essay examples about Abortion you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Issue of Sex-Selective Abortion

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Abortion: a Woman’s Choice

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Abortion: the most Debated Topic

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Women’s Rights to Choose

Every person in the United States is granted inalienable rights, whether it be to practice their own religion or vote, which should include autonomy over their own bodies.  A woman should have the right to choose what she does with her own body, and in 1973 that became a possibility for American women.  In 1973 Roe v. Wade made it possible for women to legally choose to terminate unwanted pregnancies within their first two trimesters.  The government finally took into […]

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Effects of Abortion on Young Women

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The Murder of Innocence

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The History of Abortion

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Debates on Abortion Theme

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The Mother and Abortion

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Abortion and Fathers Rights

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Frequently Asked Questions

Why abortion is legal.

Due to the outcome of a Supreme Court hearing, abortion is completely legal. In 1973, the Supreme Court's ruling on Roe vs Wade provided people legal access to abortion across the entire country. While legal, some doctors will not perform abortions.

How Abortion Affects Economy?

Women who have access to legal abortion will have the ability to continue their education and careers. Women denied an abortion because of gestational limits are more than 80% more likely to experience bankruptcy or face eviction.

Where Abortion is Illegal?

Abortion is legal in the entire country of the US, but some states have restrictions based on gestational status, fetal fatal conditions, and even rape. Other countries around the world have different laws and some have completely outlawed abortion, including Honduras, the Dominican Republic, and El Salvador.

Will Abortion Affect Health?

Women who have an abortion by a medical professional are at no risk for future pregnancies and there are no risks to overall health. Abortions do not increase any risk of breast cancer or have any effect on fertility.

Is Abortion Morally Justifiable?

This will depend on the person and their beliefs. Many women find abortion to be moral and a choice they are allowed to make in regards to their own bodies. Some religions have a strict stance on abortion and deem it immoral, regardless of the reason.

How To Write an Essay About Abortion

Introduction to the topic of abortion.

Abortion is a deeply complex and often controversial topic, encompassing a range of ethical, legal, and social issues. In your essay's introduction, it is important to define abortion and the various viewpoints and ethical considerations surrounding it. This introduction should establish the scope of your essay, whether you are focusing on the moral arguments, the legal aspects, the impact on individuals and society, or a combination of these. Your introduction should set a respectful and scholarly tone, acknowledging the sensitivity of the topic and the diverse opinions held by different groups.

Developing a Balanced Argument

The body of your essay should be dedicated to presenting a balanced and well-reasoned argument. Whether your essay is persuasive, analytical, or exploratory in nature, each paragraph should focus on a specific aspect of the abortion debate. This could include the ethical implications of abortion, the legal history and current laws regarding abortion in different regions, the psychological and physical effects on individuals, or the societal impacts. It's crucial to back up your points with evidence, such as statistical data, legal texts, ethical theories, medical research, and sociological studies. Addressing counterarguments is also important to show that you have considered multiple viewpoints and to strengthen your own argument.

Exploring Ethical and Societal Implications

An essay on abortion should also delve into the ethical dilemmas and societal implications surrounding the topic. This might involve discussing the moral philosophies related to the right to life, bodily autonomy, and the definition of personhood. The societal perspective might include the impact of abortion laws on different socio-economic groups, public health considerations, and the role of education and family planning. This section of your essay should challenge readers to think critically about their own values and the role of societal norms and laws in shaping the abortion debate.

Concluding the Discussion

In your conclusion, bring together all the threads of your argument, emphasizing the complexity of the abortion debate. This is your final opportunity to reinforce your main points and leave a lasting impression on your readers. Reflect on the broader implications of the debate and the ongoing challenges in finding a consensus in such a polarized issue. You might also offer recommendations for future policy, research, or public discourse. Remember, a strong conclusion doesn't just restate what has been said; it provides closure and offers new insights, prompting readers to continue thinking about the topic long after they have finished reading your essay.

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The facts about abortion and mental health

Scientific research from around the world shows having an abortion is not linked to mental health issues but restricting access is 

Vol. 53 No. 6 Print version: page 40

More than 50 years of international psychological research shows that having an abortion is not linked to mental health problems, but restricting access to safe, legal abortions does cause harm. Research shows people who are denied abortions have worse physical and mental health, as well as worse economic outcomes than those who seek and receive them.

Meanwhile, the same research shows getting a wanted abortion does not cause significant psychological problems, despite beliefs to the contrary. In a landmark study of more than 1,000 women across 21 states, those who were allowed to obtain an abortion were no more likely to report negative emotions, mental health symptoms, or suicidal thoughts than women who were denied an abortion.

[ Related: Frequently asked questions about abortion laws and psychology practice ]

Large longitudinal and international studies have found that obtaining a wanted abortion does not increase risk for depression, anxiety, or suicidal thoughts ( The mental health impact of receiving vs. being denied an abortion , Advancing New Standards in Reproductive Health , 2018).

“It’s important for folks to know that abortion does not cause mental health problems,” said Debra Mollen, PhD, a professor of counseling psychology at Texas Woman’s University, who studies abortion and reproductive rights. “What’s harmful are the stigma surrounding abortion, the lack of knowledge about it, and the lack of access.”

Misconceptions about abortion are also linked to lower support for it—and people deserve to have accurate information so they can make informed decisions, Mollen said (Weibe, E. R., et al., Gynecology & Obstetrics , Vol. 5, No. 9, 2015 ).

How abortion impacts mental health

The Turnaway Study , a landmark analysis of abortion from Advancing New Standards in Reproductive Health (ANSIRH) at the University of California, San Francisco, served to debunk the belief that people who get abortions experience deep regret, grief, or even posttraumatic stress disorder. Instead, the most commonly felt emotion is relief (Rocca, C. H., et al., Social Science & Medicine , Vol. 248, 2020 ).

