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Argumentative Essay Outline on Abortion

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Published: Mar 13, 2024

Words: 665 | Page: 1 | 4 min read

Table of contents

Introduction, thesis statement, paragraph 1: the right to bodily autonomy, paragraph 2: the health and safety of women, paragraph 3: reproductive freedom and economic justice.

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Persuasive Essay Guide

Persuasive Essay About Abortion

Crafting a Convincing Persuasive Essay About Abortion

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Are you about to write a persuasive essay on abortion but wondering how to begin?

Writing an effective persuasive essay on the topic of abortion can be a difficult task for many students. 

It is important to understand both sides of the issue and form an argument based on facts and logical reasoning. This requires research and understanding, which takes time and effort.

In this blog, we will provide you with some easy steps to craft a persuasive essay about abortion that is compelling and convincing. Moreover, we have included some example essays and interesting facts to read and get inspired by. 

So let's start!

• 1. How To Write a Persuasive Essay About Abortion?
• 2. Persuasive Essay About Abortion Examples
• 3. Examples of Argumentative Essay About Abortion
• 4. Abortion Persuasive Essay Topics
• 5. Facts About Abortion You Need to Know

How To Write a Persuasive Essay About Abortion?

Abortion is a controversial topic, with people having differing points of view and opinions on the matter. There are those who oppose abortion, while some people endorse pro-choice arguments. 

It is also an emotionally charged subject, so you need to be extra careful when crafting your persuasive essay .

Before you start writing your persuasive essay, you need to understand the following steps.

Step 1: Choose Your Position

The first step to writing a persuasive essay on abortion is to decide your position. Do you support the practice or are you against it? You need to make sure that you have a clear opinion before you begin writing. 

Once you have decided, research and find evidence that supports your position. This will help strengthen your argument. 

Check out the video below to get more insights into this topic:

Step 2: Choose Your Audience

The next step is to decide who your audience will be. Will you write for pro-life or pro-choice individuals? Or both? 

Knowing who you are writing for will guide your writing and help you include the most relevant facts and information.

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Step 3: Define Your Argument

Now that you have chosen your position and audience, it is time to craft your argument. 

Start by defining what you believe and why, making sure to use evidence to support your claims. You also need to consider the opposing arguments and come up with counter arguments. This helps make your essay more balanced and convincing.

Step 4: Format Your Essay

Once you have the argument ready, it is time to craft your persuasive essay. Follow a standard format for the essay, with an introduction, body paragraphs, and conclusion. 

Make sure that each paragraph is organized and flows smoothly. Use clear and concise language, getting straight to the point.

Step 5: Proofread and Edit

The last step in writing your persuasive essay is to make sure that you proofread and edit it carefully. Look for spelling, grammar, punctuation, or factual errors and correct them. This will help make your essay more professional and convincing.

These are the steps you need to follow when writing a persuasive essay on abortion. It is a good idea to read some examples before you start so you can know how they should be written.

Continue reading to find helpful examples.

Persuasive Essay About Abortion Examples

To help you get started, here are some example persuasive essays on abortion that may be useful for your own paper.

Short Persuasive Essay About Abortion

Persuasive Essay About No To Abortion

What Is Abortion? - Essay Example

Persuasive Speech on Abortion

Legal Abortion Persuasive Essay

Persuasive Essay About Abortion in the Philippines

Persuasive Essay about legalizing abortion

You can also read m ore persuasive essay examples to imp rove your persuasive skills.

Examples of Argumentative Essay About Abortion

An argumentative essay is a type of essay that presents both sides of an argument. These essays rely heavily on logic and evidence.

Here are some examples of argumentative essay with introduction, body and conclusion that you can use as a reference in writing your own argumentative essay. 

Abortion Persuasive Essay Introduction

Argumentative Essay About Abortion Conclusion

Argumentative Essay About Abortion Pdf

Argumentative Essay About Abortion in the Philippines

Argumentative Essay About Abortion - Introduction

Abortion Persuasive Essay Topics

If you are looking for some topics to write your persuasive essay on abortion, here are some examples:

• Should abortion be legal in the United States?
• Is it ethical to perform abortions, considering its pros and cons?
• What should be done to reduce the number of unwanted pregnancies that lead to abortions?
• Is there a connection between abortion and psychological trauma?
• What are the ethical implications of abortion on demand?
• How has the debate over abortion changed over time?
• Should there be legal restrictions on late-term abortions?
• Does gender play a role in how people view abortion rights?
• Is it possible to reduce poverty and unwanted pregnancies through better sex education?
• How is the anti-abortion point of view affected by religious beliefs and values? 