In the study, researchers followed nearly 1,000 women across 21 states for five years to examine the similarities and differences between those who wanted and received an abortion versus those who wanted but were denied an abortion. Five years after the procedure, women who had an abortion were no more likely to report negative emotions or suicidal thoughts than women who were denied an abortion, and more than 97% of those studied said that having the abortion was the right decision (Rocca, C. H., et al., Social Science & Medicine , Vol. 248, 2020 ).

In a review of the scientific literature on abortion published 10 years earlier, an APA task force reached a similar conclusion, especially in the case of unplanned pregnancy. The task force reported that women who had an abortion in the first trimester did not face a higher risk of mental health problems than women who continued with an unplanned pregnancy ( Report of the APA Task Force on Mental Health and Abortion , 2008).

“In fact, the best predictor of a woman’s mental health after an abortion is her mental health before the abortion,” said Nancy Felipe Russo, PhD, an emeritus professor of psychology and women’s studies at Arizona State University who has spearheaded research on unwanted pregnancy, mental health, and abortion.

Another group of women—those who planned and wanted a pregnancy but terminated it during the second or third trimester because of a life-threatening birth defect—faced some psychological problems after the procedure. But those were comparable to mental health problems among women who miscarried or lost a newborn baby, and less severe than the distress among women who delivered babies with severe birth defects.

“The bottom line is that abortion in and of itself does not cause mental health issues,” said M. Antonia Biggs, PhD, a psychologist and researcher at ANSIRH and one of the leaders of the Turnaway Study.

When abortions are denied

The women in the Turnaway Study who were denied an abortion reported more anxiety symptoms and stress, lower self-esteem, and lower life satisfaction than those who received one ( JAMA Psychiatry , Vol. 74, No. 2, 2017 ). Women who proceeded with an unwanted pregnancy also subsequently had more physical health problems, including two who died from childbirth complications (Ralph, L. J., et al., Annals of Internal Medicine , Vol. 171, No. 4, 2019 ).

They faced more economic hardships, including worse credit scores, more frequent bankruptcies and evictions, and a higher chance of living in poverty. After being denied an abortion, women were also more likely to stay linked to a violent partner or to raise children alone ( The harms of denying a woman a wanted abortion , ANSIRH, 2020).

And people seeking abortions aren’t the only ones harmed when the procedure is banned.

“The children born as a result of abortion denial were not only more likely to live in poverty, but they were also more likely to experience poor bonding with their mothers,” Biggs said.

Other studies show that children born in such circumstances face a range of social, emotional, and mental health problems that continue into adulthood, including more psychiatric hospitalizations than their siblings or other children of planned pregnancies (David, H. P., Reproductive Health Matters , Vol. 14, No. 27, 2006 ; Dagg, P. K., American Journal of Psychiatry , Vol. 148, No. 5, 1991 ).

“Negative outcomes are not limited to minor problems that occur over a short span of time,” Russo said. “They can be severe outcomes of real concern.”

More stigma, barriers, and inequities

Given that the mental health impacts of denying abortion extend far beyond the procedure itself, it’s important to consider the issue in the larger context of society.

“Most people assume that if we’re talking about psychological ramifications, that’s about their feelings around having an abortion,” said Julie Bindeman, PsyD, a reproductive psychologist who cofounded and directs Integrative Therapy of Greater Washington, a private practice outside Washington, D.C. “But we really need to think about the compounding costs involved with even getting to that point.”

If a state bans abortions, a resident seeking one faces a new and significant set of barriers. They might incur additional costs for out-of-state travel, lodging, and childcare during the trip—all while missing wages at work. They might feel compelled to disclose the pregnancy to friends, family members, or coworkers from whom they’ve solicited help. They might be forced to wait longer for an appointment. All these challenges add up to more psychological stress.

Those new barriers could hinder anyone seeking an abortion, not just people in states restricting the procedure.

“Many people will be traveling to states with greater access to care, and that surge in demand for a limited number of appointments has the potential to impact everyone,” Biggs said.

Research has shown that people who face logistical barriers to accessing abortion care, including increased travel time or difficulty scheduling appointments, have more symptoms of stress, anxiety, and depression. A loss of autonomy—such as being forced to wait for an appointment or disclose a pregnancy—has the same effect ( Contraception , Vol. 101, No. 5, 2020 ).

Banning the procedure also stigmatizes it, and stigma harms mental health, according to findings from the Turnaway Study. Women in the study who felt they would be looked down on by friends, family, and community members if they had an abortion were much more likely to report psychological distress years later ( PLOS ONE , Vol. 15, No. 1, 2020 ).

Experts say the growing costs of obtaining an abortion will weigh much more heavily on those people with fewer economic resources.

“What we’re likely to see is an increased stratification, where those who have means and can travel will be able to obtain their abortions, and those who do not will face barriers upon barriers,” Bindeman said.

People who already struggle to pay for and access abortions—those living in poverty, people of color, people in rural areas, sexual and gender minorities, and young people, who are often bound by state-level parental consent and notification laws—are likely to be hardest hit by abortion bans.

“For all those reasons, this is a perfect storm of perpetuating continued inequities for people who are already marginalized,” said Bindeman.

Resources and support

While abortion isn’t linked to mental health problems, the challenges around obtaining one can be distressing. The following programs and organizations aid people who are seeking an abortion or want to talk about their experience.

Finding a credible health care provider

• Planned Parenthood partners with more than 600 sexual and reproductive health care centers nationwide.
• AbortionFinder.org offers a directory of verified abortion providers across the United States
• The National Abortion Federation offers an online “Find a Provider” tool and a Referral Line to help patients locate abortion providers in their region.
• Avoid “crisis pregnancy centers,” which promote misinformation intended to dissuade people from obtaining abortions. One study found that 80% of crisis pregnancy center websites contained false or misleading information (Bryan, A. G., et al., Contraception , Vol. 90, No. 6, 2014 ).

Social and emotional support

• Exhale Pro-Voice is a textline that offers peer counseling for people who have had abortions and their loved ones, as well as trainings on how to provide support after an abortion.
• Planned Parenthood ’s local, state, and regional centers offer various programming and activities for patients.
• Sister Song , the National Black Women’s Reproductive Justice Agenda , and other organizations focus on supporting people of color.

Financial support

• The National Network of Abortion Funds works with more than 80 organizations to provide funding for abortion, transportation, childcare, and other services.
• The National Abortion Federation provides referrals, case management, and financial assistance for people seeking abortions.
• Funding is also available from numerous regional, state, and local grassroots organizations, such as Jane’s Due Process , the Texas Equal Access Fund , and the Mississippi Reproductive Freedom Fund .

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Harris' frank talk about abortion and its impact on women's health might energize voters

Vice President Kamala Harris’ willingness to speak freely about abortion could mark a turning point in the national conversation about women’s health, experts said Monday, a day after President Joe Biden announced he would not seek re-election .

“She talks about abortion rights, and she talks about it unapologetically,” said Kelly Baden, vice president for public policy at the Guttmacher Institute, a nongovernmental research organization that works to expand reproductive rights. “She makes the connection between all facets of reproductive health care and abortion rights.”

Study after study has found that lack of access to abortion care has far-reaching health consequences.

States with strict abortion policies tend to have higher rates of infant and maternal mortality . Women living in those states are less likely to be able to access OB/GYNs or even have the ability to pay for appointments. And increasingly, medical students say abortion laws are driving them away from pursuing careers as doctors in states where the procedure is banned.

Harris has highlighted the fallout during multiple campaign trips this year, including a visit in March at a Planned Parenthood in St. Paul, Minnesota . She is the first vice president (or president) to visit a clinic that provides abortions.

“Vice President Harris has made this an incredibly important part of her work on the campaign trail. What this means, fundamentally, is that it’s going to get a lot more attention,” said Christina Reynolds, senior vice president for communications and content at EMILY’s List, an organization that supports pro-abortion-rights women in politics.

Harris is not yet the Democratic nominee for president. If that happens, experts expect her to lean heavily on the link between abortion rights and women’s health care.

“I expect to see her focus on one issue: abortion,” said Drew Altman, CEO of KFF, a nonprofit group that researches health policy issues. Altman said KFF polls find the topic “energizes voters more than anything else,” especially in states like Arizona, a key battleground state.

Jolynn Dellinger, a senior lecturing fellow at Duke Law in Durham, North Carolina, said Harris is “very comfortable talking about the extreme consequences that we have seen as a result of Dobbs.”

“She’s linking the inability to get abortion care in states that have criminalized abortion to the shutting down of clinics that provided other kinds of care, so now people can’t get that kind of care, either,” said Dellinger, who teaches and speaks about the consequences of Dobbs v. Jackson Women’s Health Organization, in which the U.S. Supreme Court overturned Roe v. Wade.

Biden, on the other hand, did not even use the word “abortion” when he addressed reproductive rights in his most recent State of the Union address. (Though he is pro-abortion-rights, Biden has said in the past that his Catholic faith makes him uncomfortable with abortion.)

And the issue got few mentions at the recent Republican National Convention in Milwaukee.

Former President Donald Trump’s son Eric seemed to dismiss the topic of abortion when NBC “TODAY” show host Savannah Guthrie asked him about the Republican platform’s no longer calling for a federal abortion ban. 

“At the end of the day, this country has real holes in the roof. And you’ve got to fix those holes, and you’ve got to stop worrying about the little spot on the wall in the basement,” he said.

The platform, however, does still include language about the 14th Amendment, saying states are “free to pass Laws protecting those rights.” In pushing for fetal personhood , anti-abortion-rights activists often cite the amendment, which says that "nor shall any State deprive any person of life, liberty, or property, without due process of law."

Donald Trump’s running mate, Sen. JD Vance of Ohio, suggested during a 2022 debate that he would support a national ban on abortion . This spring, however, he said states should have the final say on their abortion policies.

In a statement, Kristan Hawkins, president of the anti-abortion-rights group Students for Life Action, said Eric Trump’s response was “disappointing,” adding that the movement’s “greatest adversaries are the abortion bullies who have run Washington D.C. under the Democratic Party rule.”

“Still, the GOP can and must do better,” she said.

Since Roe v. Wade was overturned, voters have backed protecting abortion rights in response to ballot measures in at least seven states. This year, at least six states will have pro-abortion-rights measures on their ballots. Kristi Hamrick, vice president of media and policy for Students for Life Action, said she sees the initiatives as an effort to bolster the Democratic ticket. But she expects the measures to mobilize voters who are against abortion rights, as well.

“I do think that one result of Biden being now gone from the race is that it does elevate the life issue in that the Democrats want more abortion and the Republicans, we believe and hope, want less,” Hamrick said.

If Harris becomes the Democratic nominee, it is likely that the GOP will be forced to address the abortion issue.

Talking about access to abortion care has been “a winning card” for Harris so far, said Altman, of KFF. “I would expect to see her dial that up tremendously.” 

Erika Edwards is a health and medical news writer and reporter for NBC News and "TODAY."

Bracey Harris is a national reporter for NBC News, based in Jackson, Mississippi.