These are just some of the potential topics that you can use for your persuasive essay on abortion. Think carefully about the topic you want to write about and make sure it is something that interests you. 

Check out m ore persuasive essay topics that will help you explore other things that you can write about!

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Facts About Abortion You Need to Know

Here are some facts about abortion that will help you formulate better arguments.

• According to the Guttmacher Institute , 1 in 4 pregnancies end in abortion.
• The majority of abortions are performed in the first trimester.
• Abortion is one of the safest medical procedures, with less than a 0.5% risk of major complications.
• In the United States, 14 states have laws that restrict or ban most forms of abortion after 20 weeks gestation.
• Seven out of 198 nations allow elective abortions after 20 weeks of pregnancy.
• In places where abortion is illegal, more women die during childbirth and due to complications resulting from pregnancy.
• A majority of pregnant women who opt for abortions do so for financial and social reasons.
• According to estimates, 56 million abortions occur annually.

In conclusion, these are some of the examples, steps, and topics that you can use to write a persuasive essay. Make sure to do your research thoroughly and back up your arguments with evidence. This will make your essay more professional and convincing. 

Need the services of a persuasive essay writing service ? We've got your back!

MyPerfectWords.com that provides help to students in the form of professionally written essays. Our persuasive essay writer can craft quality persuasive essays on any topic, including abortion. 

So, just ask our experts ' do my essay ' and get professional help.

Frequently Asked Questions

What should i talk about in an essay about abortion.

When writing an essay about abortion, it is important to cover all the aspects of the subject. This includes discussing both sides of the argument, providing facts and evidence to support your claims, and exploring potential solutions.

What is a good argument for abortion?

A good argument for abortion could be that it is a woman’s choice to choose whether or not to have an abortion. It is also important to consider the potential risks of carrying a pregnancy to term.

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• America’s Abortion Quandary

2. Social and moral considerations on abortion

Table of contents.

• Abortion at various stages of pregnancy 
• Abortion and circumstances of pregnancy 
• Parental notification for minors seeking abortion
• Penalties for abortions performed illegally 
• Public views of what would change the number of abortions in the U.S.
• A majority of Americans say women should have more say in setting abortion policy in the U.S.
• How do certain arguments about abortion resonate with Americans?
• In their own words: How Americans feel about abortion 
• Personal connections to abortion 
• Religion’s impact on views about abortion
• Acknowledgments
• The American Trends Panel survey methodology

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The Last Thing This Supreme Court Could Do to Shock Us

There will be no more self-soothing after this..

For three long years, Supreme Court watchers mollified themselves (and others) with vague promises that when the rubber hit the road, even the ultraconservative Federalist Society justices of the Roberts court would put democracy before party whenever they were finally confronted with the legal effort to hold Donald Trump accountable for Jan. 6. There were promising signs: They had, after all, refused to wade into the Trumpian efforts to set aside the election results in 2020. They had, after all, hewed to a kind of sanity in batting away Trumpist claims about presidential records (with the lone exception of Clarence Thomas, too long marinated in the Ginni-scented Kool-Aid to be capable of surprising us, but he was just one vote). We promised ourselves that there would be cool heads and grand bargains and that even though the court might sometimes help Trump in small ways, it would privilege the country in the end. We kept thinking that at least for Justices Brett Kavanaugh and Neil Gorsuch and Chief Justice John Roberts , the voice of reasoned never-Trumpers might still penetrate the Fox News fog. We told ourselves that at least six justices, and maybe even seven, of the most MAGA-friendly court in history would still want to ensure that this November’s elections would not be the last in history. Political hacks they may be, but they were not lawless ones.

On Thursday, during oral arguments in Trump v. United States , the Republican-appointed justices shattered those illusions. This was the case we had been waiting for, and all was made clear—brutally so. These justices donned the attitude of cynical partisans, repeatedly lending legitimacy to the former president’s outrageous claims of immunity from criminal prosecution. To at least five of the conservatives, the real threat to democracy wasn’t Trump’s attempt to overturn the election—but the Justice Department’s efforts to prosecute him for the act. These justices fear that it is Trump’s prosecution for election subversion that will “destabilize” democracy, requiring them to read a brand-new principle of presidential immunity into a Constitution that guarantees nothing of the sort. They evinced virtually no concern for our ability to continue holding free and fair elections that culminate in a peaceful transfer of power. They instead offered endless solicitude for the former president who fought that transfer of power.