Princeton Legal Journal

The First Amendment and the Abortion Rights Debate

Sofia Cipriano

4 Prin.L.J.F. 12

Following Dobbs v. Jackson ’s (2022) reversal of Roe v. Wade (1973) — and the subsequent revocation of federal abortion protection — activists and scholars have begun to reconsider how to best ground abortion rights in the Constitution. In the past year, numerous Jewish rights groups have attempted to overturn state abortion bans by arguing that abortion rights are protected by various state constitutions’ free exercise clauses — and, by extension, the First Amendment of the U.S. Constitution. While reframing the abortion rights debate as a question of religious freedom is undoubtedly strategic, the Free Exercise Clause is not the only place to locate abortion rights: the Establishment Clause also warrants further investigation. 

Roe anchored abortion rights in the right to privacy — an unenumerated right with a long history of legal recognition. In various cases spanning the past two centuries, t he Supreme Court located the right to privacy in the First, Fourth, Fifth, Ninth, and Fourteenth Amendments . Roe classified abortion as a fundamental right protected by strict scrutiny, meaning that states could only regulate abortion in the face of a “compelling government interest” and must narrowly tailor legislation to that end. As such, Roe ’s trimester framework prevented states from placing burdens on abortion access in the first few months of pregnancy. After the fetus crosses the viability line — the point at which the fetus can survive outside the womb  — states could pass laws regulating abortion, as the Court found that   “the potentiality of human life”  constitutes a “compelling” interest. Planned Parenthood of Southeastern Pennsylvania v. Casey (1992) later replaced strict scrutiny with the weaker “undue burden” standard, giving states greater leeway to restrict abortion access. Dobbs v. Jackson overturned both Roe and Casey , leaving abortion regulations up to individual states. 

While Roe constituted an essential step forward in terms of abortion rights, weaknesses in its argumentation made it more susceptible to attacks by skeptics of substantive due process. Roe argues that the unenumerated right to abortion is implied by the unenumerated right to privacy — a chain of logic which twice removes abortion rights from the Constitution’s language. Moreover, Roe’s trimester framework was unclear and flawed from the beginning, lacking substantial scientific rationale. As medicine becomes more and more advanced, the arbitrariness of the viability line has grown increasingly apparent.  

As abortion rights supporters have looked for alternative constitutional justifications for abortion rights, the First Amendment has become increasingly more visible. Certain religious groups — particularly Jewish groups — have argued that they have a right to abortion care. In Generation to Generation Inc v. Florida , a religious rights group argued that Florida’s abortion ban (HB 5) constituted a violation of the Florida State Constitution: “In Jewish law, abortion is required if necessary to protect the health, mental or physical well-being of the woman, or for many other reasons not permitted under the Act. As such, the Act prohibits Jewish women from practicing their faith free of government intrusion and thus violates their privacy rights and religious freedom.” Similar cases have arisen in Indiana and Texas. Absent constitutional protection of abortion rights, the Christian religious majorities in many states may unjustly impose their moral and ethical code on other groups, implying an unconstitutional religious hierarchy. 

Cases like Generation to Generation Inc v. Florida may also trigger heightened scrutiny status in higher courts; The Religious Freedom Restoration Act (1993) places strict scrutiny on cases which “burden any aspect of religious observance or practice.”

But framing the issue as one of Free Exercise does not interact with major objections to abortion rights. Anti-abortion advocates contend that abortion is tantamount to murder. An anti-abortion advocate may argue that just as religious rituals involving human sacrifice are illegal, so abortion ought to be illegal. Anti-abortion advocates may be able to argue that abortion bans hold up against strict scrutiny since “preserving potential life” constitutes a “compelling interest.”

The question of when life begins—which is fundamentally a moral and religious question—is both essential to the abortion debate and often ignored by left-leaning activists. For select Christian advocacy groups (as well as other anti-abortion groups) who believe that life begins at conception, abortion bans are a deeply moral issue. Abortion bans which operate under the logic that abortion is murder essentially legislate a definition of when life begins, which is problematic from a First Amendment perspective; the Establishment Clause of the First Amendment prevents the government from intervening in religious debates. While numerous legal thinkers have associated the abortion debate with the First Amendment, this argument has not been fully litigated. As an amicus brief filed in Dobbs by the Freedom From Religion Foundation, Center for Inquiry, and American Atheists  points out, anti-abortion rhetoric is explicitly religious: “There is hardly a secular veil to the religious intent and positions of individuals, churches, and state actors in their attempts to limit access to abortion.” Justice Stevens located a similar issue with anti-abortion rhetoric in his concurring opinion in Webster v. Reproductive Health Services (1989) , stating: “I am persuaded that the absence of any secular purpose for the legislative declarations that life begins at conception and that conception occurs at fertilization makes the relevant portion of the preamble invalid under the Establishment Clause of the First Amendment to the Federal Constitution.” Judges who justify their judicial decisions on abortion using similar rhetoric blur the line between church and state. 

Framing the abortion debate around religious freedom would thus address the two main categories of arguments made by anti-abortion activists: arguments centered around issues with substantive due process and moral objections to abortion. 

Conservatives may maintain, however, that legalizing abortion on the federal level is an Establishment Clause violation to begin with, since the government would essentially be imposing a federal position on abortion. Many anti-abortion advocates favor leaving abortion rights up to individual states. However, in the absence of recognized federal, constitutional protection of abortion rights, states will ban abortion. Protecting religious freedom of the individual is of the utmost importance  — the United States government must actively intervene in order to uphold the line between church and state. Protecting abortion rights would allow everyone in the United States to act in accordance with their own moral and religious perspectives on abortion. 

Reframing the abortion rights debate as a question of religious freedom is the most viable path forward. Anchoring abortion rights in the Establishment Clause would ensure Americans have the right to maintain their own personal and religious beliefs regarding the question of when life begins. In the short term, however, litigants could take advantage of Establishment Clauses in state constitutions. Yet, given the swing of the Court towards expanding religious freedom protections at the time of writing, Free Exercise arguments may prove better at securing citizens a right to an abortion. 

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Abortion Rights Groups Rush to Back Kamala Harris

Reproductive rights organizations have been quick to come out in support of Vice President Kamala Harris as the Democratic Party’s presumptive presidential nominee after President Joe Biden announced on Sunday that he would drop out of the presidential race and endorse Harris instead.

Harris could be an even stronger proponent for reproductive health care than President Biden, who has been hesitant to speak directly about abortion during his presidency. Biden, a practicing Catholic, has said that he isn’t “big on abortion” and even opposed it in his early days as a senator, but his views have evolved over the years.

“We’re incredibly excited that we have somebody who has a long track record in fighting for abortion access as potentially being the person who’s at the top of the presidential ticket for the Democratic Party,” said Nourbese Flint, president of All* in Action Fund, a group that supports public insurance coverage of abortion, in an interview with WIRED.

Elisa Wells, cofounder of the nonprofit Plan C, which provides information on self-managed, at-home abortion with pills, told WIRED that she expects Harris to bring “strong leadership” on reproductive rights and have a “bold agenda” to restore legal access to abortion.

“Abortion rights groups will certainly be thrilled to have a candidate who will forcefully campaign on reproductive health access,” wrote Larry Levitt, executive vice president for health policy at KFF, a nonprofit health policy organization, in an email to WIRED.

Access to abortion has dwindled across the US following the Supreme Court’s 2022 overturning of Roe v. Wade , the 50-year-old landmark case that protected the right to have an abortion. Three justices appointed by former president Donald Trump—Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett—were among the five who made up the majority opinion to repeal Roe . The decision opened the door for states to ban abortion outright, and more than a dozen have done so .

Since the decision, Vice President Harris has become the Biden administration’s voice for reproductive rights. In January, she set out on a nationwide tour to highlight the harms of state abortion bans. During a kickoff speech for that tour , Harris recounted an event in high school that led her to become a prosecutor specializing in crimes against women and children: She learned that one of her best friends was being sexually abused by her stepfather.

In the speech, she referred to abortion access as a “health care crisis” and shared the story of a Wisconsin couple, Meaghan and Joe, who discovered they were pregnant and that the fetus had a severe genetic disorder that put Meaghan’s life at risk. Meaghan could not get an abortion in Wisconsin and ultimately had to travel to Minnesota to receive care.

At the event, Harris said the Biden administration was fighting to protect women’s access to reproductive care. “We trust women. We trust women to make decisions about their own bodies. We trust women to know what is in their own best interest,” she said.

Despite Biden’s discomfort around the issue, his administration has nonetheless supported policies to protect and expand access to reproductive health care. During his tenure, the Food and Drug Administration lifted the in-person dispensing requirement for the abortion pill mifepristone, allowing women to get abortion medication via telehealth services , and defended access to the pill when it was challenged in the courts. Biden administration officials also reminded insurers of their obligation to cover contraception under the Affordable Care Act, passed in 2010. And Biden vowed to veto a national abortion ban if Congress attempted to pass one.

Emily’s List, a political action committee that raises money for female candidates who support abortion rights, has already backed Harris , with its president, Jessica Mackler, calling her the “most powerful advocate and messenger on this issue.”

Reproductive Freedom for All, the oldest existing abortion rights advocacy group in the United States, formerly called NARAL Pro-Choice America, has also endorsed Harris. “There is nobody who has fought as hard for abortion rights and access, and we are proud to endorse her in this race,” its president and CEO, Mini Timmaraju, said in a statement .

Planned Parenthood Action Fund has not officially endorsed Harris yet, as that decision must be ratified by local Planned Parenthood health centers. But the fund’s president and CEO, Alexis McGill Johnson, released a statement praising the Biden administration’s record on protecting reproductive freedoms. In it, Johnson applauded Harris for putting “the needs and experiences of patients and providers front and center,” adding that Harris was the first sitting vice president to visit an abortion clinic. The Action Fund will announce its endorsement after a “rigorous endorsement process.”

The abortion issue could bring more Democrats to the polls this fall. According to a May Gallup poll , a record-high 32 percent of US voters say they would vote only for a candidate for major office who shares their views on abortion.

Former president Donald Trump, the Republican presidential nominee, has said a federal ban on abortion is not needed and instead supports states making their own decisions on whether to allow abortion.

Polling suggests that most Americans support abortion. One poll, conducted by Pew Research in April , found that 63 percent of Americans said abortion should be legal in all or most cases, while 36 percent said it should be illegal in all or most cases. Among Republicans and independents who lean Republican, 57 percent said abortion should be illegal in all or most cases, while 85 percent of Democrats and Democratic leaners say abortion should be legal in all or most cases.

Updated 7-23-2024 5:00 pm BST: Nourbese Flint’s affiliation was corrected.

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• Copy URL https://www.pbs.org/newshour/politics/democrats-hope-harris-bluntness-on-abortion-will-lead-to-2024-wins

Democrats hope Harris’ bluntness on abortion will lead to 2024 wins

WASHINGTON (AP) — President Joe Biden might not often use the word “abortion” when he talks about the overturning of Roe v. Wade, but Vice President Kamala Harris sure does. She’s also toured a Minnesota Planned Parenthood clinic where the procedure is performed and routinely links the fall of Roe to the larger issue of rising maternal mortality nationwide.