However the court disposes of Trump v. U.S. , the result will almost certainly be precisely what the former president craves: more delays, more hearings, more appeals—more of everything but justice . This was not a legitimate claim from the start, but a wild attempt by Trump’s attorneys to use his former role as chief executive of the United States to shield himself from the consequences of trying to turn the presidency into a dictatorship. After so much speculation that these reasonable, rational jurists would surely dispose of this ridiculous case quickly and easily, Thursday delivered a morass of bad-faith hand-wringing on the right about the apparently unbearable possibility that a president might no longer be allowed to wield his powers of office in pursuit of illegal ends. Just as bad, we heard a constant minimization of Jan. 6, for the second week in a row , as if the insurrection were ancient history, and history that has since been dramatically overblown, presumably for Democrats’ partisan aims.

We got an early taste of this minimization in Trump v. Anderson , the Colorado case about removing Trump from the ballot. The court didn’t have the stomach to discuss the violence at the Capitol in its sharply divided decision, which found for Trump ; indeed, the majority barely mentioned the events of Jan. 6 at all when rejecting Colorado’s effort to bar from the ballot an insurrectionist who tried to steal our democracy. But we let that one be, because we figured special counsel Jack Smith would ride to the rescue. Smith has indicted Trump on election subversion charges related to Jan. 6, and the biggest obstacle standing between the special counsel and a trial has been the former president’s outlandish claim that he has absolute immunity from criminal charges as a result of his having been president at the time. Specifically, Trump alleges that his crusade to overturn the election constituted “official acts” that are immune from criminal liability under a heretofore unknown constitutional principle that the chief executive is quite literally above the law.

The U.S. Court of Appeals for the District of Columbia Circuit held in February that the president does not have blanket or absolute immunity for all actions taken in office, including “official” acts performed under the guise of executing the law (for example, Trump’s attempt to weaponize the DOJ against election results under the pretense of investigating fraud). The D.C. Circuit’s emphatic, cross-ideological decision should have been summarily affirmed by SCOTUS within days. Instead, the justices set it for arguments two months down the road—a bad omen, to put it mildly . Even then, many court watchers held out hope that Thursday morning’s oral arguments were to be the moment for the nine justices of the Supreme Court to finally indicate their readiness to take on Trump, Trumpism, illiberalism, and slouching fascism.

It was not to be. Justice Samuel Alito best captured the spirit of arguments when he asked gravely “what is required for the functioning of a stable democratic society” (good start!), then answered his own question: total immunity for criminal presidents (oh, dear). Indeed, anything but immunity would, he suggested, encourage presidents to commit more crimes to stay in office: “Now, if an incumbent who loses a very close, hotly contested election knows that a real possibility after leaving office is not that the president is going to be able to go off into a peaceful retirement but that the president may be criminally prosecuted by a bitter political opponent, will that not lead us into a cycle that destabilizes the functioning of our country as a democracy?” Never mind that the president in question did not leave office peacefully and is not sitting quietly in retirement but is instead running for presidential office once again. No, if we want criminal presidents to leave office when they lose, we have to let them commit crimes scot-free. If ever a better articulation of the legal principle “Don’t make me hit you again” has been proffered at an oral argument, it’s hard to imagine it.

Justice Sonia Sotomayor spoke to this absurdity when she responded in what could only be heard as a cri de coeur: “Stable democratic society needs good faith of public officials,” she said. “That good faith assumes that they will follow the law.” The justice noted that despite all the protections in place, a democracy can sometimes “potentially fail.” She concluded: “In the end, if it fails completely, it’s because we destroyed our democracy on our own, isn’t it?”