Now that Harris is running for president in place of Biden, Democrats and advocates for reproductive rights are hoping that her bluntness on abortion — coupled with the administration’s policies — will help sway voters to deliver them not just the White House but key congressional seats as well.

“The president on the record was fabulous and the campaign was turning out multiple repro-focused ads a week, and had an army of surrogates,” said Mini Timmaraju, president of Reproductive Freedom for All. “But, you know, nothing is more compelling than the top of the ticket being the most compelling on the issue, and that’s what we have now.”

In her first rally as a candidate on Tuesday, Harris touched on the issue of abortion briefly. But she’s expected to make it a major feature of the campaign going forward, as she works to draw a stark contrast between herself and Republican Donald Trump.

READ MORE:  Republican leaders urge party members against racist and sexist attacks on Harris

She’s eager to portray herself as a direct and consistent advocate with a history of fighting for reproductive health issues, especially Black maternal health.

“We who believe in reproductive freedom will stop Donald Trump’s extreme abortion bans, because we trust women to make decisions about their own bodies and not have their government tell them what to do,” she said to loud cheers at a Wisconsin rally.

The Supreme Court on June 24, 2022, overturned abortion rights that had been in place since 1973. Since then, roughly half the states have put some sort of ban in place.

The consequences of these bans go far beyond restricting access for those who wish to end unwanted pregnancies. And generally, the states with the most restrictions also have the worst rates of maternal mortality.

Trump has repeatedly taken credit for the overturning of the federally guaranteed right to abortion. He nominated three of the Supreme Court justices who voted to overturn Roe. But he has publicly resisted supporting a national abortion ban.

Trump’s running mate, JD Vance, has said he adheres to Trump’s views. But in 2022, when he was running for the Senate in Ohio, Vance said: “I certainly would like abortion to be illegal nationally.”

Dr. Jamila Perritt, leader of the nonpartisan group Physicians for Reproductive Health, laid out a bleak landscape for women today that she hopes will change.

“The destruction of the health care safety net, assaults on bodily autonomy, and the rising maternal mortality rate clearly show us that pregnant people and those with the capacity for pregnancy do not have access to the options they need to stay safe and healthy,” she said, adding that it’s worse for Black women who must navigate racism on top of worsening healthcare.

“We need bold solutions to combat these crises on multiple fronts,” she said.

Even before dropping out of the race, Biden had made Harris his chief messenger on the issue. In the days following the overturning of Roe, the vice president met with lawmakers in conservative states to discuss how to protect abortion rights in the ruling’s aftermath. They convened meetings at the White House. Earlier this year, she did a reproductive rights tour in battleground states, starting in Wisconsin. She was the first vice president to tour an abortion clinic.

Harris’ husband, Doug Emhoff, has said reproductive freedom is an “everyone” issue, not a “women’s” issue. On Tuesday, in his first public appearance since his wife started pursuing the top slot on the ticket, he visited an abortion clinic.

“We’ve seen the stories of women who had to literally be on death’s door before they got treatment. It’s barbaric, it’s immoral and it must change,” Emhoff said.

The president’s personal views have evolved over his 50 years in public service, but the 81-year-old Catholic has always been more comfortable leaving the blunt talk to his vice president.

On the policy side, Biden has sought to make medication abortion more available, access to contraception easier, and his administration has gone before the Supreme Court to argue hospitals have a duty under federal law to perform the procedure in life-threatening situations even in states where abortion is now banned. Biden also has said the Hyde Amendment should be eliminated. Among other things, the amendment bars the use of federal funds to pay for abortion.

READ MORE: Harris lays out her case against Trump in first campaign event in Wisconsin

But when the president had the opportunity to hit Trump on the issue during their June 27 debate, Biden faltered, giving jumbled and even nonsensical responses, and he failed to check Trump’s false claims about Democrats’ views on the subject. That debate set his undoing in motion.

Harris’ views have been consistent, from her time in the U.S. Senate and as attorney general in California. She links the issue of abortion to the larger problems in the U.S. with maternal mortality and morbidity — plainly discussing how Black women are at a significantly greater risk for complications and less likely to be believed when something goes wrong.

As senator, she advocated for maternal health legislation. In 2019, she sponsored the Maternal CARE Act, calling for grants addressing implicit bias in maternal health care. In 2020, she introduced a law aimed at addressing maternal health outcomes with a focus on Black maternal health. She’s also co-sponsored bills addressing birth control access and funding care for uterine fibroids.

During her time as California’s attorney general, Harris also sued an anti-abortion group that secretly recorded videos of abortion providers.

Mary Ruth Ziegler, a law professor at the University of California, Davis School of Law, said Harris is poised to become among the most, if not the most, pro-abortion-rights candidates ever nominated by a major political party.

“If Harris prevails, it may have a big impact on how we address abortion rights because it’ll show that a more unapologetic, full-throated embrace of reproductive rights can lead you to win politically and overcome other political obstacles,” said Ziegler, one of the nation’s leading abortion rights scholars.

Renee Bracey Sherman, founder and co-executive director of the national abortion rights organization WeTestify, said Harris’ identity as a Black and South Asian woman uniquely positions her to speak more personally about how abortion bans disproportionately impact women of color. She said it “means something for all of us” when people of color speak thoughtfully and unapologetically.

She added: “I’m looking forward to working with someone who we don’t have to beg to use the word ‘abortion.'”

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

Chapter: 5 conclusions, 5 conclusions.

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

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

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

___________________

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Argumentative Essay

Jazatte Dalisay is a ninth-grade student at the Manhattan Center for Science and Mathematics. This essay was composed in a class tutored by James Traub, a long-time PEN Member and coordinator of PEN’s Writers in the Schools program.