But it was probably too late to make this plea, because by that point we had heard both Alito and Gorsuch opine that presidents must be protected at all costs from the whims of overzealous deep state prosecutors brandishing “vague” criminal statutes. We heard Kavanaugh opine mindlessly on the independent counsel statute and how mean it is to presidents, reading extensively from Justice Antonin Scalia’s dissent in a case arguing that independent counsels are unconstitutional. (Yes, Kavanaugh worked for Ken Starr , the independent counsel.) If you’re clocking a trend here, it’s gender. Just as was the case in Anderson , it’s the women justices doing the second-shift work here: both probing the thorny constitutional and criminal questions and signaling a refusal to tank democracy over abstractions and deflections. As was the case in the EMTALA arguments, it’s the women who understand what it looks like to cheat death.

Is the president, Sotomayor asked, immune from prosecution if he orders the military to assassinate a political rival? Yes, said John Sauer, who represented Trump—though it “depends on the circumstances.” Could the president, Justice Elena Kagan asked, order the military to stage a coup? Yes, Sauer said again, depending on the circumstances. To which Kagan tartly replied that Sauer’s insistence on specifying the “circumstances” boiled down to “Under my test, it’s an official act, but that sure sounds bad, doesn’t it?” (Cue polite laughter in the chamber.)

This shameless, maximalist approach should have drawn anger from the conservative justices—indignation, at least, that Sauer took them for such easy marks. But it turns out that he calibrated his terrible arguments just right. The cynicism on display was truly breathtaking: Alito winkingly implied to Michael Dreeben, representing Smith, that we all know that Justice Department lawyers are political hacks, right? Roberts mocked Dreeben for saying “There’s no reason to worry because the prosecutor will act in good faith.”

The conservative justices are so in love with their own voices and so convinced of their own rectitude that they monologued about how improper it was for Dreeben to keep talking about the facts of this case, as opposed to the “abstract” principles at play. “I’m talking about the future!” Kavanaugh declared at one point to Dreeben, pitching himself not as Trump’s human shield but as a principled defender of the treasured constitutional right of all presidents to do crime. (We’re sure whatever rule he cooks up will apply equally to Democratic presidents, right?) Kavanaugh eventually landed on the proposition that prosecutors may charge presidents only under criminal statutes that explicitly state they can be applied to the president. Which, as Sotomayor pointed out, would mean no charges everywhere, because just a tiny handful of statutes are stamped with the label “CAN BE APPLIED TO PRESIDENT.”

The words bold and fearless action were repeated on a loop today, as a kind of mantra of how effective presidents must be free to act quickly and decisively to save democracy from the many unanticipated threats it faces. And yet the court—which has been asked to take bold and fearless action to deter the person who called Georgia’s secretary of state to demand that he alter the vote count, and threatened to fire DOJ officials who would not help steal an election—is backing away from its own duty. The prospect of a criminal trial for a criminal president shocked and appalled five men: Thomas, Alito, Kavanaugh, and Gorsuch suggested that Smith’s entire prosecution is unconstitutional; meanwhile, Roberts sounded eager at times to handle the case just a hair more gracefully: by cutting out its heart by preventing the jury from hearing about “official acts” (which lie at the center of the alleged conspiracy). Justice Amy Coney Barrett was far more measured, teasing out a compromise with Dreeben that would compel the trial court to tell the jury it could not impose criminal liability for these “official” acts, only “private ones.” Remember, drawing that line would require months of hearings and appeals, pushing any trial into 2025 or beyond. The president who tried to steal the most recent election is running in the next one, which is happening in mere months.

The liberal justices tried their best to make the case that justice required denying Trump’s sweeping immunity claim, permitting the trial to move forward, and sorting out lingering constitutional issues afterward, as virtually all other criminal defendants must do. They got little traction. Everyone on that bench was well aware that the entire nation was listening to arguments; that the whole nation wants to understand whether Trump’s refusal to concede the 2020 election was an existential threat to democracy or a lark. Five justices sent the message, loud and clear, that they are far more worried about Trump’s prosecution at the hands of the deep-state DOJ than about his alleged crimes, which were barely mentioned. This trial will almost certainly face yet more delays. These delays might mean that its subject could win back the presidency in the meantime and render the trial moot. But the court has now signaled that nothing he did was all that serious and that the danger he may pose is not worth reining in. The real threats they see are the ones Trump himself shouts from the rooftops: witch hunts and partisan Biden prosecutors. These men have picked their team. The rest hardly matters.