Women’s rights have greatly evolved throughout the centuries. As of 2014, women in the U.S. are entitled to their right to decide when to have a child. But there is a constant debate on whether or not abortion should remain legal in the United States. The legalization of abortion has not only kept women from danger, but has provided women with a concrete solution to unplanned pregnancies and protects their civil rights. Taking abortion off the shelf of opportunity for women will only make them seek illicit and dangerous methods to abort an unwanted child and takes away the ability of women to decide what to do with their own bodies.

It is understandable why some might think abortion is an inhumane act that is unnecessary and unlawful, especially since there are alternatives. Adoption has been seen as the perfect solution to unplanned pregnancies; women can simply give their unwanted child away to someone who wants it. With adoption, infertile couples get another chance at making a family, and the child still has a chance at life. This would seem to be the most logical, and humane thing to do. So why does abortion exist?

What people who are pro-life fail to see is the psychological and emotional damage that is inflicted on the woman during the pregnancy. If abortion were to be banned, women who have gotten pregnant through rape and/or incest would have to withstand the shame and pain of knowing that an unwanted child is growing inside them. Victims would be forced to have a constant reminder of their rape. A recent study shows that rape victims are 13 times more likely to attempt suicide, and 26 times more likely to abuse substances such as alcohol and drugs (mscu.edu). Banning abortion would mean destroying the chances of women who are victims of rape to get closure. The psychological and emotional stress can fuel their desperation to rid themselves of the fetus and make them go to great lengths to do that. According to Daniel R. Mishell, Jr., MD, Chair of the Department of Obstetrics and Gynecology at the Keck School of Medicine, University of Southern California, “before abortion was legalized women would frequently try to induce abortions by using coat hangers, knitting needles, or radiator flush, or by going to unsafe “back-alley” abortionists.” In the end, banning abortion will not stop women from trying to rid themselves of the fetus, but just put their own well-being in jeopardy.

Abortion is also a concrete solution to unplanned pregnancies. Though the use of contraceptions, such as the morning-after pill, have been proven to work, it is not always as effective. “Fifty-one percent of women who have abortions had used a contraceptive method in the month they got pregnant, most commonly condoms (27 percent) or a hormonal method (17 percent)” (guttmacher.org). Often, women and teenage girls are too afraid to speak up or don’t even know that they are pregnant, and once they realize they are, it’s already too late—contraceptions are not effective after a certain amount of time. Abortion is their last chance of terminating the pregnancy in a safe and legal way.

Lastly, keeping abortion legal protects women’s rights. Women have full control over their bodies, meaning what they do with them is their decision. If abortion were illegal, women would be stripped of this right. According to Supreme Court Justice Sandra Day O’Conner, “The ability of women to participate equally in the economic and social life of the Nation has been facilitated by their ability to control their reproductive lives” (procon.org). Abortion is also viewed as a fundamental right under law. The Constitution gives “a guarantee of certain areas or zones of privacy,” and that “This right of privacy…is broad enough to encompass a woman’s decision whether or not to terminate her pregnancy” (procon.org). Making abortion illegal means robbing women of their rights.

Keeping abortion legal ensures a woman’s safety when faced with unplanned pregnancies, provides hope for rape victims and helps them in moving on with their lives, and protects women’s rights. Making abortion illegal does not stop women from trying to terminate a pregnancy, nor does it save lives. Rather, it does the opposite — illegalizing abortion puts women in danger and prevents them from having control over their own bodies.

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‘Hillbilly’ Women Will Get No Help From J. D. Vance

He has no business speaking for Kentucky.

The one time I met J. D. Vance was shortly after his book, Hillbilly Elegy , came out, at an event in Kentucky—the state where his grandparents were from and that he wrote about in the memoir. I told him I was working on a book about women from the Appalachian Mountains, about the hill women who hold communities together. He seemed interested. “My mamaw was a hill woman,” he said. “I wrote about her.”

But Vance, it soon became clear, had no business speaking for the people of Appalachia. He capitalized on Americans’ interest in the area, turning a tenuous family connection to the mountains into a lucrative and powerful platform. He then abandoned Appalachia when he ran for Senate, trading in his “hillbilly” rhetoric for speeches about his “Ohio values.”

But what bothers me more is the impact that Vance’s policies and rhetoric have on the Appalachian people that he claims to care about—particularly its women.

Vance has said that nowadays, people “shift spouses like they change their underwear” and implied that they should remain in a marriage even if it is abusive. The idea that leaving a bad marriage that is “maybe even violent” would make you happier, he said, was “one of the great tricks that I think the sexual revolution pulled on the American populace.”

I serve in Kentucky’s state Senate, but I began my legal career providing free assistance to survivors of domestic violence. In that role, I used the law to help women divorce their abusive spouses. Navigating divorce can be hard anywhere. But in rural areas, many people have to drive hours to reach a court. These places are legal deserts, with far too few lawyers handling far too many cases. It’s difficult to take off work and find child care to sit in court all day.

I now research domestic violence and rural courts. In a new study of mine , forthcoming in the Kentucky Law Journal , the numbers paint a bleak picture. Rural women seeking domestic-violence protective orders are less likely to have an attorney and less likely to receive information about supportive services than those in urban areas. A lack of resources means that they are less likely to have access to a specialized family-court judge and are more likely to have their case heard in open court, before strangers, instead of in a private proceeding. In my experience, a lot of people will decide not to get a protective order solely because they are worried about all of the people who will be in the courtroom as they tell their story of abuse.