Supreme Court wrestles with abortion clash over emergency room treatment for pregnant women

WASHINGTON — The Supreme Court appeared divided Wednesday as it grappled with whether provisions of Idaho's near-total abortion ban unlawfully conflict with a federal law aimed at ensuring certain standards for emergency medical care for patients, including pregnant women.

Some conservative justices, who have a 6-3 majority, appeared skeptical about the Biden administration’s lawsuit arguing that the state ban restricts potentially lifesaving treatment for women suffering complications during pregnancy.

Liberal members of the court appeared to back the administration's position.

The justices are weighing an appeal brought by Idaho officials who are contesting a lawsuit the Biden administration filed over abortion access in emergency situations.

The state abortion law was enacted in 2020, with a provision stating it would go into effect if the Supreme Court overturned Roe v. Wade, the 1973 ruling that found women had a constitutional right to abortion.

The 2020 law, called the Defense of Life Act,  went into effect  in 2022 when the Supreme Court  rolled back  Roe.

The state law says anyone who performs an abortion is subject to criminal penalties, including up to five years in prison. Health care professionals found to have violated the law can lose their professional licenses.

The federal government sued, leading a federal judge in August 2022 to block the state from enforcing provisions concerning medical care that is required under the federal Emergency Medical Treatment and Labor Act, or EMTALA.

The federal law, enacted in 1986, requires that patients receive appropriate emergency room care. The Biden administration argues that care should include abortions in certain situations. The law applies to any hospital that receives federal funding under the Medicare program.

There is an exception to the Idaho law if an abortion is necessary to protect the life of the pregnant woman, although the scope of the exception came under close scrutiny during the oral argument.

Idaho’s lawyer, Joshua Turner, faced tough questioning about whether the exception can also apply to a situation in which a woman has complications that pose a substantial health risk but not imminent death.

Liberal Justice Elena Kagan said federal law says “that you don’t have to wait until the person is on the verge of death.”

“If the woman is going to lose her reproductive organs, that’s enough to trigger this duty on the part of the hospital to stabilize the patient,” she said.

Fellow liberal Justice Sonia Sotomayor asked similar questions, providing several examples of real-life situations in which women have faced emergency situations when doctors had to make calls about whether to authorize abortions, including a situation in which a patient at 16 weeks of pregnancy whose water broke was at risk of sepsis or a hemorrhage after she was refused an abortion in Florida.

"Is that a case in which Idaho the day before would have said it's OK to have an abortion?" Sotomayor asked.

Turner argued that such medical decisions are “subjective” and that a doctor’s judgment in such instances would be based on good faith, not an objective standard.

Justices Amy Coney Barrett and Brett Kavanaugh, both conservatives, indicated they saw Idaho’s law as allowing for treatment similar to what the Biden administration says the federal law requires, suggesting that there may not be any conflict.

At one point Barrett said she was "shocked" at Turner's answers to questions about what kind of treatment was allowed, because "I thought your own expert had said below that these kinds of cases were covered."

Kavanaugh likewise questioned the daylight between the two laws, wondering what the implications are if "Idaho law allows an abortion in each of the emergency circumstances that is identified by the government."

"What does that mean for what we're deciding here?" he asked Turner.

Conservative Justice Samuel Alito seemed most skeptical of the federal government's argument, at one point mentioning language in the federal law referring to treatment for an "unborn child," a term more commonly used by anti-abortion advocates.

"Isn't that an odd phrase to put in a statute that imposes a mandate to perform abortions?" Alito asked Solicitor General Elizabeth Prelogar.

"Have you seen abortion statutes that use the phrase 'unborn child'? Doesn't that tell us something?"

Prelogar responded that the phrase did not displace the requirement that women get the treatment they need in emergency situations.

Conservative justices, including Neil Gorsuch, also questioned whether the federal government even has the power to mandate health standards when they are tied to Medicare funding.

In January, the Supreme Court allowed Idaho to enforce the provisions while also agreeing to hear oral arguments in the case. Other provisions of the ban are already in effect and will not be affected by how the justices rule.

The decision will affect not just Idaho but also other states, including Texas, that have enacted similar abortion bans that abortion-rights advocates say clash with the federal law.

In blocking parts of the state law that conflict with federal law, U.S. District Court Judge B. Lynn Winmill described the state’s actions as putting doctors in a difficult situation.

“The doctor believes her EMTALA obligations require her to offer that abortion right now. But she also knows that all abortions are banned in Idaho. She thus finds herself on the horns of a dilemma. Which law should she violate?” he wrote.

The San Francisco-based 9th U.S. Circuit Court of Appeals briefly put Winmill’s ruling on hold in September, but it subsequently allowed it to go back into effect, prompting the state officials to turn to the Supreme Court.

Prelogar wrote in court papers that EMTALA requires "necessary stabilizing treatment," which in cases involving pregnant women in emergency situations may require abortions.

"And in those limited but critically important circumstances EMTALA requires the hospital to offer that care," she added.

The state argues that it was only after Roe was overturned that the Biden administration said EMTALA could be interpreted to require abortions in some contexts, calling it a "nationwide abortion mandate."

EMTALA "merely prohibits emergency rooms from turning away indigent patients with serious medical conditions," Idaho Attorney General Raúl Labrador wrote in court papers. The law was not intended to override state laws regulating health care, he added.

The Idaho dispute is one of two abortion cases now pending at the Supreme Court, both of which arose in the aftermath of the 2022 decision to overturn Roe v. Wade. In the other case, the court is considering a challenge that could restrict access to mifepristone, the drug most commonly used for medication abortions.

Lawrence Hurley covers the Supreme Court for NBC News.

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Supreme Court Appears Sharply Divided in Emergency Abortion Case

The justices weighed whether a federal law aimed at protecting access to emergency medical care superseded Idaho’s near-total abortion ban.

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By Abbie VanSickle

Reporting from Washington

• April 24, 2024

The Supreme Court appeared sharply divided on Wednesday over whether federal law should allow doctors to perform emergency abortions in states with near-total bans on the procedure, in a case that could determine access to abortion in emergency rooms across the country.

The lively, two-hour argument focused on a clash between Idaho, whose law limits access to abortion unless the life of the pregnant woman is in danger, and federal law. Questioning by the justices suggested a divide along ideological — and possibly gender — lines.

“What Idaho is doing is waiting for women to wait and deteriorate and suffer the lifelong health consequences with no possible upside for the fetus,” said Solicitor General Elizabeth B. Prelogar, arguing on behalf of the federal government. “It just stacks tragedy upon tragedy.”

Justice Elena Kagan interjected that the current situation seemed untenable: “It can’t be the right standard of care to force somebody onto a helicopter.”

Although the collision between the two laws affects only those women who face dire medical complications during pregnancy, a broad decision could have implications for more than a dozen states that have enacted near-total bans on abortion since the court overturned a constitutional right to abortion in Dobbs v. Jackson Women’s Health Organization in June 2022.

The dispute was the second time in less than a month that the Supreme Court has grappled with abortion. It is a potent reminder that even after Justice Samuel A. Alito Jr. vowed in 2022 that the issue would return to elected representatives, it continues to make its way back to the court. In late March, the justices considered the availability of the abortion pill mifepristone.

The federal law at issue, the Emergency Medical Treatment and Labor Act, or EMTALA, enacted by Congress in 1986, mandates that hospitals receiving federal funds provide patients with stabilizing care.

Under Idaho’s near-total ban on abortion, the procedure is illegal except in cases of incest, rape, some instances of nonviable pregnancies or when it is “necessary to prevent the death of the pregnant woman.” Doctors who perform abortions could face criminal penalties, prison time and loss of their licenses to practice medicine.

The Biden administration maintains that the federal law conflicts with — and should override — Idaho’s. Lawyers for the state contend that the administration has improperly interpreted the federal law in a way that would bypass state bans.

Abortion opponents assert the Biden administration is trying to use the federal law to turn hospitals into legal abortion sites in states where the procedure is mostly banned.

Several of the conservative justices appeared skeptical of the federal government’s argument that the decades-old law aimed at preventing “patient dumping” — hospitals refusing to treat the poor and uninsured — should override Idaho’s abortion restrictions.

“How can you impose restrictions on what Idaho can criminalize simply because hospitals in Idaho have chosen to participate in Medicare?” Justice Alito asked.

The three liberal justices pushed back strongly on the lawyer arguing for Idaho, Joshua N. Turner, broaching several examples of pregnant women facing severe complications that could leave them unable to have children or with debilitating injuries. They also cited recent reports that, since Idaho’s ban went into effect, hospitals have flown several women to other states to receive emergency abortion care. Justice Amy Coney Barrett, a conservative, joined the tough questioning.