I met one woman who lived about an hour outside of Louisville who had been trying for years to get divorced. She couldn’t afford an attorney, so she tried to file the paperwork herself. Without a lawyer to move it along, her case went nowhere. Over the next few years, her husband would find her every so often. He would show up wherever she was staying, tell the landlord that they were married to get into the apartment, beat her up, and leave. I thought about her when I heard Vance speak so flippantly about the choice to divorce an abusive partner.

Vance has also supported an extreme abortion ban with no exceptions for rape or incest—another policy that particularly harms women in rural communities. Just two years ago, he expressed support for a national abortion ban, saying that he “certainly would like for abortion to be illegal nationally.”

I serve in the state legislature of a place with one of the most extreme abortion bans in the nation. Kentucky, like 13 other states, has a law that criminalizes abortion at all stages of pregnancy. It has one narrow exception that permits a doctor to terminate a pregnancy to prevent the death or “the serious, permanent impairment of a life-sustaining organ of a pregnant woman.” Many of the doctors I have spoken with tell me that the language is so vague, it’s hard to use in practice. Sometimes I wonder if that’s the point.

Here, too, we know that Vance’s policy stances have a real impact. One study suggests that nearly 65,000 women living in states with total abortion bans have experienced rape-related pregnancies since Roe v. Wade was overturned. And women living in rural communities have always struggled to access abortion services, just as they struggle to access health care in general.

Last year, one Kentucky woman, Hadley Duvall, became a nationally recognized leader on this issue when she shared her story of becoming pregnant at 12 after she was raped by her stepfather. Duvall miscarried, but she has spoken powerfully—most recently in a campaign ad for President Joe Biden —about what it meant to have choices. Vance would take that choice away.

J. D. Vance: The opioid of the masses

Vance has also told us his position on day-care access, one of the most important policy issues for women in rural areas. He seems uninterested in supporting this struggling sector or the families who depend on it. He has said that funding universal day care would be “class warfare against normal people,” by which he presumably meant families with mothers who wanted to and could afford to stay home full-time.

I was sworn into my first elected office when my youngest child was six weeks old. I’ve focused on child-care policy in part because I’ve had to. COVID forced 100,000 Kentucky women to leave the workforce. About 40 percent of unemployed Kentuckians currently cite a lack of child care as the reason they are not working. Statewide, we’ve lost 46 percent of our child-care centers since 2012, and many of those closures have been in rural areas.

I’m proud of the work our legislature is doing on this issue. This past session, a rural Republican sponsored a bipartisan bill to reward local communities for eliminating zoning barriers that restrict child-care centers. We need policy makers who will bring resources and attention to this crisis, not leaders like Vance who try to gaslight women into believing it doesn’t exist.

Like Vance, I, too, carry the stories of women from the mountains. Stories of women like my granny, who was from Owsley County, one of the poorest places in America. She never finished elementary school, but she pushed each of her seven children to get an education. My aunt Ruth dropped out of high school, but she was the best farmworker in the area and saved up money so her little sister could afford college. My mom was that little sister, the first of Granny’s kids to graduate high school, the first who left her holler and everything she knew in search of a better life. She built that better life for me.

The Appalachian Mountains are full of hill women holding their communities together. They don’t have the resources or support that they need to enact sweeping change. But they find creative ways to make quiet progress. We don’t hear their stories enough. More important, we don’t pass enough policies that help them. Electing J. D. Vance as vice president would only hurt them more.

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Guest Essay

Pro-Lifers Helped Bring Trump to Power. Why Has He Abandoned Us?

By Patrick T. Brown

Mr. Brown is a fellow at the Ethics and Public Policy Center, a conservative think tank, and a former senior policy adviser to Congress’s Joint Economic Committee.

I am far from the only young conservative whose interest in politics was sparked by the issue of abortion. In high school and college, we would stake out early-morning spots on the National Mall for the annual March for Life, write postcards to our elected officials and pray rosaries outside abortion clinics.

Along the way, many of us found ourselves in the Republican Party, often picking up other conservative causes along the way — low taxes, limited government, strong defense, border security. The bundle of preferences could be a bit ungainly at times, but we found progressive voices quick to shout down attempts for pro-lifers to work with Democrats . So the G.O.P. became home.

It’s hard to feel that way now. While traditional social conservatives and the Republican Party might be allies on some key issues, it appears that it is no longer just one political party that wants us to shelve our convictions in the name of political expediency. It’s both.

This shift has been a long time coming, but recent events have snapped it into focus. A secularizing America, plus the shifting composition of the Republican Party, means many G.O.P. voters are less churchgoing than prior generations. Many young conservatives, in particular, seem more enthusiastic about owning the libs than strengthening the family.

That might help explain why Republican politicians seemed so unprepared for the aftermath of the Dobbs v. Jackson Women’s Health Organization decision, which overturned Roe v. Wade. They could have prepared by focusing on politically tenable compromise and a wider array of supports for pregnant women and families . Instead, their political strategy in 2022 largely consisted of trying to change the subject , then blaming pro-lifers for poorer-than-expected midterm election results. Meanwhile the G.O.P. has been an unreliable partner in countering the state referendums that have expanded legal protections for abortion in Michigan, Ohio and other states.

Now a rewritten Republican Party platform rubber-stamped by Donald Trump loyalists largely backtracks from its goal of protecting the unborn nationwide. Sweeping language declaring a constitutional right to life has been replaced by a somewhat garbled mention of due process, specifying that states are “free to pass laws” that restrict abortion. A mention of the traditional understanding of marriage is also gone. The platform even omits standing against taxpayer funding for abortion, offering only a mention of opposing “late-term abortion” — a category often understood as excluding the roughly 99 percent of abortion procedures that occur before 21 weeks of pregnancy. The new platform makes sure to include positive mentions of birth control and in vitro fertilization yet neglects any reference to pregnancy resource centers or child care.

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