Justice Sonia Sotomayor appeared skeptical of Mr. Turner’s argument that the state’s law allows for doctors to make a good-faith determination about whether a patient’s life is in danger, describing a patient whose water broke early and required a hysterectomy and abortion.

“She can no longer have children,” Justice Sotomayor said. “All right? You’re telling me the doctor there couldn’t have done the abortion earlier?”

“Again, it goes back to whether a doctor can in good-faith medical judgment —” Mr. Turner began.

“That’s a lot for the doctor to risk,” Justice Sotomayor replied.

Justice Barrett asked what would happen if a local prosecutor did not agree with a doctor’s judgment that an abortion was necessary.

When Mr. Turner answered that “it is very case by case,” Justice Barrett joined in: “I’m kind of shocked actually because I thought your own expert had said below that these kinds of cases were covered,” she said.

Even as Mr. Turner responded that such cases would be covered if a doctor acted in good faith, Justice Barrett continued to probe.

“What if the prosecutor thought differently?” she asked. “What if the prosecutor thought, well, I don’t think any good-faith doctor could draw that conclusion.”

“That, your honor, is the nature of prosecutorial discretion, and it may result in a case,” Mr. Turner said.

An extended exchange between Justice Alito and Ms. Prelogar raised a broader question about whether some of the conservative justices may be prepared to embrace the language of fetal personhood, that is, the notion that a fetus would have the same rights as a pregnant woman.

Justice Alito, who had relied on the language of fetal personhood in writing the court’s majority opinion in Dobbs, noted that “one potentially very important phrase” had not been mentioned — the federal law's “reference to the woman’s quote, unquote, unborn child.”

“Isn’t that an odd phrase to put in a statute that imposes a mandate to perform abortions?” Justice Alito asked. “Have you ever seen an abortion statute that uses the phrase ‘unborn child?’”

Ms. Prelogar responded that it made sense in terms of that federal law because it was an attempt to ensure that hospitals treated both a pregnant woman and the fetus in an emergency medical situation.

The Biden administration has relied on EMTALA as a narrow way to challenge state-level abortion bans.

After the court overturned a constitutional right to an abortion, near-total bans on the procedure swiftly took effect in some states, including in Idaho .

Once the Republican-controlled Legislature in the state passed the Defense of Life Act, which makes it a crime to perform or assist in performing an abortion, the Biden administration sued the state in August 2022, arguing that federal law should trump the state law when the two directly conflict.

The federal law specifies that a hospital must provide care to a person with an “emergency medical condition.” For pregnant women, the law states, that means when “the absence of immediate medical attention could reasonably be expected” to jeopardize “the health of the woman or her unborn child.”

If a hospital breaks the federal law, it can be sued and potentially lose Medicare funding. The federal law also includes a provision that it will not pre-empt a state or local law unless “the requirement directly conflicts with” it.

But the state law imposes a prison sentence of up to five years if it is violated and can lead to the loss of a doctor’s medical license.

A federal trial judge temporarily blocked the state’s ban. Last fall, a three-judge panel from the U.S. Court of Appeals for the Ninth Circuit put the ruling on hold and reinstated the ban. But that decision was ultimately overridden by an 11-member panel of the appeals court, which temporarily blocked Idaho’s law as the appeal continued.

Outside the Supreme Court on Wednesday, demonstrators gathered at competing rallies.

Mylissa Farmer, 43, who said she was denied an abortion in Missouri and Kansas after her water broke at 17 weeks, spoke in support of the federal law’s protections.

“I just don’t want anyone else to go through what I did,” Ms. Farmer said. “That’s why I’m speaking out, because it’s so wrong, and I don’t see any kind of light.”

Just steps away, about a dozen anti-abortion demonstrators raised signs that read “Abortion betrays women” and “Emergency rooms are not abortion clinics.”

“What this law would do is it essentially make our hospitals and emergency rooms abortion clinics,” Bethany Janzen, 30, the founder of an anti-abortion group, said of the federal law. “And that’s a problem.”

Aishvarya Kavi contributed reporting.

Abbie VanSickle covers the United States Supreme Court for The Times. She is a lawyer and has an extensive background in investigative reporting. More about Abbie VanSickle

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

Chapter: summary and conclusions.

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

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

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

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

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

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

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

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

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

